Hallux Valgus

Hallux valgus is a common, painful foot condition that involves lateral deviation of the great toe at the metatarsophalangeal joint. It occurs with medial enlargement of the first metatarsal head and bunion formation (bursa and callus formation at the bony prominence). It's more common in women.

In congenital hallux valgus, abnormal bony alignment (an increased space between the first and second metatarsal known as metatarsus primus varus) causes bunion formation. In acquired hallux valgus, bony alignment is normal at the outset of the disorder.

Causes

Hallux Valgus are often caused by narrow-toed, high-heeled shoes. Such shoes compress the big toe and push it toward the second toe. The condition may become painful as extra bone and a fluid-filled sac grow at the base of the big toe. This leads to inflammation, swelling, and pain. Bunions occur more frequently in women and sometimes run in families.

Signs and Symptoms

• Swelling or enlargement of the metatarsophalangeal joint at the base of the big toe.
• Displacement of the big toe toward the other toes.
• Joint redness.
• Joint pain.
• Skin irritation over the bunion.

Diagnostic tests

X-rays confirm the diagnosis by showing medial deviation of the first metatarsal and lateral deviation of the great toe.

Treatment

In the very early stages of acquired hallux valgus, proper shoes and foot care may eliminate the need for further treatment. Other useful measures for early management include felt pads to protect the bunion, foam pads or other devices to separate the first and second toes at night, and a supportive pad and exercises to strengthen the metatarsal arch. Early treatment is vital in patients predisposed to foot problems such as those with rheumatoid arthritis.

If the disease progresses to severe deformity with disabling pain, the patient needs a bunionectomy. After surgery, the toe is immobilized in its corrected position by a soft compression dressing (which may cover the entire foot or just the great toe and the second toe and serves as a splint) or with a short cast (such as a light slipper spica cast).

The patient may need crutches or controlled weight bearing. Depending on the extent of the surgery, some patients walk on their heels a few days afterward; others must wait 4 to 6 weeks to bear weight on the affected foot. Supportive treatment may include physical therapy, such as warm compresses, soaks, and exercises, and analgesics to relieve pain and stiffness.

Prevention

Avoid compressing the toes of your foot with narrow, poor-fitting shoes.