Hallux Valgus

(SBQ18FA.74) Figure A is the radiograph of a 72-year-old male who complains of painful medial-sided great toe pain with push-off during ambulation and shoe wear. His examination demonstrates painful motion of the toe throughout the mid-range of motion. Nonsurgical management has failed to provide relief. Aggressive bone resection during the indicated procedure is most likely to lead to which of the following complications?

(SBQ18FA.38) A 57-year-old woman presents 2 years after undergoing bunion correction of her left foot with the inability to properly fit in her shoes in the last 4 months, despite shoe modification. On examination, she has severe pain and stiffness of her great toe, with crepitation. Her clinical image is depicted in Figure A and her radiograph is depicted in Figure B. Which of the following interventions would most likely result in pain relief and the ability to properly fit shoes?

(SBQ18FA.33) A 75-year-old female presents to your clinic with left foot pain 5 years after bilateral hallux valgus corrections by an outside surgeon. Figure A shows a clinical photograph of her feet. Which of the labeled structures in Figure B is likely contributing to the recurrent deformity and may need to be addressed if a decision is made to proceed with revision surgery?

(OBQ18.21) A 65-year-old female well known to your clinic with painful bunions recalcitrant to nonoperative management. The decision is made to proceed with a corrective procedure. Pre-operatively you plan to make cut "B" labeled in Figure A for a medial eminence resection combined with a modified McBride procedure, but intraoperatively you make the cut labeled "A". What complication is associated with making cut "A" instead of "B"?

(SBQ18FA.37) Figure A is the preoperative radiographs of a 55-year-old female that underwent hallux valgus correction one year ago. She presents to the office today and notes that her toe has become progressively “too straight.” Performing which of the intraoperative techniques will result in increased risk for iatrogenic hallux varus?

(SBQ18FA.24) A 53-year-old woman has had progressive hallux valgus deformity of her right great toe for the last 12 years. She has failed nonoperative management including shoe modifications and padded inserts. Her surgeon recommends a Lapidus procedure (1st metatarsal cuneiform arthrodesis). Which of the following is an indication for this procedure?

(SBQ18FA.35) A 65-year-old female presents with persistent pain in the left great toe. She is interested in surgery as she has been seeing a podiatrist for many years who had prescribed wider shoewear and an unknown kind of orthotic. Her exam shows pes planus which reconstitutes with heel raise, calluses under the first MTP. The 1st TMT joint shows excessive passive plantar and dorsiflexion. While examining the rest of the lower extremity, both knees are able to hyperextend to about 15 degrees but show no other malalignment. Additionally, she shows she is able to reproduce the finding shown in Figure A. Her current radiographs are shown in Figure B. What is the best surgical option to address her deformity?

(OBQ16.216) Which of the following hallux valgus pre-operative measurements would call for a surgical plan involving both a proximal metatarsal osteotomy and a distal metatarsal medial closing wedge osteotomy?

(OBQ13.264) A 56-year-old male laborer presents with the deformity shown in Figure A and B. He complains of long standing pain and swelling over the medial aspect of his right forefoot only. There is minimal tenderness with full flexion and extension of the first metatarsophalangeal joint and no tarsometatarsal joint laxity bilaterally. What treatment is most appropriate for this patient?

(OBQ13.106) A 45-year-old woman undergoes surgical treatment for hallux valgus. One year later she presents with the painless foot deformity shown in Figure A. All of the following variables can lead to the development of this deformity EXCEPT:

(SBQ12FA.7) A 42-year-old woman presents with pain localized to the dorsum of the great toe. She reports undergoing a bunion correction with limited internal fixation using a single screw 2 years prior, which initially helped her. She subsequently underwent implant removal one year later. She is now unable to properly fit shoes on that foot. Her current radiograph is depicted in Figure A. Of the following procedures below, which did she likely undergo?

(SBQ12FA.30) The procedure shown in Figure A would be most appropriate for which of the following scenarios?

(SBQ12FA.11) A 47-year-old female presents with persistent left great toe pain. Two years prior, she underwent hallux valgus corrective surgery with a Chevron osteotomy. Figure A exhibits her most recent radiograph. What is the most likely diagnosis and appropriate treatment?

(OBQ11.240) 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 23 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?

(OBQ11.260) A 38-year-old woman has a 2-year history of left greater than right foot pain. Physical examination demonstrates full 1st metatarsalphalangeal (MTP)joint dorsiflexion and plantarflexion with a 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 31 degrees and the intermetarsal angle(IMA) is measured at 16 degrees. Which of the following surgical interventions is most appropriate for correction of her deformities?

(OBQ10.138) 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:

(OBQ09.211) 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:

(OBQ08.166) 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?

(OBQ08.211) 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?

(SAE07PE.51) A 14-year-old girl has a painful hallux valgus deformity that has not responded to shoe modifications. Figure 21 shows a standing AP radiograph. What is the most appropriate surgical procedure?

(OBQ07.237) Which of the following clinical scenarios regarding hallux valgus could be appropriatley treated with a modified McBride procedure?

(OBQ06.267) 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?

(SBQ04PE.75) A 14-year-old female presents for evaluation of painful hallux valgus deformity of her left great toe. She has attempted modifying her footwear and wearing orthotic inserts, however her pain has progressed and she is now having difficulty with ambulation. Current radiographs demonstrate a hallux valgus angle of 36º, an intermetatarsal angle of 16º, and a distal metatarsal articular angle of 21º with closed first metatarsal physis. Which of the following is the best next step in treatment?