Foot Specialist

The operation of the Hallux valgus (bunion) corrects the deformity of the big toe, which tilts toward the outside of the foot. © joint-surgeon

Hallux valgus (usually called a bunion) is a common deformity of the big toe that is predominantly seen in female patients. The big toe noticeably tilts toward the outside of the foot, displacing the smaller toes. First of all, the deformity is not pretty. It is of particular concern to women whose feet no longer fit into shoes. In advanced stages, the deformity puts increasing strain on the base joint of the big toe. In the long term, the adjacent toes will develop claw or hammer toes. The base of the big toe will grow painful exostoses (outgrowths) or develop extremely painful bursitis, only worsening the problems wearing shoes. The protruding part of the ball of the foot becomes inflamed and may swell up. The strain on the base joint of the big toe may even cause painful osteoarthritis in the big toe (hallux rigidus). Often specialists speak of “Cinderella Foot Surgery” to focus on the cosmetic point of view of foot procedure. But improving the function, relieve chronic pain and treat deformities of the foot is equally important.

The specialists at our certified centre for foot and ankle surgery are experts in the gentle treatment of this deformity of the big toe. They typically use gentle, minimally invasive procedures which often leave no visible scars on the foot. This speeds up healing and rehabilitation and prevents complications following bunion surgery.

The more severe the bunion, the more complex the surgery will be and the longer the after-care period. It is therefore prudent to see a specialist early and learn about surgical options for correcting bunions.

The goal of treatment is for our patients to regain mobility as quickly as possible and experience permanent medical and cosmetic improvement of their bunion with minimal scarring.

View of the bones of the longitudinal arch of the foot: Flat valgus foot arises due to a rolled-out calcaneus and drop of the arch in the talonavicular joint (joint between the ankle and navicular bone). The hindfoot deformity resulting from flat valgus foot can also affect the upper ankle joint joint due to deformity of the talus (ankle). © rob3000, Fotolia

Flat valgus foot is a deformity of the foot where the calcaneus is rolled out. At the same time the arch of the foot drops at the inside. Flat valgus foot is most commonly caused by being overweight, wearing wrong footwear and lack of exercise. Even damage to the posterior tibial tendon (tendon of the back tibial muscle) can promote the deformity. In addition, women from middle age and beyond are three times as likely to develop flat valgus foot than men. Typical symptoms of flat valgus foot are swelling of the inside edge of the foot and the inside ankle, particularly whilst bearing weight. In early stages, insoles and consistent foot exercises help strengthen the ligaments in the foot. If all conservative treatment options have been exhausted, there are various surgical procedures. The exact extent of the surgery is determined by the physician together with the patient following a medical and diagnostic examination. Possible surgical procedures include, for example, reshaping the bone (osteotomy) or transplanting the posterior tibial tendon.

Dr. med Thomas Schneider, Orthopaedic Specialist, Foot and Ankle, Hip Surgery

• Orthopaedic Specialist at the Gelenk Klinik Orthopaedic Hospital
• PhD (1997) University of Freiburg
• Orthopaedic Specialist since 2004
• Expert Consultant for Arthroscopic Ankle and Foot Surgery, Ankle Replacement Surgery, Ligament Reconstruction, Total Hip Replacement (McMinn), Cartilage Replacement, Arthroscopic Shoulder Surgery
• Languages: English and German

Dr. Martin Rinio, MD, Orthopedist, Surgeon and Trauma Surgeon

Qualification

• Orthopaedics, surgery and trauma surgery
• Akademie der Unfallchirurgie AUC

Teaching

• Eberhard Karls Universität Tuebingen
• Akademie der Unfallchirurgie AUC

Dr. Martin Rinio has special surgery experience in hip, knee and shoulder prostheses. Working well with general practitioners is particularly important to him in ensuring patients receive comprehensive care.

Foot specialist approach to orthopaedic disorders of the foot ©Fotolia.com

The human upright gait takes its toll on the body. It creates considerable stress for our locomotor system (the ability to move using the muscular and skeletal systems) and especially for our feet.

The feet carry the whole of our body weight and walk an average of 5,000 steps a day. Our modern lifestyle and leisure activities for example sports, and the wearing of high-heeled and uncomfortable footwear, make us more prone to pain in the feet.

Fig. 1: The hallux valgus (lat. for skewed toe) is a deformity in the big toe at the metatarsophalangeal joint: It is characteristic for the big toe to point outwards. Due to increasing conflict with the shoe, friction causes an inflammation of the bursa in the metatarsophalangeal joint, often followed by additional swelling. © Gelenk-Klinik.de

What is Hallux valgus? Hallux valgusis the most common deformity of the forefoot and the toes. 23% of 18-65 year olds and over 35% of those over 65 years have hallux valgus. Due to the noticeable form it’s also referred to as a bunion or ganglion.

Here the big toe moves out of its alignment and points toward the outside edge of the foot. With hallux valgus, the often painful and inflamed, swollen metatarsal head in the metatarsophalangeal joint commonly bulges, pushing against the shoe.

Morton's neuroma (red) as swelling between the metatarsal bones of the toes (blue). If the nerve (yellow) is irritated, burning or stabbing metatarsal pain occurs throughout the area it supplies. © Dr. Thomas Schneider, MD

Morton's neuroma is a thickening of the metatarsal nerves. It causes acute shooting, burning or stabbing pain in the metatarsus (metatarsalgia) and in the toes. The pain is so severe that patients will only experience temporary relief by sitting down or taking off their shoes. After taking strain off the foot, pain quickly subsides. Formication or a feeling of numbness in the toes are symptoms of Morton's neuroma.

Morton's neuroma is a very common result of splayfoot, sometimes in combination with hallux valgus. Women are four times more likely to develop Morton's neuroma than men. This is probably related to footwear: High heels and pointed toes cause a lot of pressure on the front arch of the foot, increasing the risk of developing splayfoot. Splayfoot changes the position of the metatarsal bones and increases pressure on the nerves running along the sole of the foot.

But even men – primarily runners training a lot – can develop it. Morton's neuroma is most likely to occur between the 3rd and 4th toe, and somewhat less likely to occur between the 2nd and 3rd toe.

Dr. Thomas Schneider

With a splay foot, the transverse bulge of the forefoot disappears, causing, according to the degree of severity, the foot to be strained in places not used to pressure. The forefoot is broadened and the metatarsal bones splay fan-shaped. Often this is accompanied by a painful callused protrusion that is tender under pressure. Because of the pain, the normal rolling mechanism of the foot is disturbed and the patients instinctively malposition their foot causing the shoe to become crooked and bend outwardly.