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Congenital Hallux Varus (Atavistic Great Toe)

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Topic updated on 09/28/15 1:56am
Introduction
  • An adduction deformity of the great toe 
  • Epidemiology
    • presents in children after walking age
  • Pathophysiology
    • deformity at metatarsophalangeal joint due to 
      • imbalance between the great toe abductor and adductors
    • pathoanatomy
      • firm band-like abductor hallucis muscle
  • Risk factors
    • longitudinal epiphyseal bracket of the first metatarsal or proximal phalanx
  • Associated conditions
    • often associated with polydactyly
Presentation
  • Symptoms
    • painless deformity
Imaging
  • Radiographs
    • recommended views of the foot
      • AP
      • lateral
      • oblique
    • findings
      • short, thick 1st metatarsal 
Differential
  • Must be differentiated from metatarsus adductus
Treatment
  • Nonoperative
    • observation alone
      • indications
        • first line of treatment  as most cases resolve with age
  • Operative
    • abductor hallucis muscle release
      • indications
        •  resistant cases
    • excision of central portion of epiphyseal bracket 
      • indicated if epiphyseal bracket found to be the cause of Hallux Varus
      • resumption of longitudinal growth common if performed at a young age
      • secondary corrective realignment or lengthening is sometimes needed
 

 

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