Mr Jason Hargrave

The causes of bunion deformity are complex and multifactorial. Footwear certainly plays a role as an exacerbating factor by making the deformity worse. However, it is also known that hallux valgus occurs in unshod cultures although, in one study in Chinese Hong Kong, hallux valgus was 70 times more common among shoewearers compared with the unshod members of the same community! Bunion pain is certainly in the family with 65-80% being hereditary, however, successive generations won't always produce the deformity.

Underlying medical conditions also play a part, for example with generalized joint laxity (hypermobility) being common in the hallux valgus sufferer. Other rarer conditions such as Marfan's and Ehlers Danlos syndrome can produce remarkable joint laxity resulting in unstable and severe hallux valgus. This "splay foot" type is also seen in the more elderly patient where weakened muscles cause instability of the toes, as does rheumatoid arthritis. Other biomechanical factors such as overpronation or flatfoot, may also play a part, but remain unproven.

Conservative (nonsurgical) Treatment

Medical evidence has demonstrated that this deformity can only be reversed or corrected by surgery. However, some treatments are provided that can help give temporary relief to the symptoms caused by a malaligned big toe joint. For example, if the joint is very inflammed, an injection of cortisone (steroid) helps to temporarily reduce pain and inflammation in around 50% of cases. Changing your footwear to accommodate the wider forefoot, can also help to reduce pressure on the joint. Some clinicians believe in prescribing orthoses (insoles) for hallux valgus, although one large PhD study found that the orthoses made the problem worse in children. Toe splints have been used and studied, however, mild improvement was only seen in some children.

Bunion Surgery

The bunion surgery procedures we use can be undertaken under local anaesthetic and sedation or full general anaesthetic and be allowed home on the same day. We will normally perform a scarf (z-osteotomy) or in severe and unstable hallux valgus, fuse the base of the long 1st metatarsal bone (modified Lapidus procedure). Both these surgeries involve fixing the bones with special bone screws and or plates and remove the need for patients to have to wear a plaster cast following surgery - you will be allowed to walk! These modern techniques have a much higher success rate (~93%), and a much lower complication rate, such as reducing the incidence of vein clots and joint stiffness. They also reduce the need for time off work, with many patients being able to return from 2-weeks onwards.

The Procedure

An incision is made along the side of your foot (to make the scar less obvious). Because this is a bony deformity, the big toe joint is anatomically realigned by cutting and sliding the bones into the corrected position. They are then held in the new corrected position by using special bone screws, pins or plates. The procedure will take between 20-45 minutes. You will have stitches in the foot, which will normally be removed between around 10-21 days. You will have a heavy bandage for the first week and will be provided with a postoperative shoe to accommodate the dressing. Your first checkup appointment will be around 7-10 days, where a smaller dressing will be applied. You must keep the wound dry for the first 10 days. Providing the wound is healing without complication, you may then commence normal bathing. Further information regarding walking and exercising will be provided.

Hallux Valgus (Bunion) Surgery by Osteotomy and Internal Fixation

Xrays to show realignment with bone screw fixation, following hallux valgus correction.