Figure. Aerial view of the feet.
A 10-year-old girl presents to the office with a deformity of the left foot that has become more noticeable in the past few years. The patient reports some discomfort in the foot when wearing soccer cleats. During an examination of the patient’s feet from above (Figure), small bilateral bunions are noted.
Which statement is true regarding juvenile hallux valgus?
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Hallux valgus (ie, a bunion) is a deformity of the first metatarsophalangeal (MTP) joint that results in a medial prominence of the first metatarsal head. The deformity begins to develop when the first phalanx deviates in a valgus direction, causing a varus deviation of the first metatarsal. The deformity is usually progressive, and the big toe may start to angle inward and cross over the second toe.1,2
Bunions are commonly seen in adults but may also occur in adolescents. The deformity in adults usually is caused by wearing tight-fitting shoes, whereas in adolescents other factors such as pes planus, a long first metatarsal, metatarsus adductus, and positive family history can contribute to its development. Bunions in adolescence more commonly occur in girls (88%) between ages 10 and 15 years. Pain and stiffness in the MTP joint is uncommon in juvenile hallux valgus, in contrast to the the adult form. Treatment of juvenile bunions includes bracing at night and shoe and activity modification. A combination of anatomic variants and open growth plates in adolescents contributes to a high rate of recurrence after surgical treatment, which is not true of adult hallux valgus. Surgical treatment is generally reserved for patients after skeletal maturity is reached due to the high rate of postoperative complications in children.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
1. Chell J, Dhar S. Pediatric hallux valgus. Foot Ankle Clin. 2014;19(2):235-243.
2. Coughlin M. Juvenile hallux valgus: etiology and rreatment. Foot Ankle Int. 1995;16(11):682-697.