Hallux valgus • Help from foot exercises up to surgery

Hallux valgus is a common deformity of the big toe in women. If it is only a cosmetic problem at first, the bunion can later be very painful. There are various therapies from foot exercises to surgery and measures to prevent hallux valgus.

Hallux valgus (bunions) is one of the most common foot deformities. The frequency increases with age. Bunion is not uncommon in women in particular: they are affected much more often than men. The reason is usually the wrong footwear, for example high, pointy and narrow shoes that press the toes together.

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What is hallux valgus?

Hallux valgus is a misalignment of the big toe. It bends outwards away from the center of the body towards the smaller toes. At the same time, the metatarsal gets out of its normal axis. A more or less obvious bulge forms on the inside of the foot, depending on the severity of the deformity. Visually, the bulge resembles a ganglion. However, no additional bone material accumulates in the bunion, but the bone shifts from its original position.

Hallux valgus has other names, for example bunion, crooked toe, thick toe, big toe bunion or big toe ball. The name is derived from Latin: “hallux” means “big toe” and “valgus” means “crooked”.

Hallux forms: Hallux rigidus and Hallux varus

Hallux rigidus also affects the big toe, which limits mobility. Hallux rigidus is extremely painful. It forms because the metatarsophalangeal joint of the big toe wears out with increasing age and increased stress (arthrosis). Unlike hallux valgus, men are more often affected here. There is a counterpart to the hallux valgus – the hallux varus. Exactly the opposite happens here, namely the big toe bends towards the middle of the body. However, hallux varus is rarer.

Tight shoes, weak connective tissue: causes of hallux valgus

Hallux valgus can have various causes. There are usually several factors at play when a bunion develops.

The most common reasons are:

  • Too high, narrow or pointed shoes

  • Foot malpositions such as splayfoot and flatfoot

  • Familial predisposition: Bunion occurs more frequently in some families

  • Connective tissue weakness that also affects the tendons and ligaments that support the arch of the foot

  • Joint inflammation (arthritis)

  • Consequences of injuries, for example broken bones after an accident that healed incorrectly

  • muscle dysfunction

  • Neurological diseases such as multiple sclerosis

  • Consequence of joint wear (arthrosis)

The factors mentioned mean that the forefoot is loaded too heavily and incorrectly. The big toe deviates sideways and hallux valgus develops.

Symptoms of hallux valgus: Bunion is often painful

Hallux valgus is associated with various complaints. They are all the more difficult, the more pronounced the deformity of the forefoot is.

Possible symptoms:

  • Crooked big toe that curves away from the center of the body toward the smaller toes.

  • Thickened ball of the big toe that protrudes at the side of the foot. Many sufferers perceive this as a cosmetic problem.

  • Pain caused by damage to the skin, the joint bursa and the metatarsophalangeal joint.

  • Swelling, redness, calluses, calluses and inflammation of the ball of the big toe

  • constriction of adjacent little toes; the wrong distribution of pressure leads to painful overloading of the remaining toes, joints (metatarsal), tendons and bones in the foot.

  • Loss of mobility and wear (arthrosis) of the big toe metatarsophalangeal joint

In some cases, the symptoms are so severe that those affected can hardly walk or stand. Sometimes the hallux valgus also leads to incorrect loading of other joints, for example on the knee or hip, and triggers further complaints there.

A bunion is not always associated with pain, suffering or loss of function. As a rule, however, it gets worse over time (progressive course), since the deformity of the big toe weakens the capsule of the metacarpophalangeal joint, which in turn promotes the deformity. If you have any problems, you should see an orthopaedist.


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Hallux valgus can often be recognized at a glance

Most patients notice hallux valgus themselves. The curvature of the toe and the thick ball of the foot can hardly be overlooked. For many, the appearance of their foot is initially a cosmetic problem, which is why they seek medical help. Foot pain is also a reason for visiting professionals, usually an orthopedic practice. A look at the foot is usually enough to diagnose hallux valgus.

The doctor first asks about the symptoms and medical history (anamnesis). For example, information on lifestyle and any existing illnesses are important. This is followed by the physical examination, with the focus on the feet. It is checked whether there are skin changes, whether the skin over the protruding bunions is irritated or whether calluses, cornification, skin injuries or ulcers have formed. It is also tested how well the metatarsophalangeal joint can be moved and whether movement pain occurs. The adjacent toes and toe joints are also checked for malpositions.

