Bunions or Hallux Valgus
What are bunions or hallux valgus?
Hallux valgus or bunions is a progressive and complex deformity that affects the front part of the foot. The most obvious signs are deviation of the big toe and bony protrusion at the level of the first toe joint.. The deviation that occurs from the first toe to the second toe, together with the bony growth on the outside caused by the bunion, causes the joint to become inflamed, causing pain and may be the cause of other associated finger deformities, such as claw, hammer or gooseneck toes.
Bunions occur almost exclusively in people who wear shoes, so it is very rare to see it in populations that are accustomed to going barefoot.
The growth of the deformity occurs gradually throughout life, although, in some cases, it can evolve in less time.
Solo puedo decir que fue una bendición conocer y confiarme a éstos maravillosos profesionales. Todo el equipo es excepcional con una calidad humana inigualable y ni que hablar de los resultados que han sido fantásticos.
Eternamente agradecida.
In September I had surgery on my both feet in the Clinica San Roman in Alicante, Spain. The surgeon removed the two halluxes and put my toes straight. I am very happy with the result of what he and his great team did for me.
The procedure itself plus the days after were almost painless. I slowly but steadily walked in the lovely neigbourhood around our appartment as soon as… the following day.
My feet are much better shaped than before with the big bunions.
Also I am very pleased with the kind and gentle way everybody addressed me. I have felt safe and looked after all the time.
Yesterday, not even two months after the surgery, I bought new shoes. Every time I look at my feet in these new shoes reminds me I made a wise decision to go to this clinic with its specialized staff. They have performed minimal invasive surgery for many years and use their skills and experience to help their patients big time.
I say: thank you very much.read more
Zeer profesioneel, uiterst vriendelijk en heel belangrijk ze nemen de tijd voor iedere patiënt.
Ook de nazorg is top ! 👍👍👍
Frequently Asked Questions about Bunions or Hallux Valgus
Manchester Scale
According to the Manchester scale, bunion or hallux valgus deformity can be classified into 4 grades.
- Grade 1 is when there is no deformity.
- The mildest deformity corresponds to grade 2.
- Moderate deformities correspond to grade 3.
- The most severe are classified as grade 4.
In addition, there are other ways to classify hallux valgus, but on a practical level for patients, this Manchester classification is a simple and practical system.
It is advisable to treat this deformity in time because, the more severe it is and/or the more it affects the other fingers, the more complex the surgical treatment is and it may not have the expected results.
What to do if I have bunions?
If you have bunions, do not wait any longer and consult a podiatrist, because time will only aggravate your problem. The specialist should perform a complete examination of the foot, including x-rays. This will allow to establish the degree of bunion deformity and other deformities if any.
What shoes to wear?
As a general rule, the foot should be supported in the shoes, always avoiding toe bunching. Footwear should be comfortable, wide at the toe and, very importantly, should have adequate support on the back of the foot.
In the case of women, according to a study conducted at the University of Navarra, the heel of the shoe should not exceed 5 centimeters in length. This does not mean that on certain occasions it is not possible to wear one of a higher height.
The sole of the shoe should be thick whenever possible, as this allows cushioning the impact of walking while protecting the foot.
In summer, sandals should be limited to short distances.
What to take for pain?
There are analgesic drugs such as paracetamol or metamizole (Nolotil) that help reduce pain.
When the deformity presents bursitis or swelling, anon-steroidal anti-inflammatory drug (NSAID) such as ibuproben or dexquetoprofen could also be taken.
Always remember that before taking any medication, you should consult your physician.
How often are bunions found?
The bunion or hallux valgus is the most common foot problem in orthopedics or podiatry.
Bunions are 7-9 times more common in women than in men. In women (Nguyen et al. 2010), the frequency of bunion increases with the use of high heels and with a low body mass index. In contrast, in men, hallux valgus is associated with a high body mass index and flat feet.
Bunions and Age
What to do when you are 30 years old?
The highest incidence of bunions occurs during the third decade (Coughling & Jones, 2007) of life. At age 30, if you have this deformity, you should consult a podiatrist to assess your options. Depending on the degree of deformity, several treatment options are available. In the initial stages, the recommendations of Clínica San Roman should be followed. However, when there is a large deformity or pain that does not improve, conservative surgical treatment is the only option.
