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Correction of Acquired Hallux Varus


Indications Pitfalls

  • Hallux varus must be reducible. Malunion of the metatarsal or proximal phalanx may preclude a simple soft-tissue correction. A negative intermetatarsal angle may require correction. Consider a fusion for an arthritic joint.

Indications Controversies

  • There are no long-term studies published on the outcome of this procedure.

Treatment Options

  • Stretching out the shoe toe box can diminish irritation of the toe.

  • Several other procedures exist for the correction of hallux varus, all of which require fusion of the adjacent interphalangeal joint, bony procedures, or consist of one of the local extensor tendons ( ). Another option is a reconstruction of the lateral collateral ligament with an allograft.

Indications

  • Symptomatic deformity

  • Difficulty with footwear

  • Flexible deformity

  • Nonarthritic first metatarsophalangeal (MTP) joint

Examination/Imaging

  • Weight-bearing examination of the toe as shown in Fig. 7.1 .

    FIG. 7.1

  • Flexible great toe interphalangeal and MTP joints. A fixed deformity may require a fusion of either joint.

  • Standing anteroposterior (AP), lateral, and both oblique radiographs of the foot. Oblique views are helpful in the evaluation of the joint and sesamoids for arthritic changes ( Fig. 7.2 ).

    FIG. 7.2

  • Standing AP and lateral radiographs of the normal foot (helpful as in intraoperative template).

Surgical Anatomy

  • Lateral collateral ligaments of the great toe ( Fig. 7.3 )

    FIG. 7.3

Positioning

  • The patient is placed in the supine position.

  • A bump under the ipsilateral hip may be helpful to position the foot.

  • An ankle tourniquet can be used, but a thigh tourniquet is preferable so that no pressure is placed on the long extensors and flexors as the toe is balanced during the procedure.

Portals/Exposures

  • A medial incision over the first MTP joint ( Fig. 7.4 ).

    • Expose the capsule, in preparation for a vertical capsulotomy.

    • Locate and protect the dorsal and plantar sensory nerves.

    FIG. 7.4

  • A 3- to 4-cm incision in the first intermetatarsal space.

Portals Pearls

  • The plantar medial sensory nerve can easily be injured during the dissection and capsulotomy. It must be clearly identified, dissected free, and protected.

Portals Pitfalls

  • Previous incisions may preclude the use of two incisions. Sometimes a single dorsal-lateral incision has been used for a bunionectomy. Correction through this single incision is more difficult, but possible, if it is extended proximally and distally, and medial and lateral flaps are created.

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