3-s2.0-B9780721677842500255-main

Index

AAbductor hallucis brevis transfer,

427,428Acumed implants, 341, 342,342Adductor tendon transfer,

103-110contraindications to, 110and hallux varus, 420for intermetatarsal reduction, 108operative procedures for,

104, 105, 106, 106, 107,108, 108, 109

postop management of, 109to reduce lMA, 110to relocate hallucal sesamoids,

109-110Adductus feet

HAAin, 35IMA in, 31, 33MAAin,31PASAin, 35

Adhesionsand hallux varus, 420, 421release of, 379

Akin-type proceduresbiomechanical considerations

in, 113complications of, 125-127, 126cylindric, 116, 118, 119-120, 122distal, 113-114,115

wire fixation in, 86history of, 112oblique, 116, 117proximal, 123-125sesamoid deviation after, 465

Anatomy, 72-73, 73, 74, 75Angular relationships; see Preoperative

evaluation, radiographic,angular relationships

Ankle equinus, 348Antibiotics, 483

prophylactic, 324-325APview, 28Arthrodesis

abrasional arthroplasty for, 352,353, 354

of first metatarsocuneiform joint;see Lapidus procedure

of first MTPJ; see First metatarsopha-langeal joint arthrodesis

Arthroplastyabrasional

for hallux Iimitus/rigidus,379-382,382

for primary arthrodesis, 352,353,354

of first MTPJ; see Keller procedureimplant; see Implants

Articular damage, 445-446,446-447Aseptic necrosis, implants and, 458Assistant surgeon, 79Austin procedures, 129-160

advantages of, 157-158and avascular necrosis, 462, 463bicorrectional, 131

contraindications to, 159fixation in, 145, 146operative technique for, 152-153

biomechanical considerationsin, 134

Page numbers in italics refer to figures and tables.487

488 Index

Austin procedures-cont' dbiplane, 132

fixation in, 148, 151operative technique for, 141-152

contraindications to, 158-159disadvantages of, 158general considerations and modifica-

tions for, 134, 136, 135-137,138,139-140, 141

with Herbert screw fixation,146-148

inherent complications with,159-160

with intraarticular fracture, 446-447metatarsal neck width in, 132osteomyelitis after, 481PASAand,37postop management of, 157preop indications for, 129-130,

132,133reverse, for hallux varus, 429suspensory ligaments in, 83unicorrectional, 130

contraindications to, 158-159fixation in, 145, 150, 152operative technique for, 141-152

Youngswick modification of,153-157

Avascular necrosisand negative PASA, 418as postop complication,

462-464, 482Axis of motion, 18, 19

B

Bandaging, postoperativeapplication of, 89and hallux varus, 415, 416

Basilar osteotomy, PASA and, 37Bio-Action implants, 341, 342,343Biomet Total Toe System, 341-342,341Biopro implants, 325, 327Bone

condition ofosteoporotic,442-443radiographic evaluation of,

56-57, 59, 60cysts, 441-442, 442ectopic formation of, 453, 454excessivewedge removal of, 443

Bone-cont'dfracturing, implants and, 452,

453,458immobilization for healing

problems, 475, 477, 480Bone grafts

calcaneal, 475-476, 477, 478-479excessive lengthening using, 443for hallux limitus/rigidus, 382-383in opening abductory wedge

osteotomy, 268-269,271,274-275

for poor bone healing, 475-477,476,477

in revisional arthrodesis, 354,355-356, 355, 356, 357, 359,360,360

Bone plates and screws, 87Bunion location, 23, 25

CCallus distraction, 358, 359, 360, 360Cancellous screws, 87Capsulodesis, 379Capsulotomy/capsulorrhaphy, 79-80,

82-83complications of, 435-438, 436,

437,438in Keller procedure, 311, 312with McBride-type bunionec-

tomy, 99types of, 80-82, 81, 82

Casts, 92Charting, preoperative data, 73, 76Cheilectomy, 379,380, 381Chevron osteotomy, safe zones for, 75Closing abductory wedge osteotomy,

