Hallux Varus Research Articles

先天性内反母足指の一例

A case of congenital hallux varus was reported. He had bilateral marked hallux varus with some minor anomalies at birth, and visited us at 7 years of age. He had no history of any treatment for his feet before. His both hallucis were remarkably deviated medially with incomplete duplication. He had syndactyly of 2-3 toes and 4-5 fingers in both sides.Radiographs showed a broad first metatarsal and small calcified tissue shadow in the medial site.Surgery was indicated. For the right foot we performed Farmer's operation, and for the left applied McElvenney's method, that is loop tendon operation, with Farmer's procedure.Good alignment was obtained, so he felt no pain or disability.

Surgical repair of hallux varus.

Surgical repair of hallux varus.

A Clinical Report on Dorsal Bunion in Talipes Equinovarus

Iatrogenic dorsal bunion in children is observed mostly after operation for talipes equinovarus or post-poliomyelitic paralysis. The dorsal bunion is the deformity of the foot characterized by plantar-flexion of the great toe and concomitant dorsi-flexion of the fist metatarsal, and is often associated with hallut valgus or varus deformity.A 16 year old male with dorsal bunion with hallux varus deformity is presented. We have successfully achieved correction of the deformity by an operation developed by D. W. McKay in 1983, in which the tendons of the flexor brevis and the abductor and the adductor muscles of hallux are transferred to the neck of the first metatarsal.

Pathomechanics of congenital and acquired hallux varus: a clinical and anatomical study.

Hallux varus was observed in 69 feet among patients from a rural Indian population. This included three types of congenital hallux varus. The congenital "primary" type was the commonest and was not associated with any other foot deformity. Among the acquired forms was idiopathic hallux varus of middle age, which developed spontaneously in unshod persons and progressed gradually. Hallux varus following chronic arthritis was part of a consistent pattern of foot deformities in which the first ray collapsed in a zig-zag manner in two planes. Although the development of hallux varus is often due to intrinsic muscle imbalance, hallux varus secondary to chronic arthritis seems to occur as a result of both intrinsic and extrinsic muscle imbalance associated with midtarsal and subtalar arthritis. Muscular factors contribute to progression of the deformity also. No anatomical basis for a racial predilection for the deformity was noted. Failure to use footwear could account for the higher incidence of hallux varus in India.

Treatment of preaxial polydactyly of the foot.

Fourteen patients with preaxial polydactyly are classified into four types according to their morphologic configuration: type 1--ray duplication; type 2--completely duplicated phalanges; type 3--incompletely duplicated metatarsals; and type 4--incompletely duplicated phalanges. The surgical treatment and timing thereof appropriate for each group are discussed. Three cases of congenital hallux varus deformity are analyzed, focusing on the pathomechanism of this disorder. Based on our experience, two main factors are noticed in the etiology of congenital hallux varus deformity: inadequacy of the adductor hallucis and tightening of the fibrous band pulling the big toe into the varus.

Preaxial Polydactyly and Hallux Varus: Classification of Hallux Varus and Relationship between Hallux Varus and Preaxial Polydactyly

Abstract The clinical features of 18 patients diagnosed as having preaxial Polydactyly and hallux varus were studied.There are three types of hallux varus: 1) the medial great toe is pushed out by the lateral overlapping great toe, 2) the great toe is inverted by the deformed first metatarsus, and 3) the great toe is inverted by anchoring substance of the hypoplastic or degenerative medial great toe.The general diagnosis of “hallux varus” may be reasonable based on the common appearance, but the clinical features of these three types differ from each other. The patients with hallux varus caused by anchoring of the hypoplastic or degenerative medial great toe should be strictly differentiated from the patients with hallux varus due to deformity of the metatarsus. Special consideration for treatment is needed for each type.

慢性関節リウマチにおける内反母足指変形

Hallux varus is a rare deformity in rheumatoid arthritis. We found this deformity in 8 of 1314 patients, the frequency being only 0.6per cent. Seven were unilateral and one was bilateral. Roentgenograms of nine materials were examined.In these feet the angle of the hallux varus ranged from 2 to 60 degrees, the average being 26.6 degrees. The angle of 1st and 5th metatarsals ranged from 9 to 28 degrees, the average being 19.6 degrees. Those of 1st and 2nd metatarsals ranged from 0 to 11 degrees. They did not show the spray foot. The longitudinal arch of the foot in hallux varus was lowered distinctly, as found in the flat foot.

Polydactyly of the foot.

One hundred twenty-five patients with 194 supernumerary toes were analyzed. Postaxial polydactyly accounted for 79%. Duplication at the proximal phalanx with either a block metatarsal or a wide metatarsal head was the most common anatomical pattern. Sixty-one patients with 97 duplications evaluated at an average follow-up of 15.1 years postoperatively had 94% excellent or good results. Poor results were often associated with preaxial duplications and persistent hallux varus. Patients with central duplications often had a persistently wide forefoot. Surgical treatment is usually straightforward, but must be individualized. Preoperative radiologic assessment is mandatory. Certain technical considerations are related to better results.

