J Korean Med Assoc.  2013 Nov;56(11):1017-1022. 10.5124/jkma.2013.56.11.1017.

Prevention and treatment of hallux valgus

• Kim JH

• KMID: 2193477
• DOI: http://doi.org/10.5124/jkma.2013.56.11.1017

Abstract

In hallux valgus, one of the most common conditions affecting the forefoot, the first metatarsophalangeal joint is progressively subluxed due to lateral deviation of the hallux and medial deviation of the first metatarsal. Patients usually complain of medial prominence pain, commonly referred to as "bunion pain," plantar keratotic lesions, and lesser toe deformities such as hammer toe or claw toe deformities. The etiology of hallux valgus is multifactorial. Narrow high-heeled shoes or excessive weight-bearing have been suggested to be extrinsic factors contributing to the condition, and many other intrinsic factors also exist, such as genetics, ligamentous laxity, metatarsus primus varus, pes planus, functional hallux limitus, sexual dimorphism, age, metatarsal morphology, first-ray hypermobility, and tight Achilles tendon. When we evaluate patients with hallux valgus, careful history taking and meticulous examination are necessary. On the radiographic evaluation, we routinely measure the hallux valgus angle, intermetatarsal angle, and distal metatarsal articular angle, which are valuable parameters in decision making for bunion surgery. To prevent the development and progression of hallux valgus, a soft leather shoe with a wide toe box is usually recommended. The use of a toe separator or bunion splint may help in relieving symptoms. The purpose of hallux valgus surgery is to correct the deformity and maintain a biomechanically functional foot. When we decide on an adequate surgical option, we should consider the patient's subjective symptoms, the expectations of the patient, the degree of the de-formity, and the radiographic measurements in order to correct the deformity and prevent complications after surgery.

Keyword

Hallux valgus; Etiology; Diagnosis; Prevention; Treatment

MeSH Terms

Achilles Tendon
Congenital Abnormalities
Decision Making
Diagnosis
Flatfoot
Foot
General Surgery
Genetics
Hallux Limitus
Hallux Valgus*
Hallux*
Hammer Toe Syndrome
History
Humans
Intrinsic Factor
Ligaments
Metatarsal Bones
Metatarsophalangeal Joint
Shoes
Splints
Toes
Weight-Bearing
Intrinsic Factor

Figure

• 

  Figure 1 Foot standing anteroposterior radiographs of the left foot of a 34-year-old woman. (A) Hallux valgus angle is defined as the intersection angle between anatomical axis of the proximal phalanx and that of the 1st metatarsal, and that was measured to be 30 degrees. (B) Intermetatarsal angle is defined as the intersection angle between anatomical axis of the 1st metatarsal and that of the 2nd metatarsal, and that was measured to be 15 degrees. (C) Distal metatarsal articular angle is defined as the relationship of the articular surface of the distal 1st metatarsal with the longitudinal axis of the 1st metatarsal, and that was measured to be 24 degrees. According to the abovementioned radiographic measurements, it was categorized as moderate deformity. (D) We performed proximal chevron metatarsal osteotomy, distal soft tissue release, Akin osteotomy on the proximal phalanx and Weil osteotomy on the 2nd metatarsal.

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  Figure 2 Foot orthotic devices for hallux valgus. (A) Toe-separator. (B)Toe-separator combined with bunion protector. (C)Bunion splint.

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