- Lateral deviation of the big toe MTPJ with associated pain.
- Patients typically complain of deformity, pain, and difficulty with shoe wear due to prominent bunion.
- The patients often tolerate some degree of eminence pain for some time, but then present when that worsens, when the joint becomes arthritic and painful, or when lesser toe deformities develop.
- Examination may reveal a valgus, pronated hallux with possible lesser toe and mid/hindfoot conditions.
- A weight bearing XR of the foot is appropriate if considering surgery but not required for referral.
Initial management should include;
- Patient education.
- Advise on appropriate footwear – low-heeled, wide shoes.
- Analgesia – Paracetamol / NSAIDs.
- OTC orthotics if flat foot.
- Consider blood test if inflammatory arthropathy or gout is suspected.
- Failure of self care and analgesia after a minimum of 3 months conservative measures.
- Patient unable to find fitting shoes.
- Recurrent ulceration.
- Refer to diabetic service if patient is diabetic.
Nb – surgery is not typically indicated for isolated cosmetic deformity without pain / shoewear difficulties.