196-249comparison of pathologic conditions

addressed by, 249complications with, 242-244, 242,

243,244,245,246,247-248,247-248

hinge/axis concept in, 196-201, 197,198-199,200

Loison-Balacescu type, 204-214advantages and disadvantages

of,214operative technique of, 205,

210-211,211,212-213

Closing abductory wedgeosteotomy-cont'd

Loison-Balacescu type-cont'dpostop management of, 211, 214preop signs in, 204-205templates in, 206-210

modified Iuvara (type A), 214-223advantages and disadvantages

of,223operative technique of,

215,216-217,218,218-221,222-223,222

postop management of, 223modified Iuvara (type B),

223-235, 224advantages of, 229disadvantages of, 231-232operative technique of, 225-226,

226-229, 228, 230-232postop management of, 228preop signs in, 225,235templates in, 233-234

modified Juvara (type C),235-242

advantages of, 238disadvantages of, 238, 242operative technique of, 236,

237-238, 239-240postop management of, 236preop signs in, 236templates in, 241

Reese osteotomy guide in, 201-202,203, 204

Cortical screws, 87Crescentic osteotomy, 252-266

advantages and disadvantagesof,264

biomechanical considerationsin, 257

complications from, 265-266contraindications to, 265distal

contraindications to, 265operative technique for, 257,

258, 259postop management for, 264preop indications for, 252,

253-254, 253, 254for hallux limitus/rigidus, 397,

398-399

Index 489

Crescentic osteotomy-cont'dpostop management of, 262,

262-263proximal

contraindications to, 265operative technique for, 260-262,

260,261postop management for, 264preop indications for, 254-255,

255,256,257Crista pain, 21-22Crutches, 92

D

Darco bunion splint, 91Degenerative joint disease (DJD),

44-45, 45, 46Delayed union, as postop complica-

tion, 473-480Derotational, angulational, transposi-

tional osteotomy (DRATO)procedure, 179-181,180

Distal articular set angle (DASA),38-39,38

Dorsal Vosteotomy, 385, 389-390,390,391-392

Dorsolinear capsulotomy, 81, 81Double osteotomy of first metatarsal,

277-287advantages and disadvantages

of, 286complications from, 287operative technique in, 279-281,

280-281, 282, 283, 284, 284,285, 286

PASAin,277,278postop management of, 286preop signs and symptoms and,

278,279Drain system, 89,89Durallium implant, 320

E

Ectopic bone formation, 453, 454EHL; see Extensor hallucis longusElastic modulus, implant materials,

321-322Extensor hallucis brevis transfer/

tenodesis, 426, 426

490 Index

Extensor hallucis longus (EHL)contracture of, 23, 26evaluation of, 100-101lengthening of, 101-102severing of, 438, 439transfer of, 424, 425

F

Fibular suspensory ligament, 83-84,83,84

First metatarsalanatomic considerations of,

72,73partial ostectomy of, 95-98,

96,97radiographic evaluation

of base, 56,57,58of declination angle, 52-53,53of head shape, 45-48, 47, 48of sagittal plane alignment, 52-56,

53,54,55transverse plane shape of, 45-46, 47vascular anatomy of, 72-73, 75

First metatarsal head osteotomy,162-181

general conditions with, 162-163Hohmann's dual-plane displacement

osteotomy, 175-176, 175modifications of, 176-181, 177,

178,180Reverdin procedure, 163-168, 164,

166,168-174,169,171,172,173-174

First metatarsocuneiform jointarthrodesis; see Lapidusprocedure

First metatarsophalangeal joint (MTPJ)axis of motion, 18, 19capsulotomies, 79-83,80,81,82DID of, 44-45, 45, 46during gait, 5-7, 6fusion position, 350-351, 350, 351grooved, 46, 47intrinsic muscles of, 414ligamentous arrangement of, 72, 74nonsalvageable, 430non-weight-bearing exam of, 16, 17,

