hallux valgus

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Classification according to ICD-10
M20.1 Hallux valgus (acquired)
ICD-10 online (WHO version 2019)

Hallux valgus is the medical term for the crooked position of the big toe.


Hallux valgus and claw toe II

The valgus position in the metatarsophalangeal joint ( articulatio metatarsophalangea ) is an expression of a disturbed biomechanics of the foot. It is based on a deviation of the first first metatarsal bone . In contrast, hallux rigidus is a pure arthrosis . The valgus position in the end joint is known as hallux valgus interphalangeus . The varus deformity in the base joint is known as hallux varus .

In hallux valgus, the tendons to the toes no longer run centrally over the joint , but further laterally and pull the toes into a crooked position. Since a metatarsus primus varus is usually present at the same time, the ball of the big toe often protrudes clearly on the inner edge of the foot, and painful bursitides often develop , caused by the pressure of the shoe upper. Hammer and claw toes develop due to the contracted flexor tendons .

Hallux valgus is always a constitutional, genetically determined phenomenon and an expression of splayfoot . The ball area widens as the front transverse arch sinks in. The functionally too short tendon of the adductor hallucis muscle pulls the big toe laterally.


Cross-cultural comparisons indicate that a partial cause of hallux valgus is wearing the wrong footwear for years. The natural and healthy normal foot has a slight spread of the toes from one another - a finding that is only widespread in a few populations today.

The shoes that are mostly worn have a basic insole shape that does not correspond to the outline of the natural sole of the foot ( Meyer's line). This pushes the toes out of their original position, which leads to permanent deformation in the long run. In the advanced stage, this is initially noticeable through the misalignment of the big toe (hallux valgus). This misalignment progresses, gradually affects the other marginal toes and can lead to a longitudinal axis of the big toe pointing almost at right angles outward and crossing the adjacent toes.

Stronger forms of hallux valgus primarily affect women. This is due on the one hand to the weaker connective tissue of women, but above all to women's shoe shapes, which favor this undesirable development more than the usual men's shoes cause it in men's feet. Three factors in footwear are decisive:

  • the heel height
A higher heel (more than three to four centimeters) increases the pressure in the forefoot area. On the one hand, this promotes splayfoot formation and, on the other hand, it presses the toes into the tip of the shoe.
  • shoe tips that are too tight
The tips of the shoes are often too narrow to allow the toes the necessary space, especially to the side, but also upwards. This forces them into a misalignment that over time leads to a permanent misalignment in the ankles. When viewed from above, many women have triangular forefeet that fit exactly into the pointed toe of the shoe.
  • shoes that are too short
If the shoes are too short, the toes are also pushed out of their natural position, which not only promotes hallux valgus , but also leads to hammer and claw toes .

In February 2005, the German Medical Journal published the results of a series of tests on German schoolchildren. An alarming increase in foot deformities and foot complaints in adolescence was noted there. A significant misalignment of the big toe was found, especially in a large proportion of the girls at the age of fourteen.

Conservative treatment

Switching to flat shoes with enough space for the toes, especially wearing thong sandals , can only help in the early stages. Advanced hallux valgus cannot be eliminated or reduced in this way. However, the change to such footwear means that there is no further damage and deformation. Basically recommended is foot gymnastics , which makes the toes flexible and strengthens the holding muscles of the arches of the foot, although positive effects on hallux valgus are doubtful. Walking barefoot can aid treatment. Otherwise, orthopedic shoes with splayfoot insoles can help relieve pain when walking or wearing shoes that do not cause pressure pain on the ball of the protruding big toe.

Operative treatment

Same patient as above after Austin correction (I) and PIP arthrodesis (II)

A significant misalignment of the big toe that has occurred once can only be corrected with an operation. The appropriate procedure is selected depending on the severity of the hallux valgus and the existing symptoms. Of around 150 documented methods, around ten are in use in German-speaking countries. If, in addition to hallux valgus, there is also osteoarthritis in the metatarsophalangeal joint of the big toe ( hallux rigidus ), this must be treated as a priority. Almost all surgical methods consist of a division of the first metatarsal bone ( corrective osteotomy ), but with different incisions (e.g. scarf osteotomy ). Then the toe-facing part of the metatarsal bone is shifted in the direction of the second metatarsal bone (where it was originally located) and the two parts of the metatarsal bone are swaged in or fixed with wires or screws. Finally, the big toe is straightened again with strong seams.

After the operation, the patient can walk with a forefoot relief shoe.


Web links

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