What is Hallux Valgus?

The condition of hallux valgus affects the first metatarsophalangeal joint (MTP) and is often accompanied by severe functional impairment, foot pain, and reduced quality of life. This joint is gradually subluxed (lateral deviation of the MTP joint) resulting in the abduction of the first metatarsal while the phalanges adduct.

The result is the formation of soft tissue and bony prominence on the medial side of the first metatarsal head known as a bunion (exostosis).

Eventually, these changes result in pain and functional deficits, such as impaired gait (lateral and posterior weight shift, lower single-leg balance, pronation deformity). Individuals with flat feet or hammertoes are more likely to experience this condition.

Cause of Hallux valgus include;

  1. Wearing shoes with tight straps or heels
  2. Congenital deformity
  3. Chronic Achilles tightness
  4. Severe flat foot

Physiotherapy Management include:

Prevention

  • In order to prevent hallux valgus, it is important to wear shoes that fit properly (not too tight) and to avoid wearing high heels.

Non-operative Care

  • Providing patients with footwear with a deeper and wider toe box can help eliminate friction in the medial eminence (bunion).
  • An orthosis may help treat pes planus. Hallux valgus can recur following surgery in patients with severe pes planus.
  • It may be necessary to stretch or even lengthen Achilles tendon contracture.

Physiotherapy treatment include

  • Gait restoration training.
  • Balance & coordination training.
  • Midfoot and forefoot mobilizations.
  • Plantar Fascia Release.
  • Achilles tendon stretching.
  • Also, foot orthoses can alleviate weight-bearing stress.

Strength training

  • Using isometric holds, press the toes down and shorten the foot from a seated position to create a dome.
  • You can progress this exercise by pressing the first toe down and lifting the other four toes up then switch around, press the four toes down and lift the big toe up.
  • A resistance band can be used as an additional tool (press down on the band with toe while pulling it up with both hands). 'Foot Core Plus' is the name of this exercise.
  • After the patient is able to do it well in sitting, move on to the following positions: standing, walking, stepping up, stepping down.

Plantar Flexion Push-off Exercises.

  • Standing over the edge of a box or a step with the exercise band and pushing through it.
  • Pulling up an exercise band beneath the toes and walking with it. So you push your toes down into the band as they walk off, pressing down to push their foot off.
  • Soft tissue works as well, such as releasing the toe extensors as they get stiff and lose the ability to slide smoothly.
  • Heel raises to strengthen the plantar flexors and if they are tight it's useful to lengthen, release and stretch them by standing over the edge of a step or stair and dropping the heels down. Cotton wool can be put between the toes to stretch them out.
  • Second toe mobility and flexibility exercises.

Pain Management

  • Combo-therapy
  • Grade 1 or 2 mobilization
  • Ice therapy for example Ice-packs & Cryo-air

Swelling Management

  • Soft tissue massage
  • dry needling
  • Kinesio taping
  • Exercises that unload the inflamed structures
  • Also, Orthosis to offload the bunion.

ROM exercises

  • Joint mobilization of grades 3 & 4
  • Alignment technique
  • Soft tissue mobilization
  • Muscle and joint stretches
  • Kinesio taping
  • Bunion splint or orthotics
  • Also, Bunion stretch and soft tissue release

Exercise to restore normal muscle control and strength

  • Dorsiflexion strengthening with an elastic resistance band.
  • Towel curls
  • Also, Toe spread out.