Hallux Valgus

Introduction

 Hallux valgus means lateral deviation of great toe

 Commonest of foot deformities
 Not a single disorder; but a complex deformity of the first ray
 Frequently accompanied by deformity and symptoms in lesser toes
 Anatomy
 The head is grooved inferiorly
by medial and lateral sesamoid
bones in the tendons of Flexor
hallucis brevis
 The proximal phalynx is round
on three sides but flat
inferiorly, even concave
inferiorly for the flexor hallucis
longus tendon
Causes of Hallux Valgus

 Congenital Hallux valgus :

 Very rare
 Metatarsus primus varus is common at birth
 Concealed supernumerary phalynx may be the cause
 Shortened second metatarsal
 Hereditory :
 Johnston(1956) : Transmitted as autosomal dominance with incomplete
penetration
 Age:
 14-16 in girls and little later in boys
 Symptomatic hallux valgus is more common after 40 years of age, mostly
bilateral.
Causes of Hallux Valgus

 Sex:
 Women > Men
 Women : Men = 50: 1
 Predisposed by pointed compressive high heeled shoes
Causes of Hallux Valgus

 Shoes: “Shoes as at present worn, serve but to

deform the toes and cover the feet with
corns” – Camper (1781)

 Has been considered as extrinsic cause of Hallux Valgus

 In Chinese population, Hallux valgus was more common due to special
compressive shoe wearing habits.
 Tight fitting show at toes have been proven as cause of bunion, corns.
Pathogenesis

 1st metatarsal inclines medially

 Proximal phalynx deflects in opposite direction
 Joint knuckles towards the midline –
prominence of forefoot at the tibial border
 Great toe pronates – Nail and hallux slants
medially, pulp towards second toe
 Great toe may ride over 2nd digit or slip under
it
 Lesser toe – crowded together, clawed,
hammered
 Bunionette:- deformity at outer border of
forefoot
 Forefoot is splayed
Clinical features

 Symptoms:

 Pain in foot
 Difficulty in being fitted with shoes
 Gait changes
 Corns
 Keratosis
 Cosmetic deformity
Investigations:

 Xrays:
 3 views:
1. AP view
2. Oblique views
3. Axial exposure of Sesamoid.
 Xray of opposite foot for comparison
should be taken
Classification of hallux valgus

 Pigott (1960) classified HV into 3 types based on congruity of 1st MP

joint
 Type 1: Congrous joint
 Type 2: Deviated non congruous joint
 Type 3: Subluxated joint
Classification of hallux valgus

 Mann and conghlin(1993) classified HV into 3 types based on Hallux

valgus angle
 Mild: Angle < 20 degree, intermetatarsal angle usually less than 11 degree
 Moderate: Angle 20 - 40 degree, intermetatarsal angle between 11 and 18
degree
 Severe: Angle > 40 degree, intermetatarsal angle > 16-18 degree
Classification of hallux valgus

 From surgical point of view , it can be classified as

1. Simple hallux valgus
1. Without sagittal groove
2. With sagittal grove
2. Hallux valgus with axial rotation
1. Reducible
2. Irreducible
3. Hallux valgus with metatarsus primus varus
1. Mobile/ hypermobile first metatarsal
2. Fixed varus
4. Hallux varus with degenerative arthritis of joint
5. Hallux valgus with mixed deformities
Treatment of hallux valgus

 Conservative Management:
 Young and asymptomatic patients
• Proper fitting shoes with wide deep toe boxes
• Night splinting and other orthosis
 Once the deformity is established, it is difficult
to check the progression of disease by
conservative measures.
Surgical Treatment

 Indications of operative treatment

 Failure of non operative measures
 Persistent pain that interferes with daily work
 Severe deformity and pain unlikely to respond to conservative
measures
Mitchell osteotomy
Conclusion

 Hallux valgus is the most common deformity of foot

 Commonly seen an adolescent females and becomes symptomatic in
middle age
 Can be treated conservatively if diagnosed early
 Surgery is the only option after the deformity develops.