Hallux valgus

Hallux valgus (bunion) is a deformity of the big toe and often affects middle-aged women. The deformity is usually the result of splayfoot.

The base joint of the big toe bends towards the outside of the foot and the tip of the toe bends inwards, displacing or overlapping the adjacent toe. This deformity can appear in a number of different ways.

Symptoms

The most common symptoms include:

  • pain when wearing shoes, especially on the inside of the metatarsophalangeal joint of the big toe (where a ‘ball’ may form due to the constant irritation)
  • displacement of the smaller toes outwards/upwards with the formation of hammer toes
  • unstable gait due to the changed statics
  • pain during rest

Causes

Hallux valgus is more common in women than men. The misalignment of the toes may be hereditary or it may result from conditions that weaken the connective tissue.

Wearing shoes that are too narrow, too high or too pointed promotes the development of the toe deformity. The pressure that this exerts on the toes changes the axis of the toes, as well as the direction in which the muscles and tendons are pulled. As a result, the toe is pulled more and more towards the sole of the foot and turns inwards.

Other causes are inflammatory diseases (e.g. rheumatism), pes valgus and pes planus (flat foot), as well as genetic factors.

Diagnosis

An X-ray is carried out to determine the degree of misalignment.

There are four different stages of hallux valgus, which are crucial to determining the appropriate treatment.

  • Stage 1 – misalignment of the big toe by up to 20 degrees
  • Stage 2 – misalignment of the big toe by up to 30 degrees, with occurrence of occasional pain
  • Stage 3 – misalignment of the big toe by up to 50 degrees and pain on the balls of the feet, as well as a sensation of pressure when wearing shoes
  • Stage 4 – big toe displaces the second toe; permanent pain and extreme discomfort when walking

Treatments

Depending on the severity of the hallux valgus, conservative or surgical therapy is used.

Conservative therapies

If the angle of the hallux valgus angle is lower than 20 degrees, it is possible to treat it without surgery or to delay the surgery. The treatment is carried out using foot or toe exercises, insoles, tapes or a bunion splint.

A bunion splint can be used in the early stages of hallux valgus to build up and strengthen specific muscles in the foot. This can counteract the deformity and also relieve any pain that occurs.

Physiotherapy and special tapes can stop the progression of the deformity.

Surgical treatment

The indication and method of surgical correction are always based on the patient’s personal wishes, and are decided upon in a conversation between doctor and patient. The stage of the hallux valgus is also taken into account.

With the surgical methods and implants available today, the operation has a success rate of around 98%. Bunion operations having a bad reputation due to poor outcomes is definitely a thing of the past.

Minor misalignment

Chevronosteotomy – after separating the metatarsal heads, the bony part is removed and the two bones are connected and fixed using screws or a suture.

Moderate misalignment

Scarf and Ludloff osteotomy: The first metatarsal bone is severed on the shaft either in a Z-shape (according to Scarf) or diagonally (according to Ludloff) and then fixed with a screw.

Severe misalignment

Lapidus technique: The position of the metatarsal bone is corrected. It is fixed in place with metal plates that are screwed to the bones. The plates secure the foot in the corrected position.

Aftercare

After the operation, the patient can bear weight on the foot, but the foot should be rested for at least two weeks. A special bunion shoe, which is adapted to the individual patient, must be worn for the following four to six weeks.

FAQs

When is surgery required for hallux valgus?

Surgery is require if large parts of the joint surface are destroyed due to cartilage wear and the patient wants long-term pain relief.

Can hallux valgus go away on its own?

No, there is no evidence that hallux valgus will go away on its own. However, there are specific measures, such as a bunion splint, physiotherapy or tapes, which can be used to ensure that the condition does not progress further.

What can you do to prevent hallux valgus?

As the main cause of bunions is wearing the wrong shoes, you should avoid wearing high-heeled or pointed shoes.

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