obsolete acquired hallux varus

Obsolete Acquired Hallux Varus: A Rare Foot Deformity

Hallux varus, also known as "splaying" or "inward angulation" of the great toe, is a rare foot deformity characterized by the medial deviation of the big toe away from the second toe. This condition can result from an imbalance between the bone, tendon, and ligamentous-articular structures in the first metatarsophalangeal joint (MJ).

Causes and Risk Factors

Obsolete acquired hallux varus is often caused by prior bunion surgery that has resulted in overcorrection, leading to medial deviation of the great toe. Other predisposing factors include a small intermetatarsal angle (IM angle) and a round metatarsal head.

• Surgical complications: Release or transfer of the adductor hallucis alone is not sufficient to produce dynamic hallux varus; however, when coupled with excision of the fibular sesamoid or transection of the lateral head of the flexor brevis tendon, hallux varus likely results [1][2].
• Anatomical factors: A small IM angle and a round metatarsal head can contribute to the development of hallux varus [3].

Symptoms and Diagnosis

The symptoms of obsolete acquired hallux varus include:

• Medial deviation of the great toe away from the second toe
• Increased space between the first and second toes (splaying)
• Varus angulation of the great toe

Diagnosis is made clinically, with a visual examination of the foot revealing the characteristic medial deviation of the big toe.

Treatment and Management

Treatment for obsolete acquired hallux varus typically involves surgical correction to restore proper alignment and function to the first metatarsophalangeal joint. The goal of treatment is to alleviate symptoms, improve mobility, and prevent further complications.

References:

[1] Context 3 [2] Context 9 [3] Context 4

Common Signs and Symptoms of Obsolete Acquired Hallux Varus

Hallux varus, a condition characterized by the medial deviation of the great toe at the metatarsophalangeal (MTP) joint, can present with various signs and symptoms. The following are some common indicators of obsolete acquired hallux varus:

• Medial Deviation: A clear indication of the big toe leaning away from the small toes [5].
• Pain: Pain can result from the inward-oriented great toe rubbing up against a shoe, as well as arthritic-type pain originating from the primary joint of the great toe (1st MTP joint) due to the change in orientation of this joint [3].
• Blisters and Ingrown Toenails: Blisters on the big toe due to friction with the shoe and ingrown toenails, which are again due to pressure from footwear [4].
• Difficulty Walking or Standing: Individuals with hallux varus may experience difficulty walking or standing due to pain and discomfort [6][7][8][9][10][11][12][13][14][15].
• Limited Range of Motion: A limited range of motion in the foot and ankle, caused by pressure on the toe, can also be a symptom of hallux varus [8].
• Chronic Soreness: Chronic soreness in the foot and ankle is another common symptom of hallux varus [6][7][8][9][10][11][12][13][14][15].

It's essential to seek medical attention if you experience any of these symptoms, as early treatment can help alleviate discomfort and prevent further complications.

References: [3] Symptoms. A hallux varus deformity can produce a variety of symptoms. [4] Symptoms of hallux varus: A clear indication of the big toe leaning away from the small toes; Pain in the big toe joint; Blisters on the big toe due to friction with the shoe; An ingrown toenail which again is due to pressure from footwear; [5] What is Hallux Varus? Hallux varus is a condition where the big toe deviates towards the inside of the foot at the main toe joint. [6] Symptoms, Ailments & Signs. The typical symptoms of hallux varus include pressure pain on the big toe and difficulty walking or standing. [7] Other symptoms of hallux varus can include: Chronic soreness. Difficulty walking or standing. Difficulty wearing close-toed shoes. Foot weakness. Ingrown toenails. Limited range of motion. Swelling and pain in the foot and ankle (caused by pressure on the toe). [8] Symptoms of hallux varus are aggravated when you wear shoes that crowd the toes. [9] Explore hallux varus, a toe deformity involving inward deviation of the big toe. Learn about its causes, symptoms, diagnosis, and treatment options, empowering individuals to understand and manage this condition for improved toe alignment and foot health. [10] Jul 7, 2016 — Hallux Varus Symptoms · Chronic soreness. · Difficulty walking or standing. · Difficulty wearing close-toed shoes. · Foot weakness. · Ingrown ... [11] The usual symptoms encountered with hallux varus include deformity, pain, decreased range of motion (ROM), instability, clawing of the great toe, weakness with pushoff, and problems with shoe wear. [12] Hallux varus symptoms · Chronic soreness. · Difficulty walking or standing. · Difficulty wearing close-toed shoes. · Foot weakness. · Ingrown toenails. · Limited ... [13] The drifting of the big toe is the most obvious sign of hallux varus deformity. Other symptoms of hallux varus can include: Chronic soreness. Difficulty walking ... [14] Hallux varus symptoms · Chronic soreness. · Difficulty walking or standing. · Difficulty wearing close-toed shoes. · Foot weakness. · Ingrown toenails. · Limited ... [15] Hallux varus symptoms · Chronic soreness. · Difficulty walking or standing. · Difficulty wearing close-toed shoes. · Foot weakness. · Ingrown toenails. · Limited ...

