Bunion (Hallux Valgus)
Hallux valgus (bunion deformity) is a misalignment of the first metatarsophalangeal joint (MTPJ) that causes the big toe (hallux) to deviate towards the second toe. The deviation can be so great that the big toe under-rides the second toe. A large bump appears clinically on the medial aspect of the first MTPJ. Pain can be experienced at the bump or in the joint causing a poor quality and limitations of motion. The simple act of wearing shoes can be excruciation but does not actually cause the deformity, it only exacerbates it. Hallux valgus can be a progressive deformity causing limitation of big toe motion, degeneration of the big toe joint, and pain during ambulation.
Bunions are generally thought to be an inherited condition, and certain foot types may lead to hallux valgus at some point. Ligamentous laxity, injury, a hypermobile foot, a foot that pronates (flattens) excessively, or arthritides (such as rheumatoid or gout) are all conditions that may predispose a person to develop hallux valgus.
Conservative approaches to treatment are aimed at decreasing symptoms and slowing progression. A brief course of anti-inflammatories, padding, changing shoe styles, and orthotics are all modalities that may decrease pain and slow the progression, but will not make the “bump” go away. Once the hallux has deviated in position and changes in joint congruity have occurred, surgical reconstruction is the only definitive treatment that can change the clinical appearance. The extent of the surgical reconstruction depends on the complexity of the deformity, patient age, health status, and degree of symptoms.