Hallux Valgus and First Ray Mobility

Abstract

A proximal crescentic osteotomy of the first metatarsal combined with distal soft-tissue realignment should be considered in the surgical management of moderate and severe subluxated hallux valgus deformities. First ray mobility was routinely reduced to a normal level without the need for an arthrodesis of the metatarsocuneiform joint. Plantar gapping is not a reliable radiographic indication of hypermobility of the first ray in the sagittal plane.

Footwear modification following hallux valgus surgery: The all-or-none phenomenon

“…While cosmesis should not be regarded as an operative indication, improvement following surgery has been associated with high patient satisfaction and should be regarded as a desirable outcome [9,13,14] . We found that the majority of our patients were able to return to these comfortable shoes without residual discomfort, demonstrating satisfactory functional outcomes.…”

“…Patients reporting significant pain or functional impairment unresponsive to conservative methods (footwear modification, orthotics and nonsteroidal anti-inflammatories) should be considered for joint-preserving surgical intervention (e.g., scarf ± akin osteotomy) [6][7][8][9][10] . The safety and efficacy of these procedures in the treatment of hallux valgus deformity is well described [6,[8][9][10][11][12][13] . The return to comfortable footwear (e.g., trainers, flats, boots) is a fundamental aspect of post-operative rehabilitation and is closely related to overall patient satisfaction [8,11,[14][15][16] .…”

Salvage of recurrence after failed surgical treatment of hallux valgus

“…The foot is examined for a pes planus deformity and for contracture of the Achilles tendon, both of which may affect the choice and success of the operation. The metatarsocuneiform joint should be checked for hypermobility, mobility of more than 9 mm represents hypermobility [25], but the absolute amount of motion that constitutes hypermobility is controversial [26,27]. An interview with the patient is important not only to evaluate the major symptoms associated with the hallux valgus deformity but also to educate the patient with regard to the problem, the alternatives for treatment, and the risks and complications when an operation is indicated [2,16].…”

“…This procedure has been indicated for the correction of metatarsus primus varus in patients with moderate to severe hallux valgus and hypermobility of the first ray [39]. First ray hypermobility has been recommended to this procedure, but it is controversial [26]. Early reports identified nonunion rates of 10-12% with the modified Lapidus procedure.…”

“…Incidence of recurrence was similar for both surgical procedures even though patient selection for the Lapidus arthrodesis was based on clinically evident first ray instability. Coughlin et al reported in a prospective study that recurrence of 6 feet occured in 108 patients (127 feet) who had a hallux valgus deformity treated with a proximal crescentic osteotomy and distal soft-tissue reconstruction (and optional Akin phalangeal osteotomy), recurrent rates were 4.72% [26]. Wukich et al [44] reported complications included 11.11% recurrences during correction of metatarsus primus varus with an opening wedge plate.…”