Salvage of recurrence after failed surgical treatment of hallux valgus

Abstract

Recurrence of the deformity is unfortunately a common occurrence following surgical treatment of hallux valgus. The underlying reason for recurrence is multifactorial and includes surgeon's factor, patient's factor, and deformity components that were not addressed at the index procedure. Salvage of recurrence can be challenging for both the patient and the surgeon. Successful treatment requires understanding the underlying reason for the failure of initial treatment and correcting bony alignment, restoring the joint congruity, and balancing soft tissues. We present an algorithmic approach to revision hallux valgus surgery.

Correction of Recurred Hallux Valgus Deformity by Endoscopic Distal Soft Tissue Procedure

“…1 The underlying reason for recurrence is multifactorial and includes surgeon-based and patientbased factors as well as original components of deformity initially unaddressed at index procedure. 1 Surgical treatment of a recurred hallux valgus deformity should be undertaken using the same guidelines for correction of a primary hallux valgus deformity. 1 It requires correction of bony alignment, restoration of joint congruity, and achievement of soft tissue balance.…”

“…1 Surgical treatment of a recurred hallux valgus deformity should be undertaken using the same guidelines for correction of a primary hallux valgus deformity. 1 It requires correction of bony alignment, restoration of joint congruity, and achievement of soft tissue balance. 1,2 It is important to reduce the sesamoids beneath the first metatarsal head because the sesamoids lie within the tendons of the flexor hallucis brevis muscle.…”

“…1 It requires correction of bony alignment, restoration of joint congruity, and achievement of soft tissue balance. 1,2 It is important to reduce the sesamoids beneath the first metatarsal head because the sesamoids lie within the tendons of the flexor hallucis brevis muscle. Residual lateral position of these bones indicates that the flexor hallucis brevis is producing a valgus force on the proximal phalanx.…”

“…Residual lateral position of these bones indicates that the flexor hallucis brevis is producing a valgus force on the proximal phalanx. 1,2 Moreover, adequate release of soft tissues is important; otherwise, the intact lateral capsule and adductor hallucis tendon can maintain a continuing valgus force. 3 Recently, an arthroscopyassisted hallux valgus deformity correction with percutaneous screw fixation has been reported.…”

“…This technique is indicated in symptomatic recurrence of hallux valgus deformity especially in high-risk patients who have ulceration or recurrent ulceration as a means of performing limb preservation/salvage without extensive soft tissue and osseous trauma. 6 It is contraindicated if the recurrence is asymptomatic, 1 there is significant bony deformity due to previous bunion surgery, the distal metatarsal articular angle is greater than 10 , or the intermetatarsal space cannot be closed up manually. [3][4][5] It is also contraindicated in patients with joint stiffness after the bunion surgery, including hallux rigidus, chondrolysis, and severe degenerative joint disease.…”