HAV-angelo

Question 1

etiology and pathogenesis of HAV

Answer 1

1- Erosion of sagittal groove
Sagittal grove functionLmedial (inner) aspect of the first metatarsal head. A guide for sesamoid bone, therefore. misalignment of 1st Met
2-Strong family history -10 % acquired
3-Anatomical factor: Large IM 1-2 , round met head, long first met head
4-Abnormal Tib post and EHL tendon insertion to adductors
5-Abnormal foot posture

Question 2

Characteristics of HAV

Answer 2

• dealing with a progressive disorder
  -Operation at early age is better
• HAV induces hammer toe 2nd digit surgery success rate is lower than bunion itself

Question 3

What is the benefit of hav a classification

Answer 3

-inform prognosis of the patient
-the likelihood of progression
Normal HV angle 15 and IM angle 9

Severe: HV: 40 and IM: 18

Question 4

Tibial sesamoid position

Answer 4

essential to reduce the risk of recurrence

Question 5

Evaluation of joint congruency

Answer 5

-Congruent joints need structural correction
-Deviated need soft tissue correction
-Subluxed joints need soft tissue and structural

Question 6

What are conservative treatment of HAV?

Answer 6

Monitoring and following up - wait and see for change
Toe alignment splints
foot exercises
orthotic therapy
physical therapy
deep and wired shoe

Question 7

What are the indications for bunion surgery

Answer 7

• pain and deformity affecting balance
• ## correlation between HAV and falls

Question 8

What are the surgery names and their indications?

Answer 8

-Scarf Oseotomoy HV angle <40, deformity not correctable
-Chevom first MT osteotomy, no soft tissue release-HV angle less than 30
-Lapidus with 1st ray hypermobility

Question 9

Silver procedure

Answer 9

-no correction of IM, HVA, SESAMOID postion- Resection of Bump

Question 10

McBride procedure

Answer 10

Soft tissue procedure
removal of medial eminance, release of adductor hallucis
Relase of FHB

Question 11

Reverdine procedure

Answer 11

Increased PASA

Question 12

Mitchel ostetomy

Answer 12

-Transporting met head laterally
-poor long term outcome

Question 13

Austin or chevron osteotomy

Answer 13

mild to moderate deformity
60 V osteotomy through the 1st MH

Question 14

Scarf osteotomy

Answer 14

IM up to 22- Severe deformity

Question 14

Akin Osteotomy

Answer 14

Adjunctive procedure to address HAA

Question 15

Base wedge osteotomy

Answer 15

-Proximal osteotomy
-high degree of IM
-Indicated for adolescent
- 6-8 week NWB post op

Question 16

Destructive versus none destructive surgery?

Answer 16

if more than 50% of joint is eroded destructive surgery procedure are choice of preference

Question 17

Name destructive surgery procedure of HAV?

Answer 17

Keller arthroplasty
1st MTPJ fusion ( arthrodesis)
1MCQ lapidus fusion

Question 18

Lapidus indication?

Answer 18

-Severe IMA + HYPERMOBILITY
-OA of MCJ

Question 19

Keller arthroplasty indication

Answer 19

none healing ulcers of IPJ
Poor predictability

Question 20

1st MTPJ arthrodesis

Answer 20

severe deformity
Severe OA
proximal phalanx DF 15-20 to prevent overload
Maintains medial arch- no need for soft tissue involvement
Promotes arthritis at IPJ
Difficulty kneeling
not able to wear high heel shoes
Gold standard