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 ,2nd toe overlapping
Toe dislocation
Painful arthritis



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