18,19pain location in, 20-21,21passive dorsiflexion of, 28, 29

First metatarsophalangeal joint(MTPJ)-cont'd

radiographic evaluation of, 43-45,43,45,46

range of motion, 17First metatarsophalangeal joint (MTPJ)

arthrodesis, 347-368advantages and disadvantages of,

366-367biomechanical considerations and,

348-352complications from, 367-368contraindications to, 367fusion position in, 349-351,

350,351for hallux limitus/rigldus, 408metatarsal length and, 349operative technique of, 352-365

vs. abrasional arthroplasty, 352,353,354,354

fixation methods in, 360-361,361,362-363, 363-365,364,365

incisional approach and jointdebridement, 352

revisionalfreconstructive, 354-356,355, 356, 357-358, 358, 359,360,360

postop management of, 365-366preop indications for, 347-348

First ray, 14-16critical areas of surgical

evaluation, 63dorsiflexed, 14-16non-weight-bearing exam of, 14-16,

15, 16range of motion, 377,377

Fixationdevice selection for, 85-87, 86in first MTPI arthrodesis, 360-361,

361,362-363,363-365,364,365

Fluoroscopy, intraoperative, 87, 89Foreign body reaction, 452-453Fracturing

bone,452,453,458of implants, 449, 450, 451

Futura implants, 325,326, 327, 329,330,335,335

positioning of, 329

GGait, 6-7, 6GAITimplants, 330, 334-335, 335,

338,338,339Giannestra stepcut recession modifi-

cation; see Sagittal Z procedureGreat toe arthroplasty implant

technique; see GAIT implantsGreen modification of Reverdin

procedure; see Reverdin-Creenprocedure

H

HAA; see Hallux abductus angleHAIA; see Hallux abductus inter-

phalangeus angleHallux abducto valgus, 3-4, 4

biomechanics and, 5-7, 6deformity in, 35evaluation of; see Preoperative

evaluationvs. hallux limitus, 7opening abductory wedge osteotomy

of; see Opening abductorywedge osteotomy

progression of, 7-8recurrence with implants, 458-459stages of, 8, 9tibial sesamoid position and, 49

Hallux abductus; see Hallux valgusHallux abductus angle (HAA)

and first MTPJ arthrodesis, 349radiographic evaluation of, 34-35,34

Hallux abductus interphalangeus,18-20,20

Hallux abductus interphalangeus angle(HAIA), 39-40,39

Hallux adductus; see Hallux varusHallux distraction maneuver, 377,378Hallux elevatus, 127

implants and, 457-458Hallux fusion position, determining,

350-351,350,351Hallux glide maneuver, 377, 378Hallux hammertoe, 20

and first MTPJ arthrodesis, 349Hallux interphalangeal joint

non-weight-bearing exam of,18-20,20

pinch lesion, 22

Index 491

Hallux Iimitus/rigidus, 371-409biomechanics and, 5-7, 6, 375classification of, 373conservative treatment and,

375-378definition of, 18etiology of, 3-4,5, 371-372evaluation of; see Preoperative

evaluationfunctional, 375hallux abducto valgus vs., 7iatrogenic, 372implants and, 454joint destruction techniques for, 399,

406-408first MTPJ arthrodesis, 408resectional arthroplasty procedure,

399,406,407-408joint preservation techniques for,

378-399cheilectomy, 379,380,381chondral abrasion arthroplasty,

379-382,382combination of procedures in,

399,405,406crescentic osteotomy,

398-399,397dorsal Vosteotomy, 385, 389-390,

390,391-392Hohmann-type procedure,

383-384, 383Iuvara modification (type C), 396,

396, 397, 398, 398Mau osteotomy, 394, 395plantarflexory wedge osteotomy,

390,392,393-394,394Regnauld procedure, 382-383sagittal Z osteotomy, 399, 400,

401-402, 403, 404-405soft tissue release, 379Waterrnann procedure, 384, 385,

386-387Youngswick-Austin modification,

384-385,387,388-389preop signs and symptoms of, 374progression of, 8stages of, 10, 12-13

