Hallus valgus

A condition that occurs when there is too much pressure on the inside of the foot at the base of the big toe

What is a bunion?

A bunion is a deformity of the big toe. The tip of the big toe tilts towards the smaller toes and a bony lump appears on the inside of the foot and can rub on shoes and become swollen and inflamed. The first metatarsal bone twists and the two pea shaped bones beneath it, called the sesamoids, stop gliding normally which can also cause pain.

Bunions are often inherited and can affect both feet. The painful protrusions occur when the bones in your toes drift, and they can grow larger over time. The longer bunions are left untreated, the larger and more painful they can become. Although symptoms can be managed, the only truly effective way to treat bunions is through surgery. 

Open surgery requires the big toe being opened with long one incision and the bones being reshaped and broken. Keyhole surgery, a less invasive procedure, is performed by making five small incisions that is less traumatic to the tissue and muscle of the toe. Although not suitable for everyone, keyhole surgery can reduce recovery times with patients often able to walk without crutches the next day. 

Need to know

  • What are the symptoms of a bunion? icon plus

    Symptoms of bunions include:

    • hard lumps on the sides of your feet, by your big toes
    • big toe pointing towards your other toes
    • deformity of your lesser toes (hammer toes)
    • metatarsalgia or pain under the lesser toes
    • callosities or thickened skin
    • pain under the toes and over the bony lump
  • How are bunions diagnosed? icon plus

    Your consultant will perform a physical examination to assess your whole biomechanical alignment including whether you have joint laxity (hypermobility), flat or high arched feet, your toe alignment, the presence of toe deformities and the motion of the joints.

    An X-ray may be recommended if surgery is being considered and in some circumstances a standing CT scan may be recommended to look for 3D wear of the joints in a functional position.
  • Potential treatment options icon plus

    Non-surgical options

    • Footwear advice. Most shoes on the market are narrow, and your specialist may give you advice on fashionable alternatives that put less stress on your feet.
    • Physiotherapy to provide stretches, strengthening exercises and advice on foot and lower limb posture.
    • Bunion splints are available and can be tried but are not very successful.

    Surgical options

    • First metatarsal osteotomy. In surgery, the bony lump is removed and the toe is realigned by a controlled break of the bone and the loose ligaments are tightened.
    • Lapidus first tarsometatarsal joint fusion. This is used in cases of joint laxity or hypermobility.

    Modern surgery is not painful and requires no plaster cast after the surgery.

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This content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
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