It is widely known as a “bunion”. It is called the hallux valgus in Orthopedics and the international literature. It describes the most frequent foot deformity, although, in fact, the outward deviation of the great toe is not an individual disorder. The problem relates to the whole of the anatomical structures of the forefoot, namely the first metatarsal bone, the phalanges of the great toe, the sesamoid bones and the tendons.
Although the word “bunion” is quite descriptive, the definition of this specific disorder states that the axis of the great toe is valgus (with an outward curvature), while the axis of the first metatarsal is varus (with an inward curvature), by projecting its head upon the inner surface of the foot.
HIGH RISK GROUPS
A meta-analysis published in the Journal of Foot and Ankle Research in 2010, showed that, in the 18-65 age group, hallux valgus is a common finding in 23% of the general population, and it is also found in 35.7 % of the 65+ age group. Women are considered more vulnerable. Today, we are aware that the genetic predisposition, length and heads of the metatarsal bones, hyperactivity of the forefoot, diseases such as osteoarthritis, rheumatoid arthritis and gout, even high-heeled shoes -because they hold the foot in the wrong position- play an important role in the onset of the disease, because they exert pressure upon the hypertrophic bunion.
WHICH ARE THE SYMPTOMS?
Apart from aesthetics, this deformity, due to the loss of the layers of the articular surfaces, is associated with pain, inflammation and swelling at the base of the great toe, poor balance, walking problems, even the risk of falling - several studies link “bunions” to the patient’s quality of life. The clinical picture varies depending on the degree of deformity. Many mention the difficulty of putting on their shoes as the first sign, and the appearance of calluses (corns) on the head of the first metatarsal bone. In untreated cases, the second toe can “overlap” the first one.
WHICH IS THE BEST TREATMENT?
Initially, the treatment is conservative. Wide and soft shoes, special splints for the adduction of the great toe or other pads (especially socks, etc.) are recommended. However, there are also surgical techniques, depending on the degree of the deformities. Usually, those who have changed their lifestyle due to hallux valgus, especially if an inflammation in the soft tissues, a neuritis, mallet toe, soft tissue ulcers, or situations when the second toe overlaps the first one coexist, are brought to the operating room.
In patients without too severe deformities, a minimally invasive technique is considered the most modern one in orthopedic surgery, as a complete deformation correction is achieved, with minimal postoperative pain and an almost immediate mobilization. Osteotomies (artificial fractures and repositioning, in order for the shape of a bone to change) are performed with small tools and do not exceed 2 cm. The “corrections” of the first metatarsal bone are held by special biocompatible titanium screws for a permanent result, without a recurrence. During the operation, other foot deformities, such as a mallet toe, exostoses, calluses, or dislocations, are corrected. After surgery, the patient uses a special postoperative shoe, as neither a cast, nor crutches are needed. Suture removal is performed after approximately 2 weeks.
In severe cases with an extensive joint degeneration, arthrodesis of the first metatarsophalangeal joint is performed. Based on the literature, complications include the recurrence of the condition, usually due to the choice of the surgical technique, the appearance of pain in the heads of the other metatarsal heads, or the development of a hallux varus, if surgical overcorrection has been performed. Typically, patients may experience problems (mainly pain) in their daily routines, even 6 months after surgery.