Hallux valgus

Hallux valgus: what’s that?

A dislocation of the metatarsophalangeal joint of the large toe where the large toe in the metatarsophalangeal joint differs to the outer side of the foot and displaces the other toes (see Figure 1) is described as a hallux valgus.

This is often the consequence of a splayfoot which, for example, is facilitated by wearing high heel shoes or shoes which are too tight. The further causes of hallux valgus include injuries, weakness of the connective tissue and hereditary handicaps as well as excess weight.

Fig. 1. Hallux valgus: The eponymous symptoms are the dislocation of the big toe and the resulting protruding ball of the big toe.

At the outset, the dislocation only leads to pain under certain stress, i.e. when direct pressure is exerted on the joint whilst walking or standing. In later stages, load-independent rest pain may also be incurred.

Hallux valgus triggers may include:

• Hereditary family history, i.e. frequent occurrence in the family
• Female gender, i.e. weaker connective tissue
• Splayfoot, skewfoot, clumpfoot
• Inflammatory joint changes
• Excess weight
• Acquired dislocation, e.g. via shoes with high heels, pointed shoes, shoes which are too small
• Accident

Depending on the degree of severity, the orthopaedic specialists distinguish four hallux valgus stages:

Stage 1: Hardly visible deviation of the large toe, whereby pain can already exist in the
metatarsophalangeal joint of the toe, possibly accompanied by skin irritations in the region of the ball of the foot.

Stage 2: Inflammation of the metatarsophalangeal joint of the toe and skin reddening. Toe differs considerably to the outer side of the foot due to overstretched ligaments.

Stage 3: The large toe pushes itself above or below the neighbouring toes. Formation of circumferential growth in the region of the metatarsophalangeal joint on the inside of the foot.

Stage 4: The large toe deviates in the metatarsophalangeal joint with an angle of 90 degrees to the outer side of the foot.

Due to the dislocation, the risk of arthrosis of the large toe (hallux rigidus) may arise as a consequence of inflammation of the ball of the large toe.

How can a hallux valgus be prevented?

Walking barefoot and foot exercises to strengthen the short foot muscles contribute to the health maintenance of the feet.

What therapy options are available for hallux valgus?

During the initial stage, special insoles and (micro) braces help. These include toe spreaders, toe pads, ball rolls, hallux pads and hallux splints. Exercises and walking barefoot, e.g. in sand or grass in its early stages can exert positive influence on the further course of the hallux valgus. The conservative methods also include medicinal therapy (NSAIDS = non-steroidal anti-inflammatory agents), physiotherapy and manual therapy.

The therapy objectives are:

• Pain reduction
• Dislocation correction
• Function gain

Operative measures depend on the stage of the dislocation and various accompanying circumstances.