(i) Disorders of the first ray

Musculoskeletal conditions are a common presentation in primary care, and almost one third of these are related to the foot and ankle. Of these, the most common pathologies are disorders of the first ray, which includes hallux valgus and hallux rigidus. Pain in the first ray, which forms the weight-bearing medial column of the foot, can significantly impact on a patient's quality of life. Diagnosis is often not difficult, but it is important to examine for pathologies in the lesser rays that coexist with the presenting disorder. Initial treatment is with physiotherapy and orthotics, but surgical treatment of degenerative change and valgus deformity yields good outcomes and patient satisfaction. This article reviews the common conditions affecting the first ray, their assessment and their management.