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What Exactly Are Hallux Valgus?

Overview
Bunions Callous
When your big toe is angled towards the second toe, the deformity is called a bunion (hallux valgus). This causes a bump on the side at the base of the big toe. In addition there is often thickening of the skin and tissues next to the affected joint. The thickened skin and tissues may become inflamed, swollen and painful. Sometimes a fluid-filled sac (bursa) develops over the joint.


Causes
Women tend to get bunions more than men. This could be due to the more restrictive footwear they wear, (such as high heels or narrow toe boxes which force the big toe towards the little toes) but women also tend to have looser ligaments, making them slightly more prone. You?re also more likely to get bunions if your parents or grandparents have them.


Symptoms
It is unusual to have much bunion or hallux valgus pain when out of shoe wear or at rest. There are exceptions to this and in particular if symptoms have been ignored during the day and the bunion has become very painful during the day then some symptoms may be present at night. The pain from the region of the great toe at rest or at night is however more often a symptom of an arthritic big toe (hallux rigidus) rather than a straightforward bunion. To confuse matters these two conditions can sometimes coexist. Bunion or hallux valgus pain is most often present when walking in enclosed shoes. There may be little bunion pain in sandals or barefoot. It is unusual to have much bunion pain when not putting weight on the foot or at night. If there is bunion pain at rest or at night then there may also be arthritic change within the toe.


Diagnosis
Clinical findings are usually specific. Acute circumferential intense pain, warmth, swelling, and redness suggest gouty arthritis (see Gout) or infectious arthritis (see Acute Infectious Arthritis), sometimes mandating examination of synovial fluid. If multiple joints are affected, gout or another systemic rheumatic disease should be considered. If clinical diagnosis of osteoarthritic synovitis is equivocal, x-rays are taken. Suggestive findings include joint space narrowing and bony spurs extending from the metatarsal head or sometimes from the base of the proximal phalanx. Periarticular erosions (Martel sign) seen on imaging studies suggest gout.


Non Surgical Treatment
Treatment of hallux valgus nearly always starts with adapting shoe wear to fit the foot. In the early stages of hallux valgus, converting from a shoe with a pointed toe to a shoe with a wide forefoot (or toe box) may arrest the progression of the deformity. Since the pain that arises from the bunion is due to pressure from the shoe, treatment focuses on removing the pressure that the shoe exerts on the deformity. Wider shoes reduce the pressure on the bunion. Bunion pads may reduce pressure and rubbing from the shoe. There are also numerous devices, such as toe spacers, that attempt to splint the big toe and reverse the deforming forces.
Bunions Callous


Surgical Treatment
Bunion surgery can be performed under local or general anaesthetic. The operation usually takes between half an hour to an hour. There are several types of bunionectomies. Some involve removal and realignment of the bones in your foot. Mild bunion problems can sometimes be resolved using soft tissue release or tightening. For some very severe cases bones of the big toe are fused or the bunion is cut out along with some of the bone at the base of the toe. Be sure and discuss which type of operation you will have with your surgeon. With any type of bunionectomy your surgeon will make one or more incisions (cuts) near your big toe. They will use instruments to trim the bones and remove the bunion. Wire, screws or plates may also be used to hold the new joint in place.

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