Hallux Valgus and Osteoarthritis: A Patient's Dilemma

Q: Hallux Valgus and Osteoarthritis: A Patient's Dilemma

Hello： Based on your description, it seems that you are experiencing symptoms caused by hallux valgus, which leads to friction between the toes. <br>I recommend that you visit our orthopedic outpatient clinic for further examination and assessment. <br>Generally, you can start by

Degenerative arthritis

Dear Doctor,
Last month, I visited a physician due to severe friction and pain between my big toe and second toe while walking, which resulted in skin breakdown.
It later formed a scab, and I noticed that the bone next to my big toe was severely protruding and deformed, along with swelling and deformity in the joint of my second toe.
My toenail has also changed significantly, becoming much smaller.
Additionally, my foot and ankle are swollen (I had an ankle sprain a few months ago and received treatment from a traditional Chinese medicine practitioner, after which I began to feel something was wrong with my foot).
Now, I experience some pain while walking.
I consulted an orthopedic doctor and had X-rays taken, but the opinions of the two doctors were inconsistent.
One doctor indicated that it was a problem of cartilage hypertrophy and recommended rehabilitation, prescribing anti-inflammatory medication.
The other doctor suggested that it was a case of osteoarthritis and hallux valgus.
Which diagnosis is correct? This has left me confused! Could you please clarify this for me?
Additionally, I have been a vegetarian for over twenty years.
What medications should I take to improve my condition? Can I take glucosamine? What other issues should I be aware of? I hope you can help me understand my condition better.
Thank you very much!

Lin Tai Tai, 60~69 year old female. Ask Date: 2005/06/02

Dr. Shi Qiming reply Orthopedics

Hello: Based on your description, it seems that you are experiencing symptoms caused by hallux valgus, which leads to friction between the toes.
I recommend that you visit our orthopedic outpatient clinic for further examination and assessment.
Generally, you can start by using a specialized orthotic device for hallux valgus to correct the deviation of the big toe, along with medications to reduce swelling and pain, and wearing loose-fitting shoes to resolve your issue.
Below is some information related to hallux valgus for your reference: A normal big toe deviates outward by 10 to 15 degrees; if it exceeds 20 degrees, it is termed "hallux valgus." Hallux valgus is a condition characterized by incomplete dislocation of the metatarsophalangeal joint, primarily marked by the big toe angling outward; the first metatarsal shifts inward, forming a bony prominence.
This condition has a hereditary tendency, with a female to male ratio of 10:1.
Contributing factors include: 1.
External factors: Frequently wearing narrow, pointed, and high-heeled shoes accelerates the development of hallux valgus.
2.
Internal factors: Genetic predisposition, flat feet, and abnormal contraction of the Achilles tendon can lead to hallux valgus.
Symptoms: Pain and swelling are the most common complaints, which worsen when wearing shoes.
Additionally, the resulting bursitis can widen the foot, making it difficult to wear shoes, and the deformity affects aesthetics.
Notable celebrities such as Vivian Hsu, Takeshi Kaneshiro, and Billie Eilish have hallux valgus.
This condition not only deforms shoes but also causes pain due to friction and pressure from the bony prominence against the shoe.
Toe assessment method: Stand with your feet together and check if the big toe is angled more than 15 degrees towards the second toe.
If so, it indicates hallux valgus.
Treatment: I.
Initial treatment 1.
Shoe modification: Choose wide-toed, soft-surfaced shoes with heels no higher than 2 inches.
2.
Physical therapy: Use medial longitudinal arch support devices.
3.
Symptomatic treatment: Apply heat, rest, anti-inflammatory medications, and corticosteroid injections.
4.
Rehabilitation exercises: Perform exercises for the big toe, train toe grip with a towel, and do toe opening and closing movements.
II.
Surgical treatment: For patients who continue to experience functional impairment despite conservative treatment, several surgical options are available.
The goal is to remove the bony prominence on the inner side of the big toe, relax the tight muscles on the inner side, suture the joint capsule, and correct the angle.
Post-operative care: 1.
Keep the wound clean and dry; bone and soft tissue healing takes about 8 weeks.
2.
Post-operative training involves using crutches or wearing a walking boot.
3.
You may return to work 2 weeks to 1 month later, depending on your job situation.
4.
You can engage in sports activities after three months.
5.
Avoid wearing overly pointed or high-heeled shoes to prevent recurrence of hallux valgus.
This article is provided by Dr.
Chiu Chia-Hung from the Foot and Ankle Center of Hsu Chuan Hospital.

Reply Date: 2005/06/02

More Info

Hallux valgus, commonly known as a bunion, is a foot deformity characterized by the lateral deviation of the big toe, which can lead to pain and discomfort, especially when walking. This condition often coexists with osteoarthritis, a degenerative joint disease that can affect the joints in the feet, including the metatarsophalangeal joint of the big toe. Your symptoms, including the pain between your big toe and second toe, the formation of calluses, and the changes in your toenails, suggest that you may be experiencing both hallux valgus and possibly osteoarthritis.

The conflicting opinions from the two orthopedic doctors you consulted can be attributed to the complexity of foot conditions. One doctor suggested that you have soft tissue changes, which may indicate inflammation or other issues related to the surrounding structures of the joint. The other doctor diagnosed you with osteoarthritis and hallux valgus, which is a common association. Osteoarthritis can lead to the breakdown of cartilage in the joints, resulting in pain, swelling, and deformity. In your case, the swelling in the ankle and the changes in the toe joints could be indicative of both conditions.

To clarify your situation, it’s essential to understand that hallux valgus can lead to secondary osteoarthritis due to the abnormal mechanics of the foot. The misalignment of the big toe can cause increased stress on the second toe and the surrounding joints, leading to pain and inflammation. The presence of calluses and skin changes is a common response to friction and pressure from footwear, which can exacerbate your symptoms.

Regarding treatment, it is crucial to address both the hallux valgus and any underlying osteoarthritis. Non-surgical treatments typically include:
1. Footwear Modifications: Wearing shoes with a wide toe box can help reduce pressure on the bunion and prevent further irritation.

2. Orthotics: Custom orthotic devices can help realign the foot and distribute pressure more evenly.

3. Physical Therapy: Rehabilitation exercises can strengthen the muscles around the foot and improve flexibility, which may alleviate some pain.

4. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. If you are considering taking supplements like glucosamine (often referred to as "維骨力" in Chinese), it is generally considered safe, but you should consult with your healthcare provider to ensure it aligns with your dietary restrictions as a vegetarian.

5. Corticosteroid Injections: In cases of severe inflammation, your doctor may recommend corticosteroid injections to reduce swelling and pain.

If conservative treatments fail to provide relief, surgical options may be considered. Surgery for hallux valgus typically involves realigning the bones of the big toe and may also address any associated osteoarthritis.

As for your long-term vegetarian diet, it’s essential to ensure you are getting adequate nutrients that support joint health, including omega-3 fatty acids, vitamin D, calcium, and protein. Consider consulting a nutritionist who specializes in vegetarian diets to optimize your intake.

In summary, both diagnoses may be correct, as hallux valgus can lead to osteoarthritis. A comprehensive treatment plan that addresses both conditions is essential for improving your symptoms and quality of life. Regular follow-ups with your orthopedic specialist will help monitor your condition and adjust your treatment as necessary.

Similar Q&A

Understanding Hallux Valgus: Causes, Symptoms, and Treatment Options

Hallux valgus, commonly known as a bunion, is a deformity characterized by the lateral deviation of the big toe. The causes of hallux valgus can include genetic predisposition, wearing tight or ill-fitting shoes, and certain medical conditions such as arthritis. To diagnose hall...

Dr. Luo Zhaozhong reply Orthopedics
Hello! For hallux valgus, it is essential to first determine the angle of deviation. If it is a mild degree, conservative treatment can be attempted; for larger angles, surgical intervention may be necessary. There are various surgical methods available, and the recovery time can...

Managing Osteoarthritis: Medication, Supplements, and Health Tips

Dear Doctor: I am a patient with osteoarthritis, and I also have hallux valgus and cartilage hypertrophy. When my condition is severe, walking becomes inconvenient, so I have been taking medication for a while. It's been three months, and now I only feel slightly uncomfortab...

Dr. Lin Xiaoyi reply Orthopedics
Hello: Your symptoms of degenerative arthritis have significantly improved, which is a positive sign. It is advisable to engage in moderate exercise for maintenance, such as walking or swimming in water, or taking a leisurely 20-minute walk to maintain good physical fitness. Addi...

Understanding Early-Onset Osteoarthritis: Causes, Symptoms, and Management

Hello Dr. Yang: I have several questions and would appreciate your prompt response. Thank you! I am 37 years old, 160 cm tall, and weigh 63 kg (this is my first online consultation). Earlier this year (around February), I started experiencing mild soreness in my knees (including ...

Dr. Yang Zhengfan reply Orthopedics
Dear Annie, You have quite a few questions, and I will address the key points as follows: 1. The causes of arthritis were previously attributed to overexertion, but it is now recognized that individual physiological factors are also closely related. 2. Arthritis cannot be c...

Is Surgery Necessary for Hallux Valgus? Exploring Rehabilitation Options

Is surgery the only treatment for hallux valgus (bunion)? Can rehabilitation cure it? Thank you!

Dr. Chen Xianchang reply Rehabilitation
Hello, sir: Thank you for your inquiry. Here are my responses and recommendations: 1. Generally speaking, if hallux valgus (bunion) is too severe and alters your weight-bearing points while walking, it can lead to pain and deformity, and surgical intervention may be considered. 2...