What is Hallux Valgus?
Hallux valgus, commonly known as a bunion, is a foot deformity where the big toe deviates outward (toward the smaller toes), often accompanied by a bony bump (bunion) on the inner side of the foot. This condition is more prevalent in women and is frequently bilateral (affecting both feet).
Causes of Hallux Valgus
- Genetic predisposition – A family history increases the likelihood of developing bunions.
- Footwear – Tight, narrow, or high-heeled shoes can accelerate the condition.
- Biomechanical factors – Abnormal foot structure or function may contribute.
Symptoms and Progression
As the deformity worsens:
- The first metatarsal bone shifts upward, reducing its weight-bearing function.
- Increased pressure on the second toe can lead to:
- Pain and swelling
- Plantar plate rupture (ligament damage under the toe)
- Hammertoe deformity (toe bending abnormally)
- Callus formation under the second metatarsal
Non-Surgical Treatment Options
- Wider shoes – Reduce pressure on the bunion.
- Orthotics & padding – Help redistribute weight and relieve discomfort.
- Activity modification – Avoid high-impact activities that worsen pain.
Surgical Treatment for Hallux Valgus
Surgery is considered when conservative treatments fail, but 10% of patients report dissatisfaction post-surgery. The procedure depends on deformity severity:
1. Mild Deformities
- Distal osteotomy (e.g., Chevron) – Realigns the bone near the toe joint.
2. Moderate Deformities
- Shaft osteotomy (e.g., Scarf or Ludloff) – Corrects misalignment along the metatarsal bone.
- Basal osteotomy (e.g., proximal chevron or crescentic) – Adjusts the bone near the midfoot.
3. Severe Deformities
- Combined osteotomies – Multiple bone cuts for significant correction.
- Joint fusion (Lapidus or MTP fusion) – Stabilizes the joint in severe cases.
Alternative Procedures
- Keller’s excision arthroplasty – Removes part of the toe bone (for low-demand or high-risk patients).
- Minimally invasive surgery – Growing in popularity, though long-term UK outcomes are still under review.
Potential Complications
- Infection
- Nerve damage
- Recurrence or overcorrection
- Stiffness
- Transfer metatarsalgia (pain under other toes due to altered pressure)
- Early arthritis requiring further surgery
Conclusion
Hallux valgus is a common, often inherited condition that can worsen without proper care. While non-surgical methods help manage symptoms, surgery may be needed for severe cases. The best treatment depends on deformity severity and patient lifestyle.