Welcome to ‘Hallux valgus ‘
Also commonly know as a bunion
Information is designed to help you with your questions and concerns concerning bunions or hallux valgus. The content is limited to considering what concerns patients most and why they might seek help. Bunion is the bump (soft and hard) on the side of the big toe joint. As the toe bends outwards toward the smaller toes we call this valgus deformity. Hallux just means toe in a language no longer used. The amount of information on this subject is daunting and sadly there is some ‘fake’ material out in the media arena which only adds to confusing the picture. Most of this type of news suggests that the deformity can be corrected. In my book this would be made straight again. This is not possible without surgery. There are many things we can do without surgery so it is important not to despair.
There are usually several questions people will ask first
Do I need to do something?
If I need to have something done, can I avoid surgery?
If surgery is necessary what does it involve?
How does it affect me?
Two major concerns about hallux valgus
(1) Do you have a toe that appears deformed. Someone in the family who has a bunion deformity? Are you are worried that it might get worse. Is your foot starting to look like your grandparent’s deformed foot.
(2) Are you in pain so that your big toe joint hurts. There is pain when you walk and on top of this you feel you cannot wear the shoes you like?
Okay maybe we cannot put you into one of these groups but these are the two most common categories.
So what is a bunion?
The condition affects around 25% of the population. It is usually hereditary and therefore passed through our family genes. Women are more prone to the condition and suffer often because of the limitations of footwear style. Rarer cases can be associated with rheumatoid arthritis.
The bunion is the bump also associated with extra-bone (exostosis). If it the skin is thin a sac of fluid called a bursa or ganglion may lie beneath the skin. This comes from damaged tissues associated with the joint lining. The condition becomes more of a concern if the skin is breaks leaving a wound. If you are not good at healing an ulcer may form due to constant pressure. I patients with poorly controlled diabetes foot health advice is required from podiatrists, nurses and doctors to ensure the medical disorder is managed and hopefully prevent or even reversed. Therefore you are advised to make sure your diabetes is sorted as a priority. The illustration shows the colour changes that arise with repeated pressure. The deformity part is the joint dislocating sideways (i.e the valgus). You can get it going the other way but this is not common (i.e varus).
Advice, self-help and acting sensibly
If it is pain over the bump then DO use protective sleeves work as long as they do not take up too much room in the shoe. These type of protective are cheap and will take pressure off the skin. If the skin is damaged then apply first aid. You can use one of those cushioning plasters from a pharmacy, they work well. Add an antiseptic like Savlon products (cream or spray) to prevent infection. If the toe has developed a deeper wound that fails to heal, then seek medical advice. You should not attempt to treat an ulcer yourself. If you want to use a pad to protect the skin surface go to my article on self-help
Do toe splints work?
The internet and pharmacy (Chemists) often try to persuade us to buy a bunion splint. Well here are the facts. Do try them if you want, they won’t harm you. Equally, they will not correct your hallux valgus deformity. There is some weak evidence that a if splints are used before adolescence that the deformity will be slowed down. However splints can make the joint both more comfortable and there is scientific evidence to suggest used to support joint comfort that this works. No-one however managed to correct the toe position.
Is Age a factor?
If you are under 25 and the deformity is big then you may find that you take steps early to have the foot corrected. This means surgery. More information on age.
This is the second concern a patient will want to discuss after the toe shape and the deformity. Is the pain recent (acute) or has it been present for maybe six months or more? In some patients joint damage may be evident. It is very rare for the problem to be caused by gout but your GP may want to run a test. Stiff toe joints are more likely to be associated with joint or cartilage damage. An injection can also work and is best carried out under imaging (x-ray or ultrasound) by someone who does this regularly.
When the joint is damaged the shiny surface (cartilage) the lubrication and smooth movement is affected. Factsheet-109-The-painful-big-toe-joint- is helpful as it provides a number of diagrams the problems associated with joint damage. The aim of conservative care is to prevent the joint requiring a new joint (arthroplasty) or stiffening (arthrodesis), but sometimes this is necessary.
If you are considering surgery let me recommend my patient journey book launched in 2019 with detailed stories from patients who I had operated on. Details are provided on self help treatment. A full chapter on consent and complications is provided. The book is a story behind the scenes so it provides ‘wart an’ all!’ Available from Amazon books as an eBook and paperback or go to my bookstore.
You can also download my Factsheet on bunions click the link. Please not the fact sheet is better opened on a desk or laptop and NOT a smart phone. If you have an interesting story or concern you can write to me at email@example.com
Thanks for reading this article ‘Hallux valgus’ written by David Tollafield.
Updated July 2020
First published April 2019
ConsultingFootPain is part of Busypencilcase Reflective Communications