hallux valgus

Synonyms

Ball of the foot, ball of frost, bunion, big toe inflammation, ball of the foot, bump foot, hallux abductovalgus

English: Bunion

definition

Of the hallux valgus is the most common and most significant toe misalignment in humans. It is characterized by an outward deviation of the big toe in the base joint and an inward rotation of the toe (internal rotation). Often, over time, the incorrect loading of the joint leads to painful osteoarthritis in the Big toe joint and consequently to one Hallux rigidus.

Frequency distribution

Of the hallux valgus almost always comes in contact with one splayfoot on. The splayfoot malalignment slowly increases in the course of life. As a result, the hallux valgus malalignment also increases with age.
Both clinical pictures influence each other negatively in the course of the disease.
Women are affected significantly more often than men. The gender distribution is about 9 : 1 (female Male).

Figure hallux valgus

1. Long extensor tendon (tendon of the extensor hallucis longus muscle)
   
2. Expander tendon
   (Tendon of the adductor hallucis muscle)

With an increasing splayfoot, the big toe is pulled more and more into the hallux valgus malposition by the expander tendon (tendon of the adductor hallucis muscle).

General

As the ball of the big toe or hallux valgus the arch of the big toe becomes towards the outer edge of the foot / little toe (see: Picture above) designated.
This condition is influenced by several factors. The following are important factors:

• a system-related component (Inheritance from mother and father)
• a Muscle imbalance due to insufficient training of the foot muscles and
• shoes that are too tight

considered. The chronic stress on the ball of the big toe leads to bony attachments (Exophytes) in the area of ​​greatest stress on the head of the 1st metatarsal bone and accompanying an increasingly painful, easily inflammatory bursae formation (Bursitis).A distinction is made between different degrees of severity of the deformation. goal of operative correction In the early stages, the function of the metatarsophalangeal joint of the big toe is maintained and thus the restoration of full, painless mobility of the big toe.

The "Hallux valgus - misalignment"is a classic consequence of our western civilization. In countries and cultures in which women do not wear shoes or open shoes (e.g. sandals), they rarely train hallux valgus.
In the picture above you can see the classic hallux valgus malalignment. In addition, the tendons of the feet are shown, which are important for the development of the deformity.

Also read: Big toe joint arthrosis.

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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
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Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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root cause

Hallux valgus is often caused by an inherited weakness of the ligaments and connective tissue that affects the entire body. This causes the formation of a flat splayfoot. As a result of the reduced tension of the ligamentous apparatus, the longitudinal arch of the foot flattens out and the transverse arch, which is heavily loaded when rolling, deviates wider and wider, thus showing the weakness of the ligament connections between the Metatarsal bones.
Since the constitutional weakness of the ligamentous apparatus cannot be remedied by a doctor, only the symptoms of hallux valgus are treated. This means that only the consequences of the splayfoot can be treated, not the splayfoot itself.

By wearing comfortable shoes, our foot muscles are not trained and under-challenged, which leads to a muscular imbalance foot leads. A workout of the short Internal foot muscles, which can counteract the spreading of the arch of the foot, is prevented. In particular, unsuitable footwear z. B. with too narrow a forefoot area or too much raised heel, which increases the pressure on the forefoot many times over, play an essential role. Due to the increasing misalignment of the Foot if the direction of pull of the above Tendons.
This largely causes the inward rotation of the big toe. As the big toe becomes more bent, the muscular opponents become ineffective.

What role do shoes play in the development of hallux valgus?

For many affected people, shoes make a major contribution to the development of hallux valgus. Wearing the wrong shoes puts particularly heavy strain on the forefoot, which promotes the development of hallux valgus. This is mostly due to high-heeled shoes, in which most of the body weight rests on the ball of the foot and the forefoot. Shoes that are pointed at the front also have a negative effect on hallux valgus. Due to the limited space available for the toes, such a toe malposition can also develop.

