Hallux valgus (bunions) – one of the most common foot deformities in western cultures. In the course of the disease, a toe misalignment occurs; especially the big toe.
What is hallux valgus (bunions)?
The term hallux vagus (ball toe) is the medical term for a malposition of the so-called big toe directed towards the outside of the foot.
Depending on the patient, the deformity associated with hallux valgus (bunion) can affect different metatarsal limbs.
Common to the appearance of hallux valgus (bunions), however, is a protrusion of the metatarsal head to the inside of the foot. The course of the extensor tendons is impaired by the presence of the hallux valgus (bunions) and can thus further promote the malposition.
There are many possible causes for the occurrence of hallux valgus (bunions): Doctors assume, among other things, hereditary factors that can increase the risk of developing hallux valgus (bunions).
Such hereditary factors can be, for example, a predisposition to weak connective tissue, which as a result is less able to support the muscles and bones of the foot. This factor is also partly responsible for the fact that predominantly women are affected by hallux valgus (bunions).
Furthermore, the presence of a so-called splayfoot is a risk factor for the development of hallux valgus (bunion), since the pressure on the ball of the toe is increased. And particularly often, the wrong shoes can also lead to hallux valgus (bunions):
In Western cultures, hallux valgus (bunions) occur much more frequently; wearing high-heeled shoes (e.g. high heels, heeled shoes, heeled shoes) that are pointed is particularly unfavorable.
Symptoms, Ailments & Signs
An externally recognizable symptom of hallux valgus is a deformation of the big toe with an angle of inclination to the little toes, while the metatarsophalangeal joint of the big toe protrudes inwards due to the deformation and is usually swollen. Because normal shoes are often not wide enough to avoid putting pressure on the irritated metatarsal head, swelling, redness and irritation of the bursa in the joint often occur at this point, which causes pain when walking.
In the beginning there is usually no pain, the deformation is primarily an aesthetic problem. However, because the joint is irritated by the constant pressure over the long term, the pain increases over the years and the irritation of the metatarsophalangeal joint of the big toe can lead to arthrosis in the joint, which severely impairs walking.
In addition, the malposition of the big toe leads to a lack of space for the middle toes, which have to move upwards, which promotes hammer or claw toes, on which painful pressure points usually form due to the pressure from above in the shoe. Because the statics of the entire foot is disturbed by the bunion, the entire foot can also hurt.
A hallux valgus (bunion) can reach different degrees of severity. However, these are not always related to the symptoms caused by hallux valgus (bunions):
Even a low level can lead to complaints. The first complaints often occur at the base of the big toe: Here the head of the metatarsal bone pushes towards the inside of the foot. Since the foot is widest here, the pressure of the shoe is also greatest; bursae beneath the skin often grow to protect the bone from pressure.
This bursa can then become inflamed. The resulting incorrect loading can later lead to arthrosis (wear and tear of the cartilage) in the metatarsophalangeal joint of the big toe. In severe cases, the displacement of the big toe can be up to 90 degrees.
Depending on the stage, a hallux valgus is surgically corrected. The aim of the operation is not only to restore a cosmetically beautiful foot, but also to ensure that the foot can bear weight without pain. Depending on the severity and depending on how far the wear of the incorrectly loaded toe has already progressed, an operation cannot always bring the desired success.
In addition to this complication, there are the generally valid surgical risks that can lead to complications afterwards (pulmonary embolism, wound healing disorders).
Despite possible complications, hallux valgus should always be treated. If the condition is left untreated, severe pain in the foot can occur. The pain also involves the little toes due to “hammer toe” formation.
Since the bulge of the big toe is constantly pressing against the shoe, blisters and inflammation at the points of friction are unavoidable. In the long term, hallux valgus leads to a significant limitation in mobility; Victims avoid walking. Loss of zest for life and isolation are the consequences of untreated hallux valgus, especially for older people.
The increased risk of falling should not be underestimated. Since those affected find it difficult to walk, they tend to behave unsteadily, which in turn means that those affected are more likely to fall with a wide variety of consequences.
When should you go to the doctor?
A doctor should be consulted even with a slight misalignment of the big toe, preferably an orthopaedist, because otherwise the misalignment will progress and cause more and more problems. A doctor’s visit is also advisable if hallux valgus is already causing pain in the feet and pelvic area. The malposition of the big toe can lead to severe pain and unsteadiness when walking, which severely restricts everyday life for those affected.
