Percutaneous Osteotomies of Hallux Valgus

Abstract

(Applied Anatomy and Biomechanics) The only structures on the medial side are the capsule, collateral ligament and medial sesamoid ligament which are the most important joint stabilizers and their insufficiency is essential for the development of HV (Static stabilizers around the first MTPJ). While Dynamic stabilizers around the first MTPJ: The abductor hallucis abducts, plantar flexes and inverts the great toe while the adductor hallucis adducts, plantar flexes and everts the toe providing a balanced, so called plantar rotator cuff. (Pathogenesis) HV is a complex deformity result from multiple factors. Local factors are most important: 1-Metatarsal dimension. 2-Medial eminence. 3-Os intermetatarseum .4-Metatarsus primus varus. 5-Metatarsophalangeal joint shape. 6-First ray hypermobility. 7-Functional hallux limitus. 8-Pes planus. 9-Achilles tendon contracture. 10-Windlass model.11-Miscellaneous factors. (Management) History and careful examination is essential. Pain is the main symptom. Weight bearing X-ray A-P view for angular measurement. HVA, 1st IMA.DMAA and MTPJ congruency is backbone of classification. Conventional operative include soft tissue release and/or proximal and/or MT osteotomies.