Hallux Valgus Surgery - Richard Carey-Smith 22/2/2001
BACKGROUND
Confusing literature reports on the vast number of operative methods proposed for fixation of hallux valgus. All will change as more data appears on the Scarf osteotomy and as yet no long term studies comparing it with the other proximal osteotomies. Papers below are the classic on Mitchells, a long term follow up on proximal crescentic osteotomy and a biomechanical study. The classic on Mitchells (bunionectomy and distal metatarsal osteotomy) and indicated moderate to severe hallux valgus with subluxed MTPJ.
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Authors
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Mitchell, L; Fleming, J; Allen, R; Glenney, C; Sansford, Glenn
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Title
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Osteotomy-Bunionectomy for Hallux Valgus
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Reference
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J Bone Joint Surg [Am] 1958 : 40 A : 41-60
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Summary
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Mitchell describes his experience with over 400 operations. Precise technique, rationale for distal osteotomy, and failings are illustrated. Pts happy 80% time (1-20 yrs). Surgeons happy 51%.
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Critique
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Only looks at one method of fixation. 1/3pt 2
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metatarsalgia, one pt requiring jt excision. Did not think metatarsalgia was related to 1
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MT shortening (average 8mm short). Does state that only for patients with hallux valgus and metatarsus primus varus and pt selection essential.
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Distal soft tissue procedure and proximal crescentic osteotomy indicated in HV angle >30deg with an incongruent joint
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Authors
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Mann,RA; Rudicel, S; Graves, SC
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Title
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Hallux valgus repair using distal soft tissue procedure and proximal metatarsal osteotomy. Long term follow up.
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Reference
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JBJS (Am) 74; 124-129, 1992.
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Summary
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109 feet with HV angle 17-46deg pre to 9 (3 to 13) post op. Demonstrates correction good correction of hallux valgus angle (76% to <16deg).
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Critique
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Carefully selected patient group but no comparison to other treatment modalities.
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