Big toe

A bunion, a condition known as “bunions”, is one of the most common deformities of the foot. In this condition, the proximal phalanx of the big toe deviates outwards, resulting in the formation of a bunion on the medial side of the 1st metatarsophalangeal joint. A bony big toe is a relatively common condition. It occurs in about 23% of adults aged 18 to 65 years and up to 36% of adults over 65 years. The exact aetiology is not fully understood. It tends to occur more often in women and in those who wear tight shoes or heels. The role of heredity also appears to be important. Based on X-rays of the feet, and depending on the angles formed between the bones, the condition is classified as mild, moderate and severe.

Varicose big toe – Symptoms

Patients with big toe pain complain of:



Sore big toe – Treatment

The treatment of patients with a ring finger is initially conservative. The aim of conservative treatment is to manage the symptoms rather than to correct the actual deformity. Conservative measures include:

use of wide shoes
use of analgesics and anti-inflammatory drugs

If there is treatment failure, and the patient continues to complain of pain, surgical treatment should be considered. More than 150 surgical procedures have been described for the correction of the big toe deformity. Usually an open approach is followed, resulting in a 3 – 5 cm scar. However, there are newer minimally invasive techniques that are growing in popularity.

Surgical treatment

The most common procedures for the bunion of the big toe are corrective osteotomies of the first metatarsal. These can be done in various positions and shapes. The osteotomy can be done near the base of the metatarsal (base osteotomy), at the diaphysis (diaphyseal osteotomy) or at the neck (head osteotomy). The osteotomies are fixed with special screws. The patient is mobilised immediately after surgery using a special metatarsal unloading shoe. The most common is the Chevron osteotomy performed at the head of the first metatarsal, with a reported patient satisfaction rate of over 85%.

In the case of mild big toe neck deformities, the bones can be left undisturbed and only soft tissue procedures can be performed.

In case of severe osteoarthritis of the 1st metatarsophalangeal joint where it is unlikely that joint function can be recovered, arthrodesis can be performed. This operation is usually reserved for elderly patients. Postoperatively, up to 81% of patients had pain relief. However, the complication rate was found to be as high as 10%. In addition, patients often complain of limited footwear options, metatarsalgia and joint stiffness.


Complications of surgery include:

hammertoe of the second toe
osteoarthritis of the metatarsophalangeal joint
loss of deformity correction

If you are suffering from a painful big toe, or the well-known bunion, contact Orthopedic Surgeon Dr. Antonis Petta. The doctor has extensive experience in big toe bunion surgery. After a diagnosis, he will recommend the most appropriate treatment for your problem.