Welcome to ‘The Bunion hallux valgus deformity Number One’.
Information is designed to help you work around all those questions and concerns you might have on bunions or hallux valgus as we call the condition. I will set out some of the obvious answers to guide you on your way to more detailed information and point where to find more. The content is limited to considering what concerns patients most and why seek help. Bunion is the bump (soft and hard) and the bent deformity as the toe slides across toward the smaller toes is the valgus part. Hallux just means toe in a language no longer used. I am going to do what we all do and call all of this a bunion.
This short article is not about foot surgery but you can download feedback from my patients who have recorded their views by using the coloured [link]. 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.
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 concerns about bunions
- So you have a toe that appears deformed. Someone in the family has a bunion deformity so you are worried it may get worse, or your foot is starting to look like your grandparent’s deformed foot.
- I am in pain, my big toe joint hurts, walking is painful and I cannot wear shoes.
Okay maybe we cannot put you into one of these 2 categories but these are the two most common.
So what is it?
All the websites and information tell us the bent toe deformity is called hallux (toe) valgus (deviation). The condition affects around 25% of the population. It has hereditary origin passed through family genes. Girls (women) are more prone to the condition and suffer often because of the limitations of footwear style. Rarer cases are afflicted with the unpleasant type of arthritis called rheumatoid arthritis, but I am not going to deal with this subject and only discuss the common form which is acquired during life.
The bunion is the bump called an extra-bone or exostosis. If it is soft then a sac of fluid called a bursa or ganglion may lie beneath the skin. This comes from torn or split deeper tissue associated with joint and tendon lining. Bad news if the skin is sore, or breaks, worse if you are not good at healing, but the skin is stretched and under pressure. Poorly controlled diabetes (diabetes mellitus or DM) needs good quality foot health advice from podiatrists, nurses and doctors with an interest in diabetes. Make sure your DM is sorted as a priority.
The illustration shows the colour changes that arise with repeated pressure. The bump can be over the top of the toe or the side.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
You want to avoid surgery of course and this is our aim and to give advice and direct you to help yourself. If it is not painful and you can cope, then do nothing, but make sure all shoes fit well and have a broad front. Boys (men) do so much better even when the deformity is large.
If it is pain over the bump then protective sleeves work (figure above) and as long as they do not take up too much room, the pressure will be taken off the skin. If the skin has broken, dress it with one of those cushioning plasters from a pharmacy, they work well. Some like this illustration have a lug that sits between the toes. This causes with shoe fit often and a simple sleeve from a well-stocked pharmacy is probably better. Use sandals to alleviate the pressure and discomfort. Add an antiseptic like Savlon products (cream or spray) to prevent infection. If the toe has developed an ulcer, a type of deeper wound that fails to heal then seek medical advice. You cannot treat an ulcer yourself easily.
Do toe splints work?
The internet and pharmacy (Chemists) often try to persuade you 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 a bunion (Hallux valgus) if it is destined to deform. There is weak evidence if used before adolescence that a splint might help to slow the problem down. Splints can make the joint both more comfortable and also more painful. Sorry, there is no cure for a bunion that increases in size. The big problem is they can suddenly increase without warning.
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. The youngest patient I have seen is 9 years but you can see this at birth, although a rarity. The earliest age that I have operated is at 14 years. This is not good as there is a high rate of recurrence. The deformity and bump return. After 35 years of age, the recurrence risk seems to reduce with older age. This suggests that it is better to leave the bunion deformity. Fine if you can cope but surgical recovery is better while younger with plenty of home support.
Let is move onto pain in the joint. This is the second main concern a patient will want to discuss. There are two things your specialist podiatrist will want to consider. Is the pain recent (acute) or is it long-standing, maybe six months or more? If it is chronic then some type of 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.
If the joint lining or tendon is inflamed we can fix this, you can use my self-help treatment, the Practical-Padding-Help-sheet-3-Painful-gt-toe
An injection can also work and is best carried out under imaging (x-ray or ultrasound) by someone who does this regularly.
Moving from self-help to clinical help
When the joint is damaged the shiny surface (cartilage) is broken Factsheet-109-The-painful-big-toe-joint-. The diagrams here will help explain this better. Have an injection and review this between 3-6 months. Surgery may be needed. The aim here is to prevent the joint requiring a new joint (arthroplasty) or stiffening (arthrodesis), but sometimes this is necessary.
So there you have an introduction to bunion (hallux valgus) number one foot complaint. Consider the outline:
- You now know what it is.
- You have some idea of the chance of fixing it yourself
- You know what to look for skin break, shoe problem or joint problem.
- You know that surgery is needed for big painful deformities.
Factsheet available on bunions click the link