Hallux Varus

Hallux Varus is a fairly common deformity that affects the first metatarsal phalangeal joint of the big toe. The condition causes the big toe to point away from the second toe, and towards the other foot instead. In medical terms, this is called the medial deviation of the hallux, in relation to the first metatarsal. The capsule of the lateral joint is either absent or weakened, while the medial (outer) side is contracted.

hallux varus

Hallux Varus Causes

This condition can result from direct trauma, but it more often occurs as a complication of corrective bunion surgery. It is sometimes unavoidable; it happens when too much excision of the medial tissue or a balancing of soft tissue is performed. A “true” hallux varus refers to the deformity that affects all three planes of your foot, where the hallux itself is supinated.

Thus, the causes of hallux varus range from this iatrogenic variety (as a result of a bunion operation), to rheumatic, idiopathic, and posttraumatic causes. (The tearing of the lateral collateral ligament would be a type of post-traumatic cause.) A flexible hallux varus, on the other hand, is commonly found in newborn babies, and it will usually self-correct when the child begins to walk. Patients who have hallux varus tend to have a history of bunions or of other MTP join conditions.

Hallux Varus Symptoms

Hallux varus symptoms include pain, deformity, sharply decreased range of motion, “clawing” of the big toe, instability, weakness when “pushing off,” and problems with footwear. Hallux varus tends to look like “hitchhiker’s thumb,” but on the foot. The condition usually does not cause pain in itself; the pain encountered is usually due to friction.

For congenital deformities, prevention is difficult. In terms of treating symptoms, you should get medical advice from your podiatrist.

Hallux Varus Treatment

The treatment of hallux varus depends on the cause, and on how complex the deformity is. If congenital, the condition may be asymptomatic, and little intervention may be needed. In the early stages of hallux varus, splinting might be beneficial, but it will cease to be effective as the condition progresses.

Good podiatric care is essential, and may include treatments like: anti-inflammatory oral medication, injections, and local anaesthetics. There are more treatment procedures, which may be used alone or in conjunction with others. Here is a sample list of treatments:

  • Lengthening the medial capsular structure
  • Relocation of the sesamoids
  • Lengthening of the EHL – the extensor hallucis longus
  • Resection of skin
  • Syndactyly (for the first and second toes)
  • An abductor hallucis transfer
  • Complete joint release
  • Metatarsal phalangeal joint arthrodesis
  • Ligapro suture technique
  • Implant arthroplasty
  • Reverse Akin procedure and the Split EBH transfer
  • An EHL transfer
  • Keller resection arthroplasty
  • EHB transfer
Ultimately, corrective hallux varus surgery may be the ideal option; it may also serve as prevention for other related problems. There are a great number of surgical procedures available, but they all come back to the same principles: the tightening of soft lateral tissue, the release of medial soft tissue, a tendon transfer that aims to correct the deformity, and repair of the osseous.