Hallux valgus

Pathology
Hallux valgus is a deformity of the big toe characterized by a lateral deviation toward the other toes, often associated with a bony prominence at the first metatarsophalangeal joint (bunion).

This deformity is usually progressive and multifactorial: genetic predisposition, wearing tight or high-heeled shoes, foot alignment disorders (flatfoot), and ligamentous laxity.

Symptoms include pain over the bunion, difficulty wearing shoes, local inflammation, and sometimes deformities of the lesser toes.

Examination
Diagnosis is clinical and confirmed with weight-bearing foot X-rays.

X-rays allow assessment of the deformity angles, joint congruency, and severity, which helps guide treatment.

Treatment

Non-surgical treatment
Initial management is conservative:

• footwear modification (wide, comfortable shoes)
• orthotic insoles if needed
• toe spacers or splints
• analgesics and anti-inflammatory medication if necessary

Surgical treatment
In case of significant pain or persistent functional limitation:

• corrective surgery (first metatarsal osteotomy ± soft tissue procedures)
• technique selection depends on deformity severity

Recovery
Recovery depends on the surgical technique used.

After surgery, weight-bearing is usually allowed early with a postoperative shoe. Bone healing takes several weeks, and return to normal footwear is gradual. Most patients experience improvement in pain and comfort.

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