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Introduction
  • Epidemiology
    • presents in children after walking age
  • Pathophysiology
    • deformity at metatarsophalangeal joint due to 
      • imbalance between the great toe abductor and adductors
    • pathoanatomy
      • firm, fibrous, band-like abductor hallucis muscle
      • short, thick first metatarsal
      • longitudinal bracket epiphysis of the 1st metatarsal
      • underlying skeletal dysplasia (diastrophic dwarfism)
    • do not confuse with metatarus primus varus
      • varus deformity of the 1st metatarsal (no deformity at MTP joint)
  • Risk factors
    • longitudinal epiphyseal bracket of the first metatarsal or proximal phalanx
  • Associated conditions
    • often associated with polydactyly
Presentation
  • Symptoms
    • cosmetic deformity
      • difficult to put on shoes
      • usually painless
  • Deformity
    • can vary in severity
      • few degrees to 90 degress
Imaging
  • Radiographs
    • recommended views of the foot
      • AP
      • lateral
      • oblique
    • findings
      • short, thick 1st metatarsal 
Differential
  • Must be differentiated from metatarsus adductus
Treatment
  • Nonoperative
    • observation alone
      • indication
        • rare as deformity is thought to worsen with age
        • surgical correction often proposed in infancy
  • Operative
    • abductor hallucis muscle release
      • indication
        • mild and resistant deformities
    • excision of central portion of epiphyseal bracket 
      • indication
        • if epiphyseal bracket found to be the cause of Hallux Varus
      • resumption of longitudinal growth common if performed at a young age
      • secondary corrective realignment or lengthening is sometimes needed
    • Farmer technique 
      • indication
        • moderate to severe deformities
      • technique creates syndactyly between the 2nd toe and hallux
      • maintains deformity correction
Complications
  • Recurrence of deformity
  • Incomplete correction of deformity
 

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