Hallux valgus (bunion) and hallux rigidus

Definition

What is a hallux valgus?

Hallux valgus is the most common deformity of the forefoot and toes. Because of its conspicuous shape, it is also known as bunions or bunions. It is a deformity of the metatarsophalangeal joint of the big toe. The big toe deviates outwards and displaces the other toes. A painful, inflamed protrusion often forms at the metatarsophalangeal joint.

What is hallux rigidus?

Hallux rigidus is a degenerative disease of the metatarsophalangeal joint of the big toe, whereby the joint becomes arthritic due to wear and tear of the articular cartilage. The inflammatory processes in the metatarsophalangeal joint of the big toe can lead to stiffening and bone outgrowths (osteophytes). These also lead to friction, inflammation and restricted movement. The upward extension movement (dorsiflexion) in particular is restricted in the metatarsophalangeal joint.

Cause of hallux valgus and hallux rigidus

The causes of hallux valgus and hallux rigidus are closely linked to modern lifestyles and changing environmental conditions. Our ancestors moved extensively and intensively in order to obtain food - be it by hunting, picking berries or farming. These activities usually took place barefoot on natural, uneven ground, which optimally challenged and strengthened the foot and leg muscles.

Over the millennia, lifestyles have changed massively. Today, a lack of exercise and a predominantly sedentary lifestyle are widespread. When movement does take place, it is usually on hard, flat surfaces such as concrete or asphalt - often in immobile, supportive shoes. These altered conditions affect both the quantity and quality of movement and lead to physical adaptations that can overload the metatarsophalangeal joint. The effects of these changes on the development of hallux valgus and hallux rigidus are described below.

Lack of exercise and a sedentary lifestyle

The modern way of life, which is characterized by a lack of exercise and a sedentary lifestyle, places incorrect strain on the musculoskeletal system. The lack of exercise and sedentary lifestyle lead to physical adaptations that can promote hallux valgus and hallux rigidus. The following changes play a significant role in the development of hallux valgus and hallux rigidus:

• Weakened muscles

  A lack of exercise and a predominantly sedentary lifestyle cause the essential muscles to atrophy. Weakened muscles in the foot and lower leg area can make a decisive contribution to the development and worsening of hallux valgus and hallux rigidus. Muscular balance plays a central role in hallux valgus in particular. The small, stabilizing muscles in the foot, above all the abductor hallucis muscle, increasingly lose strength due to lack of movement and prolonged sitting. As a result, the balance of forces between the inner and outer pulling directions of the big toe becomes unbalanced. As a result, the big toe is gradually pulled outwards, while the first metatarsal head shifts inwards - creating the typical bunion.
  Weak muscles also play a negative role in hallux rigidus. The lack of stability and inadequate support for the natural rolling movement leads to incorrect and excessive strain on the joint. These one-sided or excessive loads promote premature wear of the joint cartilage. At the same time, the reduced movement results in a lack of important stimuli for the supply and nutrition of the cartilage, which further promotes degenerative processes.
  

• Foot malpositions

  Weakened muscles can also lead to foot misalignments. Foot misalignments change the statics and dynamics of walking and lead to incorrect and overloading in the big toe joint, thus promoting structural changes that encourage the development of hallux valgus and hallux rigidus.
  In the case of splayfoot, for example, the front transverse arch diverges, causing pressure to be distributed unevenly on the forefoot when walking. This puts excessive pressure on the first metatarsal head, which leads to instability in the metatarsophalangeal joint. This instability promotes the malpositioning of the big toe outwards - the typical hallux valgus develops. In addition, the lowering of the transverse arch and the incorrect loading changes the direction of pull of the tendons and ligaments, which further increases the deviation of the big toe.
  A lowering of the longitudinal arch (e.g. in flat feet or fallen arches) can lead to increased pressure on the metatarsophalangeal joint, as the natural shock absorber function of the longitudinal arch is missing. This permanent strain promotes cartilage wear and inflammatory processes, which gradually reduces the mobility of the metatarsophalangeal joint. Over time, the joint stiffens and hallux rigidus develops.
  Reduced foot musculature can also lead to overpronation and thus to unnatural and excessive strain on the metatarsophalangeal joint, which can further promote the development of hallux valgus and hallux rigidus.
  

