Orthopedics Book

Joint dislocation


Great Toe


Hallux Valgus

Aka: Hallux Valgus, Lateral Deviation of the Great Toe, Bunion
  1. Epidemiology
    1. Most common in women (26% of women ages 18 to 65 years, 36% over age 65 years)
  2. Definition
    1. Lateral Deviation of the Great Toe (first ray)
    2. Deviates at first Metatarsal-phalangeal joint (MTP)
  3. Risk Factors
    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, restrictive shoes (narrow toe box)
      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
  4. Associated Conditions
    1. Hammer toe deformity of second toe
    2. Osteoarthritis of the great toe MTP joint
  5. Symptoms
    1. Pain or deformity at great toe
  6. 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
  7. 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)
  8. 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 (from custom shoemakers who stretch the material)
      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 (may be effective, but no evidence to support)
    6. Avoid tight hose
    7. Acute Pain Management
      1. Rest
      2. Apply moist heat
  9. 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
    3. Efficacy
      1. Reduced pain and improved function at 12 months, but no benefit at 2 years
      2. Torkki (2003) Acta Orthop Scand 74(2): 209-15 [PubMed]
  10. Complications
    1. Bunion ulceration and drainage
    2. Significant pain limiting activity
    3. Osteoarthritis of the first MTP joint
  11. Resources
    1. Textbook of Hallux Valgus and Forefoot Surgery
      1. http://www.ocpm.edu/hallux/index.asp
  12. 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. Becker (2018) Am Fam Physician 98(5): 298-303 [PubMed]
    5. 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)

Hallux Valgus (C0018536)

Definition (MSH) Lateral displacement of the great toe (HALLUX), producing deformity of the first METATARSOPHALANGEAL JOINT with callous, bursa, or bunion formation over the bony prominence.
Concepts Anatomical Abnormality (T190)
MSH D006215
SnomedCT 156853006, 275352004, 122480009
English Hallux Abductovalgus, Hallux Valgus, Valgus deformity great toe-obs, Valgus deformity of great toe - observation, hallux valgus (physical finding), feet hallux valgus, hallux valgus, Hallux Valgus [Disease/Finding], hallux abductovalgus, hallux valgus disorder, Finding of valgus deformity of great toe (finding), Valgus deformity of great toe - finding, Hallux valgus, HV - Hallux valgus, Hallux abductovalgus, HAV - Hallux abductovalgus, Hallux valgus (disorder)
Swedish Hallux valgus
Czech hallux valgus, Hallux valgus, vbočený palec
Spanish Hallux valgus, deformidad en valgo del dedo gordo - hallazgo, deformidad en valgo del dedo gordo - hallazgo (hallazgo), deformidad en valgo del dedo gordo, deformidad en valgo del primer dedo del pie, hallux valgus, deformidad en valgo del primer dedo del pie (trastorno), deformidad en valgo del dedo gordo (trastorno), deformidad en valgo del hallux, Hallux Abductovalgus, Hallux Valgus
Dutch hallux valgus, Hallux abductovalgus, Hallux valgus
Portuguese Dedo grande valgo, Joanete do Dedão do Pé, Hálux Valgo, Hallus Valgo, Joanete do Grande Artelho, Hallux Abductovalgus, Hallux Valgus
Japanese ガイハンボシ, 母趾外反症, 外反拇趾, 腱膜瘤, バニオン, 母趾球滑液包腫脹, 母趾外反, 外反母趾
Finnish Vaivaisenluu
Italian Alluce abdotto-valgo, Alluce valgo
Polish Paluch koślawy
Hungarian Hallux, valgus
Norwegian Hallux valgus, Hallux Abductovalgus
French Hallux valgus
German Hallux abductovalgus, Hallux valgus
Derived from the NIH UMLS (Unified Medical Language System)

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