Hallux Valgus Correction

synonyms:

Hallux Valgus Technique CPT

• 28240 Tenotomy, lengthening or release abductor hallucis
• 28290 Correction, hallux valgus; with or without sesamoidectomy; simple exostectomy (Silver procedure)
• 28292 Correction, hallux valgus; with or without sesamoidectomy;Keller, McBride, Mayo procedure
• 28293 Correction, hallux valgus; with or without sesamoidectomy;resection of joint with implant
• 28294 Correction, hallux valgus; with or without sesamoidectomy;tendon transplant (Joplin procedure)
• 28296 Correction, hallux valgus; with or without sesamoidectomy;with metatarsal osteotomy (Mitchell, Chevron or concentric type procedures
• 28297 Correction, hallux valgus; with or without sesamoidectomy;Lapidus
• 28298 Correction, hallux valgus; with or without sesamoidectomy;phalanx osteotomy
• 28299 Correction, hallux valgus; with or without sesamoidectomy; double osteotomy
• 28310 Osteotomy, shortening, angular or rotational correction; proximal phalanx, first toe
• 28750 Arthrodesis, great toe; MTP joint

Hallux Valgus Technique Indications

Hallux Valgus Technique Contraindications

Hallux Valgus Technique Alternatives

• Non-op treatment: wide-laced (high toe box) shoes; activity modifications

Hallux Valgus Technique Planning / Special Considerations

Hallux Valgus Technique Technique

• Sign operative site.
• Pre-operative antibiotics, +/- regional block.
• General endotracheal anesthesia
• Supine position. All bony prominences well padded.
• Examination under anesthesia.
• Prep and drape in standard sterile fashion.
• 2-3cm longitudinal incision in 1st web space
• Blunt dissection to the adductor hallucis.
• Release adductor from lateral sesamoid exposing transverse metatarsal ligament.
• Place freer elevator under transverse metatarsal ligament to protection NV bundle; release transverse metatarsal ligament.
• Perforate capsule; abduct toe to neutral releaseing lateral capsule.
• With toe in neutral ensure adequate dorsiflexion can be obtained.
• Medial midline incision centered over MT head.
• Protect dorsomedial cutaneous nerve and planter medial cutaneous nerve.
• Expose capsule; expose abductor hallucis tendon plantarly.
• Perform vertical capsulotomy at joint line.
• Perform vertical capsulotomy 3-8mm proximal to previous incision and excise intervening capsule.
• Dorsal L extention of capsular incision to expose the medial eminence.
• Remove medial eminence with a saw or osteotome to make it coplanar with the metatarsal shaft (just medial to sulcus).
• Pass 3 sutures threw the adductor tendon and tie into the interosseous ligament to keep adductor tendon off the bottom of the foot.
• Plicate medial capsule with the toe in a neutral position. Small portion of dorsal capsule may need to be removed if it is redundant after removal of medial emminence.
• Irrigate.
• Close in layers.

Hallux Valgus Technique Complications

• Distal chevron osteotomy with soft tissue release complications = incomplete correction and avascular necrosis (1 – 2%).
• Distal soft tissue realignment only complications = recurrence of deformity, inadequate lateral release, and hallux varus.
• Aken procedure complications = increase in the hallux valgus deformity.
• Proximal first metatarsal osteotomy complications = hallux varus and shortening.
• Hallux Varus deformity
• Dorsomedial cutaneous nerve neurmoa / syndrome:  Dorsomedial cutaneous nerve is the terminal branch of the superficial peroneal nerve and is the most susceptible to iatrogenic injury during hallux valgus surgery.  (Miller SD, Foot Ankle INt 2001;22:198)
• Resection of both sesmoids risk development of cock-up toe deformity

Hallux Valgus Technique Follow-up care

• Post-op:
• 7-10 Days:
• 6 Weeks:
• 3 Months:
• 6 Months:
• 1Yr:

Hallux Valgus Technique Outcomes

Hallux Valgus Technique Review References

1. Mann, Disorders of the first metatarsophalangeal joint, JAAOS, 3(1):  34-43, 1995
2. Coughlin MJ: Roger A. Mann Award.  Juvenile hallux valgus: Etiology and treatment.  Foot Ankle Int 1995;16:682-697.
3. Zimmer TJ, Johnson KA, Klassen RA: Treatment of hallux valgus in adolescents by the chevron osteotomy.  Foot Ankle 1989;9:190-193.
4. Coughlin MJ, ICL 1997;46:357
5. Gould AAOS OKO Topic