Hallux varus

The hallux varus is a Varus Deviation of the big toe in the first metatarsophalangeal joint ( Art. Metatarsophalangea prima ), so that the inward medially shows. This very rare deformity is the opposite of hallux valgus and in the majority of cases a rare complication of hallux valgus corrective surgery. Other cases are congenital or post-traumatic.

causes

The most common cause is surgical overcorrection of a hallux valgus with an imbalance of the soft tissues or malposition of the first metatarsal bone. Many surgical steps can cause this:

• Excessive post-operative restraint or redression of the big toe
• Excessive medial capsule compression or insufficiency of the lateral capsule
• After removal of the fibular sesamoid bone at the metatarsophalangeal joint of the big toe, resulting in a loss of stability of the lateral capsule
• Displacement and subluxation of the medial sesamoid bone
• Excessive resection of the medial pseudoexostosis of the first metatarsal head
• Too much lateralization of the first metatarsal head in proximal or distal metatarsal I corrective osteotomies.

X-ray of a congenital hallux varus

Varus malalignment is more common in middle-aged people who go barefoot.

The congenital form, also known as hallux varus congenitus , is very rare.

Other congenital causes are shortening of the first metatarsal bone ( brachymetatarsia ), dysplasia of the first metatarsal bone, or synostosis between the first and second metatarsal bones. Varus malalignment is typical in pre-axial polydactyly with a double big toe.

Also in the context of a spastic illness, e.g. B. in infantile cerebral palsy , hallux varus can occur, as well as complex syndromes and growth disorders .

therapy

A varus deformity of up to 10 ° on its own usually does not significantly affect the foot and hardly requires therapy.

In post-interventional hallux varus there is often an additional hyperextension malposition (extension) of the big toe, which causes the big toe to protrude and create pressure points. This extension malposition usually has to be corrected surgically. For this purpose, a partial tendon transfer of the extensor hallucis longus muscle can be performed. After detaching the lateral two-thirds of the tendon from its attachment to the base of the distal phalanx, the partial tendon is passed under the transverse metatarsal ligament and anchored laterally to the base of the distal phalanx in a drill hole. As a result, when the tendon is tensed, it simultaneously guides the big toe back out of the varus malposition and out of an overstretching. If there is also a significant restriction in movement, usually a flexion contracture, in the interphalangeal joint (big toe joint), an arthrodesis is carried out there .

In the case of congenital hallux varus, the malalignment is often more pronounced, and in many cases even putting on shoes causes problems. Most of the time, the deformity progresses with further growth and surgical correction is necessary in childhood. As a rule, opening subcapital corrective osteotomies are performed on the first metatarsal bone. Since there is usually a shortening ( brachymetatarsia ) of the first metatarsal , it can be lengthened by a wedge interposition or, rarely, by a callus distraction . In the case of severe misalignments, an opening corrective osteotomy of the medial cuneiform bone is performed. Soft tissue interventions alone are usually not sufficient, but they are often necessary as a supplement. Since the deformity increases with further growth, correction is usually recommended in childhood. However, a clear risk of recurrence is described.

Individual evidence

1. ↑ ^{a b} R. A. Mann: Hallux varus: tendon transfer of the extensor hallucis longus muscle. In: N. Wülker, MM Stephens, A. Cracchiolo: Operation Atlas Foot and Ankle. 2nd Edition. Thieme-Verlag, Stuttgart 2007, ISBN 978-3-13-142592-8 , chapter 6, p. 36 ff.
2. ↑ B. Joseph et al .: Hallux varus - a study of thrty cases. In: J Foot Surg. 1984; 23, pp. 392-397.
3. ↑ ^{a b} F. Hefti: Pediatric orthopedics in practice . Springer-Verlag, Berlin 1997, ISBN 3-540-61480-X .

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !