Bunion

Hallux valgus ( German Schiefzehe, popularly Frost bales) is the medical term for the pathological obliquity of the big toe, which does not follow in the big toe base joint ( articulatio metatarsophalangea ) for Fußaußenrand out ( laterally ). The cause is usually a deviation of the first metatarsal ( metatarsal 1, short MT1) towards the Fußinnenrand, the so-called metatarsus primus varus. At the same time can also wear on the big toe base joint present, hallux rigidus.

The valgus deformity is in the distal interphalangeal joint ( interphalangeal joint ), is a bunion interphalangeus ago. A deviation of the big toe joint in the base for Fußinnenrand out ( medially ) is referred to as hallux varus.

Description

When hallux valgus (Latin = valgus, crooked ',' wrong ') is a misalignment of the big toe in the metacarpophalangeal joint to the outside. The tendons to the toes no longer run centrally over the joint, but more laterally and pull the toes into an awkward position. Since usually the same time there is a metatarsus primus varus, the big toe joint often occurs on Fußinnenrand clearly, and often form painful inflammation, caused by the pressure of the shoe upper. In addition, it comes by pressure of the big toe to the little toe often hammer and claw toe deformities of the adjacent toes.

Radiologically, one finds an enlarged angle between MT1 (1st metatarsal metatarsal = 1) and proximal phalanx (standard 10 degrees ), an increased angle between MT1 and MT2 ( norm 10-12 degrees ) and a Sesambeinluxation. Osteoarthritis characters speak for the simultaneous presence of hallux rigidus.

Causes

In addition to a hereditary predisposition two causes of bunions are seen:

• Splay: By the sinking of the anterior transverse arch at the splay there is a broadening of the ball area, a different angular position and thus also to an inclined position primarily of the first toe.

• Wrong footwear: Intercultural comparisons suggest that a partial cause of hallux valgus is the years of wearing the wrong footwear. The natural and healthy normal foot has a slight spread of the toes on each other - a fact that is now common only in a few cultures.

In the populations that carry footwear western style, however, the tight juxtaposition beds of the toes is common. Thus, the natural shine just storage has changed in just a toes just storage. Studies have shown that this has the regular for years wearing stockings that yes, lightly press the toes together sufficient. This is accelerated by wearing too tight or too short stockings.

The predominantly worn shoes have an insole basic shape that not the outline of the sole of the foot corresponds to natural ( Meyer's line by Georg Hermann von Meyer). Thus, the toes are pushed from their ancestral position, resulting in the long term to permanent deformation. In the advanced stage, then make the first by the misalignment of the big toe ( hallux valgus ) noticeable. This misalignment continues to progress, concerns gradually the other edge of toes and can lead intersecting the longitudinal axis at the big toe to a nearly perpendicular outward facing, the adjacent toes.

Stronger forms of hallux valgus affect women in the first place. The stems on the one hand the weaker connective tissue of the woman, but especially by women's shoe shapes that favor this undesirable development more than the usual men's shoes cause this in men feet. Three factors of the footwear are relevant:

• Heel height

• Too narrow toe boxes

• Too short shoes

The German Medical Journal, published in February 2005, the results of a screening of German students. There, an alarming increase of Fußfehlformen and foot discomfort was noted in adolescence. It focused mainly on a larger proportion of girls at the age of 14 years is already a significant misalignment of the big toe firmly.

Prevention

Knowing the causes, prevention strategy is clear: high-heeled shoes and close toe should not be worn too often. The feet harbor a quarter of all the bones of the people and are extremely adaptable. If varied footwear worn, damage remains from mostly. Only the regular and vast not wearing properly fitting shoes and / or shoes with higher heels leads to the aforementioned problems.

Who barefoot running much, characterized usually has beautiful feet with smooth skin and straight toes. The shoe for everyday life should have low heels and open space for the movement of the toes. High heeled shoes should be worn only in exceptional cases. Foot exercises is a great compensation for the immobilization experienced by the feet in good shoes. This is supported by footbaths and brush massages.

Conservative treatment

The switch to flat shoes with enough room for the toes, especially the wearing of thong sandal, can help only in the initial stage. An advanced hallux valgus can not be eliminated in this way or decrease. However, the change leads to derartigem footwear to the fact that there is no further damage and deformation. Although generally recommended, although highly questionable in terms of positive impact on a hallux valgus, foot exercises is that makes the toes to move and strengthens the postural muscles of the foot arch. This can support barefoot running. Otherwise, orthopedic shoes with Spreizfußeinlagen help against the pain when walking or wearing shoes that do not cause pain, pressure on the protruding big toe.

Surgical treatment

A once incurred significant deformity of the big toe can be corrected only by surgery. This is advised in the case of pain. Depending on the severity of hallux valgus and the existing complaints the corresponding method is selected. Of the approximately 150 described methods are about ten in German-speaking common. Is in addition to hallux valgus and osteoarthritis in the base joint of the big toe ( hallux rigidus ), must be treated with priority this. Almost all surgical procedures consist of a transection of the first metatarsal ( Corrective ), but in different incision (eg scarf osteotomy ). Then the toes upward preferred share of the metatarsal is displaced in the direction of the second metatarsal bone ( where it was originally located has ) and the two parts of the metatarsal are immersed or fixed with wires or screws. Finally, the big toe is being provided with strong sutures.

In osteoarthritis, the basal joint of the big toe, this " cleaned out " and the mobility to be restored. In other cases, the damaged portion of the joint is removed at the proximal phalanx of the great toe, the joint in good position stiffened ( arthrodesis ) or, rarely, an artificial joint installed.

The treatment includes a redressierenden Association until the removal of the skin sutures, then a Antivalgussocke is worn mostly by the end of the sixth postoperative week. For the same period a Forefoot used.

As an additive supplement to the guidelines for the surgical correction of hallux valgus describes the EFAS (European Foot and Ankle Society; www.efas.co.uk ) the pressing need for a holistic diagnosis of disorders of the foot. Partial corrections are often long-term result of bad or could the foot in extreme harm rather (Source: Thanos Badekas, Darmstadt, Director of the Science Committee of the EFAS ).

Complications: infection, Köpfchennekrose valgus with wide pushing the capsule, hallux varus, hallux recurrence, metatarsalgia. In the arthrodesis nonunion is unpleasant.

After surgical correction in the three middle toes hammer treated