Hallux Valgus

Hallux is the name given to the toe 1. Hallux valgus is the name given to the lateral deviation of the first toe. It is considered as an outward orientation, but it is a very complex deformity. The hallux valgus may be accompanied by deformities and calluses related to the second toe in approximately 20%, as well as deformities related to 1 metatarsal bone.

Hallux valgus deformity is the progressive deformity of the first metatarsophalangeal joint of the foot. Although narrow-toe high-heeled shoes are held responsible for etiology, patient-related factors such as pes planus, flat Achilles tendon contracture, and neuromuscular disorders are also responsible for the etiology.

With the development of hallux valgus, a number of anatomical and biomechanical changes occur in the foot, making the deformity even more symptomatic. A bunion (swelling) that develops at the medial 1st metatarsophalangeal joint level is the most prominent pathology in hallux valgus. Pain is most often felt here due to irritation of the dorsal cutaneous nerve and is usually the first cause of admission.

There are many factors that should be considered when planning treatment in patients with hallux valgus. The daily use of shoes, occupation and sports activities should be questioned.

Physical examination should be carried out separately while the patient is sitting and standing. Under load, the disease and associated components become more pronounced. It is very important how much the 1st metarsaophalengeal joint can be passively corrected. This amount of recovery provides preliminary information about the amount of recovery that will occur after surgery.

Radiographic evaluation is important in determining whether the treatment should be conservative or surgical and to decide the surgical technique to be performed. Radiographs should be taken while the patient is standing. Intermetatarsal angle, hallux valgus angle, distal metatarsal joint angle are measured on radiographs and the position of sesamoid bones is evaluated. According to the measurements, treatment (conservative or surgical) is planned.

When starting conservative treatment, it is very important for the patient to understand the problem in his foot. Conservative treatment will not correct the pathology. The aim of conservative treatment is to relieve or reduce active complaints and to provide comfort in the daily activities of the patient. Suitable patients for conservative treatment include those with ligamentous laxity, hyperelasticity, and neuromuscular disease and those who do not wish for surgical treatment.

Conservative treatment is limited to wearing low-heeled shoes with wide-toe shoes, use of finger rollers and night splints, and use of metatarsal pillows if there is metatarsal pain.

Surgical treatment is considered in patients who do not respond with conservative treatment. Pain is the basis for surgical decisions. Surgical treatment is decided according to the measurements taken on radiographs. Although there are many surgical techniques described in hallux valgus surgery, no technique has the potential to correct all pathologies in the foot alone.

In the postoperative period, the time taken for the bone to be union by osteotomy is approximately 6 weeks. During this time, the foot is wrapped with elastic bandage and shoes designed to be used after hallux valgus surgery are used. Once the joining is achieved, the patient may begin to burden. Depending on the fixation material used, it can be removed 3-6 months after surgery if it is to be removed.

Poor shoe use, hypothyroidism, rheumatoid arthritis, and neuromuscular diseases increase the recurrence rate. Other complications include hallux varus, metatarsalgia, nonunion, malunion or delayed union and avascular necrosis.