1 / 28

Hallux Valgus Correction: Algorithem and Treatment

Hallux Valgus Correction: Algorithem and Treatment. Arash Aminian MD March 17, 2011. Hallux Valgus. All bunions are not created equal Complex array of osseous & soft tissue pathology Lateral deviation of the great toe with medial deviation of the 1 st metatarsal.

varana
Download Presentation

Hallux Valgus Correction: Algorithem and Treatment

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. HalluxValgus Correction: Algorithem and Treatment Arash Aminian MD March 17, 2011

  2. Hallux Valgus • All bunions are not created equal • Complex array of osseous & soft tissue pathology • Lateral deviation of the great toe with medial deviation of the 1st metatarsal

  3. Surgical Treatment • >100 procedures for Hallux Valgus • Procedure should address deformity • Soft tissue procedure combined with bony correction most common procedure • Chevron Osteotomy with Silver eminence resection most common procedure

  4. Hallux Valgus: PE • NWB & WB • Gait/shoe wear • ROM • Hyper mobility 1st ray • Adductor tautness • Neurovascular • Footprints

  5. INDICATIONS • Painful HV failed palliative measures • Wider shoes • Activity modification • NSAIDS • No inflammatory • Non paralytic • 1st MTP Fusion

  6. CONTRAINDICATIONS • PVD • Arthritis • Neuropathic • Pure cosmetic • Osteopenia

  7. ALLIIED DEFORMITIES • METATARSALGIA • HAMMERTOES • CLAWTOES • DEVIATED TOES • NEUROMAS • EQUINUS

  8. RADIOGRAPHS STATIC DEFORMITY • AP/Lat & Sesamoid Weight-Bearing • IMA < 9 degrees • DMAA < 9 degrees • HVA < 15 degrees • Sesamoid station & metatarsal length • Congruity

  9. HVA IMA DMAA

  10. RADIOGRAPHIC ANALYSIS • High Intra, Inter-observer reliability for HVA, IMA (<5 degree, 95% confidence) • Measure from the center of MT head to center of MT base • Post-operative measures are less reliable • Anatomy distorted • Functional outcomes failed to correlate with radiographic outcomes (Thordason et al FAI 26:2005)

  11. SURGICAL GOALS • Plantigrade & painless foot • Complex array of pathological bone & soft tissue deformity must be addressed • Each procedure has limitations & indications • Multiple options should be available

  12. SURGICAL TREATMENT

  13. ALGORITHIM • Congruent Joint • Mild deformity • IMA < 15 degrees, HV < 35 degrees • No instability of the 1st Ray Chevron Osteotomy

  14. CHEVRON • Small medial eminence resection • Hallux Varus • Release the capsule through the joint • AVN • Main blood supply to the MT head: Plantar-lateral corner of the MT head • Don’t rely on the capsular plication for deformity correction • Post-op early motion

  15. CHEVRON

  16. ALGORITHIM • Incongruent Joint • Moderate deformity • IMA 15-20 degrees, HV <40 degrees • No instability of the 1st Ray SCARF Osteotomy Modified Chevron

  17. SCARF

  18. MODIFIED CHEVRON

  19. ALGORITHIM • Incongruent Joint • Severe deformity • IMA >20 degrees, HV >40 degrees • Instability of the 1st Ray Lapidus 1st MTP fusion

  20. LAPIDUS

  21. ALGORITHIM • Inflammatory Arthritis • Paralytic deformity 1st MTP fusion

  22. 1st MTP FUSION

  23. KELLER • Resection of the proximal phalanx • Older patient • Less demand • High risk patients (medical co-morbidities)

  24. Complications • AVN • Stiffness of the joint • Hallux Varus • Malunion (Dorsiflexion: transfer metatarsalgia) • Non-union (Lapidus 5%)

  25. AVN • Blood supply: Branches of the • 1st dorsal metatarsal artery • 1st Plantar metatarsal artery • Medial plantar artery • Plexus Lateral plantar corner • JBJS 2007:2018-2021.

  26. Complications: Recurrance • Do not push a procedure beyond its limits • Hypermobile 1st ray=Lapidus • DMAA ? • Loss of fixation ?

  27. Complications: Recurrance • Position of medial sesmoid and axis of 1st MT JBJS 2009: 1637-1645.

More Related