RECURRENT HALLUX VALGUS: Treatment Considerations

Many surgical procedures have been described in the literature for the correction of hallux valgus,6 but a special knowledge of the etiologic factors, pathomechanics, and patient factors is needed to achieve a permanent solution for this deformity. There are two categories of recurrence: operative factors and patient factors. The main cause of recurrence associated with operative factors is improper procedure selection.7 Other common causes include inadequate medial eminence resection, failure of lateral release, and hypermobility/ligamentous laxity. One can argue that failure to address other associated deformities in the phalanx, metatarsal, or sesamoids may also predispose a patient to recurrence (Figure 2). There are multiple patient factors mentioned in the literature associated with hallux valgus and also the progression of hallux valgus. These include generalized diseases such as rheumatoid arthritis, gout, hypothyroidism, Parkinsonism, cerebral palsy, and hereditary neuromuscular disorders. Patient controllable factors also include compliance with weight bearing status and also shoegear choices. Special attention must be brought to juvenile hallux valgus, patients with generalized joint laxity, and arthritis of the first metatarsophalangeal (MPJ). In these cases, the chance of recurrence is noted to be higher (Figure 3).7 RECURRENT HALLUX VALGUS: Treatment Considerations