Hallux valgus (bunion) – one of the most common foot deformities of Western cultures. In the course of the disease, there is a toe malposition; in particular, of the big toe.
What is hallux valgus (bunion)?
Schematic diagram showing the anatomy and structure of the foot with and without hallux valgus. Click to enlarge. The term hallux vagus (bunion) is the medical term for a deformity of the so-called big toe directed toward the outside of the foot. Depending on the patient, the deformity associated with hallux valgus (bunion) can affect different limbs of the metatarsal bones. However, the common feature of hallux valgus is a protrusion of the metatarsal head towards the inner side of the foot. The course of the extensor tendons is impaired by the presence of hallux valgus (bunion) and can thus further promote the deformity.
Causes
Possible causes for the occurrence of hallux valgus (bunion) are varied: among other things, medical experts assume hereditary factors that can increase the risk of developing hallux valgus (bunion). Such hereditary factors can, for example, be predispositions to weak connective tissue that is less able to support the muscles and bones of the foot as a result. This factor is also partly responsible for the fact that mainly women are affected by hallux valgus (bunion). Furthermore, the presence of a so-called splay foot is a risk factor for the development of hallux valgus (bunion), as the pressure on the ball of the toe is thus increased. And especially often, the wrong footwear can also lead to hallux valgus (bunion):
In Western cultures, hallux valgus (bunion) occurs much more frequently; wearing high shoes (e.g., high heels, heeled shoes)) that are pointed is particularly unfavorable.
Symptoms, complaints and signs
An externally already recognizable symptom of hallux valgus is a deformation of the big toe with an angle of inclination to the small toes, while the base joint of the big toe protrudes inward due to the deformation and is usually swollen. Because normal shoes are often not wide enough not to put pressure on the irritated metatarsal head, swelling, redness and bursa irritation at the joint often occur at this site, causing pain when walking. In the early stages, there is usually no pain, and the deformity is still primarily an aesthetic problem. However, because the joint becomes irritated in the long run due to the constant pressure, the pain increases over the years and the irritation of the metatarsophalangeal joint of the big toe can lead to arthritis in the joint, which severely affects walking. In addition, the malposition of the big toe leads to a lack of space for the middle toes, which thus have to move upwards, favoring hammer or claw toes, on which painful pressure marks usually form due to the pressure from above in the shoe. Because the bunion disturbs the statics of the entire foot, the entire foot can also hurt.
Course
A hallux valgus (bunion) can reach different degrees of severity. However, these are not always related to the discomfort caused by the hallux valgus (bunion):
Thus, even a low degree of expression can lead to discomfort. The first symptoms often occur at the base of the big toe: Here, the head of the metatarsal pushes towards the inside of the foot. Since the foot is widest here, the pressure of the shoe is also greatest; bursae located under the skin often grow to protect the bone from the pressure. Inflammation can then occur at this bursa. The resulting misalignment can lead to osteoarthritis (wear and tear of the cartilage) in the metatarsophalangeal joint of the big toe as it progresses. The displacement of the big toe can be up to 90 degrees in severe cases.
Complications
Depending on the stage, hallux valgus is corrected surgically. The goal of the operation is not only to restore a cosmetically beautiful foot, but also to allow the foot to bear weight without pain and without restrictions. Depending on the severity and how far the wear of the incorrectly loaded toe has already progressed, surgery may not always bring the desired success. In addition to this complication, there are the general surgical risks that can lead to complications afterwards (pulmonary embolisms, wound healing disorders).Despite possible complications, hallux valgus should always be treated. If the condition remains untreated, massive pain can occur in the foot. The pain also includes the small toes due to the “hammer toe” formation. Since the bulge of the big toe presses permanently against the shoe, blisters and inflammations at the friction points are hardly avoidable. In the long term, hallux valgus leads to a considerable restriction of mobility; sufferers avoid walking. Loss of enjoyment of life and isolation are the consequences of untreated hallux valgus, especially for older people. The increased risk of falling should not be underestimated. Because those affected find it difficult to walk, they tend to be unsteady, which in turn makes them prone to falls with a wide variety of consequences.
When should you see a doctor?
A doctor should be consulted even if the big toe is slightly misaligned, preferably an orthopedist, because otherwise the misalignment can progress and cause more and more discomfort. A visit to the doctor is also advisable if the hallux valgus is already causing pain in the feet and in the pelvic area. The malpositioning of the big toe can cause severe pain and unsteadiness when walking, which requires treatment and severely restricts the everyday life of the affected person. It is often necessary to seek medical treatment for the resulting pain in muscles, tendons and joints, insensitivity, swelling and circulatory problems. A specialist should always be consulted if the deformity is not only an aesthetic problem, but is associated with pain when walking. A doctor can advise on shoes that are more suitable and initiate appropriate treatment measures to correct the deformity. In addition, he can advise on surgical procedures to correct a hallux valgus, because to cure it is often necessary to have the deformity corrected surgically to achieve long-term improvement of the symptoms.
