Hallux valgus, ankle osteoarthrosis and adult acquired flatfoot deformity: a review of three common foot and ankle pathologies and their treatments

[摘要] Hallux valgus deformity is the most common reason to visit a foot and ankle surgeon in Europe. The deformity occurs more commonly in females than males (8:1). Although a familiar predisposition has been identified, the aetiology and pathogenesis of hallux valgus still remain unclear and are thought to be multifactorial. The usually accepted radiological definition of hallux valgus on weight-bearing radiographs includes increased intermetatarsal (IM > 10°) and metatarso-phalangeal (MTP > 10°) angles. However, the analysis of hallux valgus deformity is much more subtle than a simple radiographic angular evaluation. Clinically, it should include the mobility of the first MTP joint, its reducibility, the extent of intra-articular pain, the presence of transfer metatarsalgia and the presence of associated deformities including clawtoes, dislocation of the lesser MTP joints, flatfoot, etc. Radiological attention should be focussed on the congruence or incongruence of the first MTP joint, orientation of the distal metatarsal articular angle (DMAA), degenerative changes of the joint, indirect manifestations of the insufficiency of the first ray, typically including hypertrophy of the second metatarsal, fatigue fracture of the second metatarsal, osteoarthrosis of the second tarso-metatarsal joint (TMT2) and dislocation of the lesser MTP joints (Fig. 1). This careful analysis is mandatory for the choice of the most efficient treatment. Conservative treatment includes the adaptation of footwear and the design and fitting of insoles. It can bring pain alleviation but no conservative treatment has the faculty to correct the deformity.

[学科分类] 神经科学

[关键词] hallux valgus;ankle osteoarthritis;acquired flatfoot deformity;diagnosis;conservative and surgical management