Hallux valgus (bunion of the foot)

What is Hallux Valgus (Bunion)?

Hallux Valgus, commonly known as a "Bunion," is a potentially progressive deformity of the big toe. It is a bony protrusion of the metatarsal head, a "bump" on the big toe also called the hallux. It is not the bone that "grows," but rather the first metatarsal that tends to move away from the second metatarsal.

There are several types of hallux valgus:

• Congenital hallux valgus: the deformity is present from birth.
• Juvenile hallux valgus: the deformity appears at puberty.
• Acquired hallux valgus: the deformity occurs during adulthood.
• Post-traumatic hallux valgus: the deformity appears following trauma, notably ligament injuries.
• Hallux rigido valgus: the "bunion" is associated with osteoarthritis of the big toe, also referred to individually as "hallux rigidus."
• Interphalangeal hallux valgus: the deformity is not strictly in the joint, but in the first phalanx of the big toe. This is a stable form of hallux valgus.
• Iatrogenic hallux valgus: secondary to surgical intervention. This is a potential complication of surgery on the sesamoids.

Congenital hallux valgus is rare, while juvenile hallux valgus is more common. These are unstable forms because there is a "dysplasia" of the joint, particularly of the first metatarsal head. The metatarsal head is generally round, with anomalies in joint orientation that cause the deformity and promote its worsening.

The hallux valgus acquired in adulthood, which is more frequent in women, is mainly due to footwear that is not adapted to the shape of the forefoot.

Indeed, the forefoot squeezed into narrow shoes, such as high heels, can adapt to the deformity up to a point of no return, which corresponds to muscle atrophy of the intrinsic muscles of the foot. At that point, the foot becomes less toned, and the deformity begins and can progress. This deformity may stagnate at various stages or gradually worsen.

Hallux valgus generally occurs on wide forefeet that are squeezed into so-called "fashionable" shoes for women, but also into more classic flat shoes.

How to recognize the onset of hallux valgus?

The main sign of hallux valgus or bunion of the big toe is the movement and then contact between the big toe and the 2nd toe. During the progression of hallux valgus, there may be overlapping of the toes.

What are the treatments for hallux valgus?

Orthopedic insoles

Orthopedic insoles can be effective in cases of poor propulsion when walking with the big toe, resulting in pain in the pads known as "metatarsalgia."

They can also be made to correct flat feet associated with hallux valgus, as flat feet encourage the deformation of the big toe and can contribute to its worsening, or even its recurrence in case of surgical correction.

They are made by a podiatrist.

Shoes for hallux valgus

Hallux valgus means a wide forefoot, which is therefore difficult to fit into shoes. As the deformity evolves, the forefoot gradually widens and becomes more and more compressed in shoes.

• “Comfortable orthopedic shoes” for hallux valgus: There are several brands of so-called comfortable orthopedic shoes that you can buy in pharmacies.
  These are wide shoes, with a cushioning sole, and soft, flexible materials.
  With a medical prescription and depending on your health insurance, you may be eligible for reimbursement for a pair of comfortable orthopedic shoes each year.
• “Variable width shoes” for hallux valgus: Some brands of shoes, especially French, German or Spanish ones, offer different forefoot widths for the same shoe size.
  For some German models, for example, your shoe size offers 3 widths (Small, Medium, Large).
  Here are a few shoe brands that may help you “fit” your foot: Geox, Aerosol, Birkenstock, Asley, Marco, Dr Martens…
• “Stylish shoes” for hallux valgus: It is possible to wear heeled shoes if you have hallux valgus; it depends on the width of the shoe considered.
  Some brands, such as Caroline Macaron, have developed ranges of stylish shoes designed for patients with hallux valgus.
  The Repetto brand has not developed a specific range, but the width of the heel and the suppleness of the leather generally make them comfortable in cases of hallux valgus.

Splints or orthoses for hallux valgus

At present, we believe there is no simple way, such as orthoses or splints, to reverse and permanently correct hallux valgus, but temporary relief can be achieved, provided the deformity is still flexible or reducible.

We recommend wearing a splint or orthosis mainly for patients who are in pain and do not wish to undergo surgery.

The hallux valgus surgery

Hallux Valgus Surgery

The procedure is usually performed on an outpatient basis, meaning you can leave the clinic the same day, with a tourniquet inflated at the base of the ankle. The anesthesia is most often regional, targeting the ankle and foot, with the addition of sedation if needed, which will allow you to sleep during the procedure.

You may refuse sedation, but you will not be able to watch your procedure for aseptic reasons due to the operative drapes.

The duration of the surgery will depend on any additional procedures that may be associated with the correction of the hallux valgus.

Surgical Technique Used

There are many surgical techniques for correcting hallux valgus.

We do not use the percutaneous technique for the correction of hallux valgus due to the risk of stiffness and the impossibility of fine adjustment of the position of the metatarsal head; however, it may be advantageously used on the lateral rays and toes in cases of associated corrections.

We use a minimally invasive surgical technique, via a medial incision centered over the metatarsal head, including a Kramer-type first metatarsal osteotomy for its corrective power, which may be combined with a chevron osteotomy of the first phalanx and soft tissue reconstruction.