Hallux Varus Pearls

Maryellen A. Waltz, DPM took the podium at the AAWP Scientific Conference to discuss crucial questions related to hallux varus. Podiatry Today touched down with her about important aspects of her presentation.

Q: What do you feel is the most challenging aspect of hallux varus for foot and ankle surgeons?

A: Dr. Waltz said she feels the deformity’s etiology is the deciding factor.

“An overstaked metatarsal head is often much easier to treat than a spastic condition,” she explained. “Balancing the muscle imbalances can be quite challenging. A slight hallux valgus is manageable, however a severe deformity from overcorrection and misdiagnosing the true cause can be detrimental.”

Q: What do you find is the most important aspect of the workup for a patient with hallux varus?

A: Muscle testing and radiographs are vital, she said. Having a good understanding of the involved structures and their pull, including during gait, standing, and sitting is a key goal. Additionally, careful radiographic evaluation can provide information on the sesamoids and the metatarsal head.  

Q: Are there any key procedural pearls you’d like to share?

A: “Don't forget about the soft tissue structures,” stressed Dr. Waltz. “Unless performing an arthrodesis, the abductor and adductor hallucis play a role. A construct such as the SonicAnchor (Stryker) or Mini TightRope (Arthrex) work very well in balancing the pull of a muscle if needed.”

Q: Has there been a particular case that has stood out to you that you’d like to share?

A: In her experience addressing many hallux valgus cases, one patient with bilateral deformities came to mind. She shared that this patient had over-staking of the metatarsal head and severed tendons on both sides of the first MTPJ.

“The patient underwent a Weil osteotomy of the metatarsal as well as 2 Mini TightRopes to rebalance her joint,” said Dr. Waltz. “The last I was able to follow up, she was doing well and joint motion was still preserved. She is happy and enjoying life now!” 

Q: Is there anything else you’d like to add?

A: “Oftentimes we think an overly difficult procedure is necessary for these more complicated deformities and conditions, when often a more simple approach can lead to a very successful outcome,” Dr. Waltz conveyed. “Think outside of the box. A simple Weil osteotomy of the first metatarsal is a great procedure to correct some, if not all of the deformity present, when we often reserve this for a lesser metatarsal.”