Surgical Technics

Minor Hallux Valgus

Very moderate and minor Hallux Valgus; the exostosis (medial protuberance) is somewhat significant and sensitive.
Clinical stage : No decompensation and the 1st-2nd metatarsal angle is normal.

        These very occasional cases involve exostectomies (which is to take away the medial protuberance, with or without cutting the adjoining soft tissues – a modified McBride procedure), but no osteotomies, because the 1st-2nd metatarsal angle is normal.

         In my experience, these were less than 0.5% of all the cases I treated.
        In a few cases, the toe was rather askew, but the Hallux Valgus itself was not significant. This often comes with a Hallux Interphalangeus.

Hallux Interphalangeus: The deviation is located at the interphalangeal joint; this being different from a Hallux Valgus where the problem lies in the MTP (metatarso-phalangial) joint. In many cases, both pathologies come together.

Example of a mixed case (Hallux Valgus and Hallux Interphalangeus)

In many cases, an Akin osteotomy is performed as an aesthetic complement to Hallux Valgus surgery. Once the convergence of the MTP joint is achieved, it often results in a slightly deviated toe, although, medically-speaking, the goal is reached. This often disappoints patients who were expecting their toe would be perfectly straight.

There are some exceptions when Akin osteotomies cannot completely correct a Hallux Interphalangeus.

To correct the deviation and residual rotation in spite of this double osteotomy, an improvement was later added, which consisted in a closed bevelled osteotomy of the distal phalange (or “Akinette”).

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