Presentation
This patient underwent a minimally invasive corrective osteotomy for a hallux valgus deformity with a background history of Parkinson's disease. The indication for this procedure was a severe hallux valgus deformity with subsequent deformity of the second toe and ulceration of the medial aspect of the third toe due to pressure effects.
Patient Data
Intraoperative screening
The 1st x-ray shows his hallux valgus deformity.
The 2nd to 4th x-rays show that an osteotomy has been performed at the head/neck junction of the first metatarsal and then subsequently the head has been valgised and fixed in situ with a percutaneous cannulated screw. The osteotomy is performed using a micro-burr (a surgical instrument) through a small incision < 5mm. The intermetatarsal angle is decreased when comparing x-rays 3 and 5.
In x-ray 5, a second percutaneous cannulated screw has been inserted for more rigid and secure fixation.
There has been partial correction of the valgus deformity of the first metatarsal. The bony projection of the proximal aspect of the first metatarsal will be filed down so as not to cause pressure on the soft tissues.
A lateral capsular release was also performed to allow for better correction of the deformity.
Closing wedge osteotomy has been performed in the proximal phalanx in order to further correct the deformity (i.e. varise the toe) and then secured with another cannulated screw. 2nd PIP joint fusion has also been performed.
Case Discussion
This case illustrates the use of minimally invasive surgery through minor incisions (< 5 mm) to correct a hallux valgus deformity as an alternative to the conventional open procedure (e.g. Skarf Akin/1st MTPJ fusion/soft tissue correction).
One indication for a minimally invasive procedure is to minimize soft tissue damage/incisions in order to try to decrease the risk of infection.
A micro-burr is used to create the osteotomy at the metatarsal head/neck junction of the first toe in order to correct the deformity. The metatarsal head is then valgised and secured in placed with screws. Any bony spurs or prominences are then shaved down to prevent pressure from forming on the skin. This corrects any deformity arising from the metatarsal. The proximal phalanx is then osteotomised in a closing wedge (i.e. varising) using the micro-burr and then secured with a screw. A lateral 1st metatarsophalangeal joint capsulotomy is then usually performed.
In this patient, a minimally invasive technique was used to minimize soft tissue trauma given the age of the patient and her soft tissue quality as an infection is a high risk in this case.
Unable to process the form. Check for errors and try again.