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Hallux valgus, bunion in woman foot on white background

Hallux valgus, or a bunion on a foot.

Bunions are common and moreso in women than men. The official medical term for a bunion is hallux valgus, which the result of a deformity of the joint at the base of big toe or the metatarsophalangeal, that is, MTP, joint.

Hallux means the big toe, and valgus means a deformity away from the midline of the body; therefore, this deformity causes the big toe to be bent toward the other toes and crowds the adjacent toes causing a bump along the base of the big toe.

The MTP joint is an important joint in the foot and is used for balance and push-off of the foot. As such, this joint is subjected to significant forces during activities such as walking and running.

If this joint is in normal alignment, then the forces are distributed well and painless. With a bunion deformity the joint does not function well and because of its deformity there is pain and discomfort.

There are many proposed reasons as to what causes bunions including high heels and ill-fitting shoes but it is believed that there is also a hereditary component.

As the joint develops more and more of a bunion there is increased pressure on the joint, which leads to pain and discomfort especially when wearing shoes. High heels might also make a bunion more painful, since there is additional pressure and force on the joint. The skin over the joint can also become inflamed and tender to touch making it even harder to wear shoes.

Treatment of bunion is based on how painful it is and how severe the bunion deformity is.

If there is no or little pain, then the treatment is often symptomatic meaning medications and shoe modifications such as wearing less constricting shoes. Additionally, steroid injections into the joint can be helpful in decreasing the inflammation and pain. Over time as the bunion worsens the MTP joint can become arthritic and painful making these treatments less effective.

Surgery is often contemplated if initial treatment of medications, shoe modification and injections fail to remedy the symptoms associated with the bunion. If the deformity is severe and painful, the treatment is often corrective surgery. However, corrective surgery where the bunion deformity is realigned needs to be done before the MTP becomes too arthritic.

There are quite a few corrective surgeries to treat bunion surgery. The goal of the surgery is to straighten the bunion therefore removing the deformity and the pressure and pain from the joint. One surgery for a mild bunion is to shave down the bony deformity at the joint to relieve the pressure on the joint when wearing footwear.

If the bunion is severe but the joint isn’t arthritic, then surgery is focused on straightening the joint. This is done by cutting and re-aligning the bone, the metatarsal bone, which leads to the joint. This surgery is effective in correcting the bunion and will remove the pain and the deformity from the joint.

If the MTP has become arthritic with limited motion then a shaving of the bunion or a corrective bony surgery will not work and the joint has to be re-aligned and fused to relieve the painful joint. This surgery is also effective, but the downside is that patients can no longer wear high heels since the MTP joint no longer moves and therefore will not fit into high heel shoes.

In summary, a bunion deformity can be unsightly and painful but fortunately there are many treatment options available that can used to treat this deformity.

Dr. Dwight S. Tyndall, FAAOS, is an outpatient spine surgeon practicing in the Region. His column, which appears every other week, covers a wide range of health and medical issues.

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