The Treatment of Metatarsalgia with Hallux

Discussion about the treatment of hallux valgus is largely confined to the merits of various operations on the big toe itself, and the problem of associated metatarsalgia is given rather less detailed consideration. Metatarsalgia and secondary deformities of the lesser toes are common in association with hallux valgus. Bonney and Macnab (1952) recorded metatarsalgia in 45 per cent of the cases reviewed. Rogers and Joplin (1947) found that 75 per cent had dorsal subluxation ofa proximal phalanx and 63 per cent had callosities under the middle three metatarsal heads. When hallux valgus is associated with subluxation of one or more of the lesser metatarsophalangeal joints the patient may have severe metatarsalgia. This can be dealt with by excision of one or more of the painful metatarsal heads, provided that the big toe is stabilised by arthrodesis of the metatarso-phalangeal joint. This paper reports a series of patients in whom this combined procedure was carried out.