Hallux Valgus: Causes, Symptoms, and Treatments

Hallux valgus is one of the most common foot deformities, affecting a significant portion of the population, especially middle-aged women. This condition, characterized by a bony protrusion on the inner side of the foot, can cause pain and discomfort, significantly impacting the quality of life of those affected. Understanding the causes, symptoms, and available treatment options is essential to effectively address this condition.

 

Mechanism of Action and Anatomy

 

To understand hallux valgus, it is necessary to examine the anatomy of the foot. The big toe, or first toe, is connected to the first metatarsal through the metatarsophalangeal joint. Under normal conditions, these structures are aligned. However, in hallux valgus, the first metatarsal deviates inward toward the foot, while the big toe shifts laterally. This anatomical alteration causes the formation of a bony bump, commonly called a "bunion."

 

The deformity is not limited to a simple bone misalignment. As the condition progresses, the surrounding soft tissues, including tendons and ligaments, adapt to the new position, making the deformity more pronounced and harder to correct over time.

 

Risk Factors and Causes

 

The etiology of hallux valgus is multifactorial, with several elements contributing to its development:

 

1. Genetic predisposition: Many patients have a family history of hallux valgus, suggesting a hereditary component.
2. Foot anatomy: Certain anatomical features, such as a shorter first metatarsal or excessive ligament laxity, can predispose to deformity development.
3. Inadequate footwear: Prolonged use of tight, pointed shoes or high heels can exert abnormal pressure on the big toe, promoting deformity.
4. Medical conditions: Diseases such as rheumatoid arthritis or certain neuropathies can increase the risk of developing hallux valgus.
5. Trauma: Injuries to the metatarsophalangeal joint can alter foot biomechanics, predisposing to deformity.
6. Biomechanical factors: Abnormal weight distribution during walking or postural problems can contribute to the development of hallux valgus.

 

Clinical Manifestations and Symptoms

 

Symptoms of hallux valgus can vary greatly from person to person and depend on the severity of the deformity:

 

1. Pain: The most common symptom is localized pain at the site of the bony protrusion, especially during walking or when wearing shoes.
2. Inflammation: The deformed area may appear red, swollen, and warm to the touch, signs of ongoing inflammation.
3. Joint stiffness: As the condition progresses, the metatarsophalangeal joint may become less mobile and stiffer.
4. Calluses: Abnormal pressure on the skin over the deformity can cause painful calluses.
5. Deformity of other toes: In advanced cases, the big toe may overlap the second toe, causing additional deformities like hammer toes.
6. Altered gait: Pain and deformity can change the patient's walking pattern, potentially leading to problems in other body parts such as knees, hips, or back and causing postural complications.

 

Diagnosis and Clinical Evaluation

 

Diagnosis of hallux valgus requires a clinical evaluation by a specialized orthopedic surgeon:

 

1. Medical history: The doctor will gather detailed information about the patient's medical history, including any past trauma or family history of foot problems.
2. Physical examination: The orthopedic specialist will assess the foot’s appearance, joint mobility, and presence of calluses or signs of inflammation.
3. Functional assessment: The patient will be observed during walking to evaluate any gait alterations.
4. Diagnostic imaging: Weight-bearing foot X-rays (with the patient standing) are essential to assess the degree of deformity and plan the most appropriate treatment.

 

Treatment Options

 

Treatment of hallux valgus can be conservative or surgical, depending on the severity of the deformity and the patient's symptoms:

 

Conservative Treatment:

 

1. Comfortable footwear: Using shoes with enough space for toes and metatarsals can relieve pain and prevent further progression of the deformity. Orthopedic stores specialize in footwear with various shapes and volumes suitable for the prevention and treatment of hallux valgus.
2. Orthotics: Devices such as custom insoles or toe separators help redistribute load, reduce pressure on the big toe, and alleviate pain. Computerized baropodometry is used to study foot support and improve posture through the use of orthotic insoles.
3. Physical therapy: Targeted exercises can improve flexibility and strengthen foot muscles, helping slow the progression of the deformity.

 

Pain Management

Applying ice, using non-steroidal anti-inflammatory drugs (NSAIDs), and magnetotherapy can help control pain and inflammation.

 

Surgical Treatment:

 

When conservative treatment fails to produce satisfactory results, surgery may be necessary. Surgical techniques vary according to the severity of the deformity and can include:

 

1. Osteotomy: Cutting and realigning the first metatarsal bone to correct the deformity.
2. Arthrodesis: In severe cases, fusing the metatarsophalangeal joint to stabilize the foot.
3. Removal of the bony protrusion: This procedure, known as bunionectomy, can be performed in combination with other techniques.
4. Soft tissue repair: May include tendon release or transfer to balance the forces acting on the big toe.

 

It is important to emphasize that the choice of surgical treatment is carefully evaluated by the orthopedic surgeon, taking into account factors such as the patient's age, activity level, and any comorbidities.

 

Prevention and Long-Term Management

 

Although it is not always possible to completely prevent hallux valgus, certain measures can reduce the risk of developing the deformity or slow its progression:

 

1. Careful choice of footwear: Opt for comfortable shoes with enough toe space and avoid excessive use of high heels.
2. Use of insoles: They optimize load redistribution and help rebalance walking mechanics.
3. Maintaining a healthy body weight: Excess weight can increase stress on foot joints.
4. Strengthening exercises: Activities promoting foot flexibility and strength can help maintain good biomechanics.
5. Regular monitoring: Periodic check-ups with an orthopedic specialist can help identify problems early and intervene promptly.

 

Recommendations

 

Hallux valgus is a complex condition requiring a personalized approach. Understanding the mechanisms behind the deformity, combined with early diagnosis and appropriate treatment, can significantly improve the quality of life of affected patients. It is essential to consult a specialized orthopedic surgeon for an accurate assessment and to determine the most suitable treatment plan for individual needs.

 

To effectively manage hallux valgus and maintain good long-term foot function, visit us at Ortopedia, Via Taramelli 21/23, Bergamo or Contact Us!

We are available at phone number 035/212110 from Monday to Saturday, from 9:00 AM to 12:30 PM and

3:00 PM to 7:00 PM, or you can email us at: info@ortopediazambelli.it

 

Our staff is at your disposal!

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