3. History
• “Hallux Valgus" was define as static subluxation of
first Metatarsophalangeal Joint with lateral deviation
of great toe.
• This term was introduced by Carl Hueterto.
• The first surgical procedure to address the
deformity was described by Reverdin in May, 1881.
4. Definition
• deformity resembling abduction contracture in
which great toe turned away from mid-line of
body.
• commonly referred to as “Bunion”
5. Lateral deviation of Great Toe
Medial deviation of 1st
Metatarsal
Progressive subluxation of 1st
MTP joint
6. Incidence
• 1% adults in US
Gould et al studies
• increased incidence with age (3% 15-30 yrs, 9%
31-60 yrs & 16% >60yrs)
• F > M {2:1 - 4:1}
11. Pathology
• with a valgus deformity of >30 degrees, the great
toe rotates into pronation (nail face medially)
• the sesamoids bones of FHB are displaced
laterally
• also FHL & EHL tendons bowstring on the lateral
side adding to deformity forces
• the contracted adductor hallucis & lateral capsule
contribute further to the fixed deformity
12.
13. Signs/Symptoms
• Asymptomatic
• Pain/ Tenderness
• Skin calluses/ areas of redness
• Increased/Decreased 1st MTP joint R.O.M
• Pronation of great toe
20. Classification
Piggott (1960) based on x ray appearance
1. MTP joint is centred but the articular surfaces
though congruent, are tilted towards valgus
2. articular surfaces are not congruent, the
phalangeal surface being tilted towards valgus
3. the joint is both incongruent and slightly
subluxated
23. Diagnosis
Root et al (pathomechanical devlopment of hallux valgus)
• Stage 1 - excessive pronation causes hypermobility of 1st ray,
causing the tibial sesamoid ligament to be stretched and the
fibular sesamoid ligament to contract; lateral subluxation of the
proximal phalanx occurs
• Stage 2 - hallux abduction progresses, with the flexor hallucis
longus and flexor hallucis brevis gaining lateral mechanical
advantage
24. • Stage 3 - Further subluxation occurs at the 1st
MTP joint, with formation of metatarsus primus
adductus
• Stage 4 - The 1st MTP joint finally dislocates
25. Treatment
Medical
cannot change the irreversible cartilage, bony & soft tissue adaptions of the deformity
• Adapting footwear - shoes with wider & deeper toe box. Extra padding &
strapping
26. • Pharmacologic/ Physical Therapy - NSAIDS in acute episodic
inflammatory process. No evidence to support prolong physical therapy.
• Functional orthotic therapy
27. Surgical
Indications; persistent pain (not cosmetic)
progression of deformity
failure of non operative treatment
Goals; correct all pathologic elements and maintain
biomechanically functional forefoot.
Combination of soft tissue procedures with bony
procedures in almost all cases
28. • SOFT TISSUE PROCEDURES
NB. Medial & Lateral procedures done together are
contraindicated
37. Conclusion
• Hallux Valgus is abduction contracture deformity
resembling big toe displaced laterally.
• Women have a higher incidence which is directly
proportional with increase age.
• Aetiology is divided into extrinsic & intrinsic factors.
• Treatment usually non surgical first, then if failed surgical
option is advised.
• Surgery most often involves a combination of soft tissue
and bony procedures.
