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

2. 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

3. Preoperative x-rays

4. Presentation

5. Preoperative

7. Medial exostectomy
Lateral sesamoid release

8. Lateral 1st MTPJ release

9. Lateral-based closing wedge from cuneiform

11. 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

12. Better alignment post Akin
Perform Akin at proximal phalanx
Repair capsule

14. EDL/EDB
Bunionette
Tourniquet down—brisk erythema all toes

15. 1st TMT with Girdlestone

16. 6 months postoperative

17. 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