Hallux valgus symptoms

Of the hallux valgus is widespread, but in most cases it causes little discomfort. There is no correlation between the degree of the deformity and the degree of hallux valgus symptoms. Large deformities can cause few complaints and vice versa. However, the greater the misalignment, the greater the likelihood that the incorrect loading of the Metatarsophalangeal joint premature cartilage wear (arthrosis) entry.

For many women, hallux valgus is a purely cosmetic problem. The first symptoms usually occur over the ball of the big toe. This ball of the big toe is also called exostosis or medically Pseudoexostosis designated.
This is where the foot is widest, so shoes are the most pressing here. There is mechanical stress on the skin and the underlying skin Bursa. The bursa then thickens around the bone better protect. This makes the ball of the foot even bigger and the pressure in the shoe increases further. Inflammation, swelling, non-bacterial, and even bacterial bursitis (Bursitis) can arise.
In the further course, a chronically recurring, painful ball of the big toe can develop (chronic bursitis). In the end stage of the disease there is constant pain.

Like any joint the metatarsophalangeal joint of the big toe is not suitable for an oblique position (Incongruence) created. Therefore, in the further course of the hallux valgus disease, there is early wear / arthrosis of the articular cartilage (Hallux rigidus). The symptoms of wear and tear are initially evident in the movement of the big toe, which can painfully restrict the rolling process.

In general, there is a slow but chronically progressive (progressive) Worsening of the forefoot malposition. The osteoarthritis of the Metatarsophalangeal joint progresses, pain and inflammation persist and the big toe can deviate outward by up to 90 ° from the basic position. In extreme cases, the big toe can lie over or under the second and third toes.

Hallux valgus pain

As hallux valgus is a misalignment of the big toe in which the base joint bends outwards. For most of those affected, hallux valgus causes only a few complaints apart from cosmetic aspects. Sometimes, however, it can be too violent as part of a hallux valgus Pain come as an indication for a Hallux valgus surgery should be viewed.

Hallux valgus pain has various causes:
Physiologically, the foot already has its widest point at the ball of the big toe, which is why the shoe is most likely to pinch here. With hallux valgus, this area is now even larger, which is why it is too typical there Hallux valgus pain and pressure points come. Some patients also develop calluses or corns on the pressure points.

Long-term mechanical stress (for example from the pressure of a shoe) constantly increases the pressure around the joint Bursa irritated. This reacts with a thickening around the bone and protect the joint, which starts a vicious circle. In addition, chronic overuse can lead to bursitis, which can be either bacterial or non-bacterial and is one of the most painful clinical pictures of all.

Since the joint is also incorrectly stressed by the misalignment, hallux valgus can often result in a arthrosis train (Hallux rigidus). This means that the articular cartilage will wear off more and more over time. This process also leads to pain, which is particularly noticeable when the joint is working, i.e. especially when walking at the moment when the foot is rolled over the ball of the foot.

The fact that the other 4 toes are displaced from their natural place and are also permanently incorrectly loaded can also affect these toes or even the entire front Foot develop a feeling of pain.

Initially, pain usually only occurs when the metatarsophalangeal joint is stressed and / or pressure is exerted on the damaged area (e.g. from a shoe), but the person affected is pain-free again when they are resting. Over time, however, they develop into chronic permanent pain, which is associated with a major reduction in quality of life.

It is important to keep in mind that the clinical picture of the Hallux valgus does not necessarily give a direct indication of a patient's pain intensity. Of course, it is more likely that someone with pronounced hallux valgus also suffers from osteoarthritis and a significant lack of space in shoes, but the balls of the big toes that look rather inconspicuous in the early stages of hallux valgus can also trigger severe pain, while advanced deformities are sometimes relatively painless can.

Inflammation of the hallux valgus

With hallux valgus, the metatarsal bone is shifted to the side, while the big toe is crooked towards the other toes. This creates a particularly vulnerable area on the metatarsophalangeal joint of the big toe. Often the skin becomes inflamed there because it rubs against the fabric of the shoe. If the hallux valgus persists for a long time, the inflammation can also go deeper and even affect tendons and bones. The misalignment also puts an incorrect strain on the muscles. Therefore, the tendon of the big toe muscle no longer runs in a straight line over the bursa, so that this bursa can become inflamed.

