Bunion

DEFINITION
 A bunion, also known as hallux valgus, is a
deformity of the joint connecting the big
toe to the foot. The big toe often bends
towards the other toes and the joint becomes
red and painful. The onset of bunions is
typically gradual . Complications may
include bursitis or arthritis.
EPIDEMIOLOGY
 Bunions are common but the exact prevalence of bunions is
difficult to ascertain. They are known to be the most common
forefoot problem in adults. One UK-based study found a
prevalence of 28.4% in adults. A large systemic review and
meta-analysis found great variations in reported prevalence
but pooled prevalence estimates were 23% in adults aged 18-
65 years and 35.7% in people aged over 65 years.
 There is often a significant family history.
 Women are more often affected than men.
 The incidence and prevalence is lower in children and
increases with age.
 Because the risk factors affect both feet, the condition is
usually bilateral, although it may be more marked on one side
than the other.
PATHOPHYSIOLOGY
 The bump itself is partly due to the swollen bursal sac or an osseous
(bony) anomaly on the metatarsophalangeal joint. The larger part of the
bump is a normal part of the head of the first metatarsal bone that has
tilted sideways to stick out at its distal (far) end.
 Bunions are commonly associated with a deviated position of the big
toe toward the second toe, and the deviation in the angle between the
first and second metatarsal bones of the foot. The small sesamoid
bones found beneath the first metatarsal (which help the flexor tendon
bend the big toe downwards) may also become deviated over time as
the first metatarsal bone drifts away from its normal
position. Osteoarthritis of the first metatarsophalangeal joint,
diminished and/or altered range of motion, and discomfort with
pressure applied to the bump or with motion of the joint, may all
accompany bunion development. Atop of the first metatarsal head
either medially or dorso-medially, there can also arise a bursa that
when inflamed (bursitis), can be the most painful aspect of the process.
CAUSES
 There are many theories about how bunions develop,
but the exact cause is unknown. Factors likely include:
 Inherited foot type
 Foot stress or injuries
 Deformities present at birth
 Experts disagree on whether tight, high-heeled or
too-narrow shoes cause bunions or whether footwear
simply contributes to the development of bunions.
 Bunions might be associated with certain types of
arthritis, particularly inflammatory types, such as
rheumatoid arthritis.
 Causes
● Mechanical instability - unstable foot or
tendons pulling harder on one side than
another
● Tends to get worse over time
RISK FACTORS
These factors might increase your risk of bunions:
 High heels. Wearing high heels forces your toes into

the front of your shoes, often crowding your toes.

 Ill-fitting shoes. People who wear shoes that are too

tight, too narrow or too pointed are more likely to

develop bunions.
 Rheumatoid arthritis. Having this inflammatory

condition can make you more likely to develop

bunions.
 Heredity. The tendency to develop bunions might be

the result of an inherited problem with the structure

or anatomy of your foot.
SYMPTOMS
The signs and symptoms of a bunion include:
 A bulging bump on the outside of the base of

your big toe

 Swelling, redness or soreness around your big

toe joint
 Corns or calluses — these often develop where

the first and second toes rub against each other

 Ongoing pain or pain that comes and goes

 Limited movement of your big toe

DIAGNOSIS
 Bunion can be diagnosed and analyzed with
a simple x-ray, which should be taken with the
weight on the foot.The hallux valgus angle (HVA)
is the angle between the long axes of the proximal
phalanx and the first metatarsal bone of the big
toe. It is considered abnormal if greater than 15–
18°. The following HV angles can also be used to
grade the severity of hallux valgus:
 Mild: 15–20°
 Moderate: 21–39°
 Severe: ≥ 40°
 The intermetatarsal angle (IMA) is the angle
between the longitudinal axes of the first and
second metatarsal bones, and is normally less
than 9°.The IM angle can also grade the
severity of hallux valgus as:
 Mild: 9–11°
 Moderate: 12–17°
 Severe: ≥ 18°
 Diagnosis
● Only treat if painful or
problematic
● Wait until skeletal maturity
● X-rays
TREATMENT:-
Treatment may include
proper shoes, orthotics,
or NSAIDs. If this is not
effective for improving
symptoms, surgery may
be performed
 Non-Surgical
Treatments
● Icing, Motrin
● Shoes - Gel Kayano and
wider shoes
● Pads
● Injections
NON SURGICAL
 Changing shoes. Wear roomy, comfortable shoes
that provide plenty of space for your toes.
 Padding. Over-the-counter, nonmedicated
bunion pads or cushions may be helpful. They
can act as a buffer between your foot and your
shoe and ease your pain.
 Medications. Acetaminophen (Tylenol, others),
ibuprofen (Advil, Motrin IB, others) or naproxen
sodium (Aleve) can help you control the pain of
a bunion. Cortisone injections also might help.
CONT……
 Shoe inserts. Padded shoe inserts can help
distribute pressure evenly when you move your
feet, reducing your symptoms and preventing your
bunion from getting worse. Over-the-counter
supports can provide relief for some people;
others require prescription orthotic devices.
 Applying ice. Icing your bunion after you've been
on your feet too long or if it becomes inflamed
can help relieve soreness and swelling. If you have
reduced feeling or circulation problems with your
feet, check with your doctor first before applying
ice.
 Orthotics
● Reduce abnormal movement
● Reduce progression and provide support to
the foot
SURGICAL TREATMENT
 If conservative treatment doesn't relieve your
symptoms, you might need surgery. Surgery
is not recommended for cosmetic reasons;
only when a bunion causes you frequent pain
or interferes with your daily activities.
 There are many surgical procedures for

bunions, and no one technique is best for

every problem.
 Surgical procedures for bunions can be done as
single procedures or in combination. They might
involve:
 Removing the swollen tissue from around your big
toe joint
 Straightening your big toe by removing part of the
bone
 Realigning one or more bones in the forefoot to a
more normal position to correct the abnormal
angle in your big toe joint
 Joining the bones of your affected joint
permanently
Hammertoe Surgery
 Bunion
Surgery
● Austin Bunionectomy
 Bunion
Surgery
● SCARF Bunionectomy
 Bunion
Surgery
● Lapidus Bunionectomy
COMPLICATIONS
Possible complications of bunions include:
 Bursitis. This painful condition occurs when

the small fluid-filled pads that cushion the

bones near your joints become inflamed.
 Hammertoe. An abnormal bend that occurs in

the middle joint of a toe, usually the toe next

to your big toe, can cause pain and pressure.
 Metatarsalgia. This condition causes pain and

swelling in the ball of your foot.

PREVENTION
 To help prevent bunions, choose shoes
carefully. They should have a wide toe box —
no pointy toes — and there should be space
between the tip of your longest toe and the
end of the shoe.
 Your shoes should conform to the shape of

your feet without squeezing or pressing any

part of your foot.
THANK YOU