Issue 66


August/September 2004
66_front.jpg

In this issue:

  • Treatment Options for Hallux Valgus
  • Getting on the Provincial Agenda - an update from the OOA
  • Isolationnisme et dfense des droigts

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Themes - Introduction - Hallux Valgus PDF Print E-mail

Introduction

Treatment for hallux valgus has been controversial and includes various re-alignment and fusion procedures. Inadequate treatment of hallux valgus can lead to significant sequelae. Longer-term results have included a fair proportion of failures, which have required further surgical treatment. Failed hallux valgus surgery has been associated with a high incidence of litigation. The failures and the increasing demand for normal function in most patients have led to increasing enthusiasm for various treatment options. Our Themes section will discuss these important issues in detail.

Last Updated on Wednesday, 21 March 2007 11:24
 
Themes - Proximal Realignment Treatment of Moderate to Severe Hallux Valgus Deformities PDF Print E-mail

Proximal Realignment:

Treatment of Moderate to Severe Hallux Valgus Deformities

Gordon R. Goplen, M.D., FRCSC
Edmonton, AB

Introduction

A hallux valgus deformity can be the result of anatomical abnormalities at a variety of points along the first ray. Moderate to severe hallux valgus deformities are usually the result of an increased intermetatarsal (IM) angle and an incongruent metatarsophalangeal (MTP) joint. An abnormal distal metatarsal articular angle (DMAA) may also be present and should not be overlooked. Generally, the procedure or procedures selected to correct a hallux valgus deformity should address the specific anatomical abnormalities causing the deformity. The degree as well as the type of deformity is also important. One of the most powerful tools we have for the correction of a hallux valgus deformity is the proximal osteotomy. It should be considered for the correction of the more severe hallux valgus deformities, often in conjunction with other procedures.
Last Updated on Wednesday, 21 March 2007 11:25
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Themes - Distal Osteotomies and Soft Tissue Procedures for Treatment of Hallux Valgus PDF Print E-mail

Distal Osteotomies and Soft Tissue Procedures for Treatment of Hallux Valgus

N. Craig Stone, M.D., FRCSC
St. Johns, NL

When surgical management is indicated, most cases of symptomatic hallux valgus can be managed with realignment procedures in the distal portion of the first ray1. If the first intermetatarsal angle (IMA) is not excessive (<14) and there is no degenerative change in the first metatarsophalangeal joint, distal osteotomies and soft tissue procedures can effectively correct the deformity2.

Last Updated on Wednesday, 21 March 2007 11:25
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Themes - Proximal Fusions for Hallux Valgus PDF Print E-mail

Proximal Fusions

Alastair S.E. Younger, M.D., FRCSC
Vancouver, BC

Paul Lapidus popularized the first tarsometatarsal (TMT) fusion and distal realignment, although he was not the first to describe this operation. The procedure is therefore also known as a Lapidus procedure1.

Surgeons treating hallux valgus must determine precisely where the foot hurts, and then decide on a logical rationale as to why that part of the foot hurts. Most forefoot pain is due to pressure, and if the pressure point can be reduced - the pain will be resolved. Patients with hallux valgus often complain of pain under the second metatarsal head (metatarasalgia), because of loss of weight bearing through the deformed and possibly elevated first ray. The operation chosen must address the second metatarsal head overload. A Mitchell osteotomy may increase the second metatarsal load as it achieves correction at the expense of metatarsal length2.

Last Updated on Wednesday, 21 March 2007 11:25
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Themes - Fusion of the 1st MTPJ PDF Print E-mail

Fusion of the 1st MTPJ

Johnny T.C. Lau, M.D., FRCSC
Toronto, ON

Patients with severe hallux valgus with or without inflammatory or degenerative arthritis can be successfully treated with 1st MTPJ fusion. Fusion of the 1st MTPJ reliably corrects deformity, and eliminates pain in cases with arthritis. The success of fusion of the 1st MTPJ depends on the approach, preparation of bony surfaces, proper alignment, and stable internal fixation.

Last Updated on Wednesday, 21 March 2007 11:26
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