Pre-Procedure Hallux

Hallux valgus is a deformity at the base of the big toe or the metatarsophalangeal joint in which the great toe or hallux is deviated or points toward the lesser toes; in severe types of the deformity, the great toe goes over or under the second toe.

The musculotendinous attachments in the great toe bypass without any attachment to the head of the metatarsal itself to be inserted into base of the proximal and distal phalanges. When the great toe is in a normal alignment, the muscle forces exerted around it are balanced. Deformity is associated with muscle imbalance at the metatarsophalangeal joint. The muscle imbalance increases with the deformity; in long-standing hallux valgus deformity, a contracture in the overpowering lateral muscles and stretching of the medial capsule exists. As the deformity increases, the metatarsal head becomes prominent medially giving rise to the "bunion" deformity.

A number of operative procedures and osteotomies have been devised and or modified over the years. The great variety of procedures and osteotomies devised underlines the fact that all hallux valgus deformities are not similar and no single versatile osteotomy can treat them all. Therefore, exact procedure(s) selected for operative intervention is based on carefully clinical and radiological evaluation and planning.

History of the Procedure hallux

In the 19th century, the prevalent understanding of the bunion—hallux valgus—was that it was purely an enlargement of the soft tissue, first metatarsal head, or both, most commonly caused by ill-fitting footwear. Thus, treatment had varying results, with controversy over whether to remove the overlying bursa alone or in combination with an exostectomy of the medial head. These surgeries were considered to be beneath many surgeons, so the understanding of the pathology of hallux valgus was gradual in its development. Surgeons slowly began to recognize that bunions could develop as a result of numerous different factors, that they tended to be familial, and that they often were associated with other foot deformities.

As the school of thought began to shift, the first surgical treatment to address deforming pathology was developed and presented on May 4, 1881, when J. L. Reverdin gave a report on hallux abductovalgus to the Medical Society of Genfer. He described a procedure in which a curved incision medial to the extensor hallucis longus was followed by incision of the periosteum, chiseling off of the exostosis, removal of a wedge of bone from behind the capitulum of the metatarsus, and suturing of the bone with catgut. This operation is considered to be the forerunner of all operations that aim to correct hallux valgus via osteotomy.