Hallux abducto valgus (HAV) is a frequently seen abnormality of the first metatarsophalangeal joint. Limited conservative treatment options exist, making surgery the only definitive treatment option for a mild to moderate deformity. Since initially published in 2008, treatment of HAV with botulinum toxin injection has evolved as a potentially effective modality as shown in several subsequent independent studies.
Botulinum injection of two intrinsic foot muscles (extensor halluces brevis and flexor hallucis brevis) in addition to adductor hallucis under electrical stimulation is presented as an improvement to the original method.
The additional muscle injections of botulinum resulted in an further reduction of the HAV deformity and associated pain.
A significant improvement to the injection paradigm developed the author may prove to be more effective in reducing the HAV deformity and its associated pain.