What to do when you are 40 years old?
From the age of 40 is when patients with bunions should seek a definitive solution to their problem. It is a good time to see a foot surgery specialist to assess the different surgical options depending on the degree of deformity.
What to do when you are 50 years old?
If you are 50 years old and have bunions, surgical treatment is the best option. Being able to walk is very important for a healthy life.
What is minimally invasive surgery?
What type of anesthesia is used if the operation is necessary?
Why do bunions grow?
The increase in size of this deformity is due to a number of factors:
One factor in this growth is probably due to the continuous pressure exerted by the shoe on the bony protrusion.
Other factors that intervene in its growth are: the type of foot (flat, valgus), hyperlaxity or abnormal shortening of the first metatarsal, trauma, inflammatory diseases such as rheumatoid arthritis and finally, shoes with narrow toes and high heels are important factors in the development of the deformity.
Why are they called bunions?
The origin of the word bunions is attributed to ancient farm workers. In the field it was observed that many workers had this deformity. As Juan was a common name among them, this deformity became known as bunions disease .
Why do they hurt?
The pain is mainly caused by the pressure exerted by the shoe on the deformity. Occasionally the pain may be continuous probably due to entrapment of the nerve that passes through that area.
Why do bunions or hallux valgus occur?
Hallux valgus is composed of the medial (outward) deviation of the first metatarsal, the lateral deviation of the big toe or hallux, and the bony protrusion of the first metatarsal head. When the big toe or “hallux” has an outward deviation, it is called abducto valgus.
The origin of the bunion is multifactorial, that is, it is due to many causes .
Why do bunions or hallux valgus occur?
MAIN CAUSES
- Genetic causes: despite being under continuous study, it can be affirmed that bunions are transmitted from one generation to the next, although sometimes they skip a generation. Up to 83% (Coughling & Jones, 2007) of patients with bunions have a family history. The defect, which is inherited in an autosomal dominant manner (Biciuto, 2014), is an alteration in the structure of the foot, which can be bony or soft tissue.
- This produces an imbalance in the biomechanics of the foot that predisposes to the development of the deformity. These alterations can be, for example, a long first metatarsal, a curved joint of the first toe, as well as hypermobility of the first radius. This defect predisposes to the formation of hallux valgus, but it does not mean that all inherited disorders will develop bunions.
- Footwear: footwear is very important in the development of a bunion, since, as we have already mentioned, there is no bunion without shoes. The shoes that most influence their formation are those with high heels and narrow toes. Footwear that squeezes and crowds the toes accelerates bunion growth and toe deformity.
- In addition, narrow footwear causes pressure on the bony protrusion and even nerve entrapment. For this reason, bunions are up to 7-9 times more common in women than in men. Studies have shown that up to 34% of bunions (Coughling & Jones, 2007) are caused by very narrow footwear and occupation.
- The profession: Several studies conclude that certain professions that require footwear and an inadequate use of the feet may predispose to its formation.
- Age: deformity usually increases gradually throughout life. Patients usually consult for bunions after the age of 40, with some exceptions.
- Trauma/accidents: patients who have suffered some type of trauma to the foot that has affected bone, joint, soft tissue and even dislocations or sprains, can lead to hallux valgus.
- Associateddiseases: flat foot or pes cavus deformities, hypermobility and length of the first metatarsal, excessive pronation, hyperelasticity, and inflammatory diseases such as rheumatoid arthritis, gout and psoriasis are frequent causes of bunions and toe deformities.
Where do bunions appear?
The deformity appears in the joint of the first toe or big toe. When the appearance of the deformity appears in the fifth toe, it is known as Tailor’s bunion .
Where does it hurt?
Pain occurs mainlyin the deformity itself, in the joint of the first toe or in the dorsal part of the foot. It is important to remember that bunions often cause other deformities such as claw toes.
Where to buy "bunion corrector"?
The so-called “bunion correctors” are devices that try to correct the deviation of the big toe and protect it from rubbing against footwear.
However, while these so-called “correctors” may relieve the pain caused by the deformity or even temporarily and minimally correct the deviation of the big toe, they cannot remove the bunion or correct the deviation of the big toe.
