Hallux valgus / bunion
Hallux valgus is the most common foot malposition. Especially women are affected by the formation of this bony bump: The big toe pushes against the next toe, forcing the joint of the big toe to get bigger and stick out. Hallux valgus may occur as a result of an inherited structural defect, stress on the foot or a disease, e.g. arthritis. Wearing tight, narrow shoes might lead to bunions or worsen the condition. However, this is not scientifically proven.
- Skew angle of the big toe
- Visible bump on the big toe joint
- Redness around the big toe joint
- Thicker skin at the base of the big toe
- Corns or calluses (where the first and second toe overlap)
- Persistent or temporary toe or foot pain
- Restricted movement of the big toe or foot
- Shoes don’t fit properly because of hallux valgus
Hallux valgus forms when the pressures of bearing and shifting the weight fall unevenly on the joints and tendons in the feet of the affected person. This imbalance in pressure leads to instability of the big toe joint. It finally molds the parts of the joint into a hard knob that protrudes out beyond the normal shape of the foot. Tight shoes or high heels might lead to bunions or contribute to the development of hallux valgus. But this is not proven by the scientists. Other causes may be extra stress on the feet, inherited foot type, foot injuries or congenital deformities. Hallux valgus might also be associated with certain types of arthritis, especially inflammatory types, e.g. rheumatoid arthritis.
Hallux valgus is a permanent condition. But it doesn’t always cause problems. If there are complications, they might include bursitis (a painful condition when the small fluid-filled pads near the joints become inflamed), hammertoe (abnormal, often painful bend in the middle joint of a toe) and metatarsalgia (condition that results in pain and inflammation in the ball of the foot).
The position of the big toe can only be improved with lasting effect (e.g. with a night splint) as long as the patient’s skeleton is still growing. After the end of growth, conservative therapy is restricted to alleviation of symptoms. When patients visit the doctor because of hallux problems, they usually already wear wider, softer shoes in order to give their toes enough space and to reduce the pain caused by bunion. Pain in the smaller toes may also be alleviated with pads and toe straighteners.
In addition, padded shoe inserts may distribute pressure evenly when the affected person moves the feet. The inserts might reduce the symptoms as well and prevent hallux valgus from getting worse. If a patient has been on his/her feet the whole day, applying ice may relieve soreness and inflammation. However, patients with hammer toes or claw toes need surgery.
The doctor may suggest surgery if a change of footwear and other conservative measures don’t ease symptoms. The goal of the operation is to straighten the joint as much as possible and relieve pain. But it’s only recommended if a bunion causes frequent pain to the patient or interferes with his/her daily activities. It’s very important to talk to the physician about possible outcomes of hallux surgery. There are different surgical procedures for hallux valgus, depending on the severity of the bunion, foot shape, possible arthritis in the joint and other factors.
Surgical procedures may include removing the swollen tissue from the area around the big toe joint, straightening the big toe by removing part of the bone, joining the bones of the affected joint permanently, etc. Since operation is often done by using a local or general anesthetic, the patient may leave the hospital on the same day. Although some people can walk on their foot right after surgery, it normally takes weeks or even months until the patient fully recovers. Wearing proper shoes may prevent a recurrence of the condition.
It’s often possible to prevent hallux valgus or stop bunion from getting worse by:
- Wearing shoes that don’t irritate the toes
- Choosing shoes with a wide toe box
- Choosing shoes that easily conform to the shape of the feet
- Avoiding pointy-toed shoes
- Walking barefoot frequently
- Doing regular foot and toe exercises