Hallux Valgus (Bunions): Deformity of the Big Toe - Information & Specialists

Mechanical irritation can occur, particularly in shoes that are too tight and have high heels, which do not allow enough width for the toes when walking. This causes the big toe to be constantly pushed outward against the edge of the shoe. This constant pressure leads to a chronic misalignment of the bone and, consequently, to hallux valgus. It can also result in changes to cartilage, tendons, and muscles, as well as inflammation.

At the widest part of the foot, constant mechanical friction eventually leads to the formation of a painful bunion. This is caused, among other things, by inflammation of the bursa located beneath the skin.

Furthermore, the metatarsophalangeal joint of the big toe wears down more quickly due to the misalignment. This severely restricts the movement of the toe and intensifies the pain. Wear and tear of the metatarsophalangeal joint of the big toe is referred to as metatarsophalangeal osteoarthritis 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 is overlapped by the second toe.

As the condition progresses, the other toes, as well as the adjacent joints and the metatarsal bones, are also affected. This leads to overuse and painful symptoms (metatarsalgia).

Visible external symptoms include, in particular, painful calluses caused by pressure under the metatarsophalangeal joints of the smaller toes.

Orthopedic specialists or foot surgeons are the appropriate professionals to consult for a diagnosis. During the initial medical history interview, the doctor first asks the patient about their symptoms. The doctor also inquires about known risk factors.

Hallux valgus can often be clearly diagnosed simply by visual examination. If there is any doubt, an X-ray is performed.

Depending on

• severity and
• stage,
• symptoms, and
• the resulting pain

, the treating physician determines the course of treatment. A mild case of hallux valgus can be treated with conservative methods.

In moderate to severe cases, the deformity should be corrected through surgery. Depending on the stage of hallux valgus, different surgical procedures must be used. The toe deformity initially causes no pain and goes largely unnoticed. For this reason, hallux valgus is rarely diagnosed in its early stages.

In general, switching to

• orthopedic shoes,
• walking barefoot, and
• foot exercises

highly recommended for hallux valgus. Conservative treatments such as foot exercises should be pursued as long and as extensively as possible.

Advanced hallux valgus can no longer be alleviated or halted by wearing the right footwear. Instead, surgical treatment for hallux valgus must be initiated.

Surgery always carries a certain risk. As with any surgical procedure, in rare cases

• bleeding,
• thrombosis,
• nerve damage, or
• infections

may occur.

To achieve the best possible and long-lasting results, those affected should consult an experienced orthopedic technician. You’ll be in the best hands at foot surgery centers. Orthopedic technicians can optimize the healing process and help prevent the hallux valgus from recurring.

What You Need to Know About Hallux Valgus Surgery

Hallux valgus surgery is relatively complex. Earlier surgical procedures were primarily aimed at realigning the misaligned big toe and “cutting away” the bothersome bunion. Today, the goal is to preserve the joint and restore its natural alignment as much as possible. Depending on the specific circumstances, different methods are used as part of an individualized treatment plan.

In total, there are over 150 different surgical techniques for hallux valgus. In German-speaking countries, about 10 of these are commonly used. The various hallux valgus surgeries can be divided into three different groups:

• Pure soft-tissue techniques (surgeries on soft tissues such as tendons and capsules),
• pure bony surgical techniques, and
• combined procedures for correcting both bone and soft tissue.

Procedure for Hallux Valgus Surgery

Depending on the severity of the hallux valgus, it may be sufficient to remove the bony protrusion (exostosis resection) and reposition the metatarsal bone (realignment osteotomy). A small titanium screw secures the realignment. The screw generally does not need to be removed. A special shoe must be worn until complete healing, which takes approximately four to six weeks.

Another option involves a Z-shaped cut through the first metatarsal bone (osteotomy). This corrects and stabilizes the position of the toe. Recovery after surgery takes about 6 weeks, during which a special shoe must also be worn. Putting weight on the foot while wearing this special shoe is not a problem.

In severe cases of hallux valgus, the angle between the first and second metatarsal bones is significantly increased. In this case, the head of the first metatarsal bone protrudes sharply inward. One possible surgical method involves cutting through the metatarsal bone and realigning it at its base (realignment osteotomy).

Almost all common surgical methods for hallux valgus involve cutting through the metatarsal bone. They differ in the incision techniques used.

In most cases, the surgery is performed during an inpatient hospital stay.

Patients receive comprehensive information about possible complications before the procedure. Complications such as

• bone infections,
• joint infections,
• nerve or
• vascular injuries

are relatively rare.

With foot surgery, there is always an increased risk of thrombosis due to the prolonged immobilization of the leg during and after hallux valgus surgery. For this reason, preventive thrombosis prophylaxis is administered. The patient must administer the appropriate injections for a certain period of time.

Following this surgery, patients with hallux valgus should strictly adhere to the doctor’s medical advice and instructions. The focus is not only on alleviating symptoms but also on preventing the recurrence of hallux valgus. The patient must consistently incorporate the appropriate preventive and follow-up care measures into their daily routine and take them seriously.

Postoperative immobilization of the foot is important for healing. Placing excessive strain on the foot too soon could significantly worsen the long-term prognosis.

A prolonged period of being unable to work or participate in sports is essential following hallux valgus surgery. Full participation in sports is not possible until six months after surgery. However, pain-free walking should be possible much sooner.

A special orthopedic cast shoe is recommended for 6 weeks after surgery. After that, a specially fitted shoe should be worn for 3–6 months postoperatively.

It is important that the patient continues to take good care of their feet in the long term after surgery. This includes avoiding high heels as much as possible.

The same measures generally apply for successful treatment as for the prevention of hallux valgus:

• Walking barefoot frequently,
• Wearing comfortable (orthopedic) shoes,
• foot exercises, and
• foot massages.

Despite all precautions, an axial deviation may recur after hallux valgus surgery. In rare cases, a second procedure may then be necessary.

If there is no advanced osteoarthritis in the metatarsophalangeal joint of the big toe, the healing process after surgery is good to very good for the majority of patients. The long-term prognosis depends on the stage of hallux valgus at the time of diagnosis, as well as the accuracy of that diagnosis. The surgical method chosen and the surgeon’s experience also play an equally important role. In addition, the patient can influence the long-term outcome by consistently following postoperative instructions.

Since hallux valgus is often exacerbated by improper footwear, the prevention strategy follows accordingly: High-heeled shoes that are tight in the toe box should be worn only rarely. It is recommended to wear a variety of footwear; this generally prevents misalignment.

Wearing comfortable shoes with good arch support that leave plenty of room for the toes at the front is an effective preventive measure. Foot exercises are recommended to counteract the immobilization of the feet in shoes. Massages and foot baths are also beneficial for the feet.

Walking barefoot is also a good preventive measure against hallux valgus, as it acts as a kind of natural massage for the feet. When walking barefoot, the foot muscles are engaged in a completely different way than when walking in shoes.

So walk barefoot as often as possible to support the natural alignment of your toes and feet!

Even in cases of mild hallux valgus, it’s advisable to see a primary care physician or orthopedist. Once hallux valgus has developed, it’s difficult to stop the process that has already begun.

At the very latest, when the misalignment goes beyond a cosmetic deformity of the toe and is accompanied by pain, you should urgently see a specialist.

The pain can be alleviated by making appropriate adjustments to footwear, etc. However, hallux valgus can only be cured after a foot surgeon corrects the misalignment through surgery.