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Textbook of Hallux Valgus & Forefoot Surgery

Index

Preface

Hallux Valgus and Forefoot Surgery brings together a group of physicians interested in the care of the foot who unselfishly share their experience, expertise, and knowledge with those of similar interest. Deformities of the forefoot are complex, causing varying degrees of pain and suffering. Such deformities also contribute to overall functional disability in many patients suffering from the variety of deformities affecting the foot. This is especially true of older patients for whom mobility equates with independence.

This book addresses the clinical aspects of deformity of the forefoot, focusing primarily on hallux valgus. Presented in separate chapters are the anatomy of the forefoot, biomechanics of the hallux valgus deformity, and clinical and radiographic evaluation of the forefoot. These initial chapters are then followed by a series of chapters on procedures for the management of hallux valgus; these chapters address criteria for procedure selection based on clinical, radiographic, and biomechanical foundations. They include soft tissue procedures, phalangeal, distal, and proximal metatarsal osteotomy, and procedures involving the cuneiform. Each addresses a specific type of procedure in detail including indications and complications. Some repetition of material may occur in several of the chapters; this was done to allow for completeness of presentation of the material in the individual chapters and to reinforce some of the radiographic, biomechanical, and other principles relative to the specific procedures described. The terms hallux valgus and hallux abducto valgus have been used interchangeably throughout the text and for practical purposes refer to the same deformity.

The text would not be complete without addressing other deformities associated with hallux valgus that accompany the painful forefoot. These include hallux limitus and rigidus, hallux varus, nail and digital deformity, metatarsalgia, as well as neuroma and nerve entrapment syndromes. Separate chapters deal with management of diabetic and rheumatoid patients. An international perspective is added to demonstrate the similarity and diversity of the approaches to the management of hallux valgus. It is my hope that this text will become a useful resource to students, residents, and practitioners.

I would like to thank all of the contributing authors for their generous commitment of time, knowledge, and patience; it is for this reason that I dedicate the book to them.

I would also like to acknowledge the contributions made by Joan Lannoch for her art work, Donna Perzeski, who was invaluable with her library research assistance and Marsha Deetz for her assistance in producing this electronic form of the text.

Vincent J. Hetherington, D.P.M., M.S.
Dip.A.B.P.S., F.A.C.F.A.S.

Contributors

Richard J. Bogdan, D.P.M., Dip.A.B.P.S.
Private practice, La Jolla, California; formerly, Associate Professor and Chairman, Department of Biomechanics and Orthopedics, Ohio College of Podiatric Medicine, Cleveland, Ohio

Allan M. Boike, D.P.M., Dip.A.B.P.S., F.A.C.F.A.S.
Associate Professor, Department of Surgery, Ohio College of Podiatric Medicine; Podiatry Staff, Department of Podiatric Surgery, Mt. Sinai Medical Center, Cleveland, Ohio

John H. Bonk, D.P.M., Dip.A.B.P.S., F.A.C.F.A.S.
Adjunct Clinical Faculty, Department of Surgery, Ohio College of Podiatric Medicine, Cleveland, Ohio

Domenick A. Calise, D.P.M.
Assistant Professor, Department of Surgery, Ohio College of Podiatric Medicine; Director of Surgery, Cleveland Foot and Ankle Clinic, Ohio College of Podiatric Medicine, Cleveland, Ohio

Edward L. Chairman, D.P.M., Dip.A.B.P.S., F.A.C.F.A.S.
Podiatric Surgeon, Division of Podiatric Surgery, Department of Orthopaedics, Graduate Hospital, Philadelphia, Pennsylvania

Bao-Xing Chen, M.D.
Visiting Professor, Department of Orthopedic Surgery, Beijing Medical University; Professor, Department of Orthopedic Surgery, Beijing Institute of Foot Surgery, Beijing, China

