Hallux valgus AOTrauma—Foot & Ankle Module 14: The great toe

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Presentation transcript:

Hallux valgus AOTrauma—Foot & Ankle Module 14: The great toe Christy Kabbash, US

Case description 35-year-old woman Severe, painful hallux valgus deformity and overlying bursitis Second hammertoe, flexible, with painful dorsal proximal interphalangeal joint (PIP) corn Difficulty with most types of footwear/sneakers

Preoperative x-rays

Presentation

Preoperative

Medial exostectomy Lateral sesamoid release

Lateral 1st MTPJ release

Lateral-based closing wedge from cuneiform

Still hallux valgus Need Akin osteotomy 1st TMT well reduced—however, look at hallux! Compress—do not forget to remove the K-wire first! Dorsal leg screw not seen

Better alignment post Akin Perform Akin at proximal phalanx Repair capsule

EDL/EDB Bunionette Tourniquet down—brisk erythema all toes

1st TMT with Girdlestone

6 months postoperative

Take-home messages Indications for first TMT fusion: Large IM angle Metatarsocuneiform gap Incongruent joint Indications for additional Akin osteotomy: Rotation/pronation and hallux valgus interphalangeus apparent after reduction of IM angle with TMT fusion Soft-tissue procedures for flexible hammertoe