| Introduction |
- Characterized by medial deviation of great toe relative to the 1st metatarsal
- Most common cause is overcorrection during hallux valgus surgery
- overrelease of lateral capsular structures
- overplication of medial capsule
- excessive resection of the medial eminence
- overcorrection of IMA
- excision of fibular (lateral) sesamoid
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| Presentation |
- Symptoms
- often asymptomatic
- difficulty with shoe wear is the most commonly reported symptom
- may also complain of pain, decreased ROM, instability, weakness with push-off
- Physical exam
- Varus positioning of the great toe
- ER/supination of foot, walking on lateral border of foot to avoid toe-off
- often have IP joint flexion & MTP joint extension
- EHL may be medially displaced, creating a "bowstring" dynamic deformity
- tibial (medial) sesamoid may be medially displaced
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| Imaging |
- Radiographic evaluation consists of weight-bearing AP & lateral views of the foot, non-weigtbearing oblique views, and sesamoid axial views
- defined as hallux valgus angle less than or equal to 0 degrees
- 1-2 IMA, MTP joint extension, IP joint flexion, & degree of arthrosis should also be evaluated
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| Treatment |
- Nonoperative
- shoe modifications to accommodate the deformity
- extra depth and wider more flexible toe box
- placing pads over prominent areas
- taping or splinting the deformity
- Operative
- abductor hallucis release and transfer of EHL or EHB to proximal phalanx
- indications
- technique
- transfer portion of EHL or EHB under the transverse intermetatarsal ligament to the distal metatarsal neck (from lateral to medial)
- distal portion of tendon left intact, creating static stabilizer
- first MTP arthrodesis
- indications
- fixed deformity
- significant arthrosis
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