Bunion / Hallux valgus

“Classic signs of an incipient bunion are a pain when wearing and walking with tight shoes. A bunion can be recognized by the fact that the big toe deviates from the center of the body (medial). The skin is often thickened and reddened at this point. This pressure point on the big toe can cause severe pain. In the early stages, bunion correctors, gymnastics, physiotherapy or bandages often help. In the advanced stages, bunion surgery is often the only option. ” Surgery has a high success rate,” says Dr Klaus Pastl, a bunion specialist from Linz.

“A bunion can be caused by wearing the wrong shoes. However, the cause is often also due to weak connective tissue or an acquired or congenital splayfoot. If you experience these bunion symptoms, you should talk to an orthopaedist or physiotherapist about a personal therapy. He or she will teach you exercises to strengthen the connective tissue or help you to avoid surgery by using special insoles. If your hallux valgus has to be operated on with a special surgical method, the use of  natural implants  like screws made of human bone, such as the Shark Screw®, is recommended to treat your painful forefoot. This treatment allows for natural healing,” says Dr. Klaus Pastl.

Hallux valgus and hallux rigidus are both diseases that affect the metatarsophalangeal joint of the big toe. Although they are 2 different clinical pictures, it can happen that mixed forms of both diseases occur. Hallux valgus and hallux rigidus differ in the following characteristics:

Hallux valgus is an often painful deformity of the metatarsophalangeal joint of the big toe.

Hallux valgus -> Hallux = toe, valgus = crooked, bent

Hallux rigidus is a stiff, rigid joint wear in the metatarsophalangeal joint of the big toe. The joint is difficult to move and painful.

Hallux rigidus -> Hallux = toe, rigidus = stiff, immobile, heavy

Women who like to wear shoes with high heels or people who are genetically predisposed to a bunion, simple exercises in everyday life help to prevent a bunion or to stop a beginning bunion. A simple bunion exercise: for prophylaxis and prevention, brush your teeth while standing on one leg, one minute on the right and one minute on the left. Is this too easy for you? While doing this, close your eyes and make figure-eight movements with your foot in the air. Through this bunion exercise, you will strengthen your arch.

If the angle of the bunion is below 20°, surgery can often be avoided or delayed. An appointment with an orthopaedist and physiotherapist is often sufficient to effectively learn useful exercises. This bunion treatment is called conservative treatment. In other words, you do not need an operation to get well again. Regular and correct foot gymnastics or toe exercises, insoles, or massages help to strengthen your foot and muscles. Gymnastics as well as special tapes can even correct the deformity to some extent. In any case, you can stop the progression of hallux valgus. These exercises are also excellent for the prevention and prophylaxis of bunion / hallux valgus. A simple exercise for prevention is, for example, walking barefoot or running without shoes in the meadow, forest floor or balancing with your eyes closed. This strengthens the arch of the foot.

If the bunion / hallux valgus angle is over 20°, patients already suffer from pain in everyday life. Here, usually only special shoes, splints, bandages or surgery can help.

Do bunion correctors work? The advantage of a bunion corrector: quick help at low cost. The disadvantage: due to the pressure that the corrector builds up, patients often continue to have pain. Especially in the first few weeks, bunion correctors can cause pain and often irritate the skin. This pain usually goes away after a few weeks, once the foot has become accustomed to the pressure. Bunion correctors certainly offer a way of not worsening the status quo or slightly improving it. Note: Opinions on correctors are controversial. Some specialists advocate the use of bunion correctors because they can relieve pain. Other specialists share the opinion that the hallux valgus deformity cannot be corrected and therefore the indication for a corrector is not given.

If a bunion corrector causes pain, a bandage can be fitted by the treating orthopaedist. Due to the even pressure, the wearing comfort is greater than with splints. If you are still in pain after wearing a splint or bandage, surgery on the forefoot is recommended. Bunion surgery helps to get rid of it in the long term.

The method of “massaging away a bunion” is controversial. Massages certainly help to relieve acute pain in the forefoot and contribute to the general well-being of the patient. However, bunion massages cannot reduce or heal a bunion. More effective than massages are certainly bunion exercises for in-between, such as the blind one-leg stand while brushing your teeth. Bunion ointments and creams are just as beneficial. However, they only promise short-term pain relief. To complete the conservative treatment options, there are also toe spreaders, rollers for the balls of the feet, special pads (toe pads), insoles, and tapes in addition to the methods mentioned. All have the same goals: To delay surgery as long as possible and to suppress pain as much as possible. However, before you decide on a treatment, you should definitely talk to your doctor or physiotherapist about the best care for your foot.

Here, experts agree: if you want to reduce the pain caused by bunions develop, long-term remove it and get the grip on it, Surgery by a Specialists help. Here, the choice of an experienced surgeon is important. The literature speaks of almost 200 different types of bunion surgery and Techniques. However, only a few of them are actually practiced in everyday life. Depending on the degree of severity, the surgical technique or the OP method, and the used OP material. The most common methods are Bunion correction after Austin, Scarf-Osteotomy, Akin, Lapidus arthrodesis, TMT I Arthrodesis, and Chevron-Osteotomy. All surgical methods have the same goal: to restore a straight toe without pain with a full range of motion.

