Hallux Valgus is defined as a static subluxation of the first metatarsophalangeal joint. It is characterized by valgus (lateral) deviation of the great toe and varus (medial) deviation of the first metatarsal. Bony exostoses develop around the first metatarsophalangeal joint, often with an overlying bursitis. In severe cases, exostoses limit first metatarsophalangeal joint range of motion and cause pain with the pressure of footwear.
Causes
The development of hallux valgus appears to occur secondary to a combination of intrinsic and extrinsic causes. Recognized causative factors include:
- Constricting footwear (e.g. high heels)
- Excessive pronation-increased pressure on the medial border of the hallux, resulting in deformation of the medial capsular structures.
- Others-cystic degeneration of the medial capsule, Achilles tendon contracture, neuro-muscular disorders, collagen deficient diseases.
- In the early phases hallux valgus is often asymptomatic, however, as the deformity develops, pain over the medial eminence occurs.
- The pain is typicaIly relieved by removing the shoes or by wearing soft, flexible, wide-toed shoes. Blistering of the skin or development of an inflamed bursa over the medial eminence may occur.
- In severe deformity, lateral metatarsalgia may occur due to the diminished weight-bearing capacity of the first ray.
- Examination reveals the hallux valgus deformity often with a tender swelling overlying the medial eminence.
Plain X-rays should be performed to assess both the severity of the deformity and the degree of first metatarsophalangeal joint degeneration.
Treatment
- Initial treatment involves appropriate padding and footwear to reduce friction over the medial eminence.
- Correction of foot function with orthoses is essential.
- In more severe cases surgery may be required to reconstruct the first metatarsophalangeal joint and remove the bony exostoses.
- Orthoses are often required after surgery.
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