A ‘bunion’ or hallux valgus is a deformity of the big toe, with deviation towards the second toe. A bony lump is present on the inside of the foot. The lump is the head of the metatarsal bone. Swelling can occur over the lump and in some people this is painful. The bunion deformity can also cause problems with the 2nd toe (hammer toe) and pain on the under-surface of the forefoot (metatarsalgia).
It is quite common for bunions to run in families and they tend to be more common in women. They can also occur in people with flexible joints and in people with flat feet. People are often under the impression that shoes (high heels or narrow shoes) are the cause for bunions. It is unlikely that shoes are the direct cause but it is possible that they may worsen the deformity more quickly in people at risk of developing a bunion and poor fitting shoes can make the pain from a bunion worse.
A lot of people with bunions do not have any pain and do not require treatment. People with pain should try non-operative treatments first such as changing their footwear to wider fitting shoes, insoles or bunion pads to relieve pressure. In some people these simple measures may not improve pain and surgery may be necessary.
Before having an operation your doctor will usually check that you have tried non-surgical treatments and ensure that you are fit enough to have an operation. Before an operation people will have a health assessment to check this. The operation is usually performed under a general or spinal anaesthetic. People who smoke or are diabetic are at increased risk of infection and problems with wound and bone healing.
Under an anaesthetic a cut is made on the inside of the big toe. The bony bump is removed and the big toe is straightened by cutting the bones and holding them in position with small screws or bone staples. If there is a deformity of the 2nd toe this may need to be straightened too. After the operation a bandage is applied, and patients are able to walk in a special shoe that allows weight-bearing through the heel. The bandage is removed after 10-14 days to check the wound, but the special shoe needs to be worn for 6 weeks. It is likely that patients will not be able to drive a car for at least 6 weeks after the surgery and some people will need more than 6 weeks off work (depending on their job). At 6 weeks an X-ray is taken and if the bones have healed the patient will be allowed to walk in a flat shoe.
The surgeon will discuss the risks of the operation when taking your consent. There are general complications that can occur with any operation such pain, bleeding, wound problems/ infection, nerve damage and the possible complications of an anaesthetic (the anaesthetist will discuss these with you). Other complications of bunion surgery include: – – A blood clot in the leg (DVT) or lung (PE); the surgeon will assess your risk of this before the operation and may prescribe injections if required – Stiffness of the big toe joint; this can usually be improved with physiotherapy – Swelling; swelling of the foot is normal after surgery. In most people the swelling will be reduced enough after 6 weeks to allow wearing of a normal shoe but in some swelling may persist for 6-9 months. Swelling can be improved/avoided by elevating the foot after the operation. – Recurrence; the bunion deformity can return after surgery but in most cases this would be after many years. People with more severe bunions are at higher risk – Abnormal pain response; this is known as complex regional pain syndrome and results in excessive pain and loss of function. It is rare. These risks are generally uncommon, and research has shown than 80-90% of people are satisfied with the results of bunion surgery.
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