Brief overview
- What is hallux valgus? Usually painful deviation of the big toe (medical hallux) to the outside of the body (medical valgus position). Most common deformity of the forefoot. It mainly affects middle-aged and older women.
- Symptoms: In the area of the metatarsophalangeal joint, the big toe is angled towards the outside of the body. Pain and a doubled, reddened skin appear at this point.
- Causes: e.g. shoes that are too tight and/or too high, predisposition (weak connective tissue), splayfoot or other pre-existing deformities
- Treatment: conservative methods such as gymnastics, splints, supports; if necessary, surgery to correct the deformity
- Responsible specialist: orthopaedist or foot surgeon
- Prognosis: Conservative measures can prevent an increase in the deformity, but cannot reverse it. This can only be achieved by surgery (high success rate).
Hallux valgus: Treatment
Depending on how severe the deformity of the big toe is, different forms of hallux valgus therapy can be considered. They aim to reduce existing pain, correct the deformity or prevent it from progressing. The therapy also aims to maintain or restore the normal functionality of the foot and big toe.
Non-surgical hallux valgus treatment
Physiotherapy and toe exercises
People with hallux valgus can take action themselves: Regular toe exercises are definitely worth a try. It strengthens the muscles and foot tendons. This is particularly useful for mild hallux valgus in order to prevent the crooked position from becoming more pronounced. As a preventative measure, toe exercises can ensure that the misalignment does not develop in the first place.
For example, you can regularly roll your foot over a tennis ball or a so-called hedgehog ball (rubber ball with rounded “spikes”). This builds up the transverse arch of the foot. Walking barefoot also strengthens the often atrophied foot structures. The latter is best done on uneven ground such as gravel, sand, grass or bark mulch. This stimulates the foot more than walking on smooth ground.
Ask your doctor or physiotherapist to show you suitable exercises for hallux valgus therapy at home!
Hallux valgus splint
A hallux valgus splint is designed to push the big toe towards the inside of the foot – i.e. away from the other toes – by applying mechanical pressure. By adjusting the muscles and tendons, the discomfort can be reduced over time.
There are different systems and designs for hallux valgus splints. Some are only worn at night. Others also fit into normal ready-made shoes and can be worn during the day.
According to current textbook opinion, splints cannot correct an existing deformity, but can only alleviate the pain and slow down the progression of the deformity.
Alternatives to the splint
In addition to the hallux valgus splint, there are various other options for non-surgical treatment of the deformity:
A hallux valgus brace is particularly useful if the patient does not tolerate a splint well. The brace distributes the pressure on the big toe more evenly. However, the right size of support is important for the correct “pressure measurement”. Ask a specialist (e.g. an orthopaedic technician) for advice on this.
Special hallux valgus shoes can also be useful, especially to relieve the pain. These shoes are usually roomier in the forefoot area than normal shoes. This means that the forefoot is not constricted.
There are also special hallux valgus insoles. They support the midfoot with a spherical cushion (pad) and thus relieve the forefoot area. The insoles can be worn with hallux valgus shoes or normal shoes.
There are other options for conservative hallux valgus treatment. In addition to toe spreaders, toe pads and bunion rolls, these also include taping:
Drug therapy
If hallux valgus patients are unable to manage their pain in any other way, they can resort to painkillers. Doctors usually recommend non-steroidal anti-inflammatory drugs (NSAIDs) such as acetylsalicylic acid (ASA) or ibuprofen. Ask your doctor for advice!
Surgical hallux valgus treatment
If conservative treatment methods do not work or the pain is too severe, surgery is also an option for hallux valgus. There are now around 150 to 200 different types of hallux valgus surgery. However, only a handful of these are performed in practice.
The various surgical procedures usually follow a similar basic principle. The aim is to restore normal anatomical conditions as best as possible. The foot and big toe should “function” normally again and the pain should disappear or at least subside. However, it always depends on the individual starting position as to which surgical goal is possible with hallux surgery.
For mild to moderate hallux valgus deformities, the result is usually good. This means that the patient is (and remains) pain-free and the big toe is in a normal position.
How does hallux valgus surgery work?
In order to plan the operation properly, a medical examination and x-rays of the foot are very important. Nevertheless, these only give the doctor a rough guide. He can usually only assess the situation precisely during the operation, for example the condition of the cartilage in the metatarsophalangeal joint. This is why they often only decide on a specific surgical method at short notice.
Basically, hallux valgus surgery proceeds as follows:
- The doctor releases the metatarsophalangeal joint of the big toe from the contracted joint capsule and frees it from tendons to make it movable.
- The metatarsal bone is cut (osteotomy) and moved in the direction of the other toes. This corrects the main cause of hallux valgus: the excessive angle between the first two metatarsal bones.
