Hallux valgus is the most common forefoot deformity and occurs when the base of the big toe points outward abnormally and the top of the big toe leans toward the second toe.
This deformity causes the base of the finger to widen and can lead to a swollen, red, painful pocket of fluid. This condition is called bursitis. Hallux valgus is a multifactorial disease of both genetic and behavioral origin that affects a large part of the population, especially women.
Over time, if the problem is neglected, it can cause greater discomfort in maintaining the entire sole of the foot on the ground and therefore also postural.
As already mentioned, the causes are disparate. There is certainly a strong genetic component, but there can also be acquired causes. Among these, for example, certain degenerative diseases, traumas, or autoimmune diseases such as rheumatoid arthritis. Studies show that using the wrong footwear can even make these types of problems worse, due to the affected area rubbing against the shoe. Even those who work long hours on their feet may be more prone to it. In all cases, the
The predominant factor is always genetic and is linked to the excessive inward rotation of the foot.
What are the symptoms?
Hallux valgus may be initially visible but “silent”. Over time, constant postural errors or the use of too tight or pointy shoes can cause the image to worsen until the onset of pain.
The pain is felt at the level of the bony protrusion, above which bursitis with inflammation and redness can form, as mentioned above.
It can also happen that the finger rotates above the second, pushing its plantar until its axis is deflected.
This, in addition to causing postural errors, can cause calluses on the sole of the foot after the metatarsals have fallen.
It can be performed by an orthopedist, after an x-ray, performed under load. Joint aspiration is also sometimes done, in severe cases where there is pain, redness, and swelling. This test is used to rule out other conditions, such as infectious arthritis or gout.
There are basically two ways to do this: conservative and surgical. The first requires the patient to take certain necessary precautions to contain the problem as much as possible (but not to cure it). It is:
– use of appropriate footwear. The shoe should comfortably hold the foot without rubbing the fabric; it is good to minimize the use of heels or pointy shoes;
– reduce (as much as possible) the hours spent standing during the day;
– use of custom-made soles to avoid overloading the forefoot;
– use of silicone pads to reduce irritation of the protruding bone;
– use of anti-inflammatory drugs to relieve pain;
– ice packs in case of bursitis;
– perform specific daily exercises recommended by the doctor or physiotherapist (to keep the affected joint in motion).
When these techniques are not sufficient to control the progression of the disorder, surgery is necessary.
Here too, the doctor may evaluate different approaches, including:
– osteotomy, that is to say, the realignment of the joint carried out by cuts of the first metatarsal bone;
– percutaneous technique, with which small drills are inserted through tiny holes in the skin that cut through bone without the need for surgical incisions. It is an innovative technique, applicable to almost all patients and which makes it possible to walk immediately after surgery;
– intervention on soft tissues to correct the deviation.
The duration of hospitalization depends on the surgical technique, the age of the patient, and the path of rehabilitation undertaken. Physical therapy will be necessary to restore strength to the foot and correct and complete the movements. Usually, it takes a few months (about two).
Are postoperative relapses possible?
Yes, it can happen that the problem reappears a few years after the first operation. However, the new mini-surgery techniques also prove to be advantageous from this point of view: in fact, the number of relapses is markedly lower than that obtained with previous operations.