Hallux valgus, also known as bunion, is a common foot condition that affects the joint at the base of the big toe.
It causes the big toe to deviate from its normal position and point toward the other toes, creating a bony bump on the side of the foot. This can lead to pain, inflammation, stiffness, and difficulty in walking and wearing shoes.
In this article, we will explain the causes, symptoms, diagnosis, treatment, and prevention of Hallux valgus.
Causes of Hallux Valgus
The exact cause of hallux valgus is not clear, but it is likely a result of a combination of factors, such as:
-Inherited foot type: Some people have a genetic predisposition to develop hallux valgus due to the shape or structure of their foot bones, ligaments, and muscles.
-Foot stress or injury: Repeated or excessive pressure on the big toe joint can cause it to become unstable and misaligned. This can happen due to activities that involve a lot of toe bending, such as ballet, running, or soccer.
-Deformities present at birth: Some congenital conditions, such as flat feet, low arches, or loose joints, can increase the risk of developing hallux valgus later in life.
–Arthritis: Inflammatory diseases, such as rheumatoid arthritis, can damage the cartilage and bones of the big toe joint and cause it to become swollen and deformed.
-Shoe choice: Wearing shoes that are too tight, too narrow, or too pointed can squeeze the toes and force the big toe to bend towards the others. High heels can also put more pressure on the front of the foot and aggravate the condition.
Symptoms of Hallux Valgus
The main symptom of hallux valgus is the appearance of a bony bump on the side of the foot at the base of the big toe. The bump may be red, swollen, or sore, and may rub against the shoes and cause irritation. Other symptoms may include:
– Pain or stiffness in the big toe joint: The pain may be constant or intermittent, and may worsen with movement or pressure. The joint may also lose some of its range of motion and flexibility.
– Corns or calluses: These are areas of thickened skin that form where the big toe and the second toe overlap or rub against each other. They can cause further pain and discomfort.
-Hammertoes: These are deformities of the other toes that cause them to bend downwards at the middle joint. They can result from the crowding and pressure caused by the hallux valgus. They can also cause pain, inflammation, and difficulty in walking.
-Numbness or tingling: These sensations can occur in the big toe or the other toes due to the compression of the nerves by the hallux valgus or the shoes.
Diagnosis of Hallux Valgus
To diagnose hallux valgus, a doctor will examine the foot and ask about the symptoms, medical history, and shoe habits. The doctor may also order some tests, such as:
– X-ray: This is an imaging test that uses radiation to produce pictures of the bones and joints of the foot. It can help determine the degree of deformity and the presence of any arthritis or other complications.
– Blood test: This is a laboratory test that analyzes a sample of blood for signs of inflammation or infection. It can help rule out or confirm the involvement of arthritis or other systemic diseases.
Treatment of Hallux Valgus
The treatment of hallux valgus depends on the severity of the condition and the impact on the quality of life. The main goals of treatment are to relieve pain, improve function, and prevent further progression of the deformity. The treatment options include:
– Non-surgical treatments: These are conservative measures that can help manage the symptoms and slow down the worsening of the condition. They include:
– Shoe modification: Wearing shoes that are wide, comfortable, and have a low heel can reduce the pressure and friction on the big toe joint and the bunion. Shoe inserts, pads, or orthotics can also help distribute the weight evenly across the foot and correct any biomechanical problems.
– Medication: Over-the-counter pain relievers, such as acetaminophen, ibuprofen, or naproxen, can help reduce the pain and inflammation caused by hallux valgus. Prescription medications, such as corticosteroids, may also be injected into the joint to provide temporary relief.
-Physical therapy: Exercises and stretches can help improve the strength, flexibility, and alignment of the foot and the big toe. They can also help prevent stiffness and contractures of the joint. A physical therapist can design a personalized program and teach the proper techniques.
-Ice and heat therapy: Applying ice packs or cold compresses to the affected area can help reduce the swelling and pain. Applying heat pads or warm compresses can help relax the muscles and improve blood flow. Alternating between ice and heat can also be beneficial.
– Surgical treatments: These are procedures that involve cutting and reshaping the bones and soft tissues of the foot to correct the deformity and restore the function of the big toe joint. Surgery is usually considered when the non-surgical treatments fail to provide adequate relief or when the hallux valgus is severe or complicated. There are different types of surgical procedures, such as:
– Bunionectomy: This is the removal of the bony bump and the swollen tissue around the big toe joint. It can help reduce the pain and improve the appearance of the foot.
– Osteotomy: This is the cutting and realigning of the bones of the big toe and the foot. It can help restore the normal position and angle of the big toe joint and improve the stability and function of the foot.
– Arthrodesis: This is the fusion of the bones of the big toe joint with screws, plates, or wires. It can help eliminate the pain and inflammation caused by arthritis or severe deformity, but it also limits the movement of the joint.
– Arthroplasty: This is the replacement of the damaged or worn-out cartilage and bone of the big toe joint with artificial materials, such as metal or plastic. It can help restore the smooth and painless motion of the joint, but it may also wear out or loosen over time.
The choice of surgical procedure depends on several factors, such as the age, health, activity level, and preference of the patient, as well as the expertise and experience of the surgeon. The recovery time and the outcome of the surgery vary depending on the type and extent of the procedure, but they generally involve:
– Rest and elevation: Keeping the foot elevated above the heart level can help reduce the swelling and promote healing. Avoiding weight-bearing and excessive movement of the foot can also help prevent complications and speed up the recovery.
– Dressing and splinting: The surgical site will be covered with a sterile dressing and a splint or a cast to protect it from infection and injury. The dressing and the splint will be changed regularly and removed after a few weeks.
– Medication: Antibiotics will be prescribed to prevent infection and painkillers will be given to control the pain and discomfort. Anti-inflammatory drugs may also be used to reduce the inflammation and swelling.
– Physical therapy: After removing the dressing and the splint, exercises, and stretches will be recommended to restore the range of motion, strength, and flexibility of the foot and the big toe. A physical therapist can guide the patient through the rehabilitation process and monitor the progress.
– Shoe modification: Special shoes, such as surgical shoes, boots, or sandals, will be worn for several weeks or months after the surgery to protect the foot and allow it to heal properly. Gradually, the patient will be able to resume wearing normal shoes, but they should be wide, comfortable, and supportive.
The results of the surgery are usually satisfactory and long-lasting, but there are some possible risks and complications, such as:
– Infection: This is the invasion of bacteria or other microorganisms into the surgical site, causing redness, warmth, pus, fever, or pain. It can be treated with antibiotics and drainage, but it may also require further surgery or amputation in severe cases.
– Bleeding: This is the loss of blood from the surgical site, causing bruising, swelling, or hematoma (a collection of blood under the skin). It can be controlled with pressure, ice, or medication, but it may also require a blood transfusion or surgery in severe cases.
– Nerve damage: This is the injury or compression of the nerves that supply the foot and the toes, causing numbness, tingling, burning, or weakness. It can be temporary or permanent, and it may improve with medication, physical therapy, or surgery.
– Recurrence: This is the return of the hallux valgus after the surgery, causing the same or worse symptoms. It can happen due to improper healing, scar tissue formation, or continued pressure on the big toe joint.
