Hallux valgus

Symptoms of hallux valgus can vary from person to person, but the most common are :

It is important to note that pain is not always proportional to the visible deformity. Some people can have a pronounced hallux valgus without experiencing pain, while others may suffer even with a minor deformity.

The origin of hallux valgus is multifactorial and includes :

• Genetic predisposition: a family predisposition plays an important role in the development of this pathology.
• Anatomical anomalies: structural problems such as flat feet or instability of the first metatarsal can contribute to the development of hallux valgus.
• Unsuitable footwear: Wearing narrow, pointed or high-heeled shoes promotes deformity by exerting excessive pressure on the forefoot.
• Medical conditions: Certain diseases, such as rheumatoid arthritis, increase the risk of developing this deformity.

A number of factors increase the risk of developing hallux valgus:

Gender: Women are more affected than men, with a ratio of around 9:1.
Age: The risk increases with age, although the deformity can appear as early as adolescence.
Profession: Jobs requiring long periods of standing or walking can favour the onset of hallux valgus. Wearing uncomfortable, ill-fitting shoes on a regular basis can also accentuate the development of the condition.

Initial treatment of hallux valgus is generally non-surgical.

Conservative treatment of Hallux Valgus

Conservative treatment aims to relieve symptoms without recourse to surgery:

• Shoe modification: Opt for comfortable shoes with sufficient space for the toes and no pressure on the bunion.
• Orthotics and splints: Often worn at night, these splints realign the big toe. Although the concept is interesting, the results are unfortunately very disappointing and only provide temporary relief.
• Medication: Anti-inflammatories can be prescribed to help reduce pain and inflammation.
• Physiotherapy: Specific exercises can help maintain foot flexibility and strength, and improve mobility.

Surgical treatment of Hallux Valgus

When conservative treatments are no longer sufficient, surgery may be considered. The aim is to restore natural alignment between the metatarsal and phalanx by rectifying the axis of the hallux and recentering adjacent tendon structures. A bone section, or osteotomy, is commonly performed to reposition the metatarsal head. There are many different surgical techniques, but the most common are :

Osteotomy
Realignment of the bones of the foot through incisions, usually using screw or plate fixation.
Scarf osteotomy: Z-cutting of the metatarsal to realign the big toe.
Chevron technique: A variant of the osteotomy with a V-shaped cut.

Arthrodesis
Lapidus arthrodesis involves fusion of the joint at the base of the first metatarsal. This technique is reserved for more severe cases, such as flat feet or recurrences.

Exostectomy
Removal of the bony hump. This technique is usually part of a more comprehensive corrective surgery, including osteotomy and soft-tissue surgery to realign the foot.

Surgery can be performed using either the traditional open approach or the minimally invasive percutaneous technique, the latter offering faster recovery and virtually invisible scars.

Post-op

The use of canes is optional, for comfort only. Resumption of walking is immediate, with a special shoe for 6 weeks. After this period, it is possible to return to driving and gradually resume sport, except for running and contact sports, which require a minimum of 3 months. Heels may be worn from the second month. 

Left untreated, hallux valgus tends to progressively worsen. Potential complications include :

• Osteoarthritis of the big toe joint (wear and tear of the joint)
• Deformity of the other toes 
• Chronic pain that can become permanent
• Limitation of daily activities and sports
• Like all surgical procedures, hallux valgus surgery carries risks. Although uncommon and generally treatable, these risks can sometimes hinder or delay your full recovery. 

After surgery, possible complications include:

• Recurrence of the deformity (4-10% of cases)
• Nerve damage (mild local insensitivity)
• Joint stiffness
• Infections (rare, <1% of cases)
• Hallux valgus surgery generally relieves pain and corrects the alignment of the big toe in the majority of patients.

In case of visible deformity, persistent pain or limitations in daily activities and sports, as well as difficulty with footwear, it is recommended to consult a specialist.

At Hôpital de La Tour, the treatment of hallux valgus is personalized for each patient. A multidisciplinary team of surgeons and physiotherapists work together to provide the best possible treatment. The most modern surgical techniques, including minimally invasive surgery, are proposed when necessary.

Is hallux valgus hereditary?
There is a significant genetic component in the development of hallux valgus.

Can hallux valgus be prevented?
Although it is difficult to prevent, choosing the right footwear and maintaining a healthy weight can slow progression.

Is surgery always necessary?
No, many cases can be effectively treated using conservative methods. Treatments include shoe modification, orthotics, anti-inflammatory medication and physiotherapy.

Can I play sport with hallux valgus?
Yes, but it's important to choose appropriate footwear and consult a specialist if pain persists.

Can hallux valgus affect both feet?
Yes, it's common for the deformity to develop in both feet, although not necessarily to the same degree.

Can orthopedic insoles cure hallux valgus?
Insoles cannot correct the deformity, but they can help relieve symptoms and potentially slow progression.

Is hallux valgus surgery very painful?
Surgical techniques have changed considerably, and surgical correction is much less painful than is often believed.

Is it true that even when corrected, hallux valgus always returns?
The approach to treating this deformity has changed considerably over the last few decades. The risk of recurrence is low (5-10%) and can easily be corrected.