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Bunions on the big toe can be hereditary or caused by ill-fitting shoes. Nonsurgical treatments include looser shoes and silicone spacers, while surgery options depend on the degree of deformity and can include chevron osteotomy or Myerson/Ludloff procedure. Arthritis may require joint fusion or removal.
A bunion is a bunion that occurs on the big toe. Hallux means big toe and valgus means deviation from the body. Many things contribute to the occurrence of a bunion. The type of shoes you wear, if they don’t fit you, can contribute, but a bigger factor may lie in hereditary issues with bunions. You are more likely to develop bunions if your family members are also affected.
The most common place where bunion pain appears is the inner edge of the big toe, as this is the largest point of the big toe, where the maximum pressure point is located. There may also be pain in the second toe. The second toe has to work harder, as the big toe deforms and becomes less useful in the walking process. The pain will often be made worse by walking in closed shoes. You may feel less pain in sandals or open-toed shoes, and it’s unusual to feel pain when there’s no weight on the toe.
Treatment for a bunion can be nonsurgical or, less often, operative. Nonsurgical treatment includes wearing looser-fitting shoes or sandals. You can also insert silicone spacers between your toes to relieve pain when walking. These options won’t cure a bunion, but they will help make the pain more tolerable.
The decision to have surgery is usually made based on how much pain you are feeling from the bunion. There are many different operations available to treat bunions, and each one depends on the degree of deformity.
A common operation to treat hallux valgus is called a chevron osteotomy. This involves a V-shaped bone cut in the metatarsal. Once the cut is made in the metatarsal, the bone is moved and the remaining edge of the bone is shaved.
Another popular osteotomy is the Myerson/Ludloff procedure. This operation is performed on the most severe cases of hallux valgus. Screws are inserted into the metatarsal to hold the cut bone tightly and to speed bone healing. You will be able to walk in surgical shoes following the procedure. The shoes need to be worn for about five weeks.
For people with arthritis of the big toe associated with a bunion, an osteotomy will not be performed. The deformity will need to be corrected across the joint, either by fusion or by removing part of the joint. This procedure is known as an atroplasty. Fusion of the big toes corrects the deformity and prevents the hallux valgus from returning. Melting also eliminates arthritis.
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