Hallux valgus: Basal osteotomy using Arthrex Low Profile Locking Proximal Opening Wedge Osteotomy Plate
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A basal metatarsal osteotomy of the first ray is an operation for moderate to severe Hallux Valgus deformity, and most commonly is either a medially based opening wedge or a laterally based closing wedge. Less commonly performed, and more technically challenging designs of osteotomy also exist, in particular the basal chevron and the cresentic basal osteotomy.
The choice of an opening wedge osteotomy (as demonstrated in this technique) avoids the shortening of the 1st Ray which can occur with the use of a closing wedge osteotomy, but careful soft tissue balancing is required with the opening wedge.
Though the inter-metatarsal angle is well corrected (as long as an appropriately large size of open wedge plate is selected) inevitably the distal metatarsal articular angle (DMAA) is angulated more into valgus which means almost always an Akin osteotomy, or distal metatarsal osteotomy, is also required. An Akin is often also required to address pronation of the hallux which can be marked with larger deformities. Other procedures are always required to rebalance the soft tissues in particular a modified McBrides procedure and medial capsular plication (in common with most operations for Hallux Valgus correction) and on occasion careful Z-lengthening of the extensor tendons to the hallux.
Some Surgeons will routinely combine a basal osteotomy with a distal metatarsal osteotomy to correct severe deformity, though I have not found the need if using the other techniques described.
Alternate operations used for severe deformities are commonly either a corrective first MTP fusion or a Lapidus procedure, or in some peoples hands a Scarf osteotomy.
Readers will also find these other OrthOracle surgical techniques give useful, alternative perspectives Scarf osteotomy , Lapidus fusion using the I.O. Fix implant (Extremity Medical) , First MTP Fusion :Coughlin reamer preparation and Orthosolutions Cannulated 4mm screws. ,First MTP Fusion-Crossed screws technique. First MTP Fusion (using Stryker Anchorage MTP arthrodesis plate )for Hallux Varus .
Author:Mark Herron FRCS
Institution: The Wellington Hospital, London, UK.