Hallux valgus is an extremely disturbing deformity of the metatarsal bone of the first foot (also big toe). Bunion may develop pain over time and cause severe pain in the first metatarsophalangeal joint.
Many people persist living in pain for a long time and then decide to have surgery anyway. The hallux valgus deformity doesn’t improve on its own. With time it only get worse. It progresses to the point where the movement of the big toe or even the whole body is disturbed.
Hallux valgus – why does it occur?
Should we blame too tight footwear?
Did you know that women suffer from hallux valgus much more often than men? Even more than a third more often? Many describe that narrow and high-heeled shoes are those who cause the problems. At first an innocent problem, such as blisters and hardened skin, can escalate to permanent deformation of the thickening of bones and connective tissues. Prolonged pressure on the footwear only makes the condition (of the already chronic inflammation of the joint) worse.
Other causes of hallux valgus deformity
As already mentioned, many studies mention the connection between wearing the wrong shoes or too tight footwear. Among other possible causes of the bunion we include congenital flat feet.
Also, we shouldn’t forget the family history, which means that the percentage of 63% – 94% is quite high when we talk about the transfer of “genetic” material of parents or grandparents for the occurrence of hallux valgus deformity.
There are also other risk factors for a hallux valgus deformity such as various diseases. These include rheumatoid arthritis, connective tissue diseases, foot injuries, neuromuscular diseases, cerebral palsy…
What causes pain in the hallux valgus deformity?
Hallux valgus causes chronic inflammation of the joint due to lateral flexion or deviation of the thumb. Furthermore, it also causes the displacement of the first metatarsal bone.
In addition, the luxation of the sesamoid bone occur and the first metatarsophalangeal joint become overstretched. Especially the joint capsule on the medial side can be overstretched.
Since the tendon of the adductor hallucis muscle attaches at the base of the first phalanx, it may be affected too. It becomes inflamed and causes the same problems as a damaged muscle in the shoulder joint – for easier understanding.
The “the mechanism of the pulley” is very important so that we can move, carry, and distribute body weight normally when we step over the thumb. With gradual deterioration this mechanism changes. If the walking biomechanics is lost, more weight is transferred to the other feet, leading to metatarsalgia (pain in the transverse arch of the foot).
As the lateral deviation of the big toe increases, so does the rotation of the big toe, which in most cases presses on the second toe. The resulting contracture of the second toe causes pain, impaired walking biomechanics and difficulty wearing shoes.
The most characteristic is the inflammation of the hallux bursa. The skin around this area gets thick and red. The movement of the thumb is limited and painful, so is sensitive to the palpation.
Transformation of bone structures can also cause compression of the intradigital nerves, which can cause discomfort in the foot.
When do we need hallux valgus surgery?
Doctor recommends the surgery when hallux valgus is an aesthetic problem and above all it also causes pain. Diagnostic X-ray procedure performed to pinpoint problems is sufficient for the operator.
The operator, a specialist in orthopaedic, reduces the thickened joint or he grinds it while straightening pacient’s thumb.
Several types of hallux valgus procedures are performed, all depending on the size of the deformity. The patient can also choose between local, spinal or general anesthesia. The main advantage of local anesthesia is that you can go home immediately after the procedure.
After the procedure, the patient receives crutches and a special shoe. The pacient should wear this special shoe should for 6 weeks until the first appointment at the doctor’s.
Post-surgery physiotherapy for hallux valgus
6 weeks after surgery, it is advisable to visit a physiotherapist. Many don’t do this and let the leg slowly recover on its own. There is absolutely nothing wrong with this. Only the recovery time will take much longer than with the help of an expert.
It is very difficult for a person to move his finger to such an extent that he would ever cross the line of comfort or moderate pain, as he is afraid that his toe will be further injured. He also doesn’t have suitable devices at home that work on the affected area with anti-inflammatory and analgesic properties.
It is very important to prevent soft tissue scarring. By attending physiotherapy, the pacient gets educated about the correct handling and the correct implementation of exercises. Only this can successfully prevent swelling and gain the on the range of motion of the big toe more quickly.
Physiotherapy devices are an essential support for such injuries.
The most commonly used are:
- ultrasound therapy
- medium frequency analgesic electrotherapy
- RDT therapy
- Tecar therapy
- magnetic therapy
- manual therapy
In some people, internal factors can cause swelling for up to 3 months after surgery, so don’t worry if this happens to you.
Bunion also like to repeat, despite the surgery. However, you do not need to be afraid, because if the thumb is in a neutral position after one year after the procedure, the possibility of recurrence of the deformation is very small.