Hallux valgus is the medial term for a bunion deformity involving the large toe joint. As the head of the 1st metatarsal protrudes more medially the joint capsule undergoes a series of changes. These changes increase the deformity and causes a partial dislocation of the great toe joint. So as the big toe progressively dislocates towards the small toes, the head of the 1st metatarsal becomes more prominent. The functionality of the joint is compromised the greater this dislocation.
As the 1st MPJ progressively moves out of place, it can cause 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.
There are several attributing factors that can lead to a symptomatic bunion deformity. Heredity plays in important role in the development of this deformity as well as abnormal mechanical function of the foot. Statistically, more women have symptomatic bunion deformities than men.
As this deformity progresses the big toe will eventually under lap the 2nd toe which will result in hammertoe deformities of these digit. This process can continue and lead to hammertoe formation of the 3rd digit.
Shoe gear also play an important role in the symptomatology of bunion deformities. High-heeled shoes, pointed shoes, shoes that are too short or too narrow will severely aggravate a bunion deformity. However, shoes do not cause bunion deformities but simply aggravate deformities that are developing or already exist.
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.
Conservative options include shoe modifications, foot padding, anti-inflammatory medication and orthotics. Occasionally, injections may be recommended to a patient in an attempt to diminish or eliminate they’re 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. The exact type of procedure depends heavily on the degree of deformity of bunion and associated pathology.
Following surgery, you will have to wear protective shoe gear such as a surgical shoe or CAM boot. Some bunion deformities allow post-operative weight bearing. However, more severe deformities and subsequent surgical treatment demand non-weight bearing.
As a general rule, bunion surgical procedures are performed on an out-patient basis in approved Surgical Centers or in a Hospital. Following bunion surgery an individual can expect gradual return to normal function and gradual reduction of the localized swelling, which is a normal part of the healing process.