Causes and ways of treatment


Summertime is sandal time. But those who suffer from hallux valgus often prefer to hide the bump on their foot. And it's usually painful, too. What helps?

Angelina Jolie has one, just like fellow actress Tilda Swinton, designer Victoria Beckham or human rights lawyer Amal Clooney. Anyone suffering from a bunion, or hallux valgus, is therefore in the prominent company. In Germany alone, an estimated ten million people are affected, women nine times more often than men, and more than one in three people over the age of 65.

A conspicuous feature of the deformity is a bump that forms on the inside of the foot. However, this is not a ganglion, as many think. Rather, the bone ray that connects the metatarsus with the big toe spreads out strongly. The big toe itself, in turn, folds over to the other side, i.e. toward the smaller ones - the joint at its origin thus gradually protrudes more and more clearly.

Not just a "blemish

Many people not only find this unattractive, but it can also hurt like hell: the protruding area rubs against the shoe, and calluses or inflammations often form over it, so that walking causes great pain and often only a few shoe models can be worn. In addition, the malposition of the big toe can also displace the other toes in the long term.

"Where the cause of hallux valgus lies is still not known exactly," says Dr. Christiane Konerding, senior physician for foot surgery at St. Elisabethen Hospital in Frankfurt. What is clear is that there is a strong genetic component: The feet of women in a family are usually similar, even if the severity of the hallux can vary from generation to generation. Other problems, such as an X-position of the heel, can also promote the fact that tissue and ligaments no longer provide enough support for the foot bones, causing them to shift.

This is why nine out of ten people affected are female: women usually have softer ligaments than men. Often the tissue becomes even looser under the influence of hormones, for example through pregnancy. "Contrary to what is often claimed, high or pointed shoes, on the other hand, are not solely to blame," says surgeon Konerding. "Because they increase the load on the forefoot and the affected joint, they are certainly conducive to what's happening, but just not the only cause."

When should you see a doctor?

You should see a doctor at the latest when your hallux starts to cause problems. And as early as possible and not only when open wounds or pressure points have already formed or the malposition has affected other toes. "However, some women also come because the hallux bothers them visually," says Christiane Konerding. "They just want to wear nice shoes in the summer, and I can understand that, too." Surgery for purely aesthetic reasons, however, should not be performed.

The operation, in which bones are cut through and reassembled at a new angle, is no small matter and is therefore only indicated in the case of complaints that cannot be controlled in any other way. Complications can arise, and even if everything goes well, the foot can only be loaded again after six weeks, and sports must be avoided for six to nine months. "And in five to ten percent of cases, unfortunately, a hallux forms again after surgery, but fortunately it doesn't always cause discomfort," says Konerding.

However, there are also less drastic treatment options. For example, gel pads from the drugstore stabilize the toe and at the same time protect the protruding joint from the outside. There are also special bandages or splints on the market. However, which of these can really help in individual cases should always be discussed with the doctor. In addition, the following applies: A joint that is severely strained by the load during the day may be able to recover at night in a bandage, but it will not become straight again as a result. Orthotics also do not change the misalignment of the bones. However, if they are individually fitted, they often relieve the pain when walking because they cushion and lift the midfoot.

On good foot, These three exercises help with complaints and prevent 

Barefoot walking It is worthwhile to walk without shoes as often as possible - preferably on different surfaces. If you like, you can also walk with your eyes closed to concentrate even more on what your feet perceive.

On the other hand, it is always important to become active oneself. "Often, those affected only get insoles from their doctors and at some point later the advice to have an operation," criticizes physiotherapist Stella Arndt. "But it makes just as much sense to train the foot and its muscles in the case of foot problems as it does to train the back in the case of back pain." The goal is not to make the toe as straight as it was when it was young, she says, "but rather for those affected to be able to walk again without pain and enjoy movement. You can do something about that at any age."

Stella Arndt is trained in spiral dynamics, runs a practice in Lรผneburg, and gives workshops on foot health (Stella-arndt.de). She puts together an individual training program for each of her patients. Because often the crooked toe is only one of further problems, a splay foot or a hip malposition for instance. If there is too much internal rotation, there is permanently too much pressure on the inside of the foot. Some joints on the inside lose their stability, a chain reaction is triggered, and in the end, the big toe no longer has any guidance.

"Unfortunately, it's not the case that you do a few simple exercises for the hallux and everything is fine," says Arndt. Relief often comes after the first treatment, but the most important thing is to integrate the training into the gait pattern, and since walking is an automated process, that doesn't happen right away. "Of course, it's also about starting to feel your feet again in the first place. Unfortunately, most people only deal with them when they cause problems. But our feet are very sensitive organs, and that's how we should value and care for them."

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