Besides the choice of the Podiatrists in your Region the choice of surgical material is crucial for patient satisfaction. A variety of plates and screws are available to the surgeon: screws made of metal, Screws made from human bone How the Shark Screw® – your Allograft  or also bioreactive Synthetic polymer screwswhich dissolve in the bone. Each material has certain properties that can have different effects on the patient. That is why it is best to know before the Surgery about the different possibilities. So can Metal screws a second surgery to Metal removal required make. Bone screws on the other hand, are colonised by the patient’s cells, re-vascularized, supplied with blood and transformed into the patient’s own bone. After about one year, they are completely remodelled to the patient’s own bone and are no longer visible in X-rays. Thus saves the patient has a second surgery for metal removal.

Screws made from human bone (bone screws) are vascularized and colonised by the body’s own cells after insertion into the bone and thus integrated into the natural bone remodelling process. This is possible because inside these screws there is a natural system of channels, the so-called Havers channels. The body’s own vessels and bone cells can settle and spread in these structures. This creates bone structures that constantly adapt to the mechanical demands of the foot and eventually become the body’s own bone. This fact saves patients the second operation for metal removal and the associated risks, sick leave and time spent.

In contrast, foreign materials such as metals remain in the bone as foreign bodies unless they are removed during a second operation.

Bunion surgery can be performed under local or general anaesthesia. You as the patient decide together with your anaesthetist whether you want a local or general anaesthetic. To avoid nerve damage during surgery, the surgeon opens the metatarsophalangeal joint while protecting the vessels and nerves. To get a better picture of bunion surgery, watch this video of bunion surgery.

After bunion surgery, the inpatient stay is approx. 1 – 3 days. Depending on the degree of swelling of the foot, the stay may be longer. After surgery, it is important that you take the best possible care of your operated foot and keep it elevated and relieved. Immediately after surgery, you will be given a forefoot relief shoe, which you must wear for the next 4 weeks. Without this shoe, walking is strictly prohibited. If you do not follow the aftercare of your bunion surgery This is because the bone may not heal and surgery may have to be performed again. Often the surgeon prescribes physiotherapy sessions so that healing can take place even more efficiently. After surgery, the foot needs at least four weeks of rest before it can be fully loaded again. During this time, it is possible to work in the “home office”. After about 8 – 12 weeks, you will be able to do sports again without any restrictions and without pain.

The development of a bunion depends on various factors and can also be genetically influenced or promoted by certain movement patterns. This guide explains the risk groups and causes of bunion.

People who often wear shoes with high heels are at a clear disadvantage: the toes are pressed tightly together in the shoe. This causes high loads on the toes and especially on the metatarsophalangeal joint of the big toe. If high heels are worn regularly and over a long period of time, this can promote or result in a bunion or hallux valgus interphalangeus. It is therefore important to compensate for the frequent wearing of high heels: regular foot exercises and frequent barefoot walking. This strengthens the transverse and longitudinal arch of the foot.

It happens that people within the family suffer from hallux valgus or hallux valgus interphalangeus. The reason for this is usually predisposition and genetics. Children inherit stunted toes, a splay foot, poor anatomy or weak connective tissue from their parents and grandparents. Is a hallux valgus preprogrammed in these cases? No in no case, experts agree. Here, too, regular foot exercises and wearing flat shoes help to prevent hallux valgus. In addition, malpositions of the foot in childhood and adolescence can be corrected quickly, naturally and sustainably without surgery, together with the orthopedist. Deformities of the toes are also favored by rheumatic diseases, accidents or overweight.

This is how a bunion becomes noticeable: In many cases, a bunion can be recognized by the eye. The head of the metatarsophalangeal joint of the big toe leans towards the middle of the body (medial). This means that no clear, straight line of the big toe is visible. Another symptom or indication of bunion is reddened and very thickened skin at the level of the head of the metatarsophalangeal joint.

The “knob” or “ball” (often called a frost bunion or bunion toe) that forms on the inner edge of the foot is also called a pseudo-exostosis. This pseudo-exostosis is the metatarsal head of the first toe (metatarsal I head) being pushed towards the center of the body. The skin may often be swollen or red over this.

Bunion often causes the patient unpleasant pain. This often extends from the inside of the foot to the forefoot. However, pressure pain at the “frost bump“, where the head of the big toe curves inwards, is typical. Tight shoes, thickened skin at the pressure points, inflammation of the bursa in the joint, and arthritis in the joint of the big toe are the most common causes. If the pain increases, you should consult a doctor and clarify the causes before further symptoms appear and the condition restricts your everyday life. If the pain is ignored, damage such as osteoarthritis in the metatarsophalangeal joint of the big toe may occur.

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Often, a good orthopedist, foot surgeon, or trauma surgeon only needs to take one quick glance and the diagnosis is made. In order to be able to draw conclusions about the exact angle of the crooked toe, an X-ray is first necessary in case of severe pain and a planned operation. It is important that this is done while the patient is standing. This allows a more exact determination of the bunion angle and intermetatarsal angle under load and the identification of possible arthrosis. The therapy is usually different for adults and children: while conservative treatment (without surgery) is often possible in children, surgery with natural materials is often a good option for adults who want long-term healing.

The results and experience reports vary greatly, but in  85% – 90% of cases the patients are very satisfied with the result of the surgery. The subjective experiences with bone screws(screws made from human bone) show little pain for the patients in the postoperative course, which is due to the natural healing of the screw. Due to the biological origin, there is excellent tolerance in contrast to metal screws, which can cause pain if the patient is sensitive to the weather.