10 July 2015
Mr David Loveday, consultant orthopaedic surgeon at Spire Norwich Hospital, discusses how bunions (hallux valgus) effect patients in day-to-day life and the treatments available locally.
"It seems that years of wearing tight-fitting high heels may have caught up with Mrs Beckham after a recent report suggested ‘Posh Spice’ had made enquiries about having her painful and unsightly bunions surgically removed.
"Many years ago, bunions were typically associated with ladies over 60. However, although symptoms are still prevalent in this age range, as more young women are choosing fashion over the well being of their feet, a high proportion of women are presenting symptoms as young as 20.
"The medical name for a bunion is ‘hallux valgus’. The deformity causes the big toe to point towards the other toes on the same foot. In severe cases, the big toe can overlap the second toe, causing a drastic change to the overall shape of the foot. This change can lead to swelling, pain and tenderness around the big toe.
"Poorly-fitting shoes can contribute to the development of bunions. You would rarely see a patient presenting with a bunion in a country where they do not wear shoes for example. High-heeled shoes that are too tight will squeeze the foot, causing the big toe to remain in a bent position. This unnatural position puts pressure on the nerves around it and leads to pain. High heels also push most of the body weight forwards onto the front of the foot, which places considerable strain on the toe joints.
"However, the most important factor in patient’s susceptibility to develop a bunion is in fact genetics. Patients who have unusually flexible joints, are more at risk and these flexible joints are typically hereditary. Other contributing factors can be rheumatoid arthritis (inflammation and pain in the joints that result from the immune system attacking the lining of the joints) and gout (a common type of arthritis that causes painful inflammation in one or more joints).
"Bunions can be extremely painful and can affect a patient’s day-to-day quality of life. The ability to wear ‘ordinary’ shoes becomes more difficult and as the pain is unlikely to settle without intervention, the patient tends to become less mobile as a result, which isn’t ideal when many of us lead such busy lives.
"It is important to see your GP if you have a bunion that is causing pain or if you are having trouble finding footwear that fits as the longer the bunion goes untreated, the worse it will become.
"Your GP will examine your foot and ask you to do a series of movements, this will determine how severe the bunion is and typically the patient will be referred for an X-ray to see the alignment of the bones and extent of the damage to the bone.
"The severity will determine the next course of action; either the patient will be given strict advice on changing their footwear, be recommended ice packs for temporary relief of discomfort or have orthotics fitted (special devices which are inserted into your shoes) which may relieve the pressure on the bunion. These measures are all temporary and the only way to truly treat a bunion is surgery and your GP would refer the patient to a specialist in these cases.
"An osteotomy is the most common type of bunion surgery. Although there are many different types of osteotomy, they generally involve cutting and removing part of the bone in the big toe.
"During the procedure, the bony lump is removed and the bones inside the big toe are realigned with the use of specially designed metalware. This surgery is typically a day case procedure (where you will be allowed home on the same day) under general anesthetic (where the patient is asleep during the operation). Patients can walk immediately after surgery in a protective sandal for six weeks and have minimal discomfort.
"As with most things, prevention is better than cure - so although there’s not much we can do about genetics, taking more care of our feet and wearing good fitting, sensible shoes is probably a good place to start."
For further information or to make a private appointment with Mr David Loveday please contact one of the team on 01603 255 614. Further details regarding consultant orthopaedic surgeon Mr David Loveday can be found by clicking on the link to his consultant profile page and via his website www.davidloveday.co.uk.
All surgery carries an element of risk and the content of this page is provided for general information only. It should not be treated as a substitute for the professional medical advice of your doctor or other healthcare professional.