Hallux varus

toughspiders · Sep 28, 2012

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Some info from the worldly wise would be good. I've not seen many of these but we have one at the mo which is a corker!
My gut feeling is it probably requires surgery but the guy is 86 and doesn't really want it! What are the chances of managing the pain conservatively or will it more likely end up under the knife...

Admin2 · Sep 28, 2012

Related threads:
Other threads tagged with Hallux varus
Surgery for hallux varus

efuller · Sep 29, 2012

toughspiders said: ↑

Some info from the worldly wise would be good. I've not seen many of these but we have one at the mo which is a corker!
My gut feeling is it probably requires surgery but the guy is 86 and doesn't really want it! What are the chances of managing the pain conservatively or will it more likely end up under the knife...
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Why does it hurt? DJD or shoes or both?

toughspiders · Oct 2, 2012

X-ray show some dorsal lipping/spurring from proximal phalanx. Pain worse on toe off. I've asked him to purchase some rocker soles in the interim whilst I do a bit more research

Orthican · Oct 3, 2012

I had a patient with 35 degrees Hallux Varus (I know, rare) but it was from TBI so it was all neurological as opposed to mechanical. I used several modalities to hold her away from the inside of the shoe to no avail. I recommended however that she see a very nice podiatric surgeon who looked after it by surgically fixating it in a neutral position. She had struggled with the pain for a long time. She is quite happy with the outcome. Way to go podiatry surgeons!

drsarbes · Oct 3, 2012

How long has he had symptoms and what are his symptoms.

At 86 I would guess that the clinical Hallux Varus is nothing new.

If his symptoms are recent and associated with possible inflammation of the MTPJ then I would treat it as an acute synovitis, i.e., cortisone injection, off load with an orthotic, check shoes type, etc...

At 86, surgery would only be indicated if his hallux varus was interfering with his activity level. The procedure of choice for this age group would be a resectional arthroplasty (modified Keller)

GL
Steve

NewsBot · Sep 16, 2013

Congenital Hallux Varus: A Report Of Four Cases
J Moolman and A Robertson
Bone Joint J 2013 vol. 95-B no. SUPP 29 38

Purpose of study: Congenital hallux varus is a rare condition presenting with medial deviation of the big toe. It consists of 2 variants: classical congenital hallux varus caused by an abnormal metatarsal-phalangeal articulation, and a more recently described variant due to a “bracket physis” of the first metatarsal.

Our aim was to perform an audit of the spectrum of presentation of congenital hallux varus with its management and complications in our unit over a five year period.

Description of methods: A retrospective review of congenital hallux varus treated by a single surgeon was performed. Clinical notes, photographs and x-rays were reviewed. Two surgical methods of treatment were used as directed by clinical and radiological findings.

Summary of results: Four patients with congenital hallux varus were identified. Three had bilateral involvement, i.e. seven feet were treated. The ages of the patients ranged from 1 to 9 years, with 2 boys and 2 girls receiving treatment. In two patients (4 feet) the deformity was associated with pre-axial polydactyly. One patient had associated hand deformities. Only one of our four patients had a “bracket physis” and was treated with a metatarsal osteotomy. The other three patients (6 feet) were treated by soft tissue realignment using the Farmer procedure. One patient who had bilateral Farmer procedures subsequently developed a bunion over the 1st metatarso-phalangeal joint of one foot due to uncovering of the metatarsal head. No complications or recurrences were recorded in the other three patients on follow up visits.

Conclusion: Careful clinical and X-ray analysis is important to determine the type of congenital hallux varus and which method of surgical treatment is appropriate. Long term follow up is required to identify subsequent deformities.
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NewsBot · Dec 16, 2014

Prenatal diagnosis of congenital hallux varus deformity associated with pericentric inversion of chromosome 9
Sebahat Atar Gürel
Journal of Obstetrics and Gynaecology Research; Early View

Congenital hallux varus is a rare deformity of the great toe characterized by adduction of the hallux and medial displacement of the first metatarsophalangeal joint. Prenatal diagnosis of congenital hallux varus is presented herein. A 32-year-old woman was referred to our unit due to significant deviation of the fetal right great toe at 22+2 weeks of pregnancy. Ultrasound examination revealed a thick and short great toe, which was significantly angulated medially on the right side. Amniocentesis was performed and the result was reported as inv(9) (p11;q12). After delivery, the clinical examination confirmed the prenatal diagnosis. To our knowledge, this is the first reported prenatal diagnosis of an isolated congenital hallux varus. Congenital hallux varus can be diagnosed easily in the prenatal period by 2-D and 4-D ultrasonography. Prenatal karyotyping should be taken into consideration, especially in the presence of associated anomalies, such as polydactyly and clubfoot.
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