Hallux Valgus: Recognizing Symptoms, Discovering Effective Solutions

Today's article focuses on hallux valgus, emphasizing how surgery is the only definitive solution for this condition.
It is an exploratory journey that starts with understanding what hallux valgus is, moves through the analysis of symptoms to identify it, and explores the possible connection with high heel use. It then evaluates the effectiveness of braces and insoles and concludes by discovering remedies, treatments, and cures for hallux valgus.
To appreciate the importance of this topic, it is interesting to note that the phrase "hallux valgus" is searched on Google about 400,000 times a year in Italy. The reasons behind these searches are varied, but they lead us down common informational paths that this article aims to explore:

• A better understanding of what hallux valgus is;
• Techniques for diagnosis;
• An explanation of why it is not caused by high heels;
• The truth about ineffective natural remedies;
• The most effective solutions for addressing it.

What is Hallux Valgus?

Hallux valgus is a deformity affecting the front part of the foot, involving the first metatarsal and the metatarsophalangeal joint. The first metatarsal tends to deviate inward, leading to valgus of the proximal and distal phalanges.
In more severe deformities, the valgus of the first metatarsal can compromise and alter the normal anatomy of the entire forefoot, causing adjacent toes to adopt a claw-like position due to biomechanical alterations during the push-off phase and lack of space. In cases of severe hallux valgus, the second toe may even overlap the big toe.
This disruption of the forefoot anatomy leads to an alteration of biomechanics and, consequently, of walking.
However, hallux valgus should not be considered simply a skeletal deformity. Soft tissues are also involved, as evidenced by the formation of what is commonly called a “bunion” or “potato” on the foot, which is a swelling caused by friction between the bone and nearby soft tissues.
This swelling can become inflamed and develop into bursitis, which in some cases may ulcerate and lead to the risk of infection.
Although it is not a condition that requires urgent care, it is essential to monitor this deformity and consult a specialist not only in the presence of significant pain but also if the deformity progresses rapidly.

Causes of Hallux Valgus

The exact cause of hallux valgus is unknown. However, a range of risk factors associated with this condition can be identified, which may be hereditary, congenital (or primary), or acquired (or secondary).

Why does Hallux Valgus occur?

1. Genetic predisposition
2. Congenital foot malformations
3. Foot injuries
4. Trauma
5. Inflammatory and neuromuscular conditions
6. Weight, posture, and muscle tone issues

Hallux valgus is frequently associated with other foot conditions or deformities, such as the pronation syndrome, also known as flatfoot (“Progressive Collapsing Foot” in its “pathological” form), and systemic diseases like rheumatoid arthritis.
Hallux valgus predominantly affects older individuals, especially females. Cases of hypermobility, more common in women, can predispose individuals to develop hallux valgus at an early age, even during youth (juvenile hallux valgus).

In these cases, flatfoot is also commonly present. Differentiating between stable and pathological flatfoot (“progressive collapsing foot”), which can be a cause of hallux valgus, is crucial.
This distinction allows for identifying those (a small minority) where it is advisable to correct both the hindfoot and forefoot, as opposed to those where an isolated correction of the big toe should be planned as a surgical procedure.
It is, therefore, essential to evaluate the foot in its entirety, considering the forefoot, midfoot, and hindfoot as interconnected parts, rather than as independent areas.

Hallux Valgus and the Link with High Heels

Female hallux valgus is undoubtedly much more common. However, contrary to what one might think, one of the main causes of hallux valgus is not improper footwear, such as high heels, stiff shoes, or pointed shoes.
This condition also occurs in women who, by necessity or choice, wear only comfortable and flat shoes.
However, high-heeled or narrow-pointed shoes can influence hallux valgus by worsening its initial symptoms. This type of footwear can increase pressure on the big toe area, causing pain and inflammation.

Surgical treatment must be based on a clear diagnosis and precise preoperative planning. For this reason, it is essential to carefully examine the patient through a thorough clinical evaluation—this includes observing the patient while walking and analyzing foot support, with both feet always being assessed.

