Bunions (Hallux Valgus)

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A bunion is a prominence over the joint where the big toe joins the rest of the foot (1st metatarsophalangeal joint). A bunion usually develops due to a hallux valgus deformity, which is when the 1st metatarsal bone gradually deviates inwards, towards the opposite foot. The big toe moves in the opposite direction, towards the lesser toes, and this leaves the head of the 1st metatarsal bone prominent under the skin.

As a hallux valgus deformity progresses, the lesser toes can start to deform as a result. The most common sequelae are hammer toes, usually of the 2nd or 3rd toes. In addition, the skin under the balls of the foot (specifically under the 2nd and 3rd metatarsal heads) can become sore and thickened due to increased and abnormal weight going through them. As the deformity worsens, the big toe can move under or over the second toe.

What is the cause?

There is no single cause of hallux valgus. It often runs in families, but the genetic link has not been identified. The most common cause is imbalance of forces on the toe, which is probably present from early in life, and this results in a gradual progression of deformity over time. Other causes include neuromuscular disorders like polio and cerebral palsy, ligamentous laxity, and joint destruction associated with arthritis.

High-heeled pointed-toe shoes have not been shown to cause hallux valgus deformities, but they can make it painful and exacerbate the condition. Pressure from tight fitting shoes can cause bunions, corns and calluses to develop in the setting of hallux valgus.


The diagnosis of a bunion by an orthopaedic surgeon includes taking a full medical history, and performing a thorough physical examination to assess the extent of deformity and damage to the soft tissues.  Weightbearing X-rays (ie x-rays taken when you are standing up) help determine the degree of the hallux valgus and lesser toe deformities, the extent of any arthritis, and whether any concomitant problems exist.

It is important to exclude other causes of big toe pain, which include osteoarthritis, rheumatoid arthritis, infection and gout. Circulatory problems may not only cause pain, but can also lead to serious complications if surgery is undertaken. Cigarette smoking and diabetes significantly impair healing potential and increase the risk of infection.


Most bunion correction operations involve bone cuts (osteotomies) in order to re-align the deformed bones. The most common bunion surgery that Dr Zilko performs is a minimally invasive bunion correction, which is undertaken through keyhole incisions on the inner aspect of the big toe. The ultimate goal of any bunion surgery is to restore the normal shape and mechanics of the foot in order to reduce pain and discomfort and allow return to normal shoe wear.

Bunion surgery is covered by both Medicare and private health funds only when performed by an orthopaedic surgeon (medical doctor).

Please note that podiatrists performing surgery are not medical doctors; have not undergone medical school and teaching hospital surgical training for 13-15 years like orthopaedic surgeons; are unable to prescribe all antibiotics, painkillers, anti-emetics and other medications that may be required after surgery; and are not covered at all by Medicare for surgery.

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