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Hallux valgus

Background

Overview

Definition
Hallux valgus is a common foot deformity characterized by a lateral deviation of the hallux and a corresponding medial deviation of the first metatarsal, leading to a bony protrusion at the base of the toe.
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Pathophysiology
The pathophysiology of hallux valgus is multifactorial, with genetic factors playing a significant role. Biomechanical factors, including the collapse of the arch and the vertical orientation of the first metatarsal axis, also contribute to the development of the deformity. Additionally, wearing shoes that are too short or have high heels can contribute to the condition.
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Epidemiology
The prevalence of hallux valgus is estimated at 23% in adults aged 18-65 years and 35.7% in elderly aged > 65 years.
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Risk factors
Risk factors for hallux valgus progression include age, female gender, and family history. Wearing tight, narrow shoes, or high heels can contribute to the development of hallux valgus. Additionally, certain occupations requiring prolonged standing or walking and forefoot disorders, such as metatarsalgia and lesser toe deformities, can also influence the development of hallux valgus.
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Disease course
Clinically, hallux valgus presents with pain, swelling, and a visible deformity at the base of the big toe. The condition can also cause difficulty in wearing certain types of footwear, including high-heeled and narrow shoes. Hallux valgus is a chronic, progressive, and degenerative condition. Over time, the angle of deformity increases, and symptoms may worsen. In the late stages, the hallux may become painful and lose its functional utility, leading to impaired gait.
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Prognosis and risk of recurrence
The prognosis of hallux valgus varies. Without intervention, symptoms may worsen and complications, such as OA of the first metatarsophalangeal joint, may arise. However, surgical intervention can correct the deformity and alleviate symptoms, with high rates of patients returning to both comfortable and heeled shoes post-surgery.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of hallux valgus are prepared by our editorial team based on guidelines from the American College of Foot and Ankle Surgeons (ACFAS 2022), the Dutch Orthopaedic Association (NOV 2021), and the American College of Radiology (ACR 2020). ...
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Diagnostic investigations

Foot X-ray: as per ACFAS 2022 guidelines, obtain radiographic evaluation for effective assessment of the hallux valgus deformity.
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Nonpharmacologic interventions

Orthoses: as per NOV 2021 guidelines, do not offer foot orthoses to reduce pain compared to usual care (callus removal and provision of low-heel shoes with a wide-and-deep toe box) in patients with mild-to-moderate hallux valgus.
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  • Joint mobilization

  • Multicomponent interventions

Surgical interventions

Surgical outcomes: as per ACFAS 2022 guidelines, recognize that the outcomes of hallux valgus surgical correction are independent of procedure selection.
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Specific circumstances

Pediatric patients: as per ACFAS 2022 guidelines, evaluate and manage juvenile hallux valgus deformity differently than adult hallux valgus deformity.
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Follow-up and surveillance

Rehabilitation: as per ACFAS 2022 guidelines, consider offering physical medicine and rehabilitation interventions after hallux valgus surgery.
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