Gloria Christin, D.P.M., A.A.C.F.A.S.
Private practice, Toledo, Ohio

Paul S. Cwikla, D.P.M., Ph.D.
Graduate, Ohio College of Podiatric Medicine, Cleveland, Ohio

J. Colin Dagnall, L.H.D., F.Ch.S.
Member, Advisory Committee, Center for the History of Foot Care and Footwear, Pennsylvania College of Podiatric Medicine, Philadelphia, Pennsylvania; Friend, The Wellcome Institute for the History of Medicine, London, England; Chiropodist, War Pensions Directorate, Blackpool, Lancashire, England

Michael A. Feist, D.P.M., M.S.
Former Resident, California College of Podiatric Medicine, San Francisco, California

Michael Gerber, D.P.M.
Assistant Professor, Department of Surgery, Ohio College of Podiatric Medicine, Cleveland, Ohio

Charles Gudas, D.P.M.
Clinical Professor, Department of Surgery, University of Chicago Division of the Biological Sciences Pritzker School of Medicine, Chicago, Illinois

Vincent J. Hetherington, D.P.M., M.S., Dip.A.B.P.S., F.A.C.F.A.S.
Dean for Academic Affairs, and Professor and Former Chairman, Department of Surgery, Ohio College of Podiatric Medicine, Cleveland, Ohio; formerly Associate Dean for Clinical Affairs, College of Podiatric Medicine and Surgery, University of Osteopathic Medicine and Health Sciences, Des Moines, Iowa

Tadao Ishizuka, M.D., Ph.D.
Chief Director, Jonan Hospital; Counselor, Japanese Society for the Medical Study of Footwear, Tokyo, Japan

Ronald E. Johnson, D.P.M.
Associate Dean, College of Podiatric Medicine and Surgery, University of Osteopathic Medicine and Health Sciences, Des Moines, Iowa

Michael Korbol, D.P.M., P.T., F.A.C.F.A.S.
Private practice, Raleigh, North Carolina; formerly Assistant Clinical Professor, Department of Surgery, Ohio College of Podiatric Medicine, Cleveland, Ohio

D.N. Kreibich, M.B.
Senior Registrar, Department of Orthopaedic Surgery, Royal Victoria Infirmary, Newcastle, England

John E. Laco, D.P.M., Dip.A.B.P.O., Dip.A.B.P.P.C.
Associate Professor, Department of Podiatric Medicine, College of Podiatric Medicine and Surgery, Des Moines, Iowa; Residency Director, Primary Podiatric Care Program, Minnesota Extension, College of Podiatric Medicine and Surgery, Eagan, Minnesota

David M. LaPorta, D.P.M., Dip.A.B.P.S., F.A.C.F.A.S.
Staff Physician, Department of Podiatric Surgery, Monmouth Medical Center, Long Branch, New Jersey

Janis E. Lehtinen, D.P.M.
Attending Physician, Department of Surgery, Lutheran General Hospital, Park Ridge, Illinois; Associate, Department of Surgery, Lake Forest Hospital, Lake Forest, Illinois

Francis Lynch, D.P.M., Dip.A.B.P.S., F.A.C.F.A.S.
Director, Achilles Foot Health Center, North Haven, Connecticut

Maria Malone, D.P.M.
Graduate, Ohio College of Podiatric Medicine, Cleveland, Ohio

Praya Mam, D.P.M.
Former Second-Year Surgical Resident, Ohio College of Podiatric Medicine, Cleveland, Ohio

Denise M. Mandracchia, D.P.M., A.A.C.F.A.S.
Adjunct Assistant Professor, Department of Podiatric Medicine, College of Podiatric Medicine and Surgery, University of Osteopathic Medicine and Health Sciences, Des Moines, Iowa

Vincent J. Mandracchia, D.P.M., M.S., F.A.C.F.A.S.
Associate Professor, Department of Podiatric Medicine, College of Podiatric Medicine and Surgery, University of Osteopathic Medicine and Health Sciences, Des Moines, Iowa; formerly Chairman, Department of Podiatric Surgery, Springfield Hospital, Springfield, Pennsylvania

