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Hallux Valgus


Hallux valgus/ Hallux Rigidus

Hallux valgus (known as bunion) occurs when there is deviation of the hallux (big toe) away from the midline to the lesser toes, causing deviation of the metatarsal head and overlying bursa to the midline. Hallux Rigidus is the development of arthritic changes within a joint causing stiffness, pain and deformity.


Indications for referral to surgery:

  • Hallux valgus/ rigidus  with recurrent associated infection and/or ulceration

(mandating an urgent referral)

Conservative measures have been tried for 12 weeks including specialist footwear, orthoses and analgesia (+/-podiatry referral) AND the patient has:

  • Persistent pain causing significant functional impairment
  • Moderate to severe deformity (with or without lesser toe deformity) that causes significant functional impairment OR
  • Moderate to severe deformity that prevents patients from finding comfortable footwear

AND patient willing to consider surgery 

Significant functional impairment is defined as a restriction or interference with an individual’s capacity to meet personal, social or occupational demands.  Please state the impairment of the individual is experiencing.  An up to date X ray is required.

Patients undergoing Hallux Valgus surgery will need to be prepared to:

  • Be off work for 6-8 weeks for sedentary work, 3-6 months for physical work
  • Be unable to drive for 6-8 weeks (2 weeks not driving if left foot and automatic car)
  • 1 in 10 people may be unhappy after any surgery

 

Imaging - Please include an up to date X ray with weight bearing views report within or attached to the referral.  This includes for soft tissue injuries to exclude underlying pathology.  

Referrals without up to date reports included and Xrays that are not weight bearing will be returned, unless there are mitigating circumstances why this is not possible



Contributors

Lt Col M Butler, Consultant Orthopaedic Surgeon

Dr R Hopkins, General Practitioner and RMS Orthopaedic Guidelines Lead

References

British Orthopaedic Association and Royal College of Surgeons England.  Commissioning Guide Painful Deformed Great Toe In Adults, 2017.

Date reviewed                     21/08/2019

Next review due                  21/08/2020

Sifter name                          Dr Rebecca Hopkins

 

Consultant name + any other contributors           Lt Col Michael Butler, Dr Sheona Burns

 

Version 1.3