Hallux malleus, 20hallux varus repair and, 422,

423,424

492 Index

Hallux position, non-weight-bearingexam of, 23, 24

Hallux rigidus; see Hallux limitus/rigidus

Hallux toe purchase, 26, 27, 28Hallux valgus

medial capsulorraphy and, 415, 416recurrence of, 464-465, 466, 467rotation of, 60-61, 60

Hallux varus, 411-432biomechanical considerations with

repair of, 413-415, 414causes of, 411, 412from hallux valgus overcorrec-

tion,464iatrogenic, pathomechanics of,

415-416,418-419,416,417,418,419,420-421

implants and, 459-460management of, 422from Mitchell bunionectomy,

262-263operative repair technique for,

422-430abductor hallucis brevis transfer

in, 427,428extensor hallucis brevis transfer in,

426,426extensor hallucis longus transfer

in, 424, 425IMAovercorrection in, 427,429,

430-431medial capsulotomy in,

422-423, 423medial sesamoid subluxation,

423,424nonsalvageable first MTPJ in, 430PASA overcorrection in, 427, 432postop management after, 430staked or lateral subluxation of

metatarsal head in, 427preop indications for repair of,

411-413Hammertoe, 20

hallux varus repair and, 422,423,424

of second toe, 23,25Hemi-implants, 325-330, 326,

328,329dislocation of, 455

Hemi-implants-cont'dand ectopic bone, 454fracturing of, 451historical development of, 320-321operative technique for, 327,328,

329,329postop management of, 329-330preop criteria for, 326-327

Herbert screw fixation, Austinprocedure with, 146-148

Heredity, 4Hinge/axis concept, 196-201, 197,

198-199,200History, preoperative, 10-12, 13, 14Hohmann's dual-plane displacement

osteotomy, 175-176, 175modifications of, 176-181

DRATO procedure, 179-181, 180Mitchell procedure, 176-179,

177, 178Hohmann-type procedure,

383-384,383with Watermann procedure, 405

H-shaped medial capsulotomy, 80, 81Hyperkeratotic lesions, exam for,

22-23,22Hypermobility

and first MTPJ arthrodesis, 349of first ray, 14and implants, 456-457

I

Immobilization, for bone healingproblems, 475, 477, 480

Implants, 319-344; seealso specificimplants

aseptic loosening of, 452complications with, 445, 448-460

failure of, 449-450, 451infection, 448-449reactions to, 452-454, 453, 454surgical technique failure,

454-460,455,456,457,459deformation of, 450, 451dislocation of, 454, 455elastic modulus and, 321-322fatigue fracturing of, 449, 450,451general criteria for, 322for hallux limitus/rigidus, 407-408hemi-implants, 325-330

Implants-cont'dhistorical development of, 320-321Keller bunionectomy and, 319malposition of, 455-456, 456, 457pistoning of, 323telescoping of, 458, 459technique considerations in,

322-325total flexible hinge, 330-340

Futura, 335, 335GAIT, 334-335,335,338, 339LaPorta, 332,333, 334,339,340Lawrence, 334,334,338operative technique for, 336,337,

338-339outcomes with, 340preop criteria for, 336Swanson, 331, 332,332,339

two-component, 340-344Incision care, after suture removal, 90Infection

with implants, 448-449as postop complication, 480-481,

481,482,483-484,483Instruments and devices, 79Intermetatarsal angle (IMA)

and hallux varus, 418, 420-421overcorrection of, 427, 429,

430-431radiographic evaluation of, 31,32reduction of, 103, 104, 106, 106,

107, 108, 108, 109adductor tendon transfer for,

108,110osteotomy guidelines for, 33

Interphalangeal joint arthrodesis,424,425

Interpositional capsular flap, 307,308,309,310-311,310,311

Intraoperative complications, 434-447articular damage, 445-446, 446-447with capsulotomy/capsulorrhaphy,