An X-ray is unquestionably a crucial part of a comprehensive diagnosis.
It must always be performed under weight-bearing conditions, meaning the patient should be standing during the imaging.

Hallux Valgus and X-Ray: Related Conditions

Proper patient evaluation is essential. While anyone may self-diagnose hallux valgus, a specialist focuses on assessing both the severity and the underlying causes of the condition.

Certainly, the degree of deformity plays a key role in selecting the appropriate surgical technique. However, it is equally important to evaluate other conditions that may be associated with hallux valgus, such as:
etatarsalgia;

• Metatarsalgia
• Claw toes (or hammer toes)
• Possible deformities of the hindfoot (such as flatfoot or high-arched foot)

How Is Hallux Valgus Treated?

It’s important to highlight that surgery is the most effective solution for hallux valgus. In fact, only surgery allows for a full morphological and functional restoration of a foot affected by this condition.

Surgical treatment can involve various techniques, most of which aim to be minimally invasive, often performed through tiny incisions—in many cases, mere “pinholes.” The low invasiveness offers several advantages, such as:

1. Shorter surgical times
2. Lower risk of intraoperative infections
3. Faster recovery with less pain

First-generation minimally invasive surgery became quite popular in the past decade, largely due to its benefits in terms of aesthetics and rapid healing.

Today, it has been enhanced by the introduction of next-generation minimally invasive surgery (MICA). This technique uses three tiny incisions to achieve full correction of even significant deformities, ensuring stabilization and reducing the risk of recurrence, while boosting the corrective potential of this cutting-edge method.

In addition to surgical treatment, there are also conservative approaches for hallux valgus. However, these are only palliative: they may help manage pain, but they cannot restore the foot’s shape or function.

The Role of Conservative Treatment and Natural Remedies for Hallux Valgus

There are several non-surgical treatments available to manage hallux valgus (bunions), especially in its early or less severe stages. These include:

• Wearing wide, comfortable shoes
• Performing specific foot exercises
• Taking pain-relieving medication
  
• Applying anti-inflammatory creams
• Using ice packs
• Taping or bandaging
• Toe separators or bunion pads
• Corrective insoles or orthotics

When pain is not directly due to the deformity of the big toe, but rather from overload of the central metatarsals, using an insole with metatarsal offloading can provide temporary relief. However, it’s important to understand that such insoles have no corrective effect, they are only palliative.

Due to the evolutionary and degenerative nature of hallux valgus, natural remedies or so-called “grandma’s remedies” cannot cure the condition, as it is a structural bone deformity.

While some of these approaches—such as ice application or foot baths with essential oils—may provide temporary relief from pain and redness in mild cases, they are unlikely to produce lasting results. Similarly, night splints, corrective exercises, and massages do not halt or reverse the progression of bunions, as the condition evolves regardless of these interventions.

Hallux Valgus and Minimally Invasive Surgery

Hallux valgus is a very common and widespread condition, for which many corrective techniques have been proposed. Some of these have proven effective over time, while others have been completely ineffective.
Surgical intervention is necessary when hallux valgus causes disabling foot pain or is in a progressive phase. The surgical procedure involves partial resection and realignment of the protruding bone. The treatment may also be applied to both feet if the patient is diagnosed with bilateral hallux valgus.

There are several surgical techniques, with the most commonly used being:

1. Open Surgery Approach – involves a direct incision.
2. Minimally Invasive Percutaneous Approach – the most popular over the past 10 years.
3. New Generation Minimally Invasive Approach (MICA) – performed through 3 mm mini-accesses with the aid of a surgical microscope.
   
   

Open Techniques (or Open Surgery) involve small incisions that allow the surgeon to expose the bone tissue in order to perform the desired osteotomy. In these cases, stabilization devices are necessary to ensure the stability of the osteotomy.

The value of minimally invasive techniques in surgery is described by the term itself. This approach is generally preferred because it is characterized by:

• Small incisions
• Less exposure of the bones
• Preservation of soft tissues
• Shorter surgical times
• Rapid and painless post-operative recovery
• Faster return to walking

For me and my team, performing surgery using minimally invasive techniques means making the procedure as reliable as possible and allowing the patient a quicker recovery.

Minimally invasive surgery, thanks to smaller skin incisions and less exposure of soft tissues, helps reduce pain, bleeding, swelling, and speeds up the recovery period after hallux valgus surgery.
A distinctive feature of the minimally invasive technique is the absence of a tourniquet, making the post-operative period less painful. It actually takes advantage of the growth factors released by the natural bleeding during the procedure to promote and accelerate bone and soft tissue healing. This is why it does not require fixation of the osteotomies.

The Original Technique

The original minimally invasive technique does not involve the use of fixation devices, such as screws or plates. Instead, it relies on a spontaneous process in which the body regains its balance after the procedure. The patient can even bear weight immediately after the operation. The surgeon's role is simply to guide this process through corrective dressings and bandages that are applied weekly.

Variants of the Minimally Invasive Technique

Some variations of the minimally invasive technique, known as "mixed techniques," involve the use of fixation devices like small screws, similar to those used by dentists. These tools do not compromise the advantages of minimally invasive surgery but expand its potential applications, making it suitable for more complex cases.

Other Surgical Options

In cases where minimally invasive surgery is not possible, other effective techniques are used. It is important to remember that the primary goal of surgery is to restore a functionally efficient and aesthetically satisfying foot, regardless of the technique employed.
Another key aspect, as mentioned earlier, is to distinguish an isolated deformity from one that is part of a syndrome. In the latter case, it is crucial to correct all malfunctions in the foot, not just the hallux valgus, and this may require additional surgical steps to address the hallux valgus.

Hallux Valgus: Post-Operative Recovery Time

Hallux valgus is the foot condition that most frequently leads women to undergo surgery. The surgery to correct hallux valgus is relatively quick, lasting around 20-30 minutes.

Generally, these are scheduled procedures performed on an outpatient basis under peripheral anesthesia (numbing the leg or ankle down). For those who feel anxious or fearful, sedation can be added to help the patient undergo the procedure in a calm and relaxed state.

After the surgery, the desire to return to wearing regular shoes is strong. Recovery times depend on the type of surgery performed, but typically, the patient is allowed immediate weight-bearing with special post-operative shoes that are flat and designed specifically for the recovery, to be worn for 4 weeks.

It takes about 30 days after the surgery to return to walking with comfortable shoes. Light physical activities and water exercises are typically allowed around the same time, after about 30 days. It takes up to 90 days, however, to resume wearing high heels. Three months is also the required time to return to intense sports activities.

When is the best time to undergo surgery?

Many women ask me about the best season to undergo surgery. The procedure is simple and therefore suitable for any season.

In summer, pain tends to decrease, especially with the use of open shoes. However, it's also the season when our feet are more visible (remember to protect the scars with sunscreen in the first few months), and the heat can amplify post-operative swelling.
A piece of advice? Don’t wait until the last minute—plan your surgery in advance.

FAQ – Frequently Asked Questions about Hallux Valgus, Prevention, and Treatment

It mainly occurs due to factors such as genetic predisposition, joint wear associated with age, and wearing tight or ill-fitting footwear. These elements can cause the big toe to shift toward the other toes, forming a bony bump at the base of the big toe, known as "bunion" or "potato" (cipolla).

The consequences of hallux valgus vary from bone injuries to gait alterations, as the big toe plays a significant role in walking. The deformity of the big toe can also lead to bursitis, an inflammation that causes redness, swelling, and pain.

3.How can mild hallux valgus be resolved?

While hallux valgus cannot be resolved without surgery, mild cases may require wearing comfortable footwear, performing specific foot exercises, and, if necessary, using orthopedic insoles to support proper alignment.

4.Can bilateral hallux valgus be prevented?
No. Unfortunately, there is not much that can be done to prevent hallux valgus. You can attempt to slow its onset by wearing comfortable shoes, avoiding shoes with a narrow fit or too-high heels.

If you suspect you have hallux valgus or have a family predisposition, don't delay—schedule a timely check-up at my office. Together, we will evaluate the most suitable treatment to address your hallux valgus and restore the well-being of walking without pain.

This article was last updated on December 19, 2024.