Surgical Hospital :: Orthopedic Surgery

HALLUX VALGUS (Bunion Deformity)

The big toe of the foot is called the hallux. If the big toe starts to deviate inward in the direction of the baby toe the condition is called hallux valgus. As the big toe drifts over into valgus, a bump starts to develop on the inside of the big toe over the metatarsal bone. This bone prominence on the inner edge for the metatarsal is referred to as a bunion.

Bunion DeformityBunions are commonly hereditary but may also be caused or aggravated by shoe wear. The condition is far more common in women than in men and rarely occurs in individuals who do not wear shoes. Once a bunion is present the deformity of hallux valgus worsens slowly over time.

The treatment of a bunion depends entirely on how uncomfortable it is. Since the pain from a bunion is always aggravated by shoe wear, the symptoms will often depend on the type and size of shoes worn. The perception of pain or discomfort that people experience however is quite varied. There are some individuals who have small bunions that are very uncomfortable. This limits their ability to wear shoes comfortably. On the other hand, some individuals may have quite significant deformities that are annoying but do not limit their activities in anyway.

Realistically, there are only two ways to treat a bunion. Either change the size and shape of the shoe or change the size and shape of the foot.

Once a bunion gets to be irritating or painful and shoe wear is uncomfortable, surgery may be recommended. There are many different surgical procedures that can be performed. The decision to perform one type of surgery or another is based upon the extent and magnitude of the bunion deformity, the presence of arthritis in the big toe joint, and the space between the first and second metatarsals, which is called the intermetatarsal angle.


It is very rare that a bunion can be treated by simply shaving down the bump of the bone. Invariably, the deformity will recur and both the bunion and the hallux valgus will return. Therefore, the shaving of the bunion, called an exostectomy, is performed in conjunction with a cut of the first metatarsal bone (which is called an osteotomy).

Bunion Deformity

Shaving of the bump or the bunion on the side of the metatarsal is not usually successful when performed on its own. Often a bone cut (an osteotomy) on the metatarsal needs to be done in addition to the bunionectomy.

Depending on the severity of the deformity, this osteotomy can be done either at the end of the metatarsal (a distal osteotomy) or if the deformity is more severe, the osteotomy is performed at the base of the first metatarsal (a proximal osteotomy).

One of the more common distal metatarsal osteotomies that is performed is called the chevron osteotomy. Typically a small screw is inserted into the bone to hold the metatarsal head in place and speed up bone healing.
This screw would normally have to be removed surgically after some months but now the possibility for fixation by resorbable screws and pins exist which makes it possible to do the operation of a bunion in one operation. The fixation screws are made of PLLA which absorbs in approximately 9 months.

Following a chevron osteotomy, walking is permitted in a surgical shoe the next day after surgery, and the shoe is worn for approximately six weeks before a more comfortable walking/running type shoe is worn.Bunion Deformity

An operation frequently used is called the chevron osteotomy. It is a V-shaped bone cut made in the metatarsal.

 

Bunion DeformityOnce the V-cut in the metatarsal is made, the bone is shifted over and the remaining edge of the bone is shaved down as shown here.

 


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