The deformation, where there is a medial (pointed inwards) deviation of the first metatarsal (front-of-heel) bone and the lateral (pointing outwards) deviation of the thumb of the foot, is called hallux valgus, also known as bunion.

The thumb begins pointing outwards /the right one to the right — the left one to the left/, and the bone behind the thumb, (the first metatarsal bone), is pointed inwards, and between it, and the thumb forms and angle, open outwards.

This condition most commonly is presented with a bulge along the inside of the thumb, but often this deformation is wrongly diagnosed as bone growth or tissue around the joint, located at the base of the thumb.

The term “hallux valgus” comes from Latin, where “hallux” means “the thumb of the foot”, and “valgus” is used to denote a deformation, when you have a bending of the bone or the joint to the side, i.e. pointing outwards from the middle line of the body.

Although hallux valgus is a relatively common condition, the frequency of this disease has not been precisely documented. Relatively few studies are available, where great deal of the information includes empirical data, which are based o observations of patients, who have this problem.

Studies have found that the frequency increases with age, and hallux valgus (acquired) is observed in 3% of the people aged 15-30 years, in 9% of people between 31 and 60 years of age, and in 16% in those, who are aged above 60 years.

This disease is observed more often in women than in men, whereby the ratio varies from 2:1 to 4:1.

Differences in opinion exist among medical experts with regards to the cause of bunions — according to some authors hallux valgus occurs mainly as a result of the prolonged wearing of shoes, which are especially tight and have a pointy edge.

Other experts, however, contrary to the general wisdom, believe that this deformation is the result of genetic factors, and that tight shoes with high heels, or tightly adhering shoes do not lead to hallux valgus, but they only exacerbate the occurring deformation, i.e., if there is hallux valgus, such shoes maintain the thumb of the foot in abduction (taken out of the median plain of the body), whereby causing a mechanical stretch and off-setting of the medially located soft tissues.

Furthermore, tight shoes can cause pain in the bulge, which can be observed in the base of the thumb, and a pinched nerve.

Bunions occur when there is pressure onto the medial (internal) side of the thumb, which twists it in the direction outwards to, and sometimes under or over, the other fingers (angulation).

With this pressure, the tissue around the joint swell up, and become sensitive, which condition can lead to painful movement in the joint or problems when wearing shoes.

The bulge itself is partially the result of the swelling of the purse (a little baloon, filled with joint (sinovial) liquid, which softens the movements between bones, tendons and other tissues), or ossification (covering with bone matter) of the metatarsophalangeal joint (the joint between the toe bones (phallanxes) and the bones in front of the foot).

The development of hallux valgus is related to various etiological factors, including biomechanical, traumatic and metabolic.

The most common etiological cause is the biomechanical instability, which is due to different anatomic deviations.

Arthritic/metabolic conditions, which can lead to hallux valgus (acquired) include:

• gout arthritis;
• rheumatoid arthritis;
• psoriatic arthritis;
• diseases of connecting tissue, like the Ehlers-Danlos syndrome, the Marfan syndrome, loose and susceptible to stretching ligaments.

The neuromuscular diseases, which could lead to hallux valgus, are:

• multiple sclerosis;
• the Charcot-Marie-Tooth disease;
• cerebral palsy.

Traumatic conditions, which can lead to hallux valgus (acquired) include:

• irregular healing of a broken bone;
• damages within the joint;
• traumas of the soft tissue; spraining.

The structural deformities, leading to hallux valgus, are:

• the presence of an uneven surface on the joint or on the metatarsal bone;
• elevation (dorsiflexion) of the first metatarsal bone — metatarsus primus elevatus;
• external torsion (twisting) of the tibia (large shin bone); genu varum or valgum;
• femoral retrotorsion (a deformation in the upper part of the femur (the thigh bone), due to the contraction of the thigh group of muscles).

During walking, the thumb on the foot, as well as the other toes, as a whole remain arranged in parallel along the longitudinal axis of the foot, regardless of the degree of abduction (withdrawal) or pronation (twisting inside) of the front part of the foot. The cause for this is the simultaneous pulling of the adductor, extender and flexing tendons.

The diagnose of hallux valgus is put by the treating orthopedist, after careful questioning and examination.

Patients can exhibit different initial clinical signs of the disease, which is why the correctly recorded medical history is of great significance.

Some patients can display non-acute initial signs of a deep or strong pain in the first metatarsophalangeal joint when walking, whereby the condition deteriorates when doing particular activities.

This sign is indicative of a degeneration of the interjoint cartilage.

The patient might also complain of pain in the head of the metatarsal bone, which is the result of irritation by the shoe, and the painful sensation will be reduced, when the shoes are taken off. This occurrence is an indication of superficial pain in the area of the bulge.

Often, both forms of pain progress and are persistent for many years.

It is possible for the frequency and duration of the pain to increase, and the active movements can exacerbate it, and, furthermore, it is possible for patients to complain of recent significant increase in the size of the deformation.

In some cases, it is possible for the complains to be due to a trauma or an inflammatory arthritis.

Other possible signs of the disease include burning pain or tingling of the dorsal (upper) surface of the hallux valgus, which points to a neuritis (resulting from the pinched nerve) of the medial cutaneous nerve, passing along the upper surface of the foot.

Often, during the examintaion, other concomitant deformations are found, for example, a Hammer type deformation (a second toe is twisted up) or flatfootedness — either flexible or rigid flat foot.

The instability of the second toe can lead to a faster progression of the hallux valgus, and the reason for this is that the second finger acts as a suitable lateral support.

In order to select appropriate treatment, a detailed physical examination is necessary, in order to establish the etiology and the type of deformation.

The conservative therapy of the bunions includes appropriate shoes, different ortheses, rest, ice and medication. Also different cushions, pads, inserts and other orthotics means and exercises can be applied, which can significantly relieve the symptoms and improve the mobility of the foot.

The non-surgical therapy, however, is focused on the etiological factor, but is not efficient for the cartilage, bone and soft tissue deformations.

This is why most non-surgical therapies to be directed to relieving of the symptoms.

The use of shoes with a wider front must also be considered, since wider shoes remove the pressure on the bulge.

The Dr.Orthopedic orthopedic shoes for patients with hallux valgus are designed and made using special stretching leathers in the area of the bulging bone, which provide the optimum solution of the problem.