A hallux varus in simple terms is a big toe that is a deformity of the foot, where the tip of the big toe is pointing inward, inside of foot. This is the opposite of a hallux valgus (bunion), where the 1st metatarsal phalangeal joint is forced inward, and the resulting big toe points outward (outside of foot). A bunion is one of the most common big toe problems, however, a hallux varus is fairly uncommon. Most problems with hallux varus occur following the correction of a bunion deformity, in which there is an overcorrection.
Tends to occur while wearing shoes which crowd the tip of the big toe, but on the inside. The look of a hallux varus can be thought of as a “hitchhikers thumb” on the foot. It seldom causes joint pain, but rather friction pain.
Genetically, you may be born with a foot structure that is prone to a hallux varus deformity. If there is a muscular imbalance of the foot, the hallux abductor may pull more on the inside, causing a drifting of the toe. If one is bone without a fibular sesamoid, there is easily a muscle imbalance, as the hallux adductor muscle loses its full force to balance with the hallux abductor itself. These are just a few of the common ways a congenital deformity can exist to cause a hallux varus. This condition following other foot surgery is probably more common, due to the delicate balance of the muscles and tendons.
Treatment and Care
May include using anti-inflammatory oral medications, or an injection of medication and local anaesthetic to reduce swelling, if present. When you go to your doctor, x-rays are usually required to evaluate the structure of your foot, what the deformity is, or a possible cause. The podiatrist may see you to take care of any callouses that develop due to the deformity. They may advise you on different footwear, or prescribe a custom made orthotic to try and control the foot structure, especially if you have excessive pronation or supination. Your podiatrist may also recommend referral to an orthopaedic surgeon for a surgical procedure to actually fix the structural problem of your foot.
Correcting your hallux varus may be the best option for you, and can help prevent other problems. Your podiatrist will give you advice on this, since there are several surgical options, depending on severity and cause. Some simpler tendon balancing procedures can be performed, other times a balance of the sesamoid bones can be attempted with a sesamoidectomy (partial or complete removal of one or both sesamoids). An osteotomy (bone cut), can also be performed just opposite of what is created for a bunion with fixation.
Post-operative Care and Risks
Care: This is dependent on the type of surgery done. You may need a cast to protect you for a short time. Sometimes a soft bandage with a post-operative shoe is allowed. You should expect some pain following surgery, as well as swelling. Initially, you should keep your leg elevated, and advice should be given as to if occasional ice placed over the area of surgery is appropriate.
For many bunion procedures, you will be required to keep all weight off of your foot for several weeks, typically 5-8 weeks depending on procedure. Your surgeon may allow you to place some weight on the heel. You may use crutches, a walker, or wheelchair to help you keep weight off of the foot. Healing time is typically 6-8 weeks for all bone cuts. This is influenced by many factors; including your nutrition, circulation, and other medical conditions.
Risks: Surgical cuts are made through the skin, so a scar is expected. If you are a keloid former, let your surgeon know. Surgical cuts are not only made through skin, but through other layers of tissue as well; so a scar may form within your foot, and lead to adhesions.
If you are a smoker, you can expect to take longer to heal. If your bone heals real slow, it may be a delayed union, or if not at all, a non-union. If you are required to keep pressure off of your foot, your leg muscles are not being used as they were before surgery. This allows for slower movement of the blood through the leg vessels. Occasionally, this can lead to a blood clot in the leg, which can become life threatening. Hip and knee flexion, extension exercises, as well as wiggling your toes gently, can help prevent this from occurring. If you have a history of blood clots, you should let your surgeon know.
Your feet mirror your general health . . . cherish them!