Hallux Valgus: Surgical Treatment

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Hallux ValgusSurgical Treatment

• November 3, 2003
• Dr. N.C. Stone

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Intro

• Clinical Assessment
• Investigations
• Treatment

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Clinical Assessment

• Severity of Symptoms
• Location of pain
• ? Secondary cause (i.e. RA)
• Patient Expectations
• Not the incision but the decision

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Clinical Assessment

• Severity of Deformity wide forefoot
• Stiffness / Correctability
• Hypermobile 1st ray
• Lesser toe problems
• Pes planus
• Neurovascular exam

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Investigations

• STANDING AP and Lateral
• Angles
• DMAA, HV, Intermetatarsal Angle
• Congruent / Incongruent
• Degenerative Change

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IM angle 9-11
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DMAA lt10
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HV Angle lt 15
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Classification
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Surgical Decision Making

• Flow charts
• Know the principles and a few procedures
• Akin
• Chevron (and its modifications)
• Proximal 1st osteotomy
• Modified Mcbrides
• 5 common scenarios

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Scenario 1

• Older Patient
• Severe deformity (HV angle gt 40)
• Inflammatory disease
• Degenerative Changes
• FUSION ? Kellers ? Prosthetic arthroplasty

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Scenario 2

• Hypermobile 1st ray
• Lapidus Procedure

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Scenario 3

• Young Patient (congenital Hallux Valgus)
• Congruent, Increased DMAA, Increased IMA
• All Extra Articular
• Proximal
• Chevron / Medial closing wedge distally
• Akin
• NO lat release / NO medial tightening

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60 degrees
Can help fix the DMAA
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Proximal 1st Metatarsal Osteotomy

• Dome
• Opening/closing wedge
• Myerson

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Scenario 4

• Middle aged patient / wide forefoot
• Incongruent, Increased IMA, Normal DMAA
• Proximal
• Lateral release / Medial tightening (Modified
  McBride)
• /- Akin

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Modified McBride

• Adductor Hallucis release
• Transverse metatarsal ligament release
• Lateral Capsular release

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Scenario 5

• The most common one
• Middle aged female
• Not severe, Normal IMA, Slightly incongruent
• Chevron, medial capsular tightening
• /- Akin

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Complications

• Non-union
• AVN (avoid distal osteotomy and McBrides
  together)
• Recurrence
• Hallux Varus

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Hallux Varus
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Case 1
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Case 2
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Case 3
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!!Thank You!!