Hallux Valgus (Bunion)

Hallux Valgus also called a Bunion, is a deformity of the first metatarsophalangeal joint (the joint at the base of the big toe). “Hallux” is the big toe and “valgus” means the deformity of the big toe. It is more common in women. Family history of hallux valgus is the main cause of this deformity, more so than ill-fitting shoes. In feet with bunions, there is an imbalance between the following muscles of the feet: flexor halluces brevis, and adductor and abductor halluces muscles. The severity of the bunion is determined by the degree of the following angles: the hallux valgus angle (HVA) and intermetatarsal angle (IMA). As the metatarsophalangeal joint is compressed and widened during repeated impact when walking, additional bone is added to the first metatarsal head at the site of the bunion. This joint also becomes dorsiflexed and inverted, hence it’s shape.

     Many people with bunions will only experience pain at the site of the bunion when wearing tight narrow shoes with a small toe box. Some will complain of redness, tenderness, swelling, and pain with plantar flexion. If the bunion is severe, the second toe may become “hammered”: the two joints of the second toe become permanently flexed. The second toe may overlap the big toe.

     Proper fitting foot orthotics with a rocker sole, no seams over the bunion, and a deep vamp are the best treatment option. A pedorthist, podiatrist, or chiropodist may place a metatarsal pad under the top cover of the orthotic just underneath metatarsal heads (the joints at the base of the toes) will help unload the pressure off the forefoot. Surgery may be considered if pain in the bunion is extreme or for aesthetic reasons. It is not covered by OHIP and tends to be expensive. Complications of a surgical procedure include long-term pain in metatarsal heads, recurrence of bunions, and necrosis of the first metatarsal.