Hallux Valgus

Hallux Valgus: Intro - Bunion Blueprint

• Definition: Lateral deviation of hallux (great toe) & medial deviation of 1st metatarsal. "Bunion" = medial prominence over 1st MTPJ.
• Etiology Snippets: Multifactorial; tight/pointed footwear, genetics, pes planus, female sex often implicated.
• Key Angles (Deformity Markers):
  • Hallux Valgus Angle (HVA): Normal < 15°. (Angle: 1st metatarsal & proximal phalanx)
  • Intermetatarsal Angle (IMA): Normal < 9°. (Angle: 1st & 2nd metatarsals)
• Core Anatomy Involved:
  • 1st Metatarsophalangeal (MTP) joint: Site of deformity.
  • Sesamoids (tibial & fibular): Displace laterally with deformity.
  • Medial capsule & collateral ligament: Attenuated/stretched.
• Pathoanatomic Cascade:
  • Progressive 1st MTPJ subluxation.
  • Imbalance of intrinsic/extrinsic muscles.
  • Bunion formation (medial exostosis, adventitious bursa).

⭐ Hallux valgus is the most common forefoot deformity, affecting women more than men (approx. 9:1).

Hallux Valgus: Clinicals - Deformity Detective

• Presentation:

  • Lateral deviation of great toe (hallux) & medial deviation of 1st metatarsal.
  • Pain over medial eminence (bunion), footwear difficulty.
  • Numbness/tingling (compression of medial dorsal cutaneous nerve).
  • Associated deformities: hammertoe, lesser metatarsalgia.

• Examination:

  • Assess deformity reducibility, range of motion (1st MTPJ).
  • Check for callosities, skin irritation, neurovascular status.
  • Gait assessment.

• Radiographic Evaluation (Weight-bearing AP & Lateral views):

  • Key angles for severity & surgical planning:

• Assess joint congruity, arthritis, sesamoid position (📌 AP view).

Hallux Valgus: Non-Surgical - Gentle Footsteps

• Primary Goals: Alleviate pain, reduce inflammation, slow deformity progression, improve foot function.
• Footwear Modifications:
  • Wide, deep toe-box shoes.
  • Soft, non-restrictive uppers.
  • Heels < 1-2 inches.
• Orthotics & Devices:
  • Toe spacers/Hallux valgus splints (day/night).
  • Bunion pads/shields (protect prominence).
  • Arch supports (for associated pes planus).
• Analgesia: NSAIDs (oral/topical).
• Physical Therapy: Stretching (toe adductors, calf), intrinsic muscle strengthening.
• Activity Modification: Avoid pain-triggering activities.

⭐ Conservative management aims to relieve symptoms and slow progression, not to correct the anatomical deformity.

Hallux Valgus: Surgery - Bunion Be-Gone!

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High‑Yield Points - ⚡ Biggest Takeaways

• Hallux Valgus: Lateral deviation of great toe, medial deviation of 1st metatarsal.
• Ill-fitting footwear is a key extrinsic cause.
• Key angles: Hallux Valgus Angle (HVA) > 15°; Intermetatarsal Angle (IMA) > 9°.
• Bunion (medial eminence) is a characteristic painful prominence.
• Conservative: Shoe modification, orthotics, NSAIDs.
• Surgery: Osteotomies (Chevron, Scarf) for deformity correction; Keller arthroplasty for elderly.
• Complications: Recurrence, hallux varus, nerve injury.