Thomas V. Melillo, D.P.M., Dip.A.B.P.S., F.A.C.F.A.S.
Professor, Department of Podiatric Surgery, and President, Ohio College of Podiatric Medicine, Cleveland, Ohio

Tracy A. Merrell, D.P.M.
Graduate, College of Podiatric Medicine and Surgery, University of Osteopathic Medicine and Health Sciences, Des Moines, Iowa

Stephen J. Miller, D.P.M., Dip.A.B.P.S., Dip.A.B.P.O., F.A.C.F.A.S.
Teaching Faculty, The Podiatry Institute, Tucker, Georgia; Co-Founder, Northwest Podiatric Foundation, Seattle, Washington; Adjunct Faculty, Department of Surgery, Pennsylvania College of Podiatric Medicine, Philadelphia, Pennsylvania; Active Staff, Island Hospital, Anacortes, Washington

Vincent J. Muscarella, D.P.M.
Clinical Instructor, Department of Surgery, Pennsylvania College of Podiatric Medicine; Chairman, Department of Podiatric Surgery, Suburban General Hospital, Norristown, Pennsylvania

Bonnie J. Nicklas, D.P.M., Dip.A.B.P.S., F.A.C.F.A.S.
Associate Professor and Chair, Department of Surgery, Ohio College of Podiatric Medicine, Cleveland, Ohio

Lawrence M. Oloff, D.P.M
Professor, Department of Surgery; Vice-President and Dean for Academic Affairs; Co-Director, Special Problems Clinic, California College of Podiatric Medicine, San Francisco, California; Clinical Assistant Professor, Podiatric Section, Division of Orthopedic Surgery, Department of Functional Restoration, Stanford University School of Medicine, Stanford, California

Lawrence Osher, D.P.M.
Associate Professor, Department of Medicine, and Director, Department of Radiology, Ohio College of Podiatric Medicine, Cleveland, Ohio

Gordon W. Patton, D.P.M., Dip.A.B.P.S., F.A.C.F.A.S.
Teaching Faculty, Podiatry Institute, Northlake Regional Medical Center, Tucker, Georgia

Daryl Phillips, D.P.M.
Professor, Department of Podiatric Medicine, College of Podiatric Medicine, University of Osteopathic Medicine, Des Moines, Iowa

Bernard Regnauld, M.D.
Private practice, Nantes, France; formerly, Medical Intern, Department of Orthopaedics, University Hospital Centre, Nantes, France

Patrick D. Roberto, D.P.M.
Private practice, Delmont, Pennsylvania

Brad G. Samojla, D.P.M.
Assistant Professor, Department of Podiatric Medicine, Ohio College of Podiatric Medicine, Cleveland, Ohio

T.W.D. Smith, M.B., F.R.C.S., F.R.C.S.E.
Consultant Surgeon, Department of Orthopaedic Surgery, Northern General Hospital, Sheffield, England

Alan J. Snyder, D.P.M.
Private practice, North Wales, Pennsylvania; formerly, Surgical Fellow, Department of Surgery, Ohio College of Podiatric Medicine, Cleveland, Ohio

David Stanley, M.B., F.R.C.S., F.R.C.S.E.
Consultant Surgeon, Department of Orthopaedic Surgery, Northern General Hospital, Sheffield, England

Gunther Steinbock, M.D.
Orthopedic Hospital, Vienna, Austria

Richard M. Stess, D.P.M., Dip.A.B.P.S., Dip.A.B.P.O., F.A.C.F.A.S.
Assistant Clinical Professor, Department of Medicine, University of California, San Francisco, School of Medicine; Associate Clinical Professor, Department of Podiatric Medicine, California College of Podiatric Medicine; Chief, Department of Podiatry, and Director of Podiatric Education, Department of Veterans Affairs Medical Center, San Francisco, California

