Hallux Varus

A hallux varus in simple terms is a big toe that is deformity of the foot where the tip of the big toe is pointing inward (inside of foot). This is the opposite of a bunion, where at the 1st metatarsal phalangeal joint is forced inward (inside of foot), and the resulting big toe points outward (outside of foot). A bunion is one of the most common big toe problems, but a hallux varus is fairly uncommon. Most problems with hallux varus occur following the correction of a bunion deformity in which there is an overcorrection. A true hallux varus has the deformity in all three structural planes of the foot, where the big toe is supinated (varus).

Symptoms of a hallux varus usually occur while wearing shoes which crowd the tip of big toe on the inside aspect. The look of a hallux varus can be thought of a “hitchhikers thumb” on the foot. A hallux varus seldom causes joint pain, but rather friction pain.

Causes can be due to many factors. Genetically you may be born with a foot structure that is prone to a hallux varus deformity. If there is a muscular imbalance of the foot the hallux abductor may pull more on the inside causing a drifting of the toe. If one is bone without a fibular sesamoid there is easily a muscle imbalance as the hallux adductor muscle loses its full force to balance with the hallux abductor. These are just a few of the common ways a congenital deformity can exist to cause a hallux varus. A hallux varus following other foot surgery is probably more common due to the delicate balance of the muscles and tendons.

Prevention is difficult for a congenital(born with)deformity.The best prevention for symptoms may be to get advice from your podiatrist.

Podiatric Care may include using anti-inflammatory oral medications or an injection of medication and local anesthetic to reduce swelling if present. When you go to your doctor, x-rays are usually required to evaluate the structure of your foot and determine what the deformity is or a possible cause. The podiatrist may see you to take care of any callouses that develop due to the deformity. They may advise you on different shoewear or prescribe a custom made orthotic to try and control the foot structure especially if you have excessive pronation or supination. Your podiatric physician may also recommend a surgical procedure to actually fix the structural problem of your foot.

Surgery to correct your hallux varus may be the best option for you and can be preventative for other problems. Your podiatrist will give you advise on this as there are several surgical options depending on severity and cause. Some simpler tendon balancing procedures can be performed, other times a balance of the sesamoid bones can be attempted with a sesamoidectomy (partial or complete removal of one or both sesamoids). An osteotomy (bone cut) can also be performed just opposite of what is created for a bunion with fixation.

Post-operative Care and Risks of a hallux varus surgery depends on the exact surgery done. You may need a cast to protect you for a short time. Sometimes a soft bandage with a post-operative shoe is allowed. You should expect some pain following surgery as well as swelling. Especially for the first 48 hours you should keep your leg elevated and occasional ice placed over the area of surgery (about 20 minutes per hour). Surgical cuts are made through the skin so a scar is expected. If you are a keloid former, let your surgeon know. Surgical cuts are not only made through skin, but through other layers of tissue as well, a scar may form within your foot and lead to adhesions. For many bunion procedures you will be required to keep all weight off of your foot for several weeks, typically 5-8 weeks depending on procedure. Your surgeon may allow you to place some weight on the heel. You may use crutches, a walker, or wheelchair to help you keep weight off of this foot. Healing time is typically 6-8 weeks for all bone cuts. This is influenced by many factors including your nutrition, circulation, and other medical conditions. If you are a smoker you can expect to take longer to heal. If your bone heals real slow it may be a delayed union, or if not at all a non-union. If you are required to keep pressure off of your foot your leg muscles are not being used as they were before surgery. This allows for slower movement of the blood through the leg vessels. Occasionally this can lead to a blood clot in the leg which can become life threatening. Hip and knee flexion and extension exercises as well as wiggling your toes gently can help prevent this from occurring. If you have a history of blood clots you should let your surgeon know.