Rudnev was not involved in the Anderson case, he was just called in to try saving her life from tuberculosis.
From Anastasia, the Riddle of Anna Anderson:
Following a detailed report of her physical condition Rudnev remarked, "On the right foot I noted a severe deformity, apparently congenital in nature, in that the the big toe bends right in over the middle, forming a bunion."
Although the condition is not unusual,, in this case the malady was so pronounced that it could only have been present from birth.
Yes, but what I'm looking for is a description of this condition, completely independent of Anna Anderson, which states that severe cases must be congenital. I haven't come across this in any of the descriptions of hallux valgus on websites like MedLine, Mayo Clinic, or the American Podiatric Medical Association.
A doctor who was brought in to treat tuberculosis may very well not be an expert on abnormalities of the feet. Plus, "apparently congenital" leaves room for doubt in a way that "could only have been present from birth" doesn't, which means that this statement is somewhat contradictory.
I did find these, for what it's worth, and they seem to be saying that there's some correlation between severity and early onset, but not that the correlation is all that great or that "early onset" involves "at birth"; instead, it seems as though the age of 10 or 11 seems to be significant.
Correlation between hallux valgus angle and age.
Turan I
J Foot Surg ; 29:327-9.
Abstract
A study was made of the relationship between the hallux valgus angle and age. Between January 1983 and June 1985, 464 hallux valgus operations were performed on 404 patients at the Department of Orthopedic Surgery at Huddinge Hospital. The mean age of the patients was 54 +/- 12 years (range 16 to 75). The patients were divided into six groups with regard to nature and extent of radiographic changes. Linear regression analysis was used for analysis of the correlation between age and hallux valgus angle. A significant correlation was found in group 1: hallux valgus grade 1, type I (great toe rotated, slight bunion) and group 6: hallux valgus grade 2, type III (great toe rotated, severe bunion and severe arthrosis). There was a large scatter around the lines, however, which means that age is poor predictor of the hallux valgus angle.
Hallux valgus: demographics, etiology, and radiographic assessment.
Foot Ankle Int. 2007 Jul;28(7):759-77.
Coughlin MJ,
Jones CP.
Idaho Foot and Ankle Fellowship Program, Foot and Ankle Orthopaedic Surgery, Boise, ID 83706, USA.
FOOTMD@aol.com
BACKGROUND: The purpose of the study was to preoperatively evaluate the demographics, etiology, and radiographic findings associated with moderate and severe hallux valgus deformities in adult patients (over 20 years of age) treated operatively over a 33-month period in a single surgeon's practice. METHODS: Patients treated for a hallux valgus deformity between September, 1999, and May, 2002, were identified. Patients who had mild deformities (hallux valgus angle < 20 degrees), concurrent degenerative arthritis of the first metatarsophalangeal joint, inflammatory arthritis, recurrent deformities, or congruent deformities were excluded. When enrolled, all patients filled out a standardized questionnaire and had a routine examination that included standard radiographs, range of motion testing, and first ray mobility measurement. A chart review and evaluation of preoperative radiographs were completed on all eligible patients. RESULTS: One-hundred and three of 108 (96%) patients (122 feet) with a diagnosis of moderate or severe hallux valgus (hallux valgus angle of 20 degrees or more)(70) qualified for the study. The onset of the hallux valgus deformity peaked during the third decade although the distribution of occurrence was almost equal from the second through fifth decades. Twenty-eight of 122 feet (23%) developed a deformity at an age of 20 years or younger. Eighty-six (83%) of patients had a positive family history for hallux valgus deformities and 87 (84%) patients had bilateral bunions. 15% of patients in the present series had moderate or severe pes planus based on a positive Harris mat study. Only 11% (14 feet) had evidence of an Achilles or gastrocnemius tendon contracture. Radiographic analysis found that 86 of 122 feet (71%) had an oval or curved metatarsophalangeal joint. Thirty-nine feet (32%) had moderate or severe metatarsus adductus. A long first metatarsal was common in patients with hallux valgus (110 of 122 feet; 71%); the mean increased length of the first metatarsal when compared to the second was 2.4 mm. While uncommon, the incidence of an os intermetatarsum was 7% and a proximal first metatarsal facet was 7%. The mean preoperative first ray mobility as measured with Klaue's device was 7.2 mm. 16 of 22 (13%) feet were observed to have increased first ray mobility before surgery. CONCLUSIONS: The magnitude of the hallux valgus deformity was not associated with Achilles or gastrocnemius tendon tightness, increased first ray mobility, bilaterality or pes planus. Neither the magnitude of the preoperative angular deformity nor increasing age had any association with the magnitude of the first metatarsophalangeal joint range of motion. Constricting shoes and occupation were implicated by 35 (34%) patients as a cause of the bunions. A familial history of bunions, bilateral involvement, female gender, a long first metatarsal, and an oval or curved metatarsophalangeal joint articular surface were common findings. Increased first ray mobility and plantar gapping of the first metatarsocuneiform joint were more common in patients with hallux valgus than in the general population (when compared with historical controls).
1: Foot Ankle Int. 1995 Nov;16(11):682-97.
Links
Roger A. Mann Award. Juvenile hallux valgus: etiology and treatment.
Coughlin MJ.
Division of Orthopaedics, Oregon Health Sciences University, Portland, USA.
In an 11-year retrospective study of 45 patients (60 feet) with juvenile hallux valgus, a multiprocedural approach was used to surgically correct the deformity. A Chevron osteotomy or McBride procedure was used for mild deformities, a distal soft tissue procedure with proximal first metatarsal osteotomy was used for moderate and severe deformities with MTP subluxation, and a double osteotomy (extra-articular correction) was used for moderate and severe deformities with an increased distal metatarsal articular angle (DMAA). The average hallux valgus correction was 17.2 degrees and the average correction of the 1-2 intermetatarsal angle was 5.3 degrees. Good and excellent results were obtained in 92% of cases using a multiprocedural approach. Eighty-eight percent of patients were female and 40% of deformities occurred at age 10 or younger. Early onset was characterized by increased deformity and an increased DMAA. Maternal transmission was noted in 72% of patients. An increased distal metatarsal articular angle was noted in 48% of cases. With subluxation of the first MTP joint, the average DMAA was 7.9 degrees. With a congruent joint, the average DMAA was 15.3 degrees. In patients where hallux valgus occurred at age 10 or younger, the DMAA was increased. First metatarsal length was compared with second metatarsal length. While the incidence of a long first metatarsal was similar to that in the normal population (30%), the DMAA was 15.8 degrees for a long first metatarsal and 6.0 degrees for a short first metatarsal. An increased DMAA may be the defining characteristic of juvenile hallux valgus. The success of surgical correction of a juvenile hallux valgus deformity is intimately associated with the magnitude of the DMAA. Moderate and severe pes planus occurred in 17% of cases, which was no different than the incidence in the normal population. No recurrences occurred in the presence of pes planus. Pes planus was not thought to have an affect on occurrence or recurrence of deformity. Moderate and severe metatarsus adductus was noted in 22% of cases, a rate much higher than that in the normal population. The presence of metatarsus adductus did not affect the preoperative hallux valgus angle or the average surgical correction of the hallux valgus angle. Constricting footwear was noted by only 24% of patients as playing a role in the development of juvenile hallux valgus. There were six recurrences of the deformities and eight complications (six cases of postoperative hallux varus, one case of wire breakage, and one case of undercorrection).
