hallux valgus (bunions)

see also:

• orthopaedics in the ED

• bunions are a common genetic condition with incidence increasing with age¹⁾:
  • 3% in persons aged 15-30 years
  • 9% in persons aged 31-60 years
  • 16% in those older than 60 years
• of those under age 60 years, ~90% are genetic ²⁾
• bunions, particularly those developing in those older than 60 years, may also arise from biomechanical instability resulting from rheumatoid arthritis, gout, ligamental laxity disorders, NM diseases, etc
• footwear do not cause bunions but may exacerbate the symptoms:
  • tight shoes can cause medial bump pain and nerve entrapment
  • high heeled shoes with a tight toe box keep the hallux in an abducted position if hallux valgus is present, causing mechanical stretch and deviation of the medial soft tissue.

• 90% of cases of hallux valgus developing under age 60 years are genetic and presumably relate to production of elastin
• patients presenting for treatment suggest a 15:1 ratio for female:male prevalence of troublesome bunions
• 90% of patients with bunions have a family history and the genetics appears to be autosomal dominant inheritance with incomplete penetrance as it mainly affected the female relatives ³⁾

• see Omim full search
• Williams-Beuren syndrome (WBS)
  • classic WBS: low IQ, “elf-like” facies; puffy eyes, wide mouth, long neck, short, thin; cardiac abn; pectus excavatum; usually blue eyes with stellate iris; perfect pitch; hyperacusis; hypersociable; etc.
  • see Omim
• Friar's syndrome
  • peculiar facies, characterized by downslanting palpebral fissures, epicanthic folds, hypertelorism, and ptosis
  • low IQ
  • see Omim
• ROBINOW-SORAUF SYNDROME
  • a distinct acrocephalosyndactyly syndrome
  • facies like those of the Saethre-Chotzen syndrome and bilaterally broad big toes owing to partial or complete duplication of the distal phalanx
  • see Omim
• CAMPTODACTYLY SYNDROME, GUADALAJARA, TYPE I; GCS1 or FACIOTHORACOSKELETAL SYNDROME; FTSS:
  • IUGR; camptodactyly, epicanthus, broad nasal bridge, flat face, depressed lower sternum, twelfth rib hypoplasia, fibular hypoplasia;
  • see omim
• CAMPTODACTYLY SYNDROME, GUADALAJARA, TYPE II
  • IUGR, camptodactyly of all fingers, bilateral hallux valgus, short toes 2, 4 and 5, patella hypoplasia, short neck, low-set ears, microcephaly, cuboid vertebral bodies
  • see omim
• bilateral macular coloboma with cleft palate:
  • see omim
• CRANIOSYNOSTOSIS, ADELAIDE TYPE; CRSA
  • hands with coned epiphyses, distal and middle phalangeal hypoplasia, and carpal bone malsegmentation and in the feet coned epiphyses, hallux valgus, phalangeal, tarsonavicular and calcaneonavicular fusions
  • gene localized to 4p16, telomeric to D4S394
  • omim
• CRANIOSYNOSTOSIS AND DENTAL ANOMALIES; CRSDA or KREIBORG-PAKISTANI SYNDROME
  • autosomal recessive disorder is characterized by craniosynostosis, maxillary hypoplasia, and dental anomalies, including malocclusion, delayed and ectopic tooth eruption, and/or supernumerary teeth
  • see Omim
• JAWAD SYNDROME; JWDS MICROCEPHALY WITH MENTAL RETARDATION AND DIGITAL ANOMALIES
  • congenital microcephaly and moderately severe mental retardation, complete syndactyly of toes 4 and 5.
  • see omim