Surgical Mgmt of Hallux Limitus

Question 1

what is normal motion at 1st MPJ?

Answer 1

65-70 deg of dorsiflexion

Question 2

what is etiology of hallux limitus?

Answer 2

trauma**
dorsiflexed 1st met
pronation 
arthridities
long 1st met/short 2nd met
previous surgery

Question 3

what is characteristics of grade 1 hallux limitus by olaf and jacobs?

Answer 3

• pain at end ROM
• limitation of motion WB
• elevatus may be present

Question 4

what are characteristics of grade 2 hallux limitus by olaf and jacobs?

Answer 4

• pain at end ROM
• limited ROM NWB
• small dorsal exostosis of 1st met head
• some flattening of 1st met head

Question 5

what are characteristics of grade 3 hallux limitus by olaf and jacobs?

Answer 5

• pain and crepitation w/ ROM
• large dorsal oxostosis
• significant joint space narrowing, flattening of 1st met head, cartilage loss

Question 6

what are characteristics of grade 4 hallux limitus by olaf and jacobs?

Answer 6

-pain and crepitation w/ ROM

-

Question 7

how would you treat Grade 1 hallux limitus by olaf and jacobs?

Answer 7

• conservative: stretching, orthotics

- joint preservation: cheilectomy or Kessel Bonney

Question 8

how would you treat Grade 2 hallux limitus by olaf and jacobs?

Answer 8

joint preservation: Kessel bonney or 1st met osteotomy

Question 9

how would you treat grade 3 or 4 hallux limitus by olaf and jacobs?

Answer 9

-joint destructive procedure: Keller, implant, or arthrodesis

Question 10

in which ACFAS classification do you get pain will full ROM?

Answer 10

ACFAS stage 3

Question 11

in general, what is treatment approach for stage 1 or 2 hallux limitus?

Answer 11

(potentially salvagable joints) - so primarily joint reconstruction

Question 12

in general, what is treatment approach for stage 3 or 4 hallux limitus?

Answer 12

(non-salvagable joints)- so joint destructive procedures

Question 13

what are some non-joint destructive procedures?

Answer 13

1. exostectomy- Ex. Cheilectomy
2. proximal phalanx osteotomy- Ex. Kessel Bonney, Regnauld
3. 1st met osteotomy= Ex. Watermann, Youngswick, Dorsal V
4. arthrodiastasis

Question 14

Describe the Cheilectomy procedure.

Answer 14

(non-joint destructive)

is a joint clean up procedure whereby you remove the dorsal exostosis of the 1st met head

Question 15

Describe the Kessel Bonney procedure.

Answer 15

(non-joint destructive)

resection of a dorsally based wedge of bone from the base of the proximal phalanx

Question 16

Describe the Regnauld procedure.

Answer 16

(non-joint destructive) shortening osteotomy of proximal phalanx by creating a “peg-in-hole”

Question 17

describe the watermann procedure.

Answer 17

(non-joint destructive) dorsal wedge osteotomy out of 1st met head

Question 18

what is the drawback to watermann procedure?

Answer 18

may irritate sesamoids

Question 19

Describe the Youngswick procedure.

Answer 19

(non-joint destructive)

is an Austin osteotomy with a cut dosally to remove wedge to shorten met and plantarflex it

Question 20

what is the dorsal V procedure?

Answer 20

(non-joint destructive)
-chevron cut made dorsal to plantar thru met neck to allow plantarflexion of met head (but no decompression like Youngswick allows for)

Question 21

what is a sagittal Z procedure?

Answer 21

sagittal Z thru met shaft with proximal arm exiting medially and distal arm exiting laterally that allows you to lengthen or shorten and allows you to plantarflex

Question 22

describe the lambrinudi procedure.

Answer 22

plantarflexory base osteotomy to correct metatarsus primus elevatus

Question 23

what is the distraction protocol for an arthrodiastasis?

Answer 23

• intra-op distraction up to 5mm
• distraction 0.5mm/day for max. of 14 days
• leave joint static for 14 days

Question 24

what is the max. distraction for 1st MPJ?

Answer 24

8-12 mm

Question 25

what are the joint destructive techniques to be used in stages 3 and 4?

Answer 25

• arthroplasty: Keller and hemi-or total implant

- arthrodesis

Question 26

describe the Keller procedure.

Answer 26

(joint destructive)

base of proximal phalanx is removed

Question 27

when is the Keller procedure used?

Answer 27

(arthroplasty of 1st MPJ)- end-stage hallux limitus and geriatric bunions

Question 28

when would you do a 1st MPJ arthrodesis?

Answer 28

end-stage procedure that is done in younger or highly active patients compared to arthroplasty