PHYS THER
Vol. 90, No. 1, January 2010, pp. 110-120
DOI: 10.2522/ptj.20080298
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Perspectives

Hallux Valgus and the First Metatarsal Arch Segment: A Theoretical Biomechanical Perspective

Ward M. Glasoe, David J. Nuckley and Paula M. Ludewig

W.M. Glasoe, PT, MA, ATC, is Instructor, Program in Physical Therapy, University of Minnesota, Medical School, Mayo Mail Code 388, 420 Delaware St SE, Minneapolis, MN 55455 (USA).
D.J. Nuckley, PhD, is Assistant Professor, Program in Physical Therapy, University of Minnesota, Medical School.
P.M. Ludewig, PT, PhD, is Associate Professor, Program in Physical Therapy, University of Minnesota, Medical School.

Address all correspondence to Mr Glasoe at: glaso008{at}umn.edu.

Hallux valgus is a progressive foot deformity characterized by a lateral deviation of the hallux with corresponding medial deviation of the first metatarsal. Late-stage changes may render the hallux painful and without functional utility, leading to impaired gait. Various environmental, genetic, and anatomical predispositions have been suggested, but the exact cause of hallux valgus is unknown. Evidence indicates that conservative intervention for hallux valgus provides relief from symptoms but does not reverse deformity. Part 1 of this perspective article reviews the literature describing the anatomy, pathomechanics, and etiology of hallux valgus. Part 2 expands on the biomechanical initiators of hallux valgus attributed to the first metatarsal. Theory is advanced that collapse of the arch with vertical orientation (tilt) of the first metatarsal axis initiates deformity. To counteract the progression of hallux valgus, we use theory to discuss a possible mechanism by which foot orthoses can bolster the arch and reorient the first metatarsal axis horizontally.


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