Bunions or Hallux Valgus

Have you ever noticed the top of your big toe looking misshapen and unattractive? Alternatively, you may have experienced pain there while walking which made it difficult to continue or to put on certain types of footwear. All such issues can be a result of a bunion.

What is a bunion?
A bunion or hallux valgus is a condition characterized by a deformity affecting the end of the big toe. It is caused by the bone in that toe being pulled toward the other toes, resulting in a bony bump protruding from its side. A bunion can sometimes present as a red lump of skin, leading to the mistaken belief that it is a skin condition rather than a bone problem. Moreover, a bunion is an issue that gradually develops over time.

What causes a bunion to form?
A bunion forms due to structural abnormalities in the foot, which are generally a result of genetic issues, such as flat footedness or a genetic predisposition to bunions. While ill-fitting footwear or high-heeled shoes can also play a part, these are only factors that can potentially exacerbate the issue rather than being the initial cause.

Symptoms of a Bunion

During the initial stages, a bunion may not cause any discomfort, but as it grows in size or causes shoes to become tighter at the toe end, the patient may notice the following symptoms:

  • A bump forming on the outside of the big toe
  • Swelling, redness, or soreness
  • Pain that comes and goes or ongoing pain
  • A thickening of the calluses forming on the big toe
  • Limited movement in the big toe, making it difficult to walk

Possible Complications

A bunion does not usually cause any other complications to arise, although if it is not treated, the situation may not improve, and the following issues could occur:

  • Bursitis: a painful condition that occurs when the small fluid-filled pads cushioning the bones, ligaments, and muscles near the joints become inflamed.
  • Hammer toe: caused by an abnormal bend in the middle joint of the toe, resulting in pain and pressure.
  • Metatarsalgia: pain and swelling in the ball of the foot.

Diagnosing Bunions
Usually, doctors can diagnose a bunion merely by looking at the external state of the toe. However, they may wish to confirm a diagnosis through the use of a foot x-ray.

Treating Bunions
Treatment for bunions is dependent on the condition’s severity, the pain experienced by the patient, and the pressure being placed on the big toe. Treatment tends to begin with modifications to footwear, using a foot support to alleviate pain, pain relief drugs, avoiding certain physical activities that can cause the situation to deteriorate, and using cool compression to reduce pain and inflammation.

However, should those methods be unsuccessful or where pain remains that is affecting the patient’s daily life, surgery may be considered. This involves removing the enlarged portion of bone, before cutting and realigning the bone, tendons, and ligaments.

Preventing Bunions
Despite not being able to alter the shape of our feet, it is possible to select suitably wide footwear or shoes that are not too tight in order to reduce the symptoms or severity of the condition.

Written by Dr. Withoon Boonthanomwong, Orthopedic Surgeon at the Orthopedics Center, Bumrungrad International Hospital

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