435-438,436, 437, 438with implants, 445with medial eminence resection,

434-435, 435with osteotomy procedures,

441-443with tendon procedures, 438-441,

439, 440-441

Index 493

Intraoperative considerations,79-89

capsulotomies in, 79-83, 80,81,82

drain system in, 89, 89fibular sesamoid removal in, 83-85,

83, 84fixation devices in, 85-87, 86of instruments and devices, 79postop bandage in, 89radiography in, 87, 88, 89of skin scribe, 79

JJacoby bunion splint, 91Joint motion limitation, as postop

complication, 470-471Joplin procedure, 106, 107, 108,

108,109Joplin's neuritis/neuroma, 21Juvara osteotomies

complications from, 243, 243, 244,244,245, 247,247-248

and double osteotomy of firstmetatarsal, 281, 284,284,285

reverse, 429type A, 214-223

advantages and disadvantagesof, 223

operative technique, 215,215,218,218-221,222-223

pathologic conditions addressedby,249

postop management of, 223pre- and postop radiography

of,222templates in, 216-217

type B, 223,224advantages of, 229disadvantages of, 231-232postop management of, 228preop and postop radiography

of, 235preop signs of, 225

type B1operative technique, 225-226,

226-229pathologic conditions addressed

by,249

494 Index

Juvara osteotomies-cont' dtype 82

operative technique, 226, 228,230-232, 233-234

pathologic conditions addressedby, 249

type C, 235-242advantages of, 238disadvantages of, 238, 242for hallux limitusjrigidus, 396,

396, 397, 398, 398postop management of, 236preop signs and, 236

type C1operative technique, 236,237-238pathologic conditions addressed

by, 249typeC2

operative technique, 236, 239-240pathologic conditions addressed

by,249with Watermann procedure, 406

K

Kalish modification, 124, 139contraindications to, 159osteomyelitis after, 482

Keller procedure, 303-317advantages and disadvantages of,

316-317biomechanical considerations for,

304-305complications from, 317contraindications to, 317for hallux limitusjrigidus, 399, 406

with joint prostheses, 407-408metatarsal base osteotomy in,

407-408and implants, 319operative technique for, 305-313

functional procedure, 307, 308,309,310-311,310,311,312,313,313

simple procedure, 305-307,306postop management for, 313,314,

315,315-316preop indications for, 303-304

Keller resectional arthroplasty, firstMTPJ arthrodesis vs., 347

Kinetik Great Toe Implant, 341, 342

Kirschner wires, 85-86in Keller procedure, 313,313

L

Lapidus procedure, 288-301advantages and disadvantages

of,301alternative technique, 298, 299, 300complications from, 300-301,301operative technique of, 289,

291-293,292,293,294,295,295-297,296, 297

postop care of, 297-298preop signs and symptoms of, 289,

290,291LaPorta implants, 330, 332, 333,

334,336outcomes with, 340radiographs of, 340

Lateral capsular release, safe zonesfor, 75

Lateral collateral ligament, and fibularsesamoidectomy, 83, 83, 84,84

Lateral subluxation (rotation) of meta-tarsal head

and hallux varus, 416, 417operative technique for, 427

Lateral view, 28Lawrence implants, 330, 334, 334

fracturing of, 450outcomes with, 340template instrument for, 338, 338

Leg length discrepancy, first MTPJarthrodesis and, 348

Lenticular capsulotomy, 82, 82Ligaments, first MTPJ, 74Linear relationships, in radiographic

evaluation, 40-42Lisfranc dislocation, 290Loison-Balacescu type osteotomy,

204-214advantages and disadvantages

of, 214operative technique of, 205,

210-211,211,212-213pathologic conditions addressed

by, 249postop management of, 211, 214preop signs in, 204-205templates in, 206-210

