Journal List > J Korean Foot Ankle Soc > v.21(2) > 1043441

Ko and Sung: Corrective Osteotomies in Hallux Valgus

Abstract

Hallux valgus is a deformity characterized by lateral deviation of the great toe and medial deviation of the first metatarsal. When planning an operative treatment, it is important to realize that the deformity is tridimensional and diverse. Operative techniques include medial eminence resection, distal soft tissue procedure, first metatarsal osteotomy (distal, diaphyseal, proximal, or multiple), proximal phalanx osteotomy, arthrodesis (first metatarsophalangeal or metatarsocuneiform joint), and so on. Among these techniques, osteotomy is the main procedure for correcting the hallux valgus. The objective of this article is to describe the characteristics and recent advancements made for corrective osteotomies in the hallux valgus. The pathophysiology of the hallux valgus is also described.

Figures and Tables

Figure 1

Schematic representation of tendons around the first metatarsal head. (A) Normal articulation in a balanced state. (B) Relationship of the tendons in hallux valgus deformity. EHB: extensor hallucis brevis, ABH: abductor hallucis, FHBM: medial head of flexor hallucis brevis, FHBL: lateral head of flexor hallucis brevis, ADH: adductor hallucis.

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Figure 2

Relationship of the sesamoids to the metatarsal head. Left: the sesamoids stabilized by the crista. Right: atrophy of the crista with lateral deviation of the sesamoids.

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Figure 3

Triaxial coordinate plane with Z-axis motion about the first ray.

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Figure 4

Distal chevron osteotomy.

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Figure 5

Scarf osteotomy.

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Figure 6

Complications of scarf osteotomy. (A) Troughing. (B) Troughing with malrotation.

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Figure 7

(A, B) The modified rotational scarf procedure rotates the two halves of the osteotomy, assuring adequate cortical crossover and thereby eliminates linear overlap between the cortices of the first metatarsal and softer cancellous bone (used with permission from TriMed Inc., Santa Clarita, CA, USA).

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Figure 8

Ludloff osteotomy.

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Figure 9

Proximal crescentic osteotomy.

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Figure 10

(A) Proximal chevron (base proximal) osteotomy. (B) Proximal chevron (base distal) osteotomy.

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Figure 11

(A) Proximal opening wedge osteotomy. (B) Proximal closing wedge osteotomy.

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Notes

Financial support None.

Conflict of interest None.

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