Hallux Valgus / Rigidus

Hallux valgus is the medical term for bunion deformity of the big toe. When a bunion (hallux valgus) occurs, the joint at the base of the big toe—the metatarsophalangeal joint (MTP joint)—moves outward towards the centre of the body while the big toe deviates inward towards the little toe. Inheritance (family history of bunions) is the most important etiologic factor, but muscle/tendon imbalance and tight shoes promote bunion development. Bunions are far more common in women than in men.

The hallux valgus deformity (bunion) develops progressively over time and causes mild to severe pain, making it increasingly impossible to wear normal shoes. Hallux rigidus (arthritis of the big toe joint) can occur due to progressive wearing and degeneration of the big toe joint.

Diagnosis

The diagnosis of hallux valgus is obvious on clinical examination. An X-ray is obtained for precise assessment and angle measurement of the MTP joint.

Treatment

There are two basic approaches to treatment of hallux valgus: conservative and surgical. A conservative approach can be used in the early stages when the symptoms are mild to moderate. A surgical approach is used if there is severe pain and deformity.

Conservative Treatment

Proper footwear is crucial. High heels and tight shoes should NOT be worn. Cushioning heel pads and custom orthotic inserts made by an orthopaedic technician are commonly prescribed (and necessary because bunions often occur in association with other foot deformities, such as splayfoot). Bunion night splints are another conservative treatment option.

Surgical Treatment

There are various surgical options available for treatment of hallux valgus and hallux rigidus. We select the best surgical procedure for you in consideration of the specific type and extent of the deformity and the intensity of pain you are experiencing. The surgical procedures most commonly used by us are briefly described below.

SCARF osteotomy for hallux valgus:
Surgical access is obtained through a small skin incision. The metatarsal bone is then divided in a Z-shaped fashion, and the bone fragments are straightened (repositioned). Additional measures are performed to reduce the tension in the tendon and capsule, which is the reason why the toe was drawn in the wrong position. Finally, fixation screws are inserted to hold the bone fragments in the correct position. SCARF osteotomy is sometimes performed in combination with other procedures. As the toe is generally quite stable immediately after surgery, weight-bearing (walking) is permitted in a special shoe on the first day after surgery.

Cheilectomy/arthodesis for hallux rigidus:
Hallux rigidus (arthritis of the big toe) is characterised by destruction of the MTP joint surface. Cheilectomy can be performed to remove the bony bump and to restore the range of motion of the MTP joint in mild to moderate stages of the disease. Arthrodesis (surgical fusion of the joint) must be considered in patients with advanced disease and intense pain.