Diagnosis and Pathophysiology of Hallux Valgus

Kyu-Sun Jang; Tae Wan Kim; Hak Jun Kim

doi:10.14193/jkfas.2014.18.2.43

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Jang, Kim, and Kim: Diagnosis and Pathophysiology of Hallux Valgus

Review Article

J Korean Foot Ankle Soc 2014;18(2):43-47.

Published online: 10 June 2014

DOI: https://doi.org/10.14193/jkfas.2014.18.2.43

Diagnosis and Pathophysiology of Hallux Valgus

Kyu-Sun Jang, Tae Wan Kim, Hak Jun Kim

Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea

Corresponding Author: Hak Jun Kim Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul 152-703, Korea Tel: 82-2-2626-2090, Fax: 82-2-2626-1164, E-mail: dakjul@hanmail.net

Received 8 April 2014 Revised 24 April 2014 Accepted 24 April 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hallux valgus is a lateral deviation of the first phalanx and medial deviation of the first metatarsal at the first metatarsophalangeal (MP) joint. Its incidence has increased due to developing footwear. The etiologies include fashion footwear, genetic causes, anatomical abnormality around the foot, rheumatoid arthritis, and neuromuscular disorders. Physiologic alignment of the first MP joint is maintained by congruent and symmetric alignment of the articular surface of the first proximal phalanx and first metatarsal head, physiologic relationship of the distal first metatarsal articular surface and the first metatarsal shaft axis, and stable balance of soft tissue around the first MP joint and stable tarsometatarsal joint. Several factors have been associated with hallux valgus, including pes planus, hypermobility of the first tarsometatarsal joint, flattened shape of the first metatarsal head, increased distal metatarsal articular angle, and deformation of the medial capsular integrity. History and physical examination are very important to diagnosis of hallux valgus. Simple radiography provides information on deformity, particularly in weight-bearing anteroposterior and lateral radiographs. Understanding the etiologies and pathophysiology is very important for success in treatment of patients with hallux valgus.

Keywords: Hallux valgus, Diagnosis, Pathophysiology

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Figure 1.

The structure of tendon, ligament and joint capsule around first metatarsophalangeal (MP) joint. (A) Schematic illustration of plantar surface of first MP joint. (B) Schematic illustration of lateral capsule of first MP joint.

Figure 2.

Parameters which should be measured in hallux valgus. HVA: hallux valgus ankle, IMA: intermetatarsal angle, DMAA: distal metatarsal articular angle, PPAA: proximal phalangeal articular angle, MTCA: metatarsocuneiform angle.

Table1.

Radiologic Parameters of Hallux Valgus

Angle	Location	Importance	Normal
Hallux valgus angle	Between long axes of first proximal phalanx and first metatarsal, bisecting their diaphysis	Identifies the degree of deformity at the metatarsophalangeal joint	≤15^o
First-second intermetatarsal angle	Between long axes of first and second metatarsals, bisecting shafts of first and second metatarsals	Not influenced by overresection of medial eminence; not accurate for postoperative evaluation of distal osteotomies	≤9^o
Distal metatarsal articular angle	Angle of line bisecting metatarsal shaft with line through base of distal articular cartilage cap	Offset of angle is predisposing factor in development of hallux valgus	≤15^o
Proximal phalangeal articular angle	Articular angle of base of proximal phalanx in relation to longitudinal axis	Offset of angle is predisposing factor in development of hallux valgus	≤10^o
First metatarsocuneiform angle	Articular angle of base of metatarsal in relation to longitudinal axis of medial cuneiform	Offset of angle is predisposing factor of metatarsocuneiform instability	≤10^o

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