Therapy
The aim of the treatment is to relieve existing pain, correct the malpositioning of the big toe and ultimately improve the functionality of the foot. The exact therapy option chosen depends primarily on the severity of the malpositioning. In early stages, i.e. mild cases of hallux valgus, conservative (non-surgical) measures are particularly suitable to prevent the disease from progressing.
In most cases, however, they cannot achieve a cure. This requires a surgical intervention. Classically, conservative therapy aims to relieve the pressure on the foot (especially the ball of the big toe).
This can be done either by walking barefoot, wearing open or even dilated shoes or by inserting foam pads into the shoes; special insoles can additionally stabilize the foot. Foot gymnastics is always recommended in the early stages to support this. This can significantly improve the prognosis and can also be done in self-instruction.
In addition, drug-based pain therapy is an important cornerstone in the treatment of hallux valgus. In advanced stages of the disease, the outer edge of the metatarsus, where the metatarsal bone protrudes, can become inflamed.These can then be treated locally with anti-inflammatory measures in the form of diclofenac-containing or other anti-inflammatory ointments. Severe inflammation may make the use of cortisone injections necessary.
Finally, the last option for treating hallux valgus is surgery. It is used in late stages of the disease. In general, it has a good prognosis, but is associated with a lengthy healing phase.
The diagnosis and treatment of hallux valgus is done by an orthopedic surgeon. In the first instance, it must be decided whether the hallux valgus can be treated conservatively, i.e. without surgery. In this case, the orthopedist often prescribes a bandage to correct the malpositioning of the big toe.
In addition, physiotherapy should be performed to strengthen the muscles of the forefoot. Most of the treatment is therefore often carried out by physiotherapists. If an operation of the hallux valgus is necessary due to the severe symptoms, an orthopedist will perform the operation.
In addition, the general practitioner, i.e. the general practitioner in private practice, is often involved in the treatment. For example, he can temporarily prescribe painkillers. If the skin is severely affected by inflammation, a dermatologist (skin specialist) can also be consulted for treatment.
If the big toe is clearly malaligned in the advanced stage of hallux valgus, surgery is recommended to correct the deformities of the toe. Surgery is particularly indicated if conservative treatment methods, such as a hallux valgus splint, orthopedic footwear or drug therapy for pain have not been able to achieve sufficient pain relief. To date, almost 150 surgical procedures for the treatment of hallux valgus have been described, of which about ten are used in German-speaking countries.
Almost all of them involve cutting through the first metatarsal bone (belonging to the big toe) (corrective osteotomy) and then moving the toe (peripheral) part of the bone in the direction of the second metatarsal bone. In the end, the first metatarsal bone thus reaches its natural position. The two parts of the metatarsal bone are then either fixed with wires or screws or immersed.
As a last step, the big toe is brought into a straight position with strong sutures. In severe forms of the disease, stiffening between the first metatarsal and the tarsal can be considered. The insertion of a titanium plate can provide additional stability compared to a screw.
If, in addition to the hallux valgus, there is an arthrosis (hallux rigidus) in the metatarsophalangeal joint of the big toe, this must be treated as a priority. This is quite often the case. The prognosis for surgery for hallux valgus is quite good, and patients are usually pain-free after the operation.
The cause of a recurrence of the disease after surgery is usually a congenital weakness of the connective tissue. However, the healing of the bone, comparable to a bone fracture, takes about 4 – 6 weeks in any case. Therefore, it is necessary to wear a special orthopedic shoe, the so-called forefoot relief shoe, for this time.
This enables largely painless walking after the operation. Looking at the frequency of hallux valgus in different cultures, it becomes clear that wearing shoes, as it is common in most societies today, contributes at least partially to the development of the disease pattern. Especially if there is a familial accumulation of connective tissue weakness and foot malpositions, incorrect footwear can lead to a hallux valgus.
The healthy foot should have a slight spreading of the toes towards each other. However, the so-called basic insole shape of our shoes pushes the toes together and promotes the development of a permanent deformation of the foot. At an advanced stage, this finally manifests itself in the form of a hallux valgus.
This is also much more common in women, which is due on the one hand to weaker connective tissue and on the other hand to the typical shape of women’s shoes. Decisive factors here are above all the heel height, narrow shoe tips and shoes that are too short, which in addition to hallux valgus also favors other foot malpositions. Since such footwear is also worn at an ever earlier age, foot malpositions are increasingly occurring at a young age.
In the early stages of the disease, a change of shoes to flat shoes with sufficient space for the toes can help. So-called thong sandals are particularly suitable for this. Finally, in more advanced stages, orthopedic shoes with splayfoot insoles are helpful in treating the pain when walking.Furthermore, walking barefoot can also relieve the pain.
