In the surgical management of hallux valgus with a hallux valgus angle (HVA) of 38° and intermetatarsal angle (IMA) of 18°, the appropriate osteotomy for correction is:
- A Distal chevron osteotomy (Austin procedure)
- B Mitchell osteotomy (distal metatarsal step-cut)
- C Proximal crescentic osteotomy or Lapidus procedure (1st TMTJ fusion) ✓
- D Keller's arthroplasty (proximal phalanx base resection)
Explanation
Selection of hallux valgus osteotomy is based on deformity severity: mild (HVA <20°, IMA <13°) — distal osteotomy (chevron/Mitchell); moderate (HVA 20–40°, IMA 13–20°) — proximal or shaft osteotomy (Ludloff, Scarf, proximal crescentic); severe (HVA >40°, IMA >20°) or hypermobile 1st ray — Lapidus procedure (1st TMT joint arthrodesis) or proximal crescentic osteotomy with soft tissue balancing. An HVA of 38° and IMA of 18° falls in the severe-moderate range, making a proximal procedure necessary to achieve adequate correction. 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.