hallux valgus

Quick Overview

• What is Hallux valgus? Most painful deviation of the big toe (Hallux medicine) to the outside of the body (medial valgus position).
• Frequency: Most common deformity in the forefoot with about 10 million people affected in Germany. Most of them are women over 50 years old.
• symptoms: The big toe is angled in the area of ​​the base joint to the outside of the body. At this point, show a thickened, reddened skin and pain.
• Causes: For example, too tight and / or high shoes, disposition (weak connective tissue), splay or other existing deformities
• Treatment: conservative methods such as gymnastics, splint, bandage; if necessary, surgical intervention to correct the malposition
• Doctor treating: Orthopedist or foot surgeon
• Forecast: Conservative measures can prevent an increase in misalignment, but can not undo it. This is only possible by means of surgery (high success rate).

Hallux valgus: treatment

Depending on how bad the malposition of the big toe is pronounced, different forms of hallux valgus therapy come into question. They aim to reduce existing pain, to correct the malposition or to prevent its progression. In addition, one wants to maintain or restore the normal functioning of the foot and the big toe with the therapy.

Non-operative hallux valgus treatment

In some patients, the big toe is still active (such as with toe gymnastics) or passively (for example by means of splints or inserts) bring them into their normal position. Then the hallux valgus is treated conservatively (non-surgically). Different therapy methods are possible, for example:

>> Physiotherapy and toe gymnastics: In Hallux valgus affected people can become active themselves: Regular toe gymnastics is worth a try in any case. It strengthens the muscles and the foot tendons. This is especially useful for weak hallux valgus, to prevent the misalignment from increasing. As a preventive measure toe gymnastics can ensure that the malposition does not even arise.

For example, you can regularly roll your foot over a tennis ball or a so-called hedgehog ball (rubber ball with rounded “spikes”). This builds the Fußquergewölbe. Barefoot walking also strengthens the often stunted foot structures. The latter should be done on uneven ground such as gravel, sand, grass or bark mulch. The foot is stimulated more than on smooth ground.

Tip: Let your doctor or physiotherapist show suitable exercises for hallux valgus therapy at home!

>> hallux valgus rail: A hallux valgus splint is supposed to press the big toe away from the other toes by mechanical pressure towards the inside of the foot. By adjusting muscles and tendons, the malposition of the big toe can be corrected over time. There are different systems and designs for hallux valgus splints. Some are worn only at night. Others also fit in normal ready-to-wear shoes and can be worn during the day.

Splinting therapy with hallux valgus may not be the most convenient treatment. Due to the constant pressure sufferers, especially in the first few weeks often pain, or the skin is irritated. These side effects will be less over time. However, it can make sense to leave out the splint for one to two days in case of very severe pain.

According to common, under expert but controversial textbook opinion rails can not correct an existing malposition, but only alleviate the pain and slow the progression of deformation.

>> alternatives to the rail: In addition to the hallux valgus splint, there are various other options for non-operative treatment of the malposition. A Hallux valgus bandage is especially useful if the patient does not tolerate a splint well. The bandage spreads the pressure on the big toe more evenly. However, the right size of the bandage is important for the correct “print size”. Let a specialist (for example an orthopedic technician) advise you on this.

Also special Hallux valgus shoes can be useful, especially to relieve the pain. These shoes are usually more spacious in the forefoot area than normal shoes. So the forefoot is not restricted. There are also special ones Hallux valgus deposits, They support the metatarsus with a spherical cushion (pelotte) and so relieve the forefoot area. The insoles can be worn with hallux valgus shoes or normal shoes.

There are other options for conservative hallux valgus treatment. Next toe spreader, toe pad or ball roll This also counts taping:

This elastic tapes are attached to the foot in a special way. They are designed to increase the blood and lymph flow, stimulate the sensitive skin receptors and thus reduce the pain. In contrast to splints or bandages, taping as a hallux valgus therapy is usually not paid by the statutory health insurance companies. You should not even lend a hand. There are (video) instructions for it on the Internet. Without the necessary experience, however, it is unlikely that you will achieve sustainable success. Be tapped by a physical therapist or doctor who knows it.

Operative hallux valgus treatment

If the conservative methods do not work or if the pain is too strong, hallux valgus can also be used for surgical intervention. There are about 150 to 200 different types of hallux valgus surgery, However, only about a handful of these are actually performed regularly in practice.

The various Op methods usually follow a similar basic principle. Their goal is to restore the normal anatomical conditions in the best possible way. So the foot and the big toe should “work” normally again and the pain disappears or at least eases.

However, it always depends on the individual starting position, which operation goal is possible with a Hallux OP. In mild to moderate Hallux valgus deformities, the result is usually good. This means that the patient is (and remains) free of pain and the big toe is in normal position.

Hallux valgus surgery should not be performed for purely cosmetic reasons. As with any other surgery, there should be medical reasons for the procedure, such as severe pain or walking problems in hallux valgus.

How does the hallux valgus op work?

In order to plan the operation well, the medical examination and X-rays of the foot are very important. Nevertheless, these give the doctor only a rough orientation. It is usually only during the procedure that he can accurately assess the situation, such as the condition of the cartilage in the metatarsophalangeal joint. Therefore, he often decides on a specific surgical method only at short notice.

Basically, a hallux valgus op is roughly as follows:

• The doctor removes the toe joint of the big toe from the contracted capsule and frees it from tendons to make it movable.
• The metatarsal bone is severed (osteotomy) and moved in the direction of the other toes. This corrects the main cause of hallux valgus: the too large angle between the first two metatarsal bones.
• The metatarsal bone is fixed at least until complete healing by means of tiny screws. As a rule, they remain permanently in the bone (they usually do not cause any problems).
• Finally, the doctor wears the typical swelling above the metatarsophalangeal joint (pseudoexostosis) and occludes joint capsule and tissue layers.

