Hallux Valgus
Alternate Names Lateral Deviation of the Great Toe, Bunion, Hallux Abductovalgus
Definition / Cause Lateral deviation of the great toe (first ray); deviates at first metatarsal-phalangeal joint (MTP).
*The 1st metatarsal is in a Varus position *The Hallux is in a Valgus position. Environmental risks such as wearing pointed shoes, and friction over medial first metatarsal head. The sesamoids are often deviated to the lateral side of the hallux.
Epidemiology Strong familial predisposition, Hypermobility of first metatarsal, and Predisposing rheumatic conditions (Rheumatoid Arthritis, Gouty Arthritis, Psoriatic Arthritis ).  Predisposing functional disorders such as Metatarsal primus varus, Foot pronation, Tight heel cord, External tibial torsion.
Symptoms Pain or deformity at great toe. Increased valgus angle at first MTP joint. Valgus angle at first MTP joint usually <15 degrees. Valgus angle in severe cases >30 degrees. Bunion and inflamed overlying bursa may be present. Painful callus development on 2nd toe.
Graphic
Effects On Gait
  • Overpronation due to 1st ray instability.
  • Degraded toe-off
Pedorthic Objective
  • Control Motion - Reduce Pronation
  • Reduce Friction
  • Improve Gait
  • Transfer Pressure - off of the Bunion (if present)
Orthosis Type
  • OTC will work
  • Custom would be best
  • Using a plaster slipper cast method of casting ( controls the neutral position best)
  • Functional Semi-rigid Orthosis
Shoes/Shoe Mods
  • Extra depth or wide European comfort
  • No medial seams
  • A mild rocker sole shoe will help
  • A blucher style shoe
  • Use a ball and ring to stretch the shoe in the bunion area
Possible Materials
  • 5/32 Polypropylene or 4.0 mm subortholene shell
  • Rearfoot posting of cork or EVA will stabilize the shell
  • 1/8th inch poron with leather cover will offer good cushioning
Expected Outcomes
  • Using a wide forefoot shoe and the ball and ring you can make the foot more comfortable. The rocker sole would help in improving gait.
  • *Using the orthosis you can stop the excess motion of the foot and reduce friction.
Book References IP 9, 42, 107, 132, 141 CP 88-89 FED 69-70, 71f, 72f, 73f, 74f PSF 5, 30, 132 WSF 22, 24-25 PRG 47
Internet Resources http://www.rad.washington.edu/anatomy/halluxvalgus.html