Hallux valgus

• Etiology
  • Genetics
  • Shoe wear
  • Anatomical variations
• Pathology
  • Valgus deformity of big toe
  • Flexor tendons are dislocated laterally
  • Extensor tendon slips down
• Diagnosis
  • X-ray
  • Hallux valgus angle (HVA) > 15 degrees
    • Angle between the long axis of the first metatarsal and the long axis of the first phalanx
  • Intermetatarsal angle (IMA) > 9 degrees
    • Angle between first and second metatarsal
  • Distal metatarsal articular angle (DMAA) > 10 degrees
  • Dislocation of sesamoid bone
• Stages
  • Light
    • HVA 15 – 30 degrees
    • IMA 9 – 13 degrees
  • Moderate
    • HVA 30 – 40 degrees
    • IMA 13 – 20 degrees
  • Severe
    • HVA > 40 degrees
    • IMA > 20 degrees
• Treatment
  • Conservative treatment
    • Not very effective
    • Involves using hallux valgus splints
  • Surgical treatment
    • Preoperative
      • Antibiotic prophylaxis
      • 350 mmHg tourniquet to prevent bleeding
    • Operative techniques
      • Lateral release
        • The adductor tendon and lateral capsule are cut (released)
      • Distal chevron metatarsal osteotomy (DCMO)
        • A wedge-shaped part of the first metatarsal is slipped laterally and then fixed in the correct position
      • Scarf osteotomy
      • Lapidus operation
        • Involves osteodesis of medial cuneiform and first metatarsal bone
        • Used for severe deformities
  • Postoperative management
    • RICE
    • LMWH
    • Lymph drainage
    • Special shoe wear which prevents weightbearing on the forefoot
      • Worn for 4 – 6 weeks
    • Later – orthopaedic insoles