[Sportschosun, Jang Jong-ho] The inside of the foot may protrude and cause discomfort whenever shoes are worn. In some cases, the area around the big toe becomes red, swollen and painful after walking for a long time. These symptoms are easy to dismiss as a simple problem with ill-fitting shoes, but if they recur, hallux valgus should be suspected.
Hallux valgus causes not only changes in the shape of the foot but also pain and difficulty walking. As the deformity progresses, it can affect the other toes as well. Treatment is not determined solely by the severity of the deformity; it is important to consider the pain and its impact on daily life.
◇ Genetic and Acquired Factors Combine—Leaving It Untreated Can Worsen Problems in Other Toes
Hallux valgus is a complex deformity in which the big toe bends toward the second toe, the first metatarsal—the bone connecting the big toe to the top of the foot—angles inward, and the joint where the big toe and metatarsal meet becomes prominent.
Both genetic and acquired factors contribute to its development. People with a family history of hallux valgus are more likely to develop it, and it can also occur more readily in people with flat feet or flexible joints. Frequently wearing shoes with a narrow, rigid toe box or high heels can further worsen the deformity.
The most common symptom is pain at the prominent area on the inner side of the big toe. When a person walks for a long time in shoes with a narrow, rigid toe box, the protruding area can repeatedly rub against the shoe, causing redness, swelling or inflammation.
As the deformity progresses, the problem is not limited to the big toe. When the big toe can no longer function properly, weight placed on the foot shifts to the other toes. This can cause calluses and pain beneath the second or third toes. If the deformity becomes more severe, the big toe may push against the second toe, causing additional deformity. In severe cases, the joint of the second toe may even become dislocated.
◇ Does a Bent Toe Always Require Surgery?—Pain and Impact on Daily Life Are the Key Criteria
Hallux valgus does not necessarily require surgery. If symptoms are mild, it is advisable to first wear shoes with a soft, wide toe box. When the prominent area on the inner side of the big toe is painful, symptoms can be managed with conservative treatment, such as resting or taking anti-inflammatory pain medication.
However, if symptoms do not improve with these treatments and discomfort in daily life persists, surgical correction may be considered.
Surgery may be considered when pain caused by the deformity makes ordinary walking difficult; when secondary deformity or pain develops in other toes; or when the deformity is severe enough to cause calluses or wounds where the foot rubs against shoes, significantly limiting the choice of footwear.
Therefore, rather than deciding on surgery based solely on the shape of the foot, it is important to comprehensively assess the severity of pain, the condition of the deformity and its impact on daily life before choosing a treatment method.
◇ Corrective Surgery Through Small 2–3 mm Incisions: Minimally Invasive Surgery
Traditional hallux valgus surgery involved making a relatively long incision along the inner side of the foot to cut and realign the deformed bone. Although this approach makes it easier to directly view the surgical site, postoperative pain, skin scarring and the recovery period can be burdensome for patients. A minimally invasive corrective osteotomy has been introduced to reduce these burdens.
Minimally invasive surgery is performed through five or six small incisions measuring approximately 2–3 mm. The surgeon uses specialized medical instruments to cut and realign the deformed bone while checking its position with a C-arm in real time, eliminating the need for a large skin incision. This reduces concerns about scarring and may limit damage to the tissues around the bone, helping reduce early postoperative pain and support recovery.
Although the incisions are small, the realigned bone is securely fixed internally with screws. Another feature is that patients can walk while bearing weight on their heels while wearing a special postoperative shoe.
As surgical techniques continue to advance, the range of cases eligible for minimally invasive corrective osteotomy is also expanding. However, conventional open osteotomy may be necessary when the deformity is very severe. The appropriate surgical method should therefore be selected based on the patient's foot condition and the severity of the deformity.
◇ Wearing a Special Postoperative Shoe for About Four Weeks—What Are the Possible Complications?
After minimally invasive surgery, patients generally stay in the hospital for about three to four days and walk while wearing a special postoperative shoe for approximately four weeks. After that, they can begin walking in comfortable shoes depending on their recovery.
Possible postoperative complications include discomfort caused by internal fixation devices, such as screws inserted to stabilize the bone; recurrence of hallux valgus; malunion, in which the cut bone does not heal in the desired position; joint stiffness; and nerve damage.
Compared with conventional open osteotomy, minimally invasive corrective osteotomy has similar complication and recurrence rates. However, it offers the advantages of less postoperative pain and skin scarring, as well as faster recovery.
Professor Seo Jae-wan said, "Hallux valgus is not a condition for which the decision to operate is based solely on how much the toe has bent." He emphasized, "If pain persists, walking or wearing shoes becomes uncomfortable, or the deformity progresses to the other toes, it is important to consult a specialist and choose a treatment suited to the condition of your feet."
Jang Jong-ho, Reporter | bellho@sportschosun.com
This article has been translated by GripLabs Mingo AI.
