Hallux Valgus

Abstract

Hallux valgus, frequently accompanied by a medial forefoot prominence often referred to as a bunion, is a common entity seen in orthopedics. This deformity is more common in women and can frequently be familial. Patients frequently complain of difficulty wearing shoes, pain medially at the first metatarsphalangeal (MTP) joint, and cosmetic concerns over the appearance of their great toe. Simplistically, the deformity consists of lateral deviation of the proximal and distal phalanx with medial deviation of the first metatarsal. However, there is a complex interaction between several soft tissue structures that lead to the formation and progression of this deformity. Treatment initially involves nonoperative modalities such as wearing wider shoes to accommodate the deformity, toe spacers between the first and second toes, and other orthotics for symptomatic relief. Operative management is reserved for cases where symptoms are unbearable despite nonoperative measures and frequently include a combination of soft tissue releases and osteotomies. There are a variety of osteotomies available and the selection of osteotomy technique is largely dependent upon the magnitude of the deformity and the surgeon preference. Furthermore, many elderly patients with hallux valgus present with arthritis of the first MTP joint and in these cases an arthrodesis can relieve pain and correct the deformity.

Hallux Valgus Questions and Answers
What is another common name for hallux valgus?	Bunion deformity
What two types of hallux valgus exist?	Adult and juvenile
How do you describe the great toe in hallux valgus?	Hallux is in valgus and pronated
What symptoms are common with hallux valgus	Pain over medial prominence with shoe wear, pain with range of motion of first toe
What is the first-line treatment for hallux valgus?	Shoe modification (wide toe box shoe), toe spacers, and orthotics
What are some differences between adult hallux valgus and juvenile hallux valgus?	Juvenile hallux valgus is often bilateral, familial, usually not painful (more cosmetic concerns)
The sesamoids are found within which muscle’s tendons?	Flexor hallucis brevis
What is the hallux valgus angle (HVA )?	Angle between a line through the long axis of the first metatarsal and a ling through the long axis of the proximal phalanx
What is the intermetatarsal angle (IMA )?	Angle between the long axis of the first metatarsal and the second metatarsal
What is considered normal for the HVA ?	Less than or equal to 15°
What is considered normal for the IMA ?	Less than or equal to 9°
What are the names of some of the distally based osteotomies of the first metatarsal commonly used in correction of hallux valgus?	Chevron , Mitchell
What are the names of the proximally based osteotomies of the first metatarsal commonly used in correction of hallux valgus?	Scarf , Ludloff
What is the indication for a Lapidus procedure ?	First TMTJ instability, Lapidis is a fusion of the first TMTJ