15 February 2018
Mr Prem Moras is a Consultant Orthopaedic Surgeon at Spire Portsmouth Hospital, dealing solely with problems of the foot and ankle. His special interests include sports injuries, arthritis, flatfoot and bunion correction.
What exactly is a bunion?
A bunion also known as ‘Hallux Valgus’ is a bony bump that protrudes from the base of the big toe. It isn’t a growth as commonly mistaken, but a prominence of the underlying normal foot bone called first metatarsal, which has deviated inwards as the big toe then drifts and rotates outwards towards the lesser toes.
How do people get bunions?
Bunions are quite commonplace, I imagine that we all know someone who is afflicted! Although we associate their development with over-zealous use of fashion shoes, the cause can more often be in our genes (inherited). Indeed patients often report a long line of bunions suffered by their parents and grandparents.
How badly can they affect people?
Bunions affect different people in different ways. One thing that is surprising is that some people with small bunions that are really painful whereas others with pronounced deformities that give them little trouble.
A frequent symptom is foot pain localised within the big toe joint and often described as a deep ache. Sometimes people complain of throbbing and burning over the bunion region. Finding comfortable shoes can be a real problem for anyone suffering with bunions. Progressive deformities often result in over-riding of second toe or even a hammer toe. Chronic deep seated pain can also indicate arthritis within the bunion.
Does 'fashionable' footwear have an affect on bunions development?
The use of tight narrow toe-boxed shoes and high heels probably contribute to progression of symptoms rather than development of the deformity itself.
Nowadays people often ‘box-clever’ with their footwear - maybe keeping those heels in the bag for use when they are needed whilst travelling with more comfortable footwear. In London for example the Tube in rush hour is awash with people in smart business suits matched with training shoes.
Are bunions on the increase?
The incidence of bunions is no higher now than previously but, with modern treatment allowing quick, reliable and reasonably painless correction, people are just not willing to simply put up with the pain and are seeking treatment rather then suffering.
What can you do to prevent them?
There are a plethora of braces and splints that can be found on the internet or in many Sunday newspapers but, alas, none of them have been shown to prevent bunion occurring or prevent its progression. The most sensible strategy is to take time making sure your shoes are wide enough to accommodate the deformity.
How has bunion surgery changed in the past few years?
Surgery to correct bunions has come a long way over the last decade or two.
The purpose of surgery is to realign the big toe joint, so to this end, bones are cut either side of the joint, re-aligned and fixed solidly with screws. This allows for enhanced recovery, which is more comfortable and maintains the correction more reliably.
What are the latest methods of surgery?
Having performed a number of techniques including MIS (minimally invasive surgery) to correct bunions, I think the most reliable and widely used as the gold standard is the ‘scarf’ osteotomy. The term scarf comes from a traditional stable ‘joint’ used by carpenters in construction work. The procedure allows a very precise and reproducible correction of the bunion deformity with a low complication rate and a more rapid recovery during which movement of the toe is encouraged.
The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.