踇外翻矫形.pptVIP

Hallux Valgus Hallux Valgus Lateral deviation of the great toe and medial deviation of the first metatarsal Progressive subluxation of the first metatarsophalangeal (MTP) joint Hallux Valgus Static deformity due to valgus angulation of the distal articular surface of the first metatarsal or the proximal phalangeal articular surface. Pathophysiology of Deformity no single cause generalized ligamentous laxity footwear female sex family history intrinsic or anatomic conditions extrinsic causes Pathophysiology - Extrinsic Almost exclusively in shoe-wearing societies Coughlin MJ, Thompson FM: The high price of high-fashion footwear, in Jackson DW (ed): Instructional Course Lectures 44. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1995, pp 371-377. Pathophysiology Sim Fook L, Hodgson AR: A comparison of foot forms among the non-shoe and shoe-wearing Chinese population. J Bone Joint Surg 1958;40A:1058-1062 Kato T, Watanabe S: The etiology of hallux valgus in Japan. Clin Orthop 1981;157:78-81 Pathophysiology - Intrinsic Pronation of the Hindfoot Inman VT: Hallux valgus: A review of etiologic factors. Orthop Clin North Am 1974;5:59-66. Hohmann G: Der hallux valgus und die ubrigen Zehenverkrummungen Ergeben. Chir Orthop 1925;18:308-376 Pathophysiology - Intrinsic Pes planus - allows pronation of 1st MT and decreases the effect of the abductor--reported 50% incidence Metatarsus Primus Varus - lateral deviation of MTP Contracture of the Achilles tendon Generalized joint laxity Hypermobility of the first metatarsocuneiform joint Neuromuscular disorders (including cerebral palsy and stroke). Pathophysiology - Heredity Hardy and Clapham noted that 63% of the 91 patients in their series had a parent who had hallux valgus Coughlin reported that a bunion was identified in 94% of 31 mothers of children who had hallux valgus. Anatomy The Great toe is different than lesser toes Sesamoid mechanism A set of intrinsic muscles that stabilize the joint and provide