Bunions

What are bunions?Hallux Valgus (Bunions) and lesser toe deformities (link to hammer toes) are probably the most common foot deformities. Bunions are bony protrusions on the inside of the big toe and are a common source of pain and difficulty and wearing shoes. bunions1
Hallux Valgus with 2nd and 3rd Hammer toe deformities
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Correction of Hallux Valgus with Mitchell Osteotomy
They are commonly associated with deformities of the other toes, such as Hammer toes and Claw toes. The main underlying problem is the protrusion of the “knuckle bone” of the foot, known as the Metatarsal bone.
These forefoot deformities can also cause painful corns under the ball of the feet, or along the sides of the feet at the Bunions, and occasionally at the 5th toe (also known as a Bunionette Deformity). Another common association is that of flat feet, and tight calf muscles. bunions4
Corn under 2nd Metatarsal Head because of long 2nd Toe and Hallux Valgus
Pictures courtesy of LS Barouk, Springer Verlag
Many people live with these problems by wearing broader extra width shoes or open sandals but the more severe and problematic feet often need surgery. Unfortunately, foot surgery has traditionally always been associated with long down times and this has deterred many patients from surgery. Fortunately, new techniques and concepts in surgical management have shortened down times by as much as half.
Treatment OptionsTraditional techniques have been the use of Distal Osteotomies (eg Mtichell or Chevron Osteotomies) for the milder bunions. An Osteotomy is a cut made in a bone to correct deformities. These are relatively simple procedures. However, they are not able to correct the more severe deformities. The down time is about 6 to 8 weeks.

 

The more severe deformities require proximal Metatarsal osteotomies or fusions (Lapidus procedure) and take along time to heal (3 to 4 months). Usually, a cast for about 6 weeks is also needed, followed by a period in a walking boot.

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Correction of Hallux Valgus with Mitchell Osteotomy
The Scarf Osteotomy is a hybrid procedure which has the best of both worlds. It is able to correct very large deformities and yet has the shortest down time of all (4 weeks to reasonable full weight bearing walking). This is even quicker than a Mitchell Osteotomy which typically takes about 6 to 8 weeks. The term “scarf” comes from carpentry and the nature of the scarf cut is that it is more stable, allowing for quicker recovery and earlier weight bearing (see fig 3, 6A and B). With the aid of a special walking shoe, the patient is able to walk immediately with minimal pain soon after the surgery.
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The term “scarf” comes from carpentry and is the name given to a type of join in wood working
Pictures courtesy of LS Barouk, Springer Verlag
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Correction of Hallux Valgus with Scarf and Akin Osteotomy
Xrays Scarf and Akin