Why are ectropion more common in women? Will it get worse if left untreated?

Author: Xu Yingpeng, Chief Physician, Guang'anmen Hospital, China Academy of Chinese Medical Sciences

Reviewer: Zhang Zhihai, Chief Physician, Guang'anmen Hospital, China Academy of Chinese Medical Sciences

Hallux valgus is a common foot deformity characterized by chronic dislocation of the first metatarsophalangeal joint, which causes the toes to deviate from their midline and tilt outward beyond the normal physiological angle. The disease has a higher incidence rate among the population, and is more common in women, with a male-to-female ratio of about 1:9 or even 1:11.

Figure 1 Original copyright image, no permission to reprint

1. Why are women more susceptible to ectropion?

The occurrence of hallux valgus is closely related to the collapse of the arch of the foot. The arch of the foot is a convex upward arch-shaped structure composed of tarsal bones, metatarsal bones, ligaments and tendons, including the longitudinal arch of the foot and the transverse arch of the foot. Factors such as weight gain, excessive exercise, long-term standing strain, and aging may lead to a decrease in the strength of the plantar ligaments and muscles, weakening the force that maintains the arch of the foot, and then leading to the collapse of the arch of the foot. Once the arch of the foot collapses, the metatarsals will spread outward, the first metatarsal will turn inward, and the toes will be pulled by the plantar tendons and ligaments to remain in place, gradually forming hallux valgus deformity over time. Women have relatively weak ligaments and muscles, and prefer to wear high-heeled pointed shoes. High heels put more force on the arch of the foot, and the collapse may be more serious. Pointed shoes aggravate the tendency of the five toes to converge toward the center, all of which increase the risk of hallux valgus.

Figure 2 Original copyright image, no permission to reprint

Most people with hallux valgus have varying degrees of flatfoot deformity, and people with flatfoot often have hallux valgus. These two conditions are interrelated and cannot be separated. Arch collapse can cause the first metatarsal to invert, leading to hallux valgus. At the same time, hallux valgus also means that there is a problem with the biomechanical structure of the entire foot, and the arch may have begun to collapse.

Ectropion also has a certain genetic tendency. Surveys show that about 50% of female patients have a family history of maternal inheritance, and the proportion of paternal inheritance and parental inheritance is more than ten percentage points. Therefore, about 80% of patients with ectropion have a genetic history to varying degrees.

2. How to judge the severity of ectropion?

The severity of ectropion can be assessed visually and by radiographs.

The size of the valgus angle is a common indicator for assessing the severity of valgus on X-rays: 15-25 degrees is mild, 25-35 degrees is moderate, and more than 35 degrees is severe valgus. In addition, other indicators such as whether there is plantar callus, plantar pain, and the angle between the first and second toes should also be considered.

3. Will hallux valgus gradually get worse if not treated?

If no preventive measures are taken for mild hallux valgus, the arch of the foot may be strained as walking and weight bearing continue, and the degree of hallux valgus may gradually worsen. Conservative treatment cannot cure hallux valgus, but the use of arch pads can slow down its progression to a certain extent. Arch pads can maintain the stability of the arch during walking and exercise, reduce the risk of collapse, and thus delay the occurrence of hallux valgus. Once the arch of the foot is found to have a tendency to collapse, an arch pad should be used as soon as possible. The choice should be based on the individual's arch height and the thickness of the plantar tissue.

Figure 3 Original copyright image, no permission to reprint

It is recommended to avoid wearing slippers when going out, as slippers usually lack arch support and do not restrict the foot, which may cause the arch to deform and collapse, and may eventually lead to hallux valgus. Also, try not to wear high-heeled pointed shoes.

For cases where the symptoms of hallux valgus are obvious, seriously affecting the wearing of shoes and walking; or the hallux toe has affected other toes, causing the second or even third toe to cross over the hallux toe, forming a hammer toe; or severe painful calluses occur on the soles of the feet, and thick calluses grow on the weight-bearing parts, which are very painful; surgical correction treatment is required in these cases.

In general, hallux valgus is a common foot deformity associated with collapsed arches. Using arch supports can help slow the progression of hallux valgus. For hallux valgus that has seriously affected other toes, or is combined with significant symptoms such as painful plantar calluses, surgical intervention is required. If there are no symptoms, no pain, and it does not affect wearing shoes or walking, and it is purely for aesthetic reasons, surgery is not recommended.