2025 Live Webinar: Foot & Ankle Focus: Resident Review-Program and CME Materials

Program and CME Materials

Pdf Summary

This webinar presentation by Dr. Lara Atwater covers the diagnosis and management of common forefoot deformities, focusing primarily on hallux valgus and hallux rigidus.<br /><br />Hallux valgus is described as a static lateral deviation of the great toe at the first metatarsophalangeal (MTP) joint, with medial deviation of the first metatarsal. Etiologies include extrinsic factors like shoe wear (more common in females), and intrinsic factors such as severe pes planus, ligamentous laxity, hereditary predisposition, neuromuscular disorders, inflammatory arthritis, trauma, and second toe amputation. Pathoanatomy involves medial capsule attenuation, lateral structure contracture, pronation-induced hallux malposition, and displacement of the first metatarsal head, often resulting in associated lesser toe deformities.<br /><br />Radiographic assessment focuses on the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), and joint congruency to guide management. A treatment algorithm considers arthritis presence, first tarsometatarsal (TMT) joint instability, MTP joint congruency, and angle measurements. Nonoperative treatment includes footwear modification and orthotics, which only relieve symptoms. Surgical options range from distal osteotomies (e.g., Chevron), scarf osteotomy, proximal osteotomies, Lapidus TMT arthrodesis for instability, and Akin osteotomy to address phalangeal deformity.<br /><br />Complications include recurrence (especially with undercorrection or isolated soft tissue release), dorsal malunion, transfer metatarsalgia, avascular necrosis, neuropraxia, hallux varus, and nonunion in Lapidus fusion.<br /><br />Hallux rigidus is arthritis of the first MTP joint leading to progressive loss of motion, common in middle-aged adults with familial and inflammatory backgrounds. Initial treatment is conservative with activity modification, footwear changes, orthotics, and steroid injections. Surgical options depend on disease severity and pain location: dorsal cheilectomy for early disease without midrange pain, Moberg osteotomy for limited dorsiflexion, MTP arthrodesis as the gold standard for advanced arthritis, and synthetic cartilage implants for motion preservation. Keller arthroplasty is reserved for elderly low-demand patients.<br /><br />Several clinical case questions reinforce these principles, emphasizing radiographic evaluation and tailored surgical approaches.

Keywords

hallux valgus

hallux rigidus

forefoot deformities

first metatarsophalangeal joint

osteotomy

Lapidus arthrodesis

foot orthotics

radiographic assessment

MTP joint arthritis

cheilectomy