Hallux valgus (Bunion)

We will improve the shape of your foot

The little bulge on the inside of your foot is getting bigger, like a ball, almost as if another bone is growing there. At the same time, your big toe is becoming more and more crooked. Hallux valgus is a visible displacement of the big toe and also causes increasing foot pain.

Our specialists at Schoen Clinic London can relieve acute pain through conservative methods. We can also permanently correct the displacement via ground-breaking keyhole surgical treatment.

What is a bunion (hallux valgus)?

Bunions, also known as hallux valgus, are a painful protuberance of bone on the inside of the forefoot. Bunions cause pain due to rubbing on foot wear. The skin over bunions gets thick and often red and sore especially at the end of the day. The protuberance is the metatarsal bone moving inwards and the toe moving outwards, leaving a bunion where they meet at the big toe joint. This joint becomes crooked and the normal moving surfaces do not move how they used to. With time these surfaces can become arthritic which adds to the pain of the bunion.

Symptoms: How do you identify a bunion (hallux valgus)?

In the initial stages, a bunion may be completely pain free. so essentially, if your shoes are not rubbing on the prominence of the bunion then there will be no symptoms. However, those who wear narrow shoes or high heels may experience pain, the bunion may in time become inflamed, red and uncomfortable. Occasionally, patients may complain that their feet hurt at the end of the day, or when they are wearing tight shoes. Specialist footwear, e.g. work boots or ski boots may become a problem.

When the bunions are more advanced there may be symptoms in-between the toes when they rub against each other. This is mainly between the big toe and the second toe, but sometimes causes problems with neighbouring toes too. As weight-bearing changes, patients tend to weight bear mainly on the second toe metatarsal rather than the big toe, this can result in pain underneath the second or third toes. It is not uncommon for a callus or hard skin to appear in this area and in more advanced cases there may be deformities of the second or third toes, known as hammer toe deformities.

Causes: How does a bunion (hallux valgus) occur?

The cause of bunions is essentially multifactorial. We now know that genetics predisposes you to having bunions and bunion deformities can run in families. This is mainly because of the inherited predisposition to having flexible ligaments and hypermobility.

There is a common misconception that high heels, or tight shoes can cause bunions - this is not the case. Wearing shoes or high heels can encourage bunion formation in those who are already predisposed. Therefore, for the vast majority of bunion sufferers hallux valgus is inherited and there is a member of the family who has them too. If a bunion has developed then wearing shoes with high heels or narrow toe boxes can be difficult and there will be persistent pain on the prominence of the bunion.

Diagnosis: How displacement in the foot is determined

When you attend your appointment for assessment of bunions, your consultant will examine your foot and ankle plus your entire lower limb. This will give your surgeon an opportunity to see how your foot is on weight-bearing and during walking and also examine the range of motion of the big toe and the degree of flexibility that your metatarsal has. It will also give them the opportunity to examine the lesser toes to see if there are any deformities or symptoms in those areas.

An X-ray of the affected foot is normally requested in the weight-bearing position to assess the angles that the various bones are making with each other and the degree of the displacement of the first metatarsal.

Hallux valgus (Bunion): Surgery is not the only option

Together with our foot surgery specialists, you can select the best possible treatment according to the severity of your hallux valgus. At Schoen Clinic London, we offer a full range of treatments. Conservative hallux valgus treatment, such as a hallux valgus splint which helps to alleviate pain. The muscles in your foot can be specifically strengthened early on to prevent displacement from occurring. However, hallux valgus surgery is needed to permanently rectify the bone displacement, preferably before cartilage is damaged.

Hallux valgus treatment: Relieve acute pain without surgery

Many patients with bunions can manage their symptoms without the need for surgical correction. There are a number of modalities that can be helpful. Changing your footwear is key i.e. wearing shoes that are wide around the toes and have a low heel can help to alleviate the symptoms. Physiotherapy and strengthening of the small muscles within the foot can help with symptoms of foot pain in general and there are certain exercises that may be helpful. Toe spacers can help if there is any friction between the toes or to help with controlling a hammer toe deformity if this is rubbing in footwear. These splints or spacers are not likely to resolve any deformity and are only there to relieve friction symptoms.

