The hallux valgus is a deviation from the base of the big toe to the outside. The toe of the big toe is closer to the 2nd toe, resulting in deformation of the forefoot. The hallux valgus, bone deformity, is manifested as a lump at the first metatarsal, inside the foot. This deformity may be associated with inflammation called bursitis. This hump, which is therefore formed by the apex of the angle between the first metatarsal that goes inward and the big toe that goes outward, may prevent some shoes from being worn.
The hallux valgus can be very painful, as much at the level of the articulation as at the level of the skin (friction against the shoe during the walk).
There is a juvenile hallux valgus, which is often a severe form of the disease. In general, the disease begins around age 40 .
Prevalence of hallux valgus
The hallux valgus is the most common pathology of the forefoot . It would affect a little less than one in ten people in France.
Diagnostic of hallux valgus
The diagnosis of the hallux valgus is simple since it is seen with the naked eye. An X-ray is however necessary, in particular to evaluate the degree of deviation of the toe.
Causes of hallux valgus
The appearance of a hallux valgus is often due to genetic factors. There is indeed a congenital predisposition. Shoes and especially shoes with heels and pointed ends, age and menopause could also be responsible for the appearance of a hallux valgus. Finally, some diseases such as polio or rheumatological diseases such as rheumatoid arthritis would increase the risk of developing a hallux valgus. Hypersuppressive ligaments (ligamentous hyperlaxity) may also be a factor favoring the hallux valgus, as well as the form of “pronator” foot where the foot tends to sag inwards.
There is a classification of hallux valgus that depends on the angle of deviation of the big toe. Thus, some speak of light hallux valgus when this angle is less than 20 °. The hallux valgus becomes moderate between 20 and 40 ° (the phalanx is no longer in the axis of the metatarsal) and severe when the angle is greater than 40 °.
The symptoms of hallux valgus
The hallux valgus can be painless, especially if the shoes worn are adapted to the shape of the foot. But the symptoms of hallux valgus can be:
- Visible deformation of the big toe;
- Pain in the hallux valgus or soles of the foot;
- Redness, inflammation;
- Infection at the level of the friction zone;
- Deformity of other toes (toes in claws, calluses, corns);
- Difficulty walking
People at risk for hallux valgus
Women are significantly more affected than men by hallux valgus. Nine out of ten cases would involve women. The laxity of the joints, more important in women and especially in the menopausal women but also the shoes tightened at the end of the foot and the high heels are implicated.
The risk of developing a hallux valgus is also significantly higher in some families. People who have an Egyptian foot (big toe bigger than the second toe, the Egyptian foot is different from the Greek foot where the second toe is the longest) would also be more affected by the disease. The longer the big toe, the greater the stress on the shoes and the higher the risk of hallux valgus. Finally, overweight is also a contributing factor.
Some simple steps can be taken. It is mainly to wear soft, flat and wide shoes and therefore avoid shoes with high heels and sharp ends.
To limit the friction between the shoe and the onion, it is useful to check that the seams of the shoes do not pass through this bump.
Wearing a toe separator or splinting at night may also be advisable. Wearing orthopedic insoles to limit foot slump inward may limit the worsening of the hallux valgus.
Medical treatments for hallux valgus
To fight against pain related to hallux valgus, anti-inflammatory or analgesic can be taken.
Orthotics may be prescribed. These are devices that straighten the big toe and keep it as straight as possible to prevent worsening of the deformity. Sessions in the pedicure can treat corns or calluses often consecutive to hallux valgus. Stretching exercises or foot massages can also be beneficial. Therapeutic shoes can also be useful. These medical treatments can not correct the hallux valgus, but only limit its aggravation.
A simple clinical examination and X-ray are necessary.
Surgical treatment of hallux valgus
In case of hallux valgus very painful or very important deformation, a surgical operation can be considered. There are many techniques, a hundred, all of which aim to reduce the angle between the metatarsal and the phalanx . The chosen technique must be adapted to the specificities of the foot.
The operation is generally performed under loco-regional anesthesia and not under general anesthesia and hospitalization lasts an average of 3 days .
The side effects of surgery can be edema or stiffness of the toe. After the operation, the person can walk quickly. However, wearing a special shoe is necessary for several weeks. It takes 3 months of convalescence.
When both feet are reached, it is advisable to wait 6 months to 1 year between the two interventions to recover well between the two.