Hallux Valgus: What it is and How to Treat it

Hallux Valgus: What is it?

Hallux valgus is a progressive outward enlargement of the base of the big toe, caused by a deformation of the first toe, which causes the tip of the toe to point towards the other toes. Technically, it is the prominence of the medial part of the head of the first metatarsal bone.

The problem is exacerbated when the hypertrophy degenerates, causing pain and deformation of the entire foot. This deformation manifests itself by the progressive displacement of the big toe towards the ankle, the second toe, which in turn tends to deviate from its axis outwards and in this torsion drags the other toes with it. In contact with the shoe, hallux valgus can lead to secondary osteoarthritis and the formation of osteophytes, a very painful bursitis and even, in some cases, ulceration of the skin.

The age of onset of the disorder is generally between 40 and 60 years, but hallux valgus can also affect children and adolescents, and is managed in the same way at all ages.

First Symptoms: How to recognize the beginning of a hallux valgus?

The symptoms of hallux valgus are essentially pain of varying intensity, initially associated with redness of the part with bursitis, a "soft" onion-like inflammation. The other toes may have a hammer toe. When the joint is severely compromised and the bony component protrudes very obviously, the pain becomes constant and tends to radiate from the osteo-articular region affected by the deformation to the entire foot, going up to the leg and triggering functional alterations in the knee and hip joints. The foot then begins to rest incorrectly and to walk badly. Painful calluses are often observed on the soles of the feet, due to excessive plantar protrusion of the metatarsals caused by an unbalanced distribution of loads.

Other symptoms include:

• Edema;
• Tingling;
• Feeling of fatigue in the foot and leg;
• Postural problems;

It should be noted that the problem often manifests itself symmetrically in both limbs, but not with the same severity. Thus, a hallux that appears swollen, which progressively tends to move laterally, should be checked immediately first by its general practitioner, and secondly by an orthopedist, before the big toe bursitis becomes chronic and the bone spur grows increasingly outwards with calcification of the deformation. Only the doctor can make the definitive diagnosis, first by means of a clinical examination and an X-ray of the foot.

What to do to relieve the pain of hallux valgus?

Unfortunately, it is possible to intervene at an early stage, preventing the hallux valgus from degenerating. The speed of intervention makes it possible to contain the problem before it becomes seriously disabling, thus avoiding surgery, which is necessary in more serious cases.

The first thing to do is to take measures to relieve the pain. Here are some methods that could help you relieve your pain:

• First of all, avoid wearing shoes with excessively high heels and narrow toes, which put pressure on the foot joints and toes. You can also use toe cushions and splints. Ultra-flat shoes such as ballerinas and flip-flops are also not recommended. The optimal elevation does not exceed 5 cm, a medium heel that allows you to walk smoothly without concentrating the body weight on the forefoot alone. The ideal shoe will therefore have a wide and comfortable toe, a supple upper, even better if it is equipped with an anatomical and flat sole, which can also be custom-made. It is also useful to wear silicone caps that keep the toes slightly apart and distribute the body weight evenly, or directly a splint that keeps the forefoot in the correct position;
• With the classic warm foot bath, a grandmother's remedy that can be done with special products like salts or clay;
• Apply ice to the affected area;
• Taking non-steroidal anti-inflammatory drugs (NSAIDs) on medical advice, particularly for arthritic synovitis, or corticosteroids by infiltration;
• In the presence of contiguous bursitis, aspiration of the fluid using a needle (aspiration);
• With specific gymnastic exercises (stretching) on the advice of the physiotherapist;

The appearance of hallux valgus cannot be completely avoided, but with the aforementioned precautions and exercises recommended by the specialist, it is possible to reduce the worsening of the condition.

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Operating on a hallux valgus

When a hallux valgus has calcified and causes severe pain, making walking difficult or impossible, surgery is necessary. Two techniques are most often used:

• Classical surgery, also called "open surgery", because it involves disconnecting and opening the skin and tissues until the bone is exposed and direct intervention is possible;
• Percutaneous technique. In this case, only mini-incisions are made in the skin, through which a fiber optic probe is introduced to guide the operation, and miniaturized surgical instruments. It is obvious that this second type of operation is much less traumatic for the patient (it lasts about twenty minutes) and has a shorter postoperative phase, to the point that it is performed in a day hospital. The patient can walk immediately after the operation;

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