Orthopedic insoles are used in the early stages of hallux valgus, as they can stop the progression of the splayfoot. Once the hallux valgus is properly developed, the insoles can no longer be used to correct it, i.e. they do not serve as a causal therapy, but only to relieve the pain of the affected person. The structure of the foot orthosis is as follows:The foot orthosis is equipped with a foam wedge which is located between the big toe and the second toe.
This type of insole is called a splayfoot insole. The foam wedge relieves the forefoot and supports the front arch of the foot, thus reducing pain. However, pain in the area of the middle toes may occur instead.
The insoles are made by an orthopedic technician. So-called sensomotoric insoles are well suited. They specifically stimulate the weakened foot muscles by setting sensory impulses.
This either increases or decreases the muscle tension. In the best case, they have a positive effect on the foot malposition. In addition to insoles, night positioning splints and bandages can also be used to treat symptoms.
In general, the wearing of flat shoes that allow the toes sufficient space is recommended. In the early stages, foot gymnastics and reinforced barefoot walking is also recommended. This strengthens the arch of the foot.
If the arch of the foot is intact, the progression of a hallux valgus can be prevented. As a rule, the health insurance company will cover the most favorable insoles for a diagnosed hallux valgus. Statutory health insurances can pay additional payments of 20 to 80€ depending on the type of the insole.
Privately insured persons have to bear the costs themselves. In addition to insoles, foam pads can also be used in a hallux valgus. They reduce the friction of the ganglion on the shoe.
If a hallux valgus occurs in the course of an arthrosis of the big toe joint (hallux rigidus), special insoles, the so-called hallux rigidus insoles, can make it easier to roll over the painful joint. There are also silicon orthoses that can be worn in shoes during the day and relieve the metatarsophalangeal joint of the big toe. All in all, it is true that splints and bandages are used more often in cases of hallux valgus.
A toe spreader is usually a medical aid. In a hallux valgus, this is worn between the big toe and the second toe so that the malpositioning is corrected. In principle, however, toe spreaders can be used between all toes.
This is generally intended to avoid pressure points in case of malpositioned toes. In the case of hallux valgus, a toe spreader can relieve pain by improving the toe position. In addition, toe spreaders are often used in nail studios for painting the toenails.
For the treatment of hallux valgus, small bandages are often worn that cover the ball of the foot and the big toe. Such a bandage can correct or at least reduce the malpositioning of the big toe. Once a hallux valgus has developed, however, it cannot be reversed by a bandage.
However, the progression of the malpositioning can be stopped by the bandage. By stabilizing the hallux valgus and correcting the malposition, the load on the forefoot can be reduced, which often leads to pain relief. The better alignment of the big toe also improves the sense of balance of the affected person.
In trauma surgery, sports medicine and orthopedics, tape bandages made of plaster adhesive tape are widely used. They are used both to treat and prevent various diseases of the joints and muscles and ensure that those joints and muscles are not completely immobilized, but only prevent undesirable movements. Their effect is based on the fact that they transfer forces acting on the locomotor system to the skin.
At the same time, they counteract tissue swelling by promoting blood and lymph flow. Tapen can also be used in addition to other treatments when treating hallux valgus. Their main purpose is to bring the joint into a more anatomically favorable position and to absorb external forces that promote malpositioning of the big toe.
In this way, taping can be used to achieve extended freedom from pain when walking. In the meantime, there are numerous tapering methods for hallux valgus. These are easy to find online in the form of videos, but it is recommended that the dressing be applied by a physician.Tape bandages, unlike splints and Hallux valgus shoes, are usually not paid for by health insurance companies.
In addition to hallux valgus shoes and foot gymnastics, the so-called hallux valgus splint is available as a classical treatment method for hallux valgus. Its principle is based on pushing the big toe away from the other toes by mechanical pressure, i.e. towards the inner edge of the foot. This is intended to allow the tendons and muscles to adapt to a healthy foot position.
Various types of splints are available for selection. Both Hallux valgus night splints, which are worn exclusively at night, and splints that fit into the normal ready-made shoe are available. However, self-discipline is necessary for good chances of success.
In the first few days or weeks, the splint often causes irritation of the skin and increased pain in the foot, which, however, usually weakens continuously. However, it is not yet clear whether a Hallux valgus splint can lead to a permanent correction of the malposition. Nevertheless, they can contribute significantly to pain relief.
One factor that significantly contributes to foot malpositions is weak foot muscles. This is usually caused by a reduced load due to civilisation, but can also be inherited. Foot gymnastics can be a balance to a predominantly sedentary lifestyle and is suitable for adults with already existing foot malpositions, but also for children.
Particularly for hallux valgus patients, significant relief can be achieved with appropriate gymnastics. It is mainly used as a support in addition to Hallux valgus splints or orthopedic insoles. Most exercises are based on simple gripping exercises.
For example, marbles can be picked up with the toes and placed in a container, alternatively a cloth can be gripped. Another part of foot gymnastics can also be simple barefoot walking. Especially walking barefoot on sand promotes a natural and even load on the sole of the foot and a training of the floor muscles.
