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DR. PRUTHVIRAJ NISTANE Deptt. Of Orthopaedics,Unit II  Govt. Medical College and  Rajindra Hospital, Patiala
[object Object],[object Object]
 
[object Object],[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Anatomy
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pathoanatomy
Pathogenesis  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
first variant , the articular surface of the metatarsal head is offset, resembling a scoop of ice cream sitting at an angle on a cone This has been described as the distal metatarsal articular angle  Second variant the articular angle of the base of the proximal phalanx in relation to its longitudinal axis is offset. This has been described as the phalangeal articular angle
Consequences ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Patient evaluation
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Patient evaluation
X-ray ,[object Object],[object Object],[object Object],[object Object],[object Object]
Standing dorsoplantar view Non-standing  lateral oblique view Standing lateral view Axial sesamoid view
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Hallux valgus angle Intermetatarsal angle Distal metatarsal articular angle
 
[object Object],[object Object],[object Object],[object Object],Hallux valgus classification
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Non-operative treatment
 
[object Object],[object Object],[object Object],[object Object],[object Object],Indications for surgery
Associated foot disorders -  Neuritis / nerve entrapment  -  Overlapping / underlapping  2 nd  digit  -  Hammer digits  -  First metatarsocuneiform joint exostosis  -  Sesamoiditis  -  Ulceration  -  Inflammatory conditions  ( bursitis ,  tendinitis )   of  1 st  metatarsal head  Indications for surgery
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Contraindications
[object Object],[object Object],[object Object],Surgical Goals
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
      1. Valgus deviation of the great toe     2. Varus deviation of the 1 st  metatarsal     3. Pronation of  hallux and/or 1 st   metatarsal     4. Hallux valgus interphalangeus     5. Arthritis and limitation of motion of the  1 st  metatarsophalangeal joint     6. Length of the 1 st  metatarsal relative to  lesser metatarsals Preoperative evaluation
    7. Excessive mobility or obliquity of the 1 st   metatarsomedial cuneiform joint     8. The medial eminence (bunion)     9. The location of the sesamoid apparatus     10. Intrinsic and extrinsic muscle-tendon  balance and synchrony Preoperative evaluation
 
Indications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Modified McBride Bunionectomy ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],DuVries & Mann
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
A) KELLER RESECTION ARTHROPLASTY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Resection arthroplasty
B) DISTAL METATARSAL OSTEOTOMY ,[object Object]
 
Mitchell osteotomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
CHEVRON INTRACAPSULAR OSTEOTOMY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
Metatarsal Osteotomy ,[object Object]
C)  PROXIMAL FIRST METATARSAL  OSTEOTOMY ,[object Object],[object Object],[object Object]
Advantages ,[object Object],[object Object],[object Object],[object Object],[object Object]
Disadvantages ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Indications ,[object Object],[object Object],[object Object],[object Object]
Types
Types ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
Identify ???
D)  MEDIAL CUNEIFORM   OSTEOTOMY ,[object Object],[object Object],[object Object]
Medial Cuneiform Osteotomy ,[object Object]
E) PROXIMAL PHALANGEAL OSTEOTOMY (AKIN’S) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Indications ,[object Object],[object Object],[object Object],[object Object],[object Object]
Contraindications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Proximal Phalangeal Osteotomy ,[object Object]
Chevron-Akin Double Osteotomy ,[object Object]
F) ARTHRODESIS OF THE FIRST METATARSOPHALANGEAL JOINT ,[object Object],[object Object],[object Object],[object Object]
Indication ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Why to differentiate ??? ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Indicaion for surgery ,[object Object],[object Object],[object Object],[object Object],[object Object]
Types of surgery ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],AVN of 1 st  MT head ! Avoid shortening More stable then basal Extensive exposure High corrective power Mild degree Unstable
 