For this reason, we must remember that the only solution for bunions is surgery. The Minimally invasive foot surgery allows the correction of bunions and claw toes through a 5 mm incision, with almost no pain, with a quick recovery, fewer complications and allowing the patient to walk out of the surgery.
Who operates on bunions?
This operation is performed by podiatrists and medical specialists. Nowadays, there are specialists dedicated exclusively to foot surgery.
foot surgery
. You must remember that surgery is an art, which in addition to knowledge and science, requires a lot of experience to obtain a good result. For this reason, the surgery should be performed by surgeons with great experience in this field .
When do bunions appear?
These can appear at any time. Initially, they manifest as a small deformity on the external part of the joint of the first toe. This deformity may be asymptomatic or painful.
How long have bunions been known?
The oldest bunion (Isidro & Margosa, 2017) known to exist belongs to a mummy from ancient Egypt, approximately 2100 BC. It is very rare to find bunions in archaeological remains becausethese deformities are prevalent in societies that wear shoes on a daily basis .
How to prevent them?
Prevention of bunions should begin with an initial assessment by a foot specialist. X-rays of the foot should be taken along with a biomechanical gait study to detect any alterations in the footprint, imbalances, foot type and points of overload. All this will help to establish the type of deformity and if necessary, to the confection of orthopedic insoles to stabilize the foot pressures and slow down the progression of bunions.
High heels and narrow-toed shoes should also be avoided so that the toes do not bunch up and reduce pressure on the bunion area.
Footwear should fit and support perfectly. The sole of the shoe should be thick, platform type. Finally, rehabilitation exercises can be performed to strengthen the musculature of the foot to reduce hyperpronation.
Clínica San Román has made a series of recommendations based on more than 43 years of experience in the treatment of bunions.
When can I drive or work if I have minimal incision or percutaneous foot surgery?
How to correct or cure them without surgery?
Unfortunately, bunions cannot be corrected or removed without surgery. Orthopedic insoles can be used to stabilize the joint of the first toe or even a silicone separator to align the first toe a little, but in no case is it possible to correct them without surgical intervention.
Can laser surgery be performed?
Laser” surgery is a term that came into use in the 1980s in reference to minimally invasive surgery. The laser is not really used in any bunion operation, however it is defined as a laser because it is a technique that allows the correction of bunions through incisions of a few millimeters, a much faster recovery and with minimal pain.
What are the symptoms of bunions?
Bunions in the initial stages are usually asymptomatic, meaning that the patient has no symptoms. With the passage of time, they increase in size and the big toe deviates, affecting the other toes as well.
The main symptoms are as follows:
- Pain and inflammation: the main symptom is pain on the outside of the first toe. The joint swells and reddens causing pain that can become disabling. The deformity of the bone becomes inflamed with the friction of the footwear forming a painful bursitis (accumulation of inflammatory fluid). These symptoms worsen when walking or standing for long periods of time.
- Calluses and painful blisters: the deviation of the big toe towards the second toe causes deformities in the other toes which in turn produce calluses both on the dorsum of the toes and on the sole of the foot. These can produce metatarsalgia which is pain in the front part of the sole of the foot. Also, the bunion area may have calluses caused by rubbing or pressure.
- Pain due to stiffness of the big toe: The bunion deformity is often associated with some degree of osteoarthritis. Stiffness causes limitation of big toe motion and this in turn can cause pain, hypersensitivity and numbness especially with high heeled shoes.
In general, all these symptoms can be temporarily improved with the recommendations described in another section. However, over time and as it evolves, these measures will cease to be effective. Therefore, it is important to remember that the best and only treatment for bunions is surgery.
What are the complications of not treating hallux valgus?
The progression of the bunion. As we have described at the beginning of the text, the bunion, is the lump or protuberance that forms on the external part of the joint of the big toe that is usually painful and that if it is not treated, it increases in size and ends up dislocating the joint.
Occasionally, it can hurt even without shoes as a result of inflammation and nerve entrapment that occurs in the area of the deformity. With the passage of time, this deformity continues to increase in size until it becomes impossible to wear everyday footwear, causing increased pain and instability in foot support.
Another complication of not treating them is finger deformities.
