Hallux_Valgus[1][1]

Hallux Valgus & Imaging: 

Hallux Valgus & Imaging By: Joseph Smith , Gabby Kahl & Nancy Summers

Signs & Symptoms: 

Signs & Symptoms Enlargement of 1 st MTP Lateral drift of great toe Joint redness Pain Bursa on Medial side of Met head can form Bunion if inflammation occurs Clawing of the 2 nd &3 rd toes Hallux valgus and Bunion are not synonymous The muscles of the 1 st toes can shift and increase the deformity

Incidence: 

Incidence Incidence peaks during age 20-30, although common from 20-50 83% have family history of hallux valgus 84% of cases are bilateral More common in females Long first metatarsal NOT associated with tight gastrosoleus , increased 1 st ray mobility, or pes planus

Diagnosis/Prognosis: 

Diagnosis/Prognosis Presence of medial bunion with fibular deviation of the first toe Radiographs used to diagnose completely (3 views) Oblique = extent arthrosis of MTP Lateral = lateral arch and stability of 1 st TMT A/P = Hallux Valgus angle and inter-metatarsal angle assessment Prognosis: No studies comparing procedures and success rates; Also no studies comparing conservative therapy verse surgery

Functional Impact: 

Functional Impact Pain Potentially cause Hammer and Claw Toe Facilitates an excessive forefoot pronated position Increased genu valgus, medial rotation of hip

Role of Imaging: 

Role of Imaging Confirm Diagnosis (radiograph) Reassess s/p bunionectomy 3 views as mentioned in diagnosis Must be done in weight bearing

Imaging Findings: 

Imaging Findings http://emedicine.medscape.com/article/1232902-overview Alignment: The patient’s MTP joint is displaying a valgus position, with a medial drift of the metatarsal and a lateral drift of the phalanges of distal to the metatarsal.  There is a medial rotation of the metatarsal demonstrated by the appearance of the sesmoid bone.  The second MTP and PIP are out of alignment also with a rotation component.  The middle and distal phalanges of the 1 st , 2 nd , and 3 rd digit are showing extreme overlap where there should be separation.  The 2 nd digit also is displaying a “piggy back” appearance over the 1 st digit.  There is a slight medial shift of the proximal metatarsal on the medial cuneiform. Bone Density: Diffuse slight decrease in bone density throughout metatarsal and phalanges.  No other noticeable changes in bone density. Cartilage: Decreased joint space between 1 st CMT, MTP, and PIP.  Distal metatarsals displaying signs of osteoarthritis and erosions. Soft Tissue: Contour of medial foot has noticeable “Bunion”.  Swelling/inflammation present.

Angiography: 

Angiography In some cases ,after a proximal wedge osteotomy an angiography was used to determine adequate blood flow of the plantar arch.

Effect of high heel shoes: 

Effect of high heel shoes A 25 yr women On left radiograph without shoes On right radiograph with 3 inch heels Notice the Hallux Valgus shape that appears with heels

Food for Thought: 

Food for Thought Why might this disorder cause serious complications for someone with diabetes? What is another disorder that might present like hallux valgus, but after imaging would reveal itself as something different?

References: 

References Medical-Clinic Hallux Valgus. http://www.medical-clinic.org/diseases/hallux-valgus.html . Accessed October 6th, 2011 Coughlin MJ, Jones CP. Hallux Valgus: Demographics, Etiology, and Radiographic Assessment. Foot Ankle Int. 2007 28(7);759-77 Jezussek D, Honle W, Schuh A. Clinical Signs and Diagnosis of Hallux Valgus. MMW Fortschr Med. 2006 148(48): 33-4, 36 Department of Radiology: University of Washington 2007. http://www.rad.washington.edu/academics/academic-sections/msk/teaching-materials/radiology-anatomy-teaching-modules/radiographic-evaluation-of-hallux-valgus accessed October 7,2011. Kisner,C & Colby, L. Therapeutic Exercise 5 th edition . Philadelphia, LA. F.A. davis Company. 2007. Field, Lauren and Sun, Zhonghua . Multislice CT angiography of the plantar arch: A case report. Biomedical Imaging and Intervention Journal . 2010; 6 (1): pp. e10