Long flexor tendonreanastomosing, 440-441, 440-441severing of, 439-440

L-shaped medial capsulotomy, 80,81

M

MAA; seeMetatarsus adductus angleMalunion, as postop complication,

473-480Mau osteotomy, 394, 395, 428McBride-Akin procedure, and recurrent

hallux abductus, 465, 466McBride-type procedure, 98-103

with adductor tendon transfer,109,109

and crescentic osteotomy, 260fibular suspensory ligament in,

83-84Medial capsulorraphy, hallux varus

from, 415,416Medial capsulotomy, for hallux varus,

422-423, 423Medial eminence resection

complications of, 434-435, 435and hallux varus, 415, 417

Medial oblique (MO) radiographicview, 28

Medial sesamoid subluxation,and hallux varus repair,422-423, 424

Mediovertical capsulotomy, 80, 81Metallosis, 452Metatarsal elevatus, 404, 405

as postop complication, 468-470,469,470

Metatarsalgia, as postop complication,471-473

Metatarsal head cysts, 57, 59, 60Metatarsal head staking, and hallux

varus, 415, 417Metatarsal protrusion distance (MPD),

40-41,40Metatarsal width, 41-42, 41Metatarsus adductus, and recurrent

hallux valgus deformity, 465,466,467

Metatarsus adductus angle (MAA)radiographic evaluation of,

30-31,30and TAA, 32, 33, 34

Index 495

Metatarsus primus adductus, 31closing abductory wedge osteotomy

for; seeClosing abductory wedgeosteotomy

Metatarsus primus elevatus, 14-16Mineralization, radiographic evalua-

tion of, 56-57, 59Mitchell procedure, 176-179, 177, 178

hallux varus secondary to,262-263

Morton's extension, 472,473

N

Necrosisaseptic, implants and, 458avascular; seeAvascular necrosis

Neutral calcaneal stance position(NCSP), 28,29

Nonunion, as postop complication,473-480

Non-weight-bearing clinical exam;see Physical examination,preoperative, non-weightbearing

oOnychocryptosis, 23Opening abductory wedge osteotomy,

267-276advantages and disadvantages

of,275biomechanical considerations

and,268complications from, 275and double osteotomy of first meta-

tarsal, 283operative technique of, 268-270,

270-273, 272postop management of,

273-275,274preop considerations for, 268, 269

Orthoses, in preop evaluation,77-78

ORTHOSORB, in Austin proce-dure, 148

Osteomed Reflexion implant, 341, 342Osteomyelitis, 449

as postop complication, 480-481,481, 482

Osteoporotic bone, 442-443

496 Index

Osteotomy procedures; see also specificprocedures

bone density and, 56-57complications of, 441-443PASA and, 36, 37, 38

Overcorrection, as po stop complica-tion, 464-470

Overlay capsular graft, 437, 437

PPadding, in preop evaluation, 78Pain

location of, 20-22, 21in preop evaluation, 10-12

Palpation, for pain location,20-22,21

PASA; see Proximal articular set anglePast medical history, 14Peabody procedure, 165Phalangeal osteotomy procedures,

112-127Akin-type

biomechanical considerationsin, 113

complications of, 125-127,126distal, 113-114, 115oblique, 116, 117proximal, 123-125

general preop indications for,112-113

to shorten/lengthen proximalphalanx, 116, 118-123

Physical examination, preoperative,14-28

non-weight-bearing, 14-23of associated deformities,

23,25of bunion location, 23, 25of EHL contracture, 23, 26of first MTPJ, 16, 17, 18, 19of first ray, 14-16,15, 16of hallux interphalangeal joint,

18-20,20of hallux position, 23, 24of hyperkeratotic lesions,

22-23,22pain location in, 20-22, 21

weight-bearing, 23, 26,27, 28Physical therapy, after surgery,

90-91

Pinsabsorbable, 86-87fixation, in first MTPJ arthrodesis,

360-361,361Plantar adhesions release, 379Plantaraxial view, 28Plantarflexion, as postop complication,

