Deformity of the great toe due to medial deviation of the 1st metatarsal and lateral deviation of the toe itself
Aetiology
Exact aetiology unknown
Higher incidence in females
Familial tendency but no direct genetic link
Incidence increases in age but can occur in adolescence
Hallux valgus in late adolescence usually has a strong family history
Commoner in rheumatoid arthritis and other inflammatory arthropathies as well as some neuromuscular diseases (multiple sclerosis, cerebral palsy)
Clinical presentation
Usually bilateral
May be painful due to joint incongruence
May be unable to wear closed shoes - bursa and/or nerve damage
A widened forefoot may cause rubbing of the foot with shoes resulting in an inflamed bursa over the medial 1st metatarsal head → bunion
The great toe and second toe may rub causing ulceration and skin breakdown
In severe cases, the hallux may override the second toe
Joint pain indicates OA
Transfer metatarsalgia or poor balance indicates defunctioned 1st ray (segment of the foot composed of the first metatarsal and first cuneiform bones)
Management
Conservative - wearing wider and deeper shoes to prevent bunions, the use of a spacer in the first web space to stop rubbing between the great and second toes
Surgical management - osteotomies to realign the bones and soft tissue procedures to tighten slack tissues and release tight tissues
Indications: failure of conservative management, lesser toe deformities, lifestyle limitation, overlapping, functional limitation
Any surgery may alter the biomechanics of the foot - 30% of patients are not satisfied so surgery should not be performed for cosmetic reasons alone
Some patients complain of pain in the metatarsal heads (metatarsalgia) after surgery
Surgical correction in adolescents carries a risk of recurrence of the deformity later in life
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