Ageing
in the forefoot
As the foot ages it undergoes a number of changes that relate to
original shape of the foot and to changes which occur in the ligaments of the
foot. There is a general tendency for the foot to become flatter and broader.
The forefoot tends to abduct and the toes deform. The hallux gradually goes into
increasing valgus and lesser toes become relatively crowded and longer. The
consequence is increasing deformity of the lesser toes (Fig.
31.9). The hindfoot
deformities that occur are largely covered by the sections on developmental and
arthritic conditions.
HaIIux
valgus
This is probably the commonest condition seen affecting the forefoot. A wide variety of factors is involved in its aetiology.
These include:
• wearing shoes — hallux valgus is commoner in shod
populations;
• hereditary predisposition;
• metatarsus primus varus;
• increased length of the first metatarsal; and
• hypermobility of the first ray.
Treatment
Conservative treatment always has to be considered first. Advice about
ill-fitting or tight shoes may relieve symptoms or prevent episodes of infection
or minor ulceration. There is a perception that this advice will not be
tolerated by women who wish to wear fashion shoes. This is incorrect. If
properly advised about the potential risks and complications of surgery many
patients will modify their expectations and their
Surgical
treatment should be considered for persistent symptoms, recurrent ulceration or
infection, or increasing deformity leading to increasing symptoms in the lateral
part of the foot (Fig. 31.10).
No
one operation is the answer to all cases of hallux valgus and a protocol of
management should be assumed if results are going to be consistent (Table
31.2).
Factors such as age, sex, hallux valgus angle, the angle between the first and
These include:
•
hammer toe;
•
mallet toe;
•
claw toe;
•
curly toe;
•metatarsalgia;