Hallux valgus: why the bunion grows and how it is treated in Tashkent

Other names: Вальгусная деформация большого пальца, халюс вальгус, косточка на ноге, шишка у большого пальца, отклонение первого пальца стопы, бурсит первого плюснефалангового сустава

Hallux valgus is when the first toe deviates outward with the formation of a protruding “bunion” at its base. Almost everyone who encounters it describes the problem the same way: “the bone is growing.” This is the most persistent and most harmful misconception on the topic. No new bone is growing. Something else happens: the first metatarsal bone gradually deviates inward, towards the middle of the body, and the big toe, under the pressure of the shoe and the pull of its own tendons, moves outward, towards the other toes. The head of the metatarsal bone remains in place and simply begins to protrude under the skin - it is mistaken for a growth. Understanding this mechanism immediately explains the main practical consequence: what sticks out cannot be “dissolved,” softened, tightened with a bandage, or dissolved with a compress. The displaced bone can only be returned to its place, and this is done exclusively surgically.

🧾 МКБ-10: M20.1 🏥 Where it is treated: 6 The bone does not grow, but movesHeredity is more important than shoesOnly surgery straightens

👨‍⚕️ Which doctor

Traumatologist-orthopedist, foot surgeon

🔬 Diagnostics

Examination, x-ray of feet while standing with measurement of angles

💊 Treatment

Shoes and relief for pain, reconstructive surgery for deformity

📈 Prognosis

Good after the right operation

⚠️ At risk

Heredity, female gender, transverse flat feet, narrow shoes

⏱ When to see a doctor

Planned; urgently - for inflammation and wound above the “bone”

🚨 See a doctor urgently

With these signs do not wait for a scheduled appointment — the condition requires emergency care.

Кожа над «косточкой» покраснела, стала горячей, появилась резкая боль и припухлость — возможно воспаление сумки сустава
Над выступом образовалась незаживающая рана, потёртость с отделяемым или язва — особенно при сахарном диабете
Онемение, жжение или потеря чувствительности в области большого пальца
Резкая боль в суставе большого пальца ночью, в покое, с багровым отёком — так проявляется подагрический приступ, а не деформация
Второй палец начал наползать на первый или молоткообразно согнулся и болит при ходьбе
Боль сохраняется в покое и не даёт спать, обычная обувь стала полностью невозможна

What actually happens to the foot

The forefoot is held together by ligaments and muscles that form the transverse arch. When this arch weakens, the metatarsals fan out and the first one deviates inward. The big toe does not follow it: it remains attached to its tendons, which continue to pull it along the axis of the foot. As a result, the angle between the first metatarsal bone and the toe increases, and the place of their connection - the head of the first metatarsal bone - begins to protrude along the inner edge of the foot. It is this protrusion that people call the “bone.”

Then a vicious circle starts. The tendons that previously flexed and straightened the finger straight forward now pull it askew and themselves increase the deviation. The sesamoid bones, which lie under the head of the first metatarsal bone and act as a support, move sideways and stop working. The load that the first finger must bear is transferred to the second and third - painful corns appear under them, and the fingers themselves become hammer-shaped over time. The skin over the protrusion rubs against the shoe, the underlying joint capsule becomes inflamed, and pain is added to the deformity.

The first metatarsal deviates inward, increasing the intermetatarsal angle
The thumb deviates outward under the pull of its own tendons
The head of the first metatarsal bone begins to protrude under the skin - this is the “bone”
The sesamoid bones become displaced and lose their supporting function.
The load is redistributed to the second and third fingers, corns appear
The bursa above the protruding head becomes inflamed, accompanied by pain and redness

Слово «нарост» в разговоре о «косточке» неточно вдвойне. Кроме смещения кости, над её головкой действительно может утолщаться сама костная поверхность и разрастаться воспалённая слизистая сумка — но это следствие постоянного трения, а не причина деформации. Удаление одного лишь выступа без исправления положения кости даёт временный косметический эффект: угол остаётся прежним, и деформация возвращается.

Reasons: heredity, foot and only then shoes

The role of shoes in this story is both overestimated and underestimated at the same time. A narrow toe and high heel are really harmful: the heel transfers up to three-quarters of the body's weight to the forefoot, and the narrow last mechanically presses the big toe against the rest. But shoes are an accelerator, not a root cause. The deformity occurs in people who have never worn heels, including men, and often appears in adolescence. Heredity makes a decisive contribution: it is not the “bone” itself that is transmitted, but the structure of the foot - the shape of the head of the metatarsal bone, the mobility of the first ray, and the weakness of the ligaments.

