Hallux Valgus
Aeitiology
- Unknown
- Increased incidence in
- Familial clusters
- people who wear enclosed footwear
- Associted with rheumatoid arthritis
- secondary to metatarsus primsu varus
Approach
- Expose both ankles and feet
- Kneel in front of the patient
- Look
- Unilateral / bilateral?
- Estimate degree of valgus
- Rotation of nail?
- Bunion? (prominence of medial aspect of 1st MT head with or without and underlying bursa)
- Signs of inflammation of bursa?
- Hammered or retracted toe?
- Look at soles of feet ?callosities present
- Feel
- Inflammation of bunion
- Localised tenderness
- Move
- Assess range of movement of MTPJ
- Note any hypermobility (indicates instability)
Completion
- Assess range of motion of other toes
- Gait assessment - allows inspection of heel and ankle from the back
- Examine shoes - reflected in pattern of wear
- Ask how condition affects life
Investigations
- Weightbearing X-rays
- degree of valgus deformity
- First / second intermetatarsal angle (IMA) and distal metatarsal articular angle
- Presence of OA of first MTPJ
Treatment options
- Non-surgical
- Appropriate footwear - wide shoe, soft upper wide toe box and protective padding
- Physiotherapy
- Surgical
- Bunionectomy
- First metatarsal realignment osteotomy
- Excision arthroplasty (Kellers' procedure)
- Fusion / arthrodesis
