Treatment of Hallux Valgus and Rigidus

Abstract

Hallux valgus is met with more frequently than any other deformity of the adult foot. It is seen very occasionally in infants or children as a congenital deformity, but in the vast majority of instances it results directly from the long-continued deforming pressure of badly constructed shoes. Consequently it is found most commonly in women on account of the height of the heel and the narrowness of the toe in the so-called " smart " shoes which they usually wear, and as a rule the full development of the deformity is not seen before adult life.-The primary alteration in the alignment of the foot consists in the adduction of the great toe towards the outer border of the foot. This of itself constitutes the essential deformity of hallux valgus, and the alterations of the muscles, ligaments, and bones which are so commonly associated with this primary deviation are secondary to it and result from the abnormal position of the displaced great toe. Thus the head of the first metatarsal becomes abducted from the second, increasing considerably the width of the anterior portion of the first intermetatarsal space. This abduction of the metatarsal from its fellows often appears to be the outstanding and basic deformity, and may in some cases be associated with the presence of a small wedge-shaped bone, the intermetatarseum, which lies at the base of the first metatarsal between this bone and the internal cuneiform, and from the x-ray appearance it may seem that the abduction of the metatarsal is directly due to the presence of this abnormal bone. Such, however, is not the case, as in many instances the x-ray of an apparently normal foot has shown the presence of such a bone without any abduction of the metatarsal.The abduction, in fact, results directly from pressure applied by the base of the displaced first phalanx of the great toe on the inner side of the articular surface of the head of the first metatarsal, and correction of this abduction follows on removal of this abnormal pressure. Such an improvement in the alignment of the bone can usually be seen within a few days of the removal of this pressure, except in those old-standing cases where the articular surface of the base of the metatarsal has become altered as the result of the development of osteo-arthritic changes. A Vicious Muscular CircleBecause of the abduction of the first metatarsal the adductor obliquus and adductor transversus, which are attached to the inner side of the base of the first phalanx, are placed under increased tension, so that by their contraction the phalanx is pulled still further round to the inner side of the head of the metatarsal. The capsule on the inner aspect of the first metatarso-phalangeal joint becomes contracted, whilst that on the outer side of the joint is stretched, together with the abductor hallucis muscle, which is also attached on this aspect of the phalanx. The irregularly pitted, and is not capable of acting as an articular surface, even though the phalanx were restored to its normal position. Osteophytic outgrowths...

Hallux Rigidus: Prevalence and Risk Factors

“…Several risk factors have been proposed in the literature, including female sex, [14] history of trauma, [15] rheumatoid arthritis,[16] long proximal phalanx of the hallux, [17] varus deformities of the forefoot or rearfoot, [17] HV deformity,[18] soft-tissue contracture, [19] short or long rst metatarsal, [20] increased interphalangeal angle of the hallux, [21] family history, [14] and ill-tting footwear. [22] However, none of these risk factors were determined from epidemiological studies of local residents.…”

Weightbearing CT Scan Assessment of Foot Alignment in Patients With Hallux Rigidus

“…A summary of all measured CT parameters is given in Table 2. The average first metatarsal declination angle was 20.1 (range, [16][17][18][19][20][21][22][23][24][25] degrees in the hallux rigidus group and 25.0 (range, 19-30) degrees in the control group. The average second metatarsal declination angle was 24.8 (range, 19-30) degrees in the hallux rigidus group and 27.0 (range, 21-36) degrees in the control group.…”

“…20 These factors include trauma, osteochondritis dissecans, and anatomical abnormalities such as pes planus, forefoot pronation, a long first ray, a tight gastrocnemius, 19 or metatarsus primus elevatus. 1,4,9,12,18,21,22,24…”

Hallux rigidus

“…The first metatarsophalangeal joint is subject to increased mechanical stress if the great toe or the first metatarsal are longer than the second ray. A number of authors have reported an increased incidence of hallux rigidus in patients with a long great toe or with a long first metatarsal [10,11,15,18,37–39], but no statistical correlation has been proven. Infection or metabolic and inflammatory joint disease may affect the first metatarsophalangeal joint and result in painful limitation of motion and in degenerative arthritis.…”

“…In view of a recurrence rate of up to 80%[42], this technique can not generally be recommended. Subcapital dorsiflexion osteotomy of the first metatarsal has also been recommended [38,43–45], but this is technically more difficult than cheilectomy or osteotomy of the proximal phalanx.…”