Big toe joint pain? Bunions (hallux valgus)

January 21, 2019

It is estimated the average person walks 1 million steps a year.  That equates to a painful year if someone has a foot problem!  Pain affecting the big toe is a very common problem that I see in the foot and ankle clinic and can affect any age group.

A bunion is when the big toe develops a deformity and starts to point towards the small toes.  A painful bump can develop on the inside part of the foot, which makes shoe wear difficult. Bunions are more common in women and are often inherited.  Long term wear of narrow fitting shoes is another well recognised cause.  Common conditions such as rheumatoid arthritis may also contribute to the problem.

Bunions tend to be progressive, with worsening deformity over time. Quite often, as the bunion becomes more severe, the 2^nd toe has to compensate, starts to take more load and may also become painful.  This condition is known as ‘transfer metatarsalgia’.  The second toe can also bend up and develop what is known as a hammer toe deformity.  Eventually over time, arthritis may develop making the big toe joint stiff and causing deep joint pain.

As simple as it sounds, the best treatment for a painful bunion is to wear shoes which are wide enough to accommodate the foot.  Patients often wear shoes which are too narrow. A simple test I perform to see if shoes are wide enough is to stand patients barefoot on a piece of paper and draw around their foot.  Too often the foot is wider than the shoe!

For more complex deformities custom made orthotics can be very helpful.  As a last resort, surgery may be required to correct the deformity.  After surgery, typically patients need to wear a flat surgical shoe (like a slipper with a stiff sole) for 6 weeks.

At Candover Clinic, Mr Daniel Marsland, Consultant Orthopaedic Surgeon specialises in these treatments.