Hallux Abducto Valgus Sx

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Hallux Abducto Valgus Sx Iatrogenic Hallux
Varus

• Corolinda S. Helu, DPM
• Podiatric Surgical Resident
• NYCH

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Introduction

• Anatomy of 1st MPJ
• Case Presentation
• Iatrogenic Hallux Varus

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Ligaments of 1st MPJ

• What 8 ligaments are associated w/ 1st MPJ?
• Medial lateral collateral ligaments
• Medial lateral sesamoid ligaments
• Medial lateral plantar sesamoid ligaments
• Intersesamoidal ligaments
• Deep transverse ligaments

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Ligaments of 1st MPJ

• A..Medial lateral collateral lig
• D..Medial lateral sesamoid lig
• B..Medial lateral plantar sesamoid lig
• ..Intersesamoidal lig
• ..Deep transverse lig

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Ligaments of 1st MPJ

• C..Medial lateral collateral lig
• D..Medial lateral sesamoid lig
• E..Medial lateral plantar sesamoid lig
• G..Intersesamoidal lig
• H..Deep transverse lig

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Tendons of 1st MPJ

• What 6 tendons are associated w/ 1st MPJ?
• Intrinsic Muscles
• Flexor hallucis brevis
• Abductor Hallucis
• Adductor Hallucis
• Extrinsic Muscles
• Extensor hallucis longus
• Extensor hallucis brevis
• Flexor hallucis longus

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Blood Supply to 1st MPJ

• Periosteal
• outer 1/3 of cortex
• Medullary
• inner 2/3 of cortex
• Nutrient artery
• laterally _at_ mid shaft

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Nerves of 1st MPJ

• Nerves affected in Mayo Block?
• Deep peroneal
• Terminal saphenous
• Medial dorsal cutaneous
• Medial plantar nerve

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Nerves of 1st MPJ

• Dorsomedial medial of 1st MPJ
• Proper digital branch medial hallux
• First interspace release
• 1st Common digital nerve

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Case Presentation

• 47 yo healthy male c/o painful great toe w/
  increase discomfort in all shoes. Pt had been
  treated by another podiatrist over past 4 yrs but
  no improvement. Pain is worse over the past few
  months and pt desires surgical correction.
• PMH HTN, diet controlled DM
• Meds Atenolol
• Allergies NKDA
• PE Musc medial hypertrophie R 1st met head,
  discomfort w/ dorsiflexion, limited ROM 1st MPJ
  w/ WB, palpable mass dorsolateral aspect 1st MPJ
• Derm localized erythema dorsomedial 1st MPJ
• NVSI
• Xrays IM 15-16 degrees
• PASA 9 degrees
• lat view dorsal exostosis met head prox
  phalanx
• AP view lat exostosis prox phalanx, TSP 3

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Xrays
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Case Presentation

• Discussed surgical options with pt and possible
  fixation with screw
• Procedure Reverdin-Green-Laird

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Reverdin-Green

• A- Medial eminence resection
• B- PASA correction

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Reverdin-Green

• C- Horizontal cut
• D- Complete osteotomy

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Reverdin-Green-Laird

• A- Medial Eminence
• B- PASA
• C- Horizontal cut
• D- Complete osteotomy
• E- Transpostion of head

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Reverdin-Green-Laird

• Transposition
• Fixation

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1 wk Post-op Xrays
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2 mos Post- op Xrays
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Complications

• Recurrence of deformity
• Hallux Varus
• Bone healing complications

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Hallux Varus

• Congenital vs Acquired
• Abd hallucis over add hallucis
• Transverse sagittal
• Painful, disfiguring

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Corrected H varus

• 1st wk- splint
• 2nd- 3rd wk stab incision medially
• gt3wks open release
• Osteoteomy
• Implant
• Fusion w/ EHL lengthening