Hallux (lat. hallux), that is a bunion – symptoms, diagnosis, treatment
A popular hallux valgus, that is a bunion, is a deformity characterized by inappropriate position in the metatarsophalangeal joint. It most frequently arises from foot biomechanics disorder: inappropriate forces cause the deformity. There is a number of causes, the main are the following: flat foot, Achilles diseases, rheumatic diseases, tibialis posterior muscle damage.
Genetic factors (anatomic predispositions are inherited) and the environment (e.g. footwear) have a considerable impact on this disease. Most frequently, nine times more often when compared to men, women have to deal with this problem due to increased ligament system flabbiness and use of high heels.
Pain, inflammation manifesting themselves with increased heat, reddening and burning. Inappropriate position of the hallux does not provide foot stabilization, there are difficulties in walking and using the foot. Tight high heels increase the symptoms. In the event of advanced stages of the “hallux valgus”, we frequently experience co-existing deformities, e.g. claw-like fingers, hammer toe, callus, bunionette or metatarsals.
Should we react if we come up against this problem at the age of 30-40? Yes, we must remember about prevention – suitable footwear, insoles, rehabilitation. But answering the question of whether surgery is necessary – it is determined on a case-by-case basis. There are people who suffer from acute deviation but do not experience any pain. The decision about surgery treatment is made once the comprehensive examination has been carried out and the patient has been interviewed.
Methods of treatment
There are a few reasons why patient visit the clinic – persistent pain, footwear selection difficulties and very often for aesthetic reasons. The medicine has not found an effective non-surgical method of treating the hallux valgus. We have an access to a wide range of insoles and other items which assure temporary relief but in the long run turn out to be ineffective. Prevention of minor deformities allows inhibiting the disease progress. The effective solution is a surgical treatment.
A method of treatment depends on the intensity of the deviation, type and occurrence of co-existing damage and on the cause of the deformity. The advancement of degenerative changes of metatarsophalangeal joint is essential. The procedure in the case of advanced arthrosis and in the situation in which a cartilage is not subject to the disease process vary.
Once additional tests, such as X-ray, resonance, have been performed, it is necessary to specify all parameters required to choose the surgical technique. Before the surgery is commenced, a size of correction and reconstruction of a suitable bone position (correction angles) must be planned. At the same time correction of co-existing deformities is considered as well.
Most methods (e.g. chevron, scarf) are concerned with the so-called osteotomy, that is a controlled cut around the hallux joint. Next, suitable stabilizers (e.g. titanium or bioabsorbable micro-screws) are used to combine bones in order to have a stable correction.
Treatment period, rehabilitation
Most surgical treatment methods applied in Rehasport Clinic do not require post-surgical immobilization in a plaster cast. Patients use (for 4-6 weeks) a special footwear reducing the load of the forefoot, which allows early commencement of the rehabilitation. In this period patients use crutches and do exercises which they have learned after the surgery. After two weeks following the surgery, stitches are removed and X-ray is carried out. Further rehabilitation stages are focused on recovery of the entire range of movements in foot joints, suitable muscle strength, proprioception and nervous and muscle control required to reconstruct suitable walk.
Anatomy, causes, symptoms and methods of treatment discussed by:
Andrzej Pyda, Rehasport Clinic orthopedist