Does Patient Age Influence First Ray Procedure Selection?

Start Page:
Thanh Dinh, DPM, and Patricia Kim, DPM

   We also stress the importance of long-term versus short-term solutions. Temporary procedures such as Silver procedures may provide five to 10 years of relief but inevitably bony overgrowth begins to develop and cause recurrence of the deformity. For older populations, a short-term procedure may translate into a long-term solution as their activity status and age indicate a proclivity to less “wear and tear,” thus preventing acceleration of HAV symptoms. A salvage procedure with a 10-year symptom relief rate may be successful for a longer period of time for an older patient whose activity level continues to decrease.

In Conclusion

Ultimately, surgical selection is an individualized process. There is no exact formula to determine which procedure is best for which age group. A surgeon must take into account multiple factors including physiologic age, activity level and goals of the procedure for the best possible treatment for each patient. The wide arsenal of procedures and options afforded for HAV deformities allows surgeons great diversity for individualized treatment.

   Dr. Dinh is an Assistant Professor of Surgery at Harvard Medical School and is affiliated with the Beth Israel Deaconess Medical Center in Boston. She is a Fellow of the American College of Foot and Ankle Surgeons.

   Dr. Kim is a surgical podiatric resident at the Beth Israel Deaconess Medical Center in Boston.


1. Roddy E, Zhang W, Doherty M. Prevalence and associations of hallux valgus in a primary care population. Arthritis Rheum. 2008;59(6):857-862.

2. Nguyen US, Hillstrom HJ, Li W, et al. Factors associated with hallux valgus in a population-based study of older women and men: the MOBILIZE Boston Study. Osteoarthritis Cartilage. 2010:18(1):41-46.

3. Gould N, Schneider W, Ashikaga T. Epidemiological survey of foot problems in the continental United States: 1978-1979. Foot Ankle. 1980;1(1):8-10.

4. Scranton P, Zuckerman J. Bunion surgery in adolescents: results of surgical treatment. J of Ped Ortho. 1984;4(1):39-43.

5. Canale PB, Aronsson DD, Lamont RL, Manoli AD. The Mitchell procedure for the treatment of adolescent hallux valgus. A long-term study. J Bone Joint Surg. 1993:75(11):1610-8.

6. Coughlin MJ. Roger A. Mann Award. Juvenile hallux valgus: etiology and treatment. Foot Ankle Int. 1995;16(11):682-97.

7. Ball J, Sullivan JA. Treatment of juvenile bunion by Mitchell osteotomy. Orthopedics. 1985;8(10):1249-1252.

8. Zimmer TJ, Johnson KA, Klassen RA. Treatment of hallux valgus in adolescents by the chevron osteotomy. Foot Ankle. 1989:9(4):190-193.

9. Mann RA, Rudicel S, Graves SC. Repair of hallux valgus with a distal soft-tissue procedure and proximal metatarsal osteotomy. A lomng-term follow-up. J Bone Joint Surg Am. 1992;74(1):124-9.

10. Seymour DG, Pringle R. Post-operative complications in the elderly surgical patient. Gerontology. 1983;29(4):262-70.

11. Total Knee Replacement. Summary, Evidence Report/Technology Assessment: Number 86. AHRQ Publication Number 04-E006-1, December 2003. Agency for Healthcare Research and Quality, Rockville, MD.

12. Miller JW. Distal first metatarsal displacement osteotomy: its place in the schema of bunion surgery. J Bone Joint Surg Am. 1974;56(5):923-931.

image description image description

Post new comment

  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

More information about formatting options

Enter the characters shown in the image.