Bursitis

Bursitis (bursitis) is usually caused by hallux valgus on the ball of the toe. The starting point for this inflammation is often the friction between the metatarsophalangeal joint of the big toe and the shoe. This superficial inflammation gets deeper and can affect the muscles, tendons and bursa there. Bursitis can, however, also result from incorrect strain on the muscles. Bursitis is usually treated by immobilizing the affected part of the body. In the case of hallux valgus, a bandage can be helpful. This corrects the misalignment of the big toe and thus reduces the strain on the bursa.

Numbness of the big toe

If the big toe becomes numb as a result of hallux valgus, this is usually due to circulatory disorders or nerve damage. The deformity can press on the vessels and nerves and damage them to such an extent that their function is restricted. As a result of nerve damage, information about touch, temperature, pressure, pain, etc. can no longer be passed on to the brain, so that the toe feels numb.

Why does hallux valgus often occur with hallux rigidus?

Hallux rigidus is the technical term for osteoarthritis in the metatarsophalangeal joint of the big toe. Due to the misalignment of the metatarsal bone and the big toe itself, osteoarthritis occurs between these two bones, i.e. in the metatarsophalangeal joint of the big toe. The malposition triggers an incorrect load on the joint surfaces, which in the long term leads to abrasion of the protective cartilage layer, whereupon hallux rigidus develops.

diagnosis

Diagnosis of hallux valgus based on the patient's complaints:
Due to the misalignment of the big toe and the hunched metatarsal head, shoe pressure occurs and the skin becomes susceptible to inflammation. A bursa forms over the metatarsal head, which can easily become infected.

Hallux valgus causes pain and pressure points on the foot. The angled big toe and the shifting of the little toes hinder the natural walking process. There are discomforts when walking and a shortening of the stride length. Hallux valgus is not infrequently associated with a hammer toe or claw toe.
In the hammer toe, the big toe deviates downwards in its end joint. In the case of a clawed toe, the toe deviates upwards in the base joint, in the two distant (peripheral) Joints it is bent downward in a claw-like manner. Painful pressure points then appear on the bent surfaces, corns form (Clavus) and calluses. Often the accompanying splayfoot also causes pain under the unnaturally (unphysiologically) stressed metatarsal heads 2-4 (metatarsals) in the forefoot area of ​​the sole of the foot, which is also known medically as metatasalgia.

Medical examination for hallux valgus:
The deformities of the foot can already be seen from the outside. They appear as described above.

Roentgen:
An X-ray of both feet is made for a precise assessment of the bony malalignment of the hallux valgus. Any joint damage that has already occurred can be recognized. In addition, the extent of the misalignment determines the surgical corrective procedure.

Differential diagnosis

To the extent of a hallux valgus To be able to determine exactly, a dynamic foot pressure measurement should be carried out. offers the possibility of a targeted Treadmill analysis on.
By using the pressure measuring plate when walking, the rolling behavior in the foot can be measured. The ground reaction forces show the targeted use of the big toe when standing, walking and walking.
Especially for operational preparation is a Treadmill analysis advisable from a medical point of view. A treadmill analysis also enables optimal preparation for individual orthopedic insole fitting.
Anatomical misalignments are easily diagnosed and corrected and compensated for using insoles. is now offering the option of an orthopedic treadmill analysis in Frankfurt am Main.

• Orthopedicum Frankfurt
  
• Oeder Weg 2-4
• 60318 Frankfurt am Main
• Tel .: 069 558098
• [email protected]
• www.laufanalyse-frankfurt.de

therapy

The aim of treatment is to alleviate existing pain, correct the misalignment of the big toe and ultimately improve the functionality of the foot.

The exact therapy option chosen depends primarily on the severity of the deformity. In early stages, so mild cases of hallux valgus, are above all conservative (non-operationalMeasures suitable to prevent the disease from progressing. A However, they usually cannot achieve healing. For this is a surgical intervention necessary.

