Hallux valgus – the malposition of the big toe popularly known as bunion – is one of the most common foot disorders in the Western world, often developing in childhood due to wearing shoes that are too tight or too small. How does hallux valgus develop and what are its symptoms?
What is hallux valgus?
Hallux valgus is the medical term for a common deformity of the big toe in which the toe is pushed outward from the metatarsophalangeal joint – the joint that connects the toe to the foot – toward the inside edge of the foot. This causes a bursa to form on the inside of the foot over the joint as a joint bulge.
This increasing bump is popularly referred to by the terms bunion or bump foot. In this case, the big toe pushes outward with its bony base in the joint, performing a slight rotation.
How does hallux valgus develop?
In addition to a hereditary weakness of the connective tissue, the most common cause for the development of hallux valgus is wearing the wrong footwear, which constricts the foot in the forefoot area, thus leading to a rather triangular foot shape in the toe area and pushing the bones of the foot near the toes apart. If the shoe also has a heel, the weight of the foot shifts to the forefoot, so that the normal transverse arch of the foot collapses in the forefoot area and a splayfoot develops.
Tight heeled footwear is more commonly worn by women than men in our Western society, with the result that only 10 percent of all hallux valgus conditions occur in men – the weaker female connective tissue is also partly to blame. In countries where women walk barefoot or wear foot-friendly sandals, hallux valgus is virtually non-existent. Wearing stockings that are too tight or too small also promotes the development of a splay foot and hallux valgus, as this permanently suppresses normal foot posture.
The chronic misalignment of the foot and toe bones in relation to each other causes important muscle tendons of the toe musculature to be displaced from their anatomically correct place, the big toe can no longer be pulled towards the other toes, and the development of splayfoot and hallux valgus accelerates.
How does hallux valgus manifest itself?
In many cases, hallux valgus does not cause any problems other than the aesthetically unsightly bump – but the misalignment of the big toe in the joint often leads to progressive cartilage wear and then pain during movement. In addition, as the disease progresses, a space problem increasingly arises in the shoe: In the area of the ball of the big toe, the available space becomes narrower and narrower, the shoe presses and rubs against the bunion, so that an inflammation of the bursa can develop.
Inflammation, swelling and cartilage damage then lead to pain with every load on the foot: walking, running and even simple toe movements in the air are uncomfortable. Incidentally, the size and malposition of the hallux valgus do not allow any conclusion to be drawn about the severity of the complaints – even a pronounced bunion sometimes remains symptom-free.
How do you recognize a hallux valgus?
The protrusion and bulging of the bunion of the big toe as a typical symptom is visible to the naked eye. A callus often forms over the mechanically stressed bunion, and inflammation of the bursa reacts painfully to pressure.
In addition to the degree of malalignment of the phalanges (in relation to the metatarsals), the X-ray also shows the condition of the joint: To what extent is the cartilage in the metatarsophalangeal joint damaged and to what extent have bony marginal attachments formed? Depending on the findings, the treating physician will select the treatment method that is most promising given the present complaints and radiological findings.
