J Korean Foot Ankle Soc.  2014 Jun;18(2):48-55. 10.14193/jkfas.2014.18.2.48.

Operative Treatment of Hallux Valgus

• Lee JW
• Ahn JH
• Kim MS
• Kim SC

• KMID: 2181660
• DOI: http://doi.org/10.14193/jkfas.2014.18.2.48

Abstract

Hallux valgus, or a 'bunion', is a deformity characterized by lateral deviation of the big toe. Surgery is indicated when conservative treatments have failed to result in improvement of symptoms. Operative techniques include simple bunionectomy, distal soft tissue procedure, phalangeal osteotomy, metatarsal osteotomy (distal, shaft, or proximal), arthrodesis (metatarsophalangeal or tarsometatarsal), or resection arthroplasty. Good results are expected when the selection of operative technique is based on the correct treatment principle.

Keyword

Hallux valgus; Phalangeal osteotomy; Metatarsal osteotomy; Arthrodesis; Resection arthroplasty

MeSH Terms

Arthrodesis
Arthroplasty
Congenital Abnormalities
Hallux Valgus*
Metatarsal Bones
Osteotomy
Toes

Figure

• 

  Figure 1. (A) The radiograph of right foot shows mild hallux valgus deformity with a hallux valgus angle of 26o and the 1st intermetatarsal angle of 12o. (B) This photo demonstrates the distal chevron metatarsal osteotomy. The metatarsal head fragment was laterally displaced and fixed with a Kirschner-wire. (C) The deformity was adequately corrected with distal chevron metatarsal osteotomy. Postoperative hallux valgus angle was 8o and the 1st intermetatarsal angle was 7o. (D) The radiograph at postoperative 1 year shows that the correction of the deformity has been well maintained.

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  Figure 2. This photo demonstrates the biplanar distal chevron metatarsal osteotomy with excision of medial wedge to decrease the distal metatarsal articular angle.

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  Figure 3. (A) This photo shows the proximal crescentic metatarsal osteotomy through the dorsal approach. (B) A special saw-blade is needed for the proximal crescentic osteotomy.

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  Figure 4. These illustrations demonstrate two types of proximal chevron metatarsal osteotomy. (A) The apex of osteotomy is located 2 cm distally from the metatarso-cuneiform joint. (B) The apex of osteotomy is located proximally, and the base is located 2 to 2.5 cm distally from the metatarso-cuneiform joint. (C) Postoperative radiograph shows the correction of deformity with proximal chevron metatarsal osteotomy.

• 

  Figure 5. These illustrations demonstrate two types of diaphyseal metatarsal osteotomy. One is the Ludloff oblique osteotomy (A), which is characterized by an oblique cut through the shaft, and the other is the scarf osteotomy (B), which consists of a transverse cut through the shaft with two chevron cuts proximally and distally.

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  Figure 6. (A) This photo shows an Akin phalangeal osteotomy with excision of medial wedge to decrease hallux valgus interphalangeus. (B) The Akin phalangeal osteotomy is usually combined with a distal or proximal chevron metatarsal osteotomy.

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  Figure 7. This radiograph shows the correction of hallux valgus deformity with triple osteotomy, which consists of proximal chevron metatarsal osteotomy, biplanar distal chevron metatarsal osteotomy and Akin phalangeal osteotomy.

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  Figure 8. (A) This photo demonstrates an excision of laterally-based wedge in the first metatarso-cuneiform joint for the correction of metatarsus varus deformity during the Lapidus procedure. (B) The radiograph at postoperative 4 weeks shows two cross screws to fix the first metatarso-cuneiform joint. The metatarsus primus varus deformity is well corrected.

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  Figure 9. (A) The right foot of a 57-year-old female with severe hallux valgus deformity was treated with a metatarsophalangeal joint fusion using a dorsal plate. (B) The sagittal angle of the first metatarsophalangeal joint should be around 20 degrees to ensure adequate function of the foot during the gait.

Reference

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