A dorsal bunion, also known as hallux flexus, is a deformity where the 1st metatarsal is in a dorsiflexed position and the proximal phalanx of the hallux is in a plantarflexed position usually articulating with the plantar aspect of the 1st metatarsal head. Hallux Flexus or Rigidus. Br Med J ; 2 doi: (Published 26 December ) Cite this as: Br Med J ; Hallux flexus is a deformity of the foot characterised by elevation of the first metatarsal head and fixed flexion at the first metatarsophalangeal joint. The deformity is predominantly seen in children following clubfoot surgery or with cerebral palsy.


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Hallux rigidus

The base of the proximal phalanx subluxes plantarly under the head of the 1st metatarsal and pushes the 1st metatarsal dorsally causing dorsiflexion of the 1st metatarsal and a dorsal bunion [ 3 ]. These two scenarios usually unfold due to congenital clubfoot, paralytic deformities, severe congenital talipes planovalgus, hallux rigidus, or iatrogenically while trying to treat these conditions [ 8 ].

The etiology most studied in the literature is a dorsal bunion following clubfoot surgery [ 1 - 16 ]. The procedures performed for clubfoot correction are soft tissue releases and then the patient develops residual deformity in the years to come.

There are several procedures described in the literature to correct a dorsal bunion. These procedures range from soft tissue correction to arthrodesis. One of the first procedures proposed for the correction of a dorsal bunion was hallux flexus resection hallux flexus the base of the first proximal phalanx which was proposed by Hohmann in [ 15 ].

McKay described a soft tissue procedure to correct dorsal bunions in children while the deformity hallux flexus still flexible [ 12 ]. This procedure involves transfer of the abductor hallucis, flexor hallux flexus brevis, and the transverse and oblique heads of the adductor hallucis to the neck of the first metatarsal.

Hallux flexus | definition of hallux flexus by Medical dictionary

A capsulotomy hallux flexus the 1st metatarsal phalangeal joint is also performed along with excision of the sesamoids. In order to prevent post-operative flexion deformity of the first interphalangeal joint, an arthrodesis of the first interphalangeal joint can be performed or tenodesis of the flexor hallucis longus to the base of the proximal phalanx, if needed [ 12 ].

Lapidus described using a plantarflexory wedge osteotomy hallux flexus the first cuneiform 83 metatarsal joint and if necessary also at the first cuneiform-navicular joint [ 11 ]. Yong studied the reverse Jones procedure coupled with a plantar-flexory osteotomy of 1st metatarsal and of the 18 patients none had a recurrence.

In the hallux flexus study they also had patients who had the Reverse Jones procedure without an osteotomy and of the 15 patients that underwent this procedure 5 of them needed a secondary procedure for recurrence of deformity Figure 3.

  • Hallux rigidus - Wikipedia
  • Hallux valgus and hallux flexus associated with cerebral palsy: analysis and treatment.
  • Hallux Flexus: Sequela of Residual Clubfoot
  • Hallux valgus and hallux flexus associated with cerebral palsy: analysis and treatment.
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Besse states that arthrodesis is needed for fixed deformities, for flexible deformity tendon transfers and osteotomies are recommended [ 2 ].

The discussion concerning surgery was to perform a plantarflexory Lapidus versus a metatarsal phalangeal joint arthrodesis or combine the two procedures. An intraoperative decision was hallux flexus against combining a Lapidus procedure and the 1st MTPJ arthrodesis as adequate hallux flexus of the first metatarsal was achieved with an isolated 1st MTPJ arthrodesis.

We postulate that a 1st MTPJ arthrodesis in these types of cases works well to reduce the dorsiflexed 1st metatarsal in a similar fashion that a 1st MTPJ arthrodesis works well to reduce an intermetatarsal angle in hallux abductovalgus surgery.

By maintaining the soft tissue attachments on the proximal phalanx, these attachments aid and assist with stabilization and reduction of the deformity. Conclusion This study described a dorsal bunion which occurred following a clubfoot deformity.


This deformity was corrected hallux flexus a 1st metatarsal phalangeal joint arthrodesis, which has only been mentioned in the literature. The patient received adequate correction of the deformity and is currently pain free and has returned to hallux flexus activity.

Hallux Flexus: Sequela of Residual Clubfoot | OMICS International

Hallux flexus or "dorsal bunion" is usually due to a weak extensor hallucis longus, overpull of the anterior tibial muscle on the first metatarsal and spasticity or contracture of the flexor hallucis longus or brevis. A weak peroneus longus muscle has not caused this deformity.

The condition is usually predictable in the growing child if all hallux flexus related to gait, collagen stability and foot hallux flexus are observed. Treatment includes soft-tissue and bone realignment.

Grade III - Severe changes with significant joint hallux flexus narrowing, extensive bony proliferation hallux flexus loose bodies or a dorsal ossicle. Physical therapy programs may be recommended, although there is very limited evidence that they provide benefit for reducing pain and improving function of the joint.

Hallux flexus

hallux flexus There are several types of surgery for hallux flexus of hallux rigidus. The type of surgery is based on the stage of hallux rigidus. Stage 1[ edit ] Stage 1 hallux rigidus involves some loss of range of motion of the big toe joint or first MTP joint and is often treated conservatively with prescription foot orthotics.