BunionsandClawtoesAbunionisalumponthesideofthefootinvolvingthemainjointofthebigtoe(the1stMTPjoint).ItisusuallycausedbyadeformityofthisjointcalledHalluxValgus(bigtoedeviatingawayfromthemidline)

Thecauseispartlygeneticandpartlyrelatedtopointyshoesandhighheels.Thisexplainswhytheconditionismorecommoninwomen.Therearenononsurgicalwaystopermanentlycorrectthedeformitybutanorthotistorpodiatristshouldbeabletoprovideyouwithabunionsplintwhichmayalleviateyoursymptoms.

HVA(halluxvalgusangle)

IMA(Intermetatarsalangle)

Surgeryshouldbeconsideredfor:PainDifficultywithfootwearOrifyounoticethatthebunionisgettingworse(progressivedeformity)Therearemanyoperationsdescribedforhalluxvalgus.Theaimistocorrectboththe:

1. Intermetatarsalangle(IMA)2. HalluxValgusangle(HVA)

Oneexampleisthescarfosteotomywithsofttissuecorrection.Thescarfshapeisderivedfromthecarpentryindustryandprovidesastablemethodofcuttingtheboneandtranslatingitbeforefixingitwithscrews.Theintermetatarsalangleiscorrectedthisway.Thesofttissuereleasecorrectsthehalluxvalgusanglebyreleasingtightstructuresbetweenthefirstandsecondtoesandtighteningthecapsuleoverthesiteofthebunion.

FollowingsurgeryyoucanexpecttostayforonenightinhospitalItisimportanttospendthefirsttwoweekswiththefootstrictlyelevatedabovethelevelofyourheartfor23hoursaday.Awoundcheckisperformedatthe2weekscheckYouwillneedtowalkinastiffsoleopentoeshoeforabout6weeks.Anxrayisthenperformedtoconfirmthatrecoveryisoccurringasplanned.

Work(thesetimeframesarespeculativeonly):Sittingdutiesat3weeksaftersurgeryStandingdutiesindoors3weeks-2monthsaftersurgeryOutdoorduties–2monthsaftersurgeryReturningtodrivingisnotastraightforwardquestion.TheremaybeinsuranceimplicationswhichneedtobecheckedItdependsonwhichfootundergoessurgeryandwhetherthecarismanualorautomaticYoumustfeelconfidenttousethebrakeinanemergencysituation.Thereareanumberofpossiblecomplicationsthatcanoccurfrombunionsurgery.Someoftheseinclude:Longtermpainandswelling–upto12monthsRecurrenceofthebunionNumbnessandincreasedsensitivityaroundthesiteofthesurgeryStiffnessinthebigtoe

Clawingofthesecondtoeisarelativelycommoncondition.ItisoftenseentogetherwithabunionbecausethereisabiomechanicalassociationbetweenthemItcausespainfromrubbingonknuckleonthetopofthetoewithfootwearandtherecanalsobeapainfulprominenceofthemetatarsalheadonthesoleofthefoot.

ItmeansthatthesecondMTP(metatarsophalangealjoint)haswornoutandthereisnowanimbalanceofthemusclespullingonthetoe.Apodiatristororthotistmaybeabletoassistwithtoestraighteningdevicesoradvisingoradjustingfootwear.SurgerytostraightenthetoemayrequireafusionofthePIPjointwheretheknuckleis.Thismaymeanapininsertedinyourtoethatwouldneedtoberemoved6weeksaftersurgeryduringavisittotheconsultingrooms.Followingsurgerythetoeisusuallyshorterbutstraighter.Possibleproblemswithsecondtoestraighteninginclude12monthgsofpainandswellingRecurrenceoftheproblemSensitivityandnumbnessaroundthetoe

Sitesofpain