Acute Hallux Valgus

Stade clinique III

At this stage the Hallux Valgus cannot be corrected by passive methods, because the adjoining soft tissues are too contracted. The first toe shows pronation, meaning it is both deviated and rotated.

Hallux Valgus Angle: 30º
Intermetatarsal angle : 14º

Also present are a displacement of the sesamoids (the lateral sesamoid to the intermetatarsal space and the internal sesamoid gone through the crista.

Principles for Treatment

Sagging of adjoining soft tissues (adductor tendon, sesamoido-phalangial ligament and metatarso-sesamoidal suspensor ligament).
Basal osteotomy of the 1st metatarsal (the only way to properly correct the condition when the 1-2 metatarsal angle is greater than 14º.

Principal techniques for basal osteotomies

Crescent osteotomy (R. Mann)
Slanted osteotomy (Ludloff- Myerson)
Scarf osteotomy (Gudas-Weil-Barouk)

All these osteotomies are associated with a sagging of adjoining soft tissues.

        Lateral slackening:

• Compound tendon (distal from the bone)
• Metatarso-sesamoid Suspensor ligament (allowing the repositioning of the sesamoids)

        Unless the surgeon faces an extreme case, he must save the metatarso-phalangial lateral ligament. This will prevent an over-correction and a Hallux Varus.

        To be technically selective, an additional incision is made at top of the foot in the area of the 1st ray.

Crescent Osteotomy (Mann’s)

An osteotomy was performed with a crescent saw 1 cm from the TMT joint, and then set in place with a small cannula-shaped screw.
This type of osteotomy gives excellent results, but in some cases, however, this binding may be unstable and lends itself to a post-operatory displacement (i.e.: either recurrence of the condition or elevation in dorsiflexion). Hence I have increasingly chosen to perform the two following osteotomies instead.

Ludloff-Myerson Osteotomy

At the moment Ludloff-Myerson osteotomy is my favourite for severe Halluces Valgi.

Ostéotomie de SCARF

        This two-way osteotomy is somewhat complex, but very versatile. It allows for a very satisfactory reduction of the inter-metatarsal angle and in the course of this technique, one can also shorten or lengthen the 1st metatarsal as well. The result is very stable after healing.         The word « scarf » is borrowed from woodworkers’ vocabulary and refers to a joining of two pieces of wood by making a long, diagonal cut on each piece then bonding them together.
        A famous orthopaedic surgeon, Dr. S. Barouk from Bordeaux, France, made this osteotomy popular and fine-tuned the procedure. He worked on the lowering of the 1st metatarsal head and bonding techniques. (It all began with J.M. Burutaran in 1976, followed by Gudas in 1982 and Zygmunt in 1983. It was in 1984 that Drs. Borrelli and Weil gave it the designation of « scarf ».)
        However, an interlocking effect could cause a certain mal-rotation and this is why I prefer to use a modified version of the Ludloff-Myerson osteotomy.

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