Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Condition/Disorder Synonyms ++ Hallux valgusBunion +++ ICD-9-CM Code ++ 735.0 Hallux valgus (acquired) +++ ICD-10-CM Code ++ M20.10 Hallux valgus (acquired), unspecified foot +++ Preferred Practice Pattern ++ 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation1 +++ Key Features +++ Description ++ Valgus deviation (lateral, abduction) of the great toe (hallux) and varus deviation of the 1st metatarsalSome rotation (valgus rotation) at the 1st metatarsal also possibleStatic 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 toInflammation 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 +++ Essentials of Diagnosis ++ Diagnosis usually made by clinical examination or x-rayCan be an independent diagnosis, not associated with disease process +++ General Considerations ++ Important to correct forefoot weight distribution following surgical correction or another bunion will developNeed to address barefoot walking or improper footwear +++ Demographics ++ Most common in women: male-female ratio 9:1222 to 36% if cases are in adolescents2Hereditary componentPoor footwear: improper fit, pointed toe, narrow forefootDancers at higher risk +++ Clinical Findings +++ Signs and Symptoms ++ Irritated skin around bunionPain in 1st metatarsal with walkingParesthesia in 1st metatarsalGlobal ligamentous laxityJoint redness and painShift of big toe towards othersDepression of 2nd metatarsal with possible formation of hammer toeCallus and blister formation around bunionDifficulty finding shoes with proper fitLateral subluxation of the flexor hallucis longus (FHL) muscle2 +++ Functional Implications ++ Pain with standingPain in affected toe with ambulationInability to wear stiff shoesNeed to wear larger shoes to accommodate bunionAltered gait pattern and mechanical issues of the forefoot +++ Possible Contributing Causes ++ Pes planus (flat feet)Excessive pronationGenu valgusLimited dorsiflexion (tight heel cord)Abnormal bone structureArthritisLeg length discrepancyCongenital Grebe syndromeNeurologic conditions, includingCerebral palsyMultiple sclerosisCharcot-Marie-ToothMarfan syndromeDown syndrome +++ Differential Diagnosis ++ Hallux rigidusSesamoiditisHammer toeMetatarsalgiaMetatarsal stress fracture +++ Means of Confirmation or Diagnosis +++ Imaging ++ X-ray +++ Findings and ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.