Is a 1st metatarsophalangeal joint angle of 16 degrees on the right side and 20 degrees on the left side indicative of hallux valgus (hallux valgus deformity) requiring correction?

From the Guidelines

Surgical correction is indicated for hallux valgus deformity with metatarsophalangeal joint angles of 16 degrees on the right foot and 20 degrees on the left foot, as both angles exceed the standard threshold of 15 degrees. The treatment approach should prioritize reducing the risk of future complications, such as foot ulcers, and improving the patient's quality of life 1.

Key Considerations

• The patient's symptoms, such as pain, difficulty with footwear, or functional limitations, should be taken into account when deciding on the best course of treatment.
• Conservative measures, including wider shoes, orthotic devices, and padding, should be attempted before considering surgery.
• The specific surgical technique, such as distal soft tissue realignment, osteotomy procedures (e.g., chevron, scarf, or Lapidus procedures), or arthrodesis, should be tailored to the individual's overall foot structure, degree of deformity, and presence of arthritis.
• The left foot, with its larger angle, may require more extensive correction to achieve optimal outcomes.

Treatment Goals

• Realignment of the first metatarsophalangeal joint to improve function and appearance.
• Addressing the underlying biomechanical issues that caused the deformity.
• Reducing the risk of future complications, such as foot ulcers, and improving the patient's quality of life, as emphasized in the standards of medical care in diabetes-2022 1.

Footwear Recommendations

• A broad and square toe box.
• Laces with three or four eyes per side.
• Padded tongue.
• Quality lightweight materials.
• Sufficient size to accommodate a cushioned insole, as recommended for patients with bony deformities or neuropathy 1.

From the Research

Hallux Valgus Correction Deformity

• The first metatarsophalangeal joint angle is an important factor in hallux valgus correction deformity, with studies indicating that angles of 16 degrees on the right side and 20 degrees on the left side may be indicative of the need for correction 2, 3.
• Research has shown that arthrodesis of the first metatarsophalangeal joint can significantly correct the intermetatarsal angle without the addition of a basal osteotomy 3.
• The Lapidus procedure, which involves arthrodesis of the first metatarsocuneiform joint, has also been shown to be effective in correcting moderate to severe hallux valgus deformity, with minimal shortening of the first metatarsal 4.
• Other studies have investigated the use of scarf osteotomy and soft tissue realignment for the treatment of adult primary hallux valgus, with promising results 5.
• The alignment of the first metatarsal-phalangeal joint is also an important consideration in the design of joint replacement implants, with the extension angle between the metatarsal and the proximal phalanx being a key factor 6.

Key Findings

• Arthrodesis of the first metatarsophalangeal joint can correct the intermetatarsal angle without a basal osteotomy 3.
• The Lapidus procedure can correct moderate to severe hallux valgus deformity with minimal shortening of the first metatarsal 4.
• Scarf osteotomy and soft tissue realignment can be an effective treatment for adult primary hallux valgus 5.
• The alignment of the first metatarsal-phalangeal joint is crucial in the design of joint replacement implants 6.

Radiographic Evaluation

• Radiographic evaluation is essential in assessing the severity of hallux valgus deformity and the effectiveness of treatment 2, 3, 4, 5.
• Measurements of the intermetatarsal angle, hallux valgus angle, and medial sesamoid position can provide valuable information on the severity of the deformity and the outcome of treatment 3, 4, 5.