Includes release of adductor from lateral sesamoid/proximal phalanx, lateral capsulotomy, medial capsular imbrication
Distal 1st MT osteotomy (intra-articular). Can perform in two planes (Biplanar distal Chevron)
reserved for mild to moderate deformities in adults and children, biplanar chevron-->correct increased DMAA
-combined with Chevron in moderate to severe deformities-hallux valgus interphalangeus
Include medial eminence removal and resection of base of proximal phalanx
-indicated in moderate to severe hallux valgus- DJD of 1st MTP- painful callosities beneath lesser MT heads
first TMT joint arthrodesis with distal soft tissue procedures (medial eminence removal, first web space release of AdH, lateral capsule release)
Nonunion (may or may not be symptomatic)
dorsiflexion of the first metatarsal with transfer metatarsalgia
Opening wedge osteotomy (often requires autograft)
-children with ligamentous laxity, flatfoot, and hypermobile first ray- adolescent with an open physis
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Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC.
Which of the following clinical scenarios regarding hallux valgus could be appropriatley treated with a modified McBride procedure?
35-year-old female with a 20 degree HVA, a 11 degree IMA, and an incongruent 1st MTP joint
40-year-old male with a 30 degree HVA, and a 15 degree IMA, and a congruent 1st MTP joint
70-year-old female with a 35 degree HVA, and a 13 degree IMA with a hypermobile 1st ray
65-year-old female with a 25 degree HVA, a 14 degree IMA, and severe hallux rigidus
85-year old minimally ambulatory male with a 45 degree HVA, and a 20 degree IMA
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A 55-year-old female attorney complains of progressive pain and deformity of the great toe. The pain is localized to a prominence of the medial metatarsal head. A clinical image is provided in figure A. Which of the following best describes the hallux deformity?
Valgus and supination
Valgus and pronation
Valgus and hyperextension
Varus and supination
Varus and pronation
A 57-year-old administrative assistant complains of pain over the bunion on her right foot. Physical exam is notable for tenderness over the medial prominence of the first metatarsophalangeal joint and hypermobility of the first ray. Shoe modifications have failed to provide relief. A clinical photograph and radiograph are provided in figures A and B. Surgical treatment with metatarsocuneiform arthrodesis is chosen. Each of the following are associated with a better clinical outcome EXCEPT:
Multiple screw fixation across the metatarsocuneiform arthrodesis
Augmentation of the metatarsocuneiform arthrodesis with bone grafting
Dorsiflexion unloading of the first metatarsal
Correction of the first intermetatarsal angle
Failure of conservative treatments prior to surgery
A 67-year old female presents with the bilateral foot deformity shown in Figures A and B. All of the following contribute to the risk of recurrence after surgery EXCEPT:
Resection of the lateral sesamoid
Lack of lateral capsular release
Lack of medial metatarsophalangeal joint capsule closure
Use of an Akin procedure alone for a moderate to severe deformity
Undercorrection of the widened 1-2 intermetatarsal (IMA) angle
A 47-year-old woman that works as an attorney has a 3-year history of bilateral painful forefeet that is exacerbated with the dress shoes she wears for work. Physical examination reveals bursal inflammation and calluses at the medial eminence of the first metatarsal with a 1st metatarsalphalangeal (MTP)joint deformity that passively corrects. A clinical image is shown in Figure A and a radiograph is shown in Figure B. The hallux valgus angle (HVA) is measured at 25 degrees and the intermetatarsal angle(IMA) is measured at 12 degrees. Which of the following surgical interventions is most appropriate for correction of her deformities?
Distal metatarsal osteotomy (Chevron)
Closing wedge osteotomy of the proximal phalanx (Akin) combined with distal soft tissue release (Modified Mcbride)
Resection of medial eminence (Silver bunionectomy)
Proximal metatarsal osteotomy and first MTP arthrodesis
Metatarsal cuneiform fusion (Lapidus)
A 34-year-old woman presents with right foot pain and a callus over the 1st metatarsalphalangeal joint. A clinical image is shown in Figure A. Accommodative shoewear has failed to relieve symptoms. Images displaying key radiographic angles in the evaluation of this disorder are shown in Figures B and C. This distal metatarsal articular angle (DMAA) is measured at 15 degrees. Which of the following operative procedures is most appropriate for this deformity?
Closing wedge osteotomy of the proximal phalanx (Akin)
Distal soft-tissue release
Distal metatarsal osteotomy
Medial eminence resection and exostectomy (Silver)
A 57-year-old female underwent surgery for severe hallux rigidus. Postoperative radiographs are shown in Figure A. One year later she complains of pain at the 2nd metatarsal head and her exam shows a plantar callosity under the 2nd metatarsal head. What procedure could have been combined with her initial operation to prevent this outcome?
Second metatarsalphalangeal joint arthrodesis
Second metatarsal osteotomy (Weil) with extensor tendon and dorsal capsular release
Flexor to extensor tendon transfer (Girdlestone-Taylor)
Second metatarsal osteotomy (Helal) with extensor tendon and dorsal capsular release
Second metatarsal head resection with extensor tendon and dorsal capsular release
HPI - Active patient, denies trauma, bilateral painless hallux valgus deformity since adolescence, no associated neuromuscular conditions, shoe modifications have failed to provide relief
Which foot would you operate on?
HPI - Patient with hallux valgus with first surgery consisted Chevron technique
What procedure do you perform ?
HPI - denies trauma, pain for several months
How would you treat this?