Why do bunions appear?

Bunions or
hallux valgus
is a common foot deformity that is often the reason for consultation with a foot specialist or podiatrist, either for aesthetic reasons, pain or other foot injuries as a result of altered gait or pressure and friction exerted by footwear.

External or extrinsic factors

  • Footwear: inappropriate use of narrow-toed shoes or high-heeled shoes.
  • Body weight: the greater the weight, the greater the probability of changes in the feet that may lead to the appearance of bunions.

Intrinsic factors

  • Hereditary factors: genetics is responsible for the predisposition, this is more noticeable in cases of juvenile onset hallux valgus.
  • Gender differences: the ratio of men to women is 1:15 according to a study by the Autonomous University of Barcelona. Although it is believed that footwear has a greater influence on women. It has also been shown that the metatarsophalangeal joint of the first toe is more rounded and smaller in women, and therefore less stable.

Systemic factors, which are linked to bunionette progression

  • Elastic or lax ligaments.
  • Age: it is more frequent between 40 and 60 years old.
  • Metatarsus primus varus.
  • Anatomical variants of the first finger joint.
  • Flat feet.
  • Short or retracted Achilles tendon.

What remedies exist for bunions or hallux valgus?

Non-surgical remedies to prevent bunions

There are preventive measures we can take to avoid the appearance of bunions, especially if there is a family history. In turn, there are conservative treatments when the deformity is in its initial phase. Basically, they are aimed at gait and footwear habits, orthotic and physiotherapeutic measures.

Changes in footwear

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  • Wear appropriate footwear: wide toe and avoid high heels, less than 4 cm.
  • Use shoe pads if necessary.
  • Physiological toe shoes (orthopedic use).
  • Application of local cold to reduce inflammation in the area after prolonged marches.


Performing toe exercises can prevent or delay the formation of bunions.

  1. Exercises to strengthen the flexor of the first toe: mobilize the metatarsophalangeal joint of the first toe and proceed to stretching.
  2. Elongation of the Achilles tendon.


Allows realignment or reduction of the deformity in cases of mild hallux valgus that allows mobilization of the joint. It may also play a role in reducing pain in some cases:

  1. Insoles: to compensate the pressure exerted on the forefoot.
  2. Splints: correct the position of the first toe and delay the rupture of the joint capsule that occurs as the deformity progresses.
  3. Interdigital separators: reduce deformity temporarily.
  4. Bunions: protect the deformity from rubbing against footwear.

Other options

  1. Functional bandage: to reduce pain and partial deformity.
  2. Electrotherapy.
  3. Kinesitherapy.
  4. Thermotherapy.

Surgery to treat bunions

Surgery is the only option when conservative treatment is insufficient and pain and/or forefoot deformity progresses. It is a definitive option since bunions do not reappear, unless an inadequate surgical technique is used or not all adjoining deformities have been corrected.

Objectives of bunion or hallux valgus surgery:

  • Decrease symptoms: pain or injury due to foot rubbing.
  • Restore motor function to correct gait problems.
  • Correct the deformity.
  • Aesthetic reasons.

Bunion surgery corrects the following deformities:

  • Reduce the intermetatarsal angle.
  • Repositions the metatarsophalangeal joint.
  • Place the sesamoids below the metatarsal head.
  • Improve the weight-bearing capacity of the first phalanx.
  • Align the hallux in a straight position.
  • Control or correct factors that originate the deformity.

Bunion surgery with osteotomy

Osteotomies are cuts made in the bones in order to correct a deformity or angulation. The best known techniques used in percutaneous foot surgery involve one or more osteotomies.

There are several sites where osteotomies are performed. In the case of hallux valgus, they are performed both above and below the deformity. Although these osteotomies may vary according to the degree of severity, pathologic history of the patient and associated deformities. In general, they can be carried out:

  • Distal osteotomy of the first metatarsal.
  • Osteotomy of the base of the first phalanx.
  • Proximal osteotomy of the first metatarsal.

Bunion surgery without osteotomy

There are minimally invasive techniques that have been proposed more recently that do not involve performing any type of osteotomy.

It is an alternative that has been developed to avoid the complications inherent to osteotomies.

The purpose of this type of technique is to correct the intermetatarsal angle (IAM) and the first metatarsal is fixed in the proper position by means of plates, support buttons or screws, usually to the second metatarsal.

Different AIM correction devices have been designed, such as:

  • Mini TightRope.
  • Fast Forward.
  • Mini TightRopo.

Surgery of bunions and claw toes

What is hallux valgus?

Hallux valgus is the most common deformity of the forefoot. It includes several alterations of the foot that occur simultaneously.

First, there is a medial deviation of the first metatarsal along with a lateral deviation and rotation of the first toe. All this produces as a consequence, a prominence or exostosis of the head of the first metatarsal, which is the most visible and recognizable deformity of bunions.

It is also a progressive deformity, which is very difficult to stop by means of conservative treatments and surgery is finally resorted to as a definitive measure for resolution.

In many cases, gait disturbances cause further disturbances in the forefoot and are often associated with toe deformities such as “claw toes”.

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What are claw toes?

It is a deformity in the fingers characterized by a bending of the joint at the base of the second finger, while the middle joint bends downward.

It is caused by a muscular imbalance and can be flexible or rigid. It is treated with physical therapy and orthoses in cases of flexible claw toes, but resolution is usually ultimately surgical in all cases.

How is the operation for hallux valgus and claw toes?

The association of bunions with toe deformities such as “claw toes” is very frequent. Therefore, it is necessary to carefully evaluate each case in order to correct all defects with surgery and guarantee the success of the procedure, as well as to avoid recurrences or complications.

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Before hallux valgus and claw toe surgery

The initial clinical examination should include the preparation of a medical history and corresponding radiological evaluation, where certain data of interest for the accurate assessment of the forefoot deformity and other associated manifestations are specified.

  • Interrogation: symptoms and evolution.
  • Inspection: both in sagittal and transverse plane
  • Mobility of the first toe joint.
  • Presence or not of subluxation of the first joint or any other type of joint pathology.
  • Paronychia.
  • Hyperkeratosis.
  • Palpation:
  • Assess swelling and pain.
  • Presence of exostoses.
  • Crepitus and pain indicating osteoarticular alterations.
  • Evaluate the presence of hypermobility or instability of the first finger.
  • Assessment of range of motion in different planes.
  • Finger deformities.
  • Radiology: which allows the measurement of the 4 basic angles and bone alterations in the rest of the fingers.