Hallux Valgus
NHS Tayside RefGuide
Warning
Who to refer
- If ulceration/ infection and wound dehisced - Urgent referral Foot and Ankle service.
- Daily pain should be primary reason for referral - either due to pressure effects or degenerate joint.
- Failure of conservative treatment for 3 months, functional impairment.
- Difficulty obtaining suitable shoes and deformity is deteriorating.
- If patient wishes to be considered for surgery.
- Surgical osteotomy/joint replacement/fusion may be necessary.
- Note that post op: unable to drive for 6 weeks, and will be off work 2 weeks for sedentary job.
Who not to refer
- Non-diabetic recurrent ulceration/ Infection - Urgent referral to Podiatry.
- Diabetic Ulcer - Urgent referral to podiatry.
- Those with no pain- surgery will not be performed for cosmetic reasons.
How to refer
SGI Gateway/Orthopaedics/Foot and Ankle Service.
Referral will be vetted by AHP and directed to most appropriate healthcare professional.
Information to include when referring
- Duration and any cause of symptoms
- Indicate site/spread of pain and if pain constant or intermittent, and/or waking at night
- Indicate ROM, functional limitation
- Include treatment to date
- XR results.
General information
- 33 per cent of people will develop hallux valgus at some stage in their lives - more common in females
- Not all bunions are painful. Can have large bunions without significant pain.
- Becomes symptomatic with ill-fitting shoes
- Deviating great toe can cause pressure on the second toe, resulting in second hammer toe.
Symptoms and signs
- Pain during walking and following activities
- Restriction of movement in great toe joint
- Can lead to mechanical function problem of the forefoot
- Irritated skin around the bunion – may blister/ulcerate, sometimes can become infected
- Joint redness and pain – secondary corns and callous.
Primary Care management
- Provide with patient information leaflet for Hallux Valgus to support self-management
- Footwear advice: avoid high heels, pointed or tight-fitting shoes. Encourage low heels, extra width shoes with laces or straps, as can be adjusted to the width of the foot. In-shoe orthosis and padding – Can be bought from any chemist / online
- Weight loss if appropriate
- Rest feet after periods of standing/walking.
- Pain medication: Analgesia & NSAIDs as appropriate.
- Intra-articular steroid injection by appropriately trained healthcare professional
- If deciding to refer please request XR foot standing AP and oblique.
Useful resources
- Hallux Valgus (NHS Tayside leaflet)
- Patient information 'A Guide to Bunion Surgery'