Hallux Valgus

Hallux valgus (commonly known as a bunion, although the names are not synonymous) is the name for the deformation of the tarsometatarsal joint.

We speak of halluxes when the first metatarsal bone points in the direction away from the foot, whereas the big toe deflects toward the remaining toes.

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Statistics indicate that:

  • Halluxes are a disease of civilization – up to 4% of the population is affected by them. 
  • In one-half of patients, deformation of the toe occurs before they reach 20 years old.
  • In the majority of cases (over 80 %), hallux valgus occurs on both feet (although not necessarily at the same time and with the same level of deformation).
  • The condition is inherited in about 75% of cases.
  • Deformation of the hallux and the related deformation of the metatarsal bone is a condition that affects women foremost. Hallux valgus occurs 9 times more often in women than in men!

 

Factors causing the formation and develepment of hallux valgus

Hallux vulgus is a condition which largely affects women, not without reason. It is caused by the construction of women’s feet, where the muscle-ligament-joint system is significantly weaker. Male feet have tougher ligaments, which makes the foot more compact and resistant to deformity. Males also have a tougher, less mobile joint system, thanks to which they are less susceptible to deformation of the big toe. The delicate construction of the muscle-ligament-joint system of women’s feet means a higher risk of hallux formation in women than in men.

Deformation of the big toe and the related deformation of the bones of the foot are also caused by inappropriate choice of footwear. Shoes that are too narrow, tight or high-heeled overstrain the front of the foot, the result being the widening of the forefoot and lowering of the transverse foot arch. A narrow toed shoe puts the toes of the foot, in particular the big toe, in the wrong position, because there is increased pressure on the big toe, which can lead to chronic inflammation. It is important to remember that not only footwear influences hallux formation. Other factors such as age, work and other illnesses are significant.

Genetic predisposition plays a critical role in the formation of halluxes. The greatest proof of this is the fact that halluxes develop even in young women who have practically never worn high heels. About 75% of hallux cases are of a genetic origin, largely from the mother’s side. That is why when halluxes develop in family members, women should choose their footwear particularly carefully in order not to increase their risk of deformity. It is also essential to prevent flatfoot during childhood.

Halluxes often develop in people who work on their feet, as their feet are chronically susceptible to excessive strain and pressure.

It is not only the structure of the foot, improper footwear or genes that may influence hallux formation. It is the presence of several disadvantageous factors (sex, footwear, family disposition and others mentioned below) that lead to this type of deformity.

Among additional factors that support the development of halluxes are also:

  • Improper biomechanics in the first foot ray
  • Excessive toe length – the so-called egyptian foot
  • injury
  • obesity
  • flatfoot
  • rheumatoidal joint inflammation and other systemic diseases
  • inactive lifestyle
  • hyperactivity (excessive joint motion) of the first bone of the forefoot, which is the cause of approx. 5 % hallux cases
  • excessive big toe length
  • damage to the Achilles tendon
  • amputation of the second toe

Don’t neglect your hallux toe!

It is important to remember that halluxes are not only a cosmetic problem. Untreated hallux toes may cause additional conditions, resulting from the level of deformity and the length of time of their existence. The untreated hallux toe may lead to serious difficulties with walking. It is worth remembering that deformities change the biomechanical action of the foot. In the case of halluxes, an uneven distribution of body weight often occurs, and the big toe is not a strong support during walking, which causes the muscles and the structure stabilizing the foot to be less resilient.

 

Complications resulting from a developing deformity of the hallux toe:

The appearance of localized inflammation is one of the most common reasons for hallux-related pain. Inflammation may be accompanied by reddening, a stinging sensation as well as swelling and pain in the area of the metatarsal joint. The progressive nature of the condition may lead to additional changes in the foot such as: claw toe, hammer toe, and metatarsalgia (pain in the ball of the foot). 

Deformity may also cause changes in the gait and pain in the knee joints, and even in the lumbosacral section of the spine.

In addition, the progressive deformation of the foot visible in the hallux toe may lead to flatfoot. Flatfoot may occur because the weight of the body acting on the deformed foot is unequally distributed – the forefoot receives the weight. In addition, the second toe of the foot is raised over the big toe that is deflected inward. The foot loses its proper structure – with the result that the transverse arch is lowered and ultimately disappears.

 

Corns, Calluses

In addition, together with the progressive deformation of the hallux toe, painful calluses may appear on the sole of the foot, the result of excessive weight and pressure on the deformed bones.

The hallux toe, in connection with other related foot deformities and changes in the proper functioning of the foot and symptoms in other toes is not a single defect but an entire set of forefoot deformities. There are currently many methods of treatment, thanks to which pain symptoms may disappear and the foot may regain is proper form and function.


dr Jan Paradowski ©
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