Treatment

The treatment of hallux valgus is dependent on the age of the patient.

Adolescents:

• usually the only symptom is deformity
• surgery, e.g. Mitchell's osteotomy of the distal end of the first metatarsal will prevent progressive deformity

Adults:

• conservative treatment:
  • careful attention to footwear
  • padding over the bunion or hammer toe
  • foot exercises
  • conservative treatment may reduce discomfort but does not delay the progression of the condition
    
    
• surgical treatment:
  • aim of surgery is to reduce the increased intermetatarsal angle, relocate the metatarsal head over the sesamoids and realign the hallux
  • in the relatively young patient (20-50 years), the condition may be treated with excision of the medial prominence and release of adductor hallucis tendon
  • Mitchell's osteotomy
  • the older, arthritic patient with secondary deformity benefits most from a Keller's excision arthroplasty

Notes (1):

• some weak evidence that abductor hallucis strengthening exercises and night splints may help to slow progression in adolescents
• surgical treatment
  • newer procedures and advances in anaesthetic techniques mean that surgery is routinely performed under local anaesthetic on a day-case basis without the need for post-operative plaster-cast immobilisation. For more severe deformities, more proximal procedures are required and may necessitate a period of immobilisation
  • surgical correction of hallux valgus using minimal access techniques
    • carried out with the patient under local or general anaesthesia and with X-ray or endoscopic monitoring. One or more small incisions are made close to the hallux metatarsophalangeal joint. The bunion is removed and the metatarsal is divided surgically. The bone fragments may be stabilised using plates, screws or wires. A dressing or plaster may be used to support the foot in the corrected position until the divided bone heals
    • NICE suggest that surgical correction of hallux valgus using minimal access techniques should only be used with special arrangements for clinical governance, consent and audit or research (2)

Reference:

1. ARC. Common foot disorders. Hands On 2006;10:1-6.
2. NICE (February 2010). Surgical correction of hallux valgus using minimal access techniques