Salvage of complications of hallux valgus surgery

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Presentation transcript:

Salvage of complications of hallux valgus surgery Daniel E. Lehman, MD Foot and Ankle Clinics Volume 8, Issue 1, Pages 15-35 (March 2003) DOI: 10.1016/S1083-7515(02)00130-4

Fig. 1 (A) 65-year-old male with symptomatic recurrent hallux valgus deformity 4 years following surgical correction. (B) Postoperative radiograph following proximal chevron osteotomy and distal capsular soft-tissue reconstruction. Patient is asymptomatic. Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 1 (A) 65-year-old male with symptomatic recurrent hallux valgus deformity 4 years following surgical correction. (B) Postoperative radiograph following proximal chevron osteotomy and distal capsular soft-tissue reconstruction. Patient is asymptomatic. Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 2 Relationship between first metatarsal arterial supply and chevron osteotomy exit sites. Safe zone is outline in cross hatch. (From Jones KA, Feiwell LA, Freedman EL, et al. The effect of chevron osteotomy with lateral capsular release on the blood supply to the first metatarsal head. J Bone Joint Surg 1995;77A:197–204; with permission.) Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 3 (A) Preoperative radiograph of 13-year-old female with symptomatic hallux valgus. (B) Radiograph taken 6 months postoperatively showing hallux varus. Patient is having difficulty with shoewear. (C) Following hallux varus correction with soft tissue realignment and distal metatarsal osteotomy, alignment is improved. Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 3 (A) Preoperative radiograph of 13-year-old female with symptomatic hallux valgus. (B) Radiograph taken 6 months postoperatively showing hallux varus. Patient is having difficulty with shoewear. (C) Following hallux varus correction with soft tissue realignment and distal metatarsal osteotomy, alignment is improved. Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 3 (A) Preoperative radiograph of 13-year-old female with symptomatic hallux valgus. (B) Radiograph taken 6 months postoperatively showing hallux varus. Patient is having difficulty with shoewear. (C) Following hallux varus correction with soft tissue realignment and distal metatarsal osteotomy, alignment is improved. Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 4 (A) Extensor hallucis brevis tendon is divided at musculotendinous junction. (B) Distal stump of extensor hallucis brevis tendon is routed deep to transverse metatarsal ligament. A drill hole is made transversely through the distal first metatarsal. (C) Extensor hallucis brevis is passed through drill hole and sewn into medial soft tissues. (From Juliano PJ, Myerson MS, Cunningham BW. Biomechanical assessment of a new tenodesis for correction of hallux varus. Foot Ankle Intl 1996;17:17–20; with permission.) Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 4 (A) Extensor hallucis brevis tendon is divided at musculotendinous junction. (B) Distal stump of extensor hallucis brevis tendon is routed deep to transverse metatarsal ligament. A drill hole is made transversely through the distal first metatarsal. (C) Extensor hallucis brevis is passed through drill hole and sewn into medial soft tissues. (From Juliano PJ, Myerson MS, Cunningham BW. Biomechanical assessment of a new tenodesis for correction of hallux varus. Foot Ankle Intl 1996;17:17–20; with permission.) Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 4 (A) Extensor hallucis brevis tendon is divided at musculotendinous junction. (B) Distal stump of extensor hallucis brevis tendon is routed deep to transverse metatarsal ligament. A drill hole is made transversely through the distal first metatarsal. (C) Extensor hallucis brevis is passed through drill hole and sewn into medial soft tissues. (From Juliano PJ, Myerson MS, Cunningham BW. Biomechanical assessment of a new tenodesis for correction of hallux varus. Foot Ankle Intl 1996;17:17–20; with permission.) Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 5 (A) Postoperative radiograph of 67-year-old female following hallux valgus correction and attempt to correct postoperative hallux varus. (B) Radiograph following successful first MTP arthrodesis. Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 5 (A) Postoperative radiograph of 67-year-old female following hallux valgus correction and attempt to correct postoperative hallux varus. (B) Radiograph following successful first MTP arthrodesis. Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 6 (A) Incomplete union 3 years following proximal metatarsal osteotomy. (B) Postoperative radiograph showing successful consolidation with use of distal tibial bone graft. Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 6 (A) Incomplete union 3 years following proximal metatarsal osteotomy. (B) Postoperative radiograph showing successful consolidation with use of distal tibial bone graft. Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 7 (A) Shortened first metatarsal following distal chevron osteotomy. (B) Postoperative radiograph following single stage lengthening with tricortical iliac crest bone graft and dorsal plate fixation. (C) A/P radiograph following plate removal. Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 7 (A) Shortened first metatarsal following distal chevron osteotomy. (B) Postoperative radiograph following single stage lengthening with tricortical iliac crest bone graft and dorsal plate fixation. (C) A/P radiograph following plate removal. Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 7 (A) Shortened first metatarsal following distal chevron osteotomy. (B) Postoperative radiograph following single stage lengthening with tricortical iliac crest bone graft and dorsal plate fixation. (C) A/P radiograph following plate removal. Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 8 (A) Patient with painful callous under second metatarsal head following hallux valgus correction. (B) Treatment with shortening osteotomy of the second metatarsal. Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 8 (A) Patient with painful callous under second metatarsal head following hallux valgus correction. (B) Treatment with shortening osteotomy of the second metatarsal. Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 9 (A) Recurrent hallux valgus deformity associated with painful second hammertoe. (B) Lateral radiograph demonstrating dorsiflexed first metatarsal. (C,D) Treatment with interpositional iliac crest graft combined with closing wedge distal chevron osteotomy. Second toe was treated with a fusion of the Proximal Interphalangeal Joint (PIP) joint. Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 9 (A) Recurrent hallux valgus deformity associated with painful second hammertoe. (B) Lateral radiograph demonstrating dorsiflexed first metatarsal. (C,D) Treatment with interpositional iliac crest graft combined with closing wedge distal chevron osteotomy. Second toe was treated with a fusion of the Proximal Interphalangeal Joint (PIP) joint. Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 9 (A) Recurrent hallux valgus deformity associated with painful second hammertoe. (B) Lateral radiograph demonstrating dorsiflexed first metatarsal. (C,D) Treatment with interpositional iliac crest graft combined with closing wedge distal chevron osteotomy. Second toe was treated with a fusion of the Proximal Interphalangeal Joint (PIP) joint. Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)

Fig. 9 (A) Recurrent hallux valgus deformity associated with painful second hammertoe. (B) Lateral radiograph demonstrating dorsiflexed first metatarsal. (C,D) Treatment with interpositional iliac crest graft combined with closing wedge distal chevron osteotomy. Second toe was treated with a fusion of the Proximal Interphalangeal Joint (PIP) joint. Foot and Ankle Clinics 2003 8, 15-35DOI: (10.1016/S1083-7515(02)00130-4)