Hallux valgus in men: demography, etiology and comparative radiographic

Abstract

Objective: The high frequency of hallux valgus in females is a known fact and has been widely mentioned in the literature. This finding tends to obscure the importance and the characteristic details of the hallux valgus in men. The severity of the deformity, its precocity and hereditary feature seem to be greater in men, but there are no reports in literature that prove these impressions, this is the objective of the present study. Methods: The records and plain radiographs of 31 men (53 feet) with diagnosis of hallux valgus were analyzed from 1985 to 2005. During that period, the senior author (CN) performed 812 procedures for hallux valgus correction in women. In order to find out gender related differences in this deformity, 31 women’s files, pared by age and affected side, were randomly selected and both clinical and radiological data were statistically compared. Results: The onset of the complaints in men was equally distributed among decades, indicating that the deformity begins earlier in this group. Among men, we can find 68% of deformity heritage: 58% from mother and 10% from father. Only 35% of the women showed inheritance of the deformity. No correlation with shoe wear was found among men. The angular radiological parameters – hallux valgus angle (HVA), distal metatarsal articular angle (DMAA) and tarsal metatarsal angle (TMA) – were significantly greater in men. The main gender difference was found to be the DMAA. This finding was supported by the first MTP congruence that was greater in men (m=57%; f=30%). No correlation with metatarsus primus varus or pes planus was found in either sex in this study. Conclusions: Based on our observations, it is possible to conclude that hallux valgus in men is a hereditary deformity, mainly transmitted by mother, with precocious onset and high severity when compared to women. We found the proportion of incidence of 15 females per 1 male in our study. The main intrinsic factor responsible for the hallux valgus in men is the high DMAA (set angle).