Hallux Abducto Valgus (HAV) - Bunion

Hallux abducto valgus occurs when the big toe angles towards the second toe while the first metatarsal angles the other way. This results in a bump on the side of the joint and angulation of the toe. The enlargement over the side of the joint area may also have overlying soft tissue swelling called a bursa. If bunions are left untreated they will probably increase over time.

There are various causes of bunions; mechanical, congenital, metabolic, traumatic.

Bunions develop over time and foot type plays a role in the development of the bunion due to foot biomechanics. Shoes help promote development of the bunion ie. If the shoe is too narrow and pointed in the forefoot and or high heels all play a role.

The symptoms of bunions are pain of the bump or the joint, redness, swelling, burning, numbness.

Diagnosis of the bunion is through physical and biomechanical evaluation of the foot and xray. This helps in staging the amount of deformity.

Prevention and treatment; Two options that one has is either conservative or surgical.

Conservative treatment;

  • Shoes need to have a wide deep toe box, shoe can be modified-stretched over the bunion. Avoid pointed narrow high heel shoes.

  • Custom orthotics help in placing the feet in a more biomechanically efficient position to help slow the progression of the bunion.

  • Toe spacer made out of gel to be placed between the first and second toe. This separates the two toes. Used during the day with socks.

  • Bunion pad that protects the bump of the bunion on the inner side of the foot.

  • Bunion splint to be used in the evening or when sleeping to also help slow the progression of the bunion. If the joint range of motion is adapted to the track bound position ie angled range of motion, the splint will possibly help joint pain, but not bunion position. The splint most successful if joint motion is not track bound/adapted, which is early stage of the bunion.

  • Ice, anti-inflammatories, injection, exercises can also be utilized.

Surgical treatment

Patients may opt for surgery once they have tried all conservative options and the bunion still is painful and increased in size. The pain is either joint or bump pain all the time. There are many possible risks and complications and extensive post op course in having surgery so one should be able to accept the consequences if the surgery does not go well and have complications.

Treating the bunion early on can help slow and possibly stop the progression and prevent further enlargement of the bunion and joint damage. Treatment options are based on symptoms and severity. Conservative treatment acts to help resolve the pain and slow the progression of the bunion. Surgical treatment makes the bunion go away, but there are risks and complications like re occurrence of the bunion.