• Fascia dysfunction

  Fasciae are connective tissue sheaths that surround and connect muscles, tendons and joints. They are crucial for smooth movement and power transmission in the body. However, these fasciae can shorten, harden or stick together if there is a lack of movement, incorrect strain or too little varied movement. In the foot area, this particularly affects the natural mobility of the metatarsophalangeal joint.
  A change in the original fascia structure in the sole of the foot or the calf muscles can create permanent tension via muscle and fascia chains, which, among other things, gradually pulls the big toe outwards - typical of hallux valgus. At the same time, the shortened, hardened or adhered fascia inhibits the deep muscles of the foot. However, these play a decisive role in stabilizing the longitudinal and transverse arches and in the correct alignment of the toes.
  At the same time, the altered fascia structure impairs the harmonious rolling movement of the foot, which promotes stiffening of the big toe joint and thus hallux rigidus. Muscle activity is also inhibited by inelastic fascia, which in turn weakens the stabilization of the joint and increases structural deformities.
  

• Joint stiffness

  Increasing stiffness of the ankles can contribute significantly to the development or worsening of hallux valgus and hallux rigidus. Joints need regular, varied movement to maintain their full function and mobility. However, if the foot is subjected to too little or one-sided strain due to a lack of movement and a sedentary lifestyle, it loses flexibility - especially in the area of the metatarsophalangeal joint. Stiff joints in the foot and lower extremities can increase the force exerted on the metatarsophalangeal joint of the big toe, as the transmission of force in the corresponding joints cannot be regulated properly.
  In the case of hallux valgus, this restricted mobility means that the natural rolling over the big toe can no longer be performed completely or correctly. Instead, the foot shifts to other structures, which unbalances the muscles and connective tissue in the area of the big toe. In combination with weak foot muscles and altered traction conditions, the big toe is pulled outwards while the metatarsal bone shifts inwards.
  Joint stiffness in the ankles limits the natural rolling movement from the heels via the metatarsophalangeal joint. If the metatarsophalangeal joint is not regularly used to its full range of motion, the cartilage supply deteriorates, which promotes degenerative processes. The joint becomes increasingly immobile, inflammatory processes increase the pain and restriction of movement - a vicious circle begins.

Hard, flat floors and stiff, restrictive footwear

The changed environmental conditions have a considerable influence on the strain on the musculoskeletal system. The hard, flat floors and immobile, supportive shoes change the biomechanics of every single step and are therefore a decisive factor in the cause of hallux valgus and hallux rigidus. The following changes play a significant role in the development of hallux valgus and hallux rigidus:

• Force impact

  When walking on natural, yielding surfaces such as meadows, sand or moss, the impact energy is gently absorbed by the ground. Modern hard surfaces such as concrete or asphalt, on the other hand, reflect the impact energy almost completely back into the foot. This significantly increases the peak loads on the foot structures. Immobile, supportive footwear, which further restricts the foot's natural cushioning and rolling function, increases the enormous point loads. This results in excessive misloading and overloading, particularly in the metatarsophalangeal joint.
  The hard, flat floors and immobile, supportive shoes mean that the force is applied to the feet more intensely and more quickly. The unnatural and high load places incorrect and excessive strain on the relevant foot muscles. Muscular imbalances can be the result, causing altered muscle tension. This can consequently lead to the big toe being pulled outwards. Hallux valgus is the result of the increased force.
  In the case of hallux rigidus, the constant stress peaks have a direct effect on the metatarsophalangeal joint of the big toe. The cartilage is broken down more quickly due to the repeated pressure, joint mobility decreases and the first painful movement restrictions occur. In the long term, the joint becomes increasingly stiff - typical of hallux rigidus.

• Unnatural sequence of movements

  On natural, soft ground, the foot must constantly make small adjustments and compensatory movements when walking in order to adapt to the surface. This actively strains the foot muscles and joints and keeps them flexible. Hard, flat floors such as concrete or asphalt, on the other hand, prevent this natural adaptation as they hardly give way. Inflexible, supportive shoes further restrict the natural rolling movement by supporting and fixing the arch of the foot. The feet no longer actively "roll" over the heel, midfoot and toes, but instead strike the ground almost rigidly. In the long term, this reduced sequence of movements leads to a reduction in the relevant foot and leg muscles, resulting in imbalances in the muscle strands. The altered muscle tension can cause the metatarsal bones to shift and favour the outward positioning of the big toe.
  Due to the reduced rolling over the forefoot, the metatarsophalangeal joint loses flexibility through lack of movement, which promotes painful stiffening. At the same time, the reduced movement results in a lack of important stimuli for the supply and nutrition of the cartilage, which further promotes degenerative processes.

