Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Hallux Valgus

SYMPTOMS

Increasing stiffness, aching pain and typical deformation of MTP I without preceding trauma. Often the symptoms are bilateral. This condition is commonly presented by middle-aged recreational athletes or sedentary people, predominantly female, but it can occur in younger individuals.

AETIOLOGY

The aetiology is unclear but there is possibly a genetic predisposition to this disease, which causes a typical mal-alignment of MTP I with secondary bursitis and joint degeneration. Asymptomatic hallux valgus does not need treatment.

CLINICAL FINDINGS

Hallux valgus is diagnosed when there is more than 10 degrees of malformation, with adducted distal phalanges and localised swelling, redness and tenderness on palpation over the MTP I joint.

INVESTIGATIONS

X-ray confirms the diagnosis and indicates the extent of mal-alignment, subluxation and lateralisation of the MTP I joint. Usually there is a degree of osteoarthritis.

TREATMENT

Try individually made orthotics in the shoes to support the anterior arch, combined with stretching of the MTP I adductor muscles. NSAID or local cortisone injections can give shortterm relief. Surgery with correction of the malalignment (osteotomy of the bone and screw fixation in a straight position) is indicated in severe and progressive cases and has excellent outcomes. Full weight bearing is usually allowed at an early stage.

REFERRALS

Refer to podiatrist or physiotherapist for mild symptoms and to orthopaedic foot surgeon if severe or deteriorating symptoms and severe mal-alignment.

EXERCISE PRESCRIPTION

Rest will not help, so allow all kinds of sporting activities using well-fitting shoes. If pain is aggravated on impact suggest cycling, swimming or similar low-impact sports as alternative to running and jumping sports.

DIFFERENTIAL DIAGNOSES

Osteoarthitis that usually does not give the typical deformation.

EVALUATION OF TREATMENT OUTCOMES
Monitor the decrease of clinical symptoms and signs, the pain should disappear and a new X-ray should be
normal, with healed osteotomy, six to twelve weeks after surgery. The screw that fixes the osteotomy can
be removed later if symptoms occur.

PROGNOSIS

Excellent with appropriate treatment. Untreated hallux valgus can lead to severe mal-alignment, MTP I osteoarthritis and pain. If the bone becomes too osteoporotic, surgery may be difficult.

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