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Journal of Bone and Joint Surgery - British Volume, Vol 86-B, Issue 1, 54-57.
doi: 10.1302/0301-620X.86B1.13502  
Copyright © 2004 by British Editorial Society of Bone and Joint Surgery
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Sensory dysfunction in the great toe in hallux valgus

M. L. Herron, FRCS Orth, Specialist Registrar in Orthopaedics1; S. Kar, MRCS, Senior House Officer in Orthopaedics1; D. Beard, DPhil, Senior Fellow2; and P. Binfield, FRCS Orth, Consultant Orthopaedic Surgeon1

1 Department of Orthopaedic and Trauma Surgery, Warwick District General Hospital, Lakin Road, Warwick CV34 5BW, UK.
2 Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK.

Correspondence should be sent to Mr M. L. Herron at The Royal Orthopaedic Hospital, Woodlands, Northfield, Birmingham B31 2AP, UK.

Injury to the dorsomedial cutaneous nerve in the foot may occur after operations for hallux valgus. Pressure neuropathy before operation is also described but remains largely unexplored. We have investigated the incidence of sensory deficit in the great toe before operating for hallux valgus and examined to what extent any deficit was related to the degree of angulation of the joint.

Forty-three patients with a total of 61 great toes with hallux valgus presenting for consideration of surgical correction had their sensation tested in pre-designated zones using a five-filament set of Semmes-Weinstein monofilaments. These allowed good inter-observer reliability with an intra-class correlation coefficient of 0.84.

Sensory symptoms were noted by only 21% of the patients, a measurable reduction in sensation by one monofilament grade or more was found in an additional 44%. No relationship was found between the degree of sensory loss and the degree of angulation.

Patients with symptomatic hallux valgus may have sensory loss in the toe without being aware of it. Normal subjective sensation does not reliably predict normal sensory function. Given the potentially high rates of nerve damage following operations for hallux valgus, we recommend objective sensory testing as part of routine assessment before surgery.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General