First Ray Surgery - 1 Hallux Valgus Evaluation

Front 1

What are some common causes of Hallux Abducto valgus?

Back 1

Hypermobile 1st ray
Rheumatic inflammatory disease
Neuromuscular disease
Post-surgical malfunction

Metarsus primus adductus
Long First Ray
Excessive pronation
Gastroc Equinus
Flexible forefoot valgus
Limb length discrepancies
Ehlers Danos Syndrome
Pes Planus foot types

Front 2

When evaluating a patient History of CC concerning HAV, it is important to note what specific factors relating to pain?

Back 2

Onset
Duration
Progression
Location

Front 3

In evaluating a runner w/ who presents w/ HAV, what other deformity is also likely to be present in hallux?

Back 3

Hallux Limitus

Front 4

If you are unsure of the vascular status of the patient, what exam would your order to have a definitive evaluation?

Back 4

Arterial Doppler Exam

which provides
ABIs
Toe Pressures
Segmental Pressures

Front 5

Normal 1st Ray position is how many degrees upon testing it for movement?

Back 5

10 degrees

5 degrees up
5 degrees down

Front 6

How many degrees is the hallux sitting down in a plantarflexed 1st ray?

Back 6

7 degrees

Front 7

How does one test for transverse plane mobility?

Back 7

Straighten out the hallux, and see if you can push the bump in.

In people who are very flexible/ or have a soft tissue deformity, the bump will go in.

In an osseus deformity, the bump will not move.

Front 8

Metatarsal Cuneiform mobility is indicated for patients with severe HAV along with what foot type?

Back 8

Flexible feet

Front 9

Crepitus

Back 9

Cartilage is destroyed

Bone is rubbing on bone

Front 10

Trackbound

Back 10

Lateral soft tissue contracture & increase in the PASA

Front 11

People with medial bunions generally have underlying ______________________

Back 11

Metatarsus Adductus

Front 12

Pinched tyloma's occur as a result of_________________________

Back 12

Medial Bunions

Front 13

How does one develop a tyloma under sub-met 1?

Back 13

Pinched tylomas usually develop as a result of a biomechanical deformity.

If the tyloma is under the met head, then it is a result of a plantar flexed metatarsal.

Front 14

Name 5 reasons one can develop a tyloma (sub met 2)

Back 14

Usually a structural abnormality of 1st ray
-Hallux limitus/rigidus
-Hypermobile 1st ray
-Hammertoe 2nd met, leading to functionally PF position
-Contracted 2nd digit
-Short 1st met
-Long 1st met
-Loss of hallux purchase

Front 15

Keller bunionectomies lead to what possible complication in regards to the hallux and its relationship to the ground?

Back 15

Loss of hallux purchase to due instability of the intrinsic muscles

Front 16

Other deformities seen with HAV deformities...include.....

Back 16

Hallux IPJ deformity - causes the foot to look like it still has a bunion

EHL contracture - use lengthening procedure (Open Z) to correct this

Bursa's

Front 17

In a patient with a bunion, when doing a WB exam, you notice when they stand their abductors fire causing the hallux to straighten out, what note would you want to make pre-op?

Back 17

Slightly under correct otherwise this patient may go into hallux varus.

Front 18

Normal passive DF of the 1st MPJ is_____________

Back 18

20-30 degrees

Front 19

The standard views for radiographic evaluation include:

Back 19

AP, Lateral, MO, Ses Axial

Front 20

Describe this bunion

Back 20

There is increase in soft tissue density and volume along the medial aspect of the 1st MPJ

Front 21

When evaluating a bunion radiographically, what 3 items should be described?

Back 21

Soft tissue

Joints

Angles

Front 22

Name this angle and how you derive it.

Back 22

Standard Met Adductus Angle

Normal is < 15*

Take the base of the medial cuneiform and draw a line to the base of the midpoint of the cuboid.

Bisect the 2nd ray, and bisect the tarsus from that point.

Front 23

What angle is this?

And how do you derive it?

Back 23

Engles Angle.

Bisect the 2nd cuneiform & bisect the 2nd met.

Normal is < /= to 24*

Anything greater means they have met adductus!!

Front 24

What angle is this?

What's normal for this?

Back 24

Classic IM angle.

Normal is </= to 8*

Front 25

TRUE IM angle is calculated how?

and why?

Back 25

Calculated by taking the
(IM angle + Met adduct. angle) - 15*

Indicated because IM angle alone does not account for underlying adductus

Front 26

What angle is this?

How do you calculate it?

What is normal?

Back 26

Proximal Articular Set Angle

Normal PASA is 8*.

Bisect the 1st met.
Draw a line from medial to lateral across the effective articular cartilage.

Angle is found by measuring the angle formed by the transverse articular cartilage line VERSUS a line perpendicular to the longitudinal bisection line.

Front 27

What angle is this?

What is normal?

Back 27

DASA

Normal is 8* or less.

Formed by taking a longitudinal bisection of the proximal phalanx, and then drawing a line from medial to lateral for the transverse articular cartilage, and then..
MEASURING the angle by drawing a line perpendicular to the transverse articular cartilage line & the existing bisection of the prox phalanx.

Front 28

What angle is this?

What is normal?

How do you measure it?

Back 28

Hallux abductus IP angle.

Normal is 10* or less.

Measure by bisecting the prox phalanx and bisecting the dist phalanx.
The degree of abduction of the distal phalanx from the prox phalanx is recorded as the HAIP angle.

Front 29

If the PASA +DASA = HAA, then it is what kind of foot deformity?

Back 29

Structural Foot Deformity.

The joint status in this case is congruent.

Front 30

If the PASA+DASA<HAA, the it is what kind of foot deformity?
(HINT: NORMAL PASA/DASA)

Back 30

Functional Foot deformity.

The joint status in this case is deviated/subluxed.

Front 31

If the PASA+DASA<HAA, then it is what kind of foot deformity?

HINT: PASA/DASA ARE ABNORMAL!!

Back 31

It is a combination foot deformity, it is both structural & functional foot deformity.

The joint status in this case is deviated/subluxed.

Front 32

What is radiograph displaying?

Back 32

The Met Protrusion distance.

Normal is +/- 2mm.

Front 33

Explain how to use this to evaluate sesamoids.

What is considered normal?

Back 33

Bisect the 1st Met, and look for the tibial sesamoid.

Normal position is 1 to 3. Anything else is abnormal.

Positions 4-7 indicate LATERAL tracking of the medial sesamoid.

Front 34

How would you evaluate 1st MPJ position?

Back 34

A normal 1st MPJ position would be evaluated by looking at the position of the sesamoid and seeing that it is proximal to the metatarsal joint line.

Front 35

A congruous joint is one in which the lines are ______________

Back 35

A congruous joint is one in which the lines are running PARALLEL.

Front 36

A deviated joint is one in which
the joint lines ____________________

Back 36

Intersect outside the joint!

Front 37

Normal joint width is ?

Back 37

2mm width is considered normal joint width

Front 38

This is an example of a _______________

Back 38

Subchondral bone cyst

Front 39

The angle being displayed is measuring ______________

Back 39

The first met declination.

Normal is up to 15*

Front 40

The shape of the 1st-met cuneiform jt shown here is round- which indicates you will need to do what kind of reduction?

Back 40

Soft tissue reduction since ROUND 1st-Met Cuneiform Jts are soft tissue in nature.

Square/oblique require an osseus procedure.