Case 20 Hallux Valgus

Case 20

Hallux Valgus

What happened ?                                            Pain and swelling  elsewhere on body ?

Shoe Wears – Worn outerside of sole

Alignment of Great toe – Valgus with pronated great toe , Unilateral , no lesser toes deformity

Attitude of Ankle / Lower extremity  - no any particular 

Look foot from Front , Side and Back on standing position

Skin over medial border of Ist MT head –thickened and hyperkeratotic , not ulcerated

Medial Arch maintained

and no too many toes from back

Gait –                                      Hallux not used in push off 

 See lumber region

Ask patient to sit and feet out of bed – see the sole of feet

Feel  -                                      Temperature normal

Always first superficially then deep for bony palpation .

Heel ,malleoli , other metarasal bones on feet ,small toes then first metatarsal ,Great toe

Sessamoid complex, medial eminence , First Metatarsophalnageal joint at last – non tender ,

Movement –                            toe

Always not to miss comment on LLD – DEVELOP A HABBIT TO THINK ON THIS

Ligamentous Instability          check if it is there

Grind test + if Arthrosis of joint

Deformity is it correctable ?

Digital Senstion , Capillary refill to say that the great toe is well perfused and has intact sensory innervation .

Ankle and Subtalar Motion

DPA / PTA

Investigations

X-ray – AP , Oblique view of Foot

            Measure deformity , normal 3-5 degrees Valgus

Treatment

Wait and see , with Toe spreader with a wide toe box

Capsulotomy

Osteotomy – Proximal Metatarsal , Distal Metatarsal , Proximal Phalanx

Arthrodesis

Complications

Ulcers , progression of deformity ,2^nd toe overlapping

Toe dislocation

Painful arthritis