A 65-year-old retired secretary presents with a painful bump associated with the medial aspect of the first metatarsophalangeal joint. She reports that the bump has developed over the past ten to 20 years. What is the most likely diagnosis?
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Contributed by Scott Dulebohn, MD
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Hallux valgus, commonly called a bunion, is more common in women than in men. Symptoms include a painless or painful bump, called an exostosis, that forms on the medial aspect of the first metatarsal phalangeal joint. Contributing physical factors include hyperelasticity syndromes, metatarsus varus, a short first metatarsal phalangeal joint, and pes valgus.
Other factors include a family history of bunions and the prolonged use of narrow, high-heeled shoes. Conservative treatment is usually all that is needed and includes wide shoes, the use of bunion pads, ice, rest, and anti-inflammatory agents for acute pain.
Most cases referred for surgery have intermetatarsal angles greater than 10 degrees or fail to improve with conservative measures. Absolute contraindications for surgery include peripheral vascular disease and local tissue infections, whereas relative contraindications include narcissistic personality disorders, painless cosmetic bunions, and age 65 years or older.
A bunionette is a bony prominence on the lateral aspect of the fifth metatarsal head.
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Adult Lab Normals
Pediatric Lab Normals
Risk of Damaging Anatomical Structures During Minimally Invasive Hallux Valgus Correction (Bösch Technique): An Anatomical Study., Kaipel M,Reissig L,Albrecht L,Quadlbauer S,Klikovics J,Weninger WJ,, Foot & ankle international, 2018 Jul 1 [PubMed PMID: 30019606]
Minimalist shoes running intervention can alter the plantar loading distribution and deformation of hallux valgus: A pilot study., Xiang L,Mei Q,Fernandez J,Gu Y,, Gait & posture, 2018 Jul 5 [PubMed PMID: 30007225]
Results of Scarf Osteotomy Without Implant Fixation in the Treatment of Hallux Valgus., Liszka H,Gądek A,, Foot & ankle international, 2018 Jul 1 [PubMed PMID: 30005168]
Point vs. traditional method evaluation of hallux valgus: interreader reliability and intermethod performance using X-ray and MRI., Heineman N,Chhabra A,Zhang L,Dessouky R,Wukich D,, Skeletal radiology, 2018 Jul 12 [PubMed PMID: 30003279]
A Comparative Study of Mini-Scarf Versus Standard Scarf Osteotomy for Hallux Valgus Correction., Boksh K,Qasim S,Khan K,Tomlinson C,Mangwani J,, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons, 2018 Jul 9 [PubMed PMID: 30001939]