What is Hallux Varus?
Hallux varus occurs when the big toe angles AWAY from the second toe. This can cause the big toe to rub against the inside of shoes which makes finding comfortable shoes very difficult. In minor cases hallux varus can be accommodated by finding wider shoes and by padding the big toe. However, more severe cases can be disabling.
What Causes Hallux Varus?
By far the most common cause of hallux varus is failed bunion surgery. A bunion is the opposite problem where the big toe angles TOWARD the second toe. When bunion correction surgery is performed over aggressively, hallux varus occurs. The reasons for having hallux varus are:
• Over corrected bunion surgery
• Underlying neurologic problems
• Congenital (present since birth)
• Traumatic injury
Symptoms of Hallux Varus
The main difficulty with hallux varus is shoe wear. Because of the abnormal position of the big toe, it can be nearly impossible to wear closed shoes in severe cases. These patients often can only wear open toed foot wear which may not be compatible with work, recreation, or colder weather. Problems that patients with hallux varus can experience include:
• Difficulty with shoe wear
• Calluses on the side of the big toe
• Ingrown toenails from rubbing on the inside of shoes
• Pain in the big toe
• Stiffness and arthritis of the big toe joint
• Personal embarrassment
Diagnosis of Hallux Varus
Hallux varus is usually obvious just by visual inspection of the foot. Standing X-rays of the foot can confirm the deformity and the severity of the angulation can be measured. X-rays can also look for problems that may have occurred from the previous surgery as well as for arthritis of the big toe joint. Physical examination by the orthopedic foot specialist will look specifically for how easily the deformity can be corrected and if there is any stiffness in the toe joint present.
Conservative Treatment of hallux varus includes:
• Wider shoes or open toe foot wear
• Strapping or taping the big toe to the second toe
• Padding the big toe with a silicone toe sleeve
• Appropriate nail care
If conservative treatment fails and the hallux varus deformity is significantly affecting the patient’s work or recreation, surgical correction may be necessary. Surgery for hallux varus falls into two main categories, reconstruction or fusion:
Reconstruction – In hallux varus, the pull of the muscles and ligaments on one side of the toe is overpowering the opposite side resulting in the deformity. Hallux varus surgery re-balances the pull of these muscles and ligaments equally on both sides of the big toe joint. This is done using tendon transfers and suture devices implanted into the bones to maintain the correct alignment. Sometimes a bone cut may also may necessary to achieve a perfect balance.
Fusion – Fusion of the big toe involves making the two bones on either side of the joint heal together into one solid piece of bone. This is done by scraping and perforating the opposing sides of the joint and then holding the bones compressed tightly together with metal plates and screws. Fusion is usually reserved for hallux varus patients who are stiff or arthritic. Patients with big toe fusions walk normally and have very few limitations with sports or work.