X-ray examination and other diagnostic measures

An X-ray of the forefoot and midfoot under load, i.e. while the patient is standing, confirms the diagnosis of hallux valgus. The x-ray shows the extent of the misalignment. The following rough classification can be made:

  • Mild hallux valgus: The curvature of the big toe compared to the normal position is less than 20 degrees.

  • Medium hallux valgus: The deviation is between 20 and 40 degrees.

  • Severe hallux valgus: The deviation from the norm is more than 40 degrees.

A foot pressure measurement (pedobarography, podometry), which shows the shape of the foot, can also be helpful. The pressure load that acts on the foot when standing is determined. The result can be displayed digitally in a graphic. Magnetic resonance imaging (MRI) is only used in special cases. It shows, for example, whether there is any other damage to bones or joints in addition to hallux valgus.

From foot exercises to surgery – this is how hallux valgus is treated

The treatment aims to relieve pain, correct the misalignment and preserve the result. The aim is also to slow down progression and to improve functionality again. Initially, non-surgical (conservative) treatment measures are used. In the case of pronounced deformations and severe pain, an operation, which is best carried out by a foot surgeon, helps. Those affected can also do something themselves to improve the symptoms.

  • Regular foot exercises: It strengthens the muscles and ligaments in the foot, which has a positive effect on the mobility of the joints. Ideally, foot sports also make the pain go away. However, sufferers must exercise regularly. Instructions for foot gymnastics and suitable exercises are now available on the Internet. Exercises in which you spread the big toe away from the remaining toes or pick up objects with your toes are particularly effective.

  • Healthy footwear: Those affected should wear comfortable shoes that do not constrict and further strain the feet. It should be soft, wide and as flat as possible. After wearing pointed high heels, foot exercises relax your feet. Often walking barefoot relieves the foot and trains the foot muscles.

  • Medicines for hallux valgus: A bunion can be very painful. Painkillers from the group of non-steroidal anti-inflammatory drugs (NSAIDs) work against these. These include ibuprofen, naproxen or acetylsalicylic acid (ASA).

  • Orthopedic aids: They help to correct the misalignment of the foot. They are available, for example, as night splints, toe pads or toe spreaders, which separate the big toe from the second toe. Although orthopedic aids do not eliminate the cause of hallux valgus, they can alleviate painful pressure points and skin inflammation and slow down the progression of hallux valgus. They are often available over the counter in pharmacies, drugstores or on the Internet. Special orthopedic insoles, on the other hand, are prescribed by a doctor and made in the medical supply store. The health insurance covers the costs, but an additional payment is due.

  • Physical therapies: In addition, physical therapies such as physiotherapy (physiotherapy) or manual therapies may be worth trying.

Hallux valgus surgery

Sometimes conservative treatment methods do not bring the desired success. In the case of pronounced hallux valgus, significant pain, pressure points, ulcers, functional restrictions of the foot or a reduced quality of life, an operation on the bunion may be advisable.

Operations usually preserve the metatarsophalangeal joint of the big toe, but sometimes this does not succeed and it has to be partially removed. A conversion (osteotomy) of the metatarsal bone may also be necessary, in which the bone axis is changed. The aim of the operation is to restore the function of the foot and make the pain go away. The consequences can be another misalignment of the foot or a recurrence of hallux valgus.

Physiotherapy (elevation, cold therapy, lymphatic drainage), special shoes, night splints or toe spreaders can support the healing success after an operation.

Preventing hallux valgus: helpful tips

Hallux valgus can be prevented with certain measures. These include the following tips:

  • Foot muscles and arches can be trained to protect against malpositions.

  • It is also advisable to walk barefoot more often. It is best to start with short distances to get your feet used to them.

  • Well-fitting, comfortable shoes that do not constrict the feet should primarily be worn. To compensate for high heels, then move and stretch your feet and toes to compensate.

  • Orthopedic aids and foot exercises can compensate for foot deformities, such as splayfoot, and prevent the development of hallux valgus.

  • Foot baths or foot massages promote blood circulation, remove excess skin and relax your feet.
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Source: Lifeline | Das Gesundheitsportal by www.lifeline.de.

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