Hallux valgus: only disability leads to bunion surgery
What is an hallux valgus?
A bunion, or " hallux valgus ", is an abnormal deviation of the base of the big toe that overflows on the inside of the foot. This deviation therefore leads to a deformation of the forefoot, at the level of the base of the big toe, with footwear difficulties.
Hallux valgus can be painful when walking, but is usually painless . When the deformity rubs in the shoe, a " callus " (thickening and induration of the skin opposite) develops and can become inflammatory (red, hot and painful bulge).
A reaction of the outer face of the bone of the deformed joint can occur and lead to a bony growth, or " exostosis ": this further aggravates the difficulties of footwear.
In case of inflammation of the protective bursa which is located between the skin and the bone of the deformed joint, we speak of “ bursitis ”, which should not be confused with gout. It then becomes extremely difficult to fit in normal shoes.
Why can a hallux valgus hurt?
Hallux valgus is usually painless. The appearance of pain must therefore be considered as evidence of a complication , which justifies seeking its cause in order to adapt the treatment.
• Most often it is callus inflammation or bursitis due to conflict with a shoe that is too tight.
• But the pain can be linked to other causes secondary to forefoot deformities , such as dislocation of the first metatarsophalangeal joint, with synovitis and distension of the joint capsule, osteoarthritis of this joint or nerve compressionmedial collateral.
• Due to changes in the normal support of the foot and increased stress , it is possible to see a stress fracture on the bones of this toe or osteonecrosis .
• Osteoarthritis, by wearing down the joint, accentuates the deviation and when the deviation of the 1st ray becomes major, the big toe passes below or above the second toe and turns towards the inside of the foot, until to cause a complete dislocation of the big toe which thus loses its functionality.
• This deformity has an impact on the other toes which curl up (“ claw toes ”) and there is metatarsal pain (“ metatarsalgia ”) related to abnormal foot pressure on the heads of the 2 nd , 3 rd and 4 th metatarsals, which are not used normally.
What are the causes of hallux valgus?
Hallux valgus is favored by heredity and repeated stresses on a predisposed forefoot, but it can have a traumatic , inflammatory (inflammatory polyarthritis or gout) or neurological (sciatica sequelae) origin.
The onion is therefore more frequently found:
• In the event of a family history of hallux valgus,
• In women, particularly after menopause ,
• In the event of neuromuscular or rheumatic disease (rheumatoid arthritis),
• In the event of frequent wear high-heeled shoes with narrow toes : this last factor cannot be solely responsible but it is nevertheless favourable+++.
• A certain number of morphological factors , with anatomical variation affecting the first or the 2nd ray , are favourable. These include a shortening of the 1st toe or, on the contrary, a very elongated 1st toe as in the "hyper-Egyptian" foot, a problem on the 2nd toe , a fore- flat foot, muscular hypotonia aggravated by obesity…
What is the evolution of hallux valgus?
In 90% of cases, hallux valgus begins between the ages of 40 and 50 . However, it can appear earlier, including in children, around the age of ten.
The hallux valgus then evolves by painful thrusts . These flare-ups are unpredictable and are accompanied by pain related to the bunion or loss of big toe function.
If the hallux valgus is moderate, and corrective factors are implemented, this deformity can stabilize . On the other hand, aggravation is generally the rule if the hallux valgus is marked and if nothing is done to prevent it.
Comments
Post a Comment