Hallux valgus is a foot deformity that occurs when the big toe bends outward and the metatarsal bone shifts inward.
Those with hallux valgus foot experience pain and swelling on the root joint (MP joint) of the big toe, due to the deteriorated structure of the foot. In addition to causing aesthetic discomfort, hallux valgus also causes walking disorders and restrictions on daily activities in later stages.
Hallux valgus is 15 times more common in women than in men. Almost one in every three women has hallux valgus. The most common risk factors for hallux valgus formation are genetic transmission and wearing high-heeled and narrow-toed shoes.
There is no method other than surgery to correct the deformity in the big toe seen in hallux valgus. Applying ice to the painful area, changing shoes, and using a night splint can provide effective solutions for pain management.
What is Hallux Valgus?
Hallux Valgus is the curvature of the big toe. Also, in Hallux valgus, the big toe noticeably slides towards the outside of the foot towards the 2nd toe. A protrusion forms at the root joint of the big toe (MP joint). This protrusion is called a bunion.
The bursae on the bony protrusion, the bunion, become compressed inside the shoe, causing swelling and pain. Over time, the displaced big toe also compresses the other toes of the foot.
This shift seen in hallux valgus is spontaneous and permanent. Over time, the big toe moves under the second toe.
The big toe joint capsule is stretched from the inside of the foot, causing pain and tenderness on the MP joint of the big toe (the joint between the big toe and the metatarsal bones).
What Causes Hallux Valgus?
Female Gender:
Hallux Valgus is most commonly seen in women, but it can also be seen in men. However, the frequency of occurrence in men is quite low. There is only 1 male hallux valgus patient for every 15 female hallux valgus patients.
Genetic Transmission:
Hallux valgus is more common in people with a family history of hallux valgus. Additionally, 70% of people with hallux valgus have a family history.
Hallux Valgus Shoe Relationship:
Hallux valgus can occur in those who wear high-heeled, pointed-toed and narrow-toed shoes, as well as in African tribesmen who have never worn shoes in their lives. In addition, hallux valgus may not occur in everyone who wears high-heeled, pointed-toed shoes.
However, if people with hallux valgus frequently wear high-heeled, pointed-toed, narrow-toed shoes, their existing hallux valgus will progress more quickly.
What is Hallux Valgus?
Hallux Valgus is the curvature of the big toe. Also, in Hallux valgus, the big toe noticeably slides towards the outside of the foot towards the 2nd toe. A protrusion forms at the root joint of the big toe (MP joint). This protrusion is called a bunion.
The bursae on the bony protrusion, the bunion, become compressed inside the shoe, causing swelling and pain. Over time, the displaced big toe also compresses the other toes of the foot.
This shift seen in hallux valgus is spontaneous and permanent. Over time, the big toe moves under the second toe.
The big toe joint capsule is stretched from the inside of the foot, causing pain and tenderness on the MP joint of the big toe (the joint between the big toe and the metatarsal bones).
What Causes Hallux Valgus?
Female Gender:
Hallux Valgus is most commonly seen in women, but it can also be seen in men. However, the frequency of occurrence in men is quite low. There is only 1 male hallux valgus patient for every 15 female hallux valgus patients.
Genetic Transmission:
Hallux valgus is more common in people with a family history of hallux valgus. Additionally, 70% of people with hallux valgus have a family history.
Hallux Valgus Shoe Relationship:
Hallux valgus can occur in those who wear high-heeled, pointed-toed and narrow-toed shoes, as well as in African tribesmen who have never worn shoes in their lives. In addition, hallux valgus may not occur in everyone who wears high-heeled, pointed-toed shoes.
However, if people with hallux valgus frequently wear high-heeled, pointed-toed, narrow-toed shoes, their existing hallux valgus will progress more quickly.
What are the symptoms of Hallux Valgus?
The most common symptom is a bulge-swelling where the thumb articulates with the metatarsal bone.
Other symptoms of Hallux Valgus:
Big Toe Curvature: The big toe is bent towards the other toes. It is the most obvious symptom of hallux valgus.
Bone Spur: A bone spur forms at the base of the big toe, on the side of the foot. This spur usually becomes red and tender.
Pain and Tenderness: There is pain and tenderness in the big toe and the bony prominence around it. The pain increases especially on days when wearing tight shoes.
Swelling and Redness: Swelling, redness and inflammation may occur in the joint at the base of the thumb.
Limited Movement: It may become difficult to move the thumb and there may be pain during movement.
Callus formation: The skin over the big toe joint may become calloused or hardened.
Changes in Foot Structure: As hallux valgus progresses, deformations and disorders such as hammer toe may develop in other toes.
