Hallux valgus (bunion): photo, cause, when to operate?

Hallux valgus (commonly called “bunion”) corresponds to a deviation of the big toe towards the other toes. He is often painful when walking and can complicate putting on shoes. The vast majority of affected patients are women. “This is partly explained by the hormonal impregnation which increases the laxity of the ligaments”, can we read on the site “Foot Surgery“. The treatment is mainly based on wearing wide shoes to limit friction. But sometimes you have to operate. What is the cause hallux valgus? How to correct a hallux valgus without surgery? When should the operation be used?

What is the definition of hallux valgus?

More commonly called bunion of the foot“hallux valgus is a forefoot deformity which can appear at any age (there are juvenile forms) and affects women more“, immediately advances Justine Zamengo, podiatrist, trainer at the Toulouse Podiatry Institute and member of the Association for the Development of Podiatry.an abnormal deviation of the big toe towards the second toe, at the level of the first metatarsal and the big toe. The misalignment of the big toe can sometimes lead to the formation of a “bunion”, which corresponds to a bony prominence.

Photo of a hallux valgus (diagram of a bunion of the foot)

What is the cause of a hallux valgus?

Hallux valgus is due to a deviation, most often congenital, of the first metatarsal bone (skeletal bone of the forefoot) towards the middle of the body, called metatartus varus. It is nevertheless favored by several elements:

• heredity
• Age (it often begins between 40 and 50 years old and menopause in women),
• Wearing shoes that are too narrow and/or high-heeled,
• Static foot disorders such as flat foot valgus
• Chronic arthritis

What are the symptoms of hallux valgus? Sore ?

If it can be asymptomatic at first, the hallux valgus then evolves by flare-ups that can be accompanied by severe pain on the inside edge of the footespecially at night. These pains are accentuated by walking. “There can sometimes be inflammation in the big toe joint“, continues the podiatrist.

What tests can diagnose a hallux valgus?

The diagnosis is clinical and radiological. As soon as there is suspicion of hallux valgus, “better to do checkup with a podiatrist to obtain treatment and prevention advice and, if necessary, to be directed to a specialized surgeon“, advises Justine Zamengo. At the same time, it is advisable to spend foot x-ray to accurately measure the deformation angle. The X-rays allow the amplitude of the deformation and the degree of articular wear to be assessed.

What are the potential complications ?

The big toe propels the body forward when walking. In case of hallux valgus, it loses this supporting role of the body, which is then ensured by the other toes. The loss of this function of the big toe aggravates the stress exerted on the other toes and can be the cause of painful symptoms. Other complications include:

• The appearance of a bursitis (inflammation)
• The appearance of claw toes
• The appearance of calluses on the soles of the feet
• Skin complications
• risk of osteoarthritis
• There formation of a hornwhich corresponds to a thickening of the stratum corneum of the epidermis on a toe, and which forms as a result of friction in shoes or great pressure on the skin while walking.

When to have hallux valgus surgery?

The operation is not reserved only for people with real disabilities because rehabilitation is long (at least a month) and painful. It can be considered:

→ In case of persistent pain (hallux valgus is inflammatory)

→ In case of significant deformation

→ In case of appearance of a complication

The surgery consists to correct the misalignment of the big toe towards the outside (in other words, putting the big toe back on its normal axis) by retensioning certain ligaments and removing the protruding piece of bone. The operation nevertheless gives good results (after convalescence, it eliminates the pain, and gives the big toe its propulsive role). Intervention is performed on an outpatient basis (or short hospitalization of 48 hours), under regional anesthesia and ankle tourniquet. “In children, surgery can be avoided by wearing nocturnal orthoses or orthoplasties that will allow the correction of the deformity.“, concludes Justine Zamengo.

Can you walk after hallux valgus surgery?

Walking is possible the day after the operation. It requires the wearing of special shoes, resting on the heel, for a period ranging from three to four weeks.

What rehabilitation to do at home after the operation?

Self-rehabilitation exerciseswho start about 15 days after the operation, play an important role in the recovery of range of motion. Self-rehabilitation is based on exercises called passive or active mobilization. Passive mobilization consists of placing the thumb resting on the soles of the feet, and exerting pressure on the big toe to push it downwards, gradually. This exercise, which has a draining effect on the edema and which increases the range of motion, is carried out in a comfortable position: most often cross-legged, the operated foot brought towards you, the other leg outside the bed. The identical movements can be reproduced on each toe, and must be renewed 3 times a daydue to 10 repetitions for each movement. The same type of exercise, without the help of the index finger, allows you to work in “active mobilization”.

What rehabilitation at the physiotherapist?

Other exercises are added to the rehabilitation program once walking is possible without a “heel support shoe”, i.e. approximately 1 month after surgery. They usually take place in the office of the physiotherapist. The sessions focus on the recovery of the propulsive support of the big toe, by working on the rolling of the step. They are accompanied by other treatments depending on the case, such as manual lymphatic drainage in the event of persistent edema.

To protect the hallux valgus, it is recommended:

• To opt for suitable shoesi.e. wide and without heels
• To have recourse to protections (such as those of the Epitact brand) reducing friction against shoes, which are sold commercially.
• Wear orthopedic insoles Or nocturnal orthoses (to be done at the podiatrist), depending on the severity of the deformity, it is also possible to have custom-made silicone appliances (orthoplasty) by the podiatrist. By re-aligning the foot and protecting it from the shoe, these protectors help relieve pain and prevent an increase in deformity.

Thanks to Justine Zamengo, podiatrist, trainer at the Toulouse Podiatry Institute and member of the Association for the Development of Podiatry.