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hallux_valgus

hallux valgus (bunions)

introduction

  • 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.

genetics

  • 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)

specific genetic disorders associated with hallux valgus

    • 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:
  • 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
  • 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
hallux_valgus.txt · Last modified: 2013/02/03 00:33 (external edit)