Hallux valgus: What really helps with a crooked big toe

In hallux valgus, the first metatarsal bone shifts outwards, whilst at the same time the big toe moves towards the other toes. As a result, the metatarsophalangeal joint of the big toe protrudes more prominently on the inside of the foot, forming the characteristic bunion.

There are many causes – a family predisposition, weak ligaments and tendons, or certain foot shapes can contribute to its development. Conditions such as rheumatoid arthritis may also play a role. Tight or pointed shoes can exacerbate an existing deformity and increase the pressure on the bunion. Shoes with particularly high heels also alter the distribution of weight in the forefoot.

Hallux valgus cannot be permanently corrected anatomically using conservative measures. However, these measures can sometimes alleviate symptoms. Wearing suitable footwear is particularly important here. The forefoot should have sufficient space so that the toes are not pressed against one another. Flat shoes can further reduce the strain.

Splints, insoles and physiotherapy are also used. Splints can temporarily move the big toe into a more favourable position, but a permanent correction of the deformity is not to be expected. The current guideline recommends conservative measures primarily for symptom relief. Targeted exercises can strengthen the foot muscles and maintain mobility. In the event of pain, anti-inflammatory painkillers may also be used, depending on the individual situation.

Surgery should not be undertaken solely on the basis of the foot’s appearance. The decisive factors are symptoms and functional limitations.

Surgery may be particularly appropriate if:

• Pain persists despite conservative measures
• it is almost impossible to wear normal footwear
• mobility is significantly restricted
• the deformity significantly impairs everyday life
• further toe deformities develop

The current S2e guideline cites symptomatic hallux valgus following unsuccessful conservative treatment as a typical indication for surgery.

There is no single ‘hallux valgus operation’. The surgical procedure is tailored individually to the type and severity of the deformity. For milder deformities, for example, bony corrections can be carried out in the area of the first metatarsal bone. In cases of more severe deformities, other corrective procedures may be necessary.

The aim is not simply to make the big toe appear straight, but to correct the bone axes, improve weight-bearing in the forefoot and preserve the function of the metatarsophalangeal joint as much as possible.

Post-operative care depends heavily on the surgical procedure chosen. In many cases, weight-bearing on the foot may be permitted at an early stage using a special non-weight-bearing or therapeutic shoe. The exact timing for resuming weight-bearing is determined by the treating team. Swelling is quite normal and may persist for some time. Particularly after foot surgery, it can take several months for the swelling to subside completely and for normal shoes to be worn comfortably again.

Physiotherapy and targeted mobility exercises can help to restore mobility to the big toe.

Surgery corrects the existing deformity but does not eliminate all the underlying causes. For this reason, a recurrence can sometimes occur. Even after successful surgery, it is still advisable to wear well-fitting shoes. They reduce pressure on the forefoot and can help prevent discomfort.

It is also important not to judge whether treatment has been successful based solely on the appearance of the foot. The decisive factors are pain, mobility, the ability to bear weight and function in everyday life.

A hallux valgus does not need to be treated as long as it does not cause any symptoms. In the case of painful deformities, suitable footwear, physiotherapy and other conservative measures can initially relieve the symptoms. If these prove insufficient and everyday life is significantly restricted, surgery can correct the deformity. The most suitable procedure depends on the individual’s anatomy and the extent of the deformity.