Bunions (hallux valgus)

In summary: not every bunion needs surgery. When the deformity advances or pain limits you, we correct it with minimally invasive surgery (small incisions), operated by Dr. Serven at Teknon and Igualada Hospital. We assess it without rush.

A bunion (hallux valgus) is a deviation of the big toe that forms the characteristic “bony lump” at the base. It is very common and advances with time: it is not merely an aesthetic problem, but a deformity that can cause pain and make finding suitable footwear difficult.

Not all bunions need surgery. The key is assessing it in time to know if it is enough to control the discomfort or if it is worth correcting it.

Operating on the bunion or not: how we decide

This is the big question for those who come in with a bunion (or “juanete”, as many people call it). And the correct answer is never automatic.

In the assessment we look at three things: if it hurts and how much it limits you, if the deviation is progressing and how it affects the rest of the foot. A large but painless bunion can wait; a moderate one that hurts every day and starts to push the other toes, perhaps not.

When surgery makes sense, it can often be done with minimally invasive surgery: very small incisions that tend to make the postoperative period lighter. Dr. Serven operates at the Teknon Medical Center in Barcelona and at Igualada Hospital, and explains without rush what it would imply in your case.

And when surgery is not necessary, we tell you so too. Bunion surgery is a tool, not a goal.

Bunions and footwear: what really helps

Footwear does not cure the bunion, but it can make the difference between living well with it or poorly:

• Wide toe box and sufficient height so the lump does not rub.
• Flexible materials in the forefoot area.
• Low heel: high heels load the forefoot and tend to worsen discomfort.
• Be careful with “miracle” separators and correctors: they may relieve, but they do not straighten the toe.

If, in addition, your gait overloads the forefoot, a gait analysis with a 3D scanner allows us to design insoles that better distribute the load while deciding the path forward.

What happens if you leave it be

The bunion is a progressive deformity: it does not correct itself and, over the years, tends to advance. This does not mean that all of them need to be operated on —many are well controlled—, but it is advisable not to lose sight of it.

When it advances a lot, the big toe stops doing its job when walking and the load passes to the neighboring toes. It is then that added problems appear: metatarsalgia, claw toes or calluses that appear again and again. And correcting a very advanced bunion tends to be a more complex surgery than correcting a moderate one.

The practical conclusion: there is no need to rush, but it is worth assessing it. Knowing at what point your bunion is allows you to decide calmly, not when pain already rules. And if you decide to wait, reviewing it from time to time allows you to monitor how it evolves and act at the right moment, without surprises.