Proximal corrective osteotomy : Correction of hallux valgus deformity

Abstract

Severe symptomatic hallux valgus deformities are usually not treatable with conservative methods in the long-term. Surgical treatment currently aims for mechanical restitution of the first ray with preserved mobility of the first metatarsophalangeal (MTP1) joint and with low risk of recurrence after surgery. Keeping these aims in mind the surgical methods consist of osteotomy at the proximal part of the first metatarsal bone with ahigh potential for correction of the deformity. Surgical interventions at the midshaft level of the first metatarsal are only useful if the anatomical shape of the metatarsal shows awide shaft, which allows alarge shift in the osteotomy. In all other cases of severe hallux valgus deformity twodifferent surgical principles are currently used and recommended: 1.proximal or basal osteotomy of the first metatarsal bone in all cases with apreserved MTP1 and tarsometatarsal (TMT-1) joint without signs of instability. 2.Arthrodesis of the TMT-1 joint in all cases of instability or degenerative changes with an intact MTP1 joint, the so-called Lapidus arthrodesis. This article gives an overview over the most important and widely used surgical techniques for correction of severe hallux valgus deformities. Emphasis is placed on the different osteosynthesis techniques and the recommended postoperative regimens. The advantages and disadvantages of the most frequently employed osteotomy techniques are discussed based on the current literature and the authors own experience.