Hallux valgus, commonly known as a bunion, is a condition where the big toe (hallux) deviates toward the second toe, causing a noticeable bump at the base of the big toe. This misalignment leads to discomfort, pain, and difficulty walking. The deformity typically results from factors like genetics, improper footwear, and conditions such as arthritis. Women are more commonly affected, and the condition usually develops gradually over time.
How Common It Is and Who Gets It? (Epidemiology)
Hallux valgus is a widespread condition, affecting a significant portion of the adult population, especially those over the age of 50. It is more common in women, with a higher incidence in individuals who frequently wear tight shoes or high heels. Genetics also play a key role, as the condition tends to run in families.
Why It Happens – Causes (Etiology and Pathophysiology)
The primary cause of hallux valgus is hypermobility of the first tarsometatarsal (TMT) joint, which leads to the misalignment of the first metatarsal. This misalignment forces the big toe to drift inward toward the second toe. Over time, this shift causes the formation of a bunion, along with associated pain and swelling. Other contributing factors include muscle imbalances, improper footwear, and inflammatory conditions like arthritis.
How the Body Part Normally Works? (Relevant Anatomy)
The first metatarsophalangeal (MTP) joint, where the big toe meets the foot, is a hinge joint that allows for the flexion and extension of the toe during walking and running. The joint’s stability is essential for proper foot mechanics, particularly during the push-off phase of walking. In hallux valgus, the misalignment of the first metatarsal affects the toe’s movement, causing discomfort and functional limitations.
What You Might Feel – Symptoms (Clinical Presentation)
Patients with hallux valgus often experience the following symptoms:
- A visible bump at the base of the big toe.
- Pain or tenderness at the bunion site, especially when walking or wearing shoes.
- Swelling and redness over the bunion.
- Limited range of motion in the big toe joint.
- Difficulty wearing shoes, particularly narrow ones.
- Corns or calluses on the toes due to overlapping or rubbing.
How Doctors Find the Problem? (Diagnosis and Imaging)
Diagnosis begins with a physical examination, where the doctor assesses the deformity and evaluates the range of motion in the big toe. X-rays are used to confirm the diagnosis, measuring the angles of the first metatarsal and big toe to determine the severity of the deformity. In some cases, additional imaging, such as MRI or CT scans, may be used to assess the underlying joint structure.
Classification
Hallux valgus is classified based on the severity of the deformity, which is typically measured by the hallux valgus angle (HVA) and intermetatarsal angle (IMA). Mild cases have HVA <20° and IMA <15°, while severe cases may have HVA >40° and IMA >20°. Severe deformities often require surgical intervention.
Other Problems That Can Feel Similar (Differential Diagnosis)
Conditions that may mimic hallux valgus include hallux rigidus (arthritis of the big toe), tailor’s bunion (a bunion on the little toe), and sesamoiditis (inflammation of the sesamoid bones under the big toe). These can be differentiated by clinical examination and imaging.
Treatment Options
Non-Surgical Care
Non-surgical treatment is focused on pain relief and halting the progression of the deformity. Options include:
-
- Orthotics: Custom-made insoles or toe spacers.
- Footwear modifications: Shoes with a wider toe box or cushioned soles.
- NSAIDs: For pain and inflammation.
- Ice therapy: To reduce swelling and discomfort.
Surgical Care
If conservative treatments fail, surgery may be necessary to correct the deformity. Two common procedures are discussed below:
-
- Lapidus Procedure (CPT 28740)
A fusion of the first tarsometatarsal joint, addressing the root cause of instability. This procedure is ideal for patients with severe deformities or hypermobility at the joint. - Lapiplasty 3D Bunion Correction
An advanced version of the Lapidus procedure that corrects the deformity in three dimensions. It uses precision instruments and specialized implants for strong fixation, allowing for earlier weight-bearing and better outcomes.
- Lapidus Procedure (CPT 28740)
Recovery and What to Expect After Treatment
Recovery depends on the surgical technique used:
- After surgery, patients are typically placed in a special boot to protect the foot.
- Full weight-bearing is usually restricted for 6–8 weeks, followed by partial weight-bearing.
- Physical therapy is crucial to restore mobility and strength in the foot and ankle.
- Full recovery can take 3–6 months, depending on the procedure.
