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Hallux Valgus


A bunion, also referred to as a hallux valgus deformity, refers to a malalignment of the forefoot in which there is a prominence over the inner aspect of the foot near the great toe. This enlargement is generally caused by medial deviation of the metatarsal bone and lateral deviation of the great toe. This is a common and disabling deformity in which the patient can experience pain especially when wearing shoes. It may limit walking activities and sports participation. Occasionally, intermittent numbness or chronic thickening of the skin in the area at the prominence is experienced. There are multiple reasons a bunion may development. Grandparents, parents, and children may have hereditary bunions that run in the family. Another important factor in the development of a bunion deformity is poor choice of footwear, and specifically high-heeled, pointed, or narrow toe-box shoes. The majority of the bunion operations are performed on females, which may be secondary to footwear selection. If you must wear fashionable shoes, then consider selecting a style with a lower heel and a more rounded toe-box.

Conservative Treatment

The goal of bunion treatment is pain relief and deformity correction. In early stages, the use of soft shoes with a large toe-box, or leather stretchers to soften your shoes may be beneficial. Anti-inflammatory medications and pads to minimize pressure over the bunion may be helpful. A bunion splint at night may be helpful to slow progression of the deformity. Ice or topical anti-inflammatories may decrease pain and inflammation.

Surgical Intervention

As the bunion becomes more bothersome, operative intervention may be beneficial to correct the malaligned toe. There are many different types of surgical repairs designed for different types of bunion deformities. Much of this decision making is based off of radiographs obtained in the office. The operative correction of a bunion deformity usually includes the placement of orthopaedic implants such as small plates or low-profile screws. The internal fixation generally does not cause a problem and most commonly is left in place permanently. Once the bone heals, a small minority of patients choose to have implants removed for a variety of reasons. Two of the most popular procedures I use for bunion correction include:
Minimally Invasive Surgery (MIS)
Nearly 90% of my patients can now be corrected through a minimally invasive surgical approach. This depends on radiographic findings, amount of arthritis, or severity of the deformity. This approach is preferred by many because of less pain, less anesthesia required, smaller incisions, and a quicker recovery.
The Lapidus Procedure (Lapifuse)
Some more severe bunions, or those associated with midfoot arthritis or a flatfoot, may best be treated with a Lapidus procedure which involves fusion of the 1st TMT joint. This may predictably maintain correction in larger deformities, and may also simultaneously alleviate midfoot pain or arch collapse.

After Surgery

Following surgery, careful postoperative care is needed in order to keep the foot in proper alignment while healing occurs. Bunion correction is almost always performed as an outpatient day surgery in which the patient does not spend the night in the hospital. Office visits are necessary to inspect the incisions and to splint the toe in the correct position. You will likely be able to bear weight on your heel the first week after surgery. Although we will allow you to put weight on your heel, we will ask you to walk flat-footed for about 6 weeks without rising up on your tip-toes. Generally this is done in a postoperative boot or hard-soled post-operative shoe for 6 weeks. Transitioning back into a regular shoe usually occurs around 6 weeks after surgery. Resumption of sports activities, such as jogging, usually can be safely performed after walking normally in a shoe for a few weeks. Time off from work depends on occupation, but at least 1 week off may be necessary for elevation of the foot to help control swelling for a few days. 
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