Makindo Medical Notes

About

• Bunions: Also known as hallux valgus, bunions are characterized by a bony bump that forms on the joint at the base of the big toe (1st metatarsophalangeal joint).

Aetiology

• Prevalence: Affects approximately 2.5% of children aged 9-10 years in the UK and around 48% of adults.
• Risk Factors: More common in females, often associated with wearing high-heeled or narrow-toed shoes that increase pressure on the 1st MTP joint.
• Genetic Predisposition: Family history can play a role, with some individuals genetically predisposed to foot shape that encourages bunion formation.

Clinical Features

• Pain and Swelling: Over the medial aspect of the 1st MTP joint, often with associated redness and tenderness.
• Valgus Deformity: The big toe begins to point laterally towards the other toes, creating a visible deformity.
• Secondary Changes: Enlargement of the 5th MTP joint (on the little toe side) is known as a Tailor's bunion or bunionette.

Investigations

• Usually Not Required: Diagnosis is often clinical based on the physical appearance and symptoms.
• X-rays: May be indicated if surgical intervention is considered, to assess the degree of joint deformity and alignment.

Differential Diagnosis

• Joint trauma
• Tendonitis
• Bursitis
• Fibrositis
• Gout
• Rheumatoid arthritis
• Degenerative joint disease
• Tenosynovitis

Management

• Footwear: Avoid high-heeled shoes and wear wide-fitting, flexible shoes (e.g., leather) that reduce pressure on the 1st MTP joint.
• Exercises: Specific exercises can help alleviate bunion pain and maintain joint flexibility.
• Symptomatic Relief: Apply ice and elevate the foot to reduce pain and swelling in acute flare-ups.
• Non-Surgical Interventions: Use of bunion pads, splints, insoles, or shields to protect the bunion and relieve discomfort.
• Surgical Management: Considered if there is severe pain or functional impairment that doesn’t respond to conservative measures. Surgery may involve realignment of the joint and removal of the bony prominence.
• Cosmetic Concerns: Patients with asymptomatic bunions or those concerned with cosmetic appearance should generally be managed in primary care, with referrals to secondary care only if symptomatic.

References

• NHS - Bunions
• Orthopaedic Outcomes - Hallux Valgus