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| Bunion ( Hallux Valgus) |
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What is a bunion?
The classical definition of a bunion was a bursa (a fluid-filled sac) on the side of the foot near the base of the big toe. The bursa was caused by chronic friction of the patient's first metatarsal bone (the bone to which the big toe attaches) and the shoe.
Today most people consider a bunion to be the enlarged bone on the side of the foot that typically caused the bursa. (See the illustration to the left.) Along with this bump, there is usually an associated mis-alignment of the big toe which leans towards the second toe.
Bunion pictures
Clinical + 2 x rays views
In medical jargon, the term for a bunion is "Hallux Abducto Valgus," or "HAV" for short. Though the condition is really slightly different, it may also be known as "Hallux Valgus."
Bunions are usually a progressive problem, and can make it difficult to find shoes that fit. The condition is often quite uncomfortable, not only because of the pressure the shoes exert on the bump, but because of the other factors associated with bunions, which we shall discuss shortly.
What causes a bunion?
Bunions are among the most common problems of the foot. They are several possible reasons a bunion may develop, though a biomechanical abnormality (improper function of the foot) is the most common cause. In an unstable flat foot, for example, a muscular imbalance often develops that, over time, causes bunions.
Bunions tend to run in families, and there is a common belief among podiatrists that genetic factors play a role in predisposing some people to develop bunions. Ill fitting shoes-like high heels and pointed toe boxes-exacerbate the condition. Deformity develops faster and worsens due to additional trauma which also makes bunions more painful. Poor shoe choices is at least one of the reasons bunions are much more common in women than men.
What symptoms do people with bunions have?
Bunions typically start out as a mild bump or outward bending of the big toe. Bunions at this stage are usually only a concern of appearance at this stage, and at this point they often don't hurt much.
Over time, the ligaments that connect the bones of the toe stretch out, and the tendons attaching to the big toe gradually pull it farther and farther towards the second toe. Sometimes patients will find their first and second toes begin to press together too much, and they'll often get a painful corn between those toes. As the bunion progresses, the big toe may begin to ride on top of the second toe, or vice versa, creating a second deformity.
Others will develop bump pain at the site of the bony enlargement on the side of the foot. A painful bursa may develop at that site. This is particularly true in tight shoes. Many patients also develop a painful callus beneath the foot. Capsulitis types of metatarsalgia may develop in the joints beneath these calluses, particularly in the second and third metatarso-phalangeal joints (the joints in the ball of the foot).
Over time, with the toe held in a crooked position for enough time, arthritis develops in the big toe joint. This will usually result in decreased range of motion of that joint (a condition known as Hallux limitus) which as a result, often causes the patient to changes in the way a patient walks. Often the patient walks in an "out-toed", or duck-like, fashion, which very frequently causes secondary pain in the legs, knee, hip and low back.
Treatment for bunions
The main goal of treatment is to relieve pressure on the bunion and smaller toes, and to diminish the progression of joint deformities. In certain cases, this may be done with conservative measures such as padding the region, taking anti-inflammatory medications or physical therapy to reduce pain and pressure on the joint. Shoe changes and custom orthoses are very helpful in reducing pain through conservative measures. If conservative care is not successful, the latest surgical treatments are utilized in order to return the patient to a level of comfort and stability with the least amount of down time. Orthoses are often required post surgery to nullify the abnormal forces that caused the bunion deformity in the first place.
Surgical therapy
Surgical therapy is aimed at reconstruction of the bones to place them in their original position. This allows reduction in pain and correction of the bone position. This means that after surgery, the foot can carry the body's weight properly.
Many surgical procedures are used to correct bunions and there are more than 125 procedures. The decision to employ a procedure is based on the severity of the deformity, the patient's age, the general health of the patient, their activity level, and the status of the bones and connective tissues.
In most cases, a bone cut is required to allow correction of the deformity and realignment of the great toe. In severe cases, a fusion of the long bone attaching to the great toe is used to realign the great toe and correct abnormal motion of the foot. In such a case, only abnormal motion is lost but some limitation in post-operative activity or change in shoe gear may be required if the foot has developed accommodative structural and functional changes.
Through the use of the latest techniques and equipment, patient is able to place limited weight on their surgical foot from the day of surgery and to return to trainers/tennis shoes as early at 4 weeks. The use of screws allows the bones to be held stable position, although complete healing requires 6 to 8 weeks, patients are very happy to be able to walk in a trainer/tennis shoe at 4 weeks.
At the earliest appropriate time, a customized course of physical therapy is established at our institute to allow rapid recovery with minimal joint stiffness or pain.
Click here for more information on Podiatry consultants at London Bridge Hospital
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London Bridge Hospital
27 Tooley Street
London, SE1 2PR
Tel: 020 7407 3100
Fax: 020 7407 3162 |
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