Deceptions in hallux valgus – what to look for to limit failures?

Abstract

The treatment of hallux valgus is dependent on multiple factors, from clinical examination, patient considerations, clinical findings, radiographic assessment, and surgeon preference. Appropriate procedure selection and proper technique will usually result in good to excellent outcomes. As with any procedure however, there are complications following hallux valgus correction. These commonly include recurrence, transfer metatarsalgia, AVN, hallux varus, and nonunion and malunion of metatarsal osteotomies. In order to decrease the risks of complication, a precise and meticulous physical exam should be conducted preoperatively and should assess for the presence of planovalgus deformity, tight heel cord, rigid or correctable hallux valgus, great toe pronation, corns or calluses of the lesser toes, second metatarsophalangeal joint synovitis, interdigital neuromas, or first tarsometatarsal joint hypermobility. In addition, a surgeon should select appropriate osteotomies to correct complex hallux valgus deformities. As a general principle, the severity of deformity dictates treatment options. A distal Chevron osteotomy provides predictable outcomes for mild and select cases of moderate hallux valgus. For more severe deformities, multiple proximal first metatarsal procedures, combined with a distal soft-tissue procedure, appear to provide satisfactory treatment. These include proximal crescentic, proximal Chevron, proximal oblique (Ludloff), proximal closing wedge, Scarf osteotomies, and the Lapidus procedure. Finally, a surgeon should adhere to rigid bone principles to correct complex hallux valgus deformities.