William F. Todd, D.P.M., Dip.A.B.P.S., F.A.C.F.A.S.
Director, Diabetic Foot Center, and Member, Residency Training Committee, Monsignor Clement Kern Hospital for Special Surgery, Warren, Michigan

Randall K. Tom, D.P.M.
Second-Year Resident, Monsignor Clement Kern Hospital for Special Surgery, Warren, Michigan

Rodney Tomczak, D.P.M., Ed.D., Dip.A.B.P.S., F.A.C.F.A.S.
Professor, Department of Podiatry, University of Osteopathic Medicine, Des Moines, Iowa

John V. Vanore, D.P.M.
Attending Medical Staff, Doctors Hospital of Hyde Park; private practice, Chicago, Illinois

George F. Wallace, D.P.M., Dip.A.B.P.S., Dip.A.B.P.O.
Clinical Instructor, Department of Podiatry, and Chairman and Residency Director of Podiatric Surgery, University of Medicine and Dentistry of New Jersey, Hasbrough Heights, New Jersey

Marilyn J. Waller, D.P.M.
Private practice, Hayward, California

John M. White, D.P.M.
Private practice, New Boston, Texas

Kendrick A. Whitney, D.P.M.
Clinical Instructor, Department of Orthopaedics, Pennsylvania College of Podiatric Medicine; Co-Director, Diabetic Foot Clinic, and Instructor, Department of Orthopaedics, Foot and Ankle Institute of the Pennsylvania College of Podiatric Medicine, Philadelphia, Pennsylvania

James E. Zelichowski, D.P.M.
Staff Member, Department of Surgery, Henry General Hospital, Stockbridge, Georgia; Former Chairman, Department of Surgery, and Externship Director, Atlanta Hospital, Atlanta, Georgia

Foreward

It is my extreme pleasure to have the opportunity to write the foreword for Hallux Valgus and Forefoot Surgery. This book is a marvelous amalgamation of basic and clinical sciences from the perspective of a diverse and expert international group of contributing authors. The diversity and caliber of these authors make this text valuable and interesting.

Since the 1980s, there has been an enormous volume of material written about forefoot and hallux valgus surgery. This book provides a systematic approach to forefoot surgery with topics ranging from surgical anatomy, pathology, biomechanics, biomaterials, fixation and criteria based surgical techniques, and complications. It is an important and very readable text that discusses the scientific materials commonly seen in the busy foot and ankle surgical practice; it provides a fine perspective of surgical approaches both the time honored classic procedures and state-of-the-art cutting edge innovations. The most commonly confronted pathology in the forefoot is brilliantly discussed and illustrated in this comprehensive book. International input adds to the scope and freshness of the overall presentation.

Dr. Hetherington, the consummate educator, has held many academic positions and is currently the Dean for Academic Affairs and Professor of Surgery at the Ohio College of Podiatric Medicine. Having known Dr. Hetherington since his residency days, I have had the joy of witnessing his emergence as a preeminent authority on research and education as it relates to foot and ankle pathology on an international level.

Hallux Valgus and Forefoot Surgery is an outstanding text that is a must for any practitioner of foot and ankle surgery.

David C. Novicki, D.P.M., F.A.C.F.A.S.
President, American College of Foot and Ankle Surgeons, Park Ridge, Illinois
Attending Clinical Physician
Veterans Administration Hospital
West Haven, Connecticut

