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Dr. Ebraheim’s educational animated video describes the condition of bunions - types. Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Find me on Instagram @OrthoInitiative Bunion Types Hallux Valgus is a bunion deformity of the big toe. Tailor’s bunion or bunionette deformity is a deformity of the 5th metatarsal. Another bunion type is a dorsal bunion. Hallux valgus is a common foot deformity with a lot of misconceptions about them. People sometimes describe this deformity as a bump on the side of the big toe. This visible bump (bunion) is usually associated with a lot of changes in that part of the foot. The big toe will deviate laterally (point towards the second toe), and this will throw the bone out of alignment, creating the bunion. It is a progressive problem that may cause pain or soreness, burning sensation, inflammation or redness, and women are more likely to have bunions than men. It is more prevalent in aging females. Bunions are usually progressive, and they do not disappear. The symptoms occur when wearing shoes with a tight shoe box or when wearing high heels. Etiology is multifactorial, which includes chronic exposure to narrow toe box shoes and maybe some genetic predisposition. The valgus deviation of the proximal phalanx promotes varus positioning of the first metatarsal which displaces the metatarsal head medially, leaving the sesamoid complex laterally translated relative to the metatarsal head. The first line of treatment of hallux valgus is shoe modification, pads, orthosis, or spacers. Surgical correction is done if the symptoms persist despite conservative treatment, including shoe modification. Surgical correction is done if the symptoms persist despite conservative treatment, including shoe modification. The type of surgery depends on the severity of the condition. It is a prominence of the lateral part of the fifth metatarsal head. It is more common in females. It is usually bilateral and has three types. In Type I, the fifth metatarsal head is enlarged or there might be lateral exostosis. In Type II, there is bowing of the fifth metatarsal. In Type III, there is increased four and five intermetatarsal (IM) angle. It is the most common type. Nonoperative treatment of Tailor’s Bunion is anti-inflammatory medications, shoe modification, or orthotics. Surgery is done if conservative treatment fails to relieve the symptoms. Do lateral condylectomy (excise the bump) for Type I. Do distal metatarsal osteotomy for Type II. Do oblique diaphyseal osteotomy if the intermetatarsal (IM) angle is more than 12 degrees. Dorsal bunion occurs due to dorsal flexed first metatarsal, over activity of the tibialis anterior muscle. The tibialis anterior muscle is an antagonistic muscle to the peroneus longus muscle. Dorsal bunion can also occur due to weakness of the peroneus longus tendon. Dorsal bunion can occur as a residual deformity after correction of a clubfoot deformity. The imbalance between a strong tibialis anterior tendon and a weak gastrocnemius soleus complex, which is compensated by strong secondary plantar flexors, such as the flexor hallucis longus and brevis will lead to the development of dorsal bunion. Over time, the contracture of this tendon results in plantar flexion of the big toe and a dorsal bunion. The patient complains of a deformity such as dorsal callosities and metatarsalgia. The shaft of the first metatarsal is dorsiflexed, and the great toe is plantar flexed, resulting in a prominent head of the first metatarsal. The condition is usually treated with tibialis anterior lengthening or flexor hallucis longus transfer to the plantar aspect of the first metatarsal head, and maybe plantar flexion osteotomy of the first ray. In general, dorsal bunion occurs due to a normal tibialis anterior muscle overpowering a weak peroneus longus, which results in elevation or dorsiflexion of the first ray, and this is usually seen in patients with a history of a club foot. Usually the gastrocnemius soleus is weak due to prior surgery. This is compensated by plantar flexion of the big toe by using the flexor hallucis brevis.