467-468,468Plantarflexory wedge osteotomy, 390,

392, 393-394, 394Plantarmedial pinch lesion, 22Plates

complications with, 445fixation, in first MTPJ arthrodesis,

363-365, 364, 365Postoperative complications, 462-484

avascular necrosis, 462-464delayed union, nonunion,

and malunion, 473-480infection, 480-484limitation of joint motion, 470-471metatarsalgia, 471-473overcorrection and undercorrection,

464-470Postoperative considerations, 90-92, 91Preoperative evaluation, 1-66

anatomic considerations in, 72-73,73,74,75

and assistant surgeon, 79charting of data in, 73, 76of EHL tendon, 100-101etiologic factors in, 3-8

of hallux abducto valgus, 4, 7,7-8,8

of hallux limitus, 5, 7, 8form for, 65-66history in, 10-12, 13, 14interpretation of findings in, 61-62,

63, 64orthoses, padding and shoes in,

77-78physical exam in, seePhysical exami-

nation, preoperativeradiographic, 28, 30-61

of bone condition, 56-57,59, 60of bony prominences, 61, 62ofDASA, 38-39,38of first metatarsal base, 56, 57, 58of first metatarsal head shape,

45-48,47, 48

Preoperative evaluation-cont'dradiographic-cont'd

of first metatarsal sagittal planealignment, 52-56, 53, 54, 55

of first MTPJ, 43-45, 43, 45, 46of HAA, 34-35, 34of HAIA, 39-40,39ofIMA, 31,32of MAA, 30-31, 30of metatarsal protrusion distance,

40-41,40of metatarsal width, 41-42, 41of PASA, 35-36,36,36,37,38of proximal phalanx length,

42,42of sesamoids, 48-52, 49,

50-51,52ofTAA, 32-34,33ofvalgus rotation of hallux,

60-61, 60views in, 28

template utilization in, 76-77, 77use of, 78-79

Pronation, abnormal, 6-7Proximal articular set angle (PASA)

Austin procedure and, 144in double osteotomy of first meta-

tarsal, 277-278, 278,282functional vs. dysfunctional, 36,36,

37,38overcorrection of, 418, 419,

427,432radiographic evaluation of, 35-36,

36,38SCARF procedure and, 186,187

Proximal phalanxanatomic considerations of, 72, 73length of

and first MTPJarthrodesis, 349radiographic evaluation of, 42, 42

procedures to shorten orlengthen, 116, 118-120,119-120, 121, 122-123

RRadiography

intraoperative, 87, 88, 89preop; see Preoperative evaluation,

radiographicpostop,90

Index 497

Range of motionexercises, for hallux limitus,

376-377,376of first MTPJ, 17implants and, 456-457

Rectus feetHAAin, 35and lMA, 31, 33PASAin, 35

Reese osteotomy guide, 136, 139-140,142,201

application of, 201-202,203, 204in Iuvara type A osteotomy, 218,

218-221in Youngswick-Austin procedure,

155-156,155Regnauld procedure, 118-120,

122-123for hallux limitus/rigidus,

382-383Relaxed calcaneal stance position

(RCSP),28Removable bunion splint, 90, 91Resectional arthroplasty with prosthe-

ses, 399, 406, 407-408Reverdin-Green procedure,

168-170, 169and double osteotomy of first meta-

tarsal, 281-282, 282, 285reverse, 427, 432

Reverdin procedure, 163-168advantages and disadvantages of,

167-168modifications, 168-174

Reverdin-Creen procedure,168-170, 169, 281-282, 282,285,427,432

Reverdin-Laird procedure,170-171,171,172,173-174,173-174

operative technique, 163-166,164postop management of, 166-167preop criteria for, 163radiography of, 166

