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BUNION (HALLUX VALGUS)

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What is a bunion?

A bunion is a problem with your big toe . It happens when your big toe bends, or deviates, towards your 2nd toe. The medical term for a bunion is ‘hallux valgus’ and this translates as ‘deviated big toe’ – with hallux meaning your big toe and ‘valgus’ means when any bit of your body deviates away from the centre line of your body.

A bunion is the prominent bone sticking out from the inside of your big toe joint with the bone behind it – the metatarsal bone. The long bone (metatarsal) in the front of your foot and the bones of your toe should lie in a straight line. A bunion occurs when the long metatarsal bone angles towards your other foot but your toe bones point towards your 2nd toe of the same foot, as in the pictures above.


THREE MAIN TYPES OF BUNION

1. Small boney growth from tight shoes

When shoes are too tight it causes pressure in the forefoot to the area behind the big toe and behind the fifth toe. This occurs in men and women.  To check if you have this type of bunion and bunionette, look at the big toenail and toe when standing. It should be level and straight. Look at your shoes when wearing them. Ballerina pumps, slip on shoes and high heels are the main culprit. Are the boney areas exactly where the edge of the forefoot where the shoe cuts across the top and side of the foot?  The pressure from tight footwear makes the bone react and grow larger. It may also start to grow a swelling called a buses to protect the bone which makes the lumps look larger than they actually are.

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2. Forefoot splay and widening

This type is exclusively found in women’s feet particularly with hormone changes or after having children or age related. Normal female hormones make the ligaments softer and more chewing gum like. They hold the forefoot bones together tightly. But with hormones affecting these ligaments the forefoot gets wider over time. The big toe also starts to deviate and move towards the second toe and the toenail plate on the big toe also turns. To see if you have Type II bunion stand on your feet and look at your big toe. If the big toe moves across towards the second toe then you have Type II bunion. It should be noted that there is a good medial arch and straight ankle and there is no involvement from the medial arch collapsing.

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3. Bunion and bunionette with medial ankle collapse,
medial arch collapse, forefoot splaying.

This is the most complex of all the bunions. This can be found in children men and women. It starts with the medial ankle leaning in and collapsing the medial arch. The forefoot then splays, collapses and widens making the first and fifth metatarsal push outwards. The big toe will appear to be moving towards the second toe and the toenail will be leaning away from its centre position. The longer the problem goes on, the fifth toe will also start to lean towards the 4th toe and the nail will turn down towards the ground also.

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How are bunions treated?

There are both surgical and non-surgical (conservative) options. Surgery is not a quick-fix solution. Commonly called a ‘bunionectomy’ there are actually over 130 procedures and your specialist orthopaedic surgeon will discuss with you the most appropriate, once he has assessed your feet.

You should choose a surgeon with specific expertise and interest in foot surgery and we are glad to provide referral to the best both in Dubai and internationally. Your surgeon will explain costs, post-operative time on either crutches or wheelchair, as well as post surgical splinting or custom orthotics and appropriate footwear in order to keep his/her good work in place and to minimize risk of recurrence or complications.

The most effective non-surgical bunion treatment is custom corrective orthotics. These must be made for your feet, diagnosis and prescription by a qualified podiatrist, following a full assessment. In contrast, over-the-counter insoles from a shop or pharmacy are not designed to correct biomechanical deformities or anomalies and only provide shock absorption or cushioning. Custom orthotics can prevent the bunion worsening by offloading weight from the toe and joint. Once the joint and foot posture anchoring the toe is corrected, we can then also look at straightening the toe deviation with custom made toe props.

There are also specialist protective gel sleeves we can provide you with, to protect the bony prominence from rubbing within your footwear and causing a bursa or pain.

At Dubai Podiatry Centre, we work unlike other Podiatrists and intervene proactively with our patients to correct foot alignment where possible, achieving measurable, visible results to your foot posture and any resultant pain. We think more as engineers and have developed innovative orthotic solutions that are far advanced beyond orthotic therapy of even 15 years ago.

Whatever your job – from cabin crew in high heels for 16 hours or more, to a busy mum, there are far more advanced technologies and treatments available now, without resorting to medical footwear or large, clumsy insoles.



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