Hallux Valgus: Treatment and Minimally Invasive Surgery

What is hallux valgus or bunion?

Bunions, or hallux valgus, are a deformity of the big toe, where its alignment changes and it begins to deviate towards the second toe. This deviation leads to bone formation, a bump, on the side of the foot where the toe joins the foot. This area can become inflamed and cause pain.

The term "hallux" refers to the big toe. When the hallux deviates from its axis pointing towards the little toe, it is called a "valgus" deviation. This inevitably creates a bony protrusion on the foot, also known as a bunion.

This defect disrupts the correct alignment of the toes and, in some cases, the pressure exerted by the big toe can lead to a deformation of the second toe joint, which in turn "pushes" the third toe and so on.

Bunions tend to progress slowly and worsen over time. They are one of the most common foot deformities and, although anyone can suffer from them, they are more frequent in women. This higher prevalence in women is probably due to their preference for narrower and tighter shoes and the fact that their ligaments are more "loose".

What are the causes?

Bunions are more common in women and their cause is linked to genetic factors, meaning there is a hereditary component in the appearance of this pathology. Be careful if close relatives (mother, grandparents, sisters) have this pathology.

Moreover, certain rheumatological diseases can be at the origin of hallux valgus. This is the case with rheumatoid arthritis, which can lead to bunions as well as other foot pathologies, such as claw toes and metatarsalgia (toe pain, not to be confused with hallux valgus pain).

Certain alignment defects or increased mobility of the joints in the back of the foot can also predispose to the appearance of bunions.

A very common factor closely linked to bunions is the use of inappropriate footwear. Prolonged use of high-heeled shoes and, above all, very pointed shoes is associated with hallux valgus.

In summary, the constant pressure exerted on the toes by unsuitable footwear, particularly tight, pointed shoes and/or high heels, is one of the main causes of bunions.

In addition, other factors are also responsible for the appearance of bunions:

• Wearing high heels;
• Using smaller, tighter shoes or shoes with narrow toes;
• Arthritis;
• Congenital foot problems, such as a malformation;

How to recognize a bunion?

Hallux valgus pain is one of the main symptoms of bunions, localized to the points where the shoe exerts the most pressure, but also in the other toes and the sole of the foot.

Other symptoms include: redness, heat/burning sensation, swelling, tingling and skin irritation around the affected area.

In the case of bunions, pain occurs mainly after prolonged standing or walking in tight, high-heeled shoes. Sometimes it can develop and become severe, preventing the person from walking. The intensity of the pain generally decreases with rest and after removing or changing shoes.

When bunions become more pronounced and deform the foot, the pain can be constant and persistent, even at rest.

Here are some measures to relieve bunion pain:

• Apply ice to the affected areas for a few minutes to relieve inflammation;
• Use analgesics and anti-inflammatories to control pain and inflammation if recommended by your doctor;
• Use cushions on the joint or other orthopedic devices such as a hallux valgus orthosis;
• Replace tight, narrow, high-heeled shoes with wide, flexible, rounded or square-toed low-heeled shoes;
• Rest and elevate your feet every day for at least ten minutes;
• Do daily barefoot hallux valgus exercises;
• Avoid standing for long periods or engaging in activities and sports that put pressure on the affected areas;

If you notice a deformation of your toes, consult your orthopedic doctor.

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How is the diagnosis made?

The diagnosis of hallux valgus is made with the help of an orthopedic doctor, a professional who will link the physical symptoms of the foot to the problem. In most cases, the patient is asked to take X-rays of the affected area to better understand the situation. It is worth noting that the X-ray is taken with the person standing, as body weight has an influence and can define the dimensions of the deformity. From there, the orthopedic surgeon can define the next steps to take to solve the problem. It is also important to remember that after the diagnosis, other factors are also taken into account in order to choose the best type of hallux valgus treatment. These include questions such as other complaints the patient may have, the severity of the condition, the person's profile, their personal expectations, their general health status and their age. By respecting these factors, the orthopedist can opt for less radical actions, aimed at relieving pain and preventing the progression of the metatarsal alteration, or opt for surgical correction. In the first case, the most commonly used techniques are the use of anti-inflammatory drugs, toe separators and orthopedic accessories such as hallux valgus orthosis or hallux valgus corrector, or special hallux valgus shoes, in order to minimize the pressure suffered by the deformed area.

On the other hand, surgery is performed much more for clinical than aesthetic reasons.

Hallux valgus: when to operate?

The hallux valgus operation aims to remove the bunion, restore the normal functioning of the area, reconstruct the affected joint or realign the bones of the foot. Finally, with the hallux valgus operation the patient has the advantage of seeing the symptoms eliminated and the functions restored.

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