Hallux valgus
Hallux valgus means thatvthe big toe has tilted towards the index (second) toe. The end of the bone upon which the big toe sits (first metatarsal) is pushed sideways towards the opposite foot producing a bony bulge and pressing inside the shoe. The overlying skin becomes inflamed and the whole bump is called a bunion. It might look like it, but there is no growth or thickening of the actual bone.
The forefoot broadens, the big toe weakens and, depending on the overall structure of the foot, body weight can become painfully transferred to the base of the second and third toes under the ball of the foot. The big toe also presses on the second toe it or crosses under it. The smaller toes become painfully clawed.
People often ask if they have bunions because they have worn bad shoes. Some feet with bunions have simply adpted the tapered shape of the court shoe or 'winkle picker' they have been habitually forced into but there is undoubtedly a very strong genetic component. It seems that we can inherit a foot which tolerates any shoe, develops bunions upon even the slightest restriction or somewhere in between. There are documented cases of families with bunions in societies where shoes are not worn at all.
Surgery is not advisable for appearance alone. People are most likely to be happy with the results of an operation if done for symptoms such as pain or difficulty with even well-fitted footwear. Symptoms can often be eased by choosing more foot-friendly shoes, use of orthotics or padding but the deformity does usually progress, perhaps slowly, once it has reached a cetain stage.
Surgical treatment of hallux valgus has progressed greatly in recent years as understanding of the complex mechanics of the foot have improved and operative procedures have evolved accordingly. It is now appreciated that simply taking the bump off rarely helps and that the older methods which greatly shortened the big toe while straightening it can produce different problems in later years. We employ several operations and combinations of procedures, the most appropriate for a particular foot determined by thorough clinical assessment. Correction involves altering the shape of the affected bones and/or joints. A frequent method is the chevron osteotomy (osteotomy means to cut a bone). If the deformity is quite severe, a scarf osteotomy might be offered, especially if we are worried about excess pressure beneath the ball of the foot. Less commonly, there is a problem at the joint at the base of the big toe's metatarsal bone, necessitating a Lapidus fusion. Any tilt or bend within the big toe itself is corrected by an Akin osteotomy