Review Question - QID 218617

Pes planus deformity has been associated with the progression of hallux valgus.

Hallux valgus is a condition characterized by lateral deviation of the great toe. This causes the metatarsal head to drift medially and the proximal phalanx to shift into valgus. The bursa of the medial eminence becomes inflamed and prominent, and the extensor hallucis longus and flexor hallucis longus tendons bowstring laterally, exaggerating the deformity. Progression is associated with pes planus which produces an elevation and functional lengthening of the first metatarsal, limiting the first metatarsophalangeal joint movement. Studies have determined that distal metatarsal articular angle (DMAA) and AP talo-first metatarsal angle at initial presentation are associated with the progression of hallux valgus deformity.

Lee et al. investigated the radiographic measurements associated with the progression of hallux valgus during at least 2 years of follow-up. They found that the DMAA and AP talo-first metatarsal angle at initial presentation were found to be significant factors affecting the progression of hallux valgus deformity. They concluded the change in the HVA during follow-up was significantly correlated with changes in the IMA and DMAA.

Perera et al. reviewed the causes of hallux valgus and factors that contribute to deformity progression over time, such as genetic predispositions, laxity of the foot's stabilizing structures, and poor footwear. They stated that a combination of factors come together to cause hallux valgus and that a more tailored approach to treatment is needed based on the specific causes and progression in the individual patient.

Doty and Harris reviewed the treatment of hallux valgus. The authors stated the relationship between hallux valgus and first-ray hypermobility is still being debated in the medical community with some studies suggesting that hypermobility can be corrected without fusing the joint, while others argue that it is a primary cause of the deformity and recommend surgical correction including joint fusion. They concluded that the appropriate treatment algorithm will depend on the anatomic and radiographic examination of the first metatarsocuneiform joint.

Figure A is a lateral radiograph of the foot with a significant pes planus deformity.

Incorrect answers
Answers 1, 3, 4, and 5: Pes planus has not been associated with the progression of cross-over toe, tarsal coalition, hammer toe, or first metatarsal supination.