Some of the most important factors to consider
are the patients chief complaint was a shoe
problem, the 1st MPJ is pain-free, the 1st
metatarsal head is fine and the cause of the
problem was an over corrected IMA . I consider
this to be a mild hallux varus compared to the
usual hallux varus that presents to my office. My
procedure of choice would be a reverse Akin
osteotomy (lateral wedge osteotomy of the hallux
base) which would also reverse some of the soft
tissue deformities. This would make the big toe
straight and allow the patient to wear a nice
shoe and add quality to her life.
I have used this procedure many times and have
had good results. I can't see any possible reason
to fuse a non painful joint and in my experience
a reverse Akin is an excellent procedure and the
patient can be placed into a regular shoe which
helps maintain the correction as the osteotomy
heals. I assume some doctors feel a fusion would
make it unlikely to get a recurrence of a hallux
varus, but in 35 years of practice I have rarely
found this to be a problem. I have probably
redone the reverse Akin one or two times, but
there are really no surgeries that never have to
be repeated on a few occasions.
The procedure is relatively painless and the
patient has such beneficial results compared to
having a foot where you can't wear a decent shoe
that the patient would rarely object to another
surgery down the road and the initial results are
comparably to some of the excellent you tubes I
have seen using a tight rope procedure. The
reverse Akin could be done with fixation,
percutaneous fixation or with non fixation which
is my choice. The big toe can be manipulated
during the post op course if necessary to get a
good correction with non fixation, but you can
lose this opportunity with fixation.
Ed Cohen, DPM, Gulfport, MS, ecohen1344@aol.com
