FIRST MTPJ SURGICAL CASE PRESENTATIONSHEATHER RAFAL, DPM SECRETARY, AAWP VICE PRESIDENT, DPMA

CASE 1: HPI AND PMH

• HPI: 67 year old female, retired RN, with c/o progressively worsening RT foot bunion pain. The bunion is symptomatic in shoes, when walking and making her more sedentary.

• PMH: RA

CASE 1:X-RAY FINDINGS

• IMA about 25 degrees. • HAA about 40 degrees. • Increased TSP. • Valgus rotation of proximal phalanx.

CASE 1: PRE-OP X-RAYS

CASE 1:PRE-OP X-RAYS

CASE 1: 1ST MTPJ ARTHRODESIS POST-OP

CASE 1:1ST MTPJ ARTHRODESIS POST-OP

CASE 2:HPI AND PMH

• 30 year old female presents with a painful bunion deformity, present for years. Failed wider shoes and toe spacers.

• She has no medical issues.

CASE 2:PHYSICAL EXAM

• Moderate hallux valgus deformity, valgus rotation of the great toe, large dorsomedial prominence at 1st metatarsal head.

• Slight hallux interphalangeus. • Semi-flexible and reducible. • Moderate 1st metatarsal cuneiform joint hypermobility. • No pain with passive 1st MTPJ ROM • No joint crepitus.

CASE 2:PRE-OP X-RAYS

CASE 2:PRE-OP X-RAYS

CASE 2:LAPIDUS POST-OP

CASE 2:LAPIDUS POST-OP

CASE 3:HPI

• 57 year old male concerned with laterally deviated hallux of left foot present for many years.

• Moderate pain on ambulation and in shoes. • Progressively getting worse over the past few years. • He has tried changing shoes and orthotics over the years.

CASE 3:PMH

• PMH: Arthritis, Diabetes type II, High Blood Pressure, Hypercholesterolemia. • All: NKDA • PSH: knee surgery. • Fam Hx: Diabetes, sickle cell. • Soc Hx: +Alcohol Use, Quit illicit drug use and smoking.

CASE 3: PHYSICAL EXAM

· WB: Mild pain DF 1st MTPJ · Mild Pes Planus

· NWB: 1st MTPJ stiffness with ROM · Decreased ROM of 1st MTPJ · Track bound · Laterally deviated hallux, abutting the 2nd digit

CASE 3:X-RAY FINDINGS

• IM angle= 16.2 degrees • Tibial Sesamoid position= 7 • Deviated joint • Mild medial eminence

CASE 3:PRE-OP X-RAYS

CASE 3:LONG ARM AUSTIN POST-OP

CASE 4:HPI AND PMH

• 39 year old female with painful bunion bilateral (RT > LT). Present for years, she has had prior evaluations over the years.

• Medial side of the joint is aching, swollen and throbbing. • Pain has limited her activities.

• PMH: Depression and migraines. • Soc Hx: Nonsmoker, occasionally drinks wine.

CASE 4:PHYSICAL EXAM

• Large hallux valgus deformity. • Pain upon palpation of both the medial eminence and lateral joint. • Deformity is reducible. • No crepitus

CASE 4:PRE-OP X-RAYS

• Pre-op x-ray concerns/procedure selection thoughts:

• There is a cyst in the medial 1st met head. • IM angle around 16 degrees. • Slightly short 1st metatarsal

CASE 4:PRE-OP X-RAYS

CASE 4:OPENING WEDGE POST-OP