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Hallux Varus

What is a hallux varus deformity?

Hallux varus is a deformity involving the great toe and great toe joint, known as the first metatarsophalangeal joint. “Hallux” means big toe/great toe and “varus” means inward angulation/position.

The great toe deviates away from the second toe, increasing the space between the first and second toes, also known as “splaying”. Hallux varus deformities are classified as either congenital (present since birth, most commonly associated with intrauterine position, inflammatory arthritis or neurological conditions) or acquired (from trauma or overcorrection during bunion surgery).

What causes a hallux varus deformity?

The most common cause is a complication from doing an overcorrection of a bunion deformity. Development of a hallux varus deformity is due to imbalance of the tendons and ligaments surrounding the great toe joint. Due to the deformity, activity and shoe gear can become painful. Long-standing deformity can lead to arthritis of the big toe joint.

How common is hallux varus?

Hallux varus deformities are rare, according to the literature only seen in 2-14% of the population.

How is hallux varus diagnosed?

Hallux varus deformities are primarily diagnosed with a clinical exam. The doctor will assess where the big toe sits in relation to the lesser toes, and evaluate the range of motion and strength of the muscles surrounding the great toe joint. Most of the time there will be splaying between the first and second toes, callus formation or ingrown toe nails due to unwarranted pressure and pain when walking.

X-rays of the foot will also be evaluated and are helpful to determine the degree of deformity and any surgical procedures that were previously performed. If the deformity is thought to be caused by an inflammatory or neurological condition, blood work and appropriate consultations will be recommended.

Can hallux varus be treated non-operatively?

Treatment will depend on severity of the deformity. Early recognition of great toe deviation can be treated with stretching exercises and taping techniques/splinting to hold the toe in a specific position to allow soft tissue healing. If the deformity is mild, modifying shoe-gear with a wide toe box and extra padding can be beneficial.

When is hallux varus surgery a good option?

Surgery can be a good option if the patient has:

  • persistent pain in the big toe joint,
  • pain despite change in shoe gear,
  • had to decrease activity.

Surgery can also be a good option if the big toe continues to drift away from the second toe despite splinting. The goal of surgery is to create a pain-free, straight toe that is able to fit comfortably in a shoe.

What are the treatment options for hallux varus?

Surgical treatment involves soft tissue balancing or an osteotomy to realign the toe. In some cases, a fusion of the toe joint is necessary. Non-surgical treatment involves using a brace or splint.

Why choose the International Center for Limb Lengthening for treatment of hallux varus?

With a collective experience of over thirty years of helping patients with lower leg, foot and ankle problems, the Foot and Ankle Service of the Rubin Institute for Advanced Orthopedics is one of the leading treatment centers for foot and ankle conditions in the United States. Your doctor will take the time to make sure you understand all of your options and then will customize your treatment to meet your specific needs. Our patients benefit from our team-centered approach with world-renowned surgeons and specialized physician assistants, nurses and physical therapists. We help patients with hallux varus achieve their best possible result.

Doctors who treat hallux varus