Bunion (hallux valgus) Information for patients What is a bunion? The scientific name for a bunion is hallux valgus, which refers to the condition in which the big toe (hallux) is angled towards the second toe (valgus), often producing painful swelling or a lump on the big toe joint. What causes a bunion? The exact cause of bunions is unknown and it is not clear if you can do anything to prevent or stop them getting worse. Genetics (a family history of bunions), inappropriate footwear and the way you walk (foot mechanics) are considered as factors. What are the symptoms and problems caused by a bunion? Bunions may not cause you any trouble, but sometimes they can cause: pain - you may have difficulty walking due to pain, redness and swelling the foot to become too wide making it difficult to find wide enough shoes arthritis in the big toe the second toe to be pushed up by the big toe and become hammered. This can cause the second toe to rub on footwear and you might overload the ball of the foot causing callus and corn formation Can children develop a bunion? Bunions can occur in children. This is called ‘juvenile hallux valgus’ and is thought to be associated with foot mechanics and shape. This condition should be assessed by your NHS podiatrist. Page 1 of 4 What is the initial treatment for a bunion? You need to change your footwear. Go for wider, deeper shoes with a fastening in a soft leather or a material without stitching or seams A wider, deeper shoe will limit pressure on the skin overlying the bunion and the second toe which can cause pain and inflammation as well as callus and corns Shoes with an adjustable fastening, such as a lace, buckle or velcro strap to allow for width across the forefoot and also hold the shoe in place Avoid slip-on shoes and high heels because they have to be tighter to stay on the feet. With nothing to hold the foot in place, the toes often slide to the end of the shoe where they are exposed to pressure. There should be a centimetre between the end of the longest toe and the end of the shoe High heels throw more weight onto the ball of the foot, putting the toes under further pressure and onto uncomfortable joints If it is essential to wear smart dress shoes, for example dress code for work – consider wearing wider, deeper shoes outside work hours, such as trainers. This should help to reduce any discomfort you are experiencing with the bunion Other treatments include: Insoles / orthotics - research to date has shown that foot orthoses, an insole which supports and influences the mechanics of the foot, do not stop bunions from getting worse. However, they may prevent bunions from forming in the first place Padding - using materials such as fleecy web, fleecy foam, felt or gel bunion covers can help protect the skin and joints from footwear friction/rubbing caused by the footwear Splinting - some research recommends the use of night splints for children with the objective of stabilizing the deformity Page 2 of 4 Will I need surgery? Surgery is not available on the NHS for cosmetic correction of bunions. If you have tried everything else to manage your painful bunion, then surgery available on the NHS may be the best option for you. The aim of surgery is to correct the cause of the bunion and reduce the symptoms. There are risks and complications with any type of surgery; therefore surgery is usually not advised unless your bunion is causing pain or starting to deform your other toes. What are the risks of surgery? Recurrence of bunion Metalwork problems, such as screws Fracture of first metatarsal How is the operation performed? There are lots of different types of procedures to treat bunions. The exact procedure you have will depend on the size of your bunion and the shape of your foot, and whether or not you have arthritis in the joint of your big toe. Your Podiatric Surgeon or Foot and Ankle Orthopaedic Consultant will discuss the best procedure for you dependent on your individual situation. The operation is performed as a day case procedure under a general anaesthetic. A local anaesthetic block is used around the ankle to decrease discomfort after surgery. Usually, the operation will involve your surgeon removing some bone and re-aligning it to make the side of your foot look straighter. The exact shape of the cut will depend on your specific needs. Your surgeon might also need to repair ligaments and tendons in your foot. They may use screws or wires to keep everything in place. These are usually permanent, but sometimes your surgeon will remove them later. To access your bunion, your surgeon may first make a cut on the inner side of your foot, over your big toe joint. Or they might do keyhole surgery and get to the bone through several small cuts. An operation called metatarsal osteotomy is a common type of bunion surgery that involves cutting and re-shaping the bone of your big toe joint. Page 3 of 4 What can I expect after surgery? You will be discharged home from hospital on the day of the operation with painkillers to take when required You must keep your foot up above the level of your groin for 23 hours every day for two weeks. This minimises swelling, decreases discomfort and reduces the risk of wound complications and infection You will be able to weight bear in a special shoe from day one to move around the house How soon will I recover? Two weeks after your surgery you will be seen for a wound check. If the wound is healed you will be able to do more walking around but will be quite uncomfortable until six weeks after surgery when you will be seen again At your six week appointment, you will have an X-ray to check on the healing of the bone Between six weeks and three months you should expect to return to work and normal activities After three months you should be discharged Between three months and one year there will still be some swelling and minor discomfort This information is available in audio, Braille, large print and other languages. To request a copy, please ask a member of staff. Reviewed by Readers’ Panel November 2018 Printed December 2018 Review December 2020 Ref: CCICP/PS/0211218 Page 4 of 4 .