Hallux valgus (also known as bunion) is a bony bump on the inside of the foot at the base of the big toe with the big toe tilting towards the second toe.
Many people who have bunions do not get any real problems with their feet and nothing needs to be done.
Some people will however get pain around the big toe or problems with their shoes
The bump can make foot wider and it can be difficult to find shoes which are comfortable
The bump can rub on shoes and become red and swollen and in some cases the skin can blister
Some people with bunions go on to have problems with their smaller toes too.
What causes bunions?
Inherited factors and the shape of the bones in feet can cause bunions. Footwear which does not fit well probably has a role in making bunions more uncomfortable and increasing problems in the future.
What tests may be done?
You do not need any x-rays or special tests to diagnose bunions, these are only used for planning surgery.
What can you do to help your bunion?
There are many non-surgical treatments that can help.
Footwear: One of the most important things you can do to help is to wear the right footwear. You should try to wear wide shoes with a low heel that fit you comfortably. Shoes with laces or an adjustable strap are best as they can be adjusted to the width of your foot. Do not wear high heeled, pointed or tight shoes as this will make your pain worse.
Diet: Losing weight will reduce the strain on your feet.
Medication: Painkillers such as paracetamol can reduce the pain. Follow the advice from your community pharmacist or other healthcare professional about taking medication. It is important to take medication regularly.
Exercise: Helps build the strength of the small muscles in your feet, which can take the strain off the toes and we think help to delay or stop problems getting worse.
What else can be done?
Most patients with bunions respond well to non-surgical treatments, especially changing their footwear. Where these have been tried and failed then there may be other options. If your pain does not start improving after a period of 3 months of following the advice above, please phone 0141 347 8909 to see a healthcare professional who can assess your foot.
Some patients may be referred on for Orthopaedic footwear or a surgical opinion.
Surgery
Surgery is considered in patients who have significant problems with their bunions and have tried non-surgical management which has not worked usually over at least 12 months.
An operation will not give you an entirely normal foot, but it will correct the shape of the big toe and narrow your foot back towards a more usual shape.
The aim of bunion surgery is to straighten the big toe and make it more comfortable. There are several procedures for bunion surgery and the best surgery for you depends on the size of your foot.
For most people the surgery is a bony surgery where the bones of your toe are cut and reset to straighten your big toe. This is called an osteotomy, some people who have developed arthritis in their big toe joint need a different type of operation where the big toe joint is surgically stiffened (fused). Very occasionally if your foot is more complicated an operation would be done further back in the middle of your foot to help straighten and support it.
Bunion surgery is largely very successful with around 85% of people happy with the outcome but as with any operation there are some risks.
It may take 3-6 months for you to be back to your normal level of activity where you will be able to work standing all day, however every person is different.
The leaflets below provide some added information, however, if you feel you would liketo talk to a podiatrist about your options, please phone 0141 347 8909 for more advice and support.
Glasgow Royal Infirmary has a specialised Foot and Ankle Service which includes orthopaedic foot and ankle consultants, Advanced Podiatry Practitioners (APP), specialist nurses and other member of the orthopaedic team.
Many foot and ankle problems can be treated by a local Podiatry Service in Community Health Centres. You can self-refer directly to these services without having to ask your GP to refer you.
To access the Community Podiatry Services contact your local area:
Glasgow – 0141 347 8909
Lanarkshire – 01236 731881
If your foot and ankle condition is not improving or if you require further assessment, you may be referred to the Orthopaedic APP for review.
Although you may have already undergone podiatry management before, the specialist podiatrist in the Orthopaedic Department has an advanced role having undertaken additional orthopaedic training. They work in a similar role to the orthopaedic consultants and can arrange and manage further tests such as x-rays, MRI scans and blood tests. In addition, assessment and discussions about foot and ankle surgery can be carried out by our APP Podiatrist.
Appointments with the orthopaedic podiatrist
Appointments to see our specialist podiatrists are arranged by medical professionals. If you need to reschedule or cancel an appointment that has already been organised for you at Glasgow Royal Infirmary Orthopaedic Podiatry Department, please use our Patient Focused Booking lines open during office hours.
0141 201 3105
0141 201 3114
Pain is always made in the brain. No exception, the brain decides.
About 30-50% of people in the UK live with persistent pain. It is the leading cause of disability in the world. Pain is usually the result of a combination of different things but its impact can be significant and negatively affect our physical and mental health, our social and home lives and our ability to stay in work.
The links below with take you to information on the NHSGGC pain service, as well as some other fantastic online resources and information about pain which will help your understanding of pain and empower you to take back control and manage your pain.
Are there alternative options for non-digital information?
Please contact our team and we will provide non-digital options either through mailed hardcopies, telephone discussion or one-to-one education sessions.
What do I do if I need an interpreter?
If your English is limited or if you need the services of a sign-language interpreter please contact the Orthopaedic Team as soon as possible so that an interpreter can be arranged.
The big toe joint (called the metatarsophalangeal joint or MPT joint) is an important joint that needs to be able to bend for the foot to work as efficiently as it should. Sometimes, for a variety of reasons, the joint can become stiff and make walking painful at this area – and sometimes it can become so bad that it results in a complete loss of movement.
Footwear is important in these cases. If the joint cannot bend, then a shoe with a stiff sole – or rocker sole like the examples pictured below- can be useful. A shoe with a decent heel height may make symptoms worse as this will ask more of the joint and so may be best avoided – or at least limited. It is also important to point out that themake and price of the shoe/trainer is not important, as long as it is fit for purpose.
