Hallux valgus - initial postoperative therapy program

When talking about foot deformations we can state that the valgus position of the first metatarsal bone is the most common foot deformation known as hallux valgus. It is considered that this deformation is not only the most common foot deformation, but also the most common deformation of the human musculoskeletal system in general. The deformation is basically a malalignment in the base of the first metatarsal bone where that base starts moving outwardly and by doing so the tip of the toe starts going inwardly and by doing that it pushes against other metatarsal bones at the top of the foot. That way the foot gets wider at its base and at the top it takes on a narrow almost pointy look.

Aquired or congenital increased mobility of the first metatarsal bone is the primary cause for hallux valgus. The first metatarsal bone should be the lowest positioned bone in the foot, but with this deformation it gets lifted up and by doing so it impairs the foot bimechanics because the loads are transferred onto the medial arch of the foot which then falls inwardly. The causes of hallux valgus can be many, it is often hereditary, commonly with the female sex, it can occur due to degenerative joint illnesses (atrhritis), and low quality, too tight, too stiff or high heeled footwear can also percipitate this deformation.

Symptoms include pain and inflammation at the base of the first metatarsal bone on its medial side which can vary depending on the degree of the deformation and can be of a progressive nature if proper treatment or no treatment at all are not implemented.

Degrees of hallux valgus:

1. Normal foot
2. Foot with an overly mobile first metatarsal bone
3. The tendons and ligaments of the foot pull the tip of the first metatarsal bone toward other toes
4. The medial arch of the foot falls inwardly and the foot base widens even more
5. Final stage with a bulge (pseudoegzostosis) at the inner part of the first metatarsal bone base

The pseudoegzostosis which appears on the medial side of the first metatarsal bone base occurs due to friction caused by wearing too tight footwear and is a result of an inflammatory process which happens because of cartilage and joint degeneration. The bulge can be extremely painful and cause significant problems with wearing and choosing footwear and with foot biomechanics wb+hich has already been undermined. With time the bulge starts ossificating, ie. a calcification occurs at that spot.

Treatment, depending on the degree of the deformity, can be either conservative or surgical. With lower degrees a conservative approach is used where higher quality, wider, more flexible and comfortable footwear is used in order to decrease the level of pain and inflammation. Ice and anti-inflammatory medication can also be used with the same purpose. In the later, functional, stage of therapy stretching, strenghtening and balance exercises for foot muscles are used in order to regain its full functionality. We try to activate those muscle that have been inactive or had decreased activity due to the deformation. The surgical approach is advised in later stages of the deformation when the pain is very intense and debilitating and the bulge of the first metatarsal bone is in its final form. Surgery is based on correction of functional deficits and restoring full functionality in all three plains of the foot.

Prevention: use of quality, wide enough and flexible footwear and avoidance of high heeled and narrow footwear. Correctional exercises if there are indications of it developing or the deformation already has developed, etc.

Initial program

Program that is used during first 6 weeks after a surgical correction of hallux valgus deformity was performed on the foot. During that period the affectes foot should bear no weight and patients use crutches or a protective orthopaedic brace which puts the load during ewalking on the back of the foot leaving the front of the foot protected. Therapy is aimed at inflammation, sweeling and pain reducing, use of simple foot and ankle mobility exercises and static strenght exercises of the foot and lower leg muscle in order to enable the foot to heal fully and regain some range of motion and strenght and to create the best basis for the later stages of functional therapy.