Standing Both feet Xray showing Hallux Valgus
Definition
Hallux Valgus is a complex deformity of the first ray, involving a medial deviation of the first metatarsal and a lateral deviation (and pronation) of the great toe. It is more common in woman.
Symptoms
The patient usually suffers from pain on the medial aspect of the toe, as well as deformity leading to shoe wearing difficulty. It may be associated with metatarsalgia (pain in the ball of the foot) and lesser toes deformities (hammertoes, claw toes)
Risk factors
Several risk factors may lead to the developpement of Hallux valgus deformity:
genetic predisposition
ligamentous laxity (1st tarso-metatarsal joint instability)
convex metatarsal head
2nd toe deformity/amputation
pes planus
rheumatoid arthritis
cerebral palsy
shoes with high heel and narrow toe box
Associated conditions
hammer toe deformity (leading to metatarsalgia)
callosities
Treatment
Conservative treatment is the first line: orthosis if pes planus or metatarsalgia, spacer, shoe modification
Surgery is frequently required to correct the deformation. Many interventions exist, all aiming to correct the deformity of the first ray. The most frequently used is the Scarf + Akin Osteotomy.
Recently, Percutaneous interventions are getting more attention
This surgery can be done in ambulatory unit. Full weight Bearing is immediate with an orthopedic shoe.
Returning to normal shoes is allowed in 3 weeks.
Complications
As for every intervention, surgical interventions are at risk of Hematoma, nerve damage, secondary displacement, infection, stiffness.