HV angles on radiographic images of 32 patients were first measured using the Pi-View Star software on a digital workstation with these values being set as the reference standard. Two attending orthopedic surgeons, blinded to the computerized measurements, utilized the iPhone running the Hallux Angles application to measure the angles on images displayed on a parallel-positioned computer monitor. Decision-making regarding the myriad surgical options to correct hallux valgus is a complex procedure involving radiographic assessment of standardized angles that define severity. When performed manually, these measurements show a great deal of variability between-and are highly error-prone. Computerized assessment is the current standard, utilizing a software program to calculate the angles. The foot is a complex structure made up of many bones and muscles. The foot has three arches that give strength and stability to the foot. The three arches are the transverse, lateral, and medial arch. The arches allow the 26 bones of the foot to move and support the muscles and ligaments that are present. According to the American Academy of Orthopaedic Surgeons, a bunion forms due to a condition known as hallux valgus. This is a Latin term that means a turning outward of the big toe. The bunion is made up of a combination of soft tissue and bone. You Might Also Like Causes. A dorsoplantar radiograph with the foot under load is required. An additional lateral or oblique view in this position contributes little extra information because the bones are superimposed, but may help to depict deformities of the smaller toes and instability of neighboring joints. Only under conditions of loading can the angle between the first and second metatarsals (intermetatarsal angle) be determined accurately. The radiograph will show the congruence of the metatarsophalangeal joint, i.e., whether a subluxation exists, and should also be inspected for any signs of osteoarthritis (joint space narrowing, subchondral sclerosis). Use an ice pack to alleviate pain, inflammation and redness associated with the bunion. Apply the ice on the joint after elevating the foot on a stool. One can also use bunion gel pads, bunion shields or bunion splints to reduce the pain and inflammation. The gel pads and shields are to be worn over the foot or applied directly over the bunion to protect the foot against pressure, friction and abrasion, while wearing shoes. The splint on the other hand is worn at night to correct the position of the toe. It can also be worn during the day while wearing shoes. This flexibility exercise is usually performed by a therapist, but can also be performed by the patient himself. Cross your affected foot over your unaffected knee and gently grab your foot with your opposite hand behind the big toe joint. Hold your foot stationary throughout this exercise. Use your other hand to gently begin pulling your bit toe away from your foot as if you were trying to pull your toe directly out of its socket. Hold this pressure and begin to gently rotate your toe in a clockwise/counterclockwise motion. You Might Also Like Dorsiflexion Exercises The angle formed between the yellow and green line represents the hallux abductus angle or the deviation of the big toe (hallux) relative to the first metatarsal bones. If this angle is too large there are osteotomy procedures available (surgically breaking and re-aligning bone) to fix this angle as well. The next video demonstrates implant surgery for correction of a bunion. As just mentioned, this is generally done when your doctor determines that the cartilage is too worn out to be salvaged and is then replaced by an artificial joint. This procedure is sometimes performed in conjunction with an osteotomy procedure to realign the metatarsal and toe bones. A new device called the TightRope fixation manufactured by Arthrex is a high tension wire that is placed through the first and second metatarsal bones in an effort to reduce the distance between the two bones. The beauty of this concept is that an osteotomy does not have to be performed. Since most bunion complications generally center around the osteotomy itself, having another option to reduce the intermetatarsal angle is very exciting. This condition can be an acquired problem such as the example above or a congenital problem where there is a flare laterally of the fifth metatarsal bone resulting in the head of the bone being very prominent. The most common cause of hallux valgus is poorly fitting shoes, according to the American Academy of Orthopaedic Surgeons. Shoes with a tight toe box that push the toes together can lead to the formation of a bunion. High-heeled shoes are the worst for this condition. In fact, the American Academy of Orthopaedic Surgeons state that studies have shown that the majority of women in the U.S. wear shoes that are too small, and over half of them have bunions. Other factors like improper foot mechanics due to altered arch height play a role. Hallux valgus can also result from genetic factors and conditions like arthritis and neurological disorders. The symptoms can be varied, but normally theyinclude burning, numbness, pain, and a full feeling in the ball of the foot.These symptoms are often made worse with dress shoes. A bunion is inflammation of the soft tissues around the outer edge of the big toe at the joint where it is attached to the foot. The medical term for this type of inflammation is 'bursitis' and refers to the bursa or sac near the joint. Bunions are associated with various diseases of the joints including osteoarthritis and rheumatoid arthritis but usually there is no obvious underlying illness. What causes bunions and who is at risk?