Hallux Abductovalgus diagnosis is made by completion of the history and physical exam and a lower extremity exam, subjective and objective findings, radiological evaluation and other diagnostic procedures.

1. History: This may include any of the following:
   1. Chief complaint
   2. Duration
   3. Onset
   4. Anything that improves or exacerbates
   5. Any previous treatment
   6. General medical history
   7. Allergic condition
   8. Medication taken
   9. Surgical history
   10. Family history
   11. Social history

   The patient may be asymptomatic with a small bump, but some patients with mild deformities may have severe pain. Their lifestyle may be altered to the point that they may be unable to perform the activities that they would normally perform. Hallux abductovalgus may be caused by biomechanical abnormalities, and may be an inherited condition. Pressure from the shoe may also cause pain or neuritis and ulceration in the area.

2. Physical examination may include:
   1. Vascular evaluation
   2. Neurology exam
   3. Orthopedic exam
   4. Biomechanical exam
   5. Dermatological exam

   With a hallux abductovalgus deformity the great toe may or may not be deviated laterally. Hallux abductovalgus may be caused by biomechanical abnormalities that may lead to dysfunction in the first ray. There are numerous conditions associated with hallux abductovalgus, and sometimes it is necessary to treat these associated conditions while treating the hallux abductovalgus deformity.

3. Concomitant conditions may include:
   1. Overlapping or under lapping second toe
   2. Metatarsalgia
   3. Pain in the lesser digits
   4. Contracture of the lesser digits
   5. Plantar grade position of the adjacent metatarsal heads
   6. Sesamoiditis
   7. Dorsal Exostosis
   8. Arthritic degeneration
   9. Neuritis and/or Neuroma
   10. (Extensor hallucis longus) EHL tendon contraction
4. Diagnostic procedure
1. Radiological examination: X-rays must be taken. They may be used to evaluate the type of deformity: soft tissue, osseous position deformity, structure deformity, joint destruction, sesamoid position. X-rays may be weight bearing, partial weight bearing, or non-weight bearing.
2. Laboratory testing may be used to rule out inflammatory disease, degenerative joint disease, systemic illnesses, etc.

1. Nonsurgical treatment
   1. Padding the area with bunion pads
   2. Injection of local anesthetic, anti-inflammatory injections, cortisones, oral anti-inflammatories
   3. Shoe modifications (i.e., wider shoes, molded shoes)
   4. Analgesics
   5. Physical therapy
   6. Orthotic treatment
2. Surgical treatment
   1. Partial removal of the medial side and/or dorsal aspect of the first metatarsal head. This is done with or without a soft tissue release.
   2. Correcting the osseous deviation or subluxation of the joint. This may be performed with or without single or multiple osteotomies, or may be done with a Keller procedure.

1. A soft tissue release with an ostectomy of the first metatarsal head
2. Osteotomy at the proximal phalanx
3. One or more osteotomies of the metatarsal
4. A joint destruction procedure whereby an arthroplasty of the proximal phalanx is performed, with or without an implant
5. A fusion along with the removal of the bump of the first metatarsal. At this time it may be necessary and indicated to surgically correct other deformities such as hammertoes, metatarsalgia, flexion deformities, and/or sesamoid pain.

Fixation may be used at the discretion of the surgeon, and may be internal or external or not at all.

The surgical procedure is primarily performed in the doctor's office, but may also be done in the hospital or an ambulatory surgical center.

Local anesthetic is sufficient unless there are extenuating circumstances. Intravenous (IV) sedation may or may not be utilized with this.

Absence of bleeding via tourniquet is not required and is not recommended with minimal incision surgery.

Antiseptic preparation usually consists of antiseptic scrub pre-op, and sterile draping and technique.

Need based on patient's past medical history and current medical status.

May be given at the discretion of the surgeon.

May be performed at the same surgical session or in different surgical sessions.

1. X-rays are necessary to access the progress of osseous healing. They should be taken immediately postoperatively and may be indicated at intervals throughout the postoperative follow-up period, depending on the type of procedure performed and the wishes of the doctor. Non-weight bearing (NWB) x-rays, weight-bearing (WB) x-rays taken at the angle and base of gait, or semi-weight bearing (SWB) x-rays are acceptable. NWB, SWB, or (WB) x-rays are taken at the discretion of the surgeon.
2. Postoperative immobilization may consist of casting, a splint, surgical shoe, a rigid sole shoe, or external splinting via gauze, tape, etc.
3. Internal fixation of fixating devices are not required when doing bunion surgery, but may be used at the discretion of the surgeon when it is appropriate.