Family predisposition - the deformity is often traced in the mother and grandmother
Female gender: occurs several times more often in women than in men
Transverse flatfoot and flattened forefoot
Excessive mobility of the first ray of the foot and connective tissue weakness
Narrow shoes with a pointed toe and a heel higher than four to five centimeters
Inflammatory joint diseases, primarily rheumatoid arthritis
Age-related changes in the ligamentous apparatus and weight gain

Hence the practical conclusion, which is often disappointing: changing shoes to comfortable ones will stop the chafing and relieve the pain, but will not return the toe to its place. Wide shoes with a soft top and a stable low heel are the right and necessary measure, because they relieve the main source of suffering. Just don't expect her to straighten her finger. Unloading insoles are also useful, but do not straighten: they help redistribute pressure and relieve pain in the forefoot, especially when calluses have already appeared under the second and third toes.

Symptoms and stages

The first thing that is usually noticed is not the pain, but the shoes: the usual pair suddenly begins to press in the same place, and a characteristic bulge appears on the inside. Then comes redness and soreness of the skin over the protrusion after a long walk. In later stages, the pain moves inside the joint, crunching and limited mobility of the big toe appear, and dense, painful calluses form under the ball of the foot. Often it is they, and not the “bone” itself, that forces a person to see a doctor.

Protruding “bone” along the inner edge of the foot, rubbing with shoes
Redness and tenderness of the skin over the protrusion after walking
Deviation of the thumb towards the second, subsequently - creeping of the fingers over each other
Pain and crunching in the joint itself, limitation of flexion and extension of the finger
Corns and burning pain under the ball of the foot at the base of the second and third toes
Hammertoe deformity of adjacent fingers with calluses on their upper surface
Inability to wear regular shoes, need to buy a larger size

The degree of deformation is assessed not by eye or by the size of the lump, but by the angles on an x-ray photograph, which must be taken while standing: the angle of deviation of the big toe and the angle between the first and second metatarsal bones. Additionally, they look at the position of the sesamoid bones, the condition of the joint space and the mobility of the joint between the first metatarsal and sphenoid bones. It is this set of parameters that determines which operation is suitable for a particular person - and explains why two patients with outwardly identical “bones” may have different interventions.

Conservative treatment: what it can and cannot do

This is the most sensitive question on the topic, and the honest answer is that conservative treatment controls symptoms but does not correct the deformity. Neither orthotics, nor silicone interdigital spacers, nor night abduction splints, nor bandages, nor massage, nor physical therapy return the displaced metatarsal bone to the correct position and do not reduce the angle of deviation of the toe. Numerous tests of these products show the same thing: pain and walking comfort may improve, but the angles in the picture do not.

Wide shoes with soft tops and low, stable heels are the most effective measure against pain.
Unloading insoles and pads under the forefoot - for corns and burning pain under the pad
Silicone ridge caps - protect skin from chafing
Toe spacers - reduce friction between toes without straightening them
Night abduction splints - may reduce morning pain, do not correct deformity
Exercises for the foot muscles and stretching improve support, but do not change the angle

Важно понимать, зачем это делается. Консервативные меры полностью оправданы: они снимают боль, останавливают натирание и позволяют жить нормально годами, а у человека с сахарным диабетом или сосудистыми проблемами это ещё и защита кожи от язв. Но если ортопедический салон обещает «исправить косточку без операции» и «убрать шишку за курс», обещание не соответствует механике происходящего. Отклонённая кость возвращается на место только хирургически.

Operation: when is it needed and how does it work?

The indication for surgery is not the size of the protrusion or the appearance of the foot, but pain and limitation of life: the inability to wear normal shoes, pain when walking, corns, deformation of adjacent toes. A modern foot surgeon usually does not advise operating solely for the sake of aesthetics, because any intervention involves a recovery period and a risk of complications. The essence of the operation is always the same: to return the first metatarsal bone to its correct position. To do this, it is crossed, displaced and fixed with screws or a plate, and in addition the soft tissues around the joint are balanced.

Планирование по рентгенограммам стоя: измеряются углы, оценивается подвижность первого луча и состояние сустава.
Выбор уровня остеотомии: при умеренной деформации кость пересекают ближе к головке, при выраженной — ближе к основанию или выполняют вмешательство на суставе между плюсневой и клиновидной костью.
Коррекция положения кости и фиксация винтами. Металл в большинстве случаев не удаляют.
Уравновешивание мягких тканей: сухожилий и капсулы сустава, чтобы палец не тянуло обратно.
При выраженном артрозе самого сустава вместо коррекции может выполняться его фиксация в функционально выгодном положении.
Одновременно при необходимости исправляют молоткообразную деформацию соседних пальцев.

Anesthesia is most often conducted - a nerve block at the level of the leg or foot, so general anesthesia is not always required. In many cases, the intervention is done on a one-day basis and the person goes home the same day. There are also minimally invasive techniques in which the bone is crossed through punctures under X-ray control. They are attractive due to smaller incisions, but are not suitable for all deformities, and the choice of technique remains with the surgeon after studying the images.

