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Hallux Varus Workup

  • Author: Amy Jo Ptaszek, MD; Chief Editor: Jason H Calhoun, MD, FACS  more...
 
Updated: Sep 23, 2014
 

Imaging Studies

Weightbearing radiographs of both feet, including anteroposterior (see the first and second images), lateral (see the third and fourth images), and sesamoid views, help clinicians to assess the degree of varus, the intermetatarsal (IM) and interphalangeal (IP) angles, the position of the sesamoids relative to the metatarsal head, and any degenerative changes in the metatarsophalangeal (MTP) or IP joints.

Anteroposterior radiograph of the foot. This imageAnteroposterior radiograph of the foot. This image shows iatrogenic hallux varus following proximal osteotomy and distal soft-tissue realignment.
Anteroposterior radiograph of the foot. This imageAnteroposterior radiograph of the foot. This image depicts idiopathic hallux varus.
Lateral radiograph of the foot. This image depictsLateral radiograph of the foot. This image depicts iatrogenic hallux varus following proximal osteotomy and distal soft-tissue realignment.
Lateral radiograph of the foot. This image shows iLateral radiograph of the foot. This image shows idiopathic hallux varus.
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Laboratory Studies

Order laboratory studies that are applicable to the specific patient. If infection is suspected, obtain the following indices:

  • Erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • White blood cell (WBC) count

Joint aspiration may also be indicated. If inflammatory disease is suspected, obtain rheumatoid arthritis (RA) and antinuclear antibody (ANA) factors.

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Contributor Information and Disclosures
Author

Amy Jo Ptaszek, MD Assistant Professor, Department of Orthopedic Surgery, University of Texas Southwestern Medical Center

Amy Jo Ptaszek, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Jason H Calhoun, MD, FACS Department Chief, Musculoskeletal Sciences, Spectrum Health Medical Group

Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Michigan State Medical Society, Missouri State Medical Association, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, Texas Orthopaedic Association, Musculoskeletal Infection Society

Disclosure: Nothing to disclose.

Additional Contributors

John S Early, MD Foot/Ankle Specialist, Texas Orthopaedic Associates, LLP; Co-Director, North Texas Foot and Ankle Fellowship, Baylor University Medical Center

John S Early, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma Association, Texas Medical Association

Disclosure: Received honoraria from AO North America for speaking and teaching; Received consulting fee from Stryker for consulting; Received consulting fee from Biomet for consulting; Received grant/research funds from AO North America for fellowship funding; Received honoraria from MMI inc for speaking and teaching; Received consulting fee from Osteomed for consulting; Received ownership interest from MedHab Inc for management position.

References
  1. Jahss MH. Disorders of the hallux and first ray. Disorders of the Foot and Ankle: Medical and Surgical Management. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1991. 1084-9.

  2. Miller JW. Acquired hallux varus: a preventable and correctable disorder. J Bone Joint Surg Am. 1975 Mar. 57(2):183-8. [Medline]. [Full Text].

  3. Granberry WM, Hickey CH. Idiopathic adult hallux varus. Foot Ankle Int. 1994 Apr. 15(4):197-205. [Medline].

  4. Orzechowski W, Dragan S, Romaszkiewicz P, Krawczyk A, Kulej M, Morasiewicz L. Evaluation of follow-up results of McBride operative treatment for hallux valgus deformity. Ortop Traumatol Rehabil. 2008 May-Jun. 10(3):261-73. [Medline].

  5. Popelka S, Vavrík P, Hromádka R, Sosna A. [Our results of the Lapidus procedure in patients with hallux valgus deformity]. Acta Chir Orthop Traumatol Cech. 2008 Aug. 75(4):271-6. [Medline].

  6. Lagaay PM, Hamilton GA, Ford LA, Williams ME, Rush SM, Schuberth JM. Rates of revision surgery using Chevron-Austin osteotomy, Lapidus arthrodesis, and closing base wedge osteotomy for correction of hallux valgus deformity. J Foot Ankle Surg. 2008 Jul-Aug. 47(4):267-72. [Medline].

