Hallux valgus(Bunion)
What does Hallux valgus mean?
Hallux valgus is a deviation of the first toe outward. Valgus deformity is one of the most common.
Disease
Hallux valgus occurs in about 1% of the general human population. Women are predisposed to this deformity 2-4 times more often than men. The older a person gets, the higher the incidence of this disease.
The primary manifestation of Hallux valgus is the presence of a “bump” on the inner edge of the foot closer to the base of the first toe. This formation becomes “bony” over time. At this stage, the patient usually feels pain. Significant flexion of the first toe creates great difficulty when choosing shoes.
Visualization diagnostics for Hallux valgus is performed based on X-ray examination. In severe cases, CT and MRI are performed. Laboratory tests in some situations can help determine the cause of the disease.
Depending on the severity of the subjective and objective symptoms, your doctor will make a personalized treatment plan. It may be conservative or suggest the need for surgical intervention. After surgery, it is important to undergo a comprehensive rehabilitation that will restore the anatomical and functional status of the foot.
Types and stages of Hallux valgus
According to the classification, there are following stages of Hallux valgus based on the calculated angle of displacement of the thumb (usually this angle should not exceed 15°):
- In the first stage, the angle varies between 15 and 25°.
- In the second stage – the angle increases to 40°.
- In the third stage, the angle varies between 40 and 50°.
- In the fourth stage – the whole angle exceeds more than 50°.
In a simplified version, the course of Hallux valgus can be presented in the form of 2 stages:
- stage of “soft” formation, when a moderate density “bump” forms in the area of the first metatarsophalangeal joint;
- stage of “dense” formation, which corresponds to the formation of an osteophyte.
Symptoms
What does bunion mean? The main symptom of this condition is the so-called osteophyte. It is a bulge formed along the inner edge of the foot because of a deviation of the first finger outward from the area of the metatarsophalangeal joint. This condition gives a person a certain degree of discomfort when choosing shoes, especially model ones that keep their shape.
Hallux valgus deformity of the first toe is often accompanied by the appearance of unpleasant and painful sensations. The pain increases with prolonged walking and exercise.
Due to a foot anatomy violation, the “plantar callus” are seen in areas of increased skin keratinization in places of constant mechanical compression (hyperkeratosis).
Symptoms of Hallux valgus
The following causes of Hallux valgus are identified:
- hereditary;
- instability of the joints of the foot, which can be the result of congenital deformities, connective tissue dysplasia, acquired abnormalities in the structure after injuries and diseases;
- an inflammatory process in the area of the mobile bone joints of the foot (the result of gout, rheumatoid arthritis, or psoriatic arthritis injury);
- post-traumatic changes (after fractures, sprains, or joint damage).
- genetic diseases involving lesions of connective tissue (Marfan syndrome and others);
- diseases of the nerve complex (multiple sclerosis, cerebral palsy);
- specific of the tibia position when it is bent outwards;
- X – or O-shaped curvature of the knees;
- altered position of the femur in relation to the pelvic bone base.
Diagnostics – clinical recommendations
According to clinical guidelines, the diagnosis of Hallux valgus begins with an objective examination of the foot. The orthopedist will pay attention to the condition of the first metatarsophalangeal joint, the presence of associated deformities, the severity of the plantar hyperkeratosis, and other signs.
The goal of diagnostics and hallux valgus grading is performed based on X-ray examination data. X-ray scanning is performed with two predictions of resting condition and load. Both feet – both right and left – are examined.
Your doctor will assess several parameters:
- position of the first metatarsal bone;
- in the direction of the first finger;
- the relationship between the joint ends at the first metatarsophalangeal joint;
- proper cartilage plates (early detection of osteoarthritis);
- topographical and anatomical condition of other foot bones;
- height of the foot arches.
Radiological data is usually sufficient to establish a diagnosis. However, if Hallux valgus is suspected to develop due to metabolic or inflammatory conditions, the doctor will order laboratory tests. So, if gout is suspected, the level of uric acid in the blood is determined; if rheumatoid arthritis is suspected, then a comprehensive evaluation, laboratory, and rheumatological tests are performed, etc.
