| The correction of a hallux valgus deformity with a
proximal 1st metatarsal osteotomy and distal soft tissue repair is achieved
with a three-incision technique. A lateral soft tissue release and reconstruction
at the first metatarsophalangeal joint releases contracted structures including
the lateral capsule, the transverse inter-metatarsal ligament and the conjoint
adductor tendon. Rarely is the lateral sesamoid excised. Through a medial
incision, the medial eminence or exostosis is resected. The sesamoids are
realigned and the medial capsule is reefed. With a third incision, a proximal
first metatarsal osteotomy is performed that corrects a widened 1－2 intermetatarsal
angle. With correction of the hallux valgus and the 1－2 intermetatarsal
angle, pronation of the hallux is corrected. This correction is routinely
used for hallux valgus deformities characterized by subluxation of the metatarsophalangeal
joint. In the presence of a mild hallux valgus deformity an osteotomy may
not be necessary. With degenerative arthritis or a congruent metatarsophalangeal
joint, alternative surgical procedures are indicated. |