Diagnostic Tests for Obsolete Acquired Hallux Varus

Obtaining laboratory studies may be necessary in certain cases to rule out infection or inflammation, which can contribute to the development of hallux varus ([3]). However, these tests are not typically used as a primary diagnostic tool.

• Blood tests: These are only needed if an infectious or inflammatory process is suspected. They can help identify underlying conditions that may be contributing to the deformity ([13]).

Imaging Studies

Imaging studies, such as X-rays, play a crucial role in diagnosing hallux varus. They can help assess the degree of deformity and any previous surgical procedures that may have contributed to the condition ([6], [7], [8]). X-rays can also aid in identifying any underlying bone or joint abnormalities.

• X-rays: These are essential for evaluating the foot's anatomy and assessing the severity of the deformity. They can help determine if there are any underlying conditions, such as arthritis or fractures, that may be contributing to the hallux varus ([6], [7]).

Clinical Examination

A thorough clinical examination is also necessary to diagnose hallux varus. This involves evaluating the foot's appearance and assessing the range of motion in the metatarsophalangeal (MTP) and interphalangeal (IP) joints ([5], [9]). The healthcare professional will also take a medical history to determine if there have been any previous surgeries or injuries that may have contributed to the deformity.

• Clinical examination: This is essential for diagnosing hallux varus. It involves evaluating the foot's appearance and assessing the range of motion in the MTP and IP joints ([5], [9]).

Other Diagnostic Tests

In some cases, other diagnostic tests may be necessary to rule out underlying conditions that may be contributing to the hallux varus. These can include:

• CT scans: These may be used to evaluate the foot's anatomy in more detail and identify any underlying bone or joint abnormalities.
• MRI scans: These can help identify any soft tissue injuries or inflammation that may be contributing to the deformity.

However, these tests are not typically used as a primary diagnostic tool for hallux varus. The diagnosis is usually made based on clinical examination and imaging studies.

Treatment Options for Obsolete Acquired Hallux Varus

Obtaining effective treatment for obsolete acquired hallux varus can be challenging, but various options are available to manage this condition.

• Conservative Management: Mild cases of hallux varus may be treated with conservative measures such as stretching exercises and splints. This approach is often recommended for patients who have not experienced significant symptoms or functional impairment.
• Surgical Revision: In more severe cases, surgical revision may be necessary to correct the deformity. The goal of surgery is to restore proper alignment and function of the first ray. Surgical options include soft tissue procedures, tendon transfers, and bony reconstruction.

Soft Tissue Procedures

Soft tissue procedures are often used to address issues related to ligamentous laxity or imbalance. These may involve:

• Tendon Transfers: This involves transferring tendons from other areas of the foot to improve stability and alignment.
• Ligament Reconstruction: In some cases, reconstructing the ligaments surrounding the first metatarsophalangeal joint may be necessary.

Bony Reconstruction

In more severe cases, bony reconstruction may be required. This can involve:

• Arthrodesis: Fusing the bones of the foot to create a stable and functional joint.
• Osteotomy: Cutting and repositioning bones to improve alignment and function.

Important Considerations

When considering treatment options for obsolete acquired hallux varus, it's essential to take into account factors such as:

• Severity of Deformity: The degree of deformity will influence the choice of treatment.
• Patient Symptoms: Patients with significant symptoms or functional impairment may require more aggressive treatment.
• Underlying Causes: Identifying and addressing underlying causes, such as soft tissue imbalance or bony abnormalities, is crucial for effective treatment.

References

1. [4] by T Leemrijse · 2020 · Cited by 23 — There are two main options for surgical revision to restore 1st ray propulsion: 1) static or dynamic reconstruction of the ligamentous structures, conserving ...
2. [9] by BD Bevernage · 2009 · Cited by 66 — Appropriate treatment for hallux varus requires comprehensive radiographic and systematic clinical assessment to identify the involved factors.
3. [12] Appropriate treatment for hallux varus requires comprehensive radiographic and systematic clinical assessment to identify the involved factors. A classification scheme must incorporate many variables in order to determine the best approach to correcting the deformity.

The differential diagnosis for obsolete acquired hallux varus involves identifying the underlying factors that contribute to this condition. According to various medical sources [8][9], the presentation of hallux varus may be clear clinically and radiographically, but underlying disease processes contributing to the deformity are often complex.

Some possible causes of obsolete acquired hallux varus include:

• Abnormal insertion of the abductor hallucis tendon: This can lead to medial deviation of the great toe [4].
• Contracture of the muscle: Contracture of the muscles surrounding the big toe can also contribute to this condition [4].
• Trauma: Physical trauma or injury to the big toe can cause hallux varus [5][6].
• Congenital deformity: Some people are born with a foot structure that predisposes them to a hallux varus foot deformity [6][9].

It's also worth noting that differential diagnosis for hallux varus may involve considering other conditions, such as:

• Hallux valgus: A condition characterized by the lateral deviation of the great toe [12].
• Sesamoid disorders: Conditions affecting the sesamoids bones in the foot [12].

A comprehensive radiographic and systematic clinical assessment is necessary to identify the involved factors and determine the best approach for correcting the deformity [14].