Hallux Valgus (Bunions)

HALLUX VALGUS

Hallux valgus is one of the most common foot disorders. It is a condition in which the big toe (hallux) deviates laterally (toward the side). It is a foot deformity in which the big toe deviates from its normal plane. A deformed big toe affects the entire structure of the foot. As the disease progresses, it leads to severe foot and toe pain, and inflammation may also develop. The inflammation causes the foot to swell and the pain to increase, and if left untreated, the condition can get even worse.

The big toe first deviates to the side, and then the tip of the big toe and the nail also rotate sideways in the frontal plane. The deviated tip of the big toe can ride over the adjacent toe, so pain also begins to be felt in the other joints.

Hallux valgus is seen predominantly in middle-aged and older women. However, it can also occur in adolescents and young adults. Women are affected more than men. It is seen almost exclusively in societies where people wear shoes.

General Precaution

Wearing tight shoes should be avoided.

Causes

• High-heeled, narrow-toed shoes are thought to cause hallux valgus.
• Flat feet can also be counted among the causes of hallux valgus. Abnormally increased pressure on the first metatarsophalangeal joint during walking may be a cause.
• Certain conditions such as rheumatoid arthritis, gout or post-traumatic changes
• Other conditions (such as amputation of one of the other toes, severe hammer toe deformity or Achilles tendon contracture)

Prevalence

It is seen in up to 33% of individuals.

Risk Factors

Heredity

Choice of footwear

There may be a genetic contribution that has not yet been identified. Two thirds of patients have a family history.

How Is Hallux Valgus Diagnosed?

Signs and Symptoms

• Patients often complain about the cosmetic appearance and the difficulty they have wearing shoes.
• The main symptom is pain over the medial prominence due to pressure from shoes.
• The patient develops lateral deviation of the big toe and a medial prominence.
• The deformity may increase with weight bearing.
• As the condition worsens, the big toe may press on the second toe, causing pain and deformity in the second toe.

Physical Examination

• The patient is examined while sitting and standing.
• The hallux valgus deformity is assessed by manually correcting the alignment of the big toe.
• A careful neurovascular and musculoskeletal examination of the limb is performed.

Tests (Imaging, pathological findings)

How Is Hallux Valgus Treated?

General Precautions

• It should first be treated with non-surgical methods.
• Choosing appropriate footwear is important.
• Narrow-toed and high-heeled shoes should be avoided.
• Wide-toed shoes made of soft leather should be preferred.
• Toe spacers, splints and night splints can be used.
• In patients with Achilles contracture and flat feet, stretching exercises and custom-made insoles may be helpful.
• Custom-made shoes or wide shoes with extra depth can be made if necessary.

Special Treatment; physical therapy

Medical treatment; medications and painkillers can be used.

Surgery; the goals of surgical treatment are to relieve pain, correct the deformity, restore normal biomechanics and achieve an adequate range of joint motion. There are many surgical options. The treatment plan depends on many factors.

Surgical indications (situations requiring surgery):

• Failed non-surgical treatment
• Worsening pain and deformity
• Reduced function and reduced tolerance for wearing shoes

Surgical contraindications (situations in which surgery should not be used)

• Cosmetic concern without symptoms
• Vascular insufficiency

Follow-up

Patient follow-up is important with regard to surgical complications (such as wound problems, infection, recurrence of the deformity and joint stiffness).

Deformities and inflammation of the foot should not be taken lightly, and you should always see a healthcare provider.