Hallux Valgus, Hallux Rigidus, deformity, foot health, foot problems

You are here: Home

Biomechanics. Foot

Biomechanics

Hallux valgus seems to be the hallmark of forefoot deformities. Its occurrence in the modern society has been estimated to be between one-tenth, one-sixth, and one-third of the population. It has also been noted to occur at least twice as often in women as in men. It has on several occasions been referred to as the "hallux valgus complex", meaning that when it occurs, it is associated with a multitude of other symptoms or deformities of the forefoot. These include calluses under the forefoot, metatarsalgia, splayfoot, flatfoot, plantar fascitis, and hammer toes. Thus, in the study of hallux valgus one often must discuss all these other deformities.

Hallux valgus seems to be a deformity that was uncommon until the wearing of fully enclosed shoes and boots.

Normal Anatomy of the Forefoot / Hallux valgus / Rigidus

(A) A foot that has never worn shoes. (B) A normal foot that has worn shoes. Feet that have never worn shoes are commonly found to have the digits in alignment with their respective metatarsals, giving the foot a fan shape. Normal feet that wear shoes are commonly found to have the digits in alignment with the longitudinal axis of the rearfoot, thus giving the foot a sarcophagus shape.

women hallux valgus

From the fact that the deformity occurs mostly in the shoe-wearing population, and that women tend to wear pointed-toed, high-heeled shoes, the most obvious conclusion would be and has been that wearing misfitted, pointed-toed shoes is the primary etiology in initiating hallux valgus.

Diagnosis of Hallux Valgus. Pressure Mapping Systems.

Diagnosis of Hallux Valgus

The treatment of a bunion depends entirely on how uncomfortable it is. Treatment depends upon a medical diagnosis.

For diagnostics of diseases of feet, diabetic feet, it is necessary to pass inspection on the special equipment. This equipment shows the distribution of load on foot.

Pressure Mapping for Patient Care, Medical Research

Hallux Valgus diagnosis

HALLUX VALGUS

Synonyms: hallux abductovalgus, hallux abducto-valgus, bunion

hallux valgus bunion

Two opposing viewpoints exist—that the etiology of hallux valgus is the habitual wearing of pointed shoes, and that the etiology includes hereditary, congenital, biomechanical, and traumatic causes, but not the wearing of shoes—and over the years, studies have found evidence to support both claims.

Definition

The term "hallux valgus" or "hallux abducto-valgus" are the most commonly used medical terms associated with a bunion anomaly, where "hallux" refers to the great toe, "valgus" refers to the abnormal angulation of the great toe commonly associated with bunion anomalies, and "abductus/-o" refers to the abnormal drifting or inward leaning of the great toe towards the second toe, which is also commonly associated with bunions. It is important to state that "hallux abducto" refers to the motion the great toe moves away from the body's midline. Deformities of the lower extremity are usually named in accordance to the body's midline, or the line bisecting the body longitudinally into two halves. Bunions can also be found on the distal end of your ischial tuberosity and can be cancerous. Condition affects 1% of adults in the United States. Incidence increases with age.

Signs and symptoms

The symptoms of bunions include irritated skin around the bunion, pain when walking, joint redness and pain, and possible shift of the big toe toward the other toes. Blisters may form more easily around the site of the bunion as well.

Having bunions can also make it harder to find shoes that fit properly; bunions may force a person to have to buy a larger size shoe to accommodate the width the bunion creates. Wearing high heels also becomes more of a problem for those with bunions as the heel puts pressure on the toes, which may be irritating to most people in general but particularly for people with bunions.

When bunion deformity becomes severe enough the foot can hurt in different places even without the constriction of shoes because it then becomes a mechanical function problem of the forefoot.

The main factors that are implicated in the cause are

genetic predisposition (more in adolescent type hallux valgus)
use of footwear with a small and constricting toe box
rheumatoid arthritis
cerebral palsy
Gout
Flat feet

Conservative treatment of hallux valgus:

- Orthopedic devices: insoles
- Night Splints
- Foot Gymnastics
- Physiotherapy

Operative treatment

- Operation Hallux Valgus

Surgical Techniques

Modified McBride. Technique - a soft tissue only procedure: medial capsule of 2nd MTP is suture to lateral capsule of 1st. interposition of adductor hallucis is realeased and interposed.
Original McBride. Technique - included lateral sesamoidectomy and has been abandoned.
Chevron. Technique - Distal 1st MT osteotomy (intra-articular). Can perform in two planes (Biplanar distal Chevron).
Mitchell. Technique - Distal 1st MT osteotomy (extra-articular). More proximal than Chevron).
Scarf / Ludloff / Mau. Technique - Metatarsal shaft osteotomies..
Akin. Technique - proximal pahalanx medial closing wedge osteotomy.
Lapidus procedure. Technique - first TMT joint arthrodesis with distal soft tissue procedures (medial eminence removal, first web space release of AdH, lateral capsule relase).
MTP arthrodesis.
First Cuneiform Osteotomy. Technique - Opening wedge osteotomy (often requires iliac crest bone graft).
Proximal crescentric or Broomstick. Technique - Proximal metatarsal osteotomies. Combined with medial eminence removal and first web space lateral capsular and adductor tendon release.

When is need for surgery?

- Continuous pain
- Rapidly increasing deformity
- Skin ulceration
- Difficulties in finding suitable footwear
- Disturbing of the lesser toes with development of secondary deformities

A bunion is an enlargement of bone or tissue around the joint at the base of the big toe (metatarsophalangeal joint).The big toe (hallux) may turn in toward the second toe (angulation), and the tissues surrounding the joint may be swollen and tender.

Today the term usually is used to refer to the pathological bump on the side of the great toe joint. The bump is partly due to the swollen bursal sac and/or an osseous (bony) anomaly on the mesophalangeal joint (where the first metatarsal bone and hallux meet). The better part of the bump is actually a normal part of the head of first metatarsal bone that has tilted sideways to stick out at its top.