Hallux valgus conservative therapy

How can hallux valgus be treated without surgery?

If the hallux valgus - a crooked position of the big toe - has already occurred, conservative therapies can only alleviate the symptoms. There are many possible causes for the development of the crooked toe. They can be both inherited and acquired through unfavourable footwear. If a hallux valgus - colloquially known as a bunion - does not cause any discomfort at all or only minor discomfort at first, conservative therapy methods can be useful. Various techniques are used to reduce the strain on the foot and increase its resilience.

While insoles, silicone pads, hallux valgus splints or hallux valgus toe spreaders serve to relieve the foot, physiotherapy can be used to specifically strengthen the muscles of the foot. The therapeutic goal of conservative hallux valgus treatment is always to reduce pain and alleviate initial discomfort.

The technical term hallux valgus comes from the Latin language and means "crooked big toe". It describes the visible malposition of the big toe. The sometimes painful and unattractive crooked position of the big toe is caused by a static deviation in the joint axis. The big toe bends towards the outside of the foot towards the little toes and displaces them. The joint of the toe is clearly visible on the inside of the foot. Painful pressure points and even bursitis can develop here.

At the same time as the big toe becomes crooked, hammer and claw toes can develop on the toes in advanced stages. The malposition also negatively influences the distribution of the entire body weight on the sole of the foot. The middle metatarsal is subjected to greater stress with hallux valgus than with a healthy foot.

Various causes lead to the development of a bunion. Often the predisposition to hallux valgus is also hereditary due to weakness of the connective tissue. Heavy stress on the forefoot joints due to incorrect footwear such as high heels also promotes the development of this deformity. This is also one reason why hallux valgus affects 70 percent of women. A bunion can also be caused by foot malpositions, arthritis (inflammatory changes in the joints), neurological diseases or bone fractures. Other risk factors include being overweight and standing.

A bunion can be painless. However, if the progressive deformity causes discomfort over time, various treatment therapies are available. However, it is a fact that conservative therapy methods such as wearing hallux valgus insoles for hallux valgus splints can only alleviate discomfort by relieving the pressure. In order to correct the crooked position of the big toe or the static cause in the long term, a bunion should be treated surgically.

With hallux valgus, pain and discomfort are very subjective. Here it is important to weigh up the level of suffering against the expense and risks of treatment. Therefore, Dr. Gottlieb attaches great importance to a comprehensive, careful diagnosis. This includes a systematic examination of the feet. This includes a visual diagnosis, a detailed manual examination and the preparation of X-ray images.

Conservative therapy methods can only alleviate the suffering caused by a bunion. Surgical intervention is always necessary to correct the actual cause. The most common conservative treatment methods include:

• Orthopaedic techniques, such as shoe insoles and
• Upholstery
• Hallux valgus splint (orthosis)
• Hallux valgus night splint (orthosis)
• Physiotherapy
• Hallux valgus toe spreader
• Bandages and Taping
• Toe and silicone padding
• Painkillers and anti-inflammatories

Orthopaedic techniques: shoe insoles and cushioning can reduce pain

The cause of hallux valgus is a pathological change in the statics of the foot. The resulting misalignment of the big toe cannot be corrected by hallux valgus insoles. However, orthopaedic hallux valgus insoles can help to limit discomfort and relieve pain by supporting the natural position of the foot and thereby relieving the big toe. Padding can soften the rest of the foot and protect sensitive areas from pressure.

Wearing so-called hallux valgus shoes can also be helpful. These are cut extra comfortably and offer toes and bunion of the foot sufficient freedom of movement in the front part of the shoe. Hallux valgus shoes are now available in many attractive designs, from sneakers to ballerina shoes. However, special hallux valgus shoes can only alleviate pain. They in no way help to eliminate it.

Dr Gottlieb, the specialist foot surgeon in Berlin, advises:

"An orthopaedic insole cannot make the toe straight again. Nevertheless, orthotics are helpful for hallux valgus complaints because they support the natural foot position and relieve pressure on the big toe."

Special hallux valgus splints can alleviate complaints

The purpose of a hallux valgus splint (orthosis) is to counteract the deformity by applying targeted traction to the crooked big toe and to guide the toe into a straighter position. The hallux valgus splint pushes the big toe towards the inside of the foot by means of mechanical traction and at the same time ensures a better distance to the little toes. At the same time, it relieves the stressed MTP-joint and supports the foot in healthy rolling.

Hallux valgus splints come in different designs and versions. They are usually made of lightweight aluminium and are held in place with Velcro fasteners. Extra thin hallux valgus splints are particularly comfortable and can be worn very comfortably under stockings and in shoes. There are hallux valgus splints that are worn during the day, but also special hallux valgus night splints.

These are only used at night as a positioning splint and work when the foot is at rest. This allows lower traction forces to act on the big toe malposition for a longer period of time.

Therapy with a hallux valgus splint is not the most pleasant way to relieve discomfort. Almost all hallux valgus splints have the disadvantage that the strong mechanical pressure exerted on the big toe can cause pain. It can also cause skin irritation and inflammation of the joint. In case of severe traction pain, it is helpful to pause wearing the splint for one to two days.

