1. The document discusses various surgical procedures for correcting hallux valgus deformity, including distal soft tissue procedures, osteotomies of the first metatarsal, and phalangeal osteotomies. 2. Common procedures described are the modified McBride bunionectomy, Mitchell osteotomy, Chevron osteotomy, and Ludloff osteotomy. 3. Patient factors like age, severity of deformity, and joint arthritis help determine which procedure is most appropriate. Soft tissue procedures are preferred for milder cases while more severe deformities may require metatarsal osteotomies.

1. DR. PRUTHVIRAJ NISTANE Deptt. Of Orthopaedics,Unit II Govt. Medical College and Rajindra Hospital, Patiala

9. Anatomy

12. Pathoanatomy

16. first variant , the articular surface of the metatarsal head is offset, resembling a scoop of ice cream sitting at an angle on a cone This has been described as the distal metatarsal articular angle Second variant the articular angle of the base of the proximal phalanx in relation to its longitudinal axis is offset. This has been described as the phalangeal articular angle

23. Standing dorsoplantar view Non-standing lateral oblique view Standing lateral view Axial sesamoid view

31. Associated foot disorders - Neuritis / nerve entrapment - Overlapping / underlapping 2 nd digit - Hammer digits - First metatarsocuneiform joint exostosis - Sesamoiditis - Ulceration - Inflammatory conditions ( bursitis , tendinitis ) of 1 st metatarsal head Indications for surgery

35. 1. Valgus deviation of the great toe 2. Varus deviation of the 1 st metatarsal 3. Pronation of hallux and/or 1 st metatarsal 4. Hallux valgus interphalangeus 5. Arthritis and limitation of motion of the 1 st metatarsophalangeal joint 6. Length of the 1 st metatarsal relative to lesser metatarsals Preoperative evaluation

36. 7. Excessive mobility or obliquity of the 1 st metatarsomedial cuneiform joint 8. The medial eminence (bunion) 9. The location of the sesamoid apparatus 10. Intrinsic and extrinsic muscle-tendon balance and synchrony Preoperative evaluation

46. Resection arthroplasty

60. Types

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82. Hallux Valgus <25  Congruent Joint Soft tissue procedures Chevron osteotomy Mitchell osteotomy Incongruent Joint (subluxation) Distal soft-tissue realignment + Chevron osteotomy Mitchell osteotomy Treatment of Hallux Valgus

83. Hallux Valgus 25  -40  Congruent Joint Chevron osteotomy + Akin procedure Mitchell osteotomy Incongruent Joint Distal soft-tissue realignment + proximal osteotomy Treatment of Hallux Valgus

84. Severe Hallux Valgus >40  Congruent Joint Double osteotomy Akin + 1 st metatarsal osteotomy Akin + 1 st cuneiform opening wedge osteotomy Treatment of Hallux Valgus

85. Severe Hallux Valgus >40  Incongruent Joint Distal soft-tissue realignment + Proximal osteotomy First cuneiform opening wedge osteotomy Treatment of Hallux Valgus

86. Hypermobile 1 st MTC Joint Distal soft-tissue realignment + fusion 1 st metatarsocuneiform joint Degenerative joint disease Fusion or Keller procedure or prosthesis Treatment of Hallux Valgus

88. Post-operative management HV night splint to be worn for 6-8 wks after dressing changes are completed