Essential Insights On Hallux Valgus

By Richard O. Lundeen, DPM

   Back when I left the didactic world of podiatry school and entered my residency, I was ready for a transition that would blend the books with practice. Of course, the first two surgeries I performed did not fit the mold. The first one was a cartilage articulation preservation procedure (CAPP) and the other was a Keller procedure.    The CAPP procedure was familiar to me only in books and the Keller seemed “outdated.” To my surprise, both surgeries turned out well and gave me an appreciation that diverse types of procedures can have a good outcome when they are performed well and on the proper patients.    Granted, there were old standards like the first metatarsophalangeal fusion and Lapidus procedures but during my residency, new surgical procedures like the Austin and Scarf were coming down the pike for hallux valgus. There were also innovative new procedures (such as the Swanson total joint arthroplasty and Juvara basal osteotomy) that enthusiastic residents like myself quickly adapted.    During the first part of my residency, base wedge osteotomies were the norm. We would commonly do them bilaterally, with or without a pin for fixation, and use circlage wire across the osteotomy. Patients usually walked on these osteotomies the day of surgery. Today, a base wedge would not be treated in this manner. The latter days of my training revolved around the Austin procedure. At first, we would not fixate the capital fragment but after a couple of metatarsal heads dislocated, they were all fixated. The Austin was certainly easier to perform than the base wedges and healed a lot faster with fewer complications. Patients were up and in shoes faster.

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