Treatment of hallux valgus with the help of physiotherapy

Physiotherapy cannot increase the mobility of the hallux valgus toe. However, the muscles of the arch of the foot can be trained through targeted manual therapy, which has a positive effect on the statics and the entire foundation of the foot. There are some simple hallux valgus exercises for foot and toe gymnastics that have a strengthening effect on the foot muscles. For example, gripping exercises, rolling exercises with a small ball or simply walking barefoot on a regular basis are suitable for hallux valgus gymnastics.

Dr Gottlieb advises:

"With physiotherapy, the hallux valgus patient can do something himself. Through regular training, he or she strengthens and reinforces the foundation of his or her foot. Pain or walking problems can thus be alleviated."

 

Toe spreaders can provide relief and prevent pressure sores

Hallux valgus toe spreaders are worn between the big toe and the second toe. They are made of soft silicone, are particularly comfortable and thus offer a gentle way of conservative treatment. Whether worn barefoot, in socks or shoes, they keep the crooked toe in a straighter position. They can relieve pain and fit comfortably into almost any footwear. Unsightly calluses, pressure sores or corns can be avoided by wearing hallux valgus toe spreaders. But there are also disadvantages: Depending on the degree of malposition of the big toe and personal disposition, hallux valgus toe spreaders can also increase the pressure on the smaller toes and thus trigger further pain.

How does taping work for the treatment of hallux valgus?

The hallux valgus taping method is mainly used for gentle pain therapy. When taping a bunion, an attempt is made to bring the metatarsophalangeal joint of the big toe from the crooked position back to the normal position with the help of a tape. Taping hallux valgus can also have disadvantages. If the traction exerted on the crooked big toe is too strong, this can trigger pain.

Painkillers for the treatment of hallux valgus

The pain that a bunion can cause in everyday life should not be underestimated. The crooked position of the big toe causes a misalignment of the joint, to which it can react with inflammation. Especially when the feet are subjected to great stress due to standing for long periods of time or wearing unfavourable footwear, severe pain can occur. In the case of acute hallux valgus pain, treatment with medication can be useful. Hallux valgus painkillers with an anti-inflammatory effect are often the first choice.

What other conservative treatment options are there?

A hallux valgus cannot be changed once growth is complete. All conservative therapy methods are therefore purely symptomatic treatment.

Conservative treatment options for hallux valgus at a glance:

• Orthopaedic techniques, such as shoe insoles and
• Upholstery
• Hallux valgus splint (orthosis)
• Hallux valgus night splint (orthosis)
• Physiotherapy
• Hallux valgus toe spreader
• Taping
• Toe and silicone padding
• Painkillers and anti-inflammatories

The treatment of hallux valgus with bandages is not effective, as these cannot permanently counteract the crooked position of the big toe.

The therapeutic goals of conservative hallux valgus treatment are primarily to reduce pain and alleviate discomfort. If the load on the foot is higher than its load-bearing capacity in the case of a hallux valgus deformity, two adjustments can be made:

• on the one hand, reduce the load on the foot with orthopaedic shoe inserts
• on the other hand, increase resilience through muscle training (physiotherapy)

Hallux valgus splints, on the other hand, only straighten the crooked toe temporarily. They do not improve the statics of the foot.

In the case of more severe deformities and persistent pain, a hallux valgus operation is advisable. Patients with years of foot pain and/or severely limited mobility due to a bunion, but also patients who can no longer practise their sport because of this, should seek comprehensive advice from Dr. Gottlieb. After a thorough, individual diagnosis, Dr. Gottlieb recommends whether a hallux valgus operation is goal-oriented.

The foot surgeon Dr Tonio Gottlieb is a recognised expert on the subject of foot health and foot surgery. He will examine you with the utmost care and also pay attention to your entire body statics. Based on a comprehensive diagnosis, he will always give you a stringent recommendation for action. Whether you need an initial diagnosis or a second opinion - make your personal consultation appointment now!

Once a bunion has developed, the crooked position of the big toe cannot disappear on its own. The tendency is for this deformity to worsen over time. Without surgery, arthrosis of the metatarsophalangeal joint of the big toe can develop in the further course of the disease, which can lead to the inability to walk. In general, the decision for an operation depends on the patient's perception of pain, the personal situation and the consideration of the effort and risks involved in treating hallux valgus.

In some cases, outpatient surgery - under general anaesthesia - is possible for hallux valgus. Every surgical hallux valgus correction is very individual - there is no 'patent remedy'. The surgeon can also combine different surgical procedures as required to achieve the desired result. Dr. Gottlieb will advise you individually and comprehensively and will always weigh up the costs and risks when making a surgical decision in order to achieve the best possible result for you as a patient.

Dr Gottlieb advises:

"To the question "when do you have to operate on a hallux valgus?", I like to answer my patients: a hallux valgus is not an emergency indication. But there are very good standard surgical procedures that can achieve the very best results in many cases. Pain and discomfort caused by a hallux valgus can only be permanently eliminated by surgery. So you don't necessarily have to operate on a bunion - but I advise doing it."

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