Hallux valgus is classified according to the severity of the misalignment:

1. Mild hallux valgus:
   • The deviation angle of the big toe is up to 20°.
2. Moderate hallux valgus:
   • The deviation angle is between 20° and 40°.
3. Severe hallux valgus:
   • The deviation angle exceeds 40° and is often accompanied by other deformities.

The causes of the misalignment are diverse and include:

• Genetic predisposition:
  • Hallux valgus often occurs more frequently in families, indicating a genetic predisposition.
• Foot deformities:
  • A splayfoot or flatfoot increases the load on the forefoot and promotes the misalignment.
• Unsuitable footwear:
  • Tight, pointed, or high-heeled shoes encourage the deviation of the big toe.
• Age and gender:
  • Women and older people are more often affected, which is due to hormonal and connective tissue differences.
• Injuries or diseases:
  • Trauma or inflammatory diseases such as rheumatoid arthritis can promote the development of a hallux valgus.

The symptoms depend on the severity of the misalignment and include:

• Pain:
  • Localized pain in the area of the big toe joint, which is intensified by pressure and strain.
• Swelling and redness:
  • Inflammatory reactions due to friction, often associated with bursitis.
• Restricted movement:
  • Reduced mobility of the big toe joint, especially in advanced misalignment.
• Skin changes:
  • Calluses or corns due to pressure points.
• Aesthetic impairment:
  • The visible bulge can be perceived as bothersome and limit the choice of footwear.

The diagnosis is made through a combination of medical history, clinical examination, and imaging techniques:

• Medical History:
  • Collection of medical history, symptoms, and footwear.
• Clinical Examination:
  • Assessment of foot shape, deviation angle, and tenderness of the big toe joint.
• Imaging Techniques:
  • X-ray: Assessment of the angle between the big toe and metatarsal bone as well as other bony changes.
  • MRI: Visualization of soft tissue damage in case of suspected accompanying diseases.

Conservative Therapy

In early stages or with mild symptoms, conservative measures can help:

• Shoe Adjustment:
  • Use of wide, comfortable shoes with enough space for the toes.
• Orthopedic Insoles:
  • Support of the arch to reduce the load on the forefoot.
• Toe Spreaders and Splints:
  • Improvement of toe position and pain relief in mild misalignments.
• Physiotherapy:
  • Exercises to strengthen the foot muscles and improve mobility.
• Pain Therapy:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and inflammation.

Surgical Therapy

In advanced hallux valgus or severe symptoms, surgery is necessary:

• Chevron Osteotomy:
  • Correction of the misalignment by cutting and reshaping the metatarsal bone.
• Lapidus Arthrodesis:
  • Fusion of the first metatarsal joint for stabilization.
• Minimally Invasive Procedures:
  • Gentle techniques for correcting minor misalignments with faster recovery.

To prevent hallux valgus, the following measures are recommended:

1. Suitable footwear: Wearing shoes with a wide toe box and good cushioning.
2. Foot exercises: Regular exercises to strengthen the foot muscles.
3. Avoiding overload: Avoiding tight or high-heeled shoes in everyday life.
4. Early treatment: Immediate therapy at the first signs of misalignment.
5. Weight management: Reducing excess weight to relieve the foot.