Treatment and therapy
Depending on the degree of severity of a hallux valgus (bunion), there are different treatment methods. If the hallux valgus (bunion) is not yet far advanced or does not cause any discomfort, treatments are possible by conservative means. If the hallux valgus (bunion) is more advanced and the big toe is possibly already affected by arthrosis, surgery is sometimes advised. Conservative treatment steps consist, for example, in the application of targeted foot gymnastics to strengthen the musculature. The musculature is further strengthened by barefoot running. Appropriate orthopedic footwear can also help to relieve the strain on the hallux valgus (bunion). Such relief can also be achieved, for example, by gluing appropriate orthopedic support pads into standard footwear. Painful bursitis, which is often associated with hallux valgus (bunion), can be treated with anti-inflammatory drugs. When deciding on a surgical measure, it depends on various factors which surgical method is most suitable; these factors include, for example, the amount of complications, the stage of hallux valgus (bunion), the presence of arthrosis in the big toe or also the age of a patient. There are currently approximately six different hallux valgus (bunion) surgeries that are most commonly performed.
Outlook and prognosis
If a bunion is not treated, it can worsen over the years and cause osteoarthritis in the metatarsophalangeal joint of the big toe due to continuous pressure. The outlook depends on the age of the person affected. In childhood and young adulthood, the deformity is still easier to correct with conservative treatment methods such as a splint. When it can no longer be corrected by conservative measures, surgery is usually the only option. Complications hardly ever occur during bunion surgery, wound infections and sensory disturbances only in about 4 % of all patients. Sometimes bone healing can take longer, but further operations are rarely necessary. Even if surgery is successful, it usually takes a few weeks to heal. During this time, pain and swelling may still occur. Surgery for a hallux valgus has a major impact on the statics of the foot and walking, affecting the entire postural apparatus.If the foot is loaded incorrectly, the resulting incorrect load can damage the spine and cause back pain. Affected persons should wait about 12 weeks before doing sports, because the coordination must first be trained slowly again.
Prevention
An important step to prevent hallux valgus (bunion) lies in the choice of appropriate footwear: it is particularly favorable to wear flat shoes that allow the toes to move freely to the sides and upwards. In addition to regular movement of the foot, there is also the possibility of wearing so-called hallux valgus (bunion) splints (for example, at night) as a preventive measure to counteract deformation of the big toe and ball of the toe. Hallux valgus (bunion) – a foot deformity that can be effectively prevented by consistent measures.
Aftercare
A hallux valgus that has not been operated on should be checked at regular intervals. An orthopedist is usually responsible for follow-up appointments. This person works with the patient to determine whether the hallux symptoms have worsened both externally and internally. In order to avoid possible serious consequences, surgery is necessary in some cases. The aftercare of the operated hallux valgus depends on the type of surgery and the resulting wounds. The more complicated the operation, the longer the rest periods for the patient. After the operation, many patients have to wear special shoes. These relieve the anterior joints of the foot in particular and contribute to an optimal healing process. Follow-up appointments are made at regular intervals by the attending physician. If screws or splints were inserted into the foot during the operation, these can be removed at later appointments. This is usually only the case if the screws used cause discomfort to the patient. Hallux valgus can recur even after a successful surgery. Therefore, the patient should continue to attend follow-up appointments even after the treatment has been completed. Basically, the affected person should make sure to take care of his feet for the rest of his life. For this purpose, it is recommended to wear wide socks and comfortable shoes. In addition, regular gymnastic exercises and walking barefoot are part of both aftercare and prevention methods.
Here’s what you can do yourself
To alleviate the discomfort of a bunion, there are some measures that sufferers can use. Muscles and tendons in the foot can be strengthened with regular foot exercises. There are numerous instructions on the Internet under the search term “hallux valgus gymnastics”. Walking barefoot also strengthens the foot and supports the natural position of the foot. Decisive relief is provided by suitable footwear that is wide enough for the forefoot, i.e. not pointed and without heels that are too high. Soft shoe uppers can give over the ball of the foot and avoid further pressure. Orthopedic insoles are available at specialty stores that use a positioned stiffening element to limit the mobility of the metatarsophalangeal joint of the big toe, thus providing relief from pain while walking. The insoles have a flexible core that supports the midfoot area, they are suitable for indoor and outdoor shoes. A toe spreader can help relieve typical discomfort; it is worn between the big toe and the second toe. A spreader is made of soft material, can be worn in any shoe and has a shock absorbing effect. A hallux valgus splint has a corrective effect on the malposition of the big toe; they are available in versions with splint joints and gel cushions that can be worn in comfortable shoes. They bring the metatarsal bone into an optimal position and straighten the transverse arch of the foot. However, splints are mainly applied overnight. Foot reflexology, which targets trigger points, can also provide relief.
