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Hallux varus is a condition in which the big toe points inward, away from the other toes on the foot. The deformity can be caused by a congenital defect, an injury to the foot, or as a complication of bunion surgery. A person who has hallux varus is likely to have trouble walking and wearing shoes, tenderness, and slight swelling. Treatment for the condition depends on the severity of symptoms and how far the big toe is out of alignment. Splints and stretching exercises may be able to correct minor deformities, but most cases require surgical realignment.
When hallux varus affects an infant or young child, the cause is usually a congenital defect of the bones in the toe or the local tendon called the abductor hallucis. An especially small or tight abductor hallucis can pull the big toe away from the second toe, causing it to point toward the other foot. An older patient might experience hallux varus due to an acute injury or a chronic condition such as rheumatoid arthritis. In addition, surgery to correct a bunion may cause hallux varus if too much bone or tendon tissue is removed. In some cases, toes gradually move further and further out of alignment without a recognizable cause.
Besides the obvious visible deformity, symptoms of hallux varus can include chronic soreness, tenderness, a decreased range of motion, and weakness in the foot. Some people have trouble wearing close-toed shoes and balancing while walking or standing. If the condition is not addressed and treated, constant pressure on the toe can lead to swelling and pain that radiates throughout the foot and ankle.
A person who experiences hallux varus should schedule an appointment with his or her podiatrist or primary care doctor. A doctor can inspect the toe and conduct x-rays to determine the extent of internal damage. When misalignment is relatively minor, a podiatrist usually suggests nonsurgical corrective procedures such as wearing a splint on the toe at night and investing in comfortable shoes. Young patients who are suspected to have tight abductor hallucis tendons are candidates for guided stretching exercises, which involve gently pulling the toe in different directions to loosen the tendons over time.
Surgery is typically necessary if the condition persists or causes severe pain. A surgeon can manually force the toe back into alignment, scrape away damaged bone and cartilage tissue, and ensure that nearby tendons are secure. A patient may need to wear a cast or a special shoe for several weeks following surgery to give the toe time to heal. Corrective procedures are usually very effective, and most people are able to return to regular activity within six months.