Why Do I Have Hallux Valgus?

Overview
Your first toe or ?big? toe is medically referred to as the hallux, and is the hardest working toe of your foot because it pushes you off the ground as you walk and run. More than 50% of Women in the UK have bunions, therefore is a common deformity. The problem often runs in families although tight narrow shoes and high heels are often blamed. We offer bunion surgery to help with this problem.

Causes
Women traditionally have a higher rate of bunions, which is to be expected, since it is they who have traditionally worn shoes with high heels, a narrow toe box, or whatever fashion dictates from year to year. However, men can suffer from bunions as well, as can anyone for whom the right (or wrong) conditions exist, poor foot mechanics, improper footwear, occupational hazards, health and genetic predisposition. Finally, bunions have long been a condition associated with the elderly, and although they often appear in conjunction with inflammatory joint diseases such as arthritis (which is often associated with age), they can strike at any point in life, including adolescence.

Symptoms
Audible clicking (called ?crepitus?) and/or stiffness in the affected joint which indicates that the joint surfaces are rubbing together improperly. Inflammation, degeneration of the surfaces of the joint, deformity (including bone growth at the joint line and displacement of the toe) and ultimately, loss of range of motion in the joint. Pain at the side and top of the joint that worsens with walking and physical activity.

Diagnosis
Before examining your foot, the doctor will ask you about the types of shoes you wear and how often you wear them. He or she also will ask if anyone else in your family has had bunions or if you have had any previous injury to the foot. In most cases, your doctor can diagnose a bunion just by examining your foot. During this exam, you will be asked to move your big toe up and down to see if you can move it as much as you should be able to. The doctor also will look for signs of redness and swelling and ask if the area is painful. Your doctor may want to order X-rays of the foot to check for other causes of pain, to determine whether there is significant arthritis and to see if the bones are aligned properly.

Non Surgical Treatment
The treatment method your doctor chooses for you will be based on the severity of the bunion. Treatment can be simple and non-surgical or it can be complex, surgical, and costly. A bunion is permanent unless surgery is performed to remove it, but self-care can help to improve your symptoms. If you suspect that a bunion is developing, you should seek medical attention immediately. Here are the most common conservative treatment options. Changing your shoes. Adding custom orthotics to your shoes. Medication such as Tylenol for pain relief. Padding and taping to put your foot in its normal position. Applying ice or cold compresses to reduce swelling and pain. Keeping pressure off your affected toe, especially if there is swelling, redness, and pain. Before bed, separate the affected toe from the others with a foam-rubber pad and leave it there while you sleep.

Surgical Treatment
When a surgeon cuts and repositions a bone, it is referred to as an osteotomy. There are two basic techniques used to perform an osteotomy to realign the first metatarsal. In some cases, the far end of the bone is cut and moved laterally (called a distal osteotomy). This effectively reduces the angle between the first and second metatarsal bones. This type of procedure usually requires one or two small incisions in the foot. Once the surgeon is satisfied with the position of the bones, the osteotomy is held in the desired position with one, or several, metal pins. Once the bone heals, the pin is removed. The metal pins are usually removed between three and six weeks following surgery. In other situations, the first metatarsal is cut at the near end of the bone (called a proximal osteotomy). This type of procedure usually requires two or three small incisions in the foot. Once the skin is opened the surgeon performs the osteotomy. The bone is then realigned and held in place with metal pins until it heals. Again, this reduces the angle between the first and second metatarsal bones. Realignment of the big toe is then done by releasing the tight structures on the lateral, or outer, side of the first MTP joint. This includes the tight joint capsule and the tendon of the adductor hallucis muscle. This muscle tends to pull the big toe inward. By releasing the tendon, the toe is no longer pulled out of alignment. The toe is realigned and the joint capsule on the side of the big toe closest to the other toe is tightened to keep the toe straight, or balanced. Once the surgeon is satisfied that the toe is straight and well balanced, the skin incisions are closed with small stitches. A bulky bandage is applied to the foot before you are returned to the recovery room.

Prevention
Here are some tips to help you prevent bunions. Wear shoes that fit well. Use custom orthotic devices. Avoid shoes with small toe boxes and high heels. Exercise daily to keep the muscles of your feet and legs strong and healthy. Follow your doctor?s treatment and recovery instructions thoroughly. Unfortunately, if you suffer from bunions due to genetics, there may be nothing you can do to prevent them from occurring. Talk with your doctor about additional prevention steps you can take, especially if you are prone to them.