Crooked toe and thick bunion: What is hallux valgus?
Hallux valgus is also called a bunion or crooked toe. This is a malpositioning of the front of the foot, which is conspicuous for its “crooked toe”: the transverse arch lowers, causing the ball of the foot to widen (splayfoot). Consequently, one tendon of the big toe is too short, relatively speaking, and pulls the tip of the big toe towards the little toe.
Hallux valgus is the result of disturbed biomechanics of the foot and is often initially only a cosmetic problem. The symptoms can become more severe over the years.
Differentiation of this type of bunion from a tailor's bunion
This type of bunion should not be confused with what is known as a “tailor's bunion” (Digitus quintus varus), in which the ball of the little toe is affected. However, a tailor's bunion often occurs alongside hallux valgus or splayfoot. The cause of both malpositions is often pointy, tight shoes.
Causes and risk factors for the development of hallux valgus
Wrong footwear: Wearing high heels encourages the development and aggravation of a bunion. All the weight is on the front of the foot. Shoes that are also too narrow at the front place the big toe in the valgus position to an even greater extent.
Splayfoot: “Splayfoot” means that the transverse arch of the foot is flattened. The big toe is subsequently steered away from its proper alignment by the tendons and muscles. This constellation of factors can cause the disease to progress even further.
Being overweight: Another negative factor is severe obesity. The constant additional stress on the body can lead to a flattening of the transverse arch, which promotes the development of hallux valgus.
Genetic factors: In some families, this deformity occurs more often and over multiple generations. People who have a hereditary predisposition to it should treat their feet with special care. At a young age, foot deformities can still be corrected relatively easily.
Can hallux valgus be prevented?
Comfortable, flat shoes that do not pinch are one way to prevent hallux valgus. Wearing shoes with high heels for long periods of time, on the other hand, can exacerbate the foot’s malposition. As a preventive measure, women should therefore wear shoes with high heels less often – or even better: skip them altogether and instead occasionally walk barefoot and do foot exercises.
Classification and symptoms of a bunion: When the big toe is crooked and hurts
Doctors divide the development of hallux valgus into four stages:
- Stage 1: Pain at the metatarsophalangeal joint. Otherwise, hardly any visible change in the big toe.
- Stage 2: Inflamed metatarsophalangeal joint – also externally reddened. The malposition of the toe is visible.
- Stage 3: The big toe pushes over the neighbouring toes. Bump on the inside of the foot.
- Stage 4: The big toe forms an angle of 90 degrees at the base joint.
- Pain, redness and swelling in the area of the metatarsophalangeal joint: The level of pain a bunion can cause varies from patient to patient. Some people experience severe pain even with a mild hallux valgus, while others have hardly any pain at all despite a severe deformity.
- Pain in the metatarsus: As the disease progresses, the big toe and the first metatarsal become unstable, to the extent that sufferers often can no longer put weight on the area. The result is a protective posture. The load therefore shifts to the middle and lateral metatarsal part of the foot.
- Other foot deformities: Due to the protective posture and incorrect weight-bearing, further deformities can occur in the feet and toes in the course of time.
- Osteoarthritis: A long-standing malposition can damage the metatarsophalangeal joint of the big toe to such an extent that arthrosis (wear and tear in the joint) develops there as the years pass. Also, due to the constant protective posture adopted by the patient, adjacent joints can be overloaded.
Therapy and treatment: What to do about hallux valgus?
A malposition must be treated medically. Otherwise, it will continue to develop over the years. If wear and tear has already occurred in the metatarsophalangeal joint of the big toe, the patient's movement is restricted. In this case, surgery may be necessary. If the toe is corrected, the result can usually be maintained. The doctor will decide which form of therapy is appropriate – depending on how much the deformation in the anterior region of the foot has progressed.
- Insoles, splints, supports, tapes: If the big toe can still be brought into its original position (= flexible deformity), then conservative (non-surgical) forms of therapy can usually relieve the pain. For example, a treatment of the underlying spreading foot with insoles may be useful: In the process, parts of the midfoot are raised; this becomes narrower overall and the pressure in the closed shoe is thus reduced.
- Physical therapy: Toe and foot gymnastics can strengthen the foot muscles and connective tissue to counteract deformities. Special strength and flexibility exercises that strengthen the whole body as well as the feet. The patient learns how to train the toe and foot muscles and how to control them correctly.
- Compression with hallux relief zones: If the patient is wearing medical compression stockings, models with hallux relief zones should be used.
- Operation: If the foot disease progresses despite conservative treatment or if the pain is too severe, only an operative intervention is possible. There are various surgical procedures. The operation straightens the toe.
For a diagnosis of "splayfoot", insoles are beneficial and can also contribute to the prevention of hallux valgus.
Which doctors treat hallux valgus?
The first point of contact is your family doctor. He or she will refer you to a specialist: An orthopedist is a specialist doctor who focuses on foot deformities.
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Health personnel will make the diagnosis and can prescribe orthopaedic insoles, e.g. from medi if necessary.
Your medical retailer will fit them individually for you.