Hallux Varus

Hallux varus is a positional deformity of the great toe.  The toe is adducted, or directed towards the midline of the body.  This may cause difficulty wearing shoes, as the toe can rub against the inside of the shoe.  Additionally, it may cause a secondary contraction deformity at the hallux interphalangeal joint, which is the joint of the great toe.  Patients may also have cosmetic complaints. 

Hallux varus is most commonly seen as a complication of bunion correction.  When hallux valgus, the condition that causes a bunion, is over-corrected, the result is hallux varus.  Essentially, the great toe has been moved from one direction, past its normal position, and put into a different, unpleasant position.  Hallux varus may also be seen in inflammatory arthritic conditions such as rheumatoid arthritis or psoriatic arthritis, or in neurologic conditions such as Charcot-Marie-Tooth disease.  It can also be of a traumatic etiology.

When the deformity is painful, surgical intervention is indicated for correction.  When a foot and ankle surgeon evaluates a patient for hallux varus, it is important to consider the degree of deformity as well as any pathology that may be coming from the joint itself. 

Often times the first metatarsal-phalangeal (MTP) joint may be fused to correct for hallux varus.  This serves a number of purposes.  First, it holds the toe in a corrected position, so that it does not deviate from the optimal position.  Secondly, it addresses any arthritis that may have developed from the misaligned joint.  Misalignment of a joint is often the source of pain and arthritis.  This joint fusion, or arthrodesis, serves to address this problem.

However, fusion of a joint may not be necessary if there is no damage to the joint cartilage yet.  In cases like these, a tendon transfer around the great toe, or hallux, may be warranted. 

There are a number of different tendon transfers that have been described for the correction of hallux varus.  These techniques will typically involve the use of the extensor hallucis longus or the extensor halluics brevis.  These two muscles help to control the hallux, and the tendons of them may be used to correct a flexible deformity such as hallux varus. 

Depending on the surgeon’s preference, one or more tendon transfers may be used to correct hallux varus.  However, the most important thing for the surgeon to evaluate is the flexibility of the deformity.  If the toe can go back into it’s normal alignment easily, then a tendon transfer may be indicated.  If the toe can not be fully reduced, and there is evidence of arthritis on x-ray, then an arthrodesis may be a more appropriate procedure.

Central Florida Foot and Ankle Center 
101 6th St Nw Winter Haven, Fl 33881 
Phone: (863) 299-4551 
www.FLFootandAnkle.com