Possible Risks or Side Effects (Complications)
Complications can include:
- Infection at the surgical site (rare).
- Nonunion or malunion of the bones.
- Transfer metatarsalgia (pain in other parts of the foot).
- Recurrence of the deformity.
Long-Term Outlook (Prognosis)
The long-term success rate of surgery is high, with many patients reporting significant pain relief and improved foot function. Most patients can return to normal activities within 3–6 months after surgery, with improved alignment and reduced discomfort.
Out-of-Pocket Cost
Medicare
CPT Code 28297 – Hallux Valgus Surgery (Proximal Metatarsal Osteotomy, for Correction of Bunion): $231.14
Medicare Part B covers 80% of the approved cost for this procedure once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield typically cover that remaining 20%, minimizing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans work in coordination with Medicare to fill the coverage gap and reduce patient costs.
If you have Secondary Insurance such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans generally cover any remaining balance, including coinsurance or small deductibles, which typically range from $100 to $300, depending on your plan and provider network.
Workers’ Compensation
If your Hallux Valgus surgery is required due to a work-related injury or repetitive stress condition, Workers’ Compensation will cover all associated medical expenses, including surgery, postoperative care, and rehabilitation. You will not have any out-of-pocket expenses, as the employer’s insurance carrier pays for all approved treatments directly.
No-Fault Insurance
If your Hallux Valgus deformity is related to an automobile accident, No-Fault Insurance will typically cover the total cost of treatment, including surgery and recovery. The only potential out-of-pocket cost may be a small deductible or co-payment depending on your policy.
Example
Megan Lee underwent proximal metatarsal osteotomy (CPT 28297) to correct her hallux valgus deformity. Her estimated Medicare out-of-pocket cost was $231.14. Since Megan had supplemental insurance through AARP Medigap, her remaining balance was fully covered, leaving her with no out-of-pocket expenses for the surgery.
Frequently Asked Questions (FAQ)
Q. What is Lapidus arthrodesis?
A. It is a surgical procedure to fuse the first tarsometatarsal joint, correcting severe bunions and stabilizing the foot.
Q. How long is the recovery after Lapidus surgery?
A. Recovery typically takes 6–8 weeks of non-weight-bearing followed by physical therapy.
Q. Can I return to sports after surgery?
A. Most patients can return to low-impact activities within 3 months, while high-impact activities may take 6 months or longer.
Summary and Takeaway
Lapidus arthrodesis is an effective treatment for severe hallux valgus, offering long-term pain relief and improved foot function. The procedure provides stability and correction of the deformity, but patient selection and surgical technique are key factors for success. For those with severe deformities or failed prior surgeries, Lapidus provides a reliable solution.
Clinical Insight & Recent Findings
Recent studies have shown that modern techniques such as Lapiplasty, compared to traditional Lapidus procedures, offer quicker recovery times and stronger fixation. This has led to faster rehabilitation and less risk of recurrence.
Who Performs This Treatment? (Specialists and Team Involved)
Lapidus arthrodesis and Lapiplasty are performed by orthopedic foot and ankle surgeons or podiatric surgeons with specialized training in forefoot and midfoot reconstruction.
When to See a Specialist?
If you have persistent bunion pain, difficulty walking, or deformity progression, consult a specialist to discuss potential treatment options.
When to Go to the Emergency Room?
Seek immediate medical attention if you experience severe pain, signs of infection, or inability to bear weight on the foot after surgery.
What Recovery Really Looks Like?
During the initial recovery phase, patients should avoid weight-bearing and wear a protective boot. As healing progresses, gradual weight-bearing with physical therapy helps restore strength and mobility, typically within 3–6 months.
What Happens If You Ignore It?
Untreated hallux valgus can worsen over time, leading to chronic pain, difficulty walking, and further deformity. Severe cases may require more invasive surgery.
How to Prevent It?
Wearing supportive shoes with a wide toe box, avoiding high heels, and using custom orthotics can reduce strain on the big toe joint and prevent further progression of the deformity.
Nutrition and Bone or Joint Health
Activity and Lifestyle Modifications
After recovery, continue using supportive footwear and consider low-impact activities to reduce stress on the foot. Regular stretching and strengthening exercises can maintain flexibility and function in the foot.
Dr. Mo Athar
