Introduction: The term dorsal bunion describes a condition characterised by a swelling in the region of the 1st MTPJ with an elevated first metatarsal and a flexed toe. The literature available concentrates on the forefoot aetiology- no author has yet documented the role of the hindfoot in its pathogenesis.

Methods: We have conducted a review of 28 consecutive patients, excluding those with hallux rigidus collected prospectively in the course of a full-time foot and ankle practice between 1996 and 2005. All of the patients have been examined with respect to their primary pathology leading to the dorsal bunion and had the mobility and position of the hindfoot assessed.

Results: In the series of 28 patients, the average age was 31.6 and there were 18 male and 10 females. Every patient examined had either a rigid hindfoot or stiffness contributing to a failure to correct for abnormal forefoot position.

Conclusion: The causes of dorsal bunion may be considered to be Primary (Hallux Rigidus) or Secondary (CTEV, neurogenic, iatrogenic, global forefoot supination).

It is the authors’ view that hindfoot stiffness in secondary cases of dorsal bunion causes an inability of the footto compensate for an abnormal position of the forefoot- the 1st ray must compensate by flexion of the hallux to allow the foot to adopt a plantigrade position.