What is a bunion? Is surgery needed?

A bunion, medically known as hallux valgus, is a deformity characterised by a lateral deviation of the big toe towards the smaller toes, resulting in the enlargement of the joint at the base of the big toe. This condition typically manifests as a bony protrusion on the inner aspect of the foot, causing discomfort, inflammation, and often difficulty in finding appropriately fitting footwear.

When to consider bunion surgery?

This question comes up multiple times during our foot & ankle clinics. The answer is not always straightforward but most importantly it has to be discussed with each individual patient. For a successful outcome the response must factor in the patient's history, expectations and lifestyle.

Will my bunions get worse?

The natural history of bunions is one of progression, unfortunately. This means that when they start appearing they will get worse with time. And this is due to the fact that the equilibrium of anatomical structures gets lost and so tendons and ligaments start pulling in the wrong direction and perpetuating the deforming forces. How fast the progression or how painful they will become is uncertain and varies for every patient.

Can I cure my bunions with toe correctors or orthotics?

The myth of bunion fixation with braces or other external devices is widespread. However it is all a big fat lie.

Scientific evidence has shown that not only do these devices not change the natural history (i.e don’t slow down progression in the long term) but as soon as they are removed the toe returns to where it was. In other words, the realignment that toe correctors provide is only temporary while they are being used but not beyond that.1-2

The role that orthotics play in the treatment of bunions is purely symptomatic - to ease the pain or symptoms. These combined with adequate footwear are the mainstay of conservative treatment and can make bunions pain-free for a reasonable amount of time. These include bunion pads, toe spacers, bunion splints or braces)

Bunion surgery - when to have it?

  • You have tried several weeks or months of home remedies or care techniques with limited success and the pain continues.
  • You find it difficult to fit in shoes, and those that were comfortable before are not manageable anymore.
  • You are limited in your walking distance or cannot go about your daily activities.
  • Your bunions are getting worse and the deformity is progressing.
  • You start developing pain or deformity of the 2nd toe next to the bunion - it might curl (hammer toe) or start with pain under the ball of the foot (metatarsalgia or plantar plate tear). If severe it might even cross over the big toe.

During your consultation you will be informed about the benefits of surgery and its minor risks or how to avoid and recognise them, the recovery time, alternatives to surgery, the results of similar cases to yours, and along with your surgeon you will decide upon the treatment that best suits your needs. No question will go unanswered.

Steps involved in bunion surgery

In bunion surgery, what do they do? Contrary to what some people may think, by “shaving off the bump” the problem is not fully addressed. Unless the underlying deformity is corrected the bunion will reoccur in a matter of months.

Current techniques are aiming at rectifying the two bones that are “crooked”. This is done by a sliding cut (Scarf or Chevron osteotomy) in the metatarsal and another closing wedge cut (Akin osteotomy) in the phalanx. Once the correct position is obtained these bone cuts are held with small screws which remain within the bone and therefore are not noticeable.  This in addition to some soft tissue releases of tendons and ligaments will allow for a complete surgery that will provide long-lasting results.

This technique is well represented in this “Sawbone” model that we use in the courses I teach in for trainees to practise and learn surgical techniques. The screw heads can be seen in the bone (*) as well as the metatarsal osteotomy (1) and phalanx osteotomy (2). By using screws, patients can fully bear weight from day one while the bone is healing in the desired position. No casts, crutches or boots are required; just a small orthopaedic shoe that is used to accommodate for the dressings and bandage.

Recognising the signs and symptoms of these conditions is crucial for seeking timely medical attention. Mr Francesc Malagelada is dedicated to diagnosing and treating various foot and ankle conditions, providing personalised treatment plans to address your specific needs and help you get back on your feet comfortably. Contact us and book an appointment today!

Keep in mind that our blog is also a great place if you’d like to stay updated on the latest orthopaedic news.

This article is for information purposes only and is not a substitute for professional medical advice. Consult your physician for personalised guidance. In case of a medical emergency, contact your doctor or emergency services.

1. https://jamanetwork.com/journals/jama/fullarticle/193839

2. https://journals.sagepub.com/doi/full/10.1080/03093640701669074