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Hallux valgus is one of the most common deformities
of the foot. The deformity is hereditary and is frankly becoming more and more common. What is most disturbing, is we are
seeing more children and teenagers with symptomatic deformities. The only indication for surgery should be pain. There are
both patients and surgeons looking for cosmetic surgery, but caution anyone of this. Bunion surgery is only successful when
and if each every part of the deformity including any other deformities like a flatfoot and equinus are addressed.
Bunion
surgery is pure unadulterated carpentry. You may see surgeons advertising on the internet minimal incision surgery, painless
surgery, or walk the same day. Maybe so, but a year later, you will be sorry because your deformity will re-occur. No matter
what, surgery is traumatic. It will hurt. It will take 6 months to completely recover. Chronic foot swelling is the number
one problem post-operatively.
We also recommend that people visit www.asubunion.com. It is my website dedicated to
screwed up bunion surgery. It is simply case after case of mal-treated bunon surgery. Majority of the cases had surgeons
who were taking short-cuts. We all want quick fixes and short recoveries, but there are no miracle cures for bunions.
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Typical adult bunion deformity; however, this patient has a severe uncotrollable flatfoot which
had to be addressed
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Very mild deformity. THERE IS NO CORRELATION between the size of the deformity and pain.
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Severe deformities. The hallux is almost dislocated out of the 1st MPJ. No miracle will help
this patient. Get out the power tools.
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Worst deformity possible, the dreaded skewfoot. This foot not only has a bunion, but it has a
metadductus deformity (forefoot is adducted). Often there is a rearfoot valgus deformity as well. Even worse the lesser
toes are abducted. It is virtually impossible due to the soft tissue adaptation over the years to make this foot look good
and above stay straight.
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Worst imaginable foot to deal with - rheumatoid foot on prednisone with an ulcer under the 1st
metatarsal head. It maybe heresy, but I recommended a transmetatarsal amputation for this patient. There is no way that
you can make that foot functional traditionally.
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The bunion deformity becomes a non-functional joint leading to the development of other problems
- with this soldier, multiple metatarsal stress fractures. Correct the bunion deformity, and force the 1st Ray to bear weight
again.
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Beware of the patients that are ligamentously lax or the pregnant patient, they develop the dreaded
splayfeet (exteremely flexible and wide forefoot). These patients require the most aggressive corrections. Any undercorrection
will lead to a quick and eventual re-occurrence of the deformities.
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Osteotomies:
- Phalangeal osteotomies
- Metatarsal
head
- Metatarsal shaft
- Metatarsal base
- Combination
- 1st met-cun fusion
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Phalangeal Osteotomies:
- Akin
- Distal Akin
-
Keller
Metatarsal Head Osteotomies:
- Chevron (Austin)
- Distal L
- Reverdin
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Metatarsal Shaft Osteotomies:
- Kalish
- Mau
-
Ludloff
- Z (Scarf)
Metatarsal Base Osteotomies:
- Closing base wedge (transverse)
- Closing base wedge (oblique)
-
Opening wegde
- Proximal chevrom
- Crescentric
- Crescentric shelf
Other:
- Lapidus
- Opening wedge
cuneiform
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