J Korean Foot Ankle Soc.  2019 Dec;23(4):143-148. 10.14193/jkfas.2019.23.4.143.

Approach for the Treatment on Hallux Valgus

• Lee SH
• Lee YC

• KMID: 2465936
• DOI: http://doi.org/10.14193/jkfas.2019.23.4.143

Abstract

Although many patients who undergo bunion repair do well and have satisfactory results, a critical evaluation of these results shows the potential for improvement. Metatarsal deformity of the hallux valgus is a 3-dimensional deformity, including rotation in the coronal plane. Theoretically, it is important to understand the 3-dimensional displacement of the first metatarsal for correcting the deformities of valgus rotation in the frontal plane. Yet the current methods of metatarsal osteotomy principally attempt to correct the deformity in the transverse plane. The modified technique for the Lapidus procedure can be used in a variety of hallux valgus conditions and severities, and the early results suggest that a powerful correction can be maintained. In addition, efforts have been made to correct the 3-dimensional deformity by performing metatarsal shaft osteotomy. In the case of degenerative arthritis, first metatarsophalangeal joint arthrodesis is a good option to correct the 3-dimensional deformation. Correction of the 3-dimensional deformity, including a rotational deformity in the frontal plane of the metatarsals, should be considered when selecting surgical treatment and is essential for achieving a good prognosis for patients with hallux valgus. This article reviews the classification and treatment of hallux valgus for correction of the 3-dimensional deformity.

Keyword

Hallux valgus; Metatarsal osteotomy; Metartasal pronation; Hallux adducto valgus; Tibial sesamoid

MeSH Terms

Arthrodesis
Classification
Congenital Abnormalities
Foot Deformities
Hallux Valgus*
Hallux*
Humans
Metatarsal Bones
Metatarsophalangeal Joint
Osteoarthritis
Osteotomy
Prognosis

Figure

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  Figure 1 Triaxial coordinate plane with Z-axis motion about the 1st ray.

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  Figure 2 Current surgical algorithm for hallux valgus. DMO: distal metatarsal osteotomy, IMA: intermetatarsal angle, HVA: hallux valgus angle, DSTP: distal soft tissue procedure, PMO: proximal metatarsal osteotomy, MPT: metatarsophalangeal, TMT: tasometatarsal.

• 

  Figure 3 Radiographs illustrating for the shape of the lateral edge of the first metatarsal head. (A) In case of metatarsal external rotation, the shape of lateral edge is a round shape (arrows). (B) When there is no metatarsal rotation, the shape of lateral edge had an angular shape (arrows).

• 

  Figure 4 Radiologic findings of Triplane hallux valgus classification. (A) Radiographs showing class 1 hallux abducto valgus, with no rotation observed on the axial view. (B) Radiographs of class 2A hallux abducto valgus showing eversion of the first metatarsal and the sesamoid still in the groove with intact crista. (C) Radiographs of class 2B hallux abducto valgus showing rotation of the first metatarsal with subluxation of the sesamoid complex. (D) Radiographs of class 3 hallux abducto valgus associated with metatarsus adductus, with no first metatarsal frontal/coronal plane rotation seen on sesamoid axial view. (E) Radiographs of class 4 hallux abducto valgus showing arthrosis of the first metatarsal phalangeal sesamoid complex.

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