The main symptom of hallux valgus is the presence of pain, which reflects a change in the anatomy of the foot. The lateral deviation of the big toe, at the level of the attachment of the finger (ie the first metatarsal head) highlights the formation of the so-called "onion", a protuberance that indicates a "very painful inflammation (bursitis), which tends to worsen with rubbing If the hallux valgus is neglected, it tends to progressively worsen: the disorder begins with the big toe facing the second toe, up to determining changes in the actual alignment of the bones of the foot. For these reasons it is best to consult a doctor who can assess the condition of the foot and recommend treatments appropriate to the specific case.
mature or senile.
What are the Causes of Hallux Valgus?
The causes of hallux valgus can be:
- Congenital: people with foot alterations present from birth (example: flat feet) are more likely to develop hallux valgus in the age of growth. There are also some predisposing factors connected to a positive family history (heredity ), especially in cases of juvenile hallux valgus.
- Acquired or secondary: for rickets, traumatic, inflammatory forms, etc. the responsibility can be attributed above all to shoe models that are inadequate to the physiology of the foot, such as shoes with narrow toes, too small or with high heels. Shoes that do not fit adequately force the big toe into an unnatural position and do not support the correct pronation of the foot. Even some pathologies, such as rheumatoid arthritis and gout, can be responsible for the onset of hallux valgus. Several other conditions make it vulnerable to developing the disorder, such as length of the first metatarsal, hypermobility of the metatarsal joint, low muscle tone, some neuromuscular and connective tissue diseases (such as Marfan syndrome).
Hallux Valgus Symptoms: What Are They?
The clinical picture is mainly represented by a deformation of the first metatarsophalangeal joint, which is painful and swollen. In some cases, the alterations in the painful joint can be associated with a functional limitation, which compromises the dynamics of the foot. At the level of the bony protuberance on the outer edge of the foot, the skin presents redness or hyperkeratosis (thickening of the epithelial layer of the foot). skin). These symptoms can also affect nearby toes (such as when the big toe is superimposed on the second toe). Many people experience no symptoms in the early stages of the disorder; these often become evident when the disorder progressively tends to worsen, especially if you wear some types of footwear that do not fit properly to the foot (narrow-toed and / or high-heeled shoes).
When hallux valgus symptoms appear, they can include:
- Pain in the affected area, even at rest;
- Redness, numbness and swelling
- Thickening of the skin, which appears hard and callused
- Changes to the overall shape of the foot;
- Difficulty walking (due to pain).
Local consequences
- Joint degeneration and bursitis;
- Metatarsalgia;
- Deformities and dislocations of the fingers.
Postural consequences
- Tendency to valgus knee, with pain of the internal patellar facet of the knee;
- Stiffness of the hips;
- Accentuation of the lumbar curve, associated with chronic low back pain.
If symptoms are severe and conventional treatments are ineffective, surgery may be considered. The type of surgery used will depend on the level of deformation, the severity of the symptoms, the age of the patient, and the presence of other associated medical conditions.
, tendons and nerves, to realign the big toe with respect to the adjacent toes;
The type of surgery most frequently used is called osteotomy (percutaneous or open). This surgical technique is performed under local anesthesia and involves the execution of some cuts on the bone made to allow the correction of the deviation of the metatarsus. Osteotomy allows rapid functional recovery. Other surgical techniques contemplated are arthrodesis and resection arthroplasty (Keller).
When deciding which procedure is best suited, the surgeon must consider several factors, including:
- Age: in children, bunion surgery is often postponed due to an increased risk of bunion returning (the bones are still growing). In addition, for some patients, conventional treatments are a better choice than surgery.
- General health conditions: After surgery, the risk of developing problems is increased if there are other medical conditions that prevent or slow the healing process (example: rheumatoid arthritis, diabetes or circulatory problems).
- Professional activity and lifestyle: if the patient is a professional dancer or a sportsman, hallux valgus surgery can only be recommended in some specific cases. After the operation, in fact, the toes may be less flexible and the possibility of returning to the same level of physical performance is not guaranteed.
- Expectations of the surgery: the success of the surgery depends on the skill of the surgeon, the severity of the disorder, the type of surgery and the post-operative recovery.
- The severity of the symptoms: surgery is recommended if the extent of the deformation of the foot is severe and associated with considerable pain or if conventional treatment is not able to limit the progression of the disorder. There are, in fact, several risks and complications associated with surgical treatment and for this reason it is not recommended for cosmetic correction only.
Hallux Valgus: Recovery Times
Many hallux valgus correction procedures can be performed on an outpatient basis, so no hospitalization is required. The operation can be performed under local or general anesthesia. The recovery time depends on the type of procedure performed (after about five weeks the bandage is permanently removed). After surgery, it may be necessary to wear a cast or a special post-operative shoe to keep the foot in the correct position until the bones have consolidated. In the post-operative phase, weekly checks are scheduled to renew the dressing and, after three months, an x-ray will be taken to assess whether the degree of correction is acceptable.
of the big toe or deformity of the second toe, pushed out of place. Complications can also result from corrective surgery. Surgery is generally effective (85% of cases improves symptoms), but is associated with some complications, which can include:- Infection;
- Stiffness in the joints of the toes;
- Healing of the bone in the wrong position;
- Thickening of scar tissue;
- Recurrence of hallux valgus, with the need for further surgery.