• Weakened muscles

  The passivity of the feet on hard, flat floors and in immobile, supportive shoes also leads to a breakdown of the essential muscles. The weakened foot muscles can cause the transverse and longitudinal arches to drop. This lowering of the arch of the foot can lead to a change in the angular position of the bony and myofascial structures and thus to a skewed position of the big toe. The lowering of the arches also means that the foot loses its natural cushioning to absorb the forces acting on it. The force acting on the metatarsophalangeal joint is therefore increased, which also increases the strain. Over time, this can result in hallux valgus as well as hallux rigidus. Reduced foot musculature can also lead to overpronation and thus to unnatural and excessive strain on the metatarsophalangeal joint, which can also promote the formation of hallux valgus and hallux rigidus. Furthermore, the weakened foot musculature promotes the development of a clubfoot. The uncontrolled folding of the foot after heel strike can also lead to increased force being exerted on the metatarsophalangeal joint of the big toe, causing it to be misloaded and overloaded. Both foot deformities develop because the natural statics and mobility of the foot are out of balance.

Hallux valgus and hallux rigidus symptoms

It is important to note that the following are the most common hallux valgus and hallux rigidus symptoms. However, the list of symptoms is not complete and exhaustive. Atypical symptoms that are not listed here are also possible. Hallux valgus and hallux rigidus symptoms often depend on various factors such as pain sensation, cause, severity of the condition and physical constitution. In order to obtain a clear diagnosis of hallux valgus and hallux rigidus, a doctor should be consulted.

Hallux valgus:

• Crooked big toe: The big toe leans increasingly towards the second toe - the main characteristic of hallux valgus.
• Painful bunion: A clearly visible, often reddened and pressure-sensitive bunion develops on the inside of the foot at the metatarsophalangeal joint.
• Swelling and inflammation: Friction and pressure (e.g. in shoes) often cause irritation and inflammatory swelling around the affected joint.
• Pressure pain in the shoe: Tight or tight shoes cause pain, especially when walking or standing for long periods of time.
• Limited mobility of the big toe joint: The mobility of the joint can progressively decrease over time.
• Corns or calluses: Incorrect loading leads to an increase in calluses or corns - especially on the ball of the foot or between the toes.
• Change in gait: To avoid pain, the gait pattern is often changed, which in turn can trigger other complaints (e.g. knee or hip pain).
• Second toe is displaced or overlapped: The second toe can be pushed upwards or displaced by the pressure of the crooked big toe.
• Feeling of instability in the forefoot: Those affected often feel a loss of control or a "giving way" in the forefoot when rolling.
• Pain in the midfoot: The change in load often causes additional pain in the area of the metatarsal bones.

Hallux rigidus:

• Stiff big toe: Mobility in the metatarsophalangeal joint of the big toe is significantly restricted - upward rolling (dorsiflexion) in particular causes problems.
• Pain when walking: Pain associated with weight-bearing occurs particularly when rolling the foot or pushing off with the big toe.
• Start-up pain: At the beginning of a movement - for example when standing up - the joint hurts particularly badly, but improves after a short time.
• Pressure pain over the metatarsophalangeal joint: The joint is often sensitive to pressure, especially with tight shoes or direct contact.
• Swelling of the joint: Inflammatory reactions in the joint lead to visible swelling, occasionally accompanied by redness and warmth.
• Increased pain in cold or damp weather: Many sufferers report weather-related pain, especially when exposed to cold.
• Bone outgrowths (osteophytes): Palpable and visible bony protrusions (joint capsule ossifications) can form on the joint.
• Numbness and sensory disturbances in the big toe: Bone outgrowths or swelling caused by inflammation can exert pressure on surrounding nerves.
• Altered gait pattern: The pain and restricted movement often cause the gait pattern to change unconsciously - e.g. by shifting to the outside of the foot.
• Exercise-induced pain: Activities involving a lot of rolling movements (e.g. jogging, hiking) in particular exacerbate the symptoms.
• Avoidance posture / compensatory movements: To avoid pain, avoidance movements are used, which can lead to further problems in the knee, hip or back.

