hallux valgus


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Related to hallux valgus: hallux varus

hallux

 [hal´uks] (pl. hal´luces) (L.)
the great toe.
hallux doloro´sus a painful disease of the great toe, usually associated with flatfoot.
hallux flex´us hallux rigidus.
hallux mal´leus hammer toe affecting the great toe.
hallux ri´gidus painful flexion deformity of the great toe with limitation of motion at the metatarsophalangeal joint.
hallux val´gus angulation of the great toe toward the other toes of the foot.
hallux va´rus angulation of the great toe away from the other toes of the foot.

hal·lux val·'gus

a deviation of the disal portion of the great toe, at the metatarsophalangeal joint, toward the outer or lateral side of the foot.

hallux valgus

a deformity in which the great toe is angled away from the midline of the body toward the other toes. In some cases the great toe rides over or under the other toes. Compare hallux varus.
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Hallux valgus

hallux valgus

Podiatry A condition characterized by lateral deviation of the metatarsal head, which is angled dorsomedially, ↑ metatarsal angle, and abduction and valgus rotation of great toe Clinical Pressure, pain over 1st metatarsal head, ± shooting pains at rest Management Orthotics to control pronation, accommodative padding, wide shoes, shoe modification, cryomassage, NSAIDs, extra-articular steroid injections

hal·lux val·gus

(hal'ŭks val'gŭs)
A deviation of the tip of the great toe, or main axis of the toe, toward the outer or lateral side of the foot.

hallux valgus

A common foot deformity in which the two bones of the big toe are angled in the direction of the little toe. There is a prominent bump on the inner edge of the foot and this is subjected to undue pressure and forms a bunion (BURSITIS). Hallux valgus is caused by unsuitably pointed footwear.

hallux valgus

uniplanar, transverse-plane first-ray deformity in which the hallux tip is deviated away from the body midline, and the first metatarsal head deviated toward the body midline (Table 1, Table 2 and Table 3); progression of minor hallux valgus may be slowed down or arrested by functional orthoses worn with appropriate shoe wear; surgery may be indicated to reduce major hallux valgus Table 4
Table 1: Factors that predispose to hallux limitus/rigidus
LocationFeatureCharacteristics
Intrinsic factorsFoot shapeRectus foot
Long first toe
Long first metatarsal
Biomechanical factors within the foot that cause excess STJ and MTPJ pronation, so that foot is pronated from midstance to toe offAnkle equinus
Pes planovalgus
Forefoot varus
Metatarsus primus elevatus
Hypermobile first ray
Flexor plate immobility
Plantar soft-tissue contracture
Functional hallux limitus
Structural anomalies that predispose to excess STJ and MTPJ pronationExternal tibial torsion
Tibial varum
Knee position variants
Femoral retroversion
Longer limb
Wide-based gait
TraumaOsteochondritis
Osteoarthrosis
Soft-tissue tears
Turf toe
Extrinsic factorsInflammatory joint diseaseRheumatoid arthritis
Gout/crystal arthropathy
Psoriatic arthropathy
Generalized osteoarthritis
Sesamoid degeneration
Occupational hazard - repeated forced dorsiflexion of the first MTPJ/stubbing the first toeCarpet laying
En pointe ballet dancing
Football
Netball
Tennis
High-heeled shoes

STJ, supratalar joint; MTPJ, metatarsophalangeal joint.

Table 2: Classification of stage of hallux limitus/rigidus
StageCharacteristics
Stage 1
Functional HL
∼60° available dorsiflexion at 1 MTPJ
Functional (weight-bearing) limitation of dorsiflexion at 1 MTPJ, with:
• 1 MTPJ painful under load
• Hypermobility of first ray
• No real joint deterioration, but some osteophytosis
• Non-weight-bearing 1 MTPJ dorsiflexion near normal
Stage 2
Mild structural HL
35-55° available dorsiflexion at 1 MTPJ
Structural limitation of dorsiflexion at 1 MTPJ
• 1 MTPJ painful after exercise/movement
• Broadening and flattening of 1 MTPJ surfaces
• Narrowing of 1 MTPJ space
• Moderate osteophytosis of 1 MTPJ area
• Local bone sclerosis
• Elevation of the first ray
• Sesamoid hypertrophy
• Reduced 1 MTPJ dorsiflexion (weight- and non-weight-bearing)
• Reduced heel lift
• 1 MTPJ crepitus
Stage 3
Moderate structural HL
15-30° available dorsiflexion at 1 MTPJ
Structural loss of dorsiflexion at 1 MTPJ
• Pain within 1 MTPJ
• Marked 1 MTPJ deterioration
• Loss of 1 MTPJ space
• Extensive osteophytosis
• Bone sclerosis
• Cystic degeneration of subchondral bone
• Joint 'mice'
• Hypertrophy of sesamoids
• Elevation of the first ray
• Loss of height of MLA
• Decreased calcaneal angle
• 1 MTPJ crepitus
• Marked reduction of heel lift
Stage 4
Severe HR
<15° available dorsiflexion at 1 MTPJ
1 MTPJ immobility
• 1 MTPJ ankylosis and loss of joint space
• Marked osteophytosis and increased bulk of 1 MTPJ
• Loss of heel lift and/or hyperextension of IPJ of hallux

