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Management of Failed Hallux Valgus

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Revision Surgery of the Foot and Ankle

Abstract

Hallux valgus surgery has many potential complications apart from those inherent to all surgical procedures. These include recurrence, malunion, nonunion, avascular necrosis, and hallux varus. The effective management of these problems requires a careful clinical and radiographic evaluation. Although nonsurgical management is often effective, operative intervention is also not infrequently indicated. Recurrent hallux valgus is a complex problem frustrating to both the patient and surgeon. Often, a deformity may recur if the initial surgery was not sufficiently powered to correct the primary problem. Success treating this problem is predicated on selecting the appropriate procedure based upon the unique features of the deformity, which requires careful clinical and radiographic analysis for accurate characterization. The most common malunion types are dorsiflexion and shortening iatrogenic deformities. In this scenario, patients may complain of metatarsalgia due to stress transfer from the altered mechanics of the dysfunctional first ray. Effective surgical management may consist of not only correcting the first metatarsal deformity but also addressing pathology of the lesser metatarsals. Avascular necrosis is also a known complication of hallux valgus. Unfortunately, it is difficult to differentiate avascular necrosis from routine postsurgical clinical symptoms and radiographic findings prior to collapse of the articular surface. As such, surgical intervention is often not indicated until the more advanced stages. When this is the case, arthrodesis is most indicated. Hallux varus is another complication reviewed herein. Although hallux varus deformities may not be symptomatic, surgery may be indicated when symptoms cannot be effectively managed with accommodative shoewear. In cases of flexible deformities, tendon transfers and “reverse osteotomies” can be effective; however, arthrodesis may be required in rigid deformities and those with significant stiffness.

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Sherman, T.I., Jianzhong, Q., Mousavian, A., Orapin, J., Schon, L.C. (2020). Management of Failed Hallux Valgus. In: Berkowitz, M., Clare, M., Fortin, P., Schon, L., Sanders, R. (eds) Revision Surgery of the Foot and Ankle. Springer, Cham. https://doi.org/10.1007/978-3-030-29969-9_2

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