Essential Insights On Hallux Valgus

Start Page: 38
Here one can see a medial capsular incision from the dorsal medial aspect of the proximal portion of the metatarsal head.
With the capsule reflected from the metatarsal head, one would make an osteotomy from dorsal distal to plantar proximal in the transverse plane of the foot. The osteotomy begins dorsally just millimeters under the superior aspect of the articular surface.
As you can see, one would manipulate the osteotomized capital fragment to decompress the joint and reduce the proximal articular set angle and the intermetatarsal angle.
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Author(s): 
By Richard O. Lundeen, DPM

   Before the osteotomy, make a medial, curvilinear capsulotomy, allowing exposure of the metatarsal head for resection of the medial eminence. Following the osteotomy, reduce the head of any PASA and then translocate the head laterally to reduce the IM angle. Some shortening has to occur here for joint decompression. This osteotomy allows plantarflexion with concurrent shortening for decompression. However, one should only allow enough shortening to preserve a normal amount of dorsiflexion without jamming the joint. Excessive shortening can cause the hallux to remain dorsiflexed, preventing adequate toe purchase on the ground due to concurrent plantarflexion of the head.

   In regard to fixation of the osteotomy, one would utilize two 0.62 inch threaded Kirschner wires in the metatarsal head that are cut flush to the bone. Close the capsule with large oblique sutures of 2-0 absorbable material with the hallux held in the corrected position.
Allow the patient to ambulate in a surgical shoe and emphasize weekly dressing changes for 18 to 21 days. At that time, one can remove the sutures and place the foot in a mild compression wrap (like a Darco forefoot sleeve), and allow the patient to begin wearing an oversized soft shoe.

Dr. Lundeen is Residency Director of the Winona Hospital Podiatric Residency Program in Indianapolis.

Dr. Burks is a Fellow of the American College of Foot and Ankle Surgeons and is board certified in foot and ankle surgery. Dr. Burks practices in Little Rock, Ark.

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