Current RMA Instruments
| Reasonable Hypothesis | 25 of 2024 |
| Balance of Probabilities | 26 of 2024 |
Changes from previous Instruments
ICD coding
ICD-10-AM: M20.1
Brief description
This is a deformity of the big toe (hallux) where the distal end of the toe is deflected laterally (away from the midline). This results in a bump on the side of the foot at the base of the first toe which can become painful and affect walking and choice of footwear. The bony or soft tissue growth is also called a bunion.
Confirming the diagnosis
To confirm the diagnosis there needs to be evidence of clinical symptoms and signs of great toe deformity. Xray imaging can be used to determine the degree of deformity and assist with treatment planning.
The relevant medical specialist is an orthopaedic surgeon.
Additional diagnoses covered by these SOPs
Big toe bunion.
Conditions not covered by these SOPs
Congenital hallux valgus# - (ICD-10: Q66.89)
Osteoarthritis of the first metatarsophalangeal joint* - Osteoarthritis. However Hallux valgus may be present in addition to osteoarthritis.
* another SOP applies - the SOP has the same name unless otherwise specified
# non-SOP condition
Clinical onset
Hallux valgus may be asymptomatic but to apply this SoP, symptoms and signs consistent with hallux valgus needs to be present- pain and tenderness around the bunion, swelling and redness, difficulty moving the big toe, and noticeable lateral toe deviation.
Clinical worsening
The natural history of hallux valgus is to get worse with the passage of time. The treatment involves removing the causative factor(s) if possible. Hallux valgus does not generally result in a high level of impairment if treated early. However, surgical treatment is an option for cases involving severe deformity. It would be recommended that Orthopaedic surgical opinion is sought to address any concerns related to possible clinical worsening out of keeping with the expected natural history of this condition.
Comments on SOP factors
Factor relating to footwear: This condition will commonly occur with the use of high heel shoes in women where the front of the shoe is narrowed, forcing the big toe to turn laterally. It is unclear whether military shoes or boots would have had a narrowed anterior compartment, but a shoe or boot that was too small may have compressed the big toe laterally.