Hallux Valgus: From First Symptoms to Surgery

Causes of Hallux Valgus

Hallux valgus (also called a bunion) is the lateral deviation of the big toe, associated with a medial deviation of the first metatarsal, resulting in the formation of an often painful medial prominence (bunion). This deformity is common in women, as it is often caused by wearing tight, narrow shoes and high heels. In fact, nine out of ten cases of hallux valgus occur in women and are most often associated with wearing unsuitable footwear.

Among the causes that determine the appearance of hallux valgus, hereditary factors are the most influential, although it can also appear due to inflammatory rheumatism or other foot diseases such as flat feet or pes cavus.

Women are more prone to bunions than men. Indeed, high heels (from 4 cm) can worsen a mild hallux valgus, as can shoes that are too narrow at the forefoot (front part of the shoe).

Symptoms of a Foot Bunion

Bunions are easily identified by the patient's symptoms, which may include:

• The main and most obvious symptom of a hallux valgus is the bump that develops at the base of the big toe. This bump can be red and swollen, causing pain for the patient. These symptoms are aggravated by movement or even prolonged standing;
• Bunions are characterized by a rotation of the big toe towards the other toes and may even overlap the second toe;
• Other foot irritations such as corns, blisters, etc. are also common. In particular, the area affected by the bunion may be calloused and hardened;
• Hallux Valgus Pain: Hallux valgus pain can also be related to localized osteoarthritis in the joint due to the misalignment of the bone;
• The toe is also limited in its movement and sometimes presents with numbness and a burning sensation;
• Finally, toe deformation can be another symptom of bunions. These deformities occur when the big toe deviates due to the bunion and puts pressure on the rest of the toes, which can curl, causing what is called:
  • Hammertoes: the flexed joint is the one closest to the end of the toe;
  • Claw toes: the flexed joint is the one in the middle of the toe;
  • Mallet toes: the joint flexed upwards is the one at the base of the toe and the middle joint is flexed downwards;

These bunion problems can be more complicated to solve than a simple hallux valgus, which is why it is recommended to use a corrective treatment for hallux valgus as early as possible (with hallux valgus orthosis, hallux valgus surgery, etc.). Treating early-stage hallux valgus can prevent the long-term complications associated with this condition.

Hallux Valgus: Surgery as a Last Resort

The first hallux valgus treatment is conservative, i.e., without resorting to surgery. Prevention is always the best option. To minimize the risk of hallux valgus, never force your foot into tight, narrow shoes. Choose hallux valgus shoes that fit the shape of your feet.

Hallux Valgus: When to operate? If conservative treatment with hallux valgus orthosis or hallux valgus shoes or hallux valgus exercises is insufficient, the doctor may choose to perform hallux valgus surgery.

Two types of hallux valgus surgery are most often used:

• Open hallux valgus surgery. Corrective hallux valgus surgery involves performing bone realignments using osteotomies and tightening/loosening the soft tissues (tendons, ligaments, and joint capsule) to leave the position of the big toe as close to normal as possible. Bunion surgery can be performed using open or percutaneous techniques. In the open technique, the surgical site is approached by means of an incision through which the correction is performed. Surgical recovery depends on the technique used but involves an average 6-week period (1 week without walking) of using a rigid protective sandal and rehabilitation, and later protective shoes;
• Percutaneous or minimally invasive bunion surgery. Minimally invasive foot and ankle surgery allows surgical procedures to be performed with minimal incisions, using small drills to perform osteotomies (bone cuts) and the necessary corrections. In this way, we can perform corrections for hallux valgus, claw toes, metatarsalgia, among others, with small incisions, which improves the aesthetic aspect, postoperative pain, infection rates, and recovery time. Normally, the post-surgical period using this technique is less painful, allowing the patient to walk with the help of a sandal in the immediate post-surgical period (from the first day of hallux valgus surgery). However, it is important to emphasize that each surgical technique has its positive and negative aspects and is not applicable to all situations;

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Good Habits for Preventing Hallux Valgus

As we have already mentioned, genetics is the main cause of hallux valgus. While nothing can be done about this, it is possible to detect errors in our gait. Avoiding or reducing the overload produced in this area will help us control and prevent its appearance.

Recommendations for preventing bunions:

• Avoid high heels, as each centimeter increases the pressure on the metatarsal area;
• Do not wear narrow-toed shoes, as they facilitate the inward deformation of the thumb;
• Exercise barefoot;
• Undergo an ergonomic gait analysis, especially at the first signs of bunion appearance, to discover and correct, if necessary, the footprint with customized corrective insoles;

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