Postulating a pathophysiological association between hallux valgus and plantar venous thrombosis through cadaveric dissections – Geometric measurements pedobarographic and phlebology correlates and literature review

Abstract

This original article postulates a pathophysiological association between two uncommon clinical entities in a cadaveric subject. A female cadaver from a willed body donor was procured for educational and research purposes. During surgical dissection, the subject was observed to have hallux valgus (HV) and lateral plantar venous thrombosis (PVT) on the left foot. Clinical significance of HV was confirmed by geometric measurements of the great toe and first metatarsal. Severity of lateral PVT was established by meticulous dissection along full course of the vein and all its grossly accessible tributaries. Dissections in other regions of the same cadaveric subject did not reveal evidence of venous thrombosis elsewhere. Extensive search of the contemporary literature confirmed HV is most common in elderly females, though not very common in the general population. It also established that isolated PVT is very rare, the medial type being rarer. No study mentioned both HV and PVT in the same subject or tried to establish a pathophysiological association between both entities. Analyzing the pedobarographic and phlebology literature on HV, PVT, foot veins, gait, posture, and foot pressure points led the authors to postulate that flattening of medial arch and increased medial forefoot pressure from HV during life in elderly females could render Uhl-Gillot’s postulated ‘footpump’ incompetent. Since the principal conduit of the foot-pump is the lateral plantar vein (LPV), ineffective foot-pump could lead to lateral PVT. Considering the paucity of literature on coexisting HV and PVT in living and cadaveric subjects, more studies are required to confirm our hypothesis of this pathophysiological association.