Bunions

A bunion also known as Hallux Valgus is a deformity that occurs at the Great toe joint.  The bunion deformity is a result of a deviated great toe joint rather than growth of a bone.  The great toe joint is a complex structure involving many bones, ligaments and tendons and is different from the lesser toe joints in that it has sesamoid bones as depicted below. The sesamoid apparatus acts as a fulcrum much like the patella (knee cap) to give the tendons and ligaments force amplification.  Many studies have reported a higher prevalence of bunions in women, as high as 15 to 1, 1and occurs in 2-4% of the population. 2Studies have also shown that there is a higher prevalence of bunion formation in populations that wear shoes, however there is also a genetic link to bunion formation, and unshod peoples have demonstrated close to 3% occurrence of hallux valgus.

In the progression of a bunion, the great toe drifts laterally (toward the smaller toes) and the first metatarsal drifts medially (toward the midline of the body).  Often this deformity can progress much quicker in a pes planus foot type.

If the deformity painful and decreases the ability to perform desired activities, and makes shoe fitting difficult. Surgery may be performed to correct the deformity. 

A combination of clinical examination, X-rays, and post-operative goals will guide treatment.  X-rays show the nature of the deformity and are used to help in the decision making process for surgical correction.  Motion of joints associated with the toe are also performed to assess the deformity. There are numerous procedures available for correcting a bunion deformity.  In most cases, the severity of the bunion deformity will correlate to the surgical procedure required and more extensive post-operative limitations. 

Symptoms

  • Pain, swelling and/or redness along the inside of the foot around the great toe
  • Pain and discomfort at the bunion when wearing shoesPain and swelling under the ball of the foot, particularly under the 2nd toe joint
  • Irritation, pain from overlapping of the first and second toe
  • Arthritis may cause stiffness and discomfort in the great toe joint
  • Skin over the bunion may break down causing an ulceration, which can become infected.

Other causes of pain at the great toe joint

  • Osteoarthritis of the great toe joint
  • Inflammation of the great toe joint from inflammatory arthritis such as gout or rheumatoid arthritis
  • Fracture of the great toe or first metatarsal
  • Sesamoiditis, an inflammation of the small bones which rest in tendons under the first metatarsal

 

  1. Hardy RH, Clapham JC: Observations on hallux valgus; based on a controlled series. J Bone Joint Surg Br 33:376-391, 1951.
  2. Myerson MS: Hallux valgus. In Foot and Ankle Disorders. Philadelphia, WB Saunders, 2000, pp 213-289.
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