What are bunions ?

19-Feb-2021

If you're considering medical travel, you may appreciate a tourist attraction as a powerful explanation of what a bunion is.

Bunions are in fact much like the leaning tower of Pisa.

Figure 1

Bunions are a degenerative mechanical deformity of the forefoot. The forefoot is made up of 5 metatarsal bones and 5 toes. The most important metatarsal, which serves as a solid strut for the whole body, is the first one. It is situated on the inner part of the foot just behind the big toe.

Figure 2

In Hallux Valgus deformity, more commonly called Bunions, the first metatarsal will gradually tilt away from the foot, resulting in the Bunion deformity. Just like a tower, hence our example, this happens earlier if the tower is tilted in the beginning, which we call a congenital Hallux Valgus: this means you might have several people in your family who have it as well! It will happen faster in ladies who have more supple ligaments than men, or if you present with hyperlaxity, just like a tower which has less stable foundations. Finally, the more you wait, the more the tower tilts away: the more severe the deformity gets. That's why Hallux Valgus or Bunions get more frequent with ageing. In the end, the tower might fall upon surrounding structures: that's when clawed toes, callosities and other lesser toe ailments happen.

Figure 3

Bunion treatment is nothing more and nothing less than making the tower straight again and tightening up the loose ligaments around it. The surgeon will get access to the first metatarsal bone and straighten it so it doesn't stick out of the foot. When required he will also straighten out the lesser toes. Most modern techniques involve a tiny screw to hold the "tower" in place until it heals. The surgery is carried out under anesthetic ankle bloc and immediate walking is allowed in a special shoe (worn for around one month). Both feet can be operated on during the same procedure.   

About the author

Dr Francois Lintz is a leading consultant orthopaedic surgeon specialising in bunion surgery and all other aspects of foot and ankle surgery. A fluent English-speaker, he is based at Clinique de l'Union, a Ramsay Healthcare Group private hospital near Toulouse in Southern France.