Hallux Valgus (Bunions): Causes, Symptoms & Treatment

➤ Hallux valgus is a progressive foot deformity in which the first metatarsophalangeal (MTP) joint is affected and is often accompanied by significant functional disability and foot pain.

Hallux Valgus

CAUSES

• Genetics
• Excess weight gain,
• Activity level, and fitting shoes.

• Footwear (tight pointed shoes) Wearing tight shoes and/or heeled shoes between 20 and 39 years of age can be crucial in the development of hallux valgus in later years.
• Congenital deformity or predisposition
• Chronic achilles tightness
• Severe flatfoot
• Hypermobility of the first metatarsocunieform joint

SYMPTOMS

• Your big toe points toward your second toe, or your second toe overlaps your big toe
• A prominent bump on the inside of the MTP or big toe joint
• Pain on the inside of your foot at the big toe joint when wearing any kind of shoe
• Pain each time the big toe flexes when walking
• Redness, swelling , or thickening of the skin on the inside of the big toe joint

DIAGNOSIS

• Radiographic exmatination show the angle formed between longitudinal bisection of the 1st Metatarsal and proximal phalanx.
• A big toe position with an angle of up to 10° is still considered normal.
• A minor hallux valgus defect is 16-20°.
• A moderate hallux valgus deformity has a deviation of 16-40°.
• A severe hallux valgus deformity has a deviation of over 40°.
• Magnetic resonance imaging (MRI) will detect cartilage damage, trapped soft tissue and bone damage.

DIFFERENTIAL DIAGNOSIS

• Septic arthritis
• Gout
• Severe Trauma
• Turf toe

Management / Interventions

Non-operative treatment

• Adjustment of footwear to help in eliminating friction at the level of the medial eminence (bunion) e.g., patients should be provided of a shoe with a wider and deeper toe box
➤ The condition of pes planus may be helped by an orthosis. Severe pes planus can lead to a recurrence of hallux valgus following surgery.
Achilles tendon contracture may require stretching or even lengthening

Operative treatment

Austin/Chevron Procedure

This procedure is frequently used for mild deformities. The osteotomy is in a "V" shape, a sagittal saw is used in a medial to lateral direction inside the first metatarsal head. The loose fragment is then placed differently to correct the first metatarsal angle. The fragment is fixated with pins or screws. For read more about this procedure click here

Reverdin Procedure

A wedge is removed from the head of the first metatarsal head in order to get a better organisation of the articular cartilage. The wedge is situated on the dorsal side and medially based. In some cases, the surgeon decides that is necessary to rotate the articular cartilage. A screw or K-wire is used for fixation. For read more about this procedure click here

Scarf Procedure

When the deformity is moderate to severe, the scarf procedure is a frequently used option. The osteotomy is longitudinal, in a medial to lateral direction, inside the shaft. The capital piece is moved more to the lateral side and stabilized with two screws. For read more about this procedure click here

Closing Base Wedge Procedure

Base procedures are mostly used for severe deformities, so is this one. A wedge is made in the proximal metatarsal, on lateral side. When the wedge is removed, the distal part is translated to the lateral side causing the gap to close and the first metatarsal to align with the second. The minimum fixation is a bicortical screw. For read more about this procedure click here

Lapidus Arthrodesis

This is another option when a severe deformity is observed. By removing a piece of the articular cartilage of the medial cuneiform and the base of the first metatarsal, a fusion between the two is created. The fixation can be external, by the use of a plate or screws. For read more about this procedure click here

Akin Procedure

An extra correction can be constructed when a wedge is made on the medial side of the first proximal phalanx. The gap is closed by pushing the distal part to the medial side and fixating it. The similarities with the closing base wedge procedure stand out. For read more about this procedure click here

PHYSIOTHERAPY TREATMENT

• Adjusted footwear with wider and deeper tip
• Increase extension of MTP joint
• Relieve weight-bearing stresses (orthosis)

• Sesamoid Mobilization : The physiotherapist performs grade III joint mobilizations on the medial and lateral sesamoid of the affected first MPJ. One thumb is placed on the proximal aspect of the sesamoid and is used to apply a force from proximal to distal that causes the sesamoid to reach the end range of motion (distal glides). These are performed with large-amplitude rhythmic oscillations. No greater than 20° of movement of the MPJ should be allowed during the technique.

• Strengthening of peroneus longus

• Electrotherapy Modalities – Ultrasound, ice, electrical stimulation, MTJ mobilizations and exercises. This is more effective than physical therapy alone. The combination will result in a increase in ROM of the MTP joint, strength and function, and also a decrease in pain .
Pain is the main reason that patients seek treatment for a bunion. Inflammation is best eased using ice therapy, techniques (e.g. soft tissue massage, acupuncture, unloading taping techniques) or exercises that unload the inflamed structures. Anti-inflammatory medications may help. Orthotics can also be used to offload the bunion.

For Restoring the Normal Joint Of Motion

• Joint mobilisation (abduction and flexion) and alignment techniques (between the first and the second metatarsal)
• Massage
• Muscle and joint stretches
• Taping
• Bunion splint or orthotics
• Bunion stretch and soft tissue release.

For Strenghting Of Muscles

• Towel curls The patient spreads out a small towel on the floor, curling his/her toes around it and pulling the towel towards them.
• The ends of the band are either held by an assistant or secured against an immovable object (e.g. a table leg). The patient then dorsiflexes the ankle, pulling “towards their nose,” working against the resistance of the band.