Conventional therapies - What helps with hallux valgus and hallux rigidus

There are several approaches to treating hallux valgus and hallux rigidus. Some hallux valgus and hallux rigidus therapies are listed below. The list of hallux valgus and hallux rigidus therapies is not exhaustive. Various measures can also be combined to treat hallux valgus and hallux rigidus. A medical consultation is recommended to determine the appropriate hallux valgus and hallux rigidus therapy.

Hallux valgus:

• Wide shoes with a soft upper: relieves pressure on the bunion area and reduces pressure on the ball of the big toe.
• Insoles with pad: Support the arch of the foot and relieve pressure on the big toe.
• Toe orthoses / hallux valgus splints: Slightly straighten the big toe mechanically and prevent the deformity from progressing.
• Foot gymnastics and strengthening exercises: Strengthen the foot muscles, promote natural toe alignment and improve foot statics.
• Adaptation of running and walking habits: An analysis of the running technique or gait pattern can help to identify and correct incorrect loading in order to avoid future complaints.
• Fascia therapy and mobilization: loosen adhesions, improve circulation and support mobility in the foot.
• Walking barefoot on a natural surface: Promotes the foot muscles and the natural rolling movement.
• Physiotherapy: Individual movement exercises and manual therapy to improve the function of the foot.
• Weight reduction for overweight people: relieves the forefoot and reduces the mechanical load on the metatarsophalangeal joint.
• Acupuncture: Can help with pain and muscular tension.
• Kinesiology taping: Promotes blood circulation, supports the muscles and relieves pain.
• Surgical procedures: Depending on the severity and cause of the deformity, various surgical procedures are possible.

Hallux rigidus:

• Shoe modifications (stiff soles, roll-off aids)
  Special shoes or sole relief elements reduce the strain on the metatarsophalangeal joint and thus the pain when walking.
• Insoles with rigidus spring or carbon plates: Limit painful toe movement and improve power transmission when rolling.
• Physiotherapy and mobilization: Maintains or improves the mobility of the joint, loosens adhesions and strengthens the surrounding muscles.
• Foot gymnastics and muscle strengthening: Activates the foot muscles and can improve the load distribution on the foot.
• Fascia therapy and stretching exercises: Release tension and improve circulation in the metatarsophalangeal joint area.
• Adaptation of running and walking habits: By analyzing the running technique or gait pattern, optimization possibilities for natural rolling over the big toes can be assessed.
• Cooling for acute inflammation: Reduces swelling and pain caused by acute irritation.
• Drug treatment (NSAIDs)
  Non-steroidal anti-inflammatory drugs such as ibuprofen relieve pain and inhibit inflammation.
• Kinesiology taping: Supports joint function and blood circulation, relieves pain.
• Acupuncture: Can also be helpful for chronic pain.
• Weight reduction for overweight people: Reduces the load on the big toe joint.
• Surgical measures: Depending on the severity of the joint wear, various surgical procedures are possible. There are several solutions, including the removal of bone spurs and friction points, stiffening of the metatarsophalangeal joint and joint replacement.

Unfortunately, these measures often do not lead to a long-term reduction in the symptoms of hallux valgus and hallux rigidus, as the causes of hallux valgus and hallux rigidus are not eliminated. The aim of every hallux valgus and hallux rigidus treatment should therefore be to eliminate the causes. As described above, the lack of movement, the sedentary lifestyle, the hard, flat floors and the immobile, supportive shoes should be addressed. The kybun mode of action proves to be a suitable hallux valgus and hallux rigidus therapy that can eliminate the causes mentioned.

kybun mode of action - What helps with hallux valgus

Kybun products aim to eliminate the harmful effects of hard, flat floors and immobile, supportive shoes and actively tackle the lack of exercise and sedentary lifestyle. The elastic, springy properties of kybun products relieve pressure on the feet on the one hand and activate them on the other. The relief ensures that the symptoms of hallux valgus and hallux rigidus are reduced as a first step. Activation is intended to tackle the causes of hallux valgus and hallux rigidus so that the symptoms become a thing of the past in the long term. This makes kybun shoes ideal for hallux valgus and hallux rigidus, as they help to treat hallux valgus and hallux rigidus thanks to the following modes of action:

