summary Congenital Hallux Varus, also known as Atavistic Great Toe, is a rare idiopathic condition caused by a firm, band-like abductor hallucis muscle that occurs in children after walking age and presents with varus deformity of the big toe. Diagnosis is made clinically with varus deformity of the first toe with radiographs showing a short, thick 1st metatarsal. Treatment is usually operative with abductor hallucis muscle release for mild resistant cases or excision of the central portion of epiphyseal bracket in cases with a bracket causing the deformity. Epidemiology Demographics presents in children after walking age Risk factors longitudinal epiphyseal bracket of the first metatarsal or proximal phalanx Etiology 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) 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 login to view 2 more bullets Operative abductor hallucis muscle release indication login to view 1 more bullet excision of central portion of epiphyseal bracket indication login to view 1 more bullet resumption of longitudinal growth common if performed at a young age secondary corrective realignment or lengthening is sometimes needed Farmer technique indication login to view 1 more bullet technique creates syndactyly between the 2nd toe and hallux maintains deformity correction Complications Recurrence of deformity Incomplete correction of deformity