HALLUX VALGUS (Bunions)
What are they?
Commonly referred to as a bunion, it is often mistaken as just a bony prominence on the big toe, but is a complex deformity involving the long bone (metatarsal) of the big toe deviating away from the second toe metatarsal. This causes the soft tissues to work in a different way and results in the end of the big toe turning towards the second toe.
Why did they happen?
This is not fully understood however there is an association with foot wear, genetics/family history and other foot conditions (flat feet/inflammatory joint disease).
Pain is often associated with wearing foot wear that has a narrow toe box and is relieved when shoes are removed. With progression you may develop pain under the balls of the smaller toes or pain from deformities caused by the big toe squashing the smaller toes.
Changing foot wear to a soft and wider shoe to give the foot space, as well as a smaller heel can be of help.
Over-the-counter bunion pads and spacers can be used to help with caution, as they can make finding appropriate foot wear more challenging because they widen the foot.
The majority of hallux valgus deformities can be managed surgically by breaking the long bone (metatarsal osteotomy) of the big toe and re-positioning this to correct the deformity. This bone shift of the metatarsal is held by a small screw. Sometimes a break in the bone further along the big toe (akin osteotomy) is required to complete the
correction, this break is held with a small staple or screw. This procedure can be performed through a small incision on the side of the foot which is not visible from the top and fades with time, or through a minimally invasive approach.
If there is arthritis present, or the deformity is very severe, then a fusion procedure may be appropriate to correct the position of the toe. Other procedures maybe performed at the same sitting to deal with the lesser toe deformities, if present.
Risks of Surgery
As with any surgery there are potential risks. This will be discussed in more detail during the consultation, however common complications are stiffness, swelling, nerve injury, infection, non-union, under correction and over correction.
Your foot will be in bandaging and a surgical shoe will be provided to allow you to weight-bear whilst protecting the foot. You will be provided with crutches for support. Elevation, as much as possible, is important in the first few weeks. The bandaging will come down at 2 weeks and dressings changed, and at this stage I would allow the big toe to bend to prevent stiffness. The surgical shoe will be required for weightbearing for approximately 5-6 weeks. Swelling can be expected to be present for up to 6 months, particularly in the evenings.
With regards to return to work, it is dependent on the amount of weightbearing required. If the work is sedentary and you can keep the foot elevated, then return after 2 weeks is satisfactory. Otherwise, return to work should be expected after 6-8 weeks.