#1ST MTP JOINT SKIN#

AdductedР’В 1st MT-i.e., metatarsus primus varus (MPV)- alwaysР’В present Forefoot- neutral, but may be pronatedР’В or supinated, based on any coexisting hindfoot deformity ValgusР’В deformity of the distal end of the hallux proximal phalanx creating lateral deviation/mal-orientation of the interphalangeal joint-i.e., hallux valgus interphalangeus (HVIP)- not alwaysР’В present.Р”В«. Can exist with a normal or high DMAA, but more common with a normal DMAA. Lateral subluxationР’В of the hallux on the 1st MT head-i.e., 1st MTP joint incongruity- not alwaysР’В present. ValgusР’В deformity of the distal end of the 1st MT with lateral positioning of the articular cartilage creating lateral deviation/mal-orientation of the 1st MTP joint-i.e., high DMAA-see below- not alwaysР’В present, but more common in JHV than in adult onset HV. ValgusР’В deformity of the hallux in relation to the 1st MT-i.e., hallux valgus (HV)- alwaysР’В present. Elucidation of the segmental deformities, not allР’В necessarily present in every case The prevalence of juvenile hallux valgus (JHV) is unknown, but it is believed to be high.Р”Сћ. Maternal inheritance in over 70% of cases Age at onset less than 16 years, regardless of when it is treated Greater than 15Р’В° of valgus alignment of the hallux on the 1st MT, with medial prominence of the 1st MT head ( Figure 5-54)Р”В«.

#1ST MTP JOINT SKIN#

Z-plasty medial skin of the forefoot ( see Longitudinal Epiphyseal Bracket Resection, Figure 8-8, Chapter 8)- perform thisР’В along with any of these procedures if the skin is under excessive stretch following deformity correctionР”Р„. Distal 1st MT opening wedge varus-correcting Р’В± lengthening osteotomy ( see Chapter 8)- perform thisР’В if varus mal-orientation of a congruous 1st MTP joint persists in an older child or adolescentР”В. Distal release of abductor hallucis ( see Chapter 7) and release of medial 1st MTP joint capsule and resection of tight cordlike medial band (if present) andР’В resection of 1st MT longitudinal epiphyseal bracket ( see Chapter 8)- perform thisР’В if a 1st MT longitudinal epiphyseal bracket coexistsР”В¬. Distal release of abductor hallucis ( see Chapter 7) andР’В release of medial 1st MTP joint capsule andР’В resection of tight cordlike medial band (if present)- perform thisР’В for isolated congenital hallux varus (CHV)Р”В«. Operative treatmentР’В with reference to the surgical techniques section of the book for each individual procedureР”Р„.

If a 1st MT longitudinal epiphyseal bracket ( see Chapter 6) coexists, there will be increasing length discrepancy between the 1st and 2nd MTs, resulting in stress overload and pain under the 2nd MT head ( see Longitudinal Epiphyseal Bracket, Figure 6-4, Chapter 6)Р”В§. Increasing or persistent varus deformity of the hallux causing shoe-fitting difficultiesР”В«. Note the straight-to-slightly concave dense lateral diaphyseal cortex and the convex hypodense medial diaphyseal cortex of the 1st MT.Р”Р„. Simulated standing or standing AP and lateral of the foot ( Figure 5-53)Р”Р‡igure 5-53.Р’В AP x-ray of an infantРІР‚в„ўs foot with CHV and a 1st MT longitudinal epiphyseal bracket ( see Chapter 6). Often associated with a 1st MT longitudinal epiphyseal bracket ( see Chapter 6) with relative shortening and widening of the MTР”Р„. Medial subluxationР’В of the hallux on the 1st MT head-i.e., 1st MTP joint incongruity VarusР’В deformity of the distal end of the 1st MT with medial positioning of the articular cartilage creating medial deviation/mal-orientation of the 1st MTP joint-i.e., РІР‚Сљreverse,РІР‚Сњ or varus, distal MT articular angle (DMAA see Figure 5-56, this chapter)

VarusР’В deformity of the hallux in relation to the 1st MT-i.e., hallux varus

Philadelphia, PA: Lippincott Williams & Wilkins 2001:1187, Figure 29-34.)Р”Сћ. Lovell and WinterРІР‚в„ўs Pediatric Orthopaedics, 5th ed. B.Р’В Fibrous band (in button hook) that is occasionally seen between the hallux and a cartilaginous duplicate tarsal anlage (From Mosca VS. Often associated with 1st MT longitudinal epiphyseal bracket ( see Chapter 6 and Figure 5-53)Р”Р‡igure 5-52. Idiopathic or associated with an underlying chromosome abnormality-Pierre Robin syndrome, othersР”В. Often associated with tight cordlike structure in place of, or in addition to, the abductor hallucis ( Figure 5-52B)Р”В¬. Congenital varus alignment of the hallux on the 1st MT ( Figure 5-52)Р”В«. Principles and Management of Pediatric Foot and Ankle Deformities and Malformations, 1 Ed.

1st mtp joint