Hallux valgus - Usual Forms

Introduction

“Hallux Valgus” is a subluxation of the first matatarsophalangeal joint with a lateral deviation of the great toe and medial deviation of the the first metatarsal. It is often accompanied by a bulging of the first metatarsal head (bunion). This arching can become inflammatory because of the underlying bursitis of the metatarsal head, which deviation makes the bulge more noticeable. In most cases, the bulge comes from Hallux Valgus, but there exist very rare cases of “bunions” without the Hallux Valgus condition.

Hallux Valgus with bursitis

About two to four percent of people will naturally develop the Hallux Valgus condition, whether they wear shoes or not (thus this even include societies who always walk barefooted). However, wearing high-heels and pointy shoes could bring the number up to 48% in a predispose person!

Shoe-fashion aside, women are more prone to the condition than men, and juvenile Hallux Valgus (which appears in children) is hereditary through the mother with an uneven genetic penetrance of 72%.

The common Hallux Valgus thus definitely runs in some families.

Being flat-footed is not the major factor, except the hypermobile variety, together with generalized ligamentary hyperlaxity. In some patient a pronated flatfoot, may be a predisposing factor to the hallux valgus because the medial capsular structures cannot resist to the strong deforming forces.

When Hallux Valgus appears, there often is a combination of two factors:

1. Genetics: Bone structure of the foot. The bigger the angle between the first and the second metatarsals, the more misshaped the toe will be. If there is an additional articulation facet between the base of M1 and M2, the angle is harder to correct.

These deformations happens particularly in people who are extremely flexible (i.e., who have ligament hyperlaxity).

2. Environment: Wearing high-heel pumps, together with a pointy toe box will accentuate Hallux Valgus.

Heredity in Hallux Valgus development. The greater the angle between the first and second metatarsal, the bigger the deformation.

Various type of Hallux Valgus

The usual form is often a combination of the reasons cited above, that is: it runs in the family and the deformation becomes greater with years of wearing shoes.
Juvenile Hallux Valgus is obviously genetic. Children as young as ten years old and who never wore high-heels or pointy shoes can develop severe forms of Hallux Valgus.
Arthritis the inflammation provoke a wearing of the capsule and ligaments and the joint is gradually deformed, causing Hallux Valgus.

Rarer Types of Hallux Valgus

Post-Traumatic Hallux Valgus may occur when an accident caused a rupture or a tear of the articular capsule. An ankle trauma where the Anterior Tibialis tendon has been ruptured or torn might eventually be the cause of Hallux Valgus because of the over-use of the long extensor of the big toe (EHL : Extensor Hallucis Longus).
Neurological Hallux Valgus happens when either certain muscles are paralyzed or others are spastic, which provokes a harmful muscular imbalance, which in turns will end in Hallux Valgus.

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