Bunion (Hallux Valgus) Frequently Asked Questions

A bunion (hallux valgus deformity) is a bony bump on the outside and top of the great toe, where it connects to the foot. Half of those who have the problem will have bunions on both feet. 

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The function of the great toe is very important to normal gait. The great toe is stabilized on both sides by ligaments, and when a step is taken, the stability of the arch is maintained through the great toe’s movement. When the foot moves through a step, the great toe extends, causing the arch to rise, and stabilizing the arch at the same time. This is called the windlass mechanism. Patients with moderate to severe bunion deformities may have an abnormal gait because the bunion has compromised this mechanism. Click here for more information.
The main symptom is pain in the bunion area itself, which is caused by long-standing pressure from a shoe or boot. There can also be pain associated with a nerve that passes over the top of the bunion, especially when this nerve is irritated by shoe pressure. Click here for more information.
When the patient stands with the weight evenly distributed, the bunion is evident as a bony growth protruding from the metatarsal head at the base of the great toe, which is angled in toward the other toes. Sometimes the pressure against the second toe causes it to deform into a “hammer toe” . This condition may be more painful than the bunion itself, and can occasionally cause the second toe to partially dislocate. This can lead to the formation of a callus (transfer lesion) under the metatarsal head, which can be very painful. X-rays can reveal the extent to which the second toe is dislocated. Click here for more information.
As a general rule, a bunion does not require any treatment other than a soft shoe with plenty of room for the front of the foot. Click here for more information.

There are three surgical procedures to treat bunions; the Chevron Procedure, The Distal Soft Tissue Procedure and Proximal Metatarsal Osteotomy, and the Arthrodesis Procedure. 

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The patient will wear a special postoperative shoe for six to eight weeks. Dressings are changed weekly during this time. Once the dressings are discontinued, swelling will gradually subside over a four to six week period. Most patients are walking comfortably in the postoperative shoe two to three weeks after surgery. Click here for more information.

There are about five different procedures to correct bunion deformities. Selecting the correct operation for the deformity reduces the possibility of recurrence to less than 10%.

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Generally, patients are permitted to walk in a stiff post-operative shoe after the operation. After about two weeks the patient is usually able to place the bare foot flat on the floor. As a rule, dressings and immobilization are used for six to eight weeks after the surgery. Click here for more information.
Over the years, as bunion surgery has evolved, pain management after surgery has evolved as well. A popliteal block (an analgesic administered into the area behind the knee), done after the operation, will give 18 to 36 hours of pain relief. When it wears off, oral medication is generally sufficient to control discomfort. After four or five days, the need for pain medicine is usually minimal. Click here for more information.

Women develop bunions ten times more frequently than men. It is thought that the narrow shoes that they wear contribute significantly to the development of the deformity.

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As a general rule, the foot is immobilized for 6-8 weeks after surgery. Walking and gentle exercises are recommended for the next month to allow the foot to become strong. After three months, most activities can be resumed as tolerated. Click here for more information.

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