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Hallux Valgus Correction 28296

 

synonyms:

Hallux Valgus Technique CPT

Hallux Valgus Technique Indications

Hallux Valgus Technique Contraindications

Hallux Valgus Technique Alternatives

  • Non-op treatment: wide-laced (high toe box) shoes; activity modifications

Hallux Valgus Technique Planning / Special Considerations

 

Hallus Valgus Technique - Modified Rotational Scarf Osteotomy for Hallux Valgus

  • Sign operative site.
  • Pre-operative antibiotics, +/- regional block.
  • Anesthesia
  • Supine position. All bony prominences well padded.
  • Examination under anesthesia.
  • Prep and drape in standard sterile fashion.
  • standard medial incision over 1st MTP joint
  • reflect capsule from medial  MTP joint to expose lateral aspect of MTP joint.
  • release adductor tendon, lateral capsule 
  • resect medial eminence
  • make standard scarf osteotomy cuts
  • rotate plantar half of the bone medial to correct the IM angle
  • bone clamp the osteotomy
  • secure with two 3.0mm headless compression screws
  • verify with fluoroscopy
  • excise residual bony prominences to provide flush medial border
  • Consider Akin osteotomy of proximal phalanx if interphalangeous is present. 

Hallux Valgus Technique Technique

  • Sign operative site.
  • Pre-operative antibiotics, +/- regional block.
  • General endotracheal anesthesia
  • Supine position. All bony prominences well padded.
  • Examination under anesthesia.
  • Prep and drape in standard sterile fashion.
  • 2-3cm longitudinal incision in 1st web space
  • Blunt dissection to the adductor hallucis.
  • Release adductor from lateral sesamoid exposing transverse metatarsal ligament.
  • Place freer elevator under transverse metatarsal ligament to protection NV bundle; release transverse metatarsal ligament.
  • Perforate capsule; abduct toe to neutral releaseing lateral capsule.
  • With toe in neutral ensure adequate dorsiflexion can be obtained.
  • Medial midline incision centered over MT head.
  • Protect dorsomedial cutaneous nerve and planter medial cutaneous nerve.
  • Expose capsule; expose abductor hallucis tendon plantarly.
  • Perform vertical capsulotomy at joint line.
  • Perform vertical capsulotomy 3-8mm proximal to previous incision and excise intervening capsule.
  • Dorsal L extention of capsular incision to expose the medial eminence.
  • Remove medial eminence with a saw or osteotome to make it coplanar with the metatarsal shaft (just medial to sulcus).
  • Pass 3 sutures threw the adductor tendon and tie into the interosseous ligament to keep adductor tendon off the bottom of the foot.
  • Plicate medial capsule with the toe in a neutral position. Small portion of dorsal capsule may need to be removed if it is redundant after removal of medial emminence.
  • Irrigate.
  • Close in layers.

Hallux Valgus Technique Complications

  • Distal chevron osteotomy with soft tissue release complications = incomplete correction and avascular necrosis (1 – 2%).
  • Distal soft tissue realignment only complications = recurrence of deformity, inadequate lateral release, and hallux varus.
  • Aken procedure complications = increase in the hallux valgus deformity.
  • Proximal first metatarsal osteotomy complications = hallux varus and shortening.
  • Hallux Varus deformity
  • Dorsomedial cutaneous nerve neurmoa / syndrome:  Dorsomedial cutaneous nerve is the terminal branch of the superficial peroneal nerve and is the most susceptible to iatrogenic injury during hallux valgus surgery.  (Miller SD, Foot Ankle INt 2001;22:198)
  • Resection of both sesmoids risk development of cock-up toe deformity

Hallux Valgus Technique Follow-up care

  • Post-op:
  • 7-10 Days:
  • 6 Weeks:
  • 3 Months:
  • 6 Months:
  • 1Yr:

Hallux Valgus Technique Outcomes

Hallux Valgus Technique Review References

  1. Mann, Disorders of the first metatarsophalangeal joint, JAAOS, 3(1):  34-43, 1995
  2. Coughlin MJ: Roger A. Mann Award.  Juvenile hallux valgus: Etiology and treatment.  Foot Ankle Int 1995;16:682-697.
  3. Zimmer TJ, Johnson KA, Klassen RA: Treatment of hallux valgus in adolescents by the chevron osteotomy.  Foot Ankle 1989;9:190-193.
  4. Coughlin MJ, ICL 1997;46:357
  5. Gould AAOS OKO Topic