Hallux Valgus (Bunion)
A bunion is more than a bump - the whole first ray has to be assessed under load.
Hallux valgus is a three-dimensional deformity of the first ray in which the big toe drifts toward the lesser toes and the metatarsophalangeal joint becomes prominent and painful. Patients may struggle with shoe wear, crowding of the toes, transfer pain under the forefoot, calluses, or progressive deformity. My consultation starts with standing foot X-rays, because only weight-bearing radiographs allow reliable assessment of the key angles, joint congruency, sesamoid position, arthritis, and the real mechanics of the forefoot. There are well over 100 operative techniques for bunions, so the important question is not the name of an operation, but which correction fits your particular foot. After measuring the deformity, I assess whether the problem is mainly distal, shaft-level, proximal, related to first TMT instability, or already arthritic.
Symptoms
- Painful bump on the inner side of the forefoot
- Difficulty wearing narrower shoes
- Crowding, overlap, or irritation of the lesser toes
- Calluses or pain under the ball of the foot
Conservative treatment
- Standing foot X-rays with full measurement of the forefoot angles
- Wider shoes and local off-loading
- Toe spacers or pads for symptom relief
- Pain control and activity modification
When is surgery needed?
When symptoms persist, standing X-rays are used to choose the right correction from many possible techniques - from distal or shaft osteotomies to proximal correction or first TMT stabilization - rather than using one operation for everyone.