Hallux valgus deformity

Hallux valgus is a common foot deformity with crookedness of the big toe. In most cases, hallux valgus causes pain and walking difficulties that become more severe over time. Finding suitable shoes becomes more difficult with increasing size and is therefore very annoying. Cause-oriented treatment - with or without surgery - requires an expert diagnosis by a foot and ankle specialist.

Hallux valgus is a foot deformity that is also known colloquially as bunion.

The big toe - lat. hallux - is in the so-called valgus position, i.e. it points crookedly outwards from the body axis. Often the big toe is also twisted and is pressed against or even under the neighbouring toe. The bunion is correspondingly pushed inwards and often thickened.

Hallux valgus promotes the development of bursitis, arthrosis in the metatarsophalangeal joint of the big toe and malpositioning of the small toes (hammer or claw toes).

Hallux valgus is caused by a weak spot in the foot, a relic of evolution:

Our earliest ancestors still used the foot as a grasping organ. The mobility at the transition of the tarsal and metatarsal bones as well as the splayed position of the 1st and 2nd metatarsal bones were extremely useful. Since we use our feet for walking, these anatomical features have largely receded - almost completely in some people, less so in others.

This weak point becomes a problem when the two come together:

• Unfavourable constitution (hereditary disposition, connective tissue weakness, residual statics of the foot - especially foot malpositions such as flat foot) and
• excessive stress (long and frequent standing, unsuitable footwear - especially high heels and tight toes, overweight).

These factors can contribute to the development of hallux valgus or to an already congenital slight deformity becoming increasingly pronounced. Women are affected significantly more often than men.

Hallux valgus usually begins as a slight misalignment of the big toe. If this is not corrected professionally, the hallux valgus becomes more and more pronounced due to the incorrect loading of the arch of the foot.

Dr Tonio Gottlieb advises:
"Hallux valgus surgery should always be performed for medical reasons and never purely for cosmetic reasons. Young people in particular should seek information from a foot expert and, if necessary, get a second opinion.”

Meet Dr Gottlieb

What stages of development can hallux valgus have?

With mild hallux valgus, the big toe is only slightly crooked and still moves well, the metatarsophalangeal joint of the big toe is still fine, but the first complaints such as pressure pain, irritation and swelling may already occur.

In the case of moderate and severe hallux valgus, the crooked position of the big toe increases, making it less and less able to participate in the rolling and weight-bearing processes. It can become increasingly immobile, show increased joint wear and tear and lead to increasingly severe complaints in the big toe itself but also in the neighbouring toes and metatarsals (transfer metatarsalgia).

The developmental stages or characteristics of hallux valgus are also determined on the basis of X-ray images.

A hallux valgus leads to an external change in the foot: the widened forefoot with the inwardly protruding bunion and the crooked big toe is easy to recognise even for the layperson. In addition, hallux valgus can lead to severe pressure discomfort and pain.

Where does the pain occur with hallux valgus?

The pain of hallux valgus affects different regions of the foot:

• The bunion often shows the first signs of pain (when wearing shoes that are too tight.) Over time, sensitive pressure points and inflammations often develop, which also hurt at rest.
• Pain can occur under the metatarsophalangeal joint, at the so-called sesamoid bones, as a result of wear and tear.
• The metatarsophalangeal joint itself can also hurt. Unlike hallux rigidus, which hurts with almost every movement, this is only sometimes the case with hallux valgus.
• The sole of the foot and the metatarsal heads of the little toes hurt when the increasing immobility of the big toe and instability at the first metatarsal leads to rolling over the outside of the foot or other metatarsals (transfer metatarsalgia).

Can hallux valgus cause pain at rest?

Yes, indeed. Swollen, chafed pressure points on the ball of the foot as well as bursitis in the area of the ball of the big toe can cause pain at rest. An inflammation of the synovium or dislocation of the sesamoid bones (subluxation) may also be painful when at rest.

Surgical intervention is usually necessary at an advanced stage to enable a pain-free everyday life. This is especially true in cases of severe hallux valgus with:

• permanent pain and movement restrictions,
• progressive joint wear,
• chronic inflammation of the joint of the big toe or chronic wounds caused by the malpositioning,
• increasing stiffness of the toe or threat of increasing stiffness.

What is the procedure for a hallux valgus surgery?

Whether a hallux valgus operation is performed on an outpatient or inpatient basis is always decided by Dr. Gottlieb on a case-by-case basis in consultation with the patient. In many cases, outpatient surgery is possible for hallux valgus, which is performed under general anaesthesia.

Dr Tonio Gottlieb explains to his patient the procedure of a hallux valgus surgery

What surgical techniques are used?