- The metatarsal bone is fixed in place with tiny screws at least until it is completely healed. As a rule, however, these remain permanently in the bone (they usually do not cause any problems).
- Finally, the doctor removes the typical swelling above the metatarsophalangeal joint (pseudoexostosis) and closes the joint capsule and tissue layers.
What happens after the operation?
After the operation, the foot must be relieved as much as possible for at least four weeks. This allows the ligaments and bones to heal at rest. Physiotherapeutic measures can also support regeneration during this phase.
The foot is then slowly acclimatized to weight-bearing and weight distribution over a further four weeks. After around eight weeks, those affected can normally walk again. Sport should be possible again after around 12 weeks.
What are the risks of the operation?
In principle, hallux valgus surgery is a low-risk and usually low-impact procedure (minimally invasive surgical methods). However, as with any operation, there are some general risks such as bleeding or injury to nerves or blood vessels.
In addition, pain can persist despite hallux valgus surgery. Sometimes there is also a relapse (recurrence): The malposition of the big toe forms again. Very rarely, patients do not tolerate the fixation screws used (intolerance reactions).
As the foot is quite far away from the heart, the blood can also back up. It is therefore not unusual for the foot tissue to remain swollen for three to 12 months after hallux valgus surgery.
Hallux valgus: causes and risk factors
- Frequently wearing shoes that are too tight and/or have a high heel: the toes are compressed in such shoes. A high heel also puts more pressure on the metatarsophalangeal joints.
- Other foot malpositions: Hallux valgus can be the result of splayfoot, for example. In this case, the transverse arch in the forefoot area is flattened and the metatarsal bones move apart. Calluses on the soles of the feet can be an indication of splayfoot, which is often symptom-free.
- Predisposition: Usually several people in a family are affected by hallux valgus. Experts therefore believe that the deformity or factors that promote it can be inherited. Parents with (former) hallux valgus should therefore check their children’s feet regularly: Malpositions can still be easily corrected in childhood and adolescence.
- Excessive force: If, for example, you hit your foot on a door etc., parts of the joint capsule can tear off and the tensile forces in the foot can become unbalanced. This can result in hallux valgus. The greater the pull in the “wrong direction”, the more the big toe deviates, which in turn increases the pull and so on.
- Other: Rheumatic diseases, congenital deformities or a bone fracture that has healed in the wrong position can (in rare cases) also promote a curvature of the big toe.
Hallux valgus can be recognized with the naked eye by the typical deformity: The big toe is angled towards the outside of the body in the area of the metatarsophalangeal joint towards the neighboring toes instead of forming an almost straight line.
In addition, the skin at this point is often reddened and very thickened. Sometimes it looks as if a new bone has formed there. This is why this hallux valgus symptom is also known as pseudoexostosis (Greek: pseudês = false; exostosis = growth of new bone substance). In reality, however, it is not bone mass, but rather the head of the metatarsal bone, which is pressed towards the inner edge of the foot, and the swollen skin above it.
A special form of hallux valgus is the so-called hallux valgus interphalangeus. In this case, the angle between the metatarsal bones is normal – only the phalanges of the big toe deviate in the direction of the other toes.
The extent of the deformity does not allow any conclusions to be drawn about the severity of the pain! Sometimes even a slightly pronounced hallux valgus causes severe pain. Other people have little pain despite a severe deformity. Occasionally, hallux valgus causes no noticeable or restrictive discomfort at all.
Hallux valgus: examinations and diagnosis
No complex diagnostic measures are required to diagnose hallux valgus. As a rule, the trained eye of a doctor, ideally an orthopaedist or foot surgeon, is sufficient. They will inspect your foot carefully and look for swelling, calluses and the position of the toes and joints. They will also palpate the foot and feel your pulse
In most cases, an X-ray is also taken – in a standing position, with the weight of the body on the foot (weight-bearing X-ray). This makes it possible to determine different angles or the degree of arthrosis, for example.
An MRI (magnetic resonance or magnetic resonance imaging) of the foot is only carried out for special questions.
Hallux valgus: progression and prognosis
Without treatment, the deformity of the big toe in hallux valgus usually worsens over the years. The constant pressure on the metatarsophalangeal joint of the big toe can also cause it to wear out (osteoarthritis).
If physiotherapy, splints etc. are unable to improve the symptoms sufficiently and/or the pain is severe, surgery is performed. The success rate is high: according to specialist literature, hallux valgus surgery achieves a very good or good result in around 85% of patients treated.
After surgical correction of a hallux valgus, you will not be able to work or do sport for a certain period of time. How long this phase lasts depends on the profession or discipline in question. In the case of physically strenuous work, the forced break can last up to ten weeks. You should wait around 12 weeks before doing sport. Hallux valgus patients can obtain more precise recommendations from their doctor.