Classically, it aims conservative therapy make sure that the foot (especially the ball of the big toe) to relieve. This can be done either by walking barefoot, wearing open or widened shoes or inserting foam pads into the shoes; special insoles can additionally stabilize the foot. In addition, foot exercises are always recommended in the early stages. This can significantly improve the prognosis and can also be done with self-guidance. In addition, drug-based pain therapy is an important cornerstone in the treatment of hallux valgus.

In advanced stages of the disease, the outer edge of the metatarsus, on which the metatarsal bone protrudes, can become inflamed. These can then be treated with local anti-inflammatory measures in the form of diclofenac-containing or other anti-inflammatory ointments. Severe inflammation may require the use of cortisone injections.

After all, the final option for treating bunions is this surgery. She will be in late stages of disease used. In general, it has a good prognosis, but it is associated with a lengthy healing phase.

Which doctor treats hallux valgus?

The diagnosis and treatment of hallux valgus is carried out by an orthopedic surgeon. First and foremost, it must be decided whether the hallux valgus can be treated conservatively, i.e. without surgery. In this case, the orthopedic surgeon often prescribes a bandage that corrects the misalignment of the big toe. Physiotherapy should also be carried out to strengthen the muscles of the forefoot. Most of the treatment is therefore often carried out by the physiotherapist. If hallux valgus surgery is necessary due to the severe symptoms, an orthopedic surgeon will perform the operation.In addition, the general practitioner, i.e. the general practitioner in private practice, is often involved in the treatment. For example, he may temporarily prescribe pain medication. If the skin is severely affected by inflammation, a dermatologist (dermatologist) can be called in for treatment.

Hallux valgus surgery

If the big toe is clearly misaligned in the advanced stage of hallux valgus, an operation is recommended to correct the toe misalignment. Surgery is indicated, particularly if conservative treatment methods such as hallux valgus splints, orthopedic shoes or drug pain therapy have only achieved insufficient pain relief.

To date, almost 150 surgical procedures for the treatment of hallux valgus have been described, of which around ten are used in German-speaking countries. Almost all of them involve cutting through the first (belonging to the big toeMetatarsal (Corrective Osteotomy) and then moving the (peripheral) Part of the bone towards the second metatarsal bone. Ultimately, the first metatarsal reaches its natural position. The two parts of the metatarsal bone are then either fixed in place with wires or screws or pressed in. As a final step, the big toe is straightened with strong stitches.

In severe forms of the disease, the stiffening between the first metatarsal bone and the tarsus can be considered. Inserting a titanium plate can provide additional stability compared to a screw. If there is arthrosis (Hallux rigidus) in the metatarsophalangeal joint of the big toe in addition to hallux valgus, this must be treated as a priority. This is the case quite often.

The prognosis of an operation for hallux valgus is quite good; most patients are painless after the operation. The cause of a recurrence of the disease after an operation is usually a congenital weakness of the connective tissue. However, the healing of the bone takes about 4 - 6 weeks in each case, comparable to a broken bone. It is therefore necessary to wear a special orthopedic shoe, the so-called forefoot relief shoe, during this time. It enables largely painless walking after the operation.

Read more on the topic:

• Hallux valgus surgery
• Hammer toe surgery

special shoes

If you look at the frequency of hallux valgus in different cultures, it becomes clear that this Wearing footwearas it is common in most societies today, at least partially contributes to the development of the clinical picture. Especially when one familial accumulation of connective tissue weakness and foot malpositions, the wrong footwear can lead to hallux valgus.

Of the healthy foot should have a slight splay of the toes have to each other. The so-called basic insole shape of our shoes, however, presses the toes together and promotes the development of permanent deformation of the foot. In the advanced stage, this ultimately manifests itself in the form of hallux valgus. This is also much more common among women, which is due on the one hand to a weaker connective tissue and on the other hand to the typical women's shoe shapes. The decisive factors are above all Heel height, narrow toe and shoes that are too shortwhich, in addition to hallux valgus, also promotes other foot malpositions. Since this type of footwear is worn earlier and earlier, foot deformities increasingly occur at a young age.

