Home Functional Hallux Limitus Foot Hallux valgus
The foot
Hallux valgus
A deviation of the big toe toward the second and a bony bump at its base: hallux valgus is the most common deformity of the forefoot. Often blamed on footwear, its main factor is in fact Functional Hallux Limitus, found in 98% of cases.
A dislocation of the big toe joint
Hallux valgus is the consequence of a partial dislocation of the metatarsophalangeal joint of the first ray. The inner (medial) capsule tears, the first metatarsal drifts away from the second, and the toe turns toward the second toe.
A collapse of the forefoot is always present, and there is often a “claw-like” retraction of the second toe.
FHL, the main factor in the deformity
Various causes are cited as predisposing factors: family predisposition, high-heeled shoes, overly narrow footwear, a short first metatarsal, excess weight… Functional Hallux Limitus is nevertheless the main factor in the deformity, and it is found consistently in hallux valgus. On clinical examination, the FHL stretch test is positive in 98% of cases, despite the deviation of the toe.
In surgical practice
Considering FHL a predisposing factor, we always include a procedure to release the tendon pulley of the flexor hallucis longus in surgical corrections of hallux valgus.
Surgical treatment
When the deformity is established and symptomatic, we propose a bony realignment of the first metatarsal combined with a recentering of the sesamoid sling, through release of the lateral structures and repair of the capsule on the medial side of the first metatarsophalangeal joint. A correction of the proximal phalanx of the big toe is sometimes added, and the correction of the other toes is performed during the same operation if necessary.
An endoscopic tenolysis of the flexor hallucis longus is systematically proposed, in order to prevent joint stiffness at the first metatarsophalangeal joint and to limit the risk of recurrence of the deformity.
Hallux valgus setting in?
Identify the underlying FHL
Before the deformity progresses, the mobility assessment at the Centre du pied can objectively identify the associated FHL and guide the most appropriate management.
At a glance
Joint
first metatarsophalangeal
Deformity
toe deviated toward the 2nd
Forefoot
collapse always present
FHL stretch test
positive in 98%
Treatment
realignment + FHL tenolysis
Underlying cause
Functional Hallux Limitus
Further reading
Related pages
Hallux rigidus
Osteoarthritis of the big toe, the second most common FHL-related forefoot deformity.
Morton’s neuroma
Intermetatarsal neuralgia, another consequence of the disrupted roll-over of the foot.