Hallux valgus is the medical term for a bunion deformity involving the large big toe joint. In the simplest terms, it is a partial dislocation, or in the most advanced cases a complete dislocation, of the joint at the base of the big toe.
As the big toe progressively dislocates towards the small toes, the head of the 1st metatarsal becomes more prominent and more painful. A bunion is not an abnormal growth of bone or a tumor. The gradual dislocation of the joint causes abnormal function, and as the big toe goes in one direction, the first metatarsal head goes in the opposite direction and becomes prominent.
Any joint in the body that is partially or completely dislocated cannot function normally. Therefore, as this joint progressively moves out of place, it causes increasing pain, local swelling, and redness due to irritation from shoes. There also may be an associated “burning” sensation due to the fact that one of the nerves in the area gets pressed up against the prominent bone from shoe gear.
Bunion deformities are certainly very common in some family groups, and therefore there is a significant hereditary factor involved in developing this deformity. Abnormal mechanical function of the foot is also a major cause in the development of bunion deformities. A small percentage of individuals are actually born with bunion deformities.
Statistically, more women have symptomatic bunion deformities than men. As these deformities progress, the big toe will eventually underlap the 2nd and 3rd toes, which will result in hammertoe deformities of these digits. In some more advanced cases, a bursal sack (fluid-filled cyst) will develop between the skin and the joint. This is the body’s attempt to cushion the area, but it actually results in more pain.
Clearly, in our modern society, high-heeled shoes, pointed shoes, and shoes that are too short or too narrow will severely aggravate a bunion deformity. Shoes, however, do not cause bunion deformities but aggravate deformities that are developing or already exist.
Bunions are a complex deformity. When this joint is not functioning normally, then it will have a direct negative effect on the function of the remainder of the foot and ankle over time. Appropriate history and physical examination, bio-mechanical evaluation, and x-ray evaluation are necessary to make an accurate diagnosis and to be able to recommend an appropriate treatment plan to the patient.
Conservatively, shoe modifications, foot padding, anti-inflammatory medication, orthoses, and occasionally injections may be recommended to a patient in an attempt to diminish or eliminate their painful symptoms. Splints or digital wedges will not be effective in realigning the joint. None of these conservative treatments will change the structural position of the joint.
Your Podiatric surgeon may discuss and recommend surgical treatment. There are literally dozens of surgical procedures which have been developed over the past 150 years to treat the bunion deformity. Appropriate surgical treatment of a bunion is based on proper evaluation, and determination if you’re deformity is positional or structural.