Thumb Going Under the Second Toe: It is seen in advanced hallux valgus patients. In hallux valgus deformity, as the thumb bends outward, pressure is created on the second toe, which can cause the toes to overlap. This shift can negatively affect the balance and walking in the foot, causing pain and deformations in the other toes. The overlapping of the toes increases the difficulty of wearing shoes and joint pain.
Morton Neuroma Formation: Hallux valgus, in its advanced stages, can create pressure on the other toes, causing various changes in the foot structure. This can contribute to the development of nerve-related problems such as Morton neuroma in the foot. Morton neuroma is a condition that occurs when the nerve between the toes thickens and is usually seen between the 3rd and 4th toes.
What is Hallux Valgus?
Hallux Valgus is the curvature of the big toe. Also, in Hallux valgus, the big toe noticeably slides towards the outside of the foot towards the 2nd toe. A protrusion forms at the root joint of the big toe (MP joint). This protrusion is called a bunion.
The bursae on the bony protrusion, the bunion, become compressed inside the shoe, causing swelling and pain. Over time, the displaced big toe also compresses the other toes of the foot.
This shift seen in hallux valgus is spontaneous and permanent. Over time, the big toe moves under the second toe.
The big toe joint capsule is stretched from the inside of the foot, causing pain and tenderness on the MP joint of the big toe (the joint between the big toe and the metatarsal bones).
What Causes Hallux Valgus?
Female Gender:
Hallux Valgus is most commonly seen in women, but it can also be seen in men. However, the frequency of occurrence in men is quite low. There is only 1 male hallux valgus patient for every 15 female hallux valgus patients.
Genetic Transmission:
Hallux valgus is more common in people with a family history of hallux valgus. Additionally, 70% of people with hallux valgus have a family history.
Hallux Valgus Shoe Relationship:
Hallux valgus can occur in people who wear high-heeled, pointed-toed and narrow-toed shoes, as well as in African tribesmen who have never worn shoes in their lives. In addition, hallux valgus may not occur in everyone who wears high-heeled, pointed-toed shoes.
However, if people with hallux valgus frequently wear high-heeled, pointed-toed, narrow-toed shoes, their existing hallux valgus will progress more quickly.
What are the symptoms of Hallux Valgus?
The most common symptom is a bulge-swelling where the thumb articulates with the metatarsal bone.
Other symptoms of Hallux Valgus:
Big Toe Curvature: The big toe is bent towards the other toes. It is the most obvious symptom of hallux valgus.
Bone Spur: A bone spur forms at the base of the big toe, on the side of the foot. This spur usually becomes red and tender.
Pain and Tenderness: There is pain and tenderness in the big toe and the bony prominence around it. The pain increases especially on days when wearing tight shoes.
Swelling and Redness: Swelling, redness and inflammation may occur in the joint at the base of the thumb.
Limited Movement: It may become difficult to move the thumb and there may be pain during movement.
Callus formation: The skin over the big toe joint may become calloused or hardened.
Changes in Foot Structure: As hallux valgus progresses, deformations and disorders such as hammer toe may develop in other toes.
Thumb Going Under the Second Toe: It is seen in advanced hallux valgus patients. In hallux valgus deformity, as the thumb bends outward, pressure is created on the second toe, which can cause the toes to overlap. This shift can negatively affect the balance and walking in the foot, causing pain and deformities in the other toes. The overlapping of the toes increases the difficulty of wearing shoes and joint pain.
Morton Neuroma Formation: Hallux valgus, in its advanced stages, can create pressure on the other toes, causing various changes in the foot structure. This can contribute to the development of nerve-related problems such as Morton neuroma in the foot. Morton neuroma is a condition that occurs when the nerve between the toes thickens and is usually seen between the 3rd and 4th toes.
Which Part Affects Hallux Valgus?
First of all, Hallux Valgus is a disorder that occurs due to a bunion (big toe protrusion) on the big toe. This disorder is usually treated by the Orthopedics and Traumatology department. Orthopedists evaluate problems such as big toe deformity and create a treatment plan.
This deformity occurring on the metatarsophalangeal joint may require various treatment methods depending on the patient's complaints and the severity of the deformity.
When Hallux Valgus is diagnosed, the specialist doctor determines the appropriate treatment options by examining symptoms such as toe misalignment and foot pain. In this case, conservative treatments or surgical methods may be preferred. In severe cases, your doctor may evaluate you for surgical correction.
How is Hallux Valgus Diagnosed?
Hallux Valgus is diagnosed immediately. However, a foot x-ray is taken to better evaluate Hallux valgus.
Since Hallux Valgus is a progressive disease, x-rays are taken over time to monitor how the deformity worsens. Hallux Valgus, which begins in adolescence, progresses more rapidly.
