What is a knuckle?

Hallux valgus is a progressive deformity of the big toe that affects the first metatarsophalangeal joint and is often accompanied by significant functional disability and foot pain. This joint gradually gives way causing the big toe to twist towards the other toes and a soft tissue and bony protrusion (bulge) develops at the base of the big toe, what we commonly call a “bunch”.

It may initially appear as tenderness in the area due to friction with footwear, and the skin over the bunion may become hard, hot and red. Over time, these changes lead to permanent pain and functional deficit (such as reduced foot balance when walking), and can often be accompanied by deformities and symptoms in the other toes as well (second toe deformity, metatarsalgia). Finally, the pain in the area worsens due to the osteoarthritis that can develop.

Where is it due to?

The exact cause has not been fully elucidated. However, certain factors play a role in the development of bunions. They are:

  • Genetic predisposition (70% of patients with “cocci” have a family history).
  • Gender (it is 10 times more common in women than in men).
  • The footwear (tight pointed shoes with a high heel).
  • Systemic disease (eg rheumatoid arthritis).

Diagnosis
The diagnosis of bunion of the big toe is established by the clinical examination and a simple radiological examination. The angle formed between the first metatarsal and the proximal phalanx of the big toe is mainly evaluated through X-rays. If the angle is less than 15° then it is considered normal. Angles of 20° and above are pathological, while an angle of 45-50° is considered a severe deformity.

Prevention
Wearing shoes that fit properly (not too tight) and avoiding high heels are important measures to prevent bunions. Studies have shown that wearing tight pointed shoes and/or heels between the ages of 18 and 39 may be a factor in the development of bunions later in life.

Conservative therapy

The first treatment option, especially in cases with very little deformity, is conservative treatment. Footwear is adjusted to help eliminate friction on the shin. It is recommended to wear shoes with a wider and deeper toe and to avoid heels. In case of metatarsalgia, special insoles can be used that improve the symptoms, while also special splints, worn at night, can correct the position of the big toe.

Surgical Treatment

If conservative treatment fails and a large deformity is created with intense discomfort, then we resort to the solution of surgical treatment. A large number of surgical methods have been described to date for the treatment of bunion of the big toe. The choice of method is individualized each time depending on the degree of deformity of the big toe and the accompanying diseases. Today it is now possible to apply minimally invasive surgical methods with the use of special small tools and making small incisions in the skin which result in a faster recovery of the patient and the most ideal aesthetic result. The duration of the surgery ranges from half an hour to 2 hours, depending on the severity of the deformity and if it is accompanied by an attack on the other fingers as well.

Finally, it is good to emphasize that surgical treatment is always chosen based on the relief of the patient’s symptoms and not for cosmetic reasons, as well as that the techniques withlaser” without any incisions are tested for their effectiveness, especially in cases with great distortion.

Post-operative course – Rehabilitation

Hospitalization of the patient is not required and the patient is discharged the same day. In cases where a large deformity of the big toe has been corrected in combination with corrective operations on the other fingers, a stay of one day in the hospital is possible.

The patient’s post-operative rehabilitation involves immediate weight bearing of the foot usually with the use of braces for the first 2 weeks and a special shoe for a total of 4-6 weeks, depending on the size of the deformity corrected and whether any additional surgery was required on the other toes foot.

Patient FAQs:

  • Will I be in a lot of pain after surgery?
    No. Modern minimally invasive surgical techniques combined with modern protocols fast track anesthesia now offer a painless and bloodless result with minimal postoperative pain, which lasts only the first 24 hours and is very easily manageable at home with simple painkillers.
  • Can the “gut” be regenerated?
    No. As long as the correct choice of the type of surgery required is made, the deformity will not recur.
  • Can I have surgery on both my legs at the same time?
    Yes. It is preferable when the problem exists in both legs to treat it together in one surgery.
  • Will I ever wear heels again?
    Yes. After the correction of the deformity and after the post-operative rehabilitation has been completed, it is possible to use all the footwear of our choice.