Hallux valgus

When the big toe is crooked and painful

Hallux valgus: when the big toe is crooked and painful

Painful feet and deformity of the big toe

The way from the shoe shop to the foot surgeon is not far at all – particularly for women, who love wearing high heels often and for long periods. Because high heels favour the onset of hallux valgus, which is usually associated with pain and ugly deformities. Nevertheless, for over 100 years now, it's been difficult to imagine ladies' fashion without high heels. High heels make the legs look longer, raise petite ladies up a few centimetres, make you slender and give you a shapely bottom. And they give you an altogether sexy look to help you score points with the opposite sex.

These or similar thoughts reflect the motivation of millions of women to wear these shoes again and again, although, in doing so, their feet suffer considerably. Besides the obvious risk of stumbling, tripping, twisting ankles or caught heels, women who wear shoes with high heels too often and for too long, especially those with splayfoot and weak connective tissue, expose themselves to an additional risk: hallux valgus.

What is hallux valgus?

Hallux valgus, also known as a bunion, is a malalignment of the forefoot: the first metatarsal bone deviates outwards towards the lateral border of the foot. This widens the area around the ball of the foot (splayfoot). However, the tendon is too short for this and pulls the big toe to the side. This then points towards the small toes.

In specialist circles, it is estimated that eight to nine million people in Germany are affected. Thus every tenth individual suffers from some degree of forefoot deformity.1

Risks and causes of the onset of hallux valgus

Hallux valgus is the result of faulty biomechanics in the foot and is often only a cosmetic problem at first. But hallux valgus symptoms can grow worse over the years. 

Splayfoot

The foot's transverse arch is flattened in splayfoot: this causes the big toe to be pulled out of alignment by the tendons and muscles. This constellation may cause the condition to worsen.

Wrong footwear

Wearing high heels does more than anything else to favour the onset and progression of the condition: the weight of the whole body rests on the front part of the foot. Shoes that are also too narrow at the toes force the big toe even further into the valgus position.

Overweight

Pronounced obesity is another negative factor.

Genetic factors

In some families, hallux valgus occurs more often and over generations. People with this congenital predisposition should look after their feet particularly carefully. 

Primary predispositions

There are children as young as 12 or 13 years of age, who are already suffering from severe hallux valgus deformities. In such cases, the cause is genetic.

What symptoms do hallux valgus patients have?

  • Pain, redness and swelling around the joint at the base of the big toe: the pain experienced by hallux valgus patients varies from person to person. Even mild hallux valgus can cause some people severe pain, while others hardly have any pain despite very marked deformity.
  • Midfoot pain: as the condition progresses, the so-called first ray (the big toe and the first metatarsal bone together form the first ray) becomes unstable, so the patient can no longer bear weight on this area. The patient then adopts a protective positioning of the foot and loading is shifted to the middle and lateral parts of the midfoot.
  • Hammer toe: the skewed position of the big toe often affects the small toes as well. They are crowded together and hammer toe may develop.
  • Osteoarthritis: the persisting deformity may damage the joint at the base of the big toe so badly that the joint becomes osteoarthritic (wear and tear of the joint) after a number of years.

Treatment of hallux valgus

Once hallux valgus has developed, it can no longer be reversed. The doctor then has to decide which form of treatment is suitable – depending on how severe the deformity of the front of the foot has become.

  • Insoles, splints, supports: if the big toe can still be returned to its original position (flexible deformity), then conservative (non-surgical) treatment options can usually relieve pain. It may then be useful to treat the underlying splayed foot with insoles: these lift the second and third midfoot rays, the midfoot becomes narrower overall and the pressure in closed shoes decreases.
  • Physiotherapy: walking barefoot as well as toe and foot exercises can strengthen the foot muscles and connective tissues. This counteracts deformities. Special strengthening and mobility exercises to strengthen the feet and the whole body are called Spiraldynamik (a three-dimensional movement concept): the patient learns to train her toes and to actively keep them straight.
  • Operation: if the foot condition still progresses despite conservative treatment, the only option left is surgery. There are different operation techniques for this: the operation straightens the toe. 

Comfortable flat shoes that do not pinch are one way of preventing hallux valgus. High heel shoes aggravate splayfoot.

The reason for this is that the heads of the midfoot bones then have to bear more weight. If women were to wear high heels less often, or even not at all, this would definitely be a preventive measure.

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Sources:

1 Comfort is top priority: how shoes influence the onset of hallux valgus. Dr Armin Schupp from the Centrum für Orthopädie und Chirurgie (Centre for Orthopaedics and Surgery) in Memmingen, Germany

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