If the metacarpophalangeal joint is too severely damaged by articular stress, it can be surgically removed (resection arthroplasty, for example, the “cellar burns operation”) or stiffened (arthrodesis) to relieve pain.

What happens after the operation?

After the operation, the foot should be relieved as much as possible for at least four weeks. Then ligaments and bones can heal at rest. Also physiotherapeutic measures can support the regeneration in this phase.

Thereafter, the foot is slowly returned to load for a further four weeks, and the weight distribution is coordinated. After about eight weeks those affected can usually go again. Sport should be possible again after about 12 weeks.

What are the risks of the operation?

Basically, the hallux valgus surgery is a low-risk and usually less stressful procedure (minimally invasive surgery methods). As with any surgery, there are some general risks, such as bleeding or nerve or vascular injury.

In addition, despite hallux valgus surgery, the pain persists. Sometimes it also comes to a relapse (recurrence): The malposition of the big toe is formed again. Very rarely do patients tolerate the fixation screws used (intolerance reactions).

Since the foot is quite far away from the heart, the blood can also backlog. It is therefore not uncommon for foot tissue to be swollen for three to 12 months following hallux valgus surgery.

An earlier hallux surgery, diabetes (diabetes), circulatory disorders in the foot (PAOD) as well as osteoporosis can impair the surgical outcome.

Hallux valgus: causes and risk factors

Various factors favor the formation of hallux valgus:

• Frequent wear to tight and / or high-heeled shoes: The toes are compressed in such shoes. A high heel also puts more pressure on the toe joints.
• Other foot deformities: Hallux valgus, for example, can be the result of a splayfoot. The transverse arch in the forefoot area is flattened, the metatarsal bones diverge. An indication of the often symptom-free splayfoot may be calluses on the soles of the feet.
• Sexual orientation: Most people in a family are affected by hallux valgus. However, it does not inherit the curvature of the toe, but the tendency to weak connective tissue. Parents with (former) hallux valgus should therefore check the feet of their children regularly: In childhood and adolescence, malpositions can still be corrected well.
• Excessive force: For example, when you strike your foot against a door, etc., parts of the joint capsule may tear off and the traction forces in your foot may become unbalanced. The result can be a hallux valgus. The bigger the train is in the wrong direction, the more the big toe deviates, which in turn increases the pull, and so on.
• Miscellaneous: Also, rheumatic diseases, congenital malocclusions or a malformed bone fracture may (in rarer cases) favor a curvature of the big toe.

Hallux valgus: symptoms

A hallux valgus is typical of the naked eye deformity To recognize: The big toe is angled in the area of ​​the big toe joint to the outside of the body in the direction of the neighboring toe instead of forming an approximately straight line.

In addition, at this point is the Skin often reddened and heavily thickened, Sometimes it looks like a new bone has formed there. Therefore, this Hallux valgus symptom is also referred to as pseudoexostosis (Greek: pseudês = false, exostosis = cultivation of new bone substance). In fact, it is not about bone mass, but on the one hand to the head of the metatarsal bone, which is pressed to the inner edge of the foot, and on the other to the overlying, swollen skin.

A special form of hallux valgus is the so-called hallux valgus interphalangeus. In this case, the angle between the metatarsal bones is normally large – only the phalanges of the toes of the big toe deviate towards the other toes.

As a rule, a hallux causes valgus Pain, The stronger and sustained pressure (eg due to shoes that are too tight), the more the skin, the bursa on the joint and the metatarsophalangeal joint are damaged. This can lead to pain in the area of ​​the metatarsal or metatarsal bones (metatarsalgia). They increase over the years. In the worst case, the metatarsophalangeal joint is so severely damaged that it comes after a few years to joint wear (osteoarthritis).

The extent of the malposition does not allow a conclusion on the strength of the pain! Sometimes even a slight hallux valgus causes the strongest pain. Other people have little pain despite massive malposition. Occasionally, hallux valgus does not cause any noticeable or limiting discomfort.

Hallux valgus: examinations and diagnosis

To determine a hallux valgus, no complex diagnostic measures are necessary. As a rule, the trained eye of a doctor is sufficient for this, at best one Orthopedists or Fußchirurgs, and a physical examination. Usually, an X-ray is also taken: while standing, while the weight of the body is resting on the foot (load absorption). For example, different angles or the degree of arthrosis can be determined.

An MRI (Magnetic Resonance Imaging or Magnetic Resonance Imaging) of the foot is only made for special questions.

Hallux valgus: history and prognosis

Without treatment, the malposition of the big toe in a hallux valgus usually increases over the years. Due to the constant pressure on the metatarsophalangeal joint, it can also wear out (osteoarthritis).

If the affected person is still growing (children, adolescents), a hallux valgus can usually be corrected by conservative measures such as a splint. In adults, however, conservative therapy can only prevent the malposition from progressing and alleviate the pain. When Physiotherapy, Splint & CO. The symptoms can not improve sufficiently and / or severe pain is operated on. The success rate is high: According to specialist literature, the hallux valgus op achieved a very good or good result in about 85 percent of the patients treated.

After the surgical correction of hallux valgus, you can not work or exercise for a while. How long this phase lasts depends on the profession or discipline. During physically strenuous work, the forced break can take up to ten weeks. With sports you should wait about 12 weeks. Get more specific recommendations hallux valgusPatients from their attending physician.

Additional information

Book recommendations:

• The book for the Hallux – Feet good, everything good: Holistic help without surgery (Carsten Stark, Südwest Verlag, 2017)

guidelines:

• Guideline “Hallux valgus” of the German Society for Orthopedics and Orthopedic Surgery (DGOOC) et al. (As of April 2014)