  7. Mann RA, Coughlin MJ, eds. Adult hallux valgus. Surgery of the Foot and Ankle. 6th ed. St. Louis, Mo: Mosby, Inc; 1993. 284-92.

  8. Shim JS, Lim TK, Koh KH, Lee do K. Surgical treatment of congenital hallux varus. Clin Orthop Surg. 2014 Jun. 6(2):216-22. [Medline]. [Full Text].

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  10. Leemrijse T, Hoang B, Maldague P, Docquier PL, Devos Bevernage B. A new surgical procedure for iatrogenic hallux varus: reverse transfer of the abductor hallucis tendon: a report of 7 cases. Acta Orthop Belg. 2008 Apr. 74(2):227-34. [Medline].

  11. Hawkins FB. Acquired hallux varus: cause, prevention and correction. Clin Orthop Relat Res. 1971 May. 76:169-76. [Medline].

  12. Johnson KA, Spiegl PV. Extensor hallucis longus transfer for hallux varus deformity. J Bone Joint Surg Am. 1984 Jun. 66(5):681-6. [Medline]. [Full Text].

  13. Skalley TC, Myerson MS. The operative treatment of acquired hallux varus. Clin Orthop Relat Res. 1994 Sep. (306):183-91. [Medline].

  14. Myerson MS, Komenda GA. Results of hallux varus correction using an extensor hallucis brevis tenodesis. Foot Ankle Int. 1996 Jan. 17(1):21-7. [Medline].

  15. Juliano PJ, Myerson MS, Cunningham BW. Biomechanical assessment of a new tenodesis for correction of hallux varus. Foot Ankle Int. 1996 Jan. 17(1):17-20. [Medline].

  16. Tourné Y, Saragaglia D, Picard F, et al. Iatrogenic hallux varus surgical procedure: a study of 14 cases. Foot Ankle Int. 1995 Aug. 16(8):457-63. [Medline].

  17. Tanaka Y, Takakura Y, Kumai T, Sugimoto K, Taniguchi A, Hattori K. Proximal spherical metatarsal osteotomy for the foot with severe hallux valgus. Foot Ankle Int. 2008 Oct. 29(10):1025-30. [Medline].

  18. Chow FY, Lui TH, Kwok KW, Chow YY. Plate fixation for crescentic metatarsal osteotomy in the treatment of hallux valgus: an eight-year followup study. Foot Ankle Int. 2008 Jan. 29(1):29-33. [Medline].

  19. Choi KJ, Lee HS, Yoon YS, Park SS, Kim JS, Jeong JJ, et al. Distal metatarsal osteotomy for hallux varus following surgery for hallux valgus. J Bone Joint Surg Br. 2011 Aug. 93(8):1079-83. [Medline].

  20. Sanders M. Complications of hallux valgus surgery. Complications of Foot and Ankle Surgery. 1998. 1-18.

  21. Plovanich EJ, Donnenwerth MP, Abicht BP, Borkosky SL, Jacobs PM, Roukis TS. Failure after Soft-tissue Release with Tendon Transfer for Flexible Iatrogenic Hallux Varus: A Systematic Review. J Foot Ankle Surg. 2012 Mar. 51(2):195-7. [Medline].

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Anteroposterior radiograph of the foot. This image shows iatrogenic hallux varus following proximal osteotomy and distal soft-tissue realignment.
Lateral radiograph of the foot. This image depicts iatrogenic hallux varus following proximal osteotomy and distal soft-tissue realignment.
Clinical photo of idiopathic hallux varus of the left foot.
Anteroposterior radiograph of the foot. This image depicts idiopathic hallux varus.
Lateral radiograph of the foot. This image shows idiopathic hallux varus.
 
 
 
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