Acquired Hallux Varus

Cleveland Clinic, Department of Orthopaedic Surgery, Ohio, USA.
Foot & Ankle International (Impact Factor: 1.51). 10/1997; 18(9):586-92. DOI: 10.1177/107110079701800911
Source: PubMed


Acquired hallux varus most commonly occurs after hallux valgus surgery. Sagittal plane, coronal plane, and varus deformities are present at the metatarsophalangeal joint. Evaluation of both the metatarsophalangeal and interphalangeal joints for mobility is necessary in surgical decision making. Not all patients require surgery. The anatomy, incidence, pathogenesis, evaluation, classification, and treatment of acquired hallux varus are discussed in this review.

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    • "Its real significance lies in the degree of dissatisfaction it creates with patients often presenting with multiple symptoms. Hallux varus occurs when the tibial sesamoid is positioned medial to the first metatarsal head [30-32]. In the rotation scarf and Akin osteotomies hallux varus may be a consequence of excessive reduction of the intermetatarsal angle by the metatarsal osteotomy. "
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    ABSTRACT: The Cochrane review of hallux valgus surgery has disputed the scientific validity of hallux valgus research. Scoring systems and surrogate measures such as x-ray angles are commonly reported at just one year post operatively but these are of dubious relevance to the patient. In this study we extended the follow up to a minimum of 8 years and sought to address patient specific concerns with hallux valgus surgery. The long term follow up also allowed a comprehensive review of the complications associated with the combined rotation scarf and Akin osteotomies. Between 1996 and 1999, 101 patients underwent rotation scarf and Akin osteotomies for the treatment of hallux valgus. All patients were contacted and asked to participate in this study. 50 female participants were available allowing review of 73 procedures. The average follow up was over 9 years and the average age at the time of surgery was 57. The participants were physically examined and interviewed. Post-operatively, in 86% of the participants there were no footwear restrictions. Stiffness of the first metatarsophalangeal joint was reported in 8% (6 feet); 10% were unhappy with the cosmetic appearance of their feet, 3 feet had hallux varus, and 2 feet had recurrent hallux valgus. There were no foot-related activity restrictions in 92% of the group. Metatarsalgia occurred in 4% (3 feet). 96% were better than before surgery and 88% were completely satisfied with their post-operative result. Hallux varus was the greatest single cause of dissatisfaction. The most common adverse event in the study was internal fixation irritation. Hallux valgus surgery is not without risk and these findings could be useful in the informed consent process. When combined the rotation scarf and Akin osteotomies are an effective treatment for hallux valgus that achieves good long-term correction with a low incidence of recurrence, footwear restriction or metatarsalgia. The nature of the osteotomies allows early return to normal shoes and activity without the need for postoperative immobilisation in a plaster cast.
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    ABSTRACT: Hallux varus is usually iatrogenic in nature; however, congenital and acquired etiologies have been described in the literature. The authors present a case of traumatic hallux varus secondary to rupture of the adductor tendon. Surgical correction was performed using a soft tissue anchor for maintenance of the soft tissues utilized for repair.
    The Journal of Foot and Ankle Surgery 03/2000; 39(2):120-3. DOI:10.1016/S1067-2516(00)80036-8 · 0.85 Impact Factor
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    ABSTRACT: Morton neuroma is most likely a mechanically-induced degenerative neuropathy that predilects the third common digital nerve in middle-aged women who frequently wear fashionable shoes that are not designed for the physiology of the foot. A compression test of the affected web space is quite specific for its diagnosis, and an ultrasonograph can tell its exact size. If conservative means fail to relieve the painful symptoms of a Morton neuroma, surgical removal can produce dramatic pain relief. Metatarsalgia means pain in the metatarsal head region, and exists in three general forms: metatarsalgia of the first metatarsal head region, metatarsalgia of the fourth lateral metatarsal head region, and generalized metatarsalgia. There are numerous causes of metatarsalgia; a selected and important group of causes is discussed in this article. When conservative means fail to relieve metatarsalgia, specific surgical operations are quite effective for relief of pain, and are briefly described in the text.
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