Hallux valgus (bunion) is a deformity of the big toe and often affects middle-aged women. The deformity is usually the result of splayfoot.
The base joint of the big toe bends towards the outside of the foot and the tip of the toe bends inwards, displacing or overlapping the adjacent toe. This deformity can appear in a number of different ways.
The most common symptoms include:
Hallux valgus is more common in women than men. The misalignment of the toes may be hereditary or it may result from conditions that weaken the connective tissue.
Wearing shoes that are too narrow, too high or too pointed promotes the development of the toe deformity. The pressure that this exerts on the toes changes the axis of the toes, as well as the direction in which the muscles and tendons are pulled. As a result, the toe is pulled more and more towards the sole of the foot and turns inwards.
Other causes are inflammatory diseases (e.g. rheumatism), pes valgus and pes planus (flat foot), as well as genetic factors.
An X-ray is carried out to determine the degree of misalignment.
There are four different stages of hallux valgus, which are crucial to determining the appropriate treatment.
Depending on the severity of the hallux valgus, conservative or surgical therapy is used.
If the angle of the hallux valgus angle is lower than 20 degrees, it is possible to treat it without surgery or to delay the surgery. The treatment is carried out using foot or toe exercises, insoles, tapes or a bunion splint.
A bunion splint can be used in the early stages of hallux valgus to build up and strengthen specific muscles in the foot. This can counteract the deformity and also relieve any pain that occurs.
Physiotherapy and special tapes can stop the progression of the deformity.
The indication and method of surgical correction are always based on the patient’s personal wishes, and are decided upon in a conversation between doctor and patient. The stage of the hallux valgus is also taken into account.
With the surgical methods and implants available today, the operation has a success rate of around 98%. Bunion operations having a bad reputation due to poor outcomes is definitely a thing of the past.
Chevronosteotomy – after separating the metatarsal heads, the bony part is removed and the two bones are connected and fixed using screws or a suture.
Scarf and Ludloff osteotomy: The first metatarsal bone is severed on the shaft either in a Z-shape (according to Scarf) or diagonally (according to Ludloff) and then fixed with a screw.
Lapidus technique: The position of the metatarsal bone is corrected. It is fixed in place with metal plates that are screwed to the bones. The plates secure the foot in the corrected position.
After the operation, the patient can bear weight on the foot, but the foot should be rested for at least two weeks. A special bunion shoe, which is adapted to the individual patient, must be worn for the following four to six weeks.
Surgery is require if large parts of the joint surface are destroyed due to cartilage wear and the patient wants long-term pain relief.
No, there is no evidence that hallux valgus will go away on its own. However, there are specific measures, such as a bunion splint, physiotherapy or tapes, which can be used to ensure that the condition does not progress further.
As the main cause of bunions is wearing the wrong shoes, you should avoid wearing high-heeled or pointed shoes.
