Treatment of hallux valgus deformity

Abstract

Hallux valgus deformity is a very common pathological condition which commonly produces painful disability. It is characterised as a combined deformity with a malpositioning of the first metatarsophalangeal joint caused by a lateral deviation of the great toe and a medial deviation of the first metatarsal bone.Taking the patient’s history and a thorough physical examination are important steps. Anteroposterior and lateral weight-bearing radiographs of the entire foot are crucial for adequate assessment in the treatment of hallux valgus.Non-operative treatment of the hallux valgus cannot correct the deformity. However, insoles and physiotherapy in combination with good footwear can help to control the symptoms.There are many operative techniques for hallux valgus correction. The decision on which surgical technique is used depends on the degree of deformity, the extent of degenerative changes of the first metatarsophalangeal joint and the shape and size of the metatarsal bone and phalangeal deviation. The role of stability of the first tarsometatarsal joint is controversial.Surgical techniques include the modified McBride procedure, distal metatarsal osteotomies, metatarsal shaft osteotomies, the Akin osteotomy, proximal metatarsal osteotomies, the modified Lapidus fusion and the hallux joint fusion. Recently, minimally invasive percutaneous techniques have gained importance and are currently being evaluated more scientifically.Hallux valgus correction is followed by corrective dressings of the great toe post-operatively. Depending on the procedure, partial or full weight-bearing in a post-operative shoe or cast immobilisation is advised. Post-operative radiographs are taken in regular intervals until osseous healing is achieved.Cite this article: Fraissler L, Konrads C, Hoberg M, Rudert M, Walcher M. Treatment of hallux valgus deformity. EFORT Open Rev 2016;1:295-302. DOI: 10.1302/2058-5241.1.000005.

Early initiation of zoledronic acid does not impact bone healing or clinical outcomes of hallux valgus orthomorphia

“…The indications for combined surgery in this study were subjective clinical FTJ hypermobility of >1 cm, 16 an increased metatarsal cuneiform angle, and an interphalangeal angle of >10° as evaluated by an experienced foot and ankle surgeon; pain while walking; lesser metatarsal overload; and visible osteoarthritis in the first MTJ or FTJ on radiographs. 5 A preoperative X-ray of one 61-year-old woman is shown in Figure 1 .…”

“…Since its introduction in 1934, Lapidus arthrodesis (arthrodesis of the FTJ) has been commonly applied in patients with HV with deformity of the metatarsal cuneiform angle. 5 The nonunion rate of Lapidus arthrodesis reportedly ranges from 3.3% to 12.0%, which is the highest rate of surgical failure among all surgeries for HV. 6 Although the correction power of Lapidus arthrodesis is very high, some patients with severe deformities still need additional angular or rotational correction in the proximal phalanx by undergoing combined surgical procedures.…”

“…Akin osteotomy, the most widely used type of proximal phalanx osteotomy, is a well-known adjunct to other procedures in patients with an increased interphalangeal angle or distal articular set angle. 5 , 7 …”

A Modified Minimally Invasive Osteotomy for Hallux Valgus Allows Reduction of Malpositioned Sesamoid Bones

“…[1] [2] The patients present with a painful medial bump, medial deviation of the rst ray, and lateral deviation and pronation of the big toe. [3] Over the years, more than 150 open surgery techniques to correct this deformity have been described. [2] In recent years, there has been a conceptual change regarding bunion surgery [4] and minimally invasive approaches have become very popular outside the USA.…”

Biomechanics of common fixation devices for first tarsometatarsal joint fusion—a comparative study with synthetic bones

“…However, there are more than 100 surgical approaches for treatment of hallux valgus disease. There have been attempts to develop treatment algorithms based on the degrees of deviation of the first metatarsal bone and including co-variables such as joint degeneration or incongruity [ 3 , 4 ].…”