Hallux valgus – causes, symptoms and surgical treatment

Proven content

Hallux valgus is a condition in which the first toe of the foot begins to become valgus and tilts towards the outer edge of the foot, while the metatarsal bone deviates towards the inner edge of the foot. Hallux valgus often leads to degenerative changes in the area of ​​the metatarsophalangeal joint I. In Poland, halluxes affect approximately one hundred thousand people, but not all of them consult a doctor with them.

Hallux valgus – definition

Hallux valgus, commonly known as hallux, is a deformation of the foot that is characterized by valgus (deviation) of the first toe outwards beyond the edge of the foot and a deviation of the XNUMXst metatarsal bone towards the inner edge of the foot. Very often, the protruding bone is irritated by shoes, which causes frequent inflammation of the articular bursa and the formation of a characteristic bone superstructure. In people with advanced ailment, the big toe overlaps the second and sometimes even the third and may twist. At first, the lesions are painless and occur sporadically, but over time, local inflammation develops, which is characterized by intense pain. Often the hallux valgus leads to the formation of degenerative changes in the area of ​​the metatarticular joint, causing pain. The method of treating this condition depends on the degree of deformation of the foot and whether it is accompanied by pain and degenerative changes. Sometimes it is enough to change shoes to a more comfortable one (small heel, wide nose) and wearing an orthosis that pulls the toe medially. However, severe deformity requires surgical treatment, which is the only method that permanently changes the position of the bones and reduces the deformation.

Important: Hallux valgus usually occurs in women, not only because of the tendency to wear inappropriate footwear, but also because women have a weaker muscle-ligament structure of the foot than men. However, men also have halluxes, so it is not only the fault of bad shoes.

The causes of hallux valgus

The most common causes of hallux valgus are:

1. wearing inappropriate footwear – especially wearing high heels leads to overloading the forefoot; the forefoot widens and the transverse arch of the foot is lowered. In addition, shoes with narrow toes increase the pressure on the toe, which significantly intensifies the deformation and causes inflammation;
2. genetic predisposition – we can inherit from our relatives: a disturbed shape of the metatarsal joint, unnatural position of the metatarsal bones, the Egyptian shape of the foot (a big toe longer than the other finger), weakening of the connective tissue – these elements are the cause of hallux valgus. About 70% of all bunions occur in the family (especially in women), and a grandmother, mother, daughter or granddaughter are also unhappy owners.
3. sex – hallux is a disease that occurs much more often in women than in men (it is related to the weaker ligamentous structure of the female foot);
4. flat feet;
5. injuries;
6. excessive length of the big toe;
7. contracture in the area of ​​the Achilles tendon;
8. amputation of the second finger;
9. pathology of the posterior tibial muscle;
10. rheumatoid arthritis;
11. gout;
12. psoriatic arthritis;
13. Down’s syndrome or Marfan’s syndrome.

Hallux valgus symptoms

Bunions may be accompanied by the following symptoms:

1. reddening,
2. pain,
3. inflammation around the bones and metatarsal head,
4. exudative bursitis at the height of the metatarsophalangeal joint,
5. subluxation of the metatarsophalangeal joint.

Hallux valgus – diagnosis

Before the treatment of hallux valgus is implemented, the patient should be carefully examined. The diagnosis is very important as it helps to reduce the risk of further development of the disease. The doctor conducts an interview with the patient in which he explains the nature of the deformation of the big toe and discusses possible treatment methods. In addition, it presents the risks associated with the surgery itself and possible complications.

Diagnostic tests performed in the case of hallux valgus are:

1. ultrasound examinations,
2. morphological research,
3. radiological examinations (photos should be taken with full load),
4. computed tomography,
5. magnetic resonance imaging,
6. pedobarographic tests, which not only help in assessing the extent of pressure exerted on the plantar side of the foot while walking and standing, but also is useful in carefully planning the surgery

Hallux valgus – treatment methods

In people whose deformity is at an advanced stage and the pain is very troublesome – only surgery is effective. Thanks to newer and newer operating solutions, it is possible to avoid later wearing of plaster and prolonged immobilization. There is no one effective method of fighting hallucinations, because the causes of their formation are different. In addition, the method and anesthesia depend on the degree of deformation of the big toe. Of course, you can choose between general and regional anesthesia, but some hospitals offer bunion surgeries even under local anesthesia.

Hallux valgus surgery methods:

1. Chevron osteotomy – a type of osteotomy performed in some cases of hallux. The method is carried out in the area of ​​the head and metatarsal bones;
2. wedge and hemispherical osteotomies – used for hallux. During the procedure, the bone wedge is cut out in the vicinity of the bones, it can also be removed or moved to another place in order to correct the bunion;
3. method according to Lapidus (arthrodesis of the first metatarsophalangeal joint);
4. arthrodesis of the metatarsophalangeal joint of the big toe;
5. Scarf method: a method of stable fixation of fractures that allows for non-plaster treatment. People after bunion surgery, shortly after the surgery (2-3 days), may put a strain on the foot using special shoes. After about six weeks, patients return to walking in everyday shoes.

The listed operational methods have different indications. Chevron osteotomy and the Scraf method are performed in people with mild or moderate deformity. In turn, large distortions subjected to the Scraf method or its modifications.

In addition to surgery, there are other methods to help fight hallux valgus:

1. day or night correction appliances – used in the prevention and treatment of bunions and in rehabilitation after surgery. This product relieves pain and stops the hallux from worsening;
2. pads, pads, half-gel pads: prevent transverse flat feet, inhibit the development of bunions. Can be used as cushions for high heels;
3. silicone metatarsal insoles – dedicated to women with transverse flat feet and bunions. Thanks to the pelotte, the transverse arch of the foot is raised, which corrects the hallux;
4. hallufix – a splint recommended for prophylaxis and treatment of hallux valgus at the initial stage, with little deformation;
5. gel covers and patches for bunions: contain healing oils, soothing sore spots;
6. valgus bandage – the gel insert protects against abrasions and keeps the toe in the right position, it also affects the pressure distribution on the foot and prevents muscle weakness and bone deformation;
7. interdigital separators: they are designed to restore the original position of the fingers, relieve pain and friction. Wedges are recommended especially in the case of bunions where the fingers overlap and corns between the fingers.

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How to prevent hallux valgus?

The most important thing is to wear comfortable footwear, preferably one that is not too narrow and tight. Toe exercises and general physical activity are also recommended to prevent overweight / obesity.

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