A 50-year-old woman with hallux valgus has a hallux valgus angle (HVA) of 38° and an intermetatarsal angle (IMA) of 18° on weight-bearing AP radiograph. The DISTAL metatarsal articular angle (DMAA) is normal. The most appropriate corrective osteotomy is:
- A Mitchell's osteotomy (distal metatarsal displacement osteotomy)
- B Chevron osteotomy (distal V-osteotomy)
- C Proximal crescentic or Lapidus arthrodesis ✓
- D Scarf osteotomy (diaphyseal Z-osteotomy)
Explanation
Severe hallux valgus is defined as HVA >40° or IMA >18° (some guidelines: IMA >16°); an IMA of 18° with HVA of 38° constitutes severe deformity. Chevron and scarf osteotomies are effective for mild-moderate deformity (IMA ≤14–16°); they cannot achieve correction needed for large IMA. Proximal osteotomies (crescentic, opening/closing wedge) or Lapidus tarsometatarsal arthrodesis are indicated for severe deformity as they allow greater angular correction at the first metatarsal base. Mitchell's osteotomy is a distal procedure suitable for moderate deformity only. Lapidus is also preferred when first tarsometatarsal joint instability (hypermobility) coexists.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.