Decision Making in the Treatment of Hallux Valgus.

Hallux valgus (HV) is a valgus angulation of the first metatarsophalangeal (MTP) joint of the great toe. Hallux valgus is distinct from a bunion, which is an exostosis on the dorsomedial aspect of the first metatarsal (MT) head. The word bunion is derived from the Greek, bunio, and means turnip; better known is the meaning of the Latin derived hallux valgus, that roughly translates to “large toe with an outward angulation,” but more informally as a “crooked big toe.” Hallux valgus is also frequently painful and may both limit physical activities and create a psychological distress for patients, depending on the severity of the deformity. The condition of HV includes not only the outward lateral deviation of the great toe (distal segment of the first metatarsal) but a medial deviation of the first MT. Commonly, there is progressive subluxation of the first MTP joint. Occasionally, there is a static deformity due to valgus angulation of the distal articular surface of the first MT or proximal phalangeal articular surface. Constricting footwear is a major extrinsic cause of HV. Couglin and Thompson noted the high prevalence of HV in American females in the fourth, fifth, and sixth decades of life and its probable association with footwear type. (1) The prevalence of HV in Japanese females also increased dramatically after the introduction of high-fashion footwear following WWII.” (2)

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