Orthopedics Book


Great Toe


Hallux Valgus

Aka: Hallux Valgus, Lateral Deviation of the Great Toe, Bunion
  1. Definition
    1. Lateral Deviation of the Great Toe (first ray)
    2. Deviates at first Metatarsal-phalangeal joint (MTP)
  2. Etiologies
    1. Strong familial predisposition
    2. Hypermobility of first Metatarsal
    3. Predisposing rheumatic conditions
      1. Rheumatoid Arthritis
      2. Gouty Arthritis
      3. Psoriatic Arthritis
    4. Environmental risks
      1. Wearing pointed shoes
      2. Friction over medial first Metatarsal head
    5. Predisposing functional disorders
      1. Metatarsal primus varus
      2. Foot pronation
      3. Tight heel cord
      4. External Tibial Torsion
  3. Associated conditions
    1. Hammer toe deformity of second toe
    2. Osteoarthritis of the great toe MTP joint
  4. Symptoms
    1. Pain or deformity at great toe
  5. Signs
    1. Increased valgus angle at first MTP joint
      1. Valgus angle at first MTP joint usually <15 degrees
      2. Valgus angle in severe cases >30 degrees
    2. Bunion and inflamed overlying bursa
      1. Bony and soft tissue enlargement
      2. Occurs over medial Metatarsal head of great toe
      3. Soft tissue over Bunion may be inflamed and tender
    3. Painful callus development on 2nd toe
      1. Forced into hyperextension by deviated great toe
  6. Radiology: Foot XRay
    1. Medial exostosis (Bunion)
    2. Hallux Valgus
      1. Lateral displacement proximal phalanx
    3. Degenerative changes
      1. First Metatarsal-phalangeal joint (great toe MTP)
  7. Management: Conservative Management
    1. Relieve pressure over painful Bunion prominence
    2. Correct functional factors
      1. Correct excessive pronation
      2. Correct Achilles tendon tightness
    3. Properly fitted, low heeled stiff-soled shoes
      1. Wide, square shaped toe box
      2. Toe portion stretched to accommodate Bunion
      3. Extra-depth shoe accommodates dorsiflexed second toe
      4. No inseam where shoe contacts medial Metatarsal head
    4. Functional foot orthosis worn 5-6 hours on most days
    5. Splint separates first and second toe
    6. Avoid tight hose
    7. Acute Pain Management
      1. Rest
      2. Apply moist heat
  8. Management: Surgery
    1. Numerous surgical approaches are described elsewhere
      1. See resources below
      2. Surgery should correct biomechanical factors
        1. Simple Bunionectomy alone may not be effective
    2. Indications
      1. Severe deformity or Bunion pain
      2. Refractory to conservative management above
  9. Complications
    1. Bunion ulceration and drainage
    2. Significant pain limiting activity
    3. Osteoarthritis of the first MTP joint
  10. Resources
    1. Textbook of Hallux Valgus and Forefoot Surgery
      1. http://www.ocpm.edu/hallux/index.asp
  11. References
    1. Richardson in Canale (1998) Campbell's Ortho, p. 1621-4
    2. Martin in Ruddy (2001) Kelley's Rheumatology, p. 551
    3. Frykberg in Noble (2001) Primary Care Medicine, p. 1211
    4. Torkki (2001) JAMA 285:2474-80 [PubMed]

Bunion (C0006386)

Definition (CHV) A painful, inflamed swelling of the bursa at the first joint of the big toe
Definition (CHV) A painful, inflamed swelling of the bursa at the first joint of the big toe
Definition (MSH) Abnormal swelling of the inner aspect of the first metatarsal head affecting the first METATARSOPHALANGEAL JOINT.
Concepts Acquired Abnormality (T020)
MSH D006215
ICD9 727.1
ICD10 M20.1
SnomedCT 10478009, 156676007, 415692008
Japanese バニオン, バニオン
Portuguese Joanete
Spanish Juanete, juanete, bunio del dedo gordo, bunio del dedo gordo (trastorno), bunio del primer dedo del pie, tumefacción de la primera articulación metatarsofalángica del dedo gordo (trastorno), tumefacción de la primera articulación metatarsofalángica del dedo gordo
French Oignon, Durillon
German Fußballenentzündung, entzuendeter Fussballen, Großzehenballenentzündung
English bunion, bunion (diagnosis), bunions, Bunions, Bunion of great toe (disorder), Bunion (disorder), Bunion, Bunion of great toe, Swelling of first metatarsophalangeal joint of hallux (disorder), Swelling of first metatarsophalangeal joint of hallux, Bunion, NOS
Czech Mozol, bunion
Hungarian Lábbütyök gyulladás
Norwegian Bunion
Italian Borsite dell'alluce
Dutch eeltknobbel, Bunion
Derived from the NIH UMLS (Unified Medical Language System)

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