Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Revision Hallux Valgus Surgery


Indications

  • Ongoing pain symptomatic enough to merit surgery

  • Recurrent hallux valgus deformity

  • Second metatarsalgia or overload

  • Elevated first ray

  • Plantar flexed first ray

  • Hallux varus

  • Avascular necrosis of the first metatarsal (MT) head

  • Nonunion of osteotomy or arthrodesis

Indications Pitfalls

  • Understanding the cause of symptoms is paramount to selecting an appropriate procedure.

  • Understanding why the index procedure failed (i.e., technical, patient factors, complications) is critical to the success of any revision surgery.

  • Be certain to rule out any symptomatic metatarsophalangeal (MTP) arthritis before offering a joint sparing procedure.

  • As in any revision scenario, infection must be ruled out.

Indications Controversies

  • Treating a deformity in the absence of pain is discouraged.

  • Smoking in the setting of a nonunion is considered a relative contraindication by some experts.

Examination and Imaging

  • Location of pain (i.e., medial, plantar, transfer metatarsalgia, first MTP, first tarsometatarsal [TMT], prominent hardware)

  • Degree of deformity

  • Consider overall foot alignment (i.e., associated pes planus; Fig. 6.1 )

    FIG. 6.1

  • Anteroposterior radiograph: assess for location of deformity, nonunion, avascular necrosis of MT head, arthrosis, length of MTs, remaining hardware and sesamoid position, intermetatarsal angle, and hallux valgus angle

  • Lateral radiograph: assess for union of osteotomies, first MT or TMT arthritis, presence of pes planus, and plantar gapping of the first TMT joint ( Fig. 6.2 )

    FIG. 6.2

  • Computed tomography scan may be required if a nonunion is in the differential diagnosis ( Fig. 6.3 )

    FIG. 6.3

Treatment Options

  • MTP arthrodesis: arthritis or unstable MTP joint

  • Lapidus procedure: hypermobile first ray or undercorrected intermetatarsal angle

  • First MT osteotomies: undercorrected intermetatarsal angle

  • Aiken procedure: undercorrected or uncorrected hallux interphalangeus

  • Additional procedures may be required to address lesser toe MT length or deformities

Surgical Anatomy

  • Dorsal longitudinal incision for the first TMT or MT joint ( Fig. 6.4 )

    FIG. 6.4

  • Protect cutaneous branches of the superficial peroneal nerve

  • Retract the extensor hallucis longus tendon laterally ( Fig. 6.5 )

    FIG. 6.5

  • Protect the dorsal neurovascular bundle medially

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here

Related Posts