Since nerve compression (Morton Neuroma) is common in patients with Hallux Valgus, especially between the 3rd and 4th toes, the physical examination of patients with hallux valgus also checks whether there is nerve compression.
Degrees of Hallux Valgus
Hallux Valgus deformity is divided into various degrees according to its severity. These degrees are determined by the angle of the deformity and the incongruity between the metatarsal bones .
Mild Degree: The big toe protrusion is mild and inflammation is minimal.
Moderate: The big toe deformity becomes more pronounced and swelling may occur.
Advanced Degree: Finger alignment disorder is observed intensely and this may cause gait disorders.
Each degree requires different treatment methods. In mild cases, orthotics and shoe modifications may be sufficient, while advanced cases may require surgical intervention.
What is Good for Hallux Valgus Pain?
There are several non-surgical methods to relieve hallux valgus pain. However, none of these methods will provide permanent relief. The definitive solution to hallux valgus is surgery.
Choosing the Right Shoe: First of all, you should choose comfortable and wide-toed shoes. Do not wear high-heeled or pointed-toed shoes. This will reduce the pressure on the big toe and relieve the pain. In most Hallux Valgus patients, the pain is relieved with a change in shoes. Since patients with Hallux Valgus often prefer slippers in the summer, they do not have pain in this season. When they start wearing closed shoes in September, patients with Hallux Valgus see their doctor with pain complaints.
There are two things that patients with hallux valgus should pay attention to when choosing shoes:
Shoes that don't squeeze your feet
Shoes that won't put pressure on your toes
The pressure areas of some shoes can be expanded with shoe expanders. If the shoe continues to feel tight after this application, you should stop wearing that shoe.
Using a Night Splint: Using a splint that puts the thumb in the correct position relieves pain, albeit temporarily.
Using a Protective Pad: Using a soft silicone cushion or pad placed on the protrusion of the big toe of patients with hallux valgus reduces pain in most patients.
Using silicone between the fingers: Using silicone between the fingers relieves pain by reducing the pressure on the thumb.
Ice Application: When there is pain and swelling, applying cold with an ice pack for 15-20 minutes 3-4 times a day can reduce inflammation and pain.
Foot Exercises: Toe flexion and toe stretching exercises can help reduce stiffness and limited movement due to the deformity.
The most important point in Hallux Valgus pain management is shoe selection. In addition, wearing shoes that are not suitable for you may cause your existing hallux valgus disease to accelerate and become more painful.
For this reason, you should make sure that the shoes you wear fit your feet. Keep this in mind, most patients with hallux valgus never have pain if they do not wear shoes.
Related: How to Choose the Right Shoes?
Hallux Valgus Surgery Risks
Hallux Valgus surgery may carry various risks. Knowing these risks makes it easier for the patient to decide before surgery.
Hallux Valgus Surgery Risks | Explanation |
Infection | Infection may occur in the surgical area. |
Joint misalignment | After surgery, the metatarsophalangeal joint may become misaligned again. |
Development of arthritis | In the long term, there is a risk of developing arthritis in the joint. |
Nerve damage | Nerve damage can occur, causing numbness or tingling. |
Bleeding | Bleeding may occur during or after surgery. |
Bone Nonunion Problem | The healing process may be prolonged if the bones do not heal properly. |
Vascular Injury | During surgery, damage to the vessels in the area may occur. |
Wound Healing Problems | Wound healing may be delayed or may not heal as desired. |
Limited Movement | There may be a limitation in joint movement after surgery. |
Hammer Finger | After surgery, hammertoe development may be observed in other fingers. |
Inadequate Correction | It may occur that the deformity is not completely corrected after surgical intervention. |
Chronic Pain | Long-term foot pain may occur after surgery. |
Hallux Valgus Surgery Risks
When is Hallux Valgus Surgery Performed?
If non-surgical methods, especially shoe changes, are tried but problems caused by hallux valgus, such as pain and difficulty walking, cannot be eliminated, surgery is inevitable.
When is Surgery Performed for Hallux Valgus Seen in Adolescence (juvenile hallux valgus)?
In patients with hallux valgus seen during adolescence, surgery is avoided until growth is complete. The reason for this is that if the growth plates are not closed during surgery, the surgical procedures to be performed will be limited, therefore, in patients with juvenile type hallux valgus, growth is expected to be completed.
This condition is detected on foot X-rays. In juvenile hallux valgus, if the growth cartilage in the metatarsal bone of the big toe is lost, surgery is planned.
Another issue in juvenile type hallux valgus surgery is which technique will be used. The most effective method today is the double osteotomy technique performed on the metatarsal bone of the thumb.
