The big toe, which is obviously very small compared to the rest of the body, can cause a huge amount of pain. The big toe is referred to as the hallux. There are two common deformities that can cause the big toe (hallux) to become very painful. These two deformities are:
1. HALLUX ABDUCTO-VALGUS:
WHAT: This deformity is the most common deformity of the big toe and is more commonly referred to as bunions, but the name hallux abducto-valgus describes what the deformity looks like. The big toe is referred to as the hallux. Abducto-valgus describes that the big toe is not positioned properly and that it is pointing away from the middle of the body. The most obvious sign of hallux abducto-valgus is a bump near the big toe. Bunions do not always cause pain, but many people do not like how their feet look and may struggle to find shoes that fit over the bump.
CAUSE: There are various causes for bunions and usually one cannot be pinpointed as the exact cause of the bunion, but some of the causes include:
- Flat feet
- Wearing poorly fitting shoes.
WHO: Anyone can develop a bunion, but women commonly develop bunions more than men. Also, it is believed that there may be a genetic component since approximately 70-90% of patients with a bunion report that another family member has or had the same deformity.
TREATMENT: There are various treatments for treating hallux abducto-valgus depending on the severity and symptoms. For example, a severe painful bunion may need surgery where the big toe will be re-aligned, which will get rid of the bump and pain. If the bunion is of moderate severity the treatment of choice may be wearing custom-made orthoses or wearing a bunion splint at night to hold the foot and toe in proper alignment to prevent the deformity from getting worse. However, a very mild non-painful bunion may just need a properly fitting shoe to stop the progression of the hallux abducto-valgus.
2. HALLUX RIGIDUS:
WHAT: Hallux rigidus is the second most common big toe deformity and once again this name describe the deformity; the big toe is referred to as hallux and rigidus means that the joint is stiff. The joint that is stiff is called the first metatarsophalangeal joint; this is where the big toe meets the bone that it sits on, which is called the first metatarsal. The joint will be stiff which will result in the big toe not being able to bend enough, which will result in pain. It may be surprising, but your big toe even though very small is crucial for a smooth, balanced gait, so if the joint is too stiff, the result will be pain while walking.
CAUSE: There are many causes for the joint stiffness referred to as hallux rigidus including:
- Rheumatoid arthritis
- Degenerative arthritis
- Severely stubbed big toe or other trauma
WHO: Hallux rigidus is commonly developed in patients between 30-60 years old and is more common in females.
TREATMENT: Once again like bunions, the treatment options are dependent on the severity and pain associated with hallux rigidus. For mild to moderate hallux rigidus, a rocker bottom shoe may be indicated. A rocker bottom shoe helps with eliminating the pain that occurs from walking, because it will allow smooth, balance pain-free gait by the rocker acting as the big toe. This works because instead of stiff joint being forced to move the shoe will act like the big toe by rolling/rocking, so the foot moves properly without forcing the stiffened joint to move and jamming the big toe. If the hallux rigidus is severe, surgery may be indicated.
If you have these deformities and you are pain-free, consider yourself lucky; however, it is important to still seek treatment. With the various treatments for both types of deformities the progression of the deformity may slow down, so ideally pain will never become a problem. However, if pain does become a problem or you are already experiencing pain, surgical intervention may be an option.