Hallux valgus

Introduction Complex deformity of the 1st ray Medial deviation of 1st metatarsal bone Lateral deviation and pronation of 1st toe
Anatomy Stability of 1st ray Balance of static and dynamic structures
Pathoanatomy 1) Attenuation of medial soft-tissue structures Adductor halluces Medial joint capsule
Pathoanatomy 3) Sesamoids displace into the 1st intermatatarsal space Pronation of hallux
Etiology Women > Men
Diagnosis Symptoms Bulging bump on the outside of the base of your big toe. Swelling, redness or soreness around your big toe joint.
Severity Treatment Conservative Tx. Surgical treatment
Treatment Conservative Tx. Surgical treatment
Surgical Options S.E.R.I Minimally invasive technique Simple, Effective, Rapid, Inexpensive
Surgical Options S.E.R.I Minimally invasive technique Simple, Effective, Rapid, Inexpensive
S.E.R.I Minimally invasive technique Simple, Effective, Rapid, Inexpensive
Advantages Surgical trauma ↓ Complication ↓

 Introduction

Complex deformity of the 1st ray

Medial deviation of 1st metatarsal bone

Lateral deviation and pronation of 1st toe

Lateral dislocation of sesamoids


Anatomy 

Stability of 1st ray 

Balance of static and dynamic structures

Bony architecture of 1st TMT & 1st MTP joints

Soft-tissue structures


Requirements

1st MTP congruency

Stability and dynamic restraints

TMT joint stability


Pathoanatomy

1) Attenuation of medial soft-tissue structures

Adductor halluces

Medial joint capsule






2) 1st MT drifts into varus

     1st MTP joint subluxation laterally




Pathoanatomy

3) Sesamoids displace into the 1st intermatatarsal space 

Pronation of hallux 



Etiology

Women > Men


Extrinsic causes 

Foot wear, occupation, Trauma


Intrinsic causes 

Heredity, Pes planus

Hypermobility of 1st TM joint

Generalized laxity

Tight achilles tendon …


Diagnosis

Symptoms

Bulging bump on the outside of the base of your big toe.

Swelling, redness or soreness around your big toe joint.

Corns or calluses

Limited movement of your big toe


P/E

Forefoot, and corns, calluses, bunionettes, hammer toes…


Image modalities

X-ray (standing), CT …

Severity

Treatment

Conservative Tx.

Surgical treatment

>100 procedures exists…




Basic principle

Congruent

Corrective OT WITHOUT altering normal MTP joint


Incongruent

Corrective OT WITH soft-tissue balancing


Severity of deformity ↑

Correction needs to be more proximal


Presence of arthritic change

Arthrodesis of MTP joint 

Surgical Options

S.E.R.I

Minimally invasive technique


Simple, Effective, Rapid, Inexpensive


Advantages

Surgical trauma ↓

Complication ↓

Surgery time ↓

Recovery period ↓


Indication

Mild to moderate HV

HVA ≤ 40º, IMA ≤ 20º


Procedure


Popular posts from this blog

Mirels’ Classification for pathologic fractures

Image
 Mirels’Classification Mirels H: Metastatic disease in long bones: A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop 249:256–264, 1989. Mirels’Classification : Nature of lesion Mirels’Classification : Nature of lesion Orthopedic Radiology: A Practical Approach, Greenspan, Adam; Lippincott, 2000 Diagnosis of Bone and Joint Disorders, Resnick, Donald, W. B. Saunders Mirels’Classification : Nature of lesion Score of 8 or higher  consider prophylactic internal fixation Guideline aids in decision making, but does not serve as an absolute criterion Each patient should be evaluated individually, keeping two generally accepted principles in mind.  First, prophylactic internal fixation of an impending fracture is technically easier than fixation of an actual pathologic fracture. Second, patient morbidity is decreased with prophylactic fixation compared with fixation after the fracture. Prophylactic intramedullary fixation (↓pain and prevent subsequen...
Read more

Tibial spine fracture

Image
  Tibial spine fracture HyperExtension and femur external rotation during a fall Intercondyle eminence : Medial spine (ACL attachment) + Lateral spine ACL fiber -> tibial spine, inter-meniscal lig, MM attachment Classification Modified Meyers and McKeever classification Non-Operative management Type I, II (after C/R) Long leg cast, Slightly flexion (avoid ACL positional tension) Hemarthrosis evacuation Closed reduction (Physician’s preference for Type II) Surgical treatment Type II & III & IV Reduction method : Arthroscopic vs Open Fixation method : Suture vs Screw
Read more

Subacute osteomyelitis (Brodies abscess)

Image
 Subacute osteomyelitis (Brodies abscess) Osseous infection > 2wks without acute Sx Less common than acute hematogenous osteomyelitis (AHO) Lack of systemic illness -> delayed diagnosis Lab may be normal or slightly elevated S. aureus is most common Location is more diverse than AHO Pathophysiology Host-pathogen relationship : bacterial virulence↓ & Host resistance↑ Inadequate treatment of AHO 40% of subacute OM : recent treatment of antibiotics for other infection (Roberts JM et al. 1982) Classification Treatment Biopsy to rule out malignancy Culture to confirm pathogen 6weeks course of oral antistaphylococcal antibiotics Primary regimen IV : Nafcillin, Oxacillin, Flucloxacillin, Cefazolin PO : Dicloxacillin, Cephalexin <5y-o : Kingella kingae. Should be covered : Clindamycin is recommended (McCarthy 2005) Complication Inadequate treatment -> can progress to chronic OM Rare report of growth disturbance Few report of LLD d/t growth stimulation
Read more