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4/3: Elderly/Orthopaedics Y3/4 - MSK [11] (check ILOs) > [3] Hallux Valgus > Flashcards

[3] Hallux Valgus Flashcards

1
Q

What is hallus valgus commonly termed?

A

Bunion

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2
Q

What is hallux valgus?

A

A deformity at the first metatarsophalangeal joint

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3
Q

What is hallux valgus characterised by?

A

Medial deviation of the first metatarsal and lateral deviation with or without rotation of the hallux, associated with joint subluxation

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4
Q

How common in hallux valgus?

A

One of the most common foot problems in adult population, with a prevalence of around 35% in those aged >65 years

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5
Q

Which gender is hallux valgus more common in?

A

Women

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6
Q

What should happen to the digits during the gait cycle?

A

They should remain parallel to the long axis of the foot

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7
Q

What makes it possible for the digits to remain parallel to the long axis of the foot during the gait cycle?

A

Balance between static stabilisers and dynamic stabilisers

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8
Q

What are the static stabilisers in the foot?

A

Bones and ligaments

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9
Q

What are the dynamic stabilisers in the foot?

A

Muscles and tendonsq

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10
Q

What is the result of the gross anatomy on the foot on the first metatarsal?

A

It means the first metatarsal is inherently unstable, heavily relying on the stabilising structures

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11
Q

What is the result on the heavy reliance of the first metatarsal on other structures for stability?

A

There is a greater risk of disturbing the fine balance

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12
Q

What happens once the metatarsal head escapes the intrinsic anatomical control?

A

The extrinsic tendons become a deforming force, causing the first metatarsal head to drift medially

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13
Q

What does the medial joint tension cause when the metatarsal head escapes intrinsic anatomical control cause?

A

The bone to proliferate on the dorsomedial aspect of the head of the first metatarsal, with the cartilage being affected by the subsequent remodelling

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14
Q

What factors can further contribute to hallux valgus?

A

Anatomical variants
Genetic predisposition
Environmental factors

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15
Q

What footwear can contribute to hallux valgus in predisposed individuals?

A

Wearing high-heeled or narrow-fitting footwear

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16
Q

Why can high-heeled or narrow fitting footwear contribute to hallux valgus?

A

It keeps the hallux in a valgus position

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17
Q

What are the main risk factors for developing hallux valgus?

A

Female
Connective tissue disorders
Hypermobility syndromes

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18
Q

What anatomical variants predispose to the development of hallux valgus?

A

Long first metatarsal bone
Malalignment of the first MTP
Flat feet

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19
Q

How does hallux valgus typically present?

A

Painful medial prominence

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20
Q

What is likely to aggravate the painful medial prominence in hallux valgus?

A

Walking
Weight-bearing activities
Wearing narrow toed shoes

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21
Q

Describe likely symptom progression in hallux valgus

A

Symptoms have often been present for some time before progression, however have worsened in frequency and intensity

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22
Q

What should be assessed on examination in hallux valgus?

A

Assess position and lateral deviation of the hallux
Check for evidence of inflammation or skin breakdown over the prominence at the base of the hallux
Check for worsening of the prominence in the weight-bearing position
Assess range of movement (active and passive) and crepitus

23
Q

What is the importance of checking for movement and crepitus in hallux valgus?

A

The presence of associated pain and crepitation is indicative of cartilage degeneration

24
Q

What might be visible on examination in long-standing joint sublaxation?

A

Contracture of the extensor hallicus longus

25
Q

What might excessive keratosis on the foot indicate in hallux valgus?

A

Signs of abnormal weight distribution from an altered gait

26
Q

What is a normal range of movement of the foot?

A

5mm in both the dorsal and plantar direction from the neutral, with no motion detectable in the transverse plane

27
Q

What are the differential diagnoses for hallux valgus?

A 
Gout
Septic arthritis
Hallux rigidus
Osteoarthritis
Rheumatoid arthritis
28
Q

What is the main investigation in hallux valgus?

A

Radiographic imaging

29
Q

What useful information can be obtained from radiographic imaging in hallux valgus?

A

Determine degree of lateral deviation

See signs of joint sublaxation

30
Q

How is lateral deviation measured on radiographic imaging?

A

As the angle between the first metatarsal and the first proximal phalanx

31
Q

What degree of lateral deviation on radiographic imaging is diagnostic of hallux valgus?

A

Greater than 15 degrees

32
Q

What degree of lateral deviation on radiographic imaging is considered to be mild hallux valgus?

A

15-20 degrees

33
Q

What degree of lateral deviation on radiographic imaging is considered to be moderate hallux valgus?

A

21-39 degrees

34
Q

What degree of lateral deviation on radiographic imaging is considered to be severe hallux valgus?

A

> 40 degrees

35
Q

What is involved in the conservative management of hallux valgus?

A

Prescription of sufficient analgesia
Adjustment of footwear
Physiotherapy

36
Q

What is the purpose of analgesia in hallux valgus?

A

To limit the effects of the condition on QoL

37
Q

What is the purpose of the adjustment of footwear in hallux valgus?

A

Prevent worsening of deformity

Prevent irritation of the skin over the medial eminence

38
Q

When might an orthosis be useful in hallux valgus?

A

If the patient is has flat feet, then an orthosis may help to prevent the progression of the condition

39
Q

What is done in physiotherapy for hallux valgus?

A

Stretching exercises

Gait re-education

40
Q

Which hallux valgus patients should be considered for surgical intervention?

A

Those whose quality of life is significantly impacted by the condition

41
Q

What surgical procedures can be used in the management of hallux valgus?

A

Chevron procedure
Scarf procedure
Lapidus procedure
Keller procedure

42
Q

What happens in a chevron procedure?

A

A ‘V shaped’ osteotomy of the distal first metatarsal is created, allowing the first metatarsal to be shifted laterally back into a normal alignment, then fixed by pins and screws

43
Q

What is a chevron procedure commonly used for?

A

Mild deformities

44
Q

What happens in a scarf procedure?

A

A longitudinal osteotomy is made within the shaft of the first metatarsal, for the distal portion to be moved laterally and fixed with two screws

45
Q

What is a scarf procedure commonly used for?

A

Moderate to severe deformity

46
Q

What happens in a lapidus procedure?

A

The base of the 1st metatarsal and medial cuneiform are fused

47
Q

When is a lapidus procedure commonly used?

A

When the underlying cause is tarsometatarsal joint hypermobility

48
Q

What happens in a Keller procedure?

A

An incision is made over the first MTPJ and the joint capsule is opened to expose the joint, with the disease joint surfaces being removed for a space to be left that is stabilised by suturing of surrounding tissues and subsequent scar tissue

49
Q

When is a keller procedure commonly used?

A

When first MTPJ arthritis is severe

50
Q

What are the potential surgical complications of procedures used for hallux valgus?

A

Wound infection
Delayed healing
Nerve injury
Osteomyelitis

51
Q

What are the complications of hallux valgus?

A

Avascular necrosis
Non-union
Displacement
Reduced ROM

52
Q

What is the prognosis of hallux valgus?

A

Variable, as the deformity may remain stable, or progress rapidly

53
Q

What is the role of conservative management in hallux valgus?

A

It may alleviate symptoms, but will never correct the deformity

4/3: Elderly/Orthopaedics Y3/4 - MSK [11] (check ILOs) (38 decks)

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