What is the Aim of Hallux Valgus Surgery?
Aligning the thumb in its normal position.
Eliminate pain.
Choosing the type of surgery that will prevent Hallux Valgus from reoccurring.
Which Tissues Are Intervened In Hallux Valgus Surgery?
Tissues such as bones, joint capsules, tendons, ligaments and bursae are intervened.
What kind of procedures are performed on soft tissues during Hallux Valgus Surgery?
In the surgical treatment of hallux valgus, soft tissue surgeries alone are the most common cause of failure of hallux valgus surgeries. Soft tissue surgeries must be performed simultaneously with bone surgeries.
Soft tissue procedures involving the capsule, tendon and ligament tissues around the thumb are performed according to the needs of each patient.
By entering between the thumb and the 2nd finger next to it, the structures that stick to the thumb and cause the thumb to bend outward are cut and loosened.
These structures;
Release of the thumb adductor tendon.
Loosening of the capsule of the thumb joint.
After all soft tissue and bone procedures are completed, the joint capsule on the inside of the thumb is stretched, the thumb is given its final position, and the capsule is sutured.
How is the Bone Procedure Performed in Hallux Valgus Surgery?
Especially in Hallux Valgus surgery, two types of procedures are performed on the bone.
Removal of the bone protrusion: It is a part of Hallux Valgus surgery. It is one of the first procedures performed in hallux valgus surgery. Only the bone protrusion is not removed. We know from the historical process that when the bone protrusion is removed alone, it provides short-term relief but the hallux valgus disease returns (hallux valgus).
Corrective Procedures: In hallux valgus, curvature corrective procedures can be performed on 1 or 2 foot bones. Corrective procedures may be required on the metatarsal bone of the big toe, the big toe itself, or both. In some rare cases, it may be necessary to immobilize the joints.
Is the Same Surgery Performed on Every Patient with Hallux Valgus?
No. Hallux Valgus surgery is a personalized surgery. Each patient is evaluated separately and the appropriate surgery is selected.
Those who want to watch the simultaneous bilateral hallux valgus surgery performed by Op. Dr. Utku Erdem Özer can watch it by clicking here:
Can Hallux Valgus Be Corrected With Exercise?
Hallux Valgus deformity can be alleviated with exercise in some cases, but it cannot be completely corrected. Exercises can help reduce inflammation and swelling by strengthening the muscles around the big toe. However, this method is more commonly used as a conservative treatment and is suitable for mild cases that do not require surgery.
Physical therapy exercises can be done to reduce toe misalignment and relieve foot pain. However, if there is a severe big toe deformity or severe deterioration of the metatarsophalangeal joint, exercises may be inadequate and surgical correction may be necessary.
Hallux Valgus Exercises
In the treatment of Hallux Valgus, exercises can stop the progression of the deformity by strengthening the foot muscles. It is especially important to stretch and strengthen the toes. Simple exercises such as opening and closing your toes and picking up towels with your toes can strengthen these muscles.
These exercises, when done regularly, increase the flexibility of your foot muscles and slow down the progression of the deformity. In addition, strengthening the muscles around the foot and ankle can help keep the foot structure more uniform.
Hallux Valgus Exercise Suggestions:
Opening and closing the toes
Picking up towels with toes
Exercises to strengthen the muscles around the ankle
Comments of Those Who Had Hallux Valgus Surgery
When the comments of those who had Hallux Valgus Surgery are examined, the majority of them report that their pain has decreased significantly.
The recovery time after surgery varies from person to person, but it usually takes 6 to 8 weeks. During this time, it is important for patients to rest and do the exercises we recommend.
You can watch the comments of our patient after the hallux valgus surgery performed by Op. Dr. Utku Erdem Özer by clicking here:
Here are some of our patient comments:
Merve A .: "Mr. Utku informed me very well during and after the surgery. Although I had a little difficulty in the first weeks, I am fine now. My walks are more comfortable than before."
Selim Y .: "I was able to return to my previous activities within 6 weeks after the surgery. Thanks to the exercises given by Mr. Utku, my recovery process was very fast."
Elif T .: "I was having difficulty walking due to Hallux Valgus. I applied to Utku Erdem Özer and after the surgery I am living an almost pain-free life. I am very pleased with him."
Conclusion
Hallux Valgus is a disorder experienced due to deformity in the big toe. Problems such as bunion (big toe protrusion) and big toe deformity can cause gait disorders and pain.
Treatment options are divided into two as conservative treatment and surgical correction. Early diagnosis and appropriate treatment are very important to improve the quality of life.
Exercises should not be neglected during this process. For more detailed diagnosis and treatment, do not forget to contact us through our communication channels.
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