Hallux Valgus Lateral deviation of hallux at 1st MTP Orthopods consider >15-20% abnormal

Pathophysiology Starts with excessive pronation and/or weak abductor hallucis (relative to agonists) Conjoined Tendon of Adductors Hallucis, EHL and FHL gain mechanical advantage As 1st phalange is pulled laterally the 1st MTP displaces laterally Tension in medial aspect of 1st MTP leads to bony proliferation causing a palpable lump, or bunion, which may also develop bursae Lateral tension against sesamoid bones may cause them to dislocate laterally. Lateral one may end up between hallux and second toe.

Risk factors Genetics Women Age Tight or high heeled shoes

Patient presents with Sharp or deep pain in 1st MTP on activity Deformity Ache in 1st metatarsal head when wearing shoes History of trauma or inflammatory arthritis Maybe ulceration or keratosis if toes overlap Maybe neuritis of medial dorsal cutaneous nerve presenting as a burning pain in the dorsum of the bunion

Sequalae Subluxation of 1st MTP and resulting bunion may rub on shoe Hallux may overlap second toe OA may develop at 1st MTP as cartilage is worn due to altered mechanics. This may lead to Hallux Rigidus Dropped transverse arch, may get a pad underneath which is a good diagnostic tool. May get metatarsalgia

Investigation X Ray

Hallux Valgus Management Shoes that are wide enough and not high-heels Analgaesis Steroid Injection Orthotics Chiropodists felt Surgery if indicated by pain rather than disfigurement

Osteopathic care options Relief of pre-disposing factors Look at full lower extremity mechanics Advice on shoes and orthotics Exercise to strengthen Abductor Hallucis Longus probably only effective in very early stages Traction and articulation to aid fluid mechanics and help prevent OA Encourage barefoot walking to increase toe splay at toe-off

Miss Lasts useful contacts Canonbury for Vasyli Pro orthotics

http://www.canonbury.com/p-1500-vasyli-pro-34-length-orthotics.aspx

Run and Become for running shoe assessment

http://www.runandbecome.com/Home