Finger deformities
Deformities in the other toes: claw and hammertoes are often associated with bunionette deformity. The deviation of the big toe compresses the other toes, causing continuous pressure that is aggravated by the use of narrow-toed shoes and high heels. Over time, the toes elevate and flex to accommodate the deformity of the big toe.
Finger deformities are usually of the claw, hammer and gooseneck type. Often, the patient comes to the consultation of the foot surgery specialist when he/she presents not only the bunion but also deformities in the other toes.
For this reason, it is very important to treat the deformity as soon as possible, in order to avoid the associated deformities that occur in the rest of the foot, such as claw toes or hammer toes.
Types of finger deformities
- Claw toes: this toe deformity associated with hallux valgus affects the soft tissue, mainly muscles and tendons. In claw toes, abnormal bending of the finger joints occurs. This deformity resembles the claw that some animals have.
- Hammertoes: this deformity is also known as mallet toe due to the bending shape of the toe, resembling a hammer or mallet. At the anatomical level, there is an extension of the proximal part of the toe (metatarsophalangeal joint) and a flexion of the end part of the toe (distal interphalangeal joint).
Diagnosis
The diagnosis of the bunion is initially visual, and you can see the lump or deformity of the first joint of the big toe. It is very important to have an individualized and accurate diagnosis of the degree of severity of the bunion to assess the surgical option and future outcome of such intervention.
To establish an accurate diagnosis, the foot surgery specialist must perform:
- Complete physical examination with special attention to the lower limbs. The foot surgery specialist must assess the type of foot, joints, degree of flexibility or stiffness, skin condition, nails, pressure areas, as well as associated toe deformities.
- Anamnesis of the patient: The foot surgery specialist should perform a complete anamnesis with the symptoms that the patient presents. Also, a family history of hallux valgus, diseases (rheumatoid arthritis, psoriasis, gout, etc.), risk factors (hypertension, diabetes, arrhythmias) and previous trauma should be collected. In addition, it is important to know about any previous surgery the patient has had, his or her profession, age, allergies and factors that may have initiated the development of the bunion such as the use of inappropriate footwear.
- Radiological tests: The specialist in foot surgery should evaluate radiographs in various projections (anteroposterior, lateral and oblique) and in load whenever possible. The radiological study provides information such as the degree of deformity (different angles of the foot are measured as well as the size and composition of the bone), the type of foot (cavus, flat or normal) and toe deformities such as claw or hammer toe.
- Biomechanical study of the footprint with analysis of plantar pressures: these studies require a computerized platform that analyzes and measures every cm2 of the foot during the stride. This makes it possible to study the distribution of loads during gait, the type of foot and the body’s center of balance. These measurements are important and should be taken into account in their assessment.
- Blood analysis: prior to any intervention it is necessary to know if the patient has any current inflammatory/infectious process, the state of the liver, kidney and blood coagulation of the patient. All these parameters should be taken into consideration prior to any surgical procedure.
- Patients under treatment with anticoagulant medication should inform the foot surgery specialist to change the type of treatment for 3-6 days.
- VascularDoppler of the lower limbs: the vascular Doppler study allows measuring the blood flow of the main arteries and veins of the legs with emphasis on the feet. This study is more important in older people or those with signs and symptoms of vascular insufficiency.
TREATMENT
In patients of advanced age or with associated pathologies, deformity correction surgery may be performed.
In the initial stages, the recommendations below can be applied. When these measures fail or are insufficient, then surgery is the only solution.
There are more than 200 techniques to operate bunions, with no single universal procedure that fits all. For this reason, it is important to carry out an exhaustive preliminary study to assess the best individualized surgical option.
In general, the procedures used to operate on hallux valgus are as follows:
- Correct the deviation of the big toe (first toe) by removing the deformity.
- Realign the long bone (metatarsal) between the big toe and the back of the foot to align the anomalous angle of the first toe.
- Lengthening and/or transposition of tendons.
Although there are many ways to intervene bunions, the minimally invasive or percutaneous foot technique is generally the one that has the most benefits with the least risks.
Benefits of minimally invasive surgery
Consult with your specialist if the minimally invasive or percutaneous foot technique can be applied in your case. The benefits of this technique are as follows:
- Minimal postoperative pain.
- Minimal limitation as patients walk out of the surgery on their own feet.
