Hallux Valgus: characterised by medial deviation of the first metatarsal and lateral deviation of the hallux, opinion is split on the effectiveness of hallux correctors, but let us recap the pathophysiology first.
Foot structure, posture and functional alignment in gait are the main underlying cause, and should always be addressed first. In normal gait the hallux and first met stay more or less parallel, but in for example a pronating foot with forefoot abduction moments it allows the extensor hallucis longus and flexor hallucis longus to gain a mechanical advantage, these only increase as the joint is displaced. As this occurs greater tension is placed on the medial collateral ligaments of the 1st MTPJ joint space leading to bony proliferation, cartilage remodelling, and sesamoid subluxation laterally. At this point if the abnormal biomechanics are not corrected then the deformity will only proliferate.
With an advanced hallux valgus with bony changes the 1st MTPJ joint is becoming fairly rigid, and disappointingly at this stage bunion corrector referrals may appear and it really is too late. The joint will never be restored to good alignment, the very use of ‘corrector’ in the title is a little spurious, and at this point the device is little more than a psychological treatment. More recently referrers are being proactive in addressing the biomechanics early to prevent future deformity. A hallux valgus corrector in conjunction with a functional foot orthosis can have a good outcome in the early subtle deviations, with patients reporting a reduction in pain.
Surgery often is indicated for those moderate to severe cases, but to note surgical intervention is becoming more minimally invasive for moderate hallux valgus, requiring minor bony augmentation sparing soft tissues; reducing post-operative pain, infection, and admission time. Pace is gathering in conservative methods of managing the soft tissue therefore advocating the use of corrector’s pre surgery to prepare soft tissue, and post operatively to maintain alignment until healing is complete. They can be especially useful post op in safeguarding until a functional foot orthotic is ready to be implemented to address abnormal foot biomechanics.
In order to be effective in stretching the soft tissue a controlled dynamic stretch should be used in the correct plane. Hallux correctors often are rigid or soft, with crude designs in anchoring around the instep and pivoting on the medial aspect of the 1st MTPJ. These designs are often uncomfortable on the medial aspect of the 1st MTPJ, and often slip and or rotate directing the force not in the correct plane. Strapping or elasticity of the item will degrade and lengthen making precise incremental changes to force and fit difficult to determine, and not a constant repeatable value.
The perfect solution is the Halluxsan. It has a unique spring tension hinge that exerts an impressive corrective force of 1.1 to 6.8Nm via a numbered dial; this prolonged stretch stimulates growth in the shortened structures, and can be dialled in to a comfortable safe level depending on each individual clients requirement. Often a higher spring tension is utilised pre than post op. Post op often the scar is at the medial aspect of the 1st MTPJ therefore other devices would in fact interfere with the wound, whereas the Halluxsan can be used much earlier due the design not levering off the medial aspect of the 1st MTPJ. When used pre op or as a conservative option in its own right it will not aggravate an often vulnerable and sensitive area. It has a wide stabilising padded instep anchor which ensures no loss of position or mechanical advantage, overall an exceptionally high quality, long lasting, intuitively designed product for the best clinical outcomes.
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