Bunions are one of the most common disorders that cause foot discomfort, commonly known as Hallux Valgus, or Bunion. It is more common in women, with a male-to-female ratio of about 1:2 to 1:3. The majority of hospital visits are to adults, but studies have shown that nearly half of patients develop bunions before the age of 20. It is relatively easy to diagnose this condition, but sometimes bunions can look very similar to bunions in terms of the appearance of the medial bursa, tendon sheath cysts and gouty arthritis, so if you suspect you have a bunion but are not sure, it is recommended that you seek professional help to make an accurate diagnosis. Our clinic sees a large number of bunion patients every day. What are their most important concerns? We summarize them as follows: (1) Are bunions hereditary? Studies have confirmed that 60% to 90% of bunion patients have a family history, so this is a disease with a genetic predisposition, but some patients do not have any family history, that is because bunion is not a single cause of disease, in addition to endogenous factors such as genetics, ligamentous laxity, some specific diseases, etc., exogenous factors also play a big role. (2) Are bunions caused by improper shoe wear? Then why does my best friend wear high heels every day but does not have bunions? It is true that shoes are the most important exogenous factor. As early as 1958, a study from Hong Kong confirmed that 33% of the Chinese population who wore shoes had varying degrees of bunions, while the incidence was only 2% in the non-shoe wearing population. It is also interesting to note that Japanese women had a very low incidence of bunions until the 1970s because their traditional shoe wear was clogs that did not constrict the toes, but the westernization of Japanese shoe wear since then has led to a significant increase in the incidence of bunions among Japanese women. However, it is true that wearing inappropriate shoes is not the only cause of bunions, but the occurrence of bunions is the result of a combination of endogenous and exogenous causes. (3) Why does wearing high-heeled shoes cause bunions? This is because many fashionable high heels are so narrow that the toes are significantly squeezed inside the shoe, which in the long run causes ligamentous tissue relaxation and joint subluxation in the medial aspect of the big toe. High heels. (4) What are the symptoms of a bunion? The most common symptoms are pain in the medial phalanx, redness and swelling of the bunion, and in severe cases, inability to wear shoes or skin breakdown. In addition to this, symptoms of other toes such as the second, third and fourth may occur, such as hammertoe with toe flexion and deformation, callus under the heads of the second and third metatarsals and pain after walking long distances. (5) Is there a relationship between flat feet and bunions? There is still some academic controversy about this. It has not been proven that flat feet are the cause of bunions, but many patients with flat feet are clinically found to have a combination of more pronounced bunions, and in patients after bunion surgery, severe flat feet for correction are often a risk factor for recurrence of the deformity. (6) If a bunion has occurred, how is it treated? The treatment of bunion is divided into two stages: the first stage is to adapt the foot with shoes, i.e. conservative treatment, by replacing loose and comfortable shoes with good support to reduce friction on the bony prominence, support the arch of the foot, and assist with strength exercises of the bunion abduction muscles. If there is a combination of callus and pain under the metatarsal head you can use special arch pads to elevate the metatarsal neck and reduce the weight bearing on the metatarsal head, thus reducing the symptoms. For many bunion orthoses and split-toe devices, there are no studies to confirm their effectiveness in correcting deformities. The second stage is to adapt the foot with shoes, which means that no matter how much you try to change shoes and how conservative the treatment is, the pain of the big toe cannot be well resolved and affects daily life, so you can consider surgical treatment to correct the deformity of the forefoot. (7) Then how to choose the right shoes? It is recommended to buy shoes in the afternoon or evening, when your feet are in their greatest state of the day. Be sure to wear shoes on both feet and walk back and forth to feel the size and comfort of the shoes. Shoes with laces are best for the reference of the larger foot, the sole should not be too thin, the longest toe needs to have a gap of 1-1.5 cm from the most distal end of the shoe, and the bone protrusion area on the inside of the big toe is best corresponding to softer textured materials. (8) When do I need to consider surgery? Surgery needs to be considered if the foot cannot be accommodated with shoes, or if the big toe squeezes the second or third toe causing deformities such as deformation, dislocation or riding across the second or third toe. (9) What are the surgical options and is minimally invasive surgery possible? There are hundreds of bunion surgical procedures, and it is not possible to treat all bunions with one surgical procedure. For example, if the joint is combined with severe arthritis of the big toe, joint fusion may be required; if the joint is mildly subluxed, soft tissue release and tightening surgery can be performed; if the joint is severely subluxed, osteotomy and soft tissue surgery can be performed; if the joint is not subluxed but only the metatarsophalangeal joint surface is tilted, soft tissue surgery alone can be performed. If the joint is not subluxed but only the metatarsophalangeal joint surface is tilted, soft tissue surgery alone may cause reverse subluxation. In conclusion, the surgical method must be determined according to the patient’s symptoms, physical examination and x-ray performance, and the specific operation varies from person to person. Therefore, it is recommended that you find a professional foot and ankle surgeon to help you develop a specific surgical plan. As for minimally invasive surgery, it is necessary to minimize the trauma caused by the surgery under the premise of ensuring the efficacy; it is not scientific to judge whether it is minimally invasive by a small incision. Minimally invasive surgery must strictly grasp the indications, otherwise it will easily bring about complications such as metastatic metatarsalgia, non-healing of the osteotomy, and aggravation of joint dislocation. (10) What kind of anesthesia is used for surgery? At present, anesthesia methods are becoming more and more advanced. Our anesthesiologists can anesthetize several specific nerves around the foot under direct vision with ultrasound guidance, and then the surgery can be performed painlessly with minimal impact on the body and better postoperative analgesia. (11) Do I need a steel nail for the surgery? Generally speaking, if the bunion is moderate to severe, the bone usually needs to be cut open and placed in a normal position to allow it to grow back. The screws are generally present in the bone and do not enter the joint and do not irritate the muscles and ligaments. (12) How soon can I move around after surgery? Currently, most of the osteotomies we use are the most popular Z-osteotomies, which are very stable, and with strong internal fixation, you can generally go down to the ground after two days of postoperative pain relief, and with an inflatable brace boot, you can fully bear weight without the need for crutches. Generally, you can go back to work or school after the wound heals better in about a week after surgery. Three to four weeks after surgery, you can start to carry out functional exercises for flexion and extension of the big toe. (13) How long after surgery can I walk in my own shoes? Usually young patients can start walking in their own sneakers six weeks after surgery if the osteotomy heals as expected, but older patients with more osteoporotic bones need to delay two to four weeks. (14) Are there any risks associated with the surgery? Of course, there are possible risks such as under-correction, over-correction, recurrence of deformity, non-union of osteotomy, infection, poor skin healing, joint stiffness, etc., each of which may have an incidence of 1-5%, but with detailed examination by a specialist and good surgical operation and patient cooperation, the incidence of various complications can be reduced to a minimum. (15) Will the surgery leave scars? In the case of osteotomy, the incision we choose is usually on the medial side of the foot, and although it will leave a scar, it is usually not easily noticeable, whereas if there is an incision on the dorsum of the foot, it is usually easily noticeable. (16) Will I be able to wear nice high heels after the surgery? Many patients mistakenly believe that they can wear fashionable pointy heels after surgery, but the reality is that they may have to say goodbye to pointy heels after surgery, because the normal shape of the foot is restored after surgery and there is no way to squeeze into narrow pointy shoes.