A hallux valgus is a fixed abduction of the first metatarsophalangeal joint of the great toe. It is usually due to metatarsus primus varus which is a medial deviation or adduction of the first metatarsal with an increased first-second metatarsal angle.
A normal first metatarsophalangeal angle is ≤15° on an AP weight-bearing foot radiograph 2; anything greater indicates hallux valgus. The first-second intermetatarsal angle should be <9° on a weight-bearing foot radiograph 2.
There is a close association between the degree of metatarsus primus varus and hallux valgus. The combined deformities are present to some degree in most patients. Hallux valgus may be a result of metatarsus primus varus, and surgical correction is often based on this theory.
Treatment and prognosis
Non-surgical treatment involves the use of accommodative foot wear. This is usually achieved by the use of soft and wide shoes. While orthosis are sometimes prescribed their is minimal evidence to suggest their use will prevent the progression of the disease 6. Non-surgical treatment is deemed to have failed when the pain is no longer controlled with the suggested measures. In this cases surgical management is recommended.
The type of surgical procedure recommended will be determined by the severity of the deformity and presence of arthritis in the 1st metatarsophalangeal joint. In cases of minimal deformity and no arthritis, a distal metatarsal osteotomy of the 1st metatarsal +/- proximal phalanx may be considered. A proximal 1st metatarsal osteotomy allows for greater correction thus is used in more severe deformity. In cases where the 1st MTP joint is already degenerate or there is a recurrence of the disease a fusion procedure may be considered 6.
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