Hallux Valgus: Anatomy, Pathogenesis, Assessment, and Treatment

Abstract

Background: The first ray plays a key role in maintaining the structure of the medial arch, and as the main load-bearing structure, it is subject to substantial forces during gait. Failure anywhere along the first ray, from the distal phalanx to the talo-navicular joint, can result in HV. It is therefore worth considering the first ray biomechanics as a common factor to many of the key theories. There are no tendon attachments on the metatarsal head, and maintenance of this inherently unstable axial array requires a congruent and stable MTPJ during push-off, a distal metatarsal articulation angle that encourages stability, balanced static and dynamic restraints, and a stable tarso-metatarsal joint(TMTJ). It is a complex condition, suggesting that several factors are responsible. The different factors can be divided into extrinsic and intrinsic risks: The first treatment option is non-operative care. Conservative treatment will not make the bunion go away, but it will hopefully decrease the signs and symptoms and help patient get rid of the pain and get him back to activities. It may be the treatment of choice in the elderly and those with neurological or vascular compromise. Adjustment to footwear can be utilized to eliminate friction over the medial eminence, e.g., providing a wider and deeper toe box. High-heeled shoes are prevented.

Objective: Anatomy of the First Metatarso-phalangeal Joint and Big Toe, Pathogenesis and Etiology, Assessment, and Treatment of hallux valgus.

Conclusion: There is no procedure that can successfully apply to all deformities. Most procedures for correction of HV do work if properly performed in the right indications. Selecting the proper procedure in the appropriate foot and appropriate patient is the key to the success of each individual procedure.