Hallux valgus - also known as bunion - is a painful deformity of the big toe. In Germany alone, over 10 million people suffer from it. Women are far more frequently affected by hallux valgus, as the toe deformity is usually the result of shoes that are too tight and pointed. You can find further information and selected hallux valgus specialists here.
Many factors influence the development of hallux valgus. Some families are predisposed to it. However, most cases are due to unhealthy footwear.
Mechanical irritation can occur, particularly in shoes that are too tight and leave too little room for the toes in terms of width. The big toe is permanently pressed outwards against the edge of the shoe. This permanent pressure leads to a chronic misalignment of the bone and thus to hallux valgus. It can also lead to changes in the cartilage and tendons as well as inflammation.
Development of hallux valgus deformity: healthy on the left, hallux valgus on the right © barbulat | AdobeStock
Women are more at risk of developing hallux valgus due to shoe fashion in western industrialized nations. Conversely, in countries where open shoes or no shoes at all are worn, significantly fewer people suffer from hallux valgus.
A splayfoot position can also promote the development of hallux valgus. In this case too, the big toe is pressed towards the outer edge of the foot. The misalignments reinforce each other so that both conditions - hallux valgus and splayfoot - require medical treatment.
People with weak connective tissue have a special predisposition to developing hallux valgus. The strength and elasticity of the connective tissue also decreases with age and the entire weight of the body rests on the feet. The pressure can then lead to a widening of the foot skeleton in conjunction with incorrect loading.
The symptoms vary and change over the course of the disease depending on the severity and stage of hallux valgus.
The big toe deviates outwards from its base joint. At the beginning of the clinical picture, hallux valgus is therefore primarily a cosmetic problem.
As the condition progresses, the other toes also deviate outwards or can be overlapped by the big toe. The first painful symptoms occur on the inside of the first metatarsal bone.
High heels and pumps promote the development of hallux valgus © superelaks | AdobeStock
At the widest point of the foot, a painful bunion develops due to constant mechanical friction. This is caused, among other things, by inflammation of the bursa under the skin.
Furthermore, the metatarsophalangeal joint of the big toe wears out more quickly due to the misalignment. This severely restricts the movement of the toe and increases the pain. Wear and tear of the metatarsophalangeal joint of the big toe is referred to as metatarsophalangeal joint arthrosis or hallux rigidus.
In addition to the first toe (big toe), the second toe can also be affected by hallux valgus. In this case, the big toe partially or completely overlaps or underlaps the second toe.
Later on, the other toes as well as the neighboring joints and the metatarsal bone are also affected. This leads to overloading and painful symptoms (metatarsalgia).
Externally visible symptoms include painful pressure calluses under the metatarsophalangeal joints of the small toes.
The misalignment of the toes initially causes no pain and is not noticeable. This is why hallux valgus is rarely diagnosed in the early stages.
Orthopaedic specialists or foot surgeons are the people to contact for a diagnosis. The doctor will first ask about the patient's symptoms in a medical history interview. They will also ask about any known risk factors.
Hallux valgus can often be clearly diagnosed at a glance. In case of doubt, an X-ray examination is used.
Hallux valgus can often be recognized immediately by looking at the ball of the toes © luaeva | AdobeStock
Depending on
the attending physician determines the therapy. A mild hallux valgus can be treated with conservative therapy options.
In moderate to severe cases, the deformity should be corrected by surgery. Different surgical procedures must be used depending on the stage of hallux valgus.
In the early stages, switching to comfortable, well-fitting shoes can help to stop the deformity from worsening. The affected person must then wear shoes that are neither too tight, nor too high or too short and leave plenty of room for the toes. Thong sandals are a popular form here.
Thong sandals leave enough room for the toes © familie-eisenlohr.de | AdobeStock
In principle, switching to
Conservative treatments such as foot exercises should be used as long and as extensively as possible.
Advanced hallux valgus can no longer be reduced or stopped by wearing the right footwear. Instead, surgical treatment must be initiated.
Surgery always involves a certain degree of risk. As with any surgical procedure, in exceptional cases
can occur.
In order to achieve the best and most sustainable results possible, patients should consult an experienced orthopaedic technician. In this respect, you are in the best hands at foot surgery centers. Orthopaedic technicians can optimize the healing process and help prevent the hallux valgus from recurring.