• Activation of the foot muscles through elastic-springy properties

  The elastic, springy properties of kybun products lead to conscious instability, forcing the body to make small compensatory movements. This automatically activates and strengthens the deep-lying foot muscles. Strong foot muscles play a central role in stabilizing the arches of the feet, protecting against overpronation, reducing the load and aligning the toes.
  In hallux valgus, the big toe often shifts outwards because the stabilizing muscles are too weak to counteract the one-sided load. However, if the foot muscles are regularly activated and trained - such as by walking on an elastic, springy surface - they can better counteract the strain on the big toe and prevent deformities (such as bowed feet). In particular, the muscles that support the ball of the big toe and keep the toe in its axis benefit from this targeted activation. In this way, the risk of developing hallux valgus can be significantly reduced or its progression slowed down.
  The slow and controlled sinking of the heel into the elastic, springy material creates myofascial pretension in the muscles involved. This pretension and the improved muscular activity prevent the foot from collapsing and the forefoot can be loaded in a controlled manner, which protects the metatarsophalangeal joint from incorrect loading and overloading. The controlled lowering of the foot has a positive effect on both hallux valgus and hallux rigidus.
  The elastic, springy sole forces the foot to make a gentle but complete rolling movement from the heel to the midfoot and forefoot. As a result, the big toe joint remains in motion, is evenly loaded and benefits from the improved blood circulation and supply from the activated muscles. In this way, degenerative changes can be delayed or, in the best case, prevented, which can effectively counteract the development of hallux rigidus.

Balance and EMG

The ability to maintain balance was measured with a force plate by moving the body's center of gravity from front to back (ant-post) and sideways (med-lat) when standing. At the same time, muscular activity was recorded using electromyography (EMG).

• Natural foot roll thanks to muscle activation and roll-off function

  In a healthy rolling movement, all foot structures are loaded evenly, which supports an even distribution of the force exerted. Furthermore, the big toe is included in its natural extension and support function. This stabilizes the metatarsophalangeal joint and prevents the toe from deviating sideways - which is typical of hallux valgus. In addition, natural rolling activates the foot muscles, especially those that support the longitudinal and transverse arches and hold the joint in its axis.
  
  When the foot rolls naturally, the movement is evenly distributed from the heel to the midfoot to the big toe. The metatarsophalangeal joint of the big toe is regularly used throughout its entire range of motion - especially in extension during push-off. This repetitive, functional movement keeps the joint mobile, promotes blood circulation and stimulates the production of synovial fluid, which is crucial for cartilage nutrition (especially in the case of hallux rigidus). At the same time, the surrounding muscles are activated and strengthened, which supports the stability and relief of the joint.

• Reduction of the force impact of hard, flat floors through damping effect

  When the heel strikes the kybun shoes, the elastic, springy material is compressed. As the heel slowly sinks into the kybun sole, the load increases with a delay. The muscles can use this extra time to stabilize adequately, so that the foot does not drop uncontrollably after heel strike, causing the metatarsophalangeal joint to be misloaded and overloaded.
  Thanks to the elastic-springy property, the force generated can be absorbed for a short time and released for forward movement and active rolling. The advantages of active rolling were explained in the previous section.
  The cushioning effect of the elastic-sprung soles also relieves the metatarsophalangeal joint during the rolling phase, as the ground reaction forces are not transmitted to the joint unfiltered, but are gently cushioned and evenly distributed.

• Optimized pressure distribution

  When walking and standing in kybun shoes, the entire sole of the foot is surrounded by the elastic, springy material. This leads to optimized pressure distribution in the feet, whereby the forces exerted are distributed more evenly over the entire sole of the foot. This prevents excessive pressure peaks on the metatarsophalangeal joint - particularly on the medial side in the case of hallux valgus or directly on the joint in the case of hallux rigidus. This prevents one-sided overloading and irritation of the joint.