Minimally invasive, “keyhole” bunion surgery

One procedure we offer at Schoen Clinic London is minimally invasive keyhole surgery for bunions. Also known as Minimally Invasive Chevron and Akin (MICA) bunion surgery. This approach is less painful bunion surgery than open surgery. It also allows for faster recovery time for bunions.

The technique employs several small keyhole cuts over the bunion to break the bone and move it. This small series of scars amounts to less than twenty percent of the overall scar needed in most open surgery. There is an obvious cosmetic benefit but also with a smaller scar there is a smaller risk of infection. Once the bone is moved into its desired place it is held with screws. The screws are accurately placed using live X-ray in surgery. The screws used have a special bevelled edge leading to less screw irritation under the skin.

The bunion bump is shaved through the same keyhole used to cut one of the bones. The small cuts and little soft tissue disruption as well as optimal utilisation of each small cut allow for a rapid recovery. This is quicker and less painful than open surgery and allows you to walk immediately after surgery. Keyhole bunion surgery is done as a day-case surgery. This minimally invasive approach often needs very little post-operative pain relief.

Other surgical solutions for the treatment of bunions

The aim of surgery is to realign the first metatarsal so that it is no longer pointing towards the inside of the foot. This is done through an incision on the inner aspect of your foot and the first metatarsal bone is cut and then realigned and fixed with screws (Scarf or Chevron osteotomy). At the same time, a correction of the actual big toe bone may also be required to realign it so that it is more straight (Akin osteotomy). This will also need to be fixed with a staple or a screw.

On occasions, if there is a lot of arthritis within the big toe joint, as well as a bunion, then you may be recommended to have a big toe fusion surgery to straighten the bunion, but also to get rid of the arthritis pain. Very rarely, if the deformity is severe, you may be required to have a fusion operation in the midfoot, known as a lapidus fusion but your surgeon will discuss your particular case with you.

Hallux valgus (Bunion): Aftercare

If you have had an osteotomy and fixation (your metatarsal bone has been broken and fixed) it will take some time for the bone to heal and to become one unit again. Fortunately, however with modern techniques available, you will not need a plaster cast and you can walk on your foot from day one. Generally, the time taken for the bone to heal is around six weeks. In this time, you will use a special forefoot relief shoe, where the weight is taken on the heel rather than the forefoot.

The surgery is performed as day surgery and you have the ability to walk on the foot immediately after the operation. We normally give you a local anaesthetic block around the ankle, so you will experience no pain as the foot will be completely numb. Weight-bearing on the heel can commence using the special forefoot relief shoe on the first day.

Any bandaging and dressings are removed at two weeks to assess the wounds, to ensure that there is no infection or any problems with wound healing and thereafter, you will require the shoe alone with a padded dressing over the wounds. At six weeks following the surgery, if X-rays are satisfactory, you will be asked to remove the shoe and you can wear a comfortable and wide fitting shoe. It can be normal to experience some persistent swelling that will last around three but sometimes up to six months following surgery. However, in our experience, after around three to six months the foot can resume a normal function without any limitations and you can return to wearing your favourite shoes and participating in sporting activities.

Hallux valgus: our specialists

At Schoen Clinic London you will find incredibly passionate foot and ankle specialists who are experts in treating bunions. Mr Kumar Kunasingam is highly skilled in minimally invasive bunion surgery, and Mr Ali Abbasian is an expert in all aspects of foot and ankle conditions. Whoever you see you can be sure to receive comprehensive advice from our specialists and discuss which treatment is best for correcting your bunion.

Hallux valgus: Our specialised hospital

Schoen Clinic Orthopaedic and Spinal Hospital is located in the idyllic Harley Street area of London. With leaders in the field of bunion or hallux valgus treatments, access to rapid diagnosis and excellent treatment, your feet are in the best hands.