【Health Lecture】What is hallux valgus?

In order to ensure the scientific effect of learning health knowledge in the "2024 China Elderly Health Knowledge Competition", the organizer has collected various health science articles suitable for the elderly from various hospitals. We will share them through the "Health Lecture Hall" column. Today, Dr. Zhang Haiyang from the West Campus of Zibo Central Hospital brings us: "What is hallux valgus?" Welcome elderly friends to learn.

Hallux valgus, commonly known as "big toe", refers to a forefoot deformity in which the first metatarsophalangeal joint deviates outward beyond the normal physiological range. Hallux valgus is diagnosed when the big toe deviates outward relative to the first metatarsal bone, causing the angle between the two, i.e. the hallux valgus angle, to exceed 15°. Hallux valgus is a common disease that causes foot discomfort, with an incidence rate of about 23% in adults aged 18-65 and as high as 30% in adult women.

2. Causes of Hallux Valgus

The main causes of hallux valgus are as follows:

1: Footwear factors

Most of the patients with hallux valgus appeared in the era when humans used shoes. Wearing shoes that are too tight and pressuring the forefoot is a cause of hallux valgus. After World War II, high heels were introduced to Japan, but with it came a rapid increase in the number of patients with hallux valgus. Research data from China shows that the prevalence of hallux valgus in those who wear high heels is 15 times that of those who do not wear high heels. But wearing shoes is not the only factor that causes hallux valgus.

2. Genetic factors

Expert research reports: 69.48% of patients have a family history, 55% of patients have hallux valgus before the age of 20, and at least 50% of patients have hallux valgus before the age of 20.

3: Abnormal foot structure

1) Inversion of the first metatarsal 2) Excessive length of the first metatarsal 3) Pronation of the forefoot or big toe 4) Abnormal metatarsophalangeal joint morphology 5) Flat feet

4: Other factors

1) Rheumatoid arthritis, gouty arthritis 2) Sequelae of poliomyelitis 3) Trauma

3. How to determine whether you have hallux valgus?

The angle between the axis of the first toe and the axis of the first metatarsal bone of a normal person's foot is between 0 and 15 degrees. If it exceeds 15 degrees, it is hallux valgus.

The specific manifestations are:

The inside of the big toe joint is bulging, the surface is red and swollen, and there is pain when pressing, which is more obvious after wearing shoes. The big toe is valgus, constantly squeezing the second toe. Calluses (calluses) appear on the forefoot, and walking is painful. According to the specific progression of the disease, hallux valgus is divided into 4 stages: reversible stage

The big toe is valgus about 10 degrees, which only affects the appearance and does not directly affect walking. The patient usually does not feel pain, but because there are slight calluses on the soles of the feet, wearing high heels will cause pain.

Contracture stage

The big toe is turned outward 10 to 20 degrees, the first and second toes are obviously squeezed, the sole of the foot becomes obviously widened, and walking for a long time can easily cause pain in the big toe joint and sole of the foot.

Severe stage

The big toe is turned outward 20 to 40 degrees, the toes overlap, and it is difficult to balance the force on both feet, which seriously affects standing and walking.

Deformation stage

The big toe is turned outward more than 40 degrees, the big toe is seriously overlapped, the toes are not stressed, the arch of the foot collapses, it is difficult to walk, and the sole of the foot directly bears the pressure of the toes. This causes problems such as knee joint inflammation, back pain, etc.

4. Treatment of Hallux Valgus

1. Conservative treatment

• Reduce local pressure and wear loose shoes
• Reduce swelling and relieve pain
• Use of orthotics
• Functional Exercise
• Can relieve symptoms but cannot correct existing deformities

Various brace treatments for hallux valgus

2. If the forefoot is severely deformed, surgical treatment can be performed according to the doctor's advice to correct the deformity of the forefoot.

Surgery: Purpose

• Correction of hallux valgus (HAA).
• The medial osteophyte and the bunion of the first metatarsal head were removed.
• Correction of enlarged IMA.
• Medial sequence of the stable foot.
• Reconstruction of the first metatarsophalangeal joint that has been destroyed.
• Adjust the weight-bearing of the metatarsal heads and treat lateral toe lesions.

Surgical treatment: Approach - Soft tissue surgery. (McBride)

• Distal metatarsal osteotomy. (Chevron osteotomy of the distal first metatarsal)
• Metatarsal shaft/base osteotomy. (1st metatarsal Scarf osteotomy)
• Phalanx osteotomy. (Akin osteotomy of the proximal first phalanx)
• Medial sequence stabilization. (First metatarsophalangeal joint fusion)
• Functional reconstruction of the metatarsophalangeal joint.
• Lateral toe surgery.

5. Hallux valgus prevention measures

The prevention of hallux valgus mainly involves wearing shoes that fit the feet, especially for those with a family history of hallux valgus. It can also be prevented through exercise, such as doing more foot exercises and exercising the foot muscles. Patients with flat feet can wear corrective insoles to prevent the occurrence of this disease.

About the Author

Zhang Haiyang, West Campus of Zibo Central Hospital, Hand and Foot Surgery, attending physician, master's degree student, member of the Democratic Party (China Democratic League), graduated from Xinjiang Medical University in 2015 with a major in orthopedic surgery, has published two SCI papers since work, and studied at the Hand Surgery/Foot and Ankle Surgery Department of the Second Hospital of Shandong University in 2022. An excellent teacher of Binzhou Medical College, he is currently a member of the Science Popularization Committee of the Chinese Medical Education Association, deputy director of the Limb Deformity Repair and Reconstruction Professional Committee of the Shandong Disabled Rehabilitation Association, a member of the Foot and Ankle Professional Committee of Shandong Research Hospitals, a member of the Foot and Ankle Professional Committee of Shandong Medical Engineering, and a member of the Trauma Surgery Committee of Zibo City.

Main research directions: treatment of severe and multiple trauma, diagnosis and treatment of diseases related to foot, ankle and congenital malformations, etc. Expertise: diagnosis and treatment of diseases related to foot, ankle and congenital malformations.