Chevron Osteotomy: Analysis of Factors in Patients' Dissatisfaction

The results of all Chevron osteotomies for hallux valgus performed at the Mayo Clinic between January 1976 and June 1982 were reviewed at least 1 year after surgery. Of the total 157 patients with 228 operations eligible for inclusion in this study, 154 patients with 225 operations were interviewed. Complete satisfaction was expressed for 79.1% of the procedures, satisfaction with minor reservations for 12.9%, and dissatisfaction for 8%. For the osteotomies producing incomplete satisfaction, further investigation identified failure to achieve correction and technical errors as the most prominent factors. There were no cases of avascular necrosis, osteotomy nonunion, or hallux varus.

Duplication of the hallux.

Sixteen patients with duplication of the hallux were reviewed. Follow-up averaged 21 years. Duplication may be classified into three groups: simple hallucal duplication, a transitional type with a short thick first metatarsal, and complete first ray duplication. Routine removal of the most medial hallux or ray is to be avoided. Careful preoperative assessment is necessary to compare hallucal function, cosmesis, and metatarsal weightbearing. Surgery should also correct the associated congenital hallux varus. Surgical complications include functionless hallucis from inappropriate selection and medial soft tissue contractures with either recurrence of the hallux varus or the gradual development of a hallux varus interphalangeus.

Extensor hallucis longus transfer for hallux varus deformity.

The hallux varus deformity results from a dynamic imbalance of the tendons that cross the first metatarsophalangeal joint. This condition most frequently occurs after McBride-type operative treatment for hallux valgus. A new procedure, developed to correct this imbalance, involves transferring the extensor hallucis longus beneath the first intermetatarsal ligament into the base of the proximal phalanx, along with an arthrodesis of the first interphalangeal joint. This procedure in fifteen affected great toes gave over-all satisfactory correction of the hallux varus deformity.

Roentgenologic findings of the hydrolethalus syndrome.

The hydrolethalus syndrome is an autosomal recessive malformation syndrome which has been recently described in Finland. The name hydrolethalus refers to the main findings, namely polyhydramnios, hydrocephalus and lethality. The patients are either stillborn or die soon after birth. The typical roentgenologic findings are hypoplasia of the tibia associated with the anomalies of the respective bone ray, e.g. metatarsus primus varus atavisticus, hallux varus or hallux duplex varus and hydrocephalus with extreme micrognathia and a specific midline defect of the occipital bone.

Bilateral delta phalanx of the proximal phalanges of the great toes. A report on an affected family.

The condition known as delta phalanx (or longitudinally bracketed epiphysis) is a rare congenital anomaly first described in 1964. The deformity consists of a triangular bone with an epiphysis running along the shortened side of the phalanx in a proximal to distal direction, making longitudinal growth of the digit impossible. Isolated hallux varus congenitus due to a delta phalanx of the proximal phalanges of both great toes is extremely rare: there have been only three such cases reported, two of which were in one family--the only report of a familial occurrence of this deformity. This present report details the occurrence of isolated bilateral hallux varus congenitus in four members of one family, a father and his three eldest children. All three children show bilateral delta phalanx of the proximal phalanges of both great toes. There are associated thumb nail anomalies, but no suggestion of polydactylism.

Problems in Polydactyly of the Foot

1. Polydactyly should be treated early. 2. Adequate bone and soft tissue should be removed. 3. One arm of the Y should be removed surgically in the incompletely duplicated Y metatarsal. 4. The incompletely duplicated Y metatarsal shaved to form a single shaft may at first be bowed, but will remodel to form normal or nearly normal bone. 5. The wide metatarsal head associated with a duplicated phalanx should be narrowed surgically to avoid the development of a painful bunion. 6. Short block-like metatarsals remain abnormal. 7. Polydactyly associated with a short first metatarsal and congenital hallux varus carriers a poorer treatment prognosis and may require continuing treatment. 8. Postoperative casting and taping should be utilized to prevent angular deformities and encourage normal forefoot contour.

The etiology of hallux varus: A review.

The etiology of hallux varus: A review.

Acquired hallux varus

Acquired hallux varus deformity of either the static or the dynamic type results from surgery to correct hallux valgus deformity and the accompanying bunion. The dynamic type is disfiguring, uncomfortable, and disappointing to the patient and surgeon alike. Linear as well as rotational forces are at work to produce the deformity. When recognized early, before fixation of the first digit has occurred in the deviated and clawed position, resection of the base of the proximal phalanx will correct the deformity. More radical treatment is required in the patient who is treated late. The experience with seven feet of five patients with acquired hallux varus deformity is presented here.

Surgical hallux varus reduction.

Surgical hallux varus reduction.

Acquired Hallux Varus: Cause, Prevention and Correction

Acquired Hallux Varus: Cause, Prevention and Correction

Surgically induced hallux varus.

Surgically induced hallux varus.

Congenital hallux varus

Operative technics for the correction of the condition known as congenital hallux varus have been described. They are simple and would appear to be adequate for the permanent correction of this deformity. An examination of the literature reveals no procedure as simple.