Hallux valgus. Diagnostics & Therapy

How is Hallux valgus confirmed?

In most cases, the misalignment of the big toe is already apparent before the first symptoms occur on the foot. If the big toe rotates inwards, the toe clench often emerges painfully and ensures trouble walking, standing or putting on tight-fitting shoes.
Depending on the severity of hallux valgus deformity, our specialists choose the best treatment for you. Our therapy conentps range from conservative measures to relieve the pain to surgical care with which the deformity may be permanently removed.

 

Clinical examination of hallux valgus.

  • Checking the flexibility of the big toe. Greater movement restrictions are always an indication of the simultaneous presence of osteoarthritis.
  • Checking the blood circulation and sensitivity.
  • Analysis of the callosity of the sole. An atypically strong callosity under the middle of the forefoot, in an extension of the second and third toes, is always an indication of a disturbed load distribution in the foot.
  • Stability of the first middle-foot joint. A very loose tarsometatarsal joint can be the cause of the deformity.
  • Considering the overall position of the foot. A strong tilting of the heel to the outside with a sunken longitudinal arch may result in the development of a hallux valgus defective position.
 

X-ray of hallux valgus.

X-rays of the foot in 3 levels under stress: In a loaded situation, the position of the bones in relation to each other can be assessed precisely. The choice of therapy is based on the individual components of the deformity. Further diagnostics such as computed tomography (CT), magnetic resonance imaging or laboratory tests are indicated only in exceptional cases, when there is suspicion that another disease is largely responsible for the problem.

 

Conservative treatment of Hallux valgus.

An improvement of the symptoms can be achieved by conservative treatment.  

This can include: 

  • Choosing a sufficiently large and soft shoe
  • Fitting orthotics to provide arch support and to support the bones of the midfoot.
  • Hallux valgus splint with and without joint.
  • Physiotherapy to strengthen the foot muscles.
  • Fitting orthotics taking sensorimotor factors into account to strengthen the foot muscles

Although the symptoms of a hallux valgus deformity can be alleviated by deposits, so far, it has not been possible to positively influence the deformity with conservative methods. It must be assumed that, even with conservative treatment, the deformity slowly continues to grow, in the best case it is stopped.

 

Operative treatment of Hallux valgus.

Left: Hallux valgus before treatment, right: after the treatment.

Left: Hallux valgus before treatment, right: after the treatment.

Modern Hallux valgus surgery is focussed on the deformity of the bone. The goal is to sustainably resolve this deformity. Similarly, the X-rays are analyzed and, using these, a surgical procedure planned. The greater the misalignment, the nearer to the body the correction is performed. Of the more than 150 surgical options published in literature, a handful of scientific procedures have been authoritatively carried out throughout the world, which verifiably provide good surgical results.

 

Hallux valgus. Surgical techniques at a glance

Chevron/Austin/Reverdin green.

In all of these 3 procedures, which differ only by nuances, mild deformities are corrected near the joint. With a V- or an L-shaped incision, the 1st metatarsal bone is separated and then pushed back into the desired position. Then the surgical outcome is fixed with a wire or a screw. A bone projection/overhang is removed and the joint capsule nested.

 

Scarf Osteotomy.

Left: before a scarf osteotomy, right: after a scarf osteotomy

Left: before a scarf osteotomy, right: after a scarf osteotomy

A correction is made in the shaft area with a long Z-shaped incision with scarf osteotomy. The scarf osteotomy is suitable for low to moderate deformities.

 

Basic Osteotomy.

Left: before a basic osteotomy, right: after a basic osteotomy

Left: before a basic osteotomy, right: after a basic osteotomy

In the case of severe deformities, the correction is shifted further towards the middle of the foot. With these techniques, strong misalignments can also be permanently corrected as well. There are subtle modifications depending on whether an extension or shortening of the 1st metatarsal bone is desired.

 

Arthrodesis of the tarsometatarsal joints.

If there is a arthritis or instability of the 1st metatarsal joint, the deformity is corrected by a correction in this joint. This joint plays no role in the rolling of the foot and the movement of the toes, so that a correction in this joint will not adversely affect the mobility of the ankle and toes.

 

Akin Osteotomy.

A break in the big toe can be removed by the removal of a small wedge. In over half the cases, an akin osteotomy is performed in combination with any of the other procedures.

 

Rehabilitation after surgery of a Hallux valgus.

The bone takes 6-8 weeks to heal completely. During this phase, the bone must be protected against too much mechanical stress. This is done by a post-operative shoe. The foot is therefore able to bear weight fully through the heel and the load is greatly reduced on fore part of the foot which has been operated on. For basic osteotomy or in the case of operations on the tarsometatarsal bone, a phase with a partial weight bearing and then sometimes the use of a Lower Leg Walker, is appropriate, depending on the bone stability, which causes an even greater level of mechanical protection. Once the skin is healing well, a physiotherapeutical exercising of the metatarsophalangeal joint can be started. The foot often shows a swelling after the removal of the post-operative shoe so that, in the first few weeks, a soft, wide and comfortable shoe should be used. Experience shows that normal footwear can be used after 3 months. It can take 6 months until the internal healing is completed. At this point, the full sporting ability returns.

 

Hallux valgus

Malpositioning of the big toe is the most common reason for foot surgery. The inward position often is painful and restricts mobility.

Hallux valgus

Specialised clinics

Experts for foot disorders: Specialised clinics and hospitals for diagnostics, treatment and therapy of hallux valgus at a glance.

Specialised clinics