A 15-year-old girl with a family history of bunion deformity presents with a great toe deformity. Radiographs show an increased distal metatarsal articular angle (DMAA) with a congruent first metatarsophalangeal joint and an increased intermetatarsal angle. Which feature best distinguishes this juvenile hallux valgus from the adult form?

• A Lateral subluxation of the sesamoids with an incongruent joint
• B Isolated soft tissue imbalance without any bony abnormality
• C Increased DMAA with a congruent metatarsophalangeal joint ✓
• D Degenerative changes of the first metatarsophalangeal joint

Explanation

Juvenile or adolescent hallux valgus is characteristically associated with metatarsus primus varus, an increased distal metatarsal articular angle, and a congruent metatarsophalangeal joint, reflecting a primary structural bony deformity with a strong familial tendency. Adult hallux valgus typically shows an incongruent joint with lateral drift of the proximal phalanx and progressive sesamoid subluxation. Degenerative change is a feature of long-standing adult deformity or hallux rigidus, not of the typical adolescent presentation.

Reference: Campbell's Operative Orthopaedics, 14th ed.

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Written and medically reviewed by the StethoPrep medical team.