A 55-year-old woman with a 10-year history of painful hallux valgus deformity is being evaluated for surgery. The intermetatarsal angle (IMA) is measured at 18° and the hallux valgus angle (HVA) is 42°. Which osteotomy is most appropriate for this degree of deformity?
- A Chevron (Austin) osteotomy — distal first metatarsal
- B Mitchell osteotomy — distal first metatarsal
- C Scarf osteotomy or Lapidus arthrodesis — first tarsometatarsal joint fusion ✓
- D Keller's excision arthroplasty of the proximal phalanx
Correct answer: C. Scarf osteotomy or Lapidus arthrodesis — first tarsometatarsal joint fusion
Explanation
Severe hallux valgus is defined by HVA >40° and IMA >16°. Distal osteotomies like Chevron are limited to mild deformity (IMA <13°, HVA <30°). For severe deformity with a high IMA (>16°), proximal correction is required. The Lapidus procedure (first TMT arthrodesis) addresses hypermobility at the first TMT joint and is increasingly favoured for large, hypermobile deformities. Scarf osteotomy (mid-shaft) can correct moderate-to-severe deformities. Keller's arthroplasty is reserved for elderly low-demand patients.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.