Explanations

Detailed explanations (Physiopathology)

    The Hallux Valgus condition appears gradually during the twenties. At that stage, the big toe often looks slightly askew but the bulge (the “bunion”) can be reddish and sensitive, particularly with the friction of somewhat tight shoes, which is the first type of discomfort.

    At this point, the evolution of the condition may be delayed with the wearing of better-fitting shoes (larger toe box with lower heel). Those who have flat feet besides may be prescribed a plantar orthotic which raises the arch of the foot, thus helping with the approach angle of the big toe.

    In the evening or at night, a big-toe separator (some gelatin brace made to correct the deformation of the big toe) may reduce the pain (second type) which is caused by the pulling of both the capsule and the internal ligament. However, this brace will not ease the pain of the bursitis arising out of the shoe rubbing and does not help in preventing the advance of Hallux Valgus.

    The medial capsule and the internal collateral ligament pull away, thus causing a lateral deflection of the big toe towards the second toe. The internal sesamoid ligament stretches out progressively.

    This subluxation (i.e.: disalignment of both bones in a joint) is the starting point of successive events achieving in the establishment of Hallux Valgus.

    Once the phalange is deflected, it will push the head of the first metatarsal sideways and the angle between the 1st and 2nd metatarsals will become greater.

Another consequence is that the tendons that are astride the first metatarso phalangial joint (or 1st MTP) are out of line too, both above (Extensor Hallucis Longus = EHL: long extensor of the 1st toe) and below (Flexor Hallucis Longus= FHL : long flexor of the 1st toe). Those tendons are like a bow string which accentuates the deformation of the 1st toe (see picture above).

What’s more is that this deviation will also bring about the moving of the sesamoid dorso lateral belt. This in turn causes a rotation of the big toe called “pronation”. Thus, instead of facing upward, the toenail becomes opposite the other foot (see pictures below).

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