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Cologne Foot and Ankle Surgery Center| Hallux Valgus (Bunions)

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... it is better to carry out a comprehensive diagnosis, than to operate prematurely!

Hallux Valgus (Bunions)


The bunion is an increasing misalignment of the 1st metatarsal bone. Resulting tendon displacements cause increasing misalignment and deviation of the big toe towards the second toe. Globally, the causes are not clear, but mainly a genetic predisposition is suspected. Since the deformation occurs more frequently in girls and women, shoe fashion had been suspected for decades as a trigger. This has been considered scientifically refuted for years. The fact that even children, especially girls, often under 10 years of age, as well as men also have the deformation, also speaks against shoes as a trigger. Of course, bunion symptoms can be aggravated by unfavorable, cramped footwear.


Usually, pains develop due to the friction that the shoe causes at that location. This rubbing of the shoe leads to a red, inflamed tissue sac, called bursitis. Over time, the pain can radiate deep into the joint, affecting walking, exercising, or even just comfortable standing. The bunion can also affect the adjacent smaller toes. When the big toe begins to reach over the other toe at an angle, it will exert increased pressure on the second toe or push it upwards. This leads to hammertoes or calluses in the smaller toes.

Conservative treatment

Initially, suitable shoes should be chosen, with low heels, made of soft material and wide toe clearance. Commercially available pads for the bunion reduce the pressure on the elevation. Also, anti-inflammatory medication provides relief, but does not eliminate the cause.

Surgical treatment

A causal elimination of bunion deformation is only possible by surgery. The decision depends on the subjective suffering.
If the bunion symptoms become more severe and debilitating even with adequately sized footwear and customized pads for the ball of the foot, a surgical bunion correction should be performed. This results in normal alignment of the foot and the function of the large toe joint. Through various surgical procedures, the correct axis of the first metatarsal bone and the position of the great toe joint (metatarsophalangeal joint) is restored, and the joint is preserved. In most cases, the follow-up treatment can be done without cast in a special shoe for about 6 weeks. In many cases we can already carry out the correction with a minimally invasive procedure. After healing, the foot can be used to the fullest extent, even for athletic purposes, and there are also no restrictions with respect to footwear. A recurrence of the bunion after surgery is only observed in rare cases.

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