For patients planning surgical procedures a detailed study of the foot’s anatomy is indicated. Therefore, a computer scanor magnetic resonance imaging can be performed in the preoperative phase.
Hallux valgus treatment
Treatment for Hallux valgus is determined by the severity of the deformity and the intensity of the pain syndrome. Depending on the goals, conservative treatment or surgical intervention may be performed.
Conservative treatment
Conservative treatment is recommended in the following situations:
- mild or moderate pain;
- the early stages of Hallux valgus, when the deformity is expressed slightly;
- the presence of contraindications to surgical procedures.
The main methods of conservative treatment are:
- a range of orthopedic footwear that creates optimal support for the foot and reduces pressure on problematic areas (soft shoes with wide soles and low heels meet these requirements);
- wearing custom-made support insoles;
- regular physiotherapy and massage services;
- perform therapeutic gymnastics exercises;
- anesthesia with non-steroid anti-inflammatory drugs or local neural blockades with anesthetic agents (performed by an orthopedic traumatologist).
Surgical treatment
The main indications for surgical intervention for Hallux valgus are:
- severe pain syndrome;
- severe deformity of the region and metatarsophalangeal joint;
- limited quality of life, including professional activities, due to the presence of Hallux valgus;
- inability to wear the shoes you want.
However, surgical intervention may not work in all cases. Acute infections, exacerbation of a chronic process, and poorly corrected diseases of the internal organs are contraindications to this type of treatment.
Surgical intervention is performed under adequate anesthesia. The following anesthesia options are available, taking into account the patient’s wishes:
- local, when the anesthetic solution is injected directly into the operated area;
- conduction anesthesia, when anesthesia is injected into the femoral or lumbar region and thus it blocks the sensitive innervation along the nerve fibers of the leg;
- general anesthesia, when conscience is turned off and pain sensitivity is blocked.
Considering the specifics of the clinical situation and the mechanism of the bunion formation, the following surgical options are possible:
- cheilectomy – excision of a protruding fragment of the first metatarsal bone (the method is symptomatic; relapses are possible);
- osteotomy – dissection of bones and reconstruction of a new anatomical joint.
- arthrodesis – surgical maintenance of immobility of the first metatarsophalangeal joint (performed in severe stages of the disease when it is impossible to restore joint mobility because of severe deformity);
- prostheses for the big toe using an implant in the first metatarsophalangeal joint – complete replacement of the joint is performed if it is completely damaged;
- reconstructive plastic surgery of the tendons and soft tissues usually involves complex bone interventions that allow you to create the correct strengthening of the body.
All these types of surgery are performed in more than 750 hospitals all over the world. (https://doctor.global/results/diseases/hallux-valgus). For example, Hallux valgus surgery is performed in 45 clinics across Germany with an approximate price of $10.3 K. (https://doctor.global/results/europe/germany/all-cities/all-specializations/procedures/hallux-valgus-surgery)
Prevention
Prevention of Hallux valgus deformity of the foot consists of wearing shoes that are correctly selected for the size of the foot, timely treatment of diseases of the musculoskeletal system, normalization of weight (if it is significant excess), the use of orthopedic insoles that evenly distribute the load on the foot.
Rehabilitation of hallux valgus
Rehabilitation for Hallux valgus after surgery includes physiotherapy procedures, therapeutic massage, and gymnastics. Early after surgery, your doctor will prescribe a preventive course of antibiotics and regular antiseptic wound care treatments.
The effectiveness of rehabilitation treatment depends mainly on the patient’s willingness to cooperate with the doctor and follow their recommendations. Depending on the surgical procedures, a traumatologist may prescribe a secure immobilizing foot cast or orthosis. It is recommended to wear special shoes to relieve the front part of the foot.The duration of immobility is usually 1-2 months. Nevertheless, a few days after the surgical intervention, physiotherapy begins to restore the muscular function. First, the patient performs passive and then active movements under the supervision of a physiotherapy specialist. The movements affect the joints of the foot and fingers.
