foot ankle

Hallux Valgus

intermediate

6 min

28 marks

6 questions

Clinical Scenario

A 54-year-old female primary school teacher presents with progressive pain and deformity of her right great toe over 3 years. She reports difficulty fitting into standard footwear and pain over the medial eminence when walking. She has tried wider shoes and padding without relief. Clinical examination reveals obvious bunion deformity with hallux valgus angle estimated at 35°. The first metatarsal head is prominent medially with overlying bursa. The hallux is reducible but the first MTP joint is stiff with 40° dorsiflexion. Second toe shows early hammer toe deformity with crossover tendency.

Weight-bearing radiographs of the foot are provided.

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Clinical image for Hallux Valgus

Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License

Questions

Question 1 (4 marks)

What radiographic angles should be measured on this weight-bearing AP foot radiograph, and what are the normal values?

Question 2 (5 marks)

Describe the pathoanatomy of hallux valgus. What structures are contracted and what structures are attenuated?

Question 3 (6 marks)

What surgical options are available for this patient? Describe your decision-making algorithm based on the radiographic findings.

Question 4 (5 marks)

Describe the technique for a Scarf osteotomy including the advantages of this procedure.

Question 5 (4 marks)

What are the common complications of hallux valgus surgery and how would you prevent them?

Question 6 (4 marks)

When would you consider a Lapidus procedure over a distal/shaft osteotomy? What are the key technical points?