Bunion/Hallux Valgus

Definition/diagnostic criteria A bunion, also known as hallux valgus, is a deformity characterised by lateral deviation of the great toe, often coupled with a medial enlargement of the first metatarsal head. This deformity is often accompanied by soft tissue and bursal thickening, resulting in a prominent, painful bump on the medial side of the foot.

Epidemiology Bunions are a common foot disorder in the UK, with a higher prevalence in women and older age groups. The exact prevalence is difficult to determine due to varying definitions and study methods. Risk factors include genetics, footwear (particularly high heels and narrow-toed shoes) and rheumatoid arthritis.

Diagnosis
Clinical features:

• Pain and tenderness over the medial aspect of the first metatarsal head.
• Redness, swelling and limited motion of the big toe.
• Development of calluses on the medial side of the first metatarsal head.
• Altered gait patterns due to pain.

Investigations: Diagnosis is primarily clinical, and in primary care X-rays are not generally required. They may sometimes be helpful in assessing the degree of deformity and planning treatment. Typical radiographic findings include:

• Increased angle between the first and second metatarsals.
• Lateral deviation of the great toe.
• Osteoarthritic changes in later stages.

Treatment The treatment of bunions is tailored to the severity of symptoms and the extent of the deformity.

Non-surgical management:

• Education about appropriate footwear: wide-toed shoes with a comfortable fit.
• Orthotics to redistribute pressure away from the bunion. Referral to a podiatrist may be helpful.
• Analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief.
• Physical therapy exercises to maintain joint mobility and reduce discomfort.

Surgical management: Surgery is considered when conservative measures fail and the pain becomes debilitating. Various surgical techniques exist, including:

• Osteotomy: realigning the bones of the big toe.
• Exostectomy: removal of the bony prominence.
• Arthrodesis: fusion of the joint.

The choice of surgical technique depends on several factors, including the extent of the deformity and the patient’s age and activity level.

Prognosis The prognosis for bunion is generally good with appropriate management. Non-surgical treatments can provide significant symptom relief, although they do not correct the deformity. Surgical intervention has high rates of success and satisfaction but carries risks such as infection, recurrence of the bunion and postoperative pain.