Paediatric ImagingHallux valgus
increased lateral angulation of the proximal phalanx of the great toe with respect to the first metatarsal. The normal angle between the longitudinal axis of the proximal phalanx of the great toe and the first metatarsal is 14 - 16 in adolescence. Hallux valgus is defined as an angle of more than 20.
Radiographic assessment requires a weight bearing anteroposterior radiograph of the foot (Fig.1). There may be associated lateral displacement of the proximal phalanx base on the metatarsal head of the great toe and lateral displacement of the sesamoids. Hallux valgus is generally secondary to metatarsus primus varus which refers to a varus relationship of the first metatarsal with respect to the more proximal midfoot, in particular to the medial cuneiform reflected by an increased angle between the first and second metatarsals of more than 10. There is often an associated medial soft tissue prominence (bunion) overlying the first metatarsalphalangeal joint.
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Standing radiograph of the foot demonstrating hallux valgus. The angle between the axis of the first metatarsal and the proximal phalanx is more than 35. There is lateral subluxation of the sesamoids and associated bunion formation.
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Hallux valgus, Fig.1 | |