MEASUREMENT OF HALLUX VALGUS

AIM: TO MEASURE ANGLE OF HALLUX VALGUS

MATERIALS REQUIRED:
Transparent goniometer, and Fine-tip coloured skin markers, scale

PROCEDURE:

Position of Patient:
In supine lying-crook lying position.

Markings:
● Locate navicular tuberosity (most prominent point) which lies
approximately two finger breadth antero-inferior from medial malleolus.

● Move anterior to navicular tuberosity to find a dip which constitutes 1st

Tarso-Metarsal joint.

● Then, from locating the Tarso-Metarsal joint you move upwards to find
depression that makes the lateral most point of 1st MetaTarsal bone.

● Mark the lateral most point of 1st MetaTarsal bone with a fine tip skin
marker. Also, mark 3-4 arbitrary points on the lateral border of the 1st
MetaTarsal bone.

● Mark the medial most point of 1st MetaTarsal bone with a fine tip skin
marker. Also, mark 3-4 arbitrary points on the medial border of the 1st
MetaTarsal bone.

● Now, take the midpoint of each arbitrary points marked on medial &
lateral border of 1st MetaTarsal bone and mark it. Join the midpoints by
 drawing the line which becomes parallel to the axis of 1st MetaTarsal
bone.

● Now, follow the shaft of 1st MetaTarsal and palpate MetaTarso-

Phallangeal (MTP) joint line. To confirm MTP joint line move the great
toe phallanx by fixating shaft of 1st MetaTarsal, the palpation of the dip
or the concavity confirms the 1st MTP joint line.

● Mark the midpoint of 1st MTP joint line.

● Mark the midpoint of great toe nail.

Position of Goniometer:
Fulcrum: It is positioned on the centre of the MTP joint line.
Resting arm: It is placed on the line joining mid-points of the 1st metatarsal
along its length.
Movable arm: It is kept parallel to the axis of the first phallanx or great toe
aligned along the centre of toe nail.

Measurement:
Now, take the measurement using the goniometer.
 Fig: (a) measuring of angle of hallux valgus by goniometer.

READINGS:
Right Foot (1st MTP) = 60
Left Foot (1st MTP) = 70

RESULT:

NORMAL: 0-70
HALLUX VALGUS: 70-110
SEVERE HALLUX VALGUS: >110

CONCLUSION:
There is angle of hallux valgus for the left 1st MTP joint. The right 1st MTP joint
range is in normal.
SOURCES OF ERRORS:

Examiner error:
● Error in marking points incorrectly.
● Error in placement of goniometer fulcrum, moving arm & resting arm.

Instrument error:
● Loose screw of goniometer.
● Zero error arise if starting position of Goniometer is not at zero mark.

Reading error:
● Measuring through incorrect markings.
● Parallax error arise if used incorrect view while taking measurements.
● If patient is constantly moving while examiner is taking measurements.

Patient error:
● If patient is constantly moving while examiner is taking measurements.
● Incorrect positioning of foot during measurement or incorrect posture of
the patient during measurement.
● Plantar flexed position of foot can affect tarso-metatarsal joint,
therefore hallux valgus.

CLINICAL SIGNIFICANCE:

1) Out of all the foot deformities, 32% have hallux valgus.

2) Hallux valgus could be an independent problem, or majority of

times it is associated with ankle problem.

3) It provides important information about the severity and

progression of the deformity.
4) Hallux valgus is a common condition characterized by the
deviation of the big toe towards the other toes, leading to a
bunion formation.

5) The angle measurement can help guide treatment decisions

such as determining whether the conservative measures like
orthotics or physical therapy are sufficient or if surgical
intervention is necessary.

6) It serves as a baseline measurement for tracking the

effectiveness intervention and monitoring the progression of the
deformity