Hallux valgus
Although adults, especially women, are more prone to bunions, they can also affect children. Women, in particular, are more frequently diagnosed, often due to wearing tight, high-heeled shoes, and possibly because of differences in their foot structure.
Bunion symptoms include discomfort from ill-fitting shoes, pain around the big toe joint, and achiness. Treatment usually starts conservatively, involving lifestyle changes like wearing roomy, comfortable shoes, using padding, and physical therapy. Surgery might be considered if conservative methods fail to alleviate pain or if the bunion is worsening and interfering with daily activities.
Diagnosis
Diagnosing a bunion involves a thorough history-taking, physical examination, and X-rays. The history should cover symptom duration, footwear habits, and any previous treatments. During the physical exam, the doctor will assess your gait, toe alignment, and foot flexibility. They’ll also look for signs of pressure points, calluses, and other foot deformities, checking for any tightness in the Achilles tendon.
Overall, diagnosing and managing a bunion involves understanding your symptoms, examining your feet, and considering both conservative and surgical options based on your individual situation.
Progression
Hallux valgus, or a bunion, develops when there’s a problem with the bones and tissues around the big toe, leading to its deviation towards the other toes. This often begins with weakening of the structures supporting the big toe joint, causing it to shift out of alignment. As the condition progresses, the big toe joint becomes inflamed, and the tendons around it start pulling the toe further out of place. The severity of the condition is usually assessed by symptoms and X-rays, looking at angles that indicate the degree of deviation.
Treatment
Treatment typically starts conservatively, especially for young patients, the elderly, or those with health issues that make surgery risky. The focus is on easing symptoms and slowing down the progression of the bunion. Patients are advised to avoid tight or high-heeled shoes and opt for comfortable, roomy footwear instead. Various pads and splints may be used to relieve pain, although they haven’t been proven to correct the bunion. Medications or injections can also help manage pain.
Surgery is considered when conservative methods fail or when the bunion becomes severely painful or interferes with daily activities. However, because the outcome of surgery can vary, especially in terms of activity levels and pain afterwards, patients who are still highly active may choose to delay surgery until it becomes necessary.
When it comes to surgical treatment for hallux valgus, it’s crucial for patients to understand what to expect before going ahead. They should be aware that even after surgery, there might still be some discomfort, and they may need to continue modifying their footwear. Additionally, there’s a chance that the bunion could come back, and like any surgery, there are general risks involved.
There are numerous surgical techniques available, with over 140 described procedures, but there’s no one-size-fits-all solution. Surgeons categorize procedures based on factors like the severity of the bunion, the condition of the joint, and whether the deformity can be corrected manually. These categories include various soft tissue and bone surgeries, often used together to address each patient’s specific needs.
For younger patients with juvenile hallux valgus, it’s usually recommended to try conservative treatments for as long as possible. This is because surgery in adolescents can have a higher risk of the bunion coming back or being overcorrected due to ongoing growth.
In summary, hallux valgus is a common foot issue with a complex mix of causes, including genetics and footwear choices. While surgery is an option for those who haven’t found relief with non-surgical methods, it’s important to understand that the outcomes can vary, and there are potential risks involved. Ultimately, the choice of procedure depends on the individual’s condition and the severity of their deformity.
Do you have more questions?
What is a Bunion? What is Hallux Valgus?
A bunion is a bony bump that forms on the joint at the base of the big toe. It occurs when the big toe pushes against the next toe, forcing the joint of the big toe to get larger and stick out. This
condition is often associated with the misalignment of the bones in the foot, leading to the formation of the bunion.
This is also called hallux valgus deformity. Over time the metatarsal head (bony bump) will tend to drift and become more prominent.
What do patients with a Bunion feel?
Patients with bunions or hallux valgus will tend to feel pain around the prominence on the inside of their big toes. The presence of this bump cause pressure related symptoms with footwear. It may be difficult to tolerate normally sized shoes. Patients will also tend to have pain in between the 1 st and 2 nd toe spaces. This is due to dislocation of tendons as a result of the deformity.
What are the symptoms of a bunion?
Symptoms of bunions may include pain, swelling, redness, and restricted movement of the big toe. In some cases, bunions may not cause any discomfort, but they can still affect the alignment
of the toes and the overall structure of the foot.
Patients with bunions or hallux valgus will tend to feel pain around the prominence on the inside of their big toes. The presence of this bump cause pressure related symptoms with footwear. It may be difficult to tolerate normally sized shoes. Patients will tend to also have pain in between the 1 st and 2 nd toe spaces. This is due to dislocation of tendons as a result of the deformity.
What causes a bunion?
Bunions can be caused by various factors, including genetics, improper footwear, and certain foot conditions. High-heeled shoes and narrow-toed shoes can contribute to the development or worsening of bunions by squeezing the toes together. The pressure on the joint can lead to inflammation, pain, and the characteristic bony bump.
How do you diagnose a bunion / Hallux valgus?
Most bunion are diagnosed on clinical examination and X-rays.
What criteria is used to diagnose hallux valgus (Bunion)?
Your foot has a normal amount of outward angulation at the big toes joint. Less than 15 degrees is considered normal. This is called a Hallux Valgus Angle. 15-30 degrees is considered moderate deformity. More than 30 degrees is considered severe deformity. More than 40 degrees is considered a very severe deformity.
We also use a measurement called a intermetatarsal angle. This is also elevated in hallux valgus deformity. Normally it is less than 9 degrees, but it can be elevated in hallux valgus. Treatment options change depending on the severity of your deformity.
What are treatment options for a bunion? Is there any treatment for bunions?
Treatment options for a bunions / Hallux Valgus include operative and non operative options. The goal of treatment is to reduce pain, increase mobility, and restore function. We recommend all patients trial non-operative options prior to surgery. This includes pain management with acetaminophen or anti-inflammatories. Using appropriate footwear can make a difference. This includes shoes with wide and open toe boxes. You want shoes that will be accommodative of other foot deformities you may have. You can try spacers (silicone pads) to help with rubbing. There are low profile braces that can help correct the position of the toes.
These can sometime be useful for a period of time. If you have neighboring foot deformities (flat feet or high arches), it may be useful to get a pair of custom orthotics.
What are non-operative treatments for a bunion? What is the treatment for bunions without surgery?
We recommend all patients trial non-operative options prior to surgery. This includes pain management with acetaminophen or anti-inflammatories. Using appropriate footwear can make a
difference.
This includes shoes with wide and open toe boxes. You want shoes that will be accommodative of other foot deformities you may have. You can try spacers (silicone pads) to help with rubbing.
There are low profile braces that can help correct the position of the toes. These can sometime be useful for a period of time. If you have neighboring foot deformities (flat feet or high arches), it may be useful to get a pair of custom orthotics.
Do non-surgical bunion treatments work?
In most cases of hallux valgus / bunions the deformity tends to get worse and worse. This will likely happen over years. As this occurs, your pain will tend to be more frequent and more severe.
Non-operative treatment can help in less severe cases of hallux valgus. As the deformity worsens, as symptoms progress, non-operative measures are more likely to fail. Surgery is more likely indicated in severe cases.
What is Lapiplasty Bunion Surgery?
Lapiplasty is a type of bunion correction surgery. It an exciting new type of bunion correction that utilizes special guides / jigs to re-align the foot. It is combined with release of tight soft tissue structures and tightening of lax soft tissue structures. In doing this it corrects the bunion deformity.
How does Lapiplasty work?
The bunion is caused by a rotation and abduction deformity at the tarsometatarsal joint. We make and incision here, release the joint, and make bony cuts to allow the deformity to be corrected.
We then apply places to hold it in this position, while the joint fuses. The corrects the deformity. We then make incision around the bunion to release the tight structures in between the 1 st and 2 nd toes. This can usually be done with a small incision and a releasing device. In some cases we have to make an incision over the bunion, remove excess bone, and tighten the soft tissue (capsule) on this side to correct the deformity further.
Occasionally, in severe deformity, we have to make a bony cut in the proximal phalanx as well. This is usually fixed with a screw.
What to expect after Lapiplasty surgery? How long is recovery after Lapiplasty?
The surgery itself typically takes 1-2h and can be done as an outpatient procedure. You go home the same day in most cases.
Following surgery, you will have a dressing on your incision and a cast on your foot. Ideally the area should remain completely dry until the staples / sutures are removed (2-3 weeks after surgery). We see you at 2 weeks after surgery to remove sutures and change the cast. You will go into a pneumatic walking boot at 2 weeks after surgery.
We allow the bones to heal partially before you start weight bear. This means you start walking / weight bearing in a walking boot at 4 weeks post surgery. Physical therapy typically starts
around this time as well.
Surgery is painful. Most of the pain is experienced in the first few days. We give you strong pain medication and a pain management plan to address this. Swelling management is paramount.
The foot will swell greatly after foot surgery. Icing and elevation are imperative. After the firstweek the pain tends to improve rapidly. I anticipate at two weeks post surgery the pain is much better. At 6 weeks most the pain should be gone.
Swelling may be present for 6+ months after surgery. Eventually this returns to normal levels. This is the case for all foot surgery.
Most patients are relatively pain free and have near full function of the foot around 2-3months after Lapiplasty.
Does Lapiplasty work?
Many studies have shown that Lapiplasty reliably corrects the deformity that cause bunion related pain. Furthermore, early results suggest that patient have excellent reduction of pain and are able to mobilize sooner than other methods of bunion correction.
Who is not a candidate for Lapiplasty?
Patient who would not be a good candidate for Lapiplasty are the same patient who are not good candidates for foot surgery. This includes patients with vascular disease of the lower limb, diabetes, end stage renal failure, smokers, and patient with a history of poor wound healing.
The surgery would also be inappropriate in those patients who already have arthritis of the 1 st MTP joint (Bunion joint). Other foot deformities may preclude us from doing this surgery as
well.
Are you put to sleep for Lapiplasty bunion surgery?
Typically, yes. Most of the time this surgery is done under a general anesthetic. Often it will be combining with peripheral nerve blocks for pain control.
Is Lapiplasty surgery painful?
It is as painful as most foot surgeries. However, we do our best to control your acute pain. This is done though nerve blocks, local anesthetic, and pain medication. Typically, after the 1-2 weeks,
the pain is very manageable. The first few days are typically the worse. Most patients require opioid medication during this time. However, after that, most patients are able to cope with Acetaminophen and an anti-inflammatory.
How long does Lapiplasty bunion surgery take?
1-2 hours
What is the difference between Lapiplasty and regular bunion surgery?
Lapiplasty differed in the sense that the procedure is systematic. The guides and jigs used to correct deformity work well for all patients, all deformities, and all shapes of foot. They allow for reliable fixation. There is less guess work and more accuracy compared to traditional bunion surgery. It is success is quickly allowing it to become the most commonly performed bunion surgery in recent years.
Can bunions come back after Lapiplasty?
Bunions can recur after any surgery. However, this is usually because bunion correction is done at a young age. The younger you are, the more likely it will recur. Lapiplasty is a relatively new
procedure, and the long-term recurrence rates are not known. However, recurrence rates for Lapidus procedures (on which the Lapiplasty is based) are very low.
Can Lapiplasty correct hammer toes?
Typically, no.
Can I wear heels after Lapiplasty?
Once you are fully recovered, yes.
Can you run after Lapiplasty?
Once you are fully recovered, yes.
How long after Lapiplasty can I drive? When can I drive after Lapiplasty?
Typically, you can start driving once the walking boot is discontinued. This is usually approximately 6 weeks after surgery
How long after Lapiplasty walk I drive? When can I walk after Lapiplasty?
Typically, patients are started walking / weight bearing approximately 4 weeks after surgery.
How long are you in a boot with Lapiplasty?
4-8 weeks
Is Lapiplasty covered by insurance?
Yes
Is Lapiplasty covered by Medicare?
Yes.
How much does Lapiplasty cost?
This varies from person to person depending on the insurance plan. We are happy to work with all insurance and figure out a solution to allow us to do this for you.
Our billing agents are very helpful in this regard. Please feel free to have a conversation with one of them.
Who does Lapiplasty near me?
We can do the Lapiplasty procedure for you. Our foot and ankle specialist is well-versed in this procedure.
