Mr Mark Davies and Mr Chris Blundell run the Sheffield Foot & Ankle Centre at Claremont Private Hospital. They see all types of traumatic and non-traumatic adult foot and ankle problems.
Here is an easy-to-absorb guide about bunions, which is a common problem for Sheffield Foot & Ankle Centre.
Bunions - what are they?
The origin of the word “bunion” is uncertain but remains a common term used by both doctors and patients to problems seen in the big (great) toe. Most people refer to a bunion as either a swelling or a prominence of the big toe but for the foot and ankle specialist, this can be more specifically defined.
Hallux valgus
The word hallux is the Latin for the big toe. Combining hallux with the word valgus provides a description of the deviation of the big toe away from the midline of the body. Medically, this is what most doctors would term a bunion. People can experience pain around the main joint of the big toe associated with this deformity. Quite often, as a result of the deviation of the big toe invading their space, the lesser toes become crowded and deformed in many ways (hammer toes). It is often the case that the lesser toes are more troublesome than the big toe.
Another problem associated with hallux valgus and lesser toe deformities is the painful sensation under the ball of the foot likened to the feeling of having a stone in your shoe or walking on pebbles, called metatarsalgia. This is due to the big toe not functioning correctly.
In people suffering from rheumatoid arthritis, hallux valgus and metatarsalgia are not uncommon problems.
Hallux limitus
This term applies to a decreased amount of movement in the main joint of the big toe so that the big toe has a limited bend upwards. It can be associated with a lump on the top of the big toe and is often described as a bunion by patients. In some cases, there is pain in the main joint of the big toe mainly when the toe is bent upwards when walking.
Hallux rigidus
Usually as a result of arthritis in the main joint of the big toe, this joint becomes very stiff and any movements of the joint are painful. Not infrequently, there are swellings associated with the arthritis process that are termed bunions by patients. The pain and swelling can be exacerbated by walking and the amount of time spent on foot.
So what are the possible causes?
Studies have shown that there are many reasons for bunions and arthritis to the main joint of the big toe. Links have been established with family traits, poor footwear, certain types of arthritis, gout and previous injury.
What should you do about them?
Footwear changes
Simple measures such as finding comfortable shoes that accommodate the foot shape should be considered first. This can be helped by having the foot properly measured in a good shoe shop. In hallux limitus and rigidus, shoes with stiffer soles are often helpful and some shoes even have a curved, rocker sole to accommodate the stiff joint.
Insoles
Input from an orthotist or podiatrist can be helpful. This is particularly the case when trying to manage metatarsalgia when extra padding can be carefully placed to protect the ball of the foot. Sometimes padding around lesser toe deformities can be provided to good effect.
Pain relief and anti-inflammatory tablets
Your General Practitioner may be able to advise on what tablets to take especially in cases of established arthritis or gout.
Surgery
Hallux valgus
Historically there have been over one hundred different operation techniques that have been tried to correct the hallux valgus deformity with varied success rates. Some techniques widely employed towards the end of the twentieth century have led to long-term complications which are difficult to treat. Over the last 15 years in Europe, there has been widespread use of the Scarf procedure which has proven both versatile and reliable in coping with most deformities. More recently, minimally invasive surgical techniques (MIS) called MICA have been tried but are not proven and have not become established. However, some of the MIS techniques can be used to good effect when dealing with metatarsalgia and lesser toe deformities.
Hallux limitus
The aim of surgery is to prevent the pain on the top of the main joint of the big toe by removing the excess bone that restricts joint motion. Previously, this was performed through a two inch wound but nowadays, MIS techniques allow two small puncture wounds to access the area to good effect.
Hallux rigidus
The gold standard treatment for this problem is a time-honoured treatment of removing the painful joint and fusing the two bones together. Attempts to find a potential artificial joint replacement have not been universally successful and remain the subject of research.
Cartiva implant
Sheffield has been the main UK site for trialling this hydrogel implant designed to help treat hallux limitus and hallux rigidus. The implant acts as a spacer within the joint aiming to lessen the painful contact between both sides of the joint. The final results of the trial will be available in the Spring of 2015 but our preliminary experiences have been favourable in most cases.
The practicalities of surgical treatment
In most cases, surgery can be performed as a day case. Various methods of anaesthesia can be used and a great deal of attention is spent upon providing lasting pain relief in the post-operative period.
Simple bandaging techniques are used rather than plaster of Paris casts and patients are provided with a post-operative shoe to use for 6 weeks. Putting the foot to the ground is permitted but It is worthwhile resting the foot as much as possible for the first few weeks following surgery to optimise recovery.
To sum it up….
In most cases, bunions can be managed without any surgery but these simple measures are not effective, the complete range of modern surgical techniques can be accessed through the Sheffield Foot and Ankle Centre at Claremont Private Hospital.
For more information about the Sheffield Foot and Ankle Centre, please contact the Private Patient Team at Claremont Private Hospital on 0114 263 2114 or visit www.claremont-hospital.co.uk
Claremont Private Hospital has been at the heart of the Sheffield community for more than 60 years providing first class private healthcare in a safe, comfortable and welcoming environment.
