Armen S. Kelikian

1. Hallux valgus: metatarsus primus varus represents a complex of deformities and deficiencies that require relative versatility and adaptability in treatment.

1. Painful hallux

1. Hypermobility of the first tarso-metatarsal joint

2. Revision (relative)

3. Arthritis of the metatarsophalangeal (MTP)

4. Peripheral vascular disease

5. Narcissism

1. Hallux valgus foot scores <70

2. Anteroposterior (AP) weight-bearing X-rays of the forefoot

3. Harris floor reaction imprints

1. Ankle block and ankle tourniquet (250 mm)

2. Patient positioned supine on standard operating room table

3. Microsagittal saw (medium blades)

4. 0.062- and 0.054-in K-wires with wire driver

5. Tenotomy scissors

6. Banana #67 Beaver blade

7. Ragnell, Davis, and Hohman retractors

1. The Ragnell retractor is used to pull the proximal fragment medially to allow lateral translation of the capital or distal fragments.

2. An intra-articular adductor tenotomy is performed from medial to lateral using a banana blade.

1. Avoid excessive lateral stripping of head/neck fragments.

2. Avoid crossing the osteotomy ends.

3. Avoid notching the first metatarsal cortex during the exostectomy.