Foot & Ankle
Hallux valgus is a deviation of the tip of the big toe towards the lateral side, with the formation of a painful bony bump on the medial side of the foot at the joint between the metatarsal and the 1st phalanx. This bump becomes increasingly painful due to friction against the shoe and the joint’s discomfort.
The pain tends to spread to the other toes due to crowding and altered mechanical forces in the sole of the foot.
The big toe can no longer perform its function of propulsion during walking. As a result, these propulsive forces are distributed to the other toes.
In the vast majority of cases, the progression of the deformity is very slow. The normal position of the bones, tendons, and ligaments gradually changes over time.
As the big toe tilts towards the second toe, it can overlap it and cause additional issues. This can gradually lead to deformities of the lateral toes, such as hammer or claw toes.
Calluses can also develop where the toes rub against each other or against shoes, causing additional discomfort and difficulty in walking.
Hallux valgus is more common in women than in men, often with a family and genetic factor. This is particularly true for hallux valgus in adolescents, which develops early in life.
Certain inflammatory diseases such as rheumatoid arthritis, neuromuscular conditions like Charcot-Marie-Tooth disease or polio, can predispose to hallux valgus, often in a severe form.
Most cases develop in adulthood and result from repetitive microtrauma, often associated with tight footwear around the toes.
DIAGNOSIS :
Standing X-rays are often sufficient for diagnosis:
- Measure the alignment of the bones in the toes.
- Evaluate damage to the metatarsophalangeal joint. Long-standing hallux valgus can be accompanied by arthritic changes.
TREATMENT :
Non-surgical treatment
Surgical Treatment
The surgery
Les suites post-opératoires
Non-surgical treatment
In general, non-painful hallux valgus deformities can be managed with non-surgical treatment.
A significant portion of mild deformities and discomfort can be successfully managed with proper shoe adjustments.
Your surgeon will provide you with information on proper shoe fit and the type of footwear that would suit you best.
Custom-made orthopedic insoles, protective silicone pads, and toe spacers worn inside your shoe can help cushion the painful area over the bunion.
The effectiveness of orthopedic insoles and small orthoses at this stage is variable, and very few high-quality scientific studies demonstrate their beneficial effects.
Common pain relievers and anti-inflammatories can also help alleviate mild and occasional pain. The consumption of large quantities of pain relievers often indicates the need for an alternative solution.
Surgical Treatment
Surgical correction is considered when pain persists while wearing shoes and walking despite medical treatment.
The goal of hallux valgus surgery is to relieve pain by realigning the bone, ligaments, tendons, and nerves so that the big toe can be returned to its correct position and its function in walking propulsion.
Aesthetic reasons alone are not sufficient to justify the intervention.
The surgery
In general, the common goals of most bunion surgeries include:
- Realignment of the metatarsophalangeal joint (MTP) at the base of the big toe
- Relieving pain
- Correcting the deformity of the bones that make up the toe and foot
Surgery may involve shortening loose tissues and lengthening tight tissues. This is rarely done without some type of bone realignment, called an osteotomy. In the majority of cases, correction of soft tissues is just one part of the overall bunion corrective procedure.
In an osteotomy, your doctor makes small cuts in the bones to realign the joint. After cutting the bone, your doctor repairs this new break with pins, screws, or plates. The bones are now straighter, and the joint is balanced.
Osteotomies can be performed at different locations along the bone to correct the deformity. In some cases, in addition to cutting the bone, a small wedge of bone is removed to provide enough correction to straighten the toe.
As discussed above, osteotomies are typically performed in combination with soft tissue procedures, as both are often necessary to maintain the alignment of the big toe.
Les suites post-opératoires
Physiothérapie et exercice
Des exercices spécifiques aideront à restaurer la force et l’amplitude de mouvement de votre pied après la chirurgie. Votre médecin ou physiothérapeute peut recommander des exercices utilisant une bande chirurgicale pour renforcer votre cheville ou en utilisant des billes pour rétablir le mouvement de vos orteils.
Des exercices spécifiques tels que l’exercice de ramassage de billes aideront à restaurer le mouvement complet de votre pied.
Commencez toujours ces exercices lentement et suivez les instructions de votre médecin ou de votre physiothérapeute concernant les répétitions.
WEARING SHOES :
It will take several months for your bones to fully heal. When you have completed the initial rehabilitation period, your doctor will advise you on footwear. Athletic shoes or soft leather oxford-style shoes will provide the best protection for the bunion correction until the bones are completely healed.
To help prevent the recurrence of your bunion, avoid wearing fashionable shoes until your doctor permits it. Be aware that your doctor may recommend never wearing high-heeled shoes.
Because one of the primary causes of bunion deformity is ill-fitting footwear, returning to this type of shoe can lead to the return of your bunion. Always follow your doctor’s recommendations for proper shoe fit.
POSSIBLE COMPLICATIONS :
As with any surgical procedure, there are risks associated with bunion surgery. These rarely occur and are generally treatable, although in some cases, they may limit or prolong your full recovery.
Before your surgery, your doctor will discuss each of these risks with you and take specific measures to prevent complications.
The possible risks and complications of bunion surgery include:
- Infection
- Stiffness of the big toe joint
- Thrombophlebitis
- Recurrence of the bunion
- Nerve, tendon, or vascular injury
- Delayed bone healing
Adapted from the information sheet of the French Society of Foot Surgery (SFCP).
