A Professional Definition for the Hallux Valgus Deformity

A solid foundation for a precise and professional communication should be established by having a clear and strict definition and understanding of the bunion terminology for the benefit of better patient management.


Layman’s terminology:

#1:

Bunion = Hallux Valgus



Professional terminology and definitions:

#1:

Hallux Valgus Deformity Complex (HVDC) = Primary + Secondary Changes of foot


#2:

Primary Deformity = Metatarsus Primus Varus (MPV)


#3:

Secondary Deformities = Hallux Valgus (HV) + Bunion + Sesamoids Displacement + Collapsing Transverse Arch (Metatarsal callus/Metatarsalgia) +/- Collapsing Longitudinal Arch +/- clawed toes +/- bunionette pain


#4:

Hallux Valgus is measured by MetatarsoPhlangeal Angle (MPA) not HVA (It is for layman bot professionals.).


#5:

Metatarsus Primus Varus is measured by InterMetatarsal Angle (IMA)


#6:

Exostosis = Reactive bone formation


#7:

Bunion = Displaced "normal" first metatarsal head +/- exostosis.


#8:

Bunionectomy= Resection of part of the normal metatarsal head to compensate for MPV correction insufficiency + Exostectomy.


#9:

Exostectomy = Exostectomy only without metatarsal head resection.


#10:

Current HVDC Surgery = MPV Correction (osteotomy, Lapidus or Soft tissue procedures) + HV Correction (Distal Lateral Soft Tissue Release +/- Akin's or Metatarsophalangeal Joint Fusion) + Exostectomy
± Bunionectomy (Partial MT Head Resection) ± Transverse Arch Correction (Weil's Osteotomy) ± Longitudinal arch Restoration (Arthroereisis, Hypocure) ± Bunionette Correction (Osteotomy or Bunionettectomy) ......


#11:

Ideal HVDC Surgery = Cosmetic (Original Natural Foot Appearance) +++ Function Restoration of Windlass Mechanism of the first ray and Hallux.


#12:

Goals of HVDC Surgery = Unrestricted shoes and activities without recurrence.


#13:

Evidence of a truly physiological and effective HVDC Surgery should be
= Surgical Correction of Primary Deformity→ Spontaneous Correction of Secondary Deformities.