Mini-Invasive Surgeries in Treatment of Hallux Valgus

Abstract

HV is considered a progressive deformity characterized by subluxation of the first metatarsophalangeal joint (MTPJ) with a lateral deviation and pronation of the big toe, metatarsus varus, exostosis of the metatarsal head, and instability of the first tarsometatarsal joint (TMTJ). It is often associated with callus, and bursa over the bony prominence. No deformity of the forefoot occurs more frequently than hallux valgus. Women are much more commonly affected than men, because they frequently wear narrow, high-heeled shoes and often have more flexible soft tissues. Other factors have been implicated in the etiology of hallux valgus. e.g. flat feet which suggest that collapse of the arch under weight-bearing load orients the first metatarsal axis toward vertical and predisposes adduction of the first metatarsal, which initiates deformity. This theory was built upon the following points:  The first metatarsal rotates about its own axis.  Orientation of this axis is variable and dependent upon the shape of the medial arch.  The arch is best able to carry weight and keep its shape when the first metatarsal is properly aligned.  Collapse of the arch tends to orient the first metatarsal axis towards vertical.  Adduction of the first metatarsal occurs about a vertical axis.  Adduction of the first metatarsal predisposes hallux valgus. Non-oprative treatment is considered the first option for a patient with this deformity and if failed try surgical. The ideal surgical procedure should be able to concomitantly correct HV (hallux valgus) and IMA (intermetatarsal angle), restore joint congruity, eliminate pain, and preserve range of motion. Minimally invasive techniques are currently more used in many surgical procedures on the soft tissues and bones of the foot. Practical advantages over the open surgeries include lower complication rates and faster recovery times. Potential disadvantages are related to the need for specific equipment and extensive learning curve. One of the most frequent techniques involves a combination of chevron osteotomy of the first metatarsal with osteotomy of the first phalanx, both internally fixated. Lateral metatarsal misalignment and toe deformities can also be addressed by percutaneous treatment, with lower morbidity rates than open techniques. The MIS technique is hard to practice, requiring additional learning from experts and good knowledge of classical “open” techniques. Anatomic and technical knowledge of these evolving techniques.