• Protection against fascia dysfunction thanks to physiological movement sequences

  Thanks to the slow sinking in during heel strike and the controlled rolling, a physiological gait is made possible, which also protects the fasciae from structural changes. A well-functioning fascia network can prevent hallux valgus by providing the necessary resilience, elasticity and coordination throughout the entire musculoskeletal system - especially in the foot. Fascia envelops muscles, tendons and ligaments and transmits forces across joints. When this network is supple, well hydrated and free of adhesions, the muscles and ligaments that stabilize the metatarsophalangeal joint can work optimally. This keeps the joint in its natural axis and prevents the big toe from deviating outwards - as is the case with hallux valgus. Healthy fascia is just as important in the prevention of hallux rigidus so that the metatarsophalangeal joint can move freely when rolling. This prevents one-sided pressure loads and restricted movement, which can lead to stiffening of the joint in the long term.
  

• Improved circulation through increased movement activity

  Increased movement activity promotes blood circulation in the foot and toe area, which can make a decisive contribution to the prevention of hallux rigidus. Good blood circulation supplies the joint and surrounding tissue with oxygen and nutrients, which maintains cartilage health and inhibits inflammatory processes. At the same time, it promotes the removal of metabolic waste, which can lead to irritation and degenerative changes if there is a lack of movement. Regular exercise also keeps the metatarsophalangeal joint of the big toe mobile, prevents gradual stiffening and promotes the gliding ability of the joint surfaces - key factors in preventing the development of hallux rigidus.
  

• Promoting physical activity and reducing sedentary behavior

  The elastic, springy kybun products increase the pleasure of movement, as their unique material relieves the metatarsophalangeal joint when walking and standing. Regular, varied movement activates and strengthens the foot and leg muscles. The associated benefits have already been explained. At the same time, movement produces synovial fluid, which nourishes the cartilage in the big toe joint and protects it from wear and tear. Sitting less and walking more also ensures better blood circulation and more elastic fascia. The positive effects of this have also been described.

Application tips for hallux valgus and hallux rigidus

Before you wear kybun shoes for the first time, you should consider a few tips on how to use them. The correct use of hallux rigidus and hallux valgus shoes can help to alleviate the symptoms. Hallux valgus and hallux rigidus can also be treated with targeted therapy, which is explained in the next section.

• To begin with, only wear kybun shoes for as long as your body allows. Take breaks if the symptoms of hallux valgus and hallux rigidus become more severe or if your musculoskeletal system becomes tired. Hallux valgus and hallux rigidus treatment takes time. The activating properties of kybun products train the muscles, which can lead to so-called initial reactions, especially at the beginning.
  
• Press your heel slowly and in a controlled manner into the elastic, springy material so that you can feel your heel sink in and tense your foot and leg muscles. A deliberate and controlled heel strike will protect the metatarsophalangeal joint from uncontrolled folding of the midfoot and forefoot. At the beginning, make sure that the midfoot and forefoot are lowered slowly and that you do not roll too much over the forefoot. This is particularly important for hallux rigidus.
  
• Take small, controlled steps at the beginning to get used to walking in kybun shoes and to relieve the strain on the metatarsophalangeal joint. Increase the range of movement of your feet over time, if possible. Try to roll over the metatarsophalangeal joint in a controlled manner. In the case of hallux rigidus, test the possible range of motion of the metatarsophalangeal joint and make use of it.
  
• Try the following exercises to boost the effectiveness of kybun shoes and increase the likelihood of recovery. These are intended as a complementary therapy for hallux valgus and hallux rigidus and should be part of the treatment for hallux valgus and hallux rigidus.
  

Helpful exercises for hallux valgus and hallux rigidus

To enhance the effectiveness of kybun shoes and increase the likelihood of recovery from hallux valgus and hallux rigidus, we recommend performing the following exercises. The selection of exercises is not exhaustive and can be supplemented by other hallux rigidus and hallux valgus exercises. The basic rule for all exercises is that the pain should not get worse. If one of the exercises increases the pain, it must be discontinued. Soothing and relieving "pain" outside the pain point (e.g. in the sole of the foot) is desirable.
The exercises for hallux valgus and hallux rigidus are divided into the following areas: "Correct walking in kybun shoes", "Muscle length training", "Fascia rolling" and "Strengthening". Ideally, the different areas should be used as complementary therapy for hallux valgus and hallux rigidus

Walking correctly in kybun shoes
The quality of each individual step is crucial in the treatment of hallux valgus and hallux rigidus in order to reduce pain and eliminate incorrect and excessive strain. The kybun shoes therefore offer ideal therapy for hallux valgus and hallux rigidus.

