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Hallux Valgus

Categories
  • Education
  • Joint/Tendon
Tags
  • Ankle injury
Ankle

Hallux Valgus

Ankle and foot anatomy

The foot consists of the Hindfoot (calcaneus and talus bones), Midfoot (navicular, cuboid, cuneiform bones) and Forefoot (metatarsal and phalanx bones).

The ankle joint is a hinge joint with muscles crossing it to allow ankle range of motion (ROM) while muscles crossing the midfoot and forefoot area allow foot ROM.

Ankle and foot anatomy
Calf muscle and Achilles tendon Anatomy
Ankle and foot anatomy
Ankle Range of Motions
Ankle range of motion
Toe range of motion
Toe range of motion

Foot muscle anatomy

Foot muscle anatomy
Foot muscle anatomy
Foot muscle anatomy

Hallux valgus

  • Hallux valgus is a condition affecting the big toe where there is lateral deviation of the proximal phalanx on the metatarsal head
  • It is more common in woman
  • There is a hereditary contributing component to its incidence
  • Other disorders that cause the deformity include rheumatoid arthritis and connective tissue disorders

Abnormalities in Hallux valgus

Abnormalities in Hallux valgus
  • Valgus deviation of big toe
  • Sesamoid bones shifts outwards
  • The inside (medial) metacarpal-phalanx joint capsule becomes attenuated while the outside (lateral) capsule contracts
  • The adductor muscle becomes a perpetuating deforming factor

Hallux valgus presentation

  • Big toe deformity and progressive worsening of the deformity
  • Pain at metacarpal-phalanx joint area with pain worsening using tight-fitting shoes
  • Inside (medial) bunion with intermittent swelling and redness
  • Occasional digital nerve compression symptoms
  • Associated deformities include other toe deformities such as hammertoes
Hallux valgus presentation

Hallux valgus workup

  • Examination to confirm diagnosis
  • Radiological workup include standing foot X-rays
Hallux Valgus angle (metatarsal phalangeal angle)
Hallux Valgus angle (metatarsal phalangeal angle):
Normally ≤15°
Intermetatarsal angle
Intermetatarsal angle: Normally ≤ 9°
Distal metatarsal phalangeal angle
Distal metatarsal phalangeal angle:
Normally 0-8°

Hallux Valgus Radiology findings

Hallux Valgus angle (metatarsal phalangeal angle)
Hallux Valgus angle (metatarsal phalangeal angle):
44° (Normally ≤15°)
Intermetatarsal angle
Intermetatarsal angle: 18° (Normally ≤ 9°)
Distal metatarsal phalangeal angle
Distal metatarsal phalangeal angle:
38° (Normally 0-8°)

Hallux valgus management

  • Non operative measures include analgesia, shoe wear modifications with wider low heeled shoes, padding over bunion area
  • Definitive management is Hallux valgus surgery correction

Hallux valgus surgery

  • Soft tissue surgery procedure: bunionectomy, soft tissue release with capsule corrective procedure
  • Osteotomy: correct the bone malalignment
Hallux valgus surgery

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