Hallux Valgus (Bunions): Causes, Symptoms, and Treatment

What is Hallux Valgus?

Hallux valgus occurs when the metatarsophalangeal (MTP) joint at the base of the big toe shifts out of alignment. The big toe deviates laterally toward the smaller toes, leading to a prominent bony bump on the inside of the foot. This condition is often progressive, with symptoms worsening over time if untreated.

Causes of Hallux Valgus

Structural and Biomechanical Factors

• Genetics: Inherited foot structures (e.g., flat feet or overly flexible joints) predispose individuals to bunions.

• Footwear: Prolonged use of tight, narrow, or high-heeled shoes that squeeze the toes together.

• Overpronation: Excessive inward rolling of the foot during walking, placing strain on the MTP joint.

Medical Conditions

• Arthritis: Particularly rheumatoid arthritis, which weakens joint stability.

• Neurological Conditions: Issues like Charcot-Marie-Tooth disease that affect foot structure and muscle balance.

Symptoms of Hallux Valgus

• Visible Bump: A bony protrusion at the base of the big toe.

• Pain and Tenderness: Discomfort around the bunion, especially when wearing shoes.

• Swelling and Redness: Inflammation around the MTP joint.

• Limited Mobility: Stiffness in the big toe joint, affecting walking.

• Toe Deformities: Overlapping or crowding of the second toe due to big toe deviation.

Diagnosis of Hallux Valgus

Clinical Examination

• Visual Assessment: Inspecting the foot for bunion size and toe alignment.

• Functional Tests: Assessing range of motion, walking mechanics, and areas of tenderness.

Imaging

• X-rays: Confirm the severity of the deformity and evaluate joint alignment and bone structure.

Treatment for Hallux Valgus

Non-Surgical Treatment

1. Footwear Modifications

   • Wear wide, supportive shoes with a spacious toe box.

   • Avoid high heels or shoes with pointed toes.

2. Orthotics

   • Custom insoles to correct foot alignment and reduce pressure on the MTP joint.

3. Pain Management

   • Use ice packs to alleviate swelling and over-the-counter pain relief for discomfort.

4. Physiotherapy

   • Stretching Exercises: Improve flexibility of the big toe and surrounding muscles.

   • Strengthening Exercises: Target intrinsic foot muscles to stabilize the MTP joint.

   • Manual Therapy: Mobilization techniques to restore joint function and alignment.

5. Padding and Splinting

   • Bunion pads to protect the bunion from shoe pressure.

   • Night splints to gradually realign the big toe during sleep.

Surgical Treatment

For severe cases unresponsive to conservative care, surgery may be required.

• Bunionectomy: Removal of the bony prominence.

• Osteotomy: Cutting and repositioning the metatarsal bone to correct alignment.

• Arthrodesis: Joint fusion for advanced arthritis cases.

• Tendon or Ligament Repair: Balancing soft tissues around the joint for stability.

Rehabilitation for Hallux Valgus

Post-Surgical Rehabilitation

• Pain Management: Ice, compression, and elevation to reduce swelling and discomfort.

• Mobility Exercises: Gentle range of motion exercises for the big toe.

• Strengthening: Progressive strengthening to restore foot and ankle stability.

Long-Term Management

• Gait Retraining: Improve walking mechanics to prevent recurrence.

• Preventive Care: Continued use of supportive footwear and orthotics.

Preventing Hallux Valgus

• Choose well-fitted, supportive shoes with a wide toe box.

• Maintain a healthy weight to reduce stress on the feet.

• Perform regular foot exercises to strengthen muscles and maintain joint flexibility.

Hallux valgus can impact your daily life and mobility, but effective treatment can restore comfort and function. At Palms Physiotherapy & Allied Health, our experienced team is here to provide comprehensive care tailored to your needs. Contact us today to start your journey toward pain relief and improved foot health