Sunny days are back. Open shoes therefore come out of the closets with, for some, the complex of showing feet deformed by a hallux valgus, also called “bunion”. Dr. Régis Gamain, orthopedic surgeon and traumatologist, explains how to overcome this deformity of the foot.
- Hallux valgus often begins between the ages of 40 and 50 and mainly affects women (90 to 95% of cases).
- 30% of the elderly population and 2% of children have hallux valgus in France.
Why doctor – What is hallux valgus?
Dr Régis Gamain – Hallux valgus is the most common pathology of the forefoot and affects just under one in ten people in France. Also called “bunion”, it consists of an outward deviation of the big toe joint. The bone called the “first metatarsal” moves away from the big toe towards the inside of the foot and the joint between the metatarsal and the first joint of the big toe (metatarsal-phalangeal joint) becomes very protruding, forming a bump on the inner edge of the forefoot, hence the name “onion”. This deviation of the big toe therefore leads to a deformation of the forefoot and, consequently, footwear difficulties.
While hallux valgus can be painless, it can also get worse over time and become painful when walking. Footwear discomfort is often the first difficulty reported by patients. This pathology can go so far as to cause balance disorders or even falls, especially in the elderly. It can also be responsible for the deformation of the other little toes due to the pressure of the big toe.
Is it an increasingly frequent pathology?
Overall, there is an evolution in the number of cases because people consult more. There is a very high prevalence worldwide estimated at nearly 23% of people under 65 with hallux valgus. A figure that even reaches 35% for people over 65. However, these figures should be put into perspective: they identify all patients with a deformity, but these deformations are not necessarily the cause of pain or pathologies.
What are the causes of this malformation?
The causes of a hallux valgus are multiple. They can be:
– of an anatomical nature (flat feet, anomalies of the back of the foot, etc.);
– related to footwear (pointed, narrow, rigid shoes, etc.);
– inflammatory pathologies (linked to the joints);
– or trauma following an accident (fractures, etc.).
Are there several forms of hallux valgus?
There are 3 main forms of hallux valgus which occur at different ages of life:
– congenital hallux valgus (from birth) which is often linked to malformation syndromes.
– juvenile hallux valgus (during childhood) which largely affects women, with severe and bilateral forms (both feet are affected).
– acquired hallux valgus (from adolescence) of multiple origin which is notably linked to poorly adapted footwear.
It should also be noted that it can remain asymptomatic for a long time and thus cause no pain.
When should you consult?
An orthopedic surgeon should be consulted as soon as any deformity is observed. It is recommended that patients who have hallux valgus undergo a surgical evaluation with an x-ray to determine the degree of severity of their pathology.
The hallux valgus is slight when the angle of deviation is less than 20°, moderate when it is between 20 and 40° and severe when it is above 40°. Once this assessment has been carried out, the orthopedic surgeon can redirect the patient to the best course of care.
What are the possible treatments ?
The treatments to be considered depend on the degree of severity of the hallux valgus. Recourse to surgery is not always necessary and should not be used for prevention.
The first treatment is called “conservative”:
– this can simply consist of correcting the footwear (a shoe with good support, wider and with heels less than 5cm).
– wearing insoles for flat feet can also help correct the deformity.
– doing rehabilitation with massages is also a way to tone and soften certain foot muscles.
– pedicure treatments are also useful for treating skin problems that hallux valgus can cause (plantar callus, callus).
– flexible restraints to put in the shoe.
– finally, during inflammatory flare-ups, it is possible to prescribe analgesic and anti-inflammatory drugs to relieve pain. Indeed, the evolution of hallux valgus is not linear; painful peaks can sometimes occur.
All of these treatments can make it possible to avoid having to resort to surgery and improve the daily lives of patients who are at an early stage.
When should surgery be used?
A hallux valgus which becomes surgical is a hallux valgus which is documented (measured) and which presents persistent clinical symptoms despite well-conducted conservative medical treatment. When the patient suffers from persistent and disabling pain, it can be taken care of surgically as this becomes the only effective treatment at this stage. The goal will then be to realign the big toe to eliminate the pain and give it back its propellant role in walking.
How is the surgery performed?
The operation generally lasts less than an hour and can be performed under loco-regional anesthesia. The aftermath of the operation is not very painful, the patient is quickly operational and can walk again immediately thanks to a specific shoe which generally protects him for 5 to 6 weeks.
Are the results of a surgical operation satisfactory?
The operation is generally very successful, there are more than 90% positive feedback from operated patients. On the other hand, there may be recurrences if patients do not take into account the problems that led them to be operated on.
Is progress being made regarding hallux valgus surgery?
There are developments aimed at making the surgery as less invasive and less painful as possible. Surgical implants are constantly being improved based on scientific studies. Portable radioscopy allows, for example, minimally invasive or percutaneous surgery. Another example: improving patient comfort in the operating room is now achieved by virtual reality headsets and music.
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