踇外翻矫形概要ppt课件.pptVIP

Patient EvaluationRADIOGRAPHY Intermetatarsal Angle Intersection of 1st and 2nd MT normally 9 degrees increased with metatarsus primus varus Patient EvaluationRADIOGRAPHY Distal Metatarsal Articular Angle Defines the relationship of the distal articular surface of the 1st MT to the longitudinal axis. Quantities the magnitude of lateral slope of articular surface. Patient EvaluationRADIOGRAPHY With subluxation, the articular surface deviates laterally in relationship to the 1st Metatarsal. Usually 6 degrees. Patient EvaluationRADIOGRAPHY Congruency of MTP joint Will determine appropriate surgical repair. An intra-articular repair, or soft tissue repair in the presence of a congruent joint is at a high risk to develop postoperative stiffness or recurrence. Patient EvaluationRADIOGRAPHY Metatarsocuneiform Joint Key role in alignment of first ray. Increased IM angle consistent with juvenile HV Theorized that IM deformity or metatarsus primus varus is often the primary deformity and hallux valgus follows. Hypermobility may predispose to recurrence. Classification Mild, Moderate, and Severe Classification : Mild Hallux valgus angle of less than 20° First-second intermetatarsal angle of 11° or less. Subluxation of the lateral sesamoid, as measured on an AP radiograph, is less than 50%. Classification : Moderate Hallux valgus angle of 20° to 40° First-second intermetatarsal angle of less than 16° . 50% to 75% Subluxation of the lateral Sesamoid. Classification : Severe Hallux Valgus angle of more than 40° First-second intermetatarsal angle of 16° or more More than 75% subluxation of the lateral sesamoid. Treatment Non-operative vs. Operative All patients should be treated non-operatively first. Important to decide who wants the treatment--parents or the patient. Pain more important than cosmesis. TreatmentNON-OPERATIVE Footwear Modification Widen toe box decrease lateral deviation of great toe decrease inflammation and pain Decrease heel height pr