Hallux Abducto Valgus

Overview
The common bunion is a localized area of enlargement of the inner portion of the joint at the base of the big toe. The enlargement actually represents a misalignment of the big toe joint (metatarsal phalangeal joint) and, in some cases, additional bone formation. The misalignment causes the big toe to point outward (medically termed hallux valgus deformity) toward the smaller toes. This deformity is progressive and will increase with time. The enlarged joint at the base of the big toe (the first metatarsophalangeal joint, or MTP joint) can become inflamed with redness, tenderness, and pain. A small fluid-filled sac (bursa) adjacent to the joint can also become inflamed (bursitis), leading to additional swelling, redness, and pain. A more deep joint pain may occur as localized arthritis develops in later stages of the deformity. A less common bunion is located at the joint at the base of the smallest (fifth) toe. This bunion is sometimes referred to as a tailor's bunion or bunionette.

Causes
The main cause of bunions is excessive pressure being placed on the front of the foot, and is usually the result of wearing high-heeled shoes with pointed toes. A study by the American Orthopaedic Foot and Ankle Society found that 88 percent of women in the United States wear shoes that are too small and that 55 percent of them have bunions. Overall, bunions are nine times more common in women than men. In some cases, bunions are hereditary; they also may be caused by arthritis or polio.

Symptoms
Bunions starts as the big toe begins to deviate, developing a firm bump on the inside edge of the foot, at the base of the big toe. Initially, at this stage the bunion may not be painful. Later as the toes deviate more the bunion can become painful, there may be redness, some swelling, or pain at or near the joint. The pain is most commonly due to two things, it can be from the pressure of the footwear on the bunion or it can be due to an arthritis like pain from the pressure inside the joint. The motion of the joint may be restricted or painful. A hammer toe of the second toe is common with bunions. Corns and calluses can develop on the bunion, the big toe and the second toe due to the alterations in pressure from the footwear. The pressure from the great toe on the other toes can also cause corns to develop on the outside of the little toe or between the toes. The change in pressure on the toe may predispose to an ingrown nail.

Diagnosis
Your doctor can identify a bunion by examining your foot. Watching your big toe as you move it up and down will help your doctor determine if your range of motion is limited. Your doctor will also look for redness or swelling. After the physical exam, an X-ray of your foot can help your doctor identify the cause of the bunion and rate its severity.

Non Surgical Treatment
Initial treatment of bunions may include wearing comfortable, well-fitting footwear (particularly shoes that conform to the shape of the foot and do not cause pressure areas) or the use of splints and orthotics (special shoe inserts shaped to your feet) to reposition the big toe. For bunions caused by arthritis, medications may help reduce pain and swelling. If nonsurgical treatment fails, your doctor may suggest surgery, which resolves the problem in nearly all persons. The goal of surgery is to relieve pain and correct as much deformity as possible. The surgery is not cosmetic and is not meant to improve the appearance of the foot. Other related procedures that may be used to help diagnose foot disorders include X-rays of the bone and foot.

Surgical Treatment
For those whose bunions cause persisting pain, a surgical operation is considered for correction of the bunion. The surgical operation to correct a bunion is referred to as a bunionectomy. Surgical procedures can correct deformity and relieve pain, leading to improved foot function. These procedures typically involve removing bony growth of the bunion while realigning the big toe joint. Surgery is often, but not always, successful; failure to relieve pain can result from the big toe moving back to its previous deviated position even after surgery. However, proper footwear and orthotics can reduce the chances of surgical failure.

Prevention
To minimize the chance of developing bunions, never force your feet into shoes that don?t fit. Choose a shoe that conforms to the shape of your foot. Opt for shoes with wider insteps, broad toes, and soft soles. Shoes that are short, tight, or sharply pointed should be avoided.