Hallux valgus

1
Hallux valgus
Dr.Rami Shamout
Damascus Hosbital
2
??????? ??????HALLUX VALGUS
????? ??????? ?????? ??????? ???????? ??????
????? ?1 ????? ??????? ?2 ????? ???????
??????? ?3 ????? ??????? ??????? , ?????
??????? ????? ??????????? ? ??? ??????
3
??????? ??????HALLUX VALGUS

• ???????
• ?? ?????? ?????? ????? ?????? ?????? ??????? ? ??
  ???????? ?????? ?????? ?????? ????? ?? ????
  bunion ?????? (?????? ????? ??????? ???????)
  ??? ??? ??????? ????? ? ???? ????? ??????? ????
  ?? ????? ? ???? ?? ??????? ?????? ? ?? ???? ??
  ???????? ?????? ???????? ??????? ? ????? ?????? ?
  ?????? ????? ?? ??? ?????
• _ ?????? ?????? ???? ????? ????? ????? ????????
  ??????? ?????? ????? .
• -???? ??? ( ?????) ??????? ???????? ??????? ?
  ?????? ??????? ???????? ??????? ??? ???? ??????
  ??????? ????? ???? ????? ????????? ?????? .
• ????? ????? ??? ????? ????? ?????? ??????????
  ???? ?? ????? ????? ?????? ????? ??????? ? ??????
  ?????? ??????? ???? ???? ??? ???? ???????
  (Crist)

4
(No Transcript)
5
(No Transcript)
6
(No Transcript)
7
??????? ??????HALLUX VALGUS

• ????? ???? ????? ?????? ?????????? ?? ??? ?????
  ?????
• ? ????? ???? ???? ?? ??? ????? ????????? ??????
  ??? ??????? ??????? ????? ?????? ??? ???? ?????
  ??? ????? ????? ? ???? ???? ????? ??? ???????
  ?????? .
• ??? ???? ???
• 1- ????? ??????? ??? ???????
• 2- ???? ???????
• 3- ?????? ??????? ??????? ???????

8
??????? ??????HALLUX VALGUS

• ????? ??????? ???? ???? ????? ???? ?????? ????
  ????? ????? ? ????? ?????? ?????? ??????? ?????
  ???? ????? ???? ??????? ?????? ?????? ??? ???? ??
  ?????? ?? ????? ??????? ??? ??????? ???????
  ?????? ????????? ? ???????
• ???? ???? ????? ??????? ?? ??? ??????? ??? ???
  ?????? ?????? ???????
• ??????? ?????? ??????? ??????? ? ??????? ?????
  ??????? ??????? ???? ???? ?????
• ????? ???? ?????? ???? ??? ??? ??????? ???????? ?
  ???????? ?????? ????? ???? ?????? ???????? ??????
  ?????? ??????? ????? ????? ??????

9
(No Transcript)
10
??????? ??????HALLUX VALGUS

• ????? ???? ?????? ???? ??? ???? ?? ?????? ( 30
  35 ???? )
• ???? ??? ????? ?????? ?? ??????? (????? ??????
  ??????) ???? ???? ????? ??????? ??? ????? ??? ???
  ????? ????? ???????? ??????? ?????? ????

11
(No Transcript)
12
??????? ??????HALLUX VALGUS

• ???????? ????????? ?????? ???????? ?????? ??????
  ??????? ???????
• A- ???? ?? ??? ?????? ???? ????? ????? ??? ????
  ????? ???? ( ??? ????? ???? ) ?????? ?? ???
  ??????? ???? ???????
• B- ????? ????? ??????? ?????? ???????? ??????? ??
  ?????? ?? ?????? ???????? ???? ????????
• ??? ?????? ??? ??????? ???? ??? ( ???? ??????? )
  ?? ?????? ??????

13
(No Transcript)
14
??????? ??????HALLUX VALGUS

• ????? ???? ????? ???? ?????? ?????? ???????
• ???? ????? ? ?????
• ???? ?????? ( (BUNION
• ??? ??? ???? ?? ?????? ?????? ??????? ?????
• ?????? ??? ? ???? ?? ?????? ?????? ??????? ?????

15
??????? ??????HALLUX VALGUS

• ?????? ??????? ??????
• 1- ???? ???? ?? ????? ?????
• 2- ???? ???? ?? ????????
• 3- ???? ?????? ( Bunion )
• 4- ?????? ?????? ?????? ??????? ?????
• 5- ???? ??????? ????? ?? ????
• 6- ???? ??????? ? ???????
• 7- ??? ???????

16
??????? ??????HALLUX VALGUS
17
??????? ??????HALLUX VALGUS

• ???????? ???????????
• ???? ???? ??????? ?????? ??? ?????? ?????? ( 10 )
  ????? ??????
• ???? ????? ?? ????? ??????
• ???? ???? ?????? ??? ????? ?????? ??????? ??????
  ?????? ??????? ????? ?????? ??????

18
??????? ??????HALLUX VALGUS

• ??????? ??????
• 1- ???? ???? ?? ??????? ( ???? )
• 2- ???? ??? ????? ????? ?? ????? ?? .
• 3- ??? ????? ???? ?? ????? (??? ?? ????? ???????)
  
• 4- ??? ????? ?????? ?????? ??????? ????? ?
  ????? ?????? ?????? ?? ??? ?????
• 5-??? ????? ?????? ?????? ?????? ???????? .
• 6- ??? ????? ??? ????? ????????
• 7-???????? ????? ???? ????????? ???????
• 8-??? ??? ????? ???? ????? ( ????? ????? ???? ??
  ????? ?????? ?? ?????? ???????? ?????? 7 ?? )

19
??????? ??????HALLUX VALGUS

• ???? ??? ??? ????? ?????? ??????? ??????
• ??? ?????
• ?? ??? ???????
• ? ??? ??????? ?? ?????? ???????? ??? ??? ?????
  ??? ???? ????? ?? ????????? .

20
??????? ??????HALLUX VALGUS

• ????????? ????????
• ???? ?????
• ? ?????? ????????
• - ??? ??????? ??????? ??????
• - ??? ????? ????? ????? ?? ??? ??? ?????
  ????? ???
• - ???????? ??? ?????? ??????
• - ??? ?????? ??? ??? ????? ?????
• .

21
??????? ??????HALLUX VALGUS

• ????? ????? ???????
• - ?????? ??????
• - ????? ???? ?????? ?????? ?????? ? ???????
  ??????
• - ?????? ?????? ????? ?????
• - ?????? ???? ??????
• - ?????? ???? ????? ??? ????? ?????
• - ?????? ??? ???? ???? ??? ??????? ???? ???
  ????

22
??????? ??????HALLUX VALGUS

• - ?????? ??????
• - ?????? ???? ???? ??????? ??? ?????
  ??? ?????? ??????? ???????? ?????? ???????
• - ?????? ???????? ??????? ????? ???? ????
  ? ?????? ????????
• - ?????? ?????? ??????? ????????
• - ??? ????? ??????? ????? ???? ??? ???
  ????? ? ???? ??? ??? ????? ? ??? ??? ????? ??????
  ?????? ??????

23
??????? ??????HALLUX VALGUS

• ???????? ????????
• - ???? ????? ?????? ???????
• - ???? ?????? ( ????? )
• - ???? ????? .... ???? ??? ?????
• - ???? ?????? ?????? ??????????

24
(No Transcript)
25
??????? ??????HALLUX VALGUS

• ?????? ???????
• ???? ????? ??????? ?????? ( Hallux Valgus Angle
  )
• HVA ?? ??????? ?? ????? ?????? ??????? ????
  ?????? ???????? ?????? ? ????? ?????
• HVA gt ?15

26
??????? ??????HALLUX VALGUS

• ????? ??????? ??? ??????? ( Inter Metatarsal
  Angle )
• IMA ?? ??????? ???????? ?? ????? ??????
  ??????? ????? ??????? ????? ? ??????
• IMA gt ?9

27
(No Transcript)
28
??????? ??????HALLUX VALGUS

• ????? ??????? ???????? ??????? ??????? ( Distal
  Metatarsal Articular Angle )
• DMAA ?? ??????? ?? ??? ????? ??????? ??????
  ????? ????? ???????? ?????? ??????? ??????
  ???????? ?????
• DMAA gt ?10

29
??????? ??????HALLUX VALGUS

• ????? ??????? ??? ????????? ( Inter Phalangeal
  Angle )
• IPA ?? ??????? ??? ?????? ??????? ????????
  ???????
• IPA gt ?10

30
(No Transcript)
31
??????? ??????HALLUX VALGUS

• ??? ????? ??????? ?? ???? ?? ?????? ??????
  ??????? ?????
• ?????? ??? ???????? ?? ???? ???? ??? ??? ???
  ???? ???????? ??????? ??? ??? ?????
• ?????? ???? ?????? ?????? ????????
• ???? ?????? ???? ???? ??? ??????? ???? ???
  ?????

32
??????? ??????HALLUX VALGUS

• ????? ???? ?????? ???? ? ??? ?????? ??????
  ??????? ? ??? ???? ???? ?? ?????? ??? ??????
• ??? ??????? ?????? ???? ??? ????? ???? ?????
  ?????? ???? ????? ?????
• ??? ??? ???? ????? ???? ?? ??? ????????? ? ???
  ??????? ??????? ???????? ??????? ? ???????
  ????????? ?? ???? ??????? ??? ????? ????????
  ???????

33
??????? ??????HALLUX VALGUS

• ?????? ???????

34
??????? ??????HALLUX VALGUS

• ??????? ??? ??????? ??????
• ????? ??? ????? MC BRIDE
• ???? ????? ???? ???? 30gtH.V.A
• 13gtI.M.A
• ????? ????? ????? ?????? ???????? ??? ??????
  ?????? ?????? ?????? ??????? ??????
• 1-??????? ???????? ???????
• 2-??? ????? ???????
• 3-?????? ?????? ???????
• ??? ?????? ?????? ?? ?????? ?????? ??????? ??????
  ??????? ??????? ? 2-3 ??? ??? ????? ?????? ??
  ??????? ???????

35
??????? ??????HALLUX VALGUS

• ??????? DU Vries ??? ????? McBride
• ????? ??? ??? ????? ??????? ??? ???? ????????
  ???? ????? ?????
• ????? ??????? ??????? ???? ????? ?????? ??
  ??????? ??????? ???? ????? ????? ?? ????? ??????
  ?? ??? ????? ???????
• ??? ??????? ??????? ( ???? ???? ?? ?????? ) 3 ???
  ????? ?? ???????? ??????
• ??????? ??????? ?????? ??? 5 ????? ???????

36
Modified McBride Technique
37
??????? ??????HALLUX VALGUS

• ???? ????? ???????
• 1- ????? ??????? Chevron
• 30 H.V.A
• 12 I.M.A
• 12 D.M.A
• ???? ??????? ????
• ??? ???? ???? ????? ( ????? 3 4 ??) ?????
  ????
• ?? ??????? ???????? ???????
• ??????? ??????? ??????? ??????? Bunion

38
Chevron osteotomy Technique
39
(No Transcript)
40
??????? ??????HALLUX VALGUS

• 2- ????? ????? Mitchell
• ??? ?????? ???? ?? ?????? ???? ???? ??? ?????
• ???? ????? ??????? ?? ???? ?????
• ????? ????? ?????? ??? ?????? ? ???????

41
Mitchell osteotomy technique
42
(No Transcript)
43
??????? ??????HALLUX VALGUS

• 3- ????? ?????? Wilson
• ??? ????? ?????? Oblique osteotomy ???? ?????
  ??????
• ???? ????? ?????? ??? ??????

44
(No Transcript)
45
Reverdin osteotom - 4Wedge osteotomy of the
Ist metatarsal head
46
??????? ??????HALLUX VALGUS

• ????? ???? Akin
• 25 gt H.V.A
• 12 gt I.M.A
• ???? ??????? ????
• ??? ????? ???? ??? ??? ????? ???????? ???????
• ??????? ??????? ?????? ??????

47
Akin procedure
48
??????? ??????HALLUX VALGUS

• ???? ????? ???????
• ??? ?? ????? ??? ?????
• ?????? ??????? ?? ????? ??? ????? ?????? ??????
• ?????? ??????? ??? ????? ?????? ??????

49
??????? ??????HALLUX VALGUS

• 1- ????? ?????? ???? ???
• ???? ????? ????? ??? ??????? 20-25
  ???? ?????? ??? 40-50 ???? (??? ??? ????? ?????
  ??? ???? ????? DMAA gt 15 ????).

50

• 2- ??? ???? ?????? ????? ?? ??? ?????
• 3- ????? ?????? ???? ??? ????? ??? ????? ?? ???
  ???? (???????)
• 4- ??? ????? ???????? ?????? (??? ????? )
• 5- ??? ?????? ??????

51
??????? ??????HALLUX VALGUS
????? ??????? Lapidus ??????????? ????? ??????
?????? ?????? ??? ????? ?????? ?????? ????????
?? ?????? . ??????? ????? ?????? ????????
?????? ?????
52
(No Transcript)
53
??????? ??????HALLUX VALGUS

• ????? ??????? Peterson
• ???????????
• ????? ??????? ???????? ??????? ??????? DMAA
• ????? ??????? ??? ??????? IMA
• ???????
• ????? ????? ???????
• ????? ???? ???????

54
Peterson procedure
55
??????? ??????HALLUX VALGUS

• ????? ????? Scarf
• ?????? ?? ??? ????? 0.8 ???
• ???? ?????? ?? ????? ??? ????? ????? ?? ?????
  ????? ??? ????? ????? ( ??? Z )
• ???? ???????? ??? ?????? ??? ??????
• ??????? ?????? ????? ?? ??????

56
??????? ??????HALLUX VALGUS
57
??????? ??????HALLUX VALGUS

• ????? ???? Keller
• ????? ????????? ?????? ?????
  ??? ?? ??????? 30 45 ????
• ???? ?? ?????? ????? ?????
  ??? ??????? ??? ?? 13
• ???? ???? ????? ????? ??? ?????
  ?? ?????? ?????? ???????
  ( ??? ??? )
• ?? ??? ?????? ????????? ????
  ???? ???? ????? ?????????
• ???? ?? ???
• ????? ????? ???????? ???????
• ??? ?????? ?????? ?????? ??? ???? ????? ??????
  ????? ?????
• ????? ??? ??????? ?????? ?????? ???? ????? ??
  ??? ???????? ???????
• ????? ??????? ??? ??????? ??????? ? ??????? ???
  ???? ?? ????? ???????? ???????

58
Brandes Keller procedure
59
??????? ??????HALLUX VALGUS

• ??????? ( Arthrodesis )
• ???????????
• ???? ???? ( IMA lt 20 ? HVA lt 45 )
• ???????? ????????
• ??? ??????
• ?????? ????? ??????
• ????? ???????

60
??????? ??????HALLUX VALGUS

• ????? ???????
• ??? ???? 10 15 ???? ?????
• 25 - 30 ???? ??????? ???? ????? ( ????? ????
  ????? ???????? ??????? 15 ???? )
• 15 20 ???? ???

61
(No Transcript)
62
(No Transcript)
63
(No Transcript)
64
(No Transcript)
65
??????? ??????HALLUX VALGUS

• ??????? ?? ?????? ??????? ??????? ??????
• ????? ???? gt 25( HVA gt 30 ? IMA gt 15 )
• ???? ?????? ?????? ??????? ?????? Chevron
• 
  Mitchell
• ????? ?????? ??? ??????
  Chevron
• 
  Mitchell
• 
  Mcbride
• ?? ?? ???? ??? ???? ???? ????? ????? ???? ?????

66
??????? ??????HALLUX VALGUS

• ????? ???? ??? 25 40 ( HVA 30 40 ? IMA 15-20
  )
• ???? ???? ??????
  Chevron
• 
  Akin
• ???? ????? ???? ?? ??? ????? ????? ?? ?? ?????
  ????? ?? ???????? ?????
• ????? ???? ??? ?????? Mitchell
• ?? ??? ???? ????
  McBride
• ??? ???? ????? ????? ???? ?????
• ????? ????? ?? ????? ???????? ?????

67
??????? ??????HALLUX VALGUS

• ??? ????? ?????? ?????? ???????? ????? McBride
• 
  Arethrodesis

68
??????? ??????HALLUX VALGUS
69
??????? ??????HALLUX VALGUS
70
??????? ??????HALLUX VALGUS
71
??????? ??????HALLUX VALGUS
72
??????? ??????HALLUX VALGUS
73
??????? ??????HALLUX VALGUS
74

• ??????? ?????? ??? ???? ???? ( 10-
  19???)
• ??????? ?????? ?? ???? ??? ?????
• ?????????? ??? ????? ??????? ??????

75
(No Transcript)
76
MoKazem.com

• ??? ???????? ?? ?? ????? ??????? ?? ??????? ?
  ??????? ?? ??? ??????? ???????? ?? ???? ???????
  ??????? ?? ???? ????, ??? ????? ?. ???? ??????.
• ?????? ??? ????? ?? ??????? ??????? ?? ???
  ????????.
• This lecture is one of a series of lectures were
  prepared and presented by residents in the
  department of orthopedics in Damascus hospital,
  under the supervision of Dr. Bashar Mirali.
• This site is not responsible of any mistake may
  exist in this lecture.

?. ???? ????
Dr. Muayad Kadhim