Hallux valgus, often referred to as "a bunion," is a deformity of the big toe. It’s a sore bump which develops on the joint connecting the big toe to the foot. The toe tilts over towards the smaller toes. Sometimes a soft fluid swelling develops over the bony lump due to constant rubbing on the inside of the shoe.
Bunions tend to run in families, but that does not mean that if you have a bunion, your children will inevitably have one too. The connection may be that bunions are a bit commoner in people with unusually flexible joints, and this can be hereditary. They are also commoner in women than in men.
Bunions do occur in cultures in which shoes are not worn, but much less commonly. Shoes which squeeze the big toe or do not fit properly, or have an excessively high heel, may worsen the deformity, particularly in people who are at higher risk anyway. Other factors that may affect the likelihood of having a bunion include a family history (hereditary), flat feet, muscular imbalance conditions such as polio or cerebral palsy and rheumatoid arthritis.
The main problem is usually the pressure of the shoe over the bony prominence, which causes discomfort or pain. Sometimes the skin over the lump becomes red, blistered or infected. The foot may become broad and it may be difficult to get into wide shoes. The big toe sometimes tilts over so much that it rubs on the second toe, or pushes it up out of place so it presses on the shoe. Also, the big toe does not work as well with a bunion, and the other toes have to take more of the weight of the body as you walk. This can cause pain under the ball of the foot. Shoe pressure can also cause corns and calluses to develop. Sometimes arthritis develops in the deformed joint, causing pain in the joint.
Many people with bunions are quite comfortable if they wear wide, well fitting shoes and give them time to adapt to the shape of their feet. High heels tend to squeeze the foot into the front of the shoe and should be avoided. It is often worthwhile seeing an orthopedic surgeon if these simple measures are not quite enough.
If the above simple measures do not make you comfortable, an operation may improve the situation. An operation will not give you an entirely normal foot, but it will correct the deformity of the big toe and narrow your foot back towards a more desirable shape. There are a lot of different operations for bunions, depending on the severity of the deformity, the shape of your foot and whether arthritis has developed in the big toe joint. An orthopaedic surgeon who specialises in foot & ankle surgery can advise you on the best operation for your foot. However, an operation may not make your foot narrow enough to wear tight shoes, nor can it fully restore the strength of the big toe.