- Early recovery, between 1-5 weeks depending on the procedure.
- Outpatient surgery, no hospital admission is required.
- Local anesthesia, i.e. it does not have the possible complications of spinal or general anesthesia.
- Excellent long-term results if performed by experienced professionals.
To prevent the deformity from recurring, you should wear a shoe that adequately supports the foot without compressing the toes.
Always remember to ask the foot specialist: How will your foot look, what will be done, and what are the complications?
Other frequently asked questions about bunions
Are bunions salt deposits?
No, the deformity is an abnormal bone growth not due to salt deposits. In patients with gout, the deformity may contain urate salts. We can also read a multitude of home remedies for their removal without surgery. While all these natural remedies may improve the symptoms of some patients, we must emphasize that they have no scientific evidence and in no case correct the deformity. Surgery is the only way to eliminate them.
Are they contagious?
They are not contagious because there is no microorganism that can produce them. However, bunions do have an important hereditary genetic component. For this reason, if you have a direct relative who suffers from them, it is likely that you may develop them in the future.
For this reason it is very important to take care of the foot, using comfortable shoes, that hold well, that have thick soles and that the toes are never crowded in the shoe. For more information, go to the Clínica San Román recommendations section.
Are bunions operable?
In general, all bunions are operable but not all patients can be operated with the same technique. Older patients or patients with associated diseases are usually not good candidates for open or aggressive techniques. For these patients, less aggressive techniques such as percutaneous or minimally invasive surgery may be a good option, since they eliminate the deformity with fewer complications.
There are more than 200 surgical techniques for the correction of hallux valgus. Mainly these can be grouped into techniques that act on soft parts, techniques that require osteotomies (bone fractures with pins, needles or plates), minimally invasive or percutaneous techniques and finally techniques that combine elements of each of them. For more information read the treatment section.
Are they dangerous?
The deformity is not dangerous.
Can it be a bunion with osteoarthritis?
Yes, the deformity is usually associated with osteoarthritis. Hallux rigidus is the limitation of the first toe joint caused by severe osteoarthritis that eventually fuses the joint.
Is it possible to have bunions when you are 13 years old, 16 years old, 17 years old, 19 years old, etc... ?
Yes, it is possible. You should see a foot specialist for assessment and conservative treatment initially.
Are they cured by homeopathy?
There are currently no scientific studies to support this.
Wounded bunions: what to do?
You should heal the wound, wear a wide shoe and see a foot specialist.
Is "Bunions with pus" possible?
Yes, when there is an infected wound or callus on the deformity. You should go to your doctor for treatment of the infection and then to a podiatrist.
Do operated bunions come back?
If the intervention is performed with the appropriate technique for each deformity, the likelihood of recurrence will be lower. After the intervention, it is advisable to follow a series of tips, described in the recommendations section, so that the deformity does not recur.
BEST SOLUTION
The only solution for the correction of the deformity is surgery. In the initial stages, the advice given in the recommendations section may be useful.
Recommendations to alleviate the pain produced by bunions:
Bunions in the early stages usually do not cause pain, however, as the deformity increases, the pain worsens. For this reason, the medical and podiatric team at Clínica San Román has the following recommendations:
- Footwear: when bunions cause pain or the deformity is large, narrow-toed, high-heeled shoes should be avoided. Footwear should be comfortable, wide at the toe and, very importantly, have adequate support on the back of the foot. It is advisable to avoid both completely flat shoes and very high heels.
- Interdigital silicone: your podiatrist can make an interdigital separator to place between the first and second toes. This will reduce the pressure exerted by the big toe on the other toes.
- Local cold: local cold such as a gel pack or even a bag of frozen peas on the back of the foot can be applied at night. This will reduce inflammation and pain. Do not forget to place something between the skin and the cold to avoid possible burns.
- Medication: if you do not have allergies to medications, you can take a non-steroidal anti-inflammatory drug (NSAID) such as Ibuprofen orally. You should consult with your physician and foot surgery specialist before taking any medication.
- Postural measures: it is advisable to avoid postures that aggravate the pain, such as standing for long periods of time.
- Physiotherapy: physiotherapy in these cases will be limited to reducing inflammation and performing finger mobility exercises. This is intended to reduce the stiffness that is often present in the big toe.