Hallux Valgus occurs when there is a lateral shift of the big toe with subsequent bunion formation. It can be very debilitating and painful although many individuals with large bunions will experience no discomfort.
Normally the big toe forms a 15 degree angle to it’s corresponding metatarsal bone in the mid foot. Angles greater than 20 degrees constitute a Hallux Valgus.
Some factors which contribute to the development of bunions are tight footwear, (high heel shoes) increased angle between the toe and mid foot, overpronation (when the foot rolls in) and tight Achilles tendons.
Conservative non surgical treatment includes education on proper footwear, strengthening exercises for the muscles in the foot, taping, stretching, and modalities to reduce inflammation.
Surgical treatment aims to straighten the large toe such that the metatarsal bone is centered. An osteotomy of either the metatarsal bone or the phalanx bone (toe) can be done. This involves cutting a wedge shape out of the bone and realigning it to achieve the correct angle. Another procedure involves cutting off the bunion and repositioning the metatarsal and associated tendons in the correct position.
Post operatively patients can expect 3 to 6 months of swelling and they will be off work for awhile. Approximately 20 percent will require physiotherapy to regain full mobility and strength. Outcome measures in a study with 336 patients who underwent bunion surgery revealed 92% were satisfied with the results and 66% were able to resume all previous activities.
Written by Susan Reive, Owner of Kilborn Physiotherapy Clinic