Hallux valgus surgery is relatively complicated. Earlier surgical procedures were primarily aimed at straightening the malposition of the big toe and "cutting away" the troublesome bunion. Today, the aim is to preserve the joint and restore the natural proportions as far as possible. Different methods are used to achieve this, depending on the respective conditions in an individual treatment concept.
In total, there are over 150 different surgical techniques for hallux valgus. Around 10 of these are commonly used in German-speaking countries. The various hallux valgus operations can be divided into three different groups:
Depending on the severity of the hallux valgus, it may be sufficient to remove the bony protrusion (exostosis removal) and reposition the metatarsal bone (repositioning osteotomy). A small titanium screw fixes the realignment. The screw does not usually have to be removed again. A special shoe must be worn until complete healing, which takes around four to six weeks.
Another option is to cut the first metatarsal bone in a Z-shape(osteotomy). This corrects and fixes the position of the toe. Healing after the operation takes approx. 6 weeks, during which a special shoe must also be worn. Weight-bearing on the foot in this special shoe is not a problem.
In the severe form of hallux valgus, the angle between the first and second metatarsal bones is significantly increased. In this case, the head of the first metatarsal protrudes strongly inwards. One possible surgical method is to cut through the metatarsal bone and reposition it at its base(repositioning osteotomy).
Almost all common surgical methods for hallux valgus involve cutting through the metatarsal bone. They differ in the way they are performed.
Surgery is usually performed as part of an inpatient hospital stay.
Patients receive comprehensive information about possible complications before the procedure. Complications such as
are rather rare.
There is always an increased risk of thrombosis during and after hallux valgus surgery due to the prolonged immobilization of the leg. Preventive thrombosis prophylaxis is therefore carried out. The patient must administer appropriate injections for some time.
Following this operation, the patient should strictly adhere to the doctor's medical advice and instructions. The focus is not only on healing, but also on preventing a recurrence of hallux valgus. The patient must consistently integrate the appropriate preventive and follow-up treatment measures into everyday life and take them seriously.
Post-operative immobilization of the foot is important for healing. Putting too much strain on the foot too early could significantly worsen the long-term prognosis.
After hallux valgus surgery, it is essential that you are unable to work or play sport for a longer period of time. Sport is only fully possible again after six months. However, pain-free walking should be possible much earlier.
A special orthopaedic bandage shoe is recommended for 6 weeks after the operation. A specially adapted shoe should then be worn for 3-6 months postoperatively.
It is important that the patient continues to look after their feet in the long term after the operation. This also includes avoiding wearing high heels as much as possible.
As a rule, the same measures apply for successful treatment as for the prevention of hallux valgus:
Despite all the care taken, a deviation of the axis can occur again after hallux valgus surgery. In rare cases, a second operation is then necessary.
The long-term prognosis depends on the stage of the hallux valgus at the time of diagnosis and its accuracy. The surgical method chosen and the surgeon's experience play an equally important role. In addition, the patient can influence the long-term result by consistently adhering to the post-operative instructions.
If there is no advanced osteoarthritis in the metatarsophalangeal joint of the big toe, the healing process after surgery is good to very good in the majority of patients.
As hallux valgus is often promoted by incorrect footwear, the prevention strategy can be derived accordingly: High shoes that run tight at the front should rarely be worn. It is advisable to wear a variety of footwear, as this usually prevents deformities.
Wearing comfortable shoes with a good footbed that leave plenty of room for the toes at the front is an effective preventive measure. Foot exercises are recommended to compensate for immobilizing the feet in shoes. Massages and foot baths are also good for the feet.
Walking barefoot is also a good preventative measure against hallux valgus, as it is a kind of natural massage for the feet. Walking barefoot challenges the foot muscles in a completely different way to walking in shoes.
So walk barefoot as often as possible to support the natural position of your toes and feet!
Frequent barefoot running is good for your feet © Halfpoint | AdobeStock
Even in the case of a minor malposition of the big toe, it is advisable to consult a GP or orthopaedist. Once hallux valgus is present, it is difficult to stop the process once it has started.
At the latest when the deformity goes beyond a cosmetic deformation of the toe and is associated with pain, a specialist should be consulted urgently.
The pain can be alleviated by making appropriate changes to the footwear, etc. However, hallux valgus can only be cured after a foot surgeon has corrected the deformity as part of a surgical procedure.
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