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 Hallux Varus:   A Prophylactic Perspective

by
John M. Schuberth, DPM, FACFAS
Chief, Foot and Ankle Surgery
Kaiser Foundation Hospital

Dr. John Schuberth discusses the Mortal Sins that can be committed while performing correction of Hallux Abducto Valgus deformities. One wrongdoing is usually forgiven, yet two or more result in the misfortune known as Hallux Varus. What are these grave transgressions? 

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Fibular Sesamoidectomy

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Over correction of the Intermetatarsal Angle

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Overzealous Capsulorrhaphy

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Spiking the Head of the 1st Metatarsal

Patients typically undergo Hallux Valgus Surgery to repair a painful deformity which may also be cosmetically unacceptable to them. Should their repair result in a Hallux Varus deformity, they will be invariably perturbed. "Shoes are not made for feet with reverse contours of the digits", says Dr. Schuberth. To add insult to injury, these patients tend to develop a morbid gait.

Dr. Schuberth reviews the deformity in great detail. A negative hallux abductus angle is probably the most consistent finding. Commonly, the intermetatarsal angle is negative and the 1st MPJ is incongruous. 


As the deformity progresses, migration of the lesser toes occurs. Dr. Schuberth describes the "tie-bar phenomenon" 



Examples of Hallux Flexus and 1st MPJ Arthrosis are given.


Dr. Schuberth reviews the anatomy of the 1st MPJ and describes the repair of Hallux Varus.  Included in this lecture is a case presentation by Dr. Marc Dolce.

We see less and less Hallux Varus today, because we have a better understanding of the causes of this complication.

FYI: We can look forward to hearing Dr. Schuberth present a lecture on board review preparation in the very near future.

 
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