Hallux Valgus
It is the lateral deviation of the great toe at the metatarso-phalangeal joint.
Clinical features:
Often, deformity is the only complaint. However in some longstanding cases, there could be pain in
the great toe and there could be significant swelling on the medial side due to bunion. Friction of the
bunion due to the ill-fitting footwear could lead to skin ulceration.
Treatment:
Relaxed passive stretching of the abductors of great toe
Active exercises to the foot intrinsic muscles
Proper weight bearing methods
Footwear with straight inner border with a wedge between the I and II toe
Faradic foot bath is recommended.
Common operations performed are:
Osteotomy of neck of the first metatarsal (Mitchell's osteotomy)
Excision of the metatarsal head (Mayo's operation)
Excision of the base of proximal phalanx (Keller's operation)
Turf Toe
Turf toe describes a range of injuries to the capsuloligamentous complex of the first MTP joint.
The mechanism of the first MTP joint sprain is forced dorsiflexion of the MTP joint. The typical
football associated injury occurs when a player firmly plants his forefoot and is then struck from
behind. The continued forward motion of the leg over the fixed forefoot produces hyper dorsiflexion
of the 1 st MTP joint and increased tension on the plantar plate and capsule.
Sand Toe = Forced hyper plantarflexion of the first MTP joint
Signs and Symptoms
Acute localized pain, swelling, ecchymosis and guarding.
, Increasing degrees of swelling, pain and loss of joint motion are noted as the severity of the injury
increases.
Antalgic gait and a tendency to avoid loading by foot supination may be present
Radiographic evaluation
1 st MTP joint swelling
Ecchymosis adjacent to the area of capsular injury
Plantar tenderness at the MTP joint
Pain with passive dorsiflexion/decreased dorsiflexion
Pain with joint loading
Vertical instability of the first MTP
It is the lateral deviation of the great toe at the metatarso-phalangeal joint.
Clinical features:
Often, deformity is the only complaint. However in some longstanding cases, there could be pain in
the great toe and there could be significant swelling on the medial side due to bunion. Friction of the
bunion due to the ill-fitting footwear could lead to skin ulceration.
Treatment:
Relaxed passive stretching of the abductors of great toe
Active exercises to the foot intrinsic muscles
Proper weight bearing methods
Footwear with straight inner border with a wedge between the I and II toe
Faradic foot bath is recommended.
Common operations performed are:
Osteotomy of neck of the first metatarsal (Mitchell's osteotomy)
Excision of the metatarsal head (Mayo's operation)
Excision of the base of proximal phalanx (Keller's operation)
Turf Toe
Turf toe describes a range of injuries to the capsuloligamentous complex of the first MTP joint.
The mechanism of the first MTP joint sprain is forced dorsiflexion of the MTP joint. The typical
football associated injury occurs when a player firmly plants his forefoot and is then struck from
behind. The continued forward motion of the leg over the fixed forefoot produces hyper dorsiflexion
of the 1 st MTP joint and increased tension on the plantar plate and capsule.
Sand Toe = Forced hyper plantarflexion of the first MTP joint
Signs and Symptoms
Acute localized pain, swelling, ecchymosis and guarding.
, Increasing degrees of swelling, pain and loss of joint motion are noted as the severity of the injury
increases.
Antalgic gait and a tendency to avoid loading by foot supination may be present
Radiographic evaluation
1 st MTP joint swelling
Ecchymosis adjacent to the area of capsular injury
Plantar tenderness at the MTP joint
Pain with passive dorsiflexion/decreased dorsiflexion
Pain with joint loading
Vertical instability of the first MTP
