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Flashcards in McG 32: Juvenile HAV Deck (46):
1

what is the incidence of HAV in adolescence

22-36%

2

is juvenile HAV more common in M or F

F

3

what percent of HAV occur b/l in females

75%

4

extrinsic factors

-tight or pointed shoes
-higher in the shod population than barefoot

5

intrinsic factors

-family hx (58-50%)

6

who is 5x more likely to develop HAV

black children

7

types of juvenile HAV

-congenital
-neurogenic
-idiopathic

8

what is Roots theory for causes of HAV

-the causative factor for all hallux HAV deformity is mechanical malfunction of the 1st MTPJ
-ex. factors that increase STJ pronation and instability of the 1st ray will enhance the progression of the hallux valgus deformity

9

what did Lapidus believe was the cause of HAV deformity

-instability of the medial column

10

what percent of adolescents with HAV had an abnormally high MAA

75%

11

what does an increase in PASA indicate

an increase in PASA indicates functional adaptation of the 1st MT due to chronic malpositioning of and abnormal faces on the great toe

12

how do you measure PASA

relationship between a line connecting the medial and lateral articular margins of the 1st MT head and the longitudinal axis of the 1st MT

13

normal PASA

0-8 degrees

14

how do you measure MAA on DP projection

angle formed between the line bisecting the 2nd MT and the longitudinal line bisection of the lesser tarsus

15

normal MAA

5-17; patological ~20

16

how do you calculate the true/effective IMA

IMA + (MAA-15)

17

what neurological disorder can lead to HAV

cerebral palsy - produce spasticity or contractors of the AT

18

what other factors can contribute to HAV in adolescence

-LLD
-torsional abnormalities
-neuromuscular disease
-MAA
-pes planovalgus

19

track bound joint indicates a deviation of the 1st MTPJ which is associated with what increased angle

PASA

20

relative contraindication to surgery

-ligamentous laxity
-hyper-elasticity
-neuromuscular disorders

21

goals of surgery

relieve pain, restore proper jt function, prevent progression of the deformity improve cosmesis

22

factors to consider

-age of pt
-growth plate status (open or close)
-presence of coexisting etiologies
-age of onset and progression of the deformity
-family hx
-degree of symptomatology - psychological and physical
-pt and parent expectations

23

what age should sx be performed

11-15

24

surgical options

-base of head osteotomies
-soft tissue procedures
-hallux osteotomies
-epiphysiodesis

25

List type 1 HAV characteristics

-earlier onset
-greater familial hx
-MA
-severe deforming forces such as pes planovalgus/equinus

26

T or F: Type 1 HAV individuals would benefit from early surgical intervention

T

27

list type 2 HAV characteristics

-pts w/ moderate deformity (IM, HAA)
-rectus foot type
-controllable deforming forces

28

when should sx be performed in type 2 HAV

when skeletal maturity has been achieved

29

goal of ST procedures

relocate the sesamoid apparatus beneath the 1st MT by aligning the FHL tendon allowing proper sagittal plane motion of the hallux

30

name additional ST procedures

lateral capsulotomy
medial capsulorrhaphy
transfer of the adductor tendon

31

name distal MT osteotomies for juvenile HAV

-autin, offset V, reversion, mitchell, wilson, peabody

32

MT head osteotomies can reduce the IMA by how much

13.3

33

complications of Mitchell and Wilson osteotomies

shortening
transfer lesions
elevates
metatarsalgia

34

when are transpositional osteotomies performed

when pts have a rectus foot and moderate IMA

35

name proximal osteotomies

closing or opening base wedge osteotomy
crescentic procedures
Lapidus

36

when are proximal osteotomies performed

IMA 15 degrees or greater

37

what percent of pts had good outcomes with the Lapidus

91%

38

indications for a Lapidus

-instability of the 1st ray
-long 1st MT
-IMA >25
-underlying neuromuscular disease
-genetic conditions such as Down syndrome

39

what is epiphysiodesis

arresting the lateral physic of the 1st MT base and allowing the medial physic to continue to grow

40

advantage of epiphysiodesis

less surgery
less post-op disability (WB immediately)

41

what is the golden period for epiphysiodesis

btw ages 9-14
F: 10-12
M: 11-14

42

where should the staple be placed for epiphysiodesis

dorsal to plantar in the lateral 25% of the MT base across the physis

43

what procedure is done in conjunction with epiphysiodesis

McBride bunionectomy

44

what ancillary procedures are performed with juvenile HAV

-MA correction
-cuneiform osteotomies
-pes valgus reconstruction
-ATL

45

complications

-residual pain
-jt stiffness
-recurrence
-hypertrophic scar formation

46

T or F: adolescents are more likely to develop hypertrophic scars

T - they have a longer inflammatory phase in wound healing