Bunion Clinical Presentation

Updated: Apr 05, 2016
  • Author: Richard T Laughlin, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Presentation

History and Physical Examination

Patient demands and expectations, as well as footwear, should be assessed before treating the patient with a bunion deformity. [22] A directed history should be taken and physical examination should be performed to address vascular status, possible neuropathies, and medical comorbidities. Patients should be examined standing as this often increases the hallux valgus (HV) and associated deformities.

The forefoot and hindfoot should be assessed, as should tightness of the gastrocsoleus complex. Note pronation of the great toe, and assess the first metatarsophalangeal joint (MTPJ) for range of motion. To assess first tarsometatarsal (TMT) instability, the examiner can immobilize the lesser metatarsals (MTs) with one hand while using the other hand to grasp the first MT and move it from a plantar-lateral to a dorsomedial direction. Movement of more than 9 mm indicates hypermobility. The examiner should also check for signs of general ligamentous laxity. [23, 24]

Activity level must be assessed, as the athletic patient with high physical demands may place more emphasis on mobility of the joint than on correction of the deformity. [25]

Finally, footwear must be addressed. A good radiographic result does not necessarily translate to unrestricted footwear use; Mann and Coughlin [4] reported that only 59% of their patients had unrestricted footwear use after bunion correction.