kotsiaA hallux valgus deformity, commonly called a bunion, is when there is medial deviation of the first metatarsal and lateral deviation of the great toe (hallux), prominence, with or without medial soft-tissue enlargement of the first metatarsal head.

The condition can lead to painful motion of the joint and shoe wear difficulty.

It is important for a treating physician to understand the pathogenesis and surgical treatment options to correct hallux valgus deformities to provide the utmost care for patients with this painful forefoot deformity.

There is continued debate over the association of poor-fitting footwear and bunions. Many experts feel high-heeled shoes with a small toe box or tight-fitting shoes do not cause the deformity. However, most agree footwear can exacerbate the problem by keeping the hallux in an abducted position.

Hallux valgus has numerous recognised aetiologies, including biomechanical, traumatic, and metabolic factors. Some cases are congenital, secondary to the sloping orientation of the first tarsometatarsal joint.

Clinical presentation
Patients present to the clinic with a variety of complaints. Pain typically is localised to over the prominent medial eminence. Patients may have an enlarged bursa over the medial eminence with inflamed skin or callus. The frequency or severity of pain may have recently progressed, and pain with activity will often bring these patients in to be evaluated. The patient may have recognised an increase in the size of the deformity. Difficulty with finding comfortable shoe wear is common.

Conservative treatment
The goal of treating hallux valgus deformities is symptom resolution. Often conservative treatment options such as a shoe with a wider toe box or extra forefoot depth can decrease medial eminence pain by allowing more room in the shoe for the forefoot deformity. Toe spacers, hallux valgus splints and bunion pads can be used to symptomatically treat the bunion deformity. Unfortunately, none of the non-surgical treatment options will permanently correct the hallux valgus deformity.

Operative treatment
It must be noted that surgery of a hallux deformity should not be performed for cosmetic reasons. Surgical treatment is indicated when the patient has pain that, not alleviated by a simple change of shoes or other conservative treatments. The type of surgical treatment is usually dictated by the degree of the deformity on radiographs as well as physical exam findings.

A great number of operations have been described for the treatment of hallux valgus. The goal of surgery is the realignment of soft tissues and bones.


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* Patient consent was obtained for publication of figures