HALLUX VALGUS
When the big toe steps out of line
Hallux valgus is the most common deformity of the big toe. The big toe increasingly angles towards the smaller toes, while the joint at its base protrudes noticeably inwards – visible as a painful bunion on the inner side of the foot.
The deformity usually develops slowly over years and mainly affects women from middle age onwards. The cause is often a combination of genetic predisposition, weak connective tissue and unsuitable footwear.
As the deformity progresses it causes problems – in daily life, when walking or when wearing shoes. Left untreated, it can worsen and lead to further problems in the foot.
How does hallux valgus develop?
Hallux valgus develops through an imbalance in the arch of the foot, usually in combination with a splay foot. The transverse arch in the forefoot drops, the first metatarsal drifts inwards, while the big toe is pulled outwards.
- Genetic predisposition (it often runs in families)
- Splay foot or flat foot
- Wearing tight, high-heeled or pointed shoes
- More common in women (often weaker connective tissue)
- Overloading at work or in sport
- Hormonal changes, for example during pregnancy
Symptoms
Symptoms usually begin gradually. In the early stages, tenderness over the bunion is often the main complaint; later, restricted movement and deformities of the neighbouring toes follow. At an advanced stage the whole mechanics of the foot can change – with effects on the knee, hip or back.
A visible bunion
The protruding bone at the base of the big toe is often the first noticeable sign.
Friction, redness or inflammation
Tight footwear in particular, or prolonged loading, causes pain – above all around the bunion or the big toe.
Swelling and bruising
The constant pressure on the protruding bunion often irritates the skin and the bursa beneath it.
Treatment options for hallux valgus
Treatment of hallux valgus depends on the severity of the deformity, on your individual symptoms and on your age and the demands of your daily life. The aim is to relieve pain, prevent the deformity from progressing and – where necessary – restore the position of the big toe both functionally and anatomically.
Treatment options
Non-surgical and surgical – we will find the right approach for you
Orthopaedic insoles
Custom insoles support the transverse arch and take pressure off the bunion area – particularly useful where a splay foot or fallen arch is a contributing cause.
Adapting your footwear
Flat, wide and comfortable shoes with enough room for the toes can reduce the pressure on the joint at the base of the big toe. Models with soft inner seams and a padded forefoot are particularly helpful
Toe separators and supports
Soft corrective aids or night splints help bring the big toe into a more favourable anatomical position – usually as temporary relief or for a mild deformity.
Foot exercises and physiotherapy
Exercises to strengthen the short foot muscles, together with mobilisation and posture training, can help stabilise the mechanics of the foot and relieve symptoms.
Chevron osteotomy
In this well-established technique the first metatarsal is cut in a V shape (a chevron) – usually right at the head of the bone. The bone fragment is then shifted slightly to bring the big toe into a straighter alignment.
Akin osteotomy
Here a wedge-shaped cut is made in the proximal phalanx of the big toe in order to straighten the axis of the toe.
Lapidus procedure (first TMT joint fusion)
In this method the joint between the first metatarsal and the cuneiform bone is permanently fused (arthrodesis). It is particularly suitable where there is additional instability in the first TMT joint – for example with a splay foot or a pronounced flat foot with valgus.
Accompanying soft tissue correction (for example the modified McBride technique)
Alongside the bony correction, the soft tissues often need to be adjusted in order to stabilise the new position of the toe. This includes releasing shortened tendons and capsule tissue on the outer side and tightening or repositioning tendons on the inner side. The joint capsule can also be re-centred. These measures help to secure the correction in the long term and to prevent recurrence.
Frequently asked questions about hallux valgus
Is hallux valgus dangerous?
Do I always have to have surgery?
Do splints or insoles really help?
What happens during the operation?
How long will I be off work after the operation?
Our foot specialists
Experienced consultants for hallux valgus and foot surgery