Controlled heel strike

• Press the heel slowly and in a controlled manner into the elastic, springy material to pre-tension the foot and calf muscles.
• Lower the midfoot and forefoot slowly and in a controlled manner so that the metatarsophalangeal joint is loaded physiologically.
• Controlled foot position so that the foot does not tilt inwards.
• Take small steps at the beginning so that you do not have to roll too far over the metatarsophalangeal joint.

Controlled rolling

• Easy rolling in the forefoot without actively pushing off with a lot of force via the big toe. Active rolling puts additional strain on the metatarsophalangeal joint of the big toe.
• Test the possible range of motion when rolling in the forefoot without causing or increasing pain in the metatarsophalangeal joint.
• If possible, increase the range of motion and switch to active rolling.

Muscle length training
Muscle length training is important in the treatment of hallux valgus and hallux rigidus, as these are often caused by shortening and tension in the foot and leg muscles. Targeted stretching exercises can actively tackle the shortening and tension and are therefore an ideal therapy for hallux valgus and hallux rigidus.

Big toe correction for hallux valgus

• Place an elastic band (e.g. Theraband) around the big toe.
• Secure the strap with the other foot.
• Pull the foot outwards while standing or sitting so that the big toe is straightened.
• 2 minutes per side.
• perform 1 - 2 × daily.

Foot sole

• Take the foot in both hands.
• Actively pull the forefoot towards the shin to stretch the sole of the foot.
• Hold the exercise for 3 x 30 seconds.
• perform 1 - 2 × daily

Fascia roller
Fascia training with the fascia roller is important in the treatment of hallux valgus and hallux rigidus, as the development and symptoms are often caused by shortening and tension in the posterior chain (including the sole of the foot and calf muscles). By regularly rolling out the shortened and tense myofascial chain, the fascia roll can be used as an active hallux rigidus and hallux valgus therapy.

Foot sole

• Actively roll out the sole of the foot with a fascia roller or ball from the heels to the toes.
• Perform the exercise slowly and in a controlled manner.
• Adjust pressure to personal feeling, but go up to the tolerable pain threshold.
• Roll out any localised adhesions or hold the position at this point.
• 3 minutes per foot.
• perform 1 - 2 × daily.

Calf muscles

• One leg bent and the other leg on the fascia roll. Increase the pressure by placing the legs on both sides. Further increase by placing the legs on top of each other.
• If you experience pain in the wrist, the exercise can also be performed on the forearms.
• Actively roll out the calf above the heel to just below the hollow of the knee.
• Perform the exercise slowly and in a controlled manner.
• Adjust pressure to personal feeling, but go up to the tolerable pain threshold.
• Roll out any localised adhesions or hold the position at this point.
• At least 3 minutes per foot.
• perform 1 - 2 × daily.

Strengthening

Targeted strength training of the feet is particularly important for foot deformities (especially flat feet, fallen arches and fallen arches) in order to protect the metatarsophalangeal joint from overloading and incorrect loading. In general, strengthened foot and leg muscles help to ensure that the metatarsophalangeal joint can bear physiological weight and should therefore be part of the treatment for hallux valgus and hallux rigidus. Targeted strength training is an effective therapy for hallux valgus and hallux rigidus.

Foot muscles Longitudinal arch

• Stand upright and hip-width apart
• Heel and ball of foot have even contact with the ground.
• Slowly straighten the longitudinal arch without the heel or the ball of the foot losing contact with the ground.
• Also make sure that the movement comes from the feet and that the lift is not caused by the external rotation of the knees.
• Hold the position for 4 seconds at the highest point.
• Lower the foot again slowly and in a controlled manner.
• 3 sets of 8 - 12 repetitions per foot.
• Perform 2 - 3 × weekly.

Big toe lifts and toe raises

• Place your feet hip-width apart on the floor.
• Big toe lift: The big toe is actively lifted and slowly lowered again. All toes except the big toe remain on the floor. Do not lift the inner edge of the foot.
• Toe lift: Here, only the big toe remains on the floor. All other toes are actively lifted and slowly lowered again. Do not lift the outer edge of the foot.
• It is important that the balls of the feet and heels do not lose contact with the ground.
• To simplify the exercise, it can be performed alternately with one foot only.
• 3 sets of 8 - 12 repetitions per foot.
• Perform 2 - 3 × weekly.