If you do not see any sign of improvement after 6 – 8 weeks of following the advice and exercises in this leaflet, please phone 0141 347 8909 to see a healthcare professional who can assess your foot and potentially recommend further treatment.
An ingrown toenail occurs when the edge of the toenail grows into the surrounding skin, causing pain, swelling, and sometimes infection. It most commonly affects the big toe, but it can occur on any toe, and can make day to day activities uncomfortable.
If untreated, an ingrown toenail can become severely painful and lead to more serious complications such as infection.
Why does this happen?
There are many reasons this can occur including:
Improper Toenail Trimming: Cutting your nails too short or cutting into the corners of the nail can lead to ingrown toenails.
Excessive Sweating/Moisture: The skin surrounding the toenail(s) softens and increased the risk of toenail growing into the skin.
Tight Fitting Footwear: Shoes, socks or hosiery that is too tight can cause the toenail to grow into the surrounding skin.
Injury: Trauma to the toe, such as stubbing or pressure from our footwear can increase the risk on an ingrown toenail.
Nail Shape: Nails that are broad, curved or thickened can increase the risk of ingrown toenails.
How can I prevent this?
There are things you can do to prevent an ingrown toenail as part of your personal footcare routine. Further information and support available from our personal footcare site.
Important points to remember:
Ensure you are using the appropriate equipment and technique when cutting your nails. Cut nails straight across and avoid cutting them too short. Nail files are useful for maintaining nail length and smoothing any rough edges.
Good hygiene is essential (including hoisery). Washing and drying your feet properly can reduce risk of infection and reduce skin irritation.
It is important that your footwear is well fitting, with enough room for your toes. Avoid shoes that press your toes together. ‘Looking after your feet’ booklet
What do I do if I have an ingrown toenail?
For mild cases of ingrown toenails, the following methods may be effective:
Bathing In Salt Water: Warm water in a clean basin with ordinary table salt can sooth the symptoms of ingrown toenails and keep the affected toe(s) clean.
Correct nail cutting: Trimming your nails straight across and avoiding cutting into the edges can help the condition from worsening
Over-The-Counter Medication: Pain relief, paracetamol or ibuprofen.
Podiatry Treatment: If the ingrown toenail does not resolve, becomes more painful, persistent or infected, Podiatry treatment is advised. Details on how to make an appointment are below.
What will happen at my initial appointment?
At your initial podiatry appointment, your safety is paramount. Therefore, we will take a history of any long term health issues or medications to make sure that any management options discussed are suitable for you.
We may be able to resolve the problem on the day, however, in some cases you may need further treatment which may require a local anaesthetic (nail surgery). We will discuss all your treatment options and will refer you for nail surgery if agreed and appropriate. We will discuss with you the benefits, the risks and the alternative options which will give you the opportunity to voice any concerns you have and allow you to make an informed choice of your management plan.
We can arrange for antibiotics if they are required. You may be supplied them by the podiatrist or have them requested by you GP.
Nail Surgery
What is nail surgery?
If we have not been successful in managing your problematic nail conservatively, then we can refer you for nail surgery.
What will happen at my nail surgery appointment?
Again, you will have the chance to ask questions and voice any concerns. We will not proceed without your consent and you are free to decline treatment on the day if you so wish.
The procedure is performed under local anaesthetic which will numb the affected toe(s). This allows us to safely remove the full nail, or part of the nail depending on what was decided during the discussions. A chemical is then applied to the nail bed to prevent a portion or full nail from regrowth. This is a permanent solution which will reduce the chances of regrowth.
A family member/friend may accompany you to your appointment for support if needed.
Preparing for the appointment
Ensure you have breakfast/lunch depending on the time of your appointment
Bring open toe shoes (sandals, flip flops etc.) to accommodate the dressing that will be applied
Ask of family member/friend to drive you or consider public transport. If this is not possible you may drive
Ensure you are able to rest the foot following the procedure. The Local anaesthetic will wear off in approximately 2-3 hours, take care not to damage it while it is numb.
Aftercare and what to expect
We will discuss with you how best to look after your toe after your nail surgery procedure and provide written advice. You will be provided with a small supply of dressing and advised where you can source more dressings.
We will discuss expected healing times at the appointment. This can vary depending on any underlying health issues which may affect the rate of healing but could be anything up to 12 weeks.
It is important to monitor the are for sign signs and symptoms of infection -such as redness, increased swell or pain- and again, we will go through all this at the end of your appointment and allow you to ask any questions you may have
You can self-refer to NHS Greater Glasgow & Clyde podiatry by contacting NHSGGC Podiatry Referral Management Centre:
You will initially be given a telephone triage appointment, where you will have a consultation with one of our highly skilled podiatrists. Depending on the severity of your problem, they make any appropriate referrals or appointments as required.
Podiatry provide assessment, management and foot health education to individuals with conditions affecting the lower limb, enabling self-care and self management where possible. We have highlighted some of the most common problems below and created resources which you might find helpful in supporting your foot and lower limb health issue.
If you feel you need to speak to a podiatrist, then the details on how to do this are outlined below. It is likely that your first contact will be by telephone so we can triage you appropriately to best support your needs. Our consultations are delivered in various ways, including telephone, video, group education as well as face to face.
Podiatry does not provide personal footcare. Please refer to the ‘Personal Footcare’ resource above.
