Bunions: A review of management

Abstract

Background Bunions are a common complaint, particularly among older female patients. They are characterised by progressive deformity at the metatarsophalangeal joint, resulting in a painful dorsomedial prominence. This may cause difficulties with shoe wear and contribute to falls in the elderly. Objective The aim of this article is to discuss the aetiology, non-operative and operative management of bunions, as well as indications for referral. Discussion Initial treatment of symptomatic bunions should be non-operative. Accommodative footwear is important. There is evidence supporting the use of nonsteroidal antiinflammatory drugs, orthotics, splints/ braces and toe spacers. However, these may not provide long-term relief, and referral to an orthopaedic surgeon is recommended if the patient has a painful prominence, has exhausted non-operative treatment and is a suitable operative candidate. Cosmesis alone is not an indication for operative management. Smoking is a relative contraindication to surgery, and cessation is recommended. In paediatric or adolescent patients (juvenile bunion), surgery should be delayed until skeletal maturity.

A 28-Year-Old Woman with Down Syndrome, Congenital Heart Disease, and a History of Knee Surgery and Plantar Fasciitis, with Hallux Abducto Valgus (Bunion) and Lapiplasty Three-Dimensional Correction Surgery

“…Hallux abductus valgus (HAV), or bunions, is common in older women and involves a metatarsophalangeal joint deformity causing pain and footwear problems. Initially, non-operative methods like proper footwear, NSAIDs, orthotics, splints, and toe spacers are recommended [ 1 , 2 ]. Surgical referral is advised for patients with persistent pain who have exhausted non-operative options and are suitable for surgery; cosmetic concerns alone are not a reason for surgery.…”

Editorial: Good bones

“…The breadth of the specialty is reflected in the topics covered, including basal thumb arthritis, 5 lateral epicondylitis, 6 non-radicular low back pain, 7 pre-operative optimisation for hip and knee arthroplasty, 8 conditions affecting the Achilles tendon 9 and bunions. 10 Orthopaedic surgery continues to evolve and advance as a specialty, constantly aiming to improve quality of life for patients with musculoskeletal pathology. Recent advances in orthopaedics are discussed, including the development of data registries, improvements in medical therapy and rehabilitation protocols, and the advent of robotic assisted joint replacement.…”