Table of Contents

Chapter 1 / 1 - Introduction
  • Chapter 2 / 7 - Normal Anatomy of the Forefoot
  • Chapter 3 / 39 - Biomechanics
  • Chapter 4 / 67 - Review of Adult Foot Radiology
  • Chapter 5 / 101 - Clinical Evaluation of Hallux Abducto Valgus
  • Chapter 6 / 107 - Preoperative Assessment in Hallux Valgus
  • Chapter 7 / 125 - Soft Tissue Procedures for Hallux Abducto Valgus
  • Chapter 8 / 137 - Phalangeal Osteotomy for Hallux Valgus
  • Chapter 9 / 147 - Arthrodesis of the Interphalangeal Joint
  • Chapter 10 / 153 - Sesamoids
  • Chapter 11 / 163 - Overview of Distal First Metatarsal Osteotomies
  • Chapter 12 / 169 - Austin Procedure and Modified Austin Procedures
  • Chapter 13 / 183 - Hohmann Osteotomy
  • Chapter 14 / 197 - Mitchell Bunionectomy
  • Chapter 15 / 203 - Reverdin Procedure and its Modifications
  • Chapter 16 / 215 - Middiaphyseal Osteotomies
  • Chapter 17 / 227 - Proximal Osteotomy
  • Chapter 18 / 267 - Arthrodeses of the First Metatarsophalangel Joint
  • Chapter 19 / 279 - Arthrodesis of the First Metatarsocuneiform Joint
  • Chapter 20 / 285 - Cuneiform Osteotomy
  • Chapter 21 / 295 - Joint-Destructive Procedures
  • Chapter 22 / 307 - Hallux Varus
  • Chapter 23 / 313 - Hallux Limitus and Hallux Rigidus
  • Chapter 24 / 327 - First Metatarsophalangeal Implants
  • Chapter 25 / 347 - Review of First Metatarsophalangeal Joint Implants
  • Chapter 26 / 359 - Surgical Management of Digital Deformities
  • Chapter 27 / 379 - Orthodigital Evaluation and Therapeutic Mangement of Digital Deformity
  • Chapter 28 / 401 - Entrapment Neuropathies
  • Chapter 29 / 429 - Metatarsalgia and Lesser Metatarsal Surgery
  • Chapter 30 / 453 - Freiberg's Disease
  • Chapter 31 / 459 - Tailor's Bunion Deformity
  • Chapter 32 / 471 - Amputation of the Foot
  • Chapter 33 / 481 - Nail Surgery
  • Chapter 34 / 499 - Rheumatoid Arthritis
  • Chapter 35 / 509 - Methods for Assessing Stress Under the Pathologic Forefoot
  • Chapter 36 / 519 - Rationale for Prophylactic Surgery in the Diabetic Foot
  • Chapter 37 / 529 - International Perspectives Hallux Valgus in Japan

    Edited by

    Vincent J. Hetherington, D.P.M., M.S., Dip.A.B.P.S., F.A.C.F.A.S.


    Senior Associate Dean
    Professor Department of Surgery
    Kent State University College of Podiatric Medicine
    Independence, Ohio

    Vice President and Dean for Academic Affairs
    Professor and Former Chairman
    Department of Surgery
    Ohio College of Podiatric Medicine
    Cleveland, Ohio

    Formerly Associate Dean for Clinical Affairs
    College of Podiatric Medicine and Surgery
    University of Osteopathic Medicine and Health Sciences
    Des Moines, Iowa

    © Vincent J. Hetherington 2000

    All rights reserved. No part of this publication may be reproduced, displayed, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, including photocopying, recording, or otherwise, without prior permission of the copyright owner, (Vincent J. Hetherington, DPM, Kent State University College of Podiatric Medicine, 6000 Rockside Woods Blvd. N, Independence, Ohio, 44131 or by email at vjh@kent.edu) with the exception that single copies, including photocopies may be made for the noncommercial purpose of education and scientific advancement.

    Accurate indications, adverse reactions, and dosage schedules for drugs are provided in this book, but it is possible that they may change. The reader is urged to review the package information data of the manufacturers of the medications mentioned.

    The Publishers have made every effort to trace the copyright holders for borrowed material. If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity.

    This text has been converted from the original print version (1994) to the current electronic edition. During the conversion process it is possible that several inadvertent errors may have occurred during the conversion to the electronic format, even though the text was reviewed prior to making this edition available. The editor would be interested in identifying any such errors and may be notified by email at vjh@kent.edu