Hallux Valgus
Definition:
Aka bunion, is lateral deviation of the proximal phalanx
with subsequent medially directed pressure against the first metatarsal head
o
Congruent
= no MTP joint subluxation
o
Incongruent
= lateral subluxation of proximal phalanx on the metatarsal head
Description:
o
Weakening of first
metatarsophalangeal (MTP) medial joint capsule, contracture of lateral joint capsule
o
Eventual sesamoid
subluxation laterally
o
Extensor hallucis
longus and Flexor hallucis longus tendons deviate laterally, increasing deformity.
Etiology:
o Women:men = 10:1
o
Tight or pointed
shoes - incidence lower in populations
that do not wear shoes
o
Congenital predisposition
o
Severe flatfoot deformity
o
Tight Achilles tendon
o
Hypermobility of
first metatarsocuneiform joint
o
Rheumatoid Arthritis
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Symptoms:
o Medial eminence pain
o Metatarsalgia (first or
lesser metatarsal head pain)
o Impingement on second toe
o Inability to wear shoes
Imaging:
o Weight-bearing
anteroposterior, lateral and oblique radiographs
Treatment
Considerations:
o Symptoms severity
o Degeneration of 1st
MTP joint
o Flexibility of 1st
metatarsocuneiform joint
o HV and IM angles
o Congruent or incongruent 1st
MTP joint
o Age
Treatment
Options:
o Conservative, non-operative
-
Wide shoes
- Pads under metatarsal heads to alleviate pressure
o Distal soft-tissue procedure
= opening lateral joint capsule, tightening medial joint capsule and resection
medial eminence, for mild deformity (HV<30, IM<13)
o Distal soft tissue procedure
with proximal metatarsal osteotomy (HV up to 50, IM up to 25)
o Chevron (Mitchell) procedure
= distal metatarsal osteotomy with laterally translation of medial head, for
mild deformity
o Akin Procedure = see image
o Keller Procedure = see image
o Lapidus Procedure = (see
image, right) for severe deformity with hypermobile 1st metatarsocuneiform
joint, involves distal soft-tissue procedure and 1st
metatarsocuneiform arthrodesis (fusion)
o Many other procedures
described
