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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