this places the least amount of stress on the interphalangeal joint of great toe & provides patient w/ smoother gait pattern. toe should be in 15 deg of dorsiflexion from the floor (although during surgery it is not possible to make this determination) first toe should end up resting comfortably against the second toe toe is placed in approx 25 to 30 degrees of dorsiflexion in relation to first metatarsal and approximately 10-15 deg of valgus in a first MP joint arthrodesis arthrodesis is indicated in presence of severe subluxation or degenerative changes in metatarsophalangeal joint (IM angle > 20 degrees), an arthrodesis of MP joint may be used fusion is procedure of choice for hallux valgus assoc w/ advanced DJD, and a hallux valgus, advanced hallux valgus (IMA > 20 deg, HVA greater than 40 deg), severely subluxated or dislocated MTP joints, or for failed hallux valgus surgery cheilectomy is not the procedure of choice in presence of advanced degenerative joint changes arthrodesis provides best chance for long-standing painless joint a soft tissue procedure will fail w/ time when it is absent, a hallux valgus valgus deformity is best treated by arthrodesis of first MP joint great toe is stabilized in part by the presence of 2nd toe this is probably an under rated procedure in terms of its indications
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