It is often necessary to receive medical treatment for the resulting pain in muscles, tendons and joints, discomfort, swelling and circulatory disorders. A specialist should always be consulted if the misalignment is not just an aesthetic problem, but is associated with pain when walking.
A doctor can recommend shoes that are more appropriate and initiate appropriate treatment to correct the misalignment. In addition, he can advise on surgical procedures to correct a hallux valgus, because it is often necessary to have the malposition surgically corrected in order to achieve long-term improvement in the symptoms.
Treatment & Therapy
Depending on the degree of severity of a Hallux Valgus (bunions), there are different treatment methods. If the hallux valgus (bunions) is not yet very advanced or does not cause any symptoms, conservative treatments are possible. If the hallux valgus (ball toe) is more advanced and the big toe may already be affected by arthrosis, surgery is sometimes recommended.
Conservative treatment steps consist, for example, in the application of targeted foot exercises to strengthen the muscles. The muscles are also strengthened by walking barefoot. Appropriate orthopedic footwear can also help to relieve the hallux valgus (bunions). 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 (bunions), can be treated with medication using anti-inflammatory agents.
When deciding on an operative measure, it depends on various factors which surgical method is most suitable; These factors include, for example, the number of complications, the stage of the hallux valgus (bunions), the presence of arthrosis in the big toe or the patient’s age. There are currently about six different hallux valgus (bunions) operations that are performed most frequently.
Outlook & Forecast
If a bunion is not treated, it can get worse over the years and the constant pressure can cause osteoarthritis in the metatarsophalangeal joint of the big toe. The prospects depend on the age of those affected. In children and young adults, the misalignment can be corrected even more easily with conservative treatment methods such as a splint.
If it can no longer be remedied by conservative measures, the only thing that can usually help is an operation. Complications rarely occur during operations on the bunion, wound infections and sensory disturbances only in about 4% of all those affected. Sometimes bone healing can take longer, but further surgery is rarely necessary.
Even if an operation is successful, it usually takes a few weeks to heal. Pain and swelling may still occur during this time. An operation on a hallux valgus has a major impact on the statics of the foot and walking and influences the entire musculoskeletal system. If the foot is loaded incorrectly, the resulting incorrect loading can damage the spine and cause back pain. Those affected should wait about 12 weeks before exercising, because coordination has to be trained slowly again.
An important step in preventing hallux valgus (bunions) is to choose the right footwear: wearing flat shoes that allow the toes freedom of movement to the sides and upwards is particularly beneficial.
In addition to regular foot movement, there is also the option of wearing so-called hallux valgus (ball toe) splints (e.g. at night) as a preventive measure, which are intended to counteract deformation of the big toe and ball of the toes. The hallux valgus (ball toe) – a foot malposition that can be effectively prevented by consistent measures.
A hallux valgus that has not been operated on should be checked at regular intervals. An orthopedist is usually responsible for the follow-up appointments. In cooperation with the patient, this determines whether the symptoms of the hallux have worsened both externally and internally. In order to avoid possible serious consequences, an operation is necessary in some cases.
The aftercare of the operated hallux valgus depends on the type of operation and the resulting wounds. The more complicated the operation, the longer the grace period for the patient. After the operation, many patients have to wear special shoes. These relieve the front ankles in particular and contribute to an optimal healing process.
The aftercare appointments are carried out at regular intervals by the doctor treating you. 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.
A hallux valgus can recur even after a successful operation. Therefore, the patient should make use of further follow-up appointments even after the treatment has been completed. Basically, the affected person should take care to protect their feet for the rest of their lives. It is recommended to wear wide socks and comfortable shoes. In addition, regular gymnastic exercises and walking barefoot include both aftercare and prevention methods.
You can do that yourself
There are a number of measures that those affected can take to alleviate the symptoms of a bunion.
Musculature 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 foot position.
Appropriate footwear, wide enough for the forefoot, provides decisive relief; so not tapered and without too high heels. Soft shoe upper material can give over the ball of the foot and avoids further pressure.
Orthopedic insoles are available in specialist shops, which restrict the mobility of the metatarsophalangeal joint of the big toe by means of a positioned stiffening element and thus alleviate the pain when 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 alleviate the typical symptoms; 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 misalignment of the big toe. It is available in versions with a splint joint and gel cushion that can be worn in comfortable shoes. They bring the metatarsal bones into an optimal position and straighten the transverse arch of the foot. However, splints are mainly laid overnight.
A foot reflexology massage, which targets trigger points, can also provide relief.