Hallux Valgus (Bunion)

Plymouth Orthopaedic and Sports Injury Clinic

What is it?

Hallux valgus is a deformity of the big toe and forefoot. There is splaying of the first and second metatarsal bones which makes the forefoot wide. The soft tissue attachments to the big toe then pull the big toe towards the smallest toes. As the foot becomes broad the skin rubs on shoes and this skin can become inflamed. This is a bunion.

What problems does it cause?

The main problem with this condition is pressure over this bony prominence from shoe wear. The skin can sometimes become red and blistered. If the foot is very broad then it may be difficult to get wide enough fitting shoes.

As the big toe moves sideways it can touch the second toe. If the big toe moves further it can lie under the second toe pushing it upwards. The second toe can hence rub on shoes.

In a normal foot the weight is taken under the first metatarsal. In hallux valgus this mechanism may not work as efficiently and the other metatarsals may have take more weight. This can cause pain under the ball of the foot. This is called at metatarsalgia.

Sometimes the joint can wear out; this is called osteoarthritis. This can be painful.

What can be done about a bunion?

Most of the difficulty with bunions arises from shoe wear. Many people are comfortable if they wear wide, well fitting shoes. Sometimes the leather needs to stretch and so it is important to allow time for the feet to adapt to new shoes.
Sometimes a small pad over the bony prominence can take pressure off the bunion.
High heeled shoes tend to squeeze the foot at the front where the foot is broadest. This can make pressure problems worse.
Some shoe shops can stretch your new shoes with special moulds to make the shoes wider. It is worth asking at the shoe shop or a cobbler.

Can an operation cure a bunion?

If simple measures do not make you comfortable then an operation may improve the situation. The operation will not make your foot normal but who will correct some of the deformity of your big toe and narrow your foot back towards what it should be. There are many operations to correct bunions depending on the severity of the deformity and the shape of your foot. However the operation will not make your foot narrow enough to wear tight shoes nor can it restore the strength of your big toe.

The scarf osteotomy

The Scarf osteotomy is a z shaped cut of the first metatarsal which allows the bones to slide across one another to allow the foot to narrow. The operation is performed usually under a general anaesthetic. If one foot is being operated on then the procedure may be performed as a day case.

The first stage of the operation is a soft tissue release and this is performed through a cut between the big and second toe. The scarf osteotomy is then performed through a cut on the inside of the foot. The tow bone fragments are then fixed with two screws. A further osteotomy of the big toe may need to be performed and this is called an Akin osteotomy. This is usually fixed using a small staple.

The scarf osteotomy : post operative course

A dressing is applied to your foot at the end of surgery to hold the big toe in the corrected position.  A plaster is not routinely required.  A wedged shoe is provided allowing you to fully weightbear immediately after surgery.  Crutches are needed at least initially for balance.

You will be seen at two weeks for a wound inspection. You will then continue in your shoe until six weeks. You will usually be seen in clinic at weeks six with an x-ray. At this point you should be able mobilise in normal (but sensible) shoes. However your foot will remain swollen for some months after the operation.  The average patient has returned to normal activities three months after surgery.