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  • Hallux valgus
  • Bunion

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  • 735.0 Hallux valgus (acquired)

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  • M20.10 Hallux valgus (acquired), unspecified foot

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Description

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  • Valgus deviation (lateral, abduction) of the great toe (hallux) and varus deviation of the 1st metatarsal
  • Some rotation (valgus rotation) at the 1st metatarsal also possible
  • Static subluxation of 1st metatarsophalangeal joint (MTP)
  • Tissue surrounding 1st metatarsal joint may be inflamed and tender
  • “Bump” on medial side of the 1st toe partly due to
    • Inflammation of the bursal sac
    • Osseous (bony) anomaly on the mesophalangeal joint (where first metatarsal bone and hallux meet)
    • Large part of the bump tends to be the head of the 1st metatarsal, as it deviates medially in relation to the phalange

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Essentials of Diagnosis

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  • Diagnosis usually made by clinical examination or x-ray
  • Can be an independent diagnosis, not associated with disease process

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General Considerations

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  • Important to correct forefoot weight distribution following surgical correction or another bunion will develop
  • Need to address barefoot walking or improper footwear

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Demographics

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  • Most common in women: male-female ratio 9:12
  • 22 to 36% if cases are in adolescents2
  • Hereditary component
  • Poor footwear: improper fit, pointed toe, narrow forefoot
  • Dancers at higher risk

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Signs and Symptoms

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  • Irritated skin around bunion
  • Pain in 1st metatarsal with walking
  • Paresthesia in 1st metatarsal
  • Global ligamentous laxity
  • Joint redness and pain
  • Shift of big toe towards others
  • Depression of 2nd metatarsal with possible formation of hammer toe
  • Callus and blister formation around bunion
  • Difficulty finding shoes with proper fit
  • Lateral subluxation of the flexor hallucis longus (FHL) muscle2

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Functional Implications

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  • Pain with standing
  • Pain in affected toe with ambulation
  • Inability to wear stiff shoes
  • Need to wear larger shoes to accommodate bunion
  • Altered gait pattern and mechanical issues of the forefoot

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Possible Contributing Causes

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  • Pes planus (flat feet)
  • Excessive pronation
  • Genu valgus
  • Limited dorsiflexion (tight heel cord)
  • Abnormal bone structure
  • Arthritis
  • Leg length discrepancy
  • Congenital Grebe syndrome
  • Neurologic conditions, including

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Differential Diagnosis

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Imaging

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  • Increased angle between first and second metatarsals

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Medication

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  • NSAIDs

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Medical Procedures

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  • Surgery to straighten toe

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  • To hospital for imaging, x-ray
  • To physician for corticosteroid injection
  • To surgeon for surgical consult

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  • Antalgic gait secondary to decreased flexibility with dorsiflexion
  • Antalgic gait secondary to pain at first ...

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