Hallux Valgus (Bunion) is the medical disorder that cause deformity of the big toe metatarsopharyngeal (MTP) joint in which there is medial enlargement and lateral deviation of the big toe.
This is normally linked with bony and connective tissue enlargement of the medial aspect of the first metatarsal head that is called the bunion.
A hallus valgus (bunion) forms when the big toe points toward the second toe.
This produces a bump to occur on the inside edge of the toe.
The source is lateral deviation of the great toe so as to put a valgus deformity on the first metatarsophalangeal (MTP) joint.
A deviation of 15-20° is regarded abnormal.
This deviation affects the biomechanics of the foot.
It may induce subluxation of the first MTP joint and the big toe may even cover the second toe.
Lateral subluxation induces a prominence on the metatarsal head (bunion) often followed by the formation of a fluid-filled bursa.
This becomes painful as it scrapes against the shoe.
Shoe wear does not cause hallux valgus.
Hallux valgus can happen as a result of:
1. Heredity
People born with abnormal bones in their feet are more prone to form a bunion.
2. Flat foot (pes planus)
3. Metatarsal primus varus
4. Hyper mobile first metatarsal cuneiform joints
5. Abnormal length of first metatarsal
Tight shoes can produce pain and nerve entrapment in link with hallux valgus.
Symptoms:
1. Normal inter-metatarsal angle (the angle between the first and second metatarsals is 9 degrees or less).
The normal first MTP joint angle is less than 15 degrees.
2. Any increase of 15 degrees angle is regarded as lateral deviation of the first metatarsopharygeal joint.
3. The big toe is turned inwards towards the second inducing a medial protrusion of the MTP joint called a bunion which can become inflamed and tender.
4. There is red, thickened skin along the inside edge of the big toe forming a bony bump at this location.
5. In severe cases the first toe can overlap the second toe or the second toe may cover the in-turned big toe. The big toe is turned toward the other toes and may cross over the second toe
X-rays reveal the presence of lateral deviation of the proximal phalanx and the presence of a medial exotosis.
When a bunion first starts to form, good care of the feet should be taken.
Wide-toed shoes should be worn.
This can often resolve the pain and avoid the patient from requiring more treatment.
The felt or foam pads on the foot are used to protect the bunion, or devices called spacers to separate the first and second toes.
Cutting a hole in a pair of old, comfortable shoes to wear around the house helps.
If the hallux valgus worsens and more painful, the surgery may help to realign the toe and remove the bony bump (bunionectomy).
The result of conservative treatment is so poor that surgery may be a useful method of treatment.
Surgery may be delayed without an adverse effect on the final outcome, even though pain and patient satisfaction are reduced with early surgery.
The simplest way is the removal of the bony prominence (exostectomy).
Otherwise, Keller's arthroplasty affects producing a flexible joint by removal of the medial part of the metatarsal head together with some of the proximal phalanx.
Arthrodesis of the joint may be done.
TABLE OF CONTENT
Introduction
Chapter 1 Hallux Valgus
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Overlapping Small Toe
Chapter 8 Hammertoes
Epilogue