SSagittal Z procedure, 118, 120, 121,

122, 123for hallux limitus/rigidus, 399, 400,

401-402,403,404-405

498 Index

SCARF procedure, 183-195advantages and disadvantages of,

193, 194contraindications and complica-

tions, 194operative technique, 188-189,

189-190, 191postop management of, 193preop indications and consider-

ations for, 188reverse, 430-431technique modifications, 191,

192, 193Screws, 87

complications with, 445in first MTPJ arthrodesis, 361,

362-363, 363Second metatarsal, alignment of first

metatarsal relative to, 53-54,55, 56

Sesamoidectomyfibular, 83-85, 83,84, 100,101

and hallux varus, 419tibial

and hallux varus repair, 423, 424in McBride-type bunionec-

torny, 99Sesamoiditis, implants and, 460Sesamoids

and first MTPJ arthrodesis, 351-352hallucal

adductor tendon transfer and,109-110

relocation of, 103, 104, lOS,106,109

pain in, 21, 22radiographic evaluation of, 48-52,

49, 50-51, 52tibial

medial subluxation, 418, 418position relative to first MTPJ,

51-52,52Shoes

hallux abducto valgus from, 4, 7-8in preop evaluation, 78surgical, 92

Silicone elastomers, in implants,321-322

Silicone joint prothesis, for halluxlimitus/rigidus, 407

Silver procedure, 95-98, 96, 97sesamoid deviation after, 465

Skin scribe, 79Smart Pin, 86-87, 149-150Smart Screw, 151Soft tissue anchors, 87Soft tissue bunion procedures,

95-110adductor tendon transfer,

103-110McBride-type bunionectorny,

98-103Silver procedure, 95-98,96, 97

Soft tissue release, for hallux limitus/rigidus, 379

Sokoloff V osteotomy, 390Splint, removable bunion, 90, 91Stainless steel wire, 85, 86Staked first metatarsal head, 434, 435

operative technique for, 427Staples, 86Steinmann pins

in Austin procedure, 152in first MTPJ arthrodesis,

360-361,361Sterilization, of implants, 322-323Steroids

for hallux limitus, 375with implants, 323

Stretching exercise, for hallux limitus.376,376

Subchondral cyst formation, implantsand,453,454,454

Surgical history, 12Suture material, 85Suture removal, incision care after, 90Swanson implants, 339,339

deformation of, 451flexible hinge toe, 330,331, 332,332outcomes with, 340rotation of, 456silicone, 320-321, 320titanium, 326, 328

Synovitis, reactive, 452

TTAA; seeTotal adductus angleTailor's bunion, 415Talus, first metatarsal sagittal position

relative to, 53,54

Templatesin Austin procedure, 134,

135-137, 138utilization of, 76-77, 77

Tendon procedures; seealso specifictendons

complications of, 438-441, 439,440-441

TLS drain system, 89,89Total adductus angle (TAA),

32-34,33Total flexible hinge implants,

330-340Futura, 335, 335GAIT, 334-335, 335, 338, 339Lal'orta, 332, 333, 334,

339,340Lawrence, 334, 334, 338operative technique for, 336,337,

338-339outcomes with, 340preop criteria for, 336Swanson,331,332,332,339

Trackbound, 18, 19Transpositional capital osteotomy,

metatarsal width and, 41-42Troughing phenomenon, 184, 185,

186, 194T-shaped dorsal capsulotomy,

81-82,81T-shaped medial capsulotomy, 80, 81Two-component implants, 340-344,

341,342,343historical development of, 321

Two-component joint prosthesis, 407

Index 499

U

Undercorrection, as postopcomplication, 464-470

U-shaped medial capsulotomy, 80, 81

V

Van Ness procedure, 392Vascular anatomy, first MTPJ, 75Vitallium implant, 320

W

Watermann procedure, 384, 385,386-387

with Hohmann-type osteotomy, 405with Iuvara-type osteotomy, 406

Wedge osteotomy, excessive boneremoval in, 443

Weight-bearing clinical evaluation, 23,26,27,28

Wilson-type bunionectomy, postopradiographs of, 258

Wound care, for postop infection, 481,483-484

Wright Medical's Titanium Hemi ToeImplant, 325, 327

YYoungswick-Austin modification, 153,

154, 155-157,155, 156contraindications to, 159for hallux limitus/rigidus, 384-385,

387,388-389

zZ osteotomy, 183