When every step hurts

In Hungary, every fifth adult under the age of 65 suffers from some form of forefoot deformity, and almost every third person over the age of 65 has bunions, but hammer toe is even more common. When all shoes are uncomfortable and it hurts to walk, it is absolutely necessary to consult a specialist. According to Dr. Mátyás Czipri, an orthopedic specialist at the Duna Medical Center, forefoot surgeries traditionally have a bad reputation because of the pain associated with them, the good news is that with the use of modern foot surgery tools and surgical procedures, this is no longer true.
When every step hurts

A bunion (or hallux valgus) is a protrusion of the inner side of the forefoot at the height of the base of the big toe. The bunion is not caused by a bony outgrowth, but by the changed position of the head of the first metatarsal bone, which simultaneously tilts the big toe towards the little toes. Several factors play a role in its formation, but it has nothing to do with the shape of our feet. However, it is much more common among women, and it is more likely to occur in those with a family history of the disease. Shoe wear undoubtedly plays a role in cam formation. Closed shoes, in which there is no adequate space for the forefoot and toes, are the most dangerous, as a result of which the toes are compressed from the side. Such are narrow women's shoes with pointed toes. The high heel further increases the wedging of the forefoot in the shoe, but is not responsible for the cam itself. Not all club feet are painful, but once symptoms start, they probably won't go away on their own. Its treatment is important in order to get rid of the pain associated with the deformity, to restore the full function of our feet, and to solve the difficulties in wearing shoes.

During the operation, the changed position of the first metatarsal bone must be corrected, i.e. it must be placed back where it was originally. To do this, the bone must be cut through, slid into the correct position and fixed there with a screw. It is equally important to restore the balance of the soft tissues around the base joint of the big toe during the operation, thereby ensuring the necessary correction. Recovery after surgery is 6 weeks, the patient can get up on the day of the operation and stand on the operated leg, but during the first 6 weeks he must wear post-surgery relief shoes. Swimming and exercise bike can be started after 6 weeks, elliptical trainer after 6-8 weeks, jogging on a treadmill is possible after 9-12 weeks. You can even wear high-heeled shoes 3 months after the operation.

Hammer toe, which is a deformity of the little toes, is also a common problem. Here the finger is in a bent position, later it becomes rigid. This most often affects the 2nd and 3rd fingers. Congenital anatomical factors play a role in the appearance of hammer toe, such as the length of the toe or metatarsal bone, or some static deformity of the foot. It is often associated with autoimmune joint diseases, e.g. for rheumatoid arthritis, diabetes, and other diseases affecting the muscle and nervous system. On feet where the second toe is longer than the big toe (Greek-type foot), the probability of developing it is higher, but this phenomenon is also dependent on the shape of the foot.

Tight shoes that cause congestion of the toes or force them into a permanently bent position predispose to the appearance of hammer toe. In this case, the toe becomes bent, claw-like, and does not fit into the line of the other toes. A bony protrusion appears on the first joint of the affected finger, which fits less and less in the toe of the shoe, irritation, calluses and pain develop above it. Pain and calluses often appear under the problem finger and on the sole.

For a while, the insole that raises the transverse arch can alleviate the complaints to a certain degree, but it does not solve the real problem. It is important to wear the right shoes, in which there is enough space for the deformed toes and the material is softer. There are other aids, silicone spacers and plasters, but these can only help relieve symptoms temporarily.

Its treatment is important so that the patient gets rid of pain and difficulty wearing shoes. Along with the gradual worsening of the deformity, the complaints usually get worse, so it is worth asking for expert advice in time. Hammer toe, especially in the case of diabetes, can lead to further, even serious, problems, so surgical correction also plays an important role in preventing complications.

Several types of surgery are suitable for hammertoe correction, but it is important that the surgeon chooses the most appropriate surgery for the given deformity. During the intervention, the necessary correction is achieved step by step, depending on the severity of the deformity. Less often, even cutting a single tendon is sufficient, but usually bone must be removed at the height of the deformed joint for correction. In addition, according to the deformity, soft tissue release, tendon lengthening and occasionally joint ligament reconstruction must also be performed. Healing takes 2-6 weeks, depending on the type of intervention required for recovery.

The bony structure of the foot has a vaulted structure. The longitudinal arch runs from the heel to the forefoot, the transverse arch crosses the forefoot, from the first to the fifth metatarsal. In addition to the bones, the ligament system and the muscles of the foot also play an important role in maintaining the vaulted structure. We talk about plantar sag, or more precisely, the sag of the foot arch, when this structure changes and flattens. The flattening of the longitudinal arch results in club feet , and the lowering of the transverse arch is associated with overloading of the forefoot, pain and the development of calluses.

Some people have flatter feet from the start, this in itself cannot be considered pathological. A number of factors can play a role in the flattening of the longitudinal arch, i.e., the development of clubfoot. The most common cause is the weakness of the tendon (tibialis posterior), which plays the main role in maintaining the longitudinal arch, in addition, weakness of the ligament system of the foot, joint instability, joint wear, previous injury to the foot and diabetes can also play a role.

Transverse arch subsidence is caused by the changed statics of the load-bearing part of the sole of the forefoot. It is most often caused by deformity of the little toes (e.g. hammer toes), the cam, or excessive mobility of the first metatarsal bone, but the length and anatomical position of the metatarsal bones can also play a role. We spend our lives walking on hard, smooth, horizontal surfaces, and we don't always do this in shoes that support the feet and provide stability, this promotes their development. In the end, this can be traced back to the weakness and lack of training of both the long muscles that extend to the leg and the short muscles of the leg.

Maintenance and exercise of the leg muscles and maintaining the movement of the joints can help in prevention. It is important to use the right footwear in everyday life, but also during leisure activities and sports.

The surgical treatment of transverse vault depression primarily means the surgical correction of associated deformities, such as cam or hammer toe, only relatively rarely is an operation that changes the position of the bones of the sunken vault necessary. In such cases, as a supplement to the previously mentioned surgeries, the bones are cut and fixed in the corrected position with screws. In some cases, reconstruction of the entire forefoot is necessary.

The surgical treatment of adult athlete's foot is extremely complex. It must be adjusted to the severity of the deformity and to what extent the flexibility of the leg remains. The surgical interventions include cutting the heel bone and fixing it with screws in the appropriate position, replacing the lost muscle function with a tendon graft, and reconstructing the most important ligamentous structures of the foot. Recovery is between 6 weeks and 3 months, depending on the type of surgery, but for major surgeries, full recovery takes longer.

If you are also struggling with similar problems, you can make an appointment for our orthopedic specialist examinations by phone at +36 1 790 7070 or online!

Get to know our orthopedists:

Dr. Mátyás Czipri

Dr. Zsolt Hegedűs