Hallux Valgus (Bunions)

A bunion cannot be corrected or reversed without surgery, but many people keep symptoms under control with soft, wide shoes, low heels and silicone spacers. Surgery is considered when the foot still hurts regularly despite these measures, or when problems develop with the second toe. The NHS advises that surgery is not done just to improve how the feet look.

A bunion (hallux valgus) is more than just a bump on the side of the foot. The bunion itself is an overgrowth of new bone and soft tissue; the actual prominence comes from the metatarsal head drifting inwards while the big toe angles towards the smaller toes.

Bunions are common. A systematic review in the Journal of Foot and Ankle Research (Nix et al., 2010) estimated that hallux valgus affects 23% of adults aged 18 to 65 and 35.7% of people over 65, and that it is more common in women than in men (30% compared with 13%).

Symptoms

• A hard lump on the side of the foot by the big toe
• The big toe pointing towards the other toes
• Hard, swollen or red skin over the bunion
• Pain along the side or bottom of the foot, usually worse in shoes and when walking
• Problems with the second toe, such as rubbing, clawing or pain under the ball of the foot

There is no single cause. Likely contributors include hereditary factors, trauma or injury, arthritis (particularly rheumatoid arthritis) and footwear.

Non-surgical treatment

Appropriate footwear is key: soft lace-up shoes or trainers, with heels no higher than an inch. Silicone spacers or bunion cushions may help. The NHS also suggests wide shoes with a soft sole, ice for up to 5 minutes at a time, simple painkillers and losing weight if you are overweight. Splints and orthotics can slow deterioration, but they will not correct the bunion.

When surgery helps

Surgery is considered when the foot still hurts regularly despite conservative measures, or if problems are developing with the second toe. Options include Minimally Invasive (Keyhole) Surgery, Scarf and Akin Osteotomy, and Lapidus Procedure for more severe bunions.

It is a day-case operation under a general anaesthetic with a local anaesthetic block. The principles of open and minimally invasive (keyhole) surgery are the same: the bone is cut and moved across (translated) to correct the deformity, then secured with screws, and sometimes staples. Absorbable stitches close the wounds, and a bulky bandage stays on, and dry, for two weeks.

The risks of hallux valgus surgery include pain, bleeding, infection, scarring, damage to nerves and blood vessels, DVT and PE, recurrence, overcorrection and the need for further surgery. Full recovery can take many months. Complications are uncommon but recognised, and not everyone is completely satisfied with the result.

Recovery timeline

• 0–2 weeks: bulky dressing on and dry. Keep the foot elevated as much as possible, ideally toes above nose level. Walk in the surgical shoe, limited to 5–10 minutes per hour for the first 14 days.
• 2 weeks: clinic review; the dressing is taken down and the sutures trimmed.
• From 4 weeks: into a wide-fitting trainer. Upper body and core exercise, cross-trainer, static bike and swimming may begin.
• 4–6 weeks: the surgical shoe stops (a minimum of four weeks and a maximum of six).
• 6 weeks: second review, with an X-ray.
• 12 weeks: impact exercise and running may resume.

Driving may resume once you are back in normal footwear and out of the surgical shoe. Time off work depends on the job; most people take the first two weeks off, as it can be quite uncomfortable.

How Mr Hester can help

Mr Hester is a dual fellowship-trained foot and ankle surgeon (FRCS Tr&Orth), trained at Guy's and St Thomas' and in Toronto and Calgary, and a member of BOFAS and EFAS. Mr Hester offers keyhole (minimally invasive) bunion surgery at all four hospitals: The London Clinic, Cromwell Hospital, King Edward VII's Hospital and HCA The Shard. His NHS practice is at King's College Hospital.

Bunion surgery can be covered by medical insurance: contact your GP for a referral and then your insurer for authorisation. Self-pay patients are welcome. To book, call 020 7046 8004.

Frequently Asked Questions

Sources

1. Bunions. NHS. https://www.nhs.uk/conditions/bunions/
2. Nix S, Smith M, Vicenzino B. Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. J Foot Ankle Res. 2010;3:21. PMID: 20868524. https://pubmed.ncbi.nlm.nih.gov/20868524/
3. Bunions. Guy's and St Thomas' NHS Foundation Trust. https://www.guysandstthomas.nhs.uk/health-information/bunions