Hallux Valgus

Question 1

What are some risk factors for hallux valgus?

Answer 1

1) genetics
2) increased DMAA
3) Ligamentous laxity
4) Convex MT head
5) 2nd toe amputation
6) Pes planus
7) RA
8) Cerebral palsy

Question 2

Describe the pathoanatomy of hallux valgus?

Answer 2

1) Phalanx deviates laterally
2) Causes MT to deviate medially
3) MTP medial joint capsule becomes stretched
4) Adductor hallucis that inserts on fibular sesamoid and base of proximal phalanx becomes deforming force
5) Lateral deviation of EHL
6) Abductor hallucis migrates plantar and laterally causing plantarflexion and pronation of the phalanx

Question 3

What differentiates juvenile and adolescent hallux valgus from acquired?

Answer 3

1) bilateral and familial
2) pain is not usually primary complaint
3) DMAA increased
4) Often a/w flexible flatfoot

Question 4

What are the radiographic normals in the hallux?

Answer 4

1) HVA (hallux valgus angle)- Normal < 15 degrees; long axis of 1st MT and proximal phalanx
2) IMA (intermetatarsal angle)- <15 degrees;

Question 5

What are the soft tissue procedures involved a modified McBride for hallux valgus?

Answer 5

1) Adductor hallucis
2) Lateral capsule release
3) Transverse metatarsal ligament
4) Medial capsule imbrication

Question 6

When is a modified McBride recommended for hallux valgus?

Answer 6

1) incongruent MTP joint

2) HVA <15

Question 7

What treatment is indicated for hallux vaglus with HVA <13?

Answer 7

Distal osteotomy

Chevron, biplanar Chevron, Mitchell

Question 8

What treatment is indicated in hallux valgus with HVA >40 and IMA >13

Answer 8

Proxial osteotomy

Ludloff, Crescentic, Scarf

Question 9

When is a Lapius indicated for hallux valgus?

Answer 9

Severe IMA, metatarsus primus varus, hypermobile 1st MT joint

Question 10

What is the most common complication of hallux valgus surgery?

Answer 10

Recurrence