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Hallux valgus is a common progressive forefoot deformity that affects women more commonly than men.
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Tight-fitting and high-heeled shoes, gender, and genetics seem to be the most important predisposing factors.
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Treatment consists of footwear modification and surgical procedures, depending on the patient’s symptoms and the severity of the deformity.
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Radiographic evaluation must include weight-bearing radiographs.
Hallux Valgus
Section snippets
Key points
Diagnosis
Evaluation of the patient with suspected hallux valgus should include a thorough history, including any pertinent family history; physical examination; and radiologic examination with weight-bearing radiographs. History should focus on duration of symptoms, activity modification, footwear, and types of any previous interventions. Physical examination must include observation of gait, alignment, and range of motion of the first MTP joint and of both lower extremities, and examination of the bare
Pathogenesis/progression
The first ray bears a significant amount of weight as it maintains the position of the medial arch.10 Any deformity that disrupts the integrity of the first ray can lead to hallux valgus.5 As seen in Table 1,5 there is a series of steps in the progression of hallux valgus, but the steps are not necessarily followed in a specific order. Because the medial structures of the first MTP joint are weak, including the medial collateral ligament and the medial sesamoid bone, they tend to fail first.11
Classification
Severity of hallux valgus is typically based on symptoms and radiologic assessment using weight-bearing radiographs and is described as mild, moderate, or severe. Two angles of importance in the assessment of radiologic severity of hallux valgus are the hallux valgus angle (HVA; normal <15°)2 and intermetatarsal angle (IMA; normal <9°).4 Classification of hallux valgus is based on the HVA and IMA, and this is summarized in Fig. 1 and Table 2.
Nonoperative Treatment
Conservative interventions should be used before surgical intervention, and should be the mainstay of treatment in juvenile hallux valgus,14 the elderly, and patients with severe neuropathy or other comorbidities that make them poor surgical candidates. The goal of conservative management should be to decrease severity of symptoms and avoid lifestyle/activity modifications because there is no evidence to show that nonoperative therapies have the ability to correct the hallux valgus deformity.
Summary
Hallux valgus is a common foot problem whose cause and progression is multifactorial, complex, and poorly known. It is likely related primarily to genetic predisposition and use of tight, constrained footwear. Hallux valgus shows a predilection toward women, although this may also be related to differences in shoe preferences between sexes. It is a progressive disorder with no treatment known to slow or stop progression. Shoe inserts can be used as a conservative measure with unpredictable
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Disclosures: None.