Surgical hallux corrections are performed comparatively often, but nevertheless there is no 'patent remedy'. Sometimes the surgeon combines different procedures to provide relief:

• In principle, it is advantageous to treat hallux valgus in a cause-oriented manner, i.e. to eliminate the evolutionary overmovement between the tarsal and metatarsal bones. For this purpose, the affected joint is surgically stiffened (lapidus arthrodesis).
• The big toe is straightened (repositioning osteotomy).
• Swelling or bone spurs above or to the side of the metatarsophalangeal joint are removed (pseudoexostosis).
• In cases of advanced joint wear, it can help to fuse the metatarsophalangeal joint (arthrodesis).
• Shortening of the proximal phalanx (resection) is rarely performed nowadays.

How long does the swelling last after the surgery?

After the operation, the foot may swell for some time and only gradually become slimmer again in the course of the healing phase. How severe the swelling is and how long it lasts varies from person to person and also depends on the type and extent of the operation. The healing process can be positively influenced by elevation and expert lymphatic drainage.

The elevated position also serves to relieve the foot in general - Dr. Gottlieb will discuss further proven tips and rules of conduct for the post-operative period with you personally.

How is the aftercare following a hallux valgus surgery?

The extent and measures of aftercare depend on the chosen surgical procedure:

A fully weight-bearing conversion enables immediate full weight-bearing in the post-OP shoe, which is worn for about 6 weeks. There is usually the following course for aftercare:

• Dressing change 7 days after surgery
• Stitches removed after 14 days
• Physiotherapy as required, after 14 days at the earliest
• clinical follow-up every 14 days, more often if necessary
• X-ray check 5-6 weeks after surgery
• Final clinical and radiological check-up 12 months after the operation, if necessary also material removal

Hallux valgus surgery after which weight-bearing partially is permitted only requires a 14-day relief of the foot in the lower leg cast. A recurrence should be avoided during this period for good healing. Here, too, several follow-up appointments are necessary, which are usually composed as follows:

• Dressing change and stitch removal 14 days after surgery
• Putting on a walker (20 kg partial load) 14 days after surgery
• Physiotherapy as required, after 14 days at the earliest
• clinical follow-up every 14 days, more often if necessary
• X-ray check 6 weeks after surgery
• Load increase after 6 weeks, depending on the X-ray result
• Removal of the walker after 8 weeks, then if necessary 4 weeks of relieving insoles.
• Sports ability usually 12 weeks after the operation
• Final clinical and radiological check-up 12 months after the operation, if necessary also material removal

Dr. Gottlieb with his patient during the follow-up treatment of hallux valgus surgery

How long is sick leave after hallux valgus surgery?

The length of sick leave required after surgical hallux valgus correction depends on the extent of the procedure, the individual healing process and the patient's occupation. As a rule, you can return to your desk after 2 weeks, but in some cases even earlier; for standing professions, about 6-10 weeks are usual.

What are the risks of hallux valgus surgery?

An experienced surgeon can perform a hallux valgus operation with good chances of success and very low risk. Relapses are extremely rare, especially with the sustainable surgical methods used by Dr. Gottlieb.

Dr Gottlieb can draw on years of extensive experience in the field of hallux valgus. Before every operation, he checks the patient's general state of health and asks about possible risk factors in order to clarify the suitability for surgery and to exclude complications as best as possible. This also includes personal information about general surgical risks as well as specific risks of the chosen surgical procedure.

Dr Tonio Gottlieb advises:
"In order to achieve the most accurate and sustainable result possible in terms of aesthetics and function after a hallux valgus surgery44644644, a very experienced foot surgeon should always be your first choice for an operation. Make sure that the foot surgeon of your choice always has the whole foot and the body statics in mind and does not only treat the front foot. Important: Have the advantages and disadvantages explained to you in detail, even if the surgical procedures are combined in different ways.”

Let Dr. Gottlieb advise you

For many people, hallux valgus represents a restriction in everyday life that can be associated not least with severe pain. Since the deformity not only limits the weight-bearing capacity of the foot, but can also affect the entire body statics, there are basically two possible treatment methods for therapy without surgery:

• Reducing the load with orthopaedic insoles or sturdy shoes
• Increasing resilience through training of the musculature

Orthopaedic aids can temporarily reduce postural pain in the metatarsophalangeal joint of the big toe, but they are not able to correct the malposition. These aids include:

• Night splints (orthoses)
• Bandages worn under stockings and shoes during the day
• Tape dressings made from elastic adhesive tapes

After a thorough individual diagnosis, Dr. Gottlieb recommends whether physiotherapeutic treatment with manual therapy, spiral therapy and/or foot gymnastics is appropriate.

At the first signs of hallux valgus, you can help keep your feet healthy and fit with simple but effective measures:

• Suitable shoes for everyday wear - not too small, but not too wide either - good support is important!
• Avoid shoes with high heels and narrow toes as much as possible.
• Frequent barefoot walking - in the home and garden, on barefoot paths or with protective barefoot shoes.
• Foot gymnastics to strengthen the foot muscles.
• arly clarification of foot problems by a specialist - early diagnosis simplifies treatment!

Are you looking for an experienced foot specialist to treat hallux valgus? Are you wondering whether a conservative therapy is sufficient or a hallux valgus surgery is necessary? Would you like to get a second opinion on your orthopaedist's recommendation for surgery?