Hallux Valgus <25  Congruent Joint     Soft tissue procedures Chevron osteotomy   Mitchell osteotomy Incongruent Joint  (subluxation)     Distal soft-tissue realignment  +     Chevron osteotomy    Mitchell osteotomy Treatment of Hallux Valgus
Hallux Valgus 25  -40  Congruent Joint      Chevron osteotomy + Akin procedure    Mitchell osteotomy Incongruent Joint      Distal soft-tissue realignment +  proximal osteotomy    Treatment of Hallux Valgus
Severe Hallux Valgus >40  Congruent Joint      Double osteotomy    Akin + 1 st  metatarsal osteotomy    Akin + 1 st  cuneiform opening  wedge osteotomy Treatment of Hallux Valgus
Severe Hallux Valgus >40  Incongruent Joint      Distal soft-tissue realignment +  Proximal osteotomy    First cuneiform opening wedge  osteotomy Treatment of Hallux Valgus
Hypermobile 1 st   MTC Joint      Distal soft-tissue realignment +  fusion 1 st  metatarsocuneiform joint Degenerative joint disease     Fusion or Keller procedure or prosthesis Treatment of Hallux Valgus
Post-operative management ,[object Object],[object Object]
Post-operative management HV night splint  to be worn for 6-8 wks after dressing changes are completed
Complications of surgery ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Two types ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CORRECTION OF UNIPLANAR (STATIC) HALLUX VARUS ,[object Object],[object Object],[object Object],[object Object]
CORRECTION OF DYNAMIC (MULTIPLANAR) HALLUX VARUS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Non-operative Treatment  ,[object Object],[object Object],[object Object]
Operative Treatment ,[object Object],[object Object],[object Object],[object Object]
 
Scenario #1 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Scenario #2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Scenario #3 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Scenario #4 ,[object Object],[object Object],[object Object],[object Object],[object Object]
 

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Disorders of the hallux

  • 1. DR. PRUTHVIRAJ NISTANE Deptt. Of Orthopaedics,Unit II Govt. Medical College and Rajindra Hospital, Patiala
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  • 16. first variant , the articular surface of the metatarsal head is offset, resembling a scoop of ice cream sitting at an angle on a cone This has been described as the distal metatarsal articular angle Second variant the articular angle of the base of the proximal phalanx in relation to its longitudinal axis is offset. This has been described as the phalangeal articular angle
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  • 23. Standing dorsoplantar view Non-standing lateral oblique view Standing lateral view Axial sesamoid view
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  • 31. Associated foot disorders - Neuritis / nerve entrapment - Overlapping / underlapping 2 nd digit - Hammer digits - First metatarsocuneiform joint exostosis - Sesamoiditis - Ulceration - Inflammatory conditions ( bursitis , tendinitis ) of 1 st metatarsal head Indications for surgery
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  • 35.     1. Valgus deviation of the great toe    2. Varus deviation of the 1 st metatarsal    3. Pronation of hallux and/or 1 st metatarsal    4. Hallux valgus interphalangeus    5. Arthritis and limitation of motion of the 1 st metatarsophalangeal joint    6. Length of the 1 st metatarsal relative to lesser metatarsals Preoperative evaluation
  • 36.    7. Excessive mobility or obliquity of the 1 st metatarsomedial cuneiform joint    8. The medial eminence (bunion)    9. The location of the sesamoid apparatus    10. Intrinsic and extrinsic muscle-tendon balance and synchrony Preoperative evaluation
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  • 82. Hallux Valgus <25  Congruent Joint    Soft tissue procedures Chevron osteotomy   Mitchell osteotomy Incongruent Joint (subluxation)    Distal soft-tissue realignment +    Chevron osteotomy    Mitchell osteotomy Treatment of Hallux Valgus
  • 83. Hallux Valgus 25  -40  Congruent Joint    Chevron osteotomy + Akin procedure    Mitchell osteotomy Incongruent Joint    Distal soft-tissue realignment + proximal osteotomy    Treatment of Hallux Valgus
  • 84. Severe Hallux Valgus >40  Congruent Joint    Double osteotomy    Akin + 1 st metatarsal osteotomy    Akin + 1 st cuneiform opening wedge osteotomy Treatment of Hallux Valgus
  • 85. Severe Hallux Valgus >40  Incongruent Joint    Distal soft-tissue realignment + Proximal osteotomy    First cuneiform opening wedge osteotomy Treatment of Hallux Valgus
  • 86. Hypermobile 1 st MTC Joint    Distal soft-tissue realignment + fusion 1 st metatarsocuneiform joint Degenerative joint disease    Fusion or Keller procedure or prosthesis Treatment of Hallux Valgus
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  • 88. Post-operative management HV night splint to be worn for 6-8 wks after dressing changes are completed
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