We measured hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), proximal articular set angle (PASA), distal articular set angle, hallux interphalangeal angle, metatarsocuneiform angle, size of the medial eminence of the distal first metatarsal, tibial sesamoid position, and joint congruity of the first metatarsophalangeal joint (MTPJ).
One of the key components of a hallux valgus deformity is the size of the medial eminence. It is frequently the prominence that is the focus of pain and footwear intolerance by patients.
Hallux valgus angle and medial eminence of distal first metatarsal
A correlation analysis was performed using the Pearson correlation coefficient, which showed a positive correlation between HVA and the medial eminence of the distal first metatarsal ( r = 0.185, P < 0.01).
Patients often present with pain over the medial eminence
or MTP pain.
A proximally directed dorsal longitudinal incision is used to facilitate exposure of the entire medial eminence.
I prefer to remove the medial eminence with an osteotome oriented in distal to proximal direction just medial to the sulcus.
Following resection of the medial eminence a key elevator is used to expose the medial aspect of the first metatarsal proximal to the metaphyseal-diaphyseal junction.
The medial eminence (bunion) is often the most visible feature on physical examination.
Adjustment to footwear can be utilized to eliminate friction over the medial eminence, e.g., providing a wider and deeper toe box.
The Akin procedure is a medial eminence resection, medial capsular reefing, and a medial closing-wedge phalangeal osteotomy.
The procedure was most successful for patients who presented with and had treatment for a painful medial eminence. Mann and Pfeffinger, (12) in 72 feet, found a 92% satisfaction rate.