1 MTPJ, first metatarsophalangeal joint; MLA, medial longitudinal arch; IPJ, interphalangeal joint.

Table 3: First-ray relationships that inform a diagnosis of hallux abductovalgus (from an anteroposterior-view radiograph)
AngleLocationNormal values
Intermetatarsal angleThe angle between the longitudinal axes of the first and second metatarsals8-12°
Metatarsus adductus angleThe angle between the longitudinal axes of the lesser metatarsals and the first metatarsal<15°
Hallux abductus angleThe angle between the longitudinal axes of the hallux and the first metatarsal<20°
Proximal articular set angle (PASA)The comparison of the planes of the articular surfaces of the head of the first metatarsal and the base of the proximal phalanx of the hallux<7.5°
Distal articular set angle (DASA)The comparison of the planes of the articular surfaces of the head of the proximal and the base of the distal phalanx of the hallux<7.5°
Hallux interphalangeus angleThe angle between the longitudinal axes of the proximal and distal phalanges of the hallux<10°
Medial sesamoid positionThe relationship of the medial sesamoid and the head of the first metatarsalWithin the medial groove of the first metatarsal head
Table 4: Surgical options for the treatment of hallux abductovalgus
Surgical approachInterventionExample procedure
Joint-destructive proceduresExcision of base of hallux proximal phalanx
Arthrodesis
Keller
Screw arthrodesis
Joint-preserving proceduresClosing basal wedge osteotomy, first metatarsal
Distal metatarsal osteotomy
Basal wedge osteotomy
Wilson; Austin
Ray alignment proceduresZ osteotomy
Medial closing-wedge osteotomy, hallux
Scarf
Akin
Ray stabilization proceduresArthrodesis of first metatarsal/medial cuneiform jointLapidus
CosmesisExcision of medial eminence at head of first metatarsal (cheilectomy)Silver

There are over 100 named surgical techniques for the correction of hallux abductovalgus, most of which are modifications of a number of principles of approach.

References in periodicals archive ?
Hallux Valgus correction can be attained with one KISSIoc construct instead of two separate suture bridges.
Importantly, only those patients with mild to moderate hallux valgus deformity were included, We did not measure the degree of angula-tion of the toe of our patient, but we assessed her pain as "moderate.
Hallux valgus interphalangeus is the angle between the lines bisecting the proximal and distal phalanges of the metatarsal.
Hallux valgus is a common foot condition that is caused when the big toe bends in towards the smaller toes.
Recent peer-reviewed publications have reported various second metatarsal stress fractures associated with competitive suture -button fixation of hallux valgus.
The plate serves as the primary component in the FastForward Bunion Correction System, a new approach to surgically correct hallux valgus deformities that preserves and protects the native bone anatomy.
The Osteotomy Truss System is indicated for internal bone fixation and osteotomies in the foot and ankle, such as Evans lengthening osteotomies, opening wedge osteotomies of Hallux Valgus, and Cotton opening wedge osteotomies.
I have been using Speed Triad in patients with mild to moderate hallux valgus for several months.
Current foot deformities in two groups Hallux Valgus n Hammer toe n Clap toe n Group 1 8/22 10/22 4/22 (Heel Valgus) Group 2 11/28 9/28 3/28 (Control) Table 3.
Hallux valgus, the abnormal angulation of the great toe, can cause overlapping of the second toe over the first, or occasionally the first toe over the second, he added.
Jordan H, Brodsky A: Keller operation for hallux valgus and hallux rigidus; an end result study.
A bunion, clinically known as a hallux valgus deformity, is visible as a bump on the side of the foot near the base of the big toe and caused by the misalignment of bones in the foot.