Operative Treatment of Hallux Valgus

Jung-Woo Lee; Jae Hoon Ahn; Man-Soo Kim; Seung-Chan Kim

doi:10.14193/jkfas.2014.18.2.48

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Lee, Ahn, Kim, and Kim: Operative Treatment of Hallux Valgus

Review Article

J Korean Foot Ankle Soc 2014;18(2):48-55.

Published online: 10 June 2014

DOI: https://doi.org/10.14193/jkfas.2014.18.2.48

Operative Treatment of Hallux Valgus

Jung-Woo Lee, Jae Hoon Ahn, Man-Soo Kim, Seung-Chan Kim

Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea

Corresponding Author: Jae Hoon Ahn Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea Tel: 82-2-2258-2837, Fax: 82-2-535-9834, E-mail: jahn@catholic.ac.kr

Received 1 April 2014 Revised 14 April 2014 Accepted 14 April 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

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Keywords: Hallux valgus, Phalangeal osteotomy, Metatarsal osteotomy, Arthrodesis, Resection arthroplasty

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Figure 1.

(A) The radiograph of right foot shows mild hallux valgus deformity with a hallux valgus angle of 26^o and the 1st intermetatarsal angle of 12^o. (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 8^o and the 1st intermetatarsal angle was 7^o. (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.

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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.

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