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Hallux Valgus


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Hallux Valgus


A Hallux abducto valgus is a foot deformity consisting in the deviation of the big toe or hallux outward, that is, towards the smaller toes. It is commonly known as a bunion, although bunion probably refers more to the bump which arises from this disorder due to the prominence of the first metatarsal head on the medial edge of the foot, and the exostosis or bone growth which tends to accompany this disorder, although this exostosis may also occur in other foot disorders like hallux rigidus.


The causes behind this deformity are many, and differ from patient to patient, but the most common are those of a hereditary nature, such as the genetic predisposition to anatomical alterations to the foot: flat foot, metatarsus varus, etc; association with musculoskeletal degeneration that comes with ageing and the use of unsuitable footwear, such as tight, pointed or high-heeled, especially in women.


This disorder may cause hardly any symptoms and be easily tolerated, or, on the contrary, it may cause intense pain in different locations, especially in the bunion area. This pain fundamentally arises from rubbing against the shoe, causing inflammation (bursitis), pain in the metatarsal phalangeal joint due to its deterioration, pain in the sole of the foot, pain in the metatarsal heads (mainly between the second and third), metatarsalgia resulting from overloading when support of the first toe fails (first ray insufficiency), pain and deformity in the smaller toes (hammer toe, claw toe), caused by the displacement of the first toe, or pain arising from some other cause.


Surgical treatment is normally applied when there are symptoms, as opposed to for aesthetic reasons. Unfortunately, there are times when surgery may correct the foot in aesthetic terms, but leaves behind pain that can affect the sufferer’s quality of life.

As with the rest of medicine, prevention is the best medicine. In this case, it means the use of appropriate footwear which is wide at the front and has a low heel.

Orthopedic devices, such as night splints and toe separators, can be useful in less severe cases and in the initial stages, but they have a very limited effect. Insoles may also be used to improve metatarsalgias related with the hallux, and orthotics for deformities affecting the smaller toes. Physiotherapy may be applied to improve the mobility of the affected joints and to treat related injuries, such as tendinitis and fasciitis.

Surgical treatment is used when there are symptoms, and the technique to be used will vary from patient to patient, depending on the deformity and accompanying disorders: metatarsalgias, toe deformities, arthrosis of the affected joints, etc.

In recent years, in medical surgery in general, as well as in trauma injury and in orthopedics, minimally invasive techniques have become popular. These techniques are referred to as percutaneous foot surgery.

The main advantage of percutaneous foot surgery is that, being minimally invasive, it causes less pain, so the stay in hospital is shorter. Inflammatory reaction and pain are lessened and recovery time can be shorter, using open or classic techniques.

The use of platelet-rich plasma (PRP) in both percutaneous foot surgery and classic surgery leads to a less severe inflammatory reaction in the foot and an acceleration in the consolidation processes of the therapies carried out on the bone.