In the early stages of the disease, switching to flat shoes with enough space for the toes can help. So-called thong sandals are particularly suitable for this. In more advanced stages are finally orthopedic shoes with splayfoot insoles helpful in treating pain when walking. Walking barefoot can also reduce the pain.

Insoles for hallux valgus

Orthopedic insoles be at one hallux valgus mainly used in the early stages, as it slows the progression of the Splayfoot can stop. Once the hallux valgus is really pronounced, the insoles can no longer correct them, i.e. they are not used for causal therapy, but only to alleviate the pain of those affected.

The structure of the insert is as follows:
The insert is equipped with a foam wedge that lies between the big and second toe. This type of deposit is called Splayfoot insert designated. The foam wedge relieves the forefoot and supports the arch of the foot, so that the pain is reduced.
However, pain in the middle toe area may occur instead. The insoles are made by an orthopedic technician. So-called sensorimotor insoles. They specifically stimulate the weakened foot muscles by setting sensory impulses. Muscle tension is either increased or decreased.
Ideally, they have a positive effect on the Foot malposition.

In addition to insoles, you can also use it to treat symptoms Night storage rails and Bandages use. In general, it is recommended to wear flat shoes that give the toes enough space. In the early stages, it is also advisable to do foot gymnastics and do more barefoot walking.
This strengthens the arch of the foot. If the arch of the foot is intact, the progression of hallux valgus can be prevented.

As a rule, if you have diagnosed hallux valgus, your health insurance will cover the cheapest insoles. For those with statutory health insurance, there may be additional payments of € 20 to € 80 depending on the version.
Privately insured persons have to bear the costs themselves. In addition to insoles, ball pads made of foam can also be used as part of a hallux valgus. They reduce the friction between the upper leg and the shoe. If hallux valgus occurs in the course of a Osteoarthritis of the big toe (Hallux rigidus) special insoles, the so-called Hallux rigidus insolesmake it easier to roll over the painful joint.

There are also relieving silicone orthotics that can be worn in the shoe during the day and relieve the big toe joint. All in all, splints and bandages are increasingly being used in the case of hallux valgus.

What is a toe spreader?

A toe spreader usually refers to a medical device. In the case of hallux valgus, this is worn between the big and second toes so that the misalignment is corrected. In principle, toe spreaders can be used between all toes. In general, pressure points caused by toe misalignments should be avoided. In hallux valgus, a toe spreader can relieve pain by improving the position of the toes. In addition, toe separators are often used in nail salons when painting the toenails.

What are the benefits of bandages for treating hallux valgus?

For the treatment of hallux valgus, small bandages are often worn that cover the ball of the foot and the big toe. Such a bandage can correct or at least reduce the misalignment of the big toe. Once hallux valgus has arisen, it cannot be reversed with a bandage. The progression of the deformity can, however, be stopped by the bandage. By stabilizing the hallux valgus and correcting the deformity, the load on the forefoot can be reduced, which often leads to pain relief. The better alignment of the big toe also improves the affected person's sense of balance.

Taping a hallux valgus

In trauma surgery, sports medicine and orthopedics are Tape dressings made from adhesive plaster tape widespread. They are used both for the treatment and for the prevention of various diseases of the Joints and Muscles and ensure that those joints and muscles are not completely immobilized, but only prevent unwanted movements. Their effect is based on them Transferring forces acting on the musculoskeletal system to the skin become. At the same time, they counteract any swelling of the tissue by promoting blood and lymph flow.

Taping can also be used alongside other treatments in the treatment of hallux valgus. Their main task is to bring the joint into an anatomically more favorable position and to absorb external forces that favor a misalignment of the big toe. Taping a extended freedom from pain when walking can be achieved. There are now numerous taping methods for hallux valgus. These are easy to find online in the form of videos, but it is recommended that a doctor put the bandage on. In contrast to splints and hallux valgus shoes, tape bandages are usually not paid for by health insurance companies.

