Hallux valgus is a deviation of the first metatarsal of the big toe (in fact, Hallux means "big toe" and valgus means "outward"), which is caused by a deformation of this bone due to various factors, which we will explain later. The bone deviation, i.e., hallux valgus, causes the formation of a joint.
When the big toe rests on the second toe, more and more deviations occur and a bump forms, which occurs
on the outer side of the foot and can become inflamed and reddened, causing significant pain for the person. Therefore, a bunion is a type of bump that forms when hallux valgus deteriorates. If this deformation is not corrected in time, it can lead to other deformities affecting the rest of the toes, which we will discuss later. Bunion symptoms usually appear when the problem is in its later stages. However, there are people who have no symptoms despite having had bunions for many years. In summary,
a bunion is the result of hallux valgus.
Why do bunions appear?
There are different causes associated with the appearance of bunions:
- Improper shoe use, which presses the toes inside the shoe and limits the movement of the toes. Excessive use of high-heeled shoes also contributes to the appearance of bunions for the same reason. This is not a direct consequence, but it does contribute to their earlier appearance.
- Genetics: A defect in the mechanical structure of the foot due to hereditary factors also contributes to
the appearance of bunions. What is inherited is not the bunion itself, but the walking style that causes Hallux Valgus.
- Egyptian foot: This is when the big toe is longer than the other toes.
- Foot diseases such as flat feet or cavus feet.
- The presence of other diseases that deform bones, such as rheumatoid arthritis.
- Age: This could also be a triggering factor, as the older you get, the more likely you are to develop bunions due to increased foot use, especially after 40. However, it is also possible for a younger person to have bunions, even if they do not cause any symptoms.
The fact that bunions appear more frequently in women than in men is not accidental, as women often wear high heels and pointed shoes, making them more predisposed to developing them.
What are the symptoms of bunions?
Bunions are easily identified due to the symptoms that the patient experiences, which may include the following:
- The main and most evident symptom of a bunion is the bump that develops at the external base of the big toe. This bump may be red and inflamed, causing pain for the patient. These symptoms worsen with movement or even from standing for long periods.
- It is also common for other irritations to appear on the feet, such as calluses, blisters, etc. The area affected by the bunion may be rough and hardened.
- In terms of pain, it may also be related to localized arthritis in the joint due to the incorrect position of the bone.
- The toe may also experience limited movement and, at times, numbness and a burning sensation.
- Lastly, the deformation of the toes may be another symptom of bunions. These deformities occur when the big toe deviates due to the bunion, applying pressure to the other toes, which may curve, resulting in claw, hammer, or mallet toes. These problems caused by bunions can be more difficult to solve than just Hallux Valgus, which is why it’s recommended to address Hallux Valgus as soon as possible.
Diagnosis of Bunion
- Although diagnosing a bunion is seemingly simple, since the bump on the toe is clearly visible, to make a reliable diagnosis of the severity of the problem, the specialist will employ several techniques:
- Physical examination: The specialist will assess the severity of the big toe’s deviation and if it affects the other toes, as well as check the joint’s mobility. They will also palpate the skin to check the degree of inflammation.
- Patient’s medical history: The specialist must know the patient’s personal health status to determine if there are any risk factors contributing to the development of Hallux Valgus and the bunion. These factors may include age, occupation, pre-existing conditions like arthritis, etc.
- Radiological examination: The specialist performs X-rays of the foot, both lateral and anteroposterior. The lateral X-ray can show alterations in the foot (flat, arched) and deformities of the toes (claw, hammer, or mallet). The anteroposterior X-ray shows the characteristics of Hallux Valgus, such as the angle of the bone.
- Podoscopy: This allows dynamic analysis of the foot’s alterations.
Tips to alleviate the pain caused by bunions
If the
bunion has already developed, the patient may experience symptoms. However, it is also possible that the bunion does not present symptoms (especially at the beginning of its appearance). Here are some tips to help alleviate the pain caused by the bunion:
- Wear proper footwear, meaning avoid shoes that pinch the toes and, instead, use shoes with a wide toe box. It’s also important to avoid wearing high heels.
- Use interdigital spacers that separate the toes and keep the big toe in the proper position, as well as foam pads that prevent friction from the bunion with the shoe.
- Apply ice to the bunion 2 or 3 times a day to reduce inflammation and decrease pain.
- Taking anti-inflammatory medications can also reduce inflammation and pain, though these should be prescribed by the specialist.
- Modify activities, such as avoiding standing for long periods, which may cause pain in the bunion.
- There are also some exercises and/or massages that may temporarily relieve symptoms.
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Corrective posture: Perform this by placing the foot on a flat surface and then separating the big toe from the other toes outward for as long as possible.
- Corrective massage: To improve the toe's deformity and relax the muscle, apply pressure and slide both thumbs from the top of the foot toward the toes. Perform up to 9 deep pressures.
Two of the techniques available to eliminate bunions are as follows:
Bunion surgery or Hallux Valgus surgery with osteotomy
- This involves realigning the bone (first metatarsal) of the big toe to restore its original shape, meaning it will remain straight as it should.
- After applying local or regional anesthesia to the patient, the surgeon accesses the bunion area through an incision. Once at the location, the surgeon cuts off the protruding part of the metatarsal bone (which causes the bunion).
- After cutting the bone, the surgeon places screws in the bones to ensure they fuse properly and the bone grows back correctly. Finally, the surgical wound is sutured, and the foot is bandaged.
- It’s important to note that this intervention is generally recommended when the foot presents a deviation of more than 30°, meaning the procedure is more severe. Once the deviation is corrected, the bunion will disappear as the tissues are released from tension.
- This type of surgery is straightforward, does not require hospitalization, and is outpatient. The surgery lasts between 30 and 90 minutes.
Bunion surgery or Hallux Valgus surgery without osteotomy
This type of surgery is known as “percutaneous surgery” and is minimally invasive because the surgeon does not make large cuts to reach the problem or cut the bone, as in the previous technique. This procedure is recommended for mild or moderate cases of Hallux Valgus. It works as follows: The surgeon numbs the patient locally or regionally and then makes three or four small incisions in the area to be treated. Through these openings, the surgeon inserts the necessary surgical instruments into the patient’s foot. Using these tools, the surgeon can see the inside of the foot on a monitor in the operating room. This allows the surgeon to operate effectively. After correcting the Hallux Valgus, like the previous surgery, the pressure on the tissue is relieved, and the bunion disappears. A bandage is placed on the treated foot, which will be removed after a week. This surgery also lasts between 30 and 90 minutes.
Postoperative care after bunion surgery
After the osteotomy bunion surgery, the postoperative period lasts approximately 3 to 6 weeks. After this time, the patient can let their foot rest fully on the floor. Only by the tenth week is the patient completely healed and able to return to daily activities.
After the bunion surgery without osteotomy, the patient must wear shoes with rigid soles and a device to keep them fully rigid and prevent the first two toes from misaligning again, which would lead to deviation. It is important to note that recovery time is significantly shorter in this technique, and the healing is much quicker.
In conclusion, the main goal of each of these surgeries is the same: the complete removal of the bunion and its symptoms by correcting Hallux Valgus (that is, realigning the big toe).
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