Valgus deformity of the big toe

Deformation disease of the first (or big) toe.

Causes

Along with a hereditary predisposition that can only be proven in exceptional cases, there are 2 reasons for hallux valgus:

• Transverse flatfoot: due to the sinking of the anterior arch in transverse flatfoot, the area of the ball of the toe develops, a different angle of inclination and, thus, a crooked position in relation to other fingers.
• Wrong shoes.

Cross-cultural comparisons confirm the fact that the main cause of valgus deformity of the big toe is clearly long-term wearing of the wrong shoes for a long time. A normal and healthy foot has a slight inclination of the toes towards each other. In fact, normal feet are found in only a few cultures today. In countries where Western-made shoes are worn, on the contrary, a dense, compressed grouping of the toes is usually observed. Thus, the natural even position of all the toes turns in this case into the even position of only the big toe. Research confirms that it is enough just to regularly wear stockings for many years in a row, which lightly press the toes together. This process is accelerated by wearing stockings that are too tight or too short.

The shoes that are worn most often show a basic shape of the insoles that does not follow the natural contour of the sole (a line according to Prof. Hermann von Mayer). As a result, the toes are forced out of their normal position, leading to permanent deformity over time. In the progressive stage, this is manifested initially by the crooked position of the big toe (valgus). This crooked position progresses further, affecting the adjacent toes more and more, and can lead to a position of the big toe that lies almost on a rectangular axis with respect to the adjacent toes.

More pronounced valgus deformities of the big toe concern, first of all, women. On the one hand, this is due to the weaker connective tissues in women, but above all due to the shape of women's shoes, which favor this pathological development more than ordinary shoes in men.

3 factors of footwear are essential:

• Heel height. Due to the higher heel (above 3 - 4 cm), increased pressure is achieved in the area of the metatarsus. On the one hand, this contributes to the development of flat feet and, on the other hand, the toes are pressed into the toe of the shoe as a result.
• Too tight shoe toe. The toes of shoes are often too tight to give the necessary space to the toes (primarily on the sides, but also on the top). As a result, they are forced to remain in an incorrect position, which leads over time to a permanent malposition in the joints of the foot. Many women, when viewed from above, have a triangular forefoot that is inserted into the precisely fitted pointed toe of the shoe.
• Too small shoes. If the shoe is too small, then the toes are also forced out of their natural position, which in turn contributes not only to hallux valgus, but also results in hammer and claw toe shapes.

The German Medical Journal published in February 2005 the results of a mass medical examination of German schoolchildren. There has been an alarming increase in malformations of the legs and lower extremity complaints in adolescence. First of all, in a large percentage of the examined girls at the age of 14, a well-defined crooked position of the thumb was already established.

Prevention

Knowing the causes, the treatment strategy is as follows: do not often wear shoes with high heels and shoes with too narrow toes. The legs make up one quarter of the total bone mass of the human body and are extremely adaptable because of this. If you change your shoes often, you can avoid this damage. Only the regular and, accordingly, the predominant wearing of ill-fitting shoes or shoes with high heels leads to these problems.

People who often walk barefoot usually have beautiful feet with smooth skin and even toes. Casual shoes should have low heels and room for toes to move. High-heeled shoes should only be worn on exceptional occasions. Foot gymnastics is a wonderful compensation for relaxing and relaxing the feet, these pleasant moments also occur when wearing quality shoes. Relaxation and rest for the feet can also be achieved with the help of foot baths and massage brushes.

Symptoms

Wrong position of the big toe, with pain in the ball of the toe.

Diagnostics

Clinical examination and X-ray.

Treatment

Conservative treatment.

Switching to flat shoes with plenty of room for your toes, such as wearing “Vietnamese sandals,” may only help initially. Progressive valgus deformities of the big toe cannot be eliminated or reduced in this way. In any case, the transition to such shoes leads to the fact that there is no further development of damage and deformation. Worthy of recommendation is leg gymnastics, which makes the toes mobile and strengthens the holding muscles of the foot arch. Walking barefoot can also support this process. In other cases, orthopedic shoes with flat foot insoles or wearing shoes that do not cause any pain when pressed against the aforementioned major joint of the big toe can help.

Surgical treatment

Once manifested, a distinct malposition of the big toe can only be corrected by surgery. It is recommended in the presence of pain. Depending on the severity of the valgus deformity of the big toe and the existing complaints, an appropriate and appropriate treatment method is selected. Of the approximately 150 methods described, about 10 are used in German-speaking countries. If there is additional arthrosis of hallux valgus or arthrosis of the main joint of the big toe (rigidus), then the arthrosis should be treated first. Almost all methods of surgery consist of an incision in the first metatarsal, but the incision is made in various directions. Then, located near the toes, the part of the metatarsal bone is moved towards the second metatarsal bone (where it was originally located) and both parts of the metatarsal bone are fixed and clamped with wire or screws. In conclusion, the thumb is placed in its original position and fixed with strong sutures.

Arthrosis in the main joint of the big toe can be "cleaned out" and this can lead to the restoration of mobility. In other cases, the damaged part of the joint in the major member of the big toe is removed, the joint is reinforced in the correct position, or an artificial joint is placed (on this point, there are as yet no long-term research results).