Hallux Varus Clinical Presentation

Updated: May 28, 2020
  • Author: Amy Jo Ptaszek, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Presentation

History

The usual symptoms encountered with hallux varus include the following:

  • Deformity
  • Pain
  • Decreased range of motion (ROM)
  • Instability
  • Clawing of the great toe
  • Weakness with pushoff
  • Problems with shoe wear
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Physical Examination

Clinical examination is important to assess the stiffness of the metatarsophalangeal (MTP) and interphalangeal (IP) joints. Carefully analyze the degree of extension of the first MTP joint, and determine whether weightbearing and the dynamics of ambulation accentuate the deformity. Examine the plantar surface for any callosity under the metatarsal head. Evaluate the ROM of the MTP and IP joints, and note whether there is any pain or crepitation.

Cosmetic alignment of the hallux may not require radiographic congruence of the MTP joint. The literature suggests that some degree of varus is acceptable to patients, appears to be stable, and does not require reconstruction. According to some sources, hallux varus of 8º or less has little clinical significance. [13]  Additionally, hallux varus is better tolerated by the patient if the condition does not include a cockup deformity.

However, over time, a varus deformity becomes fixed, making it difficult to wear shoes. Contracture of the IP joint, coupled with fixed extension of the MTP joint, can produce a painful dorsomedial callosity.

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