Hallux Valgus (Bunions)
Overview
Hallux Valgus or Bunion means the big toe (the hallux) is drifting towards the second toe (in a valgus position). This results in an uncomfortable prominence on the inner side of the foot, especially when wearing shoes. The hallux typically drifts under the second toe, causing the second toe to “over-ride” the hallux. This in turn causes irritation and second toe pain, with a “hammer toe” deformity. Patients with hallux valgus typically present with pain and/or deformity. The goals of surgery are to eliminate the pain and correct the deformity, so conventional footwear will fit the foot.
Non-Surgical Treatments
Always remember, it is easier to change your shoe than your foot!! Deep toe box, wide fitting shoes can accommodate the deformity in many patients and are certainly worth a try. Bunion spacers (devices to sit between the hallux and the second toe) can ease some of the symptoms. Spacer devices work best when they are specifically made for your foot, as opposed to over-the-counter devices. Callosities can be pared by your chiropodist.
Surgery is only considered when all appropriate non-surgical treatments have failed.
Surgical Treatments
The goal of the surgery is to correct the deformity and therefore resolve your pain. Deformity correction necessitates a combination of soft tissue operations and bony operations. The soft tissue operations include releasing the tight structures and tightening up the stretched structures. The bony operations involve breaking various bones in your foot and then repositioning them to heal in a correct alignment, using plates and screws. Everyone is different and the number and extent of soft tissue and bony procedures used to achieve correction varies in each case. All procedures are performed under one anaesthetic.
Complications of Bunion Surgery
As with all surgery, Hallux Valgus or Bunion surgery has potential complications and thus the decision to proceed with surgery should be carefully considered. Overall, 90% of patients are satisfied. The complications that can arise include the following:
Swelling
The foot always swells after surgery. Therefore, elevation for the first two weeks is essential. It is okay to move about your house, but please avoid prolonged periods with your foot hanging down. It can take 6 to 12 months for the swelling to settle fully.
Recurrence of deformity
There is a 5% risk that the deformity can recur after surgery.
Over-correction
There is a 3% risk that the deformity can be over-corrected with surgery.
Neuroma Formation
There is a 1% risk of injury to the superficial nerves of the foot.
Wound Infection
Can happen in 2% of patients, occasionally needing hospital admission for elevation, rest and intravenous antibiotics.
Removal of Metal
On occasions, the screws and plates may need to be removed if they are causing discomfort.
