Treatment of the Bunion

Pharmacological treatment (analgesic or anti-inflammatory) is used to treat the pain, and may be oral or topical, which is prescribed as required as a symptomatic treatment. This treatment does not improve the deformity or the majority of symptoms associated with poor support and excess of pressure.

There are numerous orthopaedic devices on the market:

• Spacers or protectors. Alleviate the pressure on the prominent or deformed areas. The orthosis is generally made of materials that are able to reduce the pressure (silicones). These materials can be acquired prefabricated with pre-define forms, or they can be made to measure.
• Correctors. Their aim is to delay the bunion progressing and to alleviate the symptoms. These orthopaedic devices can be useful in the developing stages, but not when the deformity is already significant.
• Insoles. They alleviate the pain while walking and correct the disequilibrium of lack of support. They are unable to improve the position of the big toe.

In cases where conservative treatment does not alleviate the symptoms, there are numerous surgical techniques described for the treatment of hallux valgus. Each patient treatment is individualised and takes into account factors such as, the type and grade of the deformity, characteristics of the foot, previous illnesses, and age, among other things.

In the majority of cases the simple incision and scraping of the bunion is usually insufficient as it does not correct the deformity or means that it may reappear.

Nowadays, in almost all cases, ambulatory surgery is performed with a local anaesthetic, as such that the patient can normally go home the same day as the surgery.

It is important to clarify that the laser technique is not used, nor has it been used anywhere in the world to operate on hallux valgus. However, there is a false belief that there are surgical techniques that allow operating using small incisions, known as percutaneous or minimally invasive surgery. This technique, like any other, has its indications and limitations and must be well indicated, depending on the needs of each case.

Re-education is important as a post-operative treatment because using exercise techniques helps to recover the joint flexibility of the operated toe.

• Self-re-education of the operated hallux valgus. It forms part of the cure process and prevents stiffness in the big toe. In general, it is started 15 days after the operation, following a well-defined protocol.
• Movement exercises. After the operation and during the first four weeks, the toes must be moved in order to drain the fluid of the oedema and widen the joint range.

Among the complications of the surgical treatment, may be those common to any surgery of the locomotor system. Among these, are highlighted:

• infections, which, fortunately, have a low incidence;
• problems in the healing of the bone (consolidation), and
• re-appearance of the deformity, despite the improvement in the surgical techniques.