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Overview

Hallux Abducto Valgus, commonly called bunion, is a bony deformity affecting the angle of the joint at the base of the big toe. Some medical professionals believe that the condition is solely due to ill-fitting footwear, while others believe it is a genetic structural defect that can be exacerbated by shoes. Despite the varying opinions, the reality is that it is probably a combination of both factors. A bunion forms when pressure is applied to the side of the big toe, causing it to become inflamed and painful. The joint then protrudes, effectively making the foot wider. The second toe might then become displaced, which can cause a multitude of other issues like corn and callus development. The bunion joint will have a reduced range of motion and often ends up arthritic. The condition usually develops later in life.

Causes
There are many factors which can contribute to the development of a bunion. The common causes are genetic factors, poor foot mechanics, high-heeled or narrow footwear and trauma to the toe. It is believed that constant stress on the joint of the big toe causes mild displacement of the bones and the joint, along with thickening of the tissues and a change in the pull of the muscles. This can result in a degree of arthritis of the joint, and over time, further displacement of the toe. This may lead to pain, difficultly with fitting shoes and corns/calloused lesions due to excess pressure on the smaller digits.
SymptomsThe most common symptoms of foot bunions are toe Position, the toe points inwards towards the other toes in the foot into the hallux adbucto valgus position and may even cross over the next toe. Bony Lump, swelling on the outer side of the base of the toe which protrudes outwards. Redness, over the bony lump where it becomes inflamed. Hard Skin, over the bony lump known as a callus. Pain, it is often painful around the big toe, made worse by pressure on the toe and weight bearing activities. Change in Foot Shape, Your whole foot may gradually change shape for example getting wider. Stiffness, the big toe often becomes stiff and may develop arthritis. Foot bunions are more common with increasing age. They develop gradually overtime from repeated force through the big toe and left untreated, become more pronounced with worsening symptoms.

Diagnosis
When an x-ray of a bunion is taken, there is usually angulation between the first metatarsal bone and the bones of the big toe. There may also be angulation between the first and second metatarsal bones. These angular irregularities are the essence of most bunions. In general, surgery for bunions aims to correct such angular deformities.

Non Surgical Treatment
In most cases the symptoms of bunions can be reduced or relieved without surgery. Reducing pressure on the bunion is the first step in reducing the pain associated with the condition. Wearing correctly fitting shoes is important in achieving this. A referral to a podiatrist may be made in order to assess the need for special orthotic devices, such as custom-made arch supports and shoe inserts (eg: metatarsal pad or bar). These can help to relieve tension on the base of the big toe and help prevent flat-footedness. Specific exercises and bunion pads available over-the-counter at pharmacies may also be of benefit. Anti-inflammatory medicines can help to ease pain in the short term. Steroid injections may be used to relieve severe pain. If a sufficient reduction in symptoms is not achieved by non-surgical treatment, then surgery may be recommended.


Surgical Treatment
If your bunion has progressed to the point where you have difficulty walking, or experience pain despite accommodating shoes, you may need surgery. Bunion surgery realigns bone, ligaments, tendons and nerves so your big toe can be brought back to its correct position. Orthopedic surgeons have several techniques to ease your pain. Many bunion surgeries are done on a same-day basis, requiring no hospital stay, using an ankle-block anesthesia. A long recovery is common and may include persistent swelling and stiffness.

Prevention
There are some steps that may help prevent, or at least slow, the progression of bunions. Avoid shoes with a narrow toe box. If your foot flattens excessively, make sure you wear supportive shoes, and if necessary, get custom orthotics from your podiatrist. See your podiatrist at the first signs or symptoms of a bunion deformity, as early treatment may stop or slow its progression.