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1-2 toe taping and closed toe shoes
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Split extensor hallucis longus tendon transfer
Great toe fusion
Medial soft-tissue release and lateral capsule plication
Metatarsal osteotomy, medial capsule release, and split extensor hallucis longus tendon transfer
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Osteotomy and tendon transfer is the management of choice. The previous bunion correction resulted in excessive translation of the metatarsal head. The orthopaedic surgeon must first correct the bony deformity and allow the proximal phalanx to sit in a congruent position. The next step is to reconstruct the soft-tissue components and this can be done by releasing the medial capsule, and transferring part of the extensor hallucis longus tendon into the proximal phalanx, under the intermetatarsal ligament laterally. All three procedures are needed to adequately correct this deformity. A great toe fusion is indicated for an uncorrectable deformity or in an older patient.
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