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Hallux Varus After Bunion Surgery Why Did It happen And What To Do - - PowerPoint PPT Presentation
Hallux Varus After Bunion Surgery Why Did It happen And What To Do - - PowerPoint PPT Presentation
Hallux Varus After Bunion Surgery Why Did It happen And What To Do Now James A Nunley, MD Duke University DISCLOSURE I am a consultant for Wright Medical, Stryker, Exactech, DT Medsurg, Orthofix, Treace Medical I receive royalties from
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Hallux Varus
Several factors contribute to Hallux Varus s/p Hallux Valgus corrective surgery:
1.
Removal of fibular sesamoid
2.
Excessive resection of medial eminence
3.
Excessive medial capsuloraphy
4.
Malalignment of the osteotomy site
5.
Overcorrection via excessive lateral release
6.
Overcorrection with the post-operative bunion dressing
Foot & Ankle Zahari et al. J of Foot Surg. 1991
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Hallux Varus
Treatment Prevention: Since advent of modified McBride, post-op hallux varus s/p hallux valgus corrective surgery is rare (routinely less than 1%). Thus, the etiology now the result of excessive lateral release, overcorrection of valgus deformity, and inappropriate post-
- p dressings.
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Hallux Varus
Treatment Early post-op identification of a hallux varus deformity may be treated with aggressive dressing changes to correct the deformity
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Hallux Varus
Treatment Longstanding deformity and/or conservative therapy fails – MP joint must be assessed: No MP DJD – soft tissue correction, preserves motion MP DJD Present – First MP joint fusion
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Hallux Varus
Treatment – No MP DJD Johnson, et al.
- JBJS. 1984
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Hallux Varus
Treatment – No MP DJD Miller’s Review
- f Orthopaedics.
2008
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Case Presentation
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Case Presentation
Miller’s Review of Orthopaedics. 2008 www.Arthrex.com
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Case Presentation
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Case Presentation
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Case Presentation
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9 month followup after my bunion correction.
- Ugh. Now what?
Tell her it is her mission to promote peace? Keep taping? Of course not; this is a surgical course!
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FYI: I did not over-release on original procedure! No dorsolateral incision for lateral release
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Hardware Removal and Medial Release
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Complete Medial Release
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Fluoroscopy after Medial Release
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Recut Distal 1st MT
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Reverse Chevron
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Reverse Proximal Osteotomy
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Medial Closing Wedge
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Lateral Capsular Tightening
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Improved…
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Still too much medial pull of EHL
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Reverse Akin with Bone Graft
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Improved pull of EHL
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Medial Capsule Left Open
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One Year Followup
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One Year Followup
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Hallux Varus
Summary
Hallux varus is a rare condition. Hallux varus occurs most commonly as a complication
- f hallux valgus corrective surgery.
The most common reason for hallux varus is excessive lateral release with overcorrection of valgus deformity. However, other etiologies include fibular. sesamoidectomy (i.e. McBride procedure), excessive resection of medial eminence, overplication of medial capsular structures, malalignment of osteotomy site, and overcorrection with post-op dressing.
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