Rail / secondary rail

Next Hallux valgus shoes and foot gymnastics is the so-called classic treatment method for hallux valgus Hallux valgus splint to disposal. Its principle is based on using mechanical pressure to push the big toe away from the other toes, i.e. towards the inner edge of the foot. As a result, tendons and muscles should finally adjust to a healthy foot position again. There are different types of rails to choose from. Either Hallux valgus night splints, which are only worn at night, as well as splints which are in the normal ready-to-wear shoe are available.

However, self-discipline is necessary for a good chance of success. In the first days to weeks, the splint often causes irritation of the skin and increased pain in the foot, which, however, usually steadily weaken. However, it is not yet entirely clear whether a hallux valgus splint can lead to permanent correction of the deformity. Nonetheless, they can help significantly in pain relief.

Foot exercises for hallux valgus

One factor that contributes significantly to foot deformities is one weak foot muscles. This is mostly due to a lower exposure due to civilization, but it can also be inherited. Foot exercise can compensate for a predominantly sedentary lifestyle and is suitable for adults with already existing foot deformities, but also very suitable for children. For hallux valgus patients in particular, appropriate exercise can provide significant relief. It is mainly used as a support next to hallux valgus splints or orthopedic insoles.

Most of the exercises are based on simple grasping exercises. For this purpose, marbles can be picked up with the toes and placed in a container, or a cloth can be used as an alternative. Another component of foot gymnastics can be simply walking barefoot. Above all, walking barefoot on sand promotes a natural and even load on the soles of the feet and a training of the floor muscles.

What can you do to prevent hallux valgus?

Many external factors play a role in the development of hallux valgus. The leading factor here is wearing the wrong footwear. Therefore, you should pay attention to comfortable shoes that do not constrict the toes too much. Anyone who suffers from other malpositions of the feet, such as a flat arched foot, should wear insoles in their shoes; this can act as a preventative for hallux valgus. Since a weakening of the muscles in the foot often contributes to hallux valgus, the prevention of hallux valgus can be supplemented by muscle training. To do this, you should run barefoot a lot. Exercises such as stepping on tiptoe several times or splaying off your big toe can also strengthen the muscles.

Hallux valgus prognosis

Basically, it should be noted that if the diagnosis is correct and the surgical procedure is selected, the Long-term forecast of the operated hallux valgus is good.

It is important that the correct surgical procedure is used for the individual case of the Hallux valgus is applied.

Unless advanced yet Osteoarthritis in the basal gelk the big toe can be seen, a joint-preserving surgical procedure (e.g. Chevron or Mc Bride etc) will be applied. In many studies, the results are good to very good in over 90 percent of patients. Read our topic on this Hallux valgus surgery

For each of the forefoot correction operations mentioned above, it takes a long time Working- and Inability to exercise be expected. There is often insufficient information about this to the patient. For procedures with bone correction, a period of between 3-6 months should be assumed. From a social medicine point of view, this can be a big problem.

The successful treatment of forefoot complaints such as hallux valgus also requires close cooperation with an orthopedic technician. It is therefore advantageous if an experienced orthopedic technician can be consulted at any time during a foot consultation. From a practical point of view, such cooperation is only possible at foot surgery centers.

Figure pain ankle

Foot pain

1. Achilles tendonitis /
   Achilles tendon rupture
2. Broken bones - toes,
   Metatarsus, tarsus
   (here outer ankle fracture)
3. Ligament stretch / torn ligament
   at the ankle
4. Lower and upper heel spurs
   Calcaneus spur
5. Hammer toe and claw toe
   (Deformities of the toe bones)
   Digitus malleus
6. Plantar warts
   Verrucae plantares
7. Hallux valgus -
   (Deviation of the big toe
   in the base joint)
8. Hallux rigidus -
   (Joint wear of the
   Metatarsophalangeal joint)
9. Inflamed nails / nail fungus
10. Osteoarthritis / arthritis -
    degenerative change of
    Joints / inflammation of the joints

You can find an overview of all Dr-Gumpert images at: medical illustrations