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Hallux Valgus: Surgical Treatment

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Hallux Valgus: Surgical Treatment. November 3, 2003. Dr. N.C. Stone ... Surgical Decision Making. Flow charts. Know the principles and a few procedures. Akin ... – PowerPoint PPT presentation

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Title: Hallux Valgus: Surgical Treatment


1
Hallux ValgusSurgical Treatment
  • November 3, 2003
  • Dr. N.C. Stone

2
Intro
  • Clinical Assessment
  • Investigations
  • Treatment

3
Clinical Assessment
  • Severity of Symptoms
  • Location of pain
  • ? Secondary cause (i.e. RA)
  • Patient Expectations
  • Not the incision but the decision

4
Clinical Assessment
  • Severity of Deformity wide forefoot
  • Stiffness / Correctability
  • Hypermobile 1st ray
  • Lesser toe problems
  • Pes planus
  • Neurovascular exam

5
Investigations
  • STANDING AP and Lateral
  • Angles
  • DMAA, HV, Intermetatarsal Angle
  • Congruent / Incongruent
  • Degenerative Change

6
IM angle 9-11
7
DMAA lt10
8
HV Angle lt 15
9
(No Transcript)
10

Classification
11
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

12
Scenario 1
  • Older Patient
  • Severe deformity (HV angle gt 40)
  • Inflammatory disease
  • Degenerative Changes
  • FUSION ? Kellers ? Prosthetic arthroplasty

13
Scenario 2
  • Hypermobile 1st ray
  • Lapidus Procedure

14
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

15
60 degrees
Can help fix the DMAA
16
Proximal 1st Metatarsal Osteotomy
  • Dome
  • Opening/closing wedge
  • Myerson

17
Scenario 4
  • Middle aged patient / wide forefoot
  • Incongruent, Increased IMA, Normal DMAA
  • Proximal
  • Lateral release / Medial tightening (Modified
    McBride)
  • /- Akin

18
Modified McBride
  • Adductor Hallucis release
  • Transverse metatarsal ligament release
  • Lateral Capsular release

19
(No Transcript)
20
Scenario 5
  • The most common one
  • Middle aged female
  • Not severe, Normal IMA, Slightly incongruent
  • Chevron, medial capsular tightening
  • /- Akin

21
(No Transcript)
22
Complications
  • Non-union
  • AVN (avoid distal osteotomy and McBrides
    together)
  • Recurrence
  • Hallux Varus

23
Hallux Varus
24
Case 1
25
Case 2
26
Case 3
27
!!Thank You!!
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