Hallux valgus

From greek.doctor
  • Etiology
    • Genetics
    • Shoe wear
    • Anatomical variations
  • Pathology
    • Valgus deformity of big toe
    • Flexor tendons are dislocated laterally
    • Extensor tendon slips down
  • Diagnosis
    • X-ray
    • Hallux valgus angle (HVA) > 15 degrees
      • Angle between the long axis of the first metatarsal and the long axis of the first phalanx
    • Intermetatarsal angle (IMA) > 9 degrees
      • Angle between first and second metatarsal
    • Distal metatarsal articular angle (DMAA) > 10 degrees
    • Dislocation of sesamoid bone
  • Stages
    • Light
      • HVA 15 – 30 degrees
      • IMA 9 – 13 degrees
    • Moderate
      • HVA 30 – 40 degrees
      • IMA 13 – 20 degrees
    • Severe
      • HVA > 40 degrees
      • IMA > 20 degrees
  • Treatment
    • Conservative treatment
      • Not very effective
      • Involves using hallux valgus splints
    • Surgical treatment
      • Preoperative
        • Antibiotic prophylaxis
        • 350 mmHg tourniquet to prevent bleeding
      • Operative techniques
        • Lateral release
          • The adductor tendon and lateral capsule are cut (released)
        • Distal chevron metatarsal osteotomy (DCMO)
          • A wedge-shaped part of the first metatarsal is slipped laterally and then fixed in the correct position
        • Scarf osteotomy
        • Lapidus operation
          • Involves osteodesis of medial cuneiform and first metatarsal bone
          • Used for severe deformities
    • Postoperative management
      • RICE
      • LMWH
      • Lymph drainage
      • Special shoe wear which prevents weightbearing on the forefoot
        • Worn for 4 – 6 weeks
      • Later – orthopaedic insoles