Hallux Valgus (Subscribe)  

Authors Crista J Frank, DPM, Dan E Robinson, DPM Noriko Satake, MD & Christopher E Gentchos, MD
Hallux valgus is considered to be a medial deviation of the first metatarsal and lateral deviation and/or rotation of the hallux with or without medial soft tissue enlargement of the first metatarsal head. This...

The Lapidus procedure is a corrective fusion of the 1st TMT joint with a distal soft-tissue correction. It is designed to stabilise a hypermobile first ray. It can also be useful when a severe deformity is associated with 1st TMT OA or an adult acquired flatfoot deformity.
Like a proximal osteotomy,...

Definition
Bunion
- Med prominence of head of 1st MT
Hallux Valgus
- medial deviation 1stMT
- lateral deviation of great toe
- +/- subluxation of 1st MTPJ

Cochrane Review Ferrari J, Higgins JPT, Prior TD
Summary: There is no strong evidence of benefit from orthoses and splints for deviated big toes, but surgery may be helpful

Epidemiology
More common in girls
High incidence of +ve family history (75%)
Pathology
Congruent joint (50% cf.. 9% in adult)
Metatarsus primus varus
- increased IM angle often the 1º deformity
Epiphyses usually still open

Wheeless' Textbook of Orthopaedics
Lapidus procedure is indicated for w/ severe hallux valgus deformity + a hypermobile 1st ray;
- procedure involves: arthrodesis of metatarsalcuneiform joint
- note that shortening of metatarsal will occur if large...

Wheeless' Textbook of Orthopaedics
Modified McBride Procedure for Hallux Valgus
modified procedure includes release of adductor hallucis, transverse metatarsal ligament, and lateral capsule combined w/ excision of medial eminence and plication of the capsule medially;
...

Wheeless' Textbook of Orthopaedics
this a distal "Step Cut" metatarsal osteotomy that displaces metatarsal head laterally in order to correct hallux valgus deformity and metatasus adductus;
- Mitchell procedure (Mitchell Osteotomy) is carried out more proximally than Chevron...

Author: Ben Trewben
CONTENTS
INTRODUCTION
THE NORMAL FOOT
1ST MPJ BALL-AND-SOCKET JOINT AND THE NORMAL FOOT
THE SESAMOIDS AND THE NORMAL FOOT
SUPPORT STRUCTURES OF THE FIRST MPJ OF THE NORMAL FOOT
ANATOMY OF HAV
1ST MPJ BALL-AND-SOCKET JOINT IN HAV
THE SESAMOIDS IN HAV
SUPPORT STRUCTURES OF THE 1st MPJ IN HAV
DISCUSSION
REFERENCES

Report of papers presented at AOFAS Specialty day meeting 2001

Radiographic Evaluation of Hallux Valgus
Hallux valgus is a common foot disorder of several etiologies, which can lead to significant foot pain and deformity. Little has been published in the radiographic literature about the pre- and postoperative radiographic findings of this very common and very treatable cause of foot pain.

A Randomized Controlled Trial
Markus Torkki, MD; Antti Malmivaara, MD,PhD; Seppo Seitsalo, MD,PhD; Veijo Hoikka, MD,PhD; Pekka Laippala, PhD; Pekka Paavolainen, MD,PhD JAMA. 2001;285:2474-2480.
Conclusions Surgical osteotomy is an effective treatment for painful hallux valgus. Orthoses provide short-term symptomatic relief.

Editor Vincent J. Hetherington, D.P.M., M.S., Dip.A.B.P.S., F.A.C.F.A.S. Vice President and Dean for Academic Affairs Professor and Former Chairman Department of Surgery Ohio College of Podiatric Medicine Cleveland, Ohio