Hallux Valgus

Excerpt

Hallux valgus, commonly referred to as a bunion or juanete, is one of the most prevalent forefoot deformities (see Image. Clinical Bunion Presentation). Hallux valgus is characterized by a lateral deviation of the proximal phalanx of the great toe and a medial deviation of the first metatarsal head, which further results in the adduction of the first metatarsal, a condition known as metatarsus primus varus. The precise etiology of hallux valgus remains unproven; it is generally believed to be multifactorial. The medical literature indicates that the condition is more prevalent in women than in men, with reported ratios as high as 15:1, and is often associated with prolonged use of narrow, poorly fitted shoes, especially high-heeled footwear. This is generally regarded as aggravative versus causative.

Diagnosis of hallux valgus deformity is primarily clinical and based on the characteristic deformity with the great toe contracted towards the second digit. Tenderness over the medial bone eminence is common and often associated with a restricted and painful range of motion of the first metatarsophalangeal joint. Radiographic imaging, particularly in weight-bearing, is important for evaluating angular deformity and assessing the joint for incongruence and potential degenerative changes (see Image. Radiographic Hallux Valgus).

Initial management should focus on measures to alleviate symptoms and slow the progression of the deformity. Conservative treatments include ice, stretching, wider shoes, functional and firm orthotic/supportive devices, prescription or over-the-counter nonsteroidal anti-inflammatory drugs, cryotherapy, foot pads or toe spacers, taping, night splints, home or in-clinic physical therapy, and steroid injections. When appropriate treatments fail to provide desired relief or halt the progression of the deformity, or when the deformity compromises the patient's function, surgical management should be considered.

This determines if the patient is a good candidate for surgical correction of the deformity. Surgical outcomes are generally favorable with high patient satisfaction, especially with recent advances in surgical technique and hardware fixation. These focus on proper procedures and candidate selection, simplification of procedures, reproducibility, and more rapid recovery with fewer complications.[1]