Compared to other areas of the body, the foot is a more complex structure in terms of its anatomy, loading mechanics and diseases. The great toe is a specialized part of the foot, which is sufficiently mobile and also strong enough to support almost 90% of the weight transferred to the ground. Diseases involving the great toe may cause significant impairment in quality of daily life.
The most frequent diseases of the great toe are hallux valgus (HV) and hallux rigidus (HR), which are contradictory conditions. Most prominent difference is that HV causes pain within the shoe while HR is more painful barefoot. In young patients, they never exist simultaneously. HV is caused by many etiological factors, but HR does not have a defined etiology other than trauma. HV patients may continue their daily activities, but HR patients seek immediate remedy because of pain. Severity of the deformity may be determined easily in HV, but it is difficult to identify the severity of osteoarthritis in HR.
There are two basic and consecutive aims in the surgical treatment of HV. At the first stage, the great toe is brought to the same axis with the first metatarsal. At the second stage, the first and second metatarsals are brought closer together. Various osteotomies at various levels have been suggested for the second stage. Tips and tricks for choosing among these options are presented in this article. The major and most difficult aspect of the treatment of HR consists of identifying the stage of osteoarthritis, which determines the type of surgery. Mistakes made in this evaluation are met with high patient dissatisfaction.