First ray

Question 1

HAV deformity in each plane

Answer 1

transverse: lateral hallux deviation, medial 1st met deviation
frontal: valgus rotation, hallux abutting 2nd digit
sagittal: tracking or track-bound

Question 2

tracking vs trackbound

Answer 2

tracking: reducible deformity, hallux drifts back into valgus when passively manipulated into correct position
trackbound: irreducible deformity, hallux can’t be realigned to neutral

Question 3

HAV stage 1

Answer 3

lateral displacement of PP as compared to 1st met

Question 4

HAV stage 2

Answer 4

development of hallux abductus deformity, hallux abutting 2nd digit

Question 5

HAV stage 3

Answer 5

increased 1st IM angle

Question 6

HAV stage 4

Answer 6

subluxed or dislocated PP on 1st met head

Question 7

traditional classification: normal

Answer 7

1st IMA: < 9°
HVA: < 15°

Question 8

traditional classification: mild deformity

Answer 8

1st IMA: 9-11°
HVA: < 20°
treat w/ distal osteotomy ± soft tissue procedure

Question 9

traditional classification: moderate deformity

Answer 9

1st IMA: 11-16°
HVA: 20-40°
treat w/ proximal osteotomy ± soft tissue procedure

Question 10

traditional classification: severe deformity

Answer 10

1st IMA: >16°
HVA: >40°
treat w/ proximal osteotomy or 1st TMJ arthrodesis ± soft tissue procedure

Question 11

normal 1st IMA

Answer 11

0-8°

Question 12

1st IM angle location and meaning

Answer 12

• bisection of shaft of 1st met, bisection of shaft of 2nd met
• increased angle means head of 1st met is medially deviated: higher angle = more proximal osteotomy

Question 13

hallux valgus angle: location

Answer 13

bisection of shaft of 1st proximal phalanx, bisection of shaft of 1st met

Question 13

hallux valgus angle: normal

Answer 13

0-15°

Question 14

CORA meaning

Answer 14

point where bone’s alignment shifts/bends

Question 15

CORA significance

Answer 15

HAV is a triplanar deformity w/ CORA at 1st tarsometatarsal joint
- fixing deformity near CORA helps restore proper alignment w/o creating new issues

Question 16

hallux interphalangeus angle: normal

Answer 16

0-10°

Question 17

hallux interphalangeus angle: location, meaning

Answer 17

bisection of shaft of 1st proximal phalanx, bisection of shaft of 1st distal phalanx
- increased HIA is associated w/ hallux rigidus

Question 18

PASA location

Answer 18

line perpendicular to articular cartilage of 1st met head, bisection of shaft of 1st met

Question 19

PASA normal

Answer 19

0-8°

Question 20

DASA normal

Answer 20

0-8°

Question 21

DASA location

Answer 21

line perpendicular to cartilage of base of 1st proximal phalanx, bisection of shaft of proximal phalanx

Question 22

metatarsus adductus angle: normal

Answer 22

10-20°

Question 23

metatarsus adductus angle: location

Answer 23

bisection of lesser tarsus, bisection of 2nd met

Question 24

metatarsal protrusion distance: location and meaning

Answer 24

distance between 2 arcs representing length of 1st and 2nd met - (+): 1st is longer than 2nd - (-): 2nd is longer than 1st

Question 25

metatarsal protrusion distance: normal

Answer 25

± 2 mm

Question 26

adductor tendon transfer: two procedures

Answer 26

can go through or into metatarsal neck

Question 27

adductor tendon transfer: indications and contraindications

Answer 27

indications: - high IMA - negative or normal met protrusion distance contraindications: - positive met protrusion distance - lack of transverse 1st met mobility - atrophied adductor tendon

Question 28

silver bunionectomy: procedure

Answer 28

- medial capsulotomy exposes met head - longitudinal incision to dorsomedial aspect of joint - reflection of capsule, periosteum, resection of medial eminence

Question 29

silver bunionectomy: indications

Answer 29

indications: - elderly pt - painful bump, lesion - adequate pain-free 1st MPJ ROM - HAV

Question 30

McBride bunionectomy: procedure

Answer 30

essentially a silver + lateral soft tissue release (AdH, fibular sesamoidal ligament, tenotomy of lateral head of FHB)

Question 31

hallux osteotomies: indications

Answer 31

- hallux abutting 2nd digit - pain-free 1st MPJ ROM - hallux abductus on WB, minimal valgus rotation - congruous 1st MPJ - increased DASA, HIA

Question 32

hallux osteotomies: examples

Answer 32

distal akin, proximal akin, oblique akin

Question 33

hallux osteotomies: contraindications

Answer 33

short proximal phalanx

Question 34

distal first met osteotomies: indications

Answer 34

- mild to moderate deformity - pain - tracking 1st MPJ, reducible deformity - increased PASA - frontal plane rotation of 1st met

Question 35

distal first met osteotomies: contraindications

Answer 35

- IMA > 16°, HAA > 40° (severe deformity) - trackbound 1st MPJ - DJD

Question 36

austin procedure: steps

Answer 36

1. chevron shaped v osteotomy through metatarsal neck into head 2. lateral displacement of capital fragment

Question 37

austin procedure: angle

Answer 37

60°

Question 38

kalish modification: changes from austin

Answer 38

2 points of fixation, angle of 55°

Question 39

youngswick modification: changes from austin

Answer 39

- resection of rectangular wedge of bone at dorsal arm of V-cut - capital fragment sits more proximally decompresses 1st met

Question 40

reverdin procedure

Answer 40

medially-based wedge osteotomy of 1st met head - proximal to articular cartilage, distal to sesamoids - distal cut is parallel to articular cartilage, proximal cut is perpendicular to long axis of met

Question 41

reverdin-green: changes from reverdin

Answer 41

- horizontal L osteotomy creates plantar shelf, avoids damaging articular surface of sesamoids

Question 42

reverdin-green-laird: changes from reverdin

Answer 42

goes through the lateral cortical hinge for lateral transposition of capital fragment ADDRESSES BOTH PASA AND IMA

Question 43

shaft osteotomies: indications

Answer 43

- moderate to severe HAV - IMA 14-16° - pain

Question 44

shaft osteotomies: contraindications

Answer 44

- degenerative 1st MPJ - hypermobile 1st ray - narrow 1st met

Question 45

vogler procedure

Answer 45

shaft osteotomy - offset V with lateral displacement of capital fragment

Question 46

vogler angle

Answer 46

40°

Question 47

mau orientation

Answer 47

distal dorsal to plantar proximal

Question 48

ludloff orientation

Answer 48

dorsal proximal to plantar distal

Question 49

mau and ludloff procedure

Answer 49

through and through rotational osteotomy