Bunion (Hallux Valgus)
A bunion (clinically termed hallux valgus) is the most common deformity of the forefoot, affecting an estimated 23% of adults and up to 35% of those over age 65. It is far more prevalent in women, largely owing to footwear habits. The condition is progressive: a small medial bump in the 20s can become a painful, arthritic deformity that limits walking by the 50s. At Maryland Orthopedic Specialists, we offer the full continuum of care, from footwear counseling and custom orthotics to the latest minimally invasive surgical techniques, with the goal of relieving pain while preserving the foot's structure and function for decades to come.
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What is bunion (hallux valgus)?
A bunion (hallux valgus) is a progressive deformity of the big toe, where the toe drifts toward the others and a bony bump forms on the inner edge of the foot at its base. It can cause pain, swelling, and difficulty with footwear, and tends to worsen over time.
Hallux valgus describes a complex three-dimensional deformity of the first ray:
- The first metatarsal drifts medially (varus), causing a bony prominence (the "bunion") on the inner border of the foot at the metatarsophalangeal (MTP) joint
- The hallux (great toe) deviates laterally (valgus), sometimes crossing over or under the second toe
- The sesamoid bones beneath the 1st MTP joint shift laterally out of their groove, contributing to further instability
Radiographic measurement on weight-bearing foot X-rays quantifies the deformity:
- Hallux Valgus Angle (HVA): Angle between the 1st metatarsal and the hallux proximal phalanx. Normal <15°; mild deformity 15–20°; moderate 20–40°; severe >40°.
- Intermetatarsal Angle (IMA): Angle between the 1st and 2nd metatarsals. Normal <9°; increased IMA reflects hypermobility or instability of the 1st tarsometatarsal (TMT) joint, a key factor in surgical planning.
Contributing Factors
Genetic predisposition (familial in 70%+ of cases), female sex (10:1 ratio), flatfoot, ligamentous laxity, pointed-toe or high-heeled footwear (which worsens but does not solely cause deformity), and first-ray hypermobility. Bunions do not arise from calcium deposits or walking too much.
Symptoms — do you recognize these?
- Medial bony prominence at the 1st MTP joint, often with overlying erythema, bursitis, or callus
- Pain with shoe wear, especially narrow dress shoes; relieved when barefoot or in wide shoes
- Joint stiffness and aching with prolonged walking or standing
- Second toe problems: As the hallux deviates, it may crowd and elevate the 2nd toe, eventually causing hammertoe deformity or stress fracture of the 2nd metatarsal
- Cosmetic concern is common, though surgery is indicated for pain — not appearance alone
Call us at (301) 515-0900. Same-day appointments available at our Bethesda and Germantown locations. Early evaluation allows us to slow progression and plan effective treatment before the deformity becomes severe.
How we diagnose it
Clinical examination assesses the prominence, MTP joint range of motion, reducibility of the deformity, 1st TMT joint hypermobility, and associated forefoot pathology (2nd toe hammering, transfer metatarsalgia).
Weight-bearing foot radiographs (AP, lateral, oblique) are essential and performed at MOS. Non-weight-bearing X-rays significantly underestimate the degree of deformity. HVA and IMA are measured and guide surgical selection.
Advanced imaging (CT, MRI) is rarely needed but may be ordered pre-operatively for complex deformities, revision cases, or when osteonecrosis or cartilage loss is suspected.
Treatment options
Conservative care manages bunion pain but does not correct the deformity. Surgery is the only way to realign the toe.
Non-Operative Management
Wide toe box shoes with a soft upper and low heel are the single most effective conservative measure. Bunion pads and toe spacers cushion the bump and keep the toe more comfortable during daily activity. Custom orthotics reduce pressure on the joint and may slow progression in some patients.
Bunion Surgery (Hallux Valgus Correction)
Surgical correction of hallux valgus deformity using technique matched to severity. Options range from Chevron osteotomy for mild deformity through Lapidus fusion at the first tarsometatarsal joint for moderate-to-severe or hypermobile cases.
Click for moreRecovery & rehabilitation
- Distal chevron (open or MIS): Weight-bearing in a surgical shoe immediately to 2 weeks; return to sneakers 4–6 weeks; return to dress shoes 3–4 months; full resolution of swelling 4–6 months.
- Lapidus: Boot 6–8 weeks non-weight-bearing (traditional) or 2–4 weeks (modern early weight-bearing protocols); return to normal shoes 3–4 months.
- Swelling after any bunion surgery is expected for 6–12 months; most patients are very satisfied by 6 months.
Physical therapy post-operatively targets 1st MTP joint range of motion and gait training.
Frequently Asked Questions
Will my bunion come back after surgery?
Do I need surgery if my bunion doesn't hurt?
What is minimally invasive bunion surgery?
Can orthotics stop my bunion from getting worse?
How long after bunion surgery will I be able to walk normally and wear regular shoes?
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References
- Easley ME, Trnka HJ. Current concepts review: hallux valgus part I. Pathomechanics, clinical assessment, and nonoperative management. Foot & Ankle International. 2007;28(5):654–659. doi:10.3113/FAI.2007.0654
- Trnka HJ, Zembsch A, Wiesauer H, et al. Modified Austin procedure for correction of hallux valgus. Foot & Ankle International. 1997;18(2):119–127. doi:10.1177/107110079701800212
- Biz C, Corradin M, Petretta I, Aldegheri R. Endoscopic Lapidus procedure for hallux valgus correction: long-term results. Journal of Orthopaedic Surgery and Research. 2015;10:57. doi:10.1186/s13018-015-0197-8
- Malagelada F, Sahirad C, Dalmau-Pastor M, et al. Minimally invasive surgery for hallux valgus: a systematic review of current surgical techniques. International Orthopaedics. 2019;43(3):625–637. doi:10.1007/s00264-018-4138-x
- OrthoInfo. AAOS. Bunions. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/bunions