Hallux Valgus

Question 1

3 types of hallux valgus

Answer 1

1. Congruent
2. Incongruent
3. Arthritic

Question 2

Deforming force of hallux valgus?

Answer 2

Adductor hallicus

Question 3

Radiographic measurements of hallux valgus

Answer 3

Hallux Valgus angle: long axis of 1st MT to long axis of proximal phalanx.
- Normal: < 15 degrees
Intermetatarsal Angle: long axis of 1st MT to 2nd MT.
- Normal: < 9 degrees
Distal Metatarsal Articular Angle: Between line perpendicular to 1st MT long axis and line through base of distal articular cap.
- Normal: < 10 degrees
Hallux Valgus Interphalangeus Angle: angle between the long axis of the proximal phalanx to the distal phalanx

Question 4

Congruent Hallux Valgus characteristics?

Answer 4

congruent joint line with distal metatarsal articular angle WNL (< 9 degrees)

Question 5

Incongruent Hallux Valgus characteristics?

Answer 5

incongruent joint line with increased distal metatarsal articular angle

Question 6

Modified McBride ST Procedure for hallux valgus?

Answer 6

Soft tissue release of:
- adductor hallucis, lateral capsule, medial capsule imbrication
Due to
- Hallux valgus angle > 15 and < 25
- Intermetatarsal angle < 15 deg
- younger patients: 30-50
Rarely done alone, typically with osteotomy

Question 7

Distal metatarsal Osteotomy for hallux valgus?

Answer 7

Done for mild dz:
- Intermetatarsal angle < 13
- Hallux Valgus angle = 40 deg
Types:
- Chevron
- Biplanar Chevron - to correct distal metatarsal articular angle
- Mitchell

Question 8

Proximal metatarsal osteotomy for Hallux valgus?

Answer 8

Done for moderate disease:
- Hallus valgus angle > 40, Intermetatarsal angle > 13
Types: Crescentric, broomstick, Ludloff, Scarf

Question 9

When to combine proximal and distal metatarsal osteotomies in hallux valgus?

Answer 9

Severe disease:

• Hallux valgus angle 41-50 deg
• Intermetatarsal angle 16-20 deg

Question 10

When to perform medial cuneiform osteotomy for hallux valgus?

Answer 10

Severe disease in young patients with open physis

Question 11

Proximal Phalanx osteotomies for hallus valgus?

Answer 11

Akin Osteotomy
Indications
- hallux valgus interphalangeus
- congruent joint with DMAA <10°
- as a secondary procedure if a primary procedure (e.g., chevron or distal soft-tissue procedure) did not provide sufficient correction due to a large DMAA or HVI
- some perform Akin together with/at the time of proximal osteotomy + distal soft tissue correction because this results in progressive increase in HVI

Question 12

Fusion procedures for Hallux Valgus?

• Indications?
• Signature PE finding indicating?
• Patient Population?

Answer 12

Lapidus Procedure: 1st metatarsocuneiform arthrodesis w/ modified McBride
- Very large Intermetatarsal angle
- 1st TMT arthritis
- HYPERMOBILE 1st TMT joint
- Concomitant pes planus
MTP Arthrodesis, done for:
- CP, Down’s synd, Rheumatoid arthritis, Gout, Severe DJD, Ehler-Danlos

Question 13

Most common complication for Hallux valgus surgery?

Others?

Answer 13

Recurrence
- 2/2 to undercorrection or noncompliance
- lack of resection of adductor hallucis tendon can cause
Others:
- AVN
- Hallus Varus 2/2 to overcorrection
- Dorsal malunion with transfer metatarsalgia
- Cock up toe deformity 2/2 to FHL injury
- Neuropraxia - Medial dorsal cutaneous nerve