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A healthy 35-year-old woman has had "bunion pain" for more than 3 years. On examination, she has moderate lateral deviation of the hallux (Figure 217-1), a mildly contracted second digit, tenderness at the medial prominence, painless first metatarsophalangeal (MTP) range of motion, and a callus under the second metatarsal head. Radiographs (Figure 217-2) show medial angulation of the first metatarsal and lateral deviation of the hallux.

FIGURE 217-1

Laterally deviated hallux resulting in a bunion (hallux abducto valgus deformity). (Reproduced with permission from Naohiro Shibuya, DPM.)

FIGURE 217-2

A weight-bearing dorsoplantar plain radiograph helps in assessing severity of the deformity and determining treatment plan. (Reproduced with permission from Naohiro Shibuya, DPM.)

The patient was referred to podiatry for surgical correction of the bunion deformity. After surgery, she was placed in a post-op shoe for 4 weeks. She progressed to a regular shoe over the next month.


Bunion deformity is characterized by the presence of a medial prominence at the first MTP joint, caused by a laterally angulated hallux on a medially angulated first metatarsal. The deformity causes irritation in a tight shoe and/or pain in the MTP joint. Initial therapy can be conservative with correction of footwear and application of padding. Most of the surgical procedures correct the misalignment, rather than shave the medial prominence.


Hallux valgus, hallux abducto valgus, metatarsus adductovarus.


  • The prevalence of bunions ranges from 2% to 50%.

  • It is far more common in women.1


Bunion deformities are caused by multiple factors:

  • Genetic and hereditary factors.

  • Abnormal biomechanics (most common) such as limb length discrepancy, hypermobility/ligament laxity, flatfoot deformity, malaligned skeletal structures, and ankle equinus.

  • Inflammatory arthritis such as rheumatoid arthritis (Figure 217-3).

  • Neuromuscular diseases.

  • Ill-fitting shoes.

  • Trauma.

  • Iatrogenic causes.

  • Neoplasm.

FIGURE 217-3

A bunion caused by rheumatoid arthritis. Note the lateral (fibular) deviation of all the lesser digits. (Reproduced with permission from Naohiro Shibuya, DPM.)


  • Underlying flatfoot, metatarsus adductus (global medial angulation of the metatarsals) and equinus.

  • Family history of bunion deformity.

  • Ligamentous laxity.

  • Having to wear dress shoes (narrowed toe shoes).

  • Female gender.


The diagnosis of hallux abducto valgus deformity is made clinically and radiographically.


  • Laterally deviated hallux with/out erythema and/or edema in the medial eminence.

  • Tenderness on the medial ...

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