Preoperative Diagnosis:
Bunion of the right hallux

Postoperative Diagnosis:
Same

Anesthesