DECISION MAKING IN HALLUX VALGUS SURGERY
Nikolaus WULKER
From the Orthopaedic Department, Hannover Medical School, Hannover, Germany
Abstract
The present paper proposes a treatment plan for surgical correction of hallux valgus. Standing radiographs of the forefoot are required to determine the precise nature of the deformity. If degenerative arthrosis is present at the first metatarso-phalangeal joint, reconstructive procedures are not promising and resection arthroplasty or arthrodesis are indicated. Without degenerative changes, the presence and the amount of incongruity at the first metatarsophalangeal joint must be assessed on the anteroposterior radiograph. If present, incongruity is corrected with a lateral soft tissue release and reefing of the medial capsule. Metatarsus primus varus often accompanies first metatarso-phalangeal joint incongruity. If the intermetatarsal angle (IM) exceeds 10-15 degrees, a proximal metatarsal osteotomy is indicated. If the metatarso-phalangeal joint is congruent, a distal first metatarsal osteotomy with lateral displacement of the metatarsal head is indicated. Lateral deviation of the joint surface of the first metatarsal head relative to the first metatarsal shaft axis is assessed with the distal metatarsal articular angle (DMAA, normal
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