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Should hallux rigidus be visible on Xrays? Mine only shows a mild hallux valgus and a very small calcification (that was 8 months ago). Could that cause big toe joint paint ? Any solution?
21 أبريل 2015
رأي ثانوي

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د. Zakia Dimassi طب الأطفال
There must be something else going on to trigger significant pain in your affected toe, because mild hallux valgus should not be associated with this much pain. It could be a tendonitis, probably exacerbated by putting too much stress on your toes (I think you're the girl who dances ballet, right?), and which could arise as a complication of the bunion. Now although it has been demonstrated that ballet dancing in and by itself does not increase the likelihood of developing hallux valgus, employing an incorrect dancing technique may in fact make hallux valgus worse. I'll explain in more details:Hallux valgus deformity is commonly known as a bunion. Hallux valgus deformity in and of itself is not a bunion, but bunions tend to occur more frequently in individuals with this abnormality. A bony prominence can form as a result of the abnormal shape of the metatarso-phalangeal joint (MTP joint, where the big toe is attached to the foot) joint and this is referred to as a bunion. Bursitis (inflammation of the bursa) can also occur as a result of hallux valgus deformity (the burse is basically a sac filled with fluid, it is located on the medial side of the MTP joint of the big toe; it acts like a cushion to protect the joint from the impact of trauma).

It is true that hallux valgus deformity is not more common in dancers than in the general population, but bunions are encountered more commonly ballet dancers. Unlike what most people think, bunions are not caused by ballet or dancing on pointe. However, it remains true that employing an incorrect technique, poorly fitting pointe shoes and a predisposition due to hallux valgus deformity can exacerbate bunions.

Dancers who have an inborn deformity in the MTP joint, known as congenital metatarsus primus varus, are the most likely to develop bunion. In congenital metatarsus primus varus, the big toe has an outward-directed curvature, toward the center of the foot (away from the midline). This curvature forces the first metatarsal to be subjected to the largest portion of the force applied while doing pointe or demi-pointe. Forcing turn-out causes pronation, which can exacerbate bunions, as well as rolling forward or “winging” the foot while on pointe.

To overcome this problem, you may want to resort to padding the first metatarsal, by using a U-shaped cushion over the MTP joint and spacers between the first and second toe. These measures, along with being vigilant about how you position your foot and ankle while dancing, as well as correct fitting of pointe shoes, are likely the best approach. It is recommended that ballet
dancers suffering from bunions are fitted with a higher vamp to support the MTP joint.
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