A bunion and big-toe arthritis can occur separately or together. Hallux valgus primarily describes deviation of the toe, while hallux rigidus describes painful restriction and degeneration of the first metatarsophalangeal joint. The distinction matters because the operation designed to correct alignment may not address pain arising from advanced cartilage loss.
During examination, the clinician assesses the range and quality of joint movement. Pain at the end of motion, grinding, dorsal bony prominence and marked stiffness can suggest arthritis. It is also important to determine whether pain is mainly over the medial bunion prominence, within the joint, beneath the sesamoids or elsewhere.
Weight-bearing X-rays may show narrowing of the joint space, osteophytes, cysts, sclerosis or altered shape of the metatarsal head. The severity of radiographic change should still be correlated with symptoms because imaging and pain do not always match perfectly.
Where the joint remains reasonably preserved, a corrective osteotomy such as an Austin/Chevron procedure may be considered for an appropriate deformity. If arthritis is advanced, another procedure may provide a more predictable way of addressing pain and function. The choice depends on age, activity, movement, deformity, joint quality and personal goals.
This is another reason why selecting a bunion operation from the visible bump alone is inappropriate. The health of the joint is central to both the recommendation and the expected result.