Hallux Valgus is the scientific name for a bunion, which refers to a
condition in which the big toe is angled towards the second toe. In a
normal foot, the big toe and the long bone that leads up to it – the first
metatarsal – are in a straight line. However, hallux valgus occurs when
your long foot bone veers toward the other foot and your big toe drifts
towards your second toe.
No single cause has been proven. Genetics (a family history of bunions), footwear and foot
mechanics are considered as possible factors.
Symptoms and problems caused by hallux valgus
Your bunions may not cause you any trouble, but sometimes they can cause:
The foot may become wide so that it can be difficult to find wide enough shoes
You may get arthritis in the big toe
The second toe can become displaced by the misshapen great toe. This can cause a
to the ball of the smaller toes, which are less adept at taking increased load.
Juvenile Hallux Valgus
Hallux valgus can occur in children. This is called ‘Juvenile Hallux Valgus’. Wear and tear
arthritis known as degenerative joint arthritis or osteoarthritis which is common with adult
hallux valgus is usually rare in Juvenile Hallux Valgus.
INITIAL TREATMENTS FOR HALLUX VALGUS
FOOTWEAR – WIDER, DEEPER SHOES.
One of the best things you can do is to go for wider, deeper shoes. There should be a
centimeter between the end of your longest toe and the end of the shoe. Shoes with an
adjustable fastening e.g. a lace, buckle or
velcro strap allow for “width” across the forefoot.
bunion. A wider, deeper shoe will limit rubbing of the shoe on the skin overlying the hallux
valgus. In turn this reduces the chances of pain and inflammation in this area and also
Slip-on shoes and high heels can increase your discomfort. Slip on shoes have to be tighter
place, your toes often slide to the end of your shoe where they are exposed to pressure.
High heels throw more weight onto the ball of the foot, putting your toes under further
pressure and onto uncomfortable joints.
If it is essential to wear smart dress shoes e.g. dress code for work – consider wearing wider,
you are experiencing
with your bunion.
Padding using materials such as fleecy web, fleecy foam, felt or gel hallux valgus covers can
help protect the skin and joints from footwear friction/rubbing caused by your footwear.
Research to date has shown that foot orthoses - an insole which supports and influences
the mechanics of the foot DO NOT stop bunions from developing.
Research has shown that night splints for juvenile hallux valgus can help reduce progression
stabilizing the deformity, while orthoses could be used during the day for symptom relief.
Surgery is not available on the NHS for cosmetic correction of bunions. The aim of surgery
is to correct the cause of the bunion and reduce the symptoms. Your Podiatric Surgeon or
Foot & Ankle Orthopaedic Consultant will discuss the best procedure for you dependent on
your individual issues. There are over 130 different procedures for bunions. With all surgical
procedures there are risks and complications with any type of surgery, therefore surgery is
not usually advised unless your bunions are causing pain – or if it is starting to deform your
Some examples of surgical procedures:
Silvers procedure – this is the simplest procedure that involves removing the prominent
bump on the inside of the foot. But because it doesn’t cure the underlying deformity, it will
only be used in people with mild deformities or in older people. This is a short procedure
and the recovery is quick. Patients determined suitable for this procedure will spend 6
weeks in a post operative boot and will need to take time off work for a minimum of 3 to 4
this operation. It can take 3 to 6 months before the swelling following the surgery subsides
so until then an oversized shoe may need to be worn.
Chevron osteotomies – this is again suitable for mild to modest Hallux Valgus without
arthritis of the toe joint (known as the first metatarsophalangeal joint). This procedure
involves cutting the bone toward the end of the first metatarsal (the long bone leading up
to the big toe), before fixing it back into a straighter position. You’ll need to rest the foot for
two to four days. Patients determined suitable for this procedure will spend 6 weeks in a
post operative boot and will need to take time off work for a minimum of 3 to 4 weeks.
Those in a sedentary job may be allowed to return to work at week 3 or 4 following this
operation. It can take 3 to 6 months before the swelling following the surgery subsides so
until then an oversized shoe may need to be worn.
Base wedge osteotomy e.g. Lapidus – this is for more pronounced deformities. Recovery is
longer. You’ll need to wear a non-weight bearing cast for 4-6 weeks (i.e. you
can’t walk on
A wedge of bone is removed at the
whilst is unites (heals). Internal fixation (plates, screws or pins) is used to hold the bone cut
together. You will not notice these and they do not usually need to be removed. It is
sometimes necessary to perform a similar procedure on the big toe (Akin osteotomy) to
achieve full correction. Those in non-manual work may be able to return in approximately
6-8 weeks & those in manual work approximately 10-12 weeks
Use of text with permission from Patient.co.uk available at
http://www.patient.co.uk/health/bunions © 2014, Egton Medical Information Systems Limited.
MacFarlan AJH, Kilmartin TE. Conservative treatment of juvenile hallux valgus – A seven year
Patient information leaflet: Hallux Valgus October 2014