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Introduction: These are common deformities found in more women than men. It is thought that wearing shoes that are too tight, especially when the feet are developing, is the commonest cause of bunions. Other causes include, flat feet, genetic (family traits), loose ligaments around the big toe and generally poor foot mechanics.

Anatomy: The bunion is formed on the inside area of the big toe (Hallux) at the level of the weight-bearing area (1st Metatarsal Phalangeal Joint). As a result of pressure in this area, a hard area of tissue develops and this may become inflamed and painful. Continuing pressure may cause the big toe to move towards the 2nd toe causing an angulation described as Hallux Valgus.

Indications/Symptoms: Patients may develop a painful, swollen, reddened bump on the inside of the big toe and restriction of the movement of the big toe. In the early stages the big toe may not be angulated.

Treatment: There are 2 main options for treatment- non-surgical and surgical. Non-surgical treatment has the primary aim of reducing pressure in the affected area. This may be in the form of shoes with wider toe areas, orthotic arch supports, exercises, use of ice (for inflamed areas) and taping to maintain better foot positions. Surgical treatment involves the removal of the bunion (bunionectomy) but only if the big toe has remained in the normal, neutral position.

Complications: Recurrence is the commonest form of complication, however, as a bunionectomy is an invasive surgical procedure it carries the same risks as those associated with any invasive approach i.e. infection.

Outcome: The aim of treatment of bunions is to halt any further progression of the joint deformity. Untreated bunions tend to become larger and more painful and if associated with deviation of the big toe, may require further orthopaedic surgery.

© OrthopaedicsOpinionOnline 2011
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