Conservative Hallux Valgus Treatment

Overview
Bunions are a common problem that most individuals experience as a painful swelling or a bony protuberance at the inner base of the big toe. This condition is the result of a malalignment of the first toe. These can be hereditary or secondary to wearing high-heeled or narrow toe-box shoes.

Causes
Some people develop bunions from wearing shoes that do not fit correctly (especially high heels or narrow-toed shoes). For other people, bunions are caused by factors beyond their control. These can include a family history of a foot type that is susceptible to bunions, neuromuscular disorders, conditions affecting the joints (e.g., arthritis), severe injury to the foot, deformities at birth, problems that affect the way a person walks (e.g., rolling in at the ankles).

Symptoms
Redness, swelling, or pain along the inside margin of the foot just behind the great toe. Moderate to severe discomfort at the bunion when wearing shoes, particularly if tight fitting. A painful callus may develop over the bunion. Sometimes a painful corn on the adjacent sides of the first and second toes. Irritation if there is overlapping of the first and second toes. Arthritis may cause stiffness and discomfort in the joint between the great toe and the first metatarsal. There may be a fluid filled cyst or bursa between the skin and the "bunion bone". Skin over the bunion may break down causing an ulceration, which can become infected.

Diagnosis
Your doctor can identify a bunion by examining your foot. Watching your big toe as you move it up and down will help your doctor determine if your range of motion is limited. Your doctor will also look for redness or swelling. After the physical exam, an X-ray of your foot can help your doctor identify the cause of the bunion and rate its severity.

Non Surgical Treatment
A bunion may only need to be treated if it's severe and causing significant pain and discomfort. The different treatments for bunions are described below. If possible, non-surgical treatment for bunions will be used, which your GP can discuss with you. Non-surgical treatments can ease the pain and discomfort caused by a bunion, but they can't change the shape of your foot or prevent a bunion from getting worse over time. Non-surgical treatments include painkillers, bunion pads, orthotics, wearing suitable footwear, These are discussed in more detail below. If your bunion is painful, over-the-counter painkillers such as paracetamol or ibuprofen may be recommended.Bunion pads may also ease the pain of a bunion. Reusable bunion pads, made of either gel or fleece, are available over the counter from pharmacies. Some are adhesive and stick over the bunion, while others are held against your foot by a small loop that fits over your big toe. Bunion pads stop your foot rubbing on your shoe and relieve the pressure over the enlarged joint at the base of your big toe. Orthotics are placed inside your shoes to help realign the bones of your foot. They may help relieve the pressure on your bunion, which can ease the pain. However, there's little evidence that orthotics are effective in the long term. It's important that the orthotic fits properly, so you may want to seek advice from your GP or podiatrist (a specialist in diagnosing and treating foot conditions), who can suggest the best ones for you.

Surgical Treatment
There are many different procedures described to correct bunions. You should be aware that usually just shaving the bunion off, although it is attractive and minimally invasive, is usually not enough. Initially the foot will look much better but with time the bunion will recur. Arthrodesis refers to surgery performed on the great toe joint where the joint is fused. This is usually reserved for people with very severe deformities when other surgical options are impossible. Bunionectomy refers to the simple removal of the bunion itself. This is seldom used because it doesn?t correct the underlying bone problems. Osteomety is the commonest surgical procedure. The bone is cut and the bones realigned and pinned in place until they heal so that the underlying bone deformity is corrected and the bunion will not recur. The resection arstplasty refers to the removal of the toe joint and this creates a flexible scar that functions as the joint instead. In the past there has been some interest in implanting artificial joints but this has fallen out of favor due to the fact that they usually do not hold up with the normal every day stress that people put their feet through.

Prevention
To help prevent bunions be sure your shoes don't cramp or irritate your toes. Choose shoes with a wide toe box - there should be space between the tip of your longest toe and the end of the shoe. Your shoes should conform to the shape of your feet without squeezing or pressing any part of your foot. Avoid pointy-toed shoes.