DEFINITION
The Hallux Valgus is a deviation from the joint of the big toe.
We speak of hallux valgus when the angle between the big toe and the 1st metatarsal exceeds 10 °.
This deviation is most often associated with an internal rotation of the big toe, a dislocation of the sesamoids and an exostosis (called “onion”) on the inner edge of the 1st metatarsal head.
This deformation is most often of family origin.
The hallux valgus evolves slowly by palliation and self-maintains.
Finally, there is no correlation between the degree of deviation and the pain felt by the patient.
PREDISPOSING FACTORS
Hallux valgus mainly affects women.
Family history is conducive to the genesis of a hallux valgus.
Frequent wearing of narrow shoes and heels can promote its development.
The hallux valgus preferentially evolves on valgus feet (“collapsed”) and Greek metatarsal canons (short big toe with 2nd longer toe).
A study carried out in 1999 on 100 hallux valgus showed that the first metatarsal is in hypo static support in 99% of the cases and in hypo dynamic support in 90% of the cases.
The hypo support under the 1st metatarsal head is characterized by a deficiency of the 1st ray, the internal column will be overloaded, and under stress, the hallux will be offset in valgus by induced muscular dysfunction.
There is then a load transfer with hyper support under the 2nd metatarsal head, with or without pain.
POSTURE EFFECTS
At the postural level, we find instability in the three planes at the level of the lower limb: in the frontal plane (internalization of the load line), in the horizontal plane (associated internal rotation) and in the sagittal plane (anteriorization of the line dump). The spine can then only compensate for the misalignments induced with a pelvic tilt in the frontal plane, an increase in lumbar lordosis in the sagittal plane and a rotation of the vertebral bodies in the horizontal plane.
THE DIFFERENT TREATMENTS
The treatment will depend on the pathology and the consequences highlighted: pain, functional discomfort and unaesthetism of the deformation.
The only curative treatment is surgery. The surgeon will be able to assess the merits of the intervention. The new surgeries are less and less invasive and allow a fairly rapid recovery of walking.
There are many preventive and palliative treatments to slow the progression of hallux valgus.
Orthopedic insoles are effective against the development of hallux valgus, because they aim to treat the consequences, but also the causes of hallux, while taking into account the postural set.
In case of load transfer under the 2nd metatarsal head with pain, it is possible to make a custom cutout to relieve the painful area.
In order to prevent postural disorders, it is advisable to correct static disorders of the forefoot and forefoot in order to avoid the postural consequences mentioned above.
Footwear advice is essential and is part of the orthotic treatment with a fairly wide upper, soft leather and not too high heels. It is recommended not to exceed 3 cm in heel height so as not to overload the body weight on the metatarsal heads.
Night restraints are devices to be worn at night to maintain the 1st phalanx in physiological position. These restraints have an analgesic effect and serve to avoid any aggravation of the pathology.
Finally, orthoplasties are small silicone devices that can be used to protect conflict zones.
Christophe Lecourt
Podologist at CAP-PODOTHERAPIE (Lancy and Onex GMO)
