Hallux valgus – ball toe

Besides a already diagnosed predisposition (in exceptional cases) two reasons for hallux valgus can be ascertained:

 

Splayfoot:
By the caving-in of the anterior transversal arch the area of the ball is widening (splayfoot), another angle and with this also to a false (bias) position of especially the first toe. 
 
Wrong footgear:
Proofed by intercultural comparisons the main reason for hallux valgus is clearly the long-standing use of wrong footgear. The natural and healthy normal foot is showing a slight splay of the toes to one another. A fact that is spread only in very less cultures today.

In populations that wear foot gears like in the Western World the toes lying close together is common. Therefore, the natural radiant position of the toes has changed into a toe-lined position only. Researches show that even wearing stockings in a regular manner can be enough as the toes are pressed slightly together then. This effect is hastened by wearing too tight or to short stockings.

The most common shoes to wear show a basic innersole form that is not having the shape of a natural sole of a foot (also called Meyersche Curve after Prof. Hermann von Meyer). Because of this shape the toes are pressed from their natural position into a position that is leading to an irreparable deformation of the foot. In an advanced stadium it first becomes noticeable by an obliquely positioned big toe (hallux valgus). This obliquely positioned toe is becoming worse and is effecting gradually the other neighbouring toes and can lead to an almost right-angled curved out big toe that is leading the neighbouring toes intersected over their longitudinal axis.

Women often suffer from a stronger characteristic of the hallux valgus. That is because women have a more or less weak conjunctive tissue and, however, wear women’s shoes that favour such maldevelopment more than usually the men’s shoes do. Three factors are decisive when it comes to footgear:

Heel height
By a higher heel (over 3 to 4 centimetre) an increased pressure is developing in the area of the forefoot.

Too tight toe caps
The toe caps are often too tight to give the toes the necessary freedom (side wards but also from above). By this the toes are brought out of position that is leading to a remaining malformation of the ankle in the course of time. From a bird’s eye view many women have triangular-formed (1) forefeet that exactly fit in the hastate upper shoe cap.

Too short shoes
If the shoes are too short in the front of the foot the toes are also replaced from their natural position which is not only favoring the hallux valgus but can also lead to a hammer toe or claw toe.

The German “Ärzteblatt” published in February 2005 the study results of a study on German pupils. An alarming considerable growth of foot deformations and foot complaints were observed in adolescent pupils.

Above all the study showed a higher percentage of girls at the age of 14 that were suffering from tilting of the big toe.

Conservative treatment
The adjustment on low-heeled shoes with enough freedom for the toes and the wearing of toe-bridge sandals can only be effective elementary. An advanced hallux valgus can not be removed or alleviated by this method. However, this change of footgear can prevent from another impairment and deformation. A foot gymnastic that makes the toes flexible and strengthens the plantar arch of the fixation muscle is recommended. Walking barefoot can also strengthen this effect. Apart from that eventually orthopaedic shoes with splayfoot orthotics or the wear of shoes that cause no pressure pain to the prominent joint base of the great toe may also help.

Surgical treatment
Once a prominent false position of the big toe has aroused it can only be treated surgically. This is recommended in the case of any pain. As a function of the form of hallux valgus and the existing complaint the respective treatment method is chosen. From the approximately 150 described methods approximately ten are common in the German speaking countries. If, in addition, an arthrosis of the joint of the big toe (hallux rigidus) exists together with the hallux valgus, this must be treated prior to the false position. Almost every operation method is consisting of cutting through the first metatarsal bone but using different kind of sections. Afterwards the part of the metarsal bone that is positioned towards the toe is displaced in the direction of the second metarsal bone (where it was originally placed) and both parts are impacted or fixed with filament or screws. Finally the big toe is bended straight and fixed with strong filaments.
When suffering from arthrosis in the joint base of the big toe the inflammation can be cleaned out and the mobility can be recreated again. In other cases the damaged ankle part on the joint base of the big toe can be removed, the ankle can be braced in a good position or an artifical ankle can be implanted (no long-term result do exist so far).