Bunion (Hallux Valgus)

A bunion is more than just a bump on the side of the foot. It is a progressive deformity of the big toe that can cause pain, difficulty wearing shoes and problems with walking. As the condition worsens, the big toe gradually drifts towards the second toe, changing the shape of the foot and making everyday activities increasingly uncomfortable.

At the Foot & Ankle Centre, Dr Anand Jadhav offers comprehensive evaluation and personalised treatment for bunions, ranging from footwear advice and orthotics to advanced minimally invasive and reconstructive bunion surgery.

What is a Bunion?

A bunion, medically known as Hallux Valgus, is a deformity in which the first metatarsal bone shifts outwards while the big toe gradually moves towards the smaller toes. This creates the characteristic bony prominence on the inner side of the foot, often leading to pain, redness and difficulty wearing shoes. Left untreated, the deformity may gradually worsen over time.

What Causes Bunions?

Bunions usually develop because of a combination of inherited foot structure and mechanical factors rather than a single cause. Common risk factors include:

• Family history and inherited foot shape
• Flat feet or ligament laxity
• Rheumatoid arthritis and other inflammatory arthritis
• Neuromuscular conditions
• Connective tissue disorders
• Tight, narrow or high-heeled footwear
• Progressive weakening of the supporting ligaments of the foot

Although footwear does not usually cause bunions by itself, poorly fitting shoes can aggravate symptoms and accelerate progression in susceptible individuals.

Symptoms

Symptoms vary depending on the severity of the deformity and commonly include:

• A prominent bump on the inner side of the big toe
• Pain while walking or wearing shoes
• Redness and swelling over the bunion
• Corns or calluses between the first and second toes
• Difficulty finding comfortable footwear
• Progressive deviation of the big toe towards the second toe
• Overlapping or crowding of the lesser toes
• Reduced mobility of the big toe joint

As the deformity progresses, everyday activities such as walking, exercising and standing for long periods may become increasingly uncomfortable.

When Should You Consult a Specialist?

You should seek specialist assessment if:

• Pain interferes with daily activities
• Shoes become increasingly difficult to wear
• The deformity continues to worsen
• The second toe begins to deform
• Walking becomes painful
• Conservative measures no longer provide relief

Early assessment often allows simpler treatment and may help prevent progression of the deformity.

Diagnosis

Diagnosis is based on a detailed medical history, clinical examination, assessment of foot alignment, evaluation of toe movement and gait analysis.

Weight-bearing X-rays are essential to assess the severity of the deformity, joint alignment and any associated arthritis, helping guide the most appropriate treatment plan.

Non-Surgical Treatment

Many patients obtain good symptom relief without surgery, particularly during the early stages.

Footwear Modification

Shoes with a wide toe box reduce pressure over the bunion and improve comfort.

Custom Orthotics

Orthotic insoles help improve foot mechanics and reduce excessive loading across the forefoot.

Padding and Protective Sleeves

Soft bunion pads reduce friction and irritation from footwear.

Medication

Pain-relieving and anti-inflammatory medication may help during flare-ups.

Ice Therapy

Applying ice after prolonged walking or standing can reduce swelling and discomfort.

Although these measures relieve symptoms, they do not correct the underlying deformity or prevent the bunion from progressing.

When is Surgery Recommended?

Surgery may be recommended when:

• Pain persists despite appropriate conservative treatment
• The deformity continues to progress
• Walking becomes increasingly difficult
• Shoe wear is significantly limited
• The second toe is affected
• Arthritis develops in the big toe joint

The aim of surgery is to correct the deformity, restore foot alignment, relieve pain and improve long-term function.

Modern Bunion Surgery

Modern bunion surgery is tailored to the severity of the deformity rather than using a "one procedure fits all" approach. Depending on the individual patient, treatment may include:

Akin Osteotomy

A procedure performed on the big toe itself to correct residual angular deformity. It is often combined with other corrective procedures for optimal alignment.

Chevron Osteotomy

Commonly used for mild to moderate bunions, this procedure realigns the first metatarsal through a V-shaped bone cut and can often be performed using minimally invasive techniques.

Scarf Osteotomy

A powerful and versatile procedure for moderate to severe deformities, involving a Z-shaped cut in the first metatarsal to achieve precise correction and stable fixation with screws. It provides excellent long-term correction while preserving joint movement.

First MTP Joint Fusion (Arthrodesis)

For patients with severe deformity or advanced arthritis of the big toe joint, fusion of the joint provides reliable pain relief, corrects the deformity and restores stability, although movement at the joint is sacrificed.

The most appropriate procedure is selected after careful clinical assessment and review of weight-bearing X-rays.

Recovery After Bunion Surgery

Most bunion operations are performed as day-care procedures under regional or spinal anaesthesia. Following surgery, patients can expect:

• Immediate or next-day protected walking in a postoperative shoe
• Elevation of the foot to minimise swelling
• Regular ice application
• Wound review approximately two weeks after surgery
• Gradual return to comfortable footwear over 6–8 weeks
• Progressive rehabilitation to restore strength and mobility

Most patients experience significant improvement in pain, shoe comfort and walking ability once healing is complete.

Why Choose Dr Anand Jadhav?

With over 30 years of orthopaedic experience and 12 years of specialist practice in the NHS, United Kingdom, Dr Anand Jadhav offers advanced treatment for forefoot deformities using modern evidence-based techniques. His expertise includes:

• Bunion (Hallux Valgus) Surgery
• Minimally Invasive Bunion Correction
• Scarf, Chevron & Akin Osteotomies
• First MTP Joint Fusion
• Flatfoot & Forefoot Reconstruction
• Sports Foot Disorders
• Comprehensive Rehabilitation

Every treatment plan is tailored to the patient's foot shape, lifestyle and functional goals, with the aim of relieving pain, restoring alignment and improving quality of life.

Frequently Asked Questions (FAQs)

Can a bunion be corrected without surgery?

Conservative treatment such as wider footwear, orthotics and padding can reduce pain and improve comfort, but they cannot straighten the toe or permanently correct the deformity. Surgery is the only treatment that corrects the underlying bone alignment.

Is bunion surgery painful?

Modern anaesthesia, regional nerve blocks and improved surgical techniques have significantly reduced postoperative pain. Most patients experience manageable discomfort that improves steadily during recovery.

Will my bunion come back after surgery?

Recurrence is uncommon when the appropriate procedure is chosen and postoperative instructions are followed. The risk depends on factors such as the severity of the deformity, foot structure and underlying ligament laxity.