Recovery after surgery

Recovery is not a week or two. The bone that has been crossed and displaced must heal into its new position, and the soft tissue must adapt. The general logic is this: they are allowed to walk almost immediately, but in special unloading shoes with a hard sole, which transfers the load to the heel and protects the operated forefoot. The swelling is the longest part of the story: it lasts for months and completely goes away after the incision has healed.

Первые дни: возвышенное положение ноги, холод, обезболивание, ходьба в разгрузочной обуви на короткие расстояния.
Первые 4–6 недель: ходьба только в специальной послеоперационной обуви, контрольный снимок для подтверждения сращения.
Примерно через 6 недель: переход в широкую мягкую обувь, начало разработки движений большого пальца.
Отёк стопы к вечеру сохраняется в среднем 3–6 месяцев, иногда дольше; помогает возвышенное положение и компрессионный трикотаж.
Возвращение к сидячей работе обычно через 2–6 недель, к работе на ногах — через 2–3 месяца.
Обычная узкая или модельная обувь и спорт с ударной нагрузкой — не раньше 4–6 месяцев и по решению врача.
Полное восстановление функции стопы занимает от полугода до года.

Возврат деформации после операции возможен, и главный фактор риска здесь — не «плохая операция», а неверно подобранный уровень коррекции при выраженном исходном угле и возвращение к узкой обуви на каблуке. Второй важный момент — разработка движений: если после сращения не восстановить сгибание и разгибание большого пальца, останется жёсткий, хоть и ровный палец, а он мешает при ходьбе не меньше, чем сама «косточка». Поэтому упражнения в восстановительном периоде — не дополнение, а часть лечения.

Frequently asked questions: Hallux valgus deformity

Is it true that extra bone grows on your leg?+

No, and this is the most common misconception. New bone does not appear. The first metatarsal bone moves inward and the big toe moves outward, so the head of the metatarsal bone begins to protrude under the skin. An inflamed joint capsule and compaction of the bone surface from constant friction may be layered on top of it, but this is a consequence. That is why no ointments, compresses or “absorbable” agents have any effect on deformation.

Do braces, spacers, and night splints help straighten the finger?+

They help to live with the deformation, but do not eliminate it. Tests of these products show that pain and walking comfort can improve, and the angles of deviation on the x-ray do not change. This does not mean that you should abandon them: overlays protect the skin from chafing, separators reduce friction between the toes, and insoles relieve stress on the forefoot. You just shouldn't wait for straightening.

Did the heels cause the bunion?+

Heels and narrow toes speed up the process and make it painful, but the root cause is usually the structure of the foot, which is inherited. The deformity occurs in both men and people who have never worn heels, and sometimes begins in adolescence. Changing shoes to comfortable ones is the right step, which will remove chafing and pain, but it will not return the toe to its place.

When is it time to operate?+

When the deformity interferes with life: it hurts when walking, it is impossible to pick up ordinary shoes, corns appear under the ball of the foot, the second toe begins to deform or creep onto the first. Only a cosmetic motive is a weak indication, because any operation means several months of recovery. The decision is made together with the orthopedist based on the images and how much the problem limits everyday life.

Is it possible to simply cut off the protruding lump?+

Isolated removal of the protrusion is now practically not used. It removes the visible part of the problem, but does not change the angle between the bones, so the deformity returns and the joint may become unstable. Modern surgeries do something different: cut the metatarsal bone, return it to its correct position and fix it, while balancing the tendons around the joint.

How long does recovery take and when can you walk?+

Walking is usually allowed almost immediately, but in special postoperative shoes with hard soles that relieve the load on the forefoot - about 4-6 weeks. Then they switch to wide, soft shoes. They return to sedentary work after 2–6 weeks, to work on their feet after 2–3 months, to regular dress shoes and sports after 4–6 months. Foot swelling in the evening may last for 3-6 months and this is normal.

Do I need to remove the screws later?+

In most cases no. Modern fixators are small, installed inside the bone and do not interfere. The question of removal is raised only if the metal is felt under the skin, rubs against shoes or causes pain, and is usually discussed no earlier than a year after the operation, when the bone has completely fused.

Can the bunion appear again after surgery?+

This happens, although not often with the right technique. The risk is higher with an initially large angle of deviation, with excessive mobility of the first ray of the foot, with inflammatory diseases of the joints and with a return to narrow high-heeled shoes. Accurate selection of the level of correction based on the images and conscientious restoration of finger mobility after fusion helps reduce the risk.

The information on this page is for reference only and does not replace a doctor consultation. Only a qualified specialist can make a diagnosis and prescribe treatment after an in-person examination.

Where it is treated hallux valgus deformity в Ташкенте

Одинаково выглядящие снаружи «косточки» могут требовать совершенно разных операций: выбор методики зависит от измеренных на снимке углов и от подвижности сустава, а не от размера шишки. Приём ортопеда, рентген стоп с нагрузкой и хирургия стопы в Ташкенте: