Can you have a bunion and still have a straight toe?

Bunion deformities are the most common condition that I see and manage. There are two types of ‘bunion’ conditions that I see on a regular basis. The phrase ‘bunion’ was originally used to describe a prominence on the side of the foot (arising from the 1st metatarsal head). In today’s orthopaedic language, the majority of time, the phrase ‘bunion’ is used to describe an angulation issue with the big toe – Hallux valgus.

Hallux valgus indicates abnormal positioning of the bones that make up the big toe, being the 1st metatarsal and proximal phalanx. Patients typically present with a big toe that is angulated towards the little toes, and there is a subsequent prominence of the 1st metatarsal head due to the malposition of this bone. As the deformity progresses, the smaller toes can become affected, termed hammer toe deformities. Assuming that there is no concurrent arthritis, I perform keyhole bunion surgery to re-align the bones and straighten the big toe.

The question often arises when patients present to me with a ‘bunion’ despite having a straight big toe –  Is this also a form of bunion deformity? A bony spur arising from the joint of the great toe (typically from the dorsomedial aspect of the 1st metatarsal head) will present as a prominence of bone in this region. While this would fall under the original description of a ‘bunion’, it represents quite a different condition and subsequently requires a different management approach. This condition is termed ‘Hallux rigidus’ and represent arthritis affecting the big toe joint (1st MTP joint). The bony prominence that patients notice, is a spur of bone that is seen in the setting of the arthritis. Typically there is stiffness within the joint and associated pain from the arthritis.

Given the arthritis that is affecting the joint, surgical options are designed to remove the bony spur in combination with treatment of the underlying arthritis. Traditionally a fusion procedure of the toe has been performed, although newer treatment options are now available. These include inserting a ‘hydrogel cap’ into the joint to alleviate arthritic pain whilst allowing joint range of motion. This is called a ‘Cartiva’ implant.

As you can see, there are several options for managing ‘bunions’ depending on the specifics of the presentation and whether there is angulation of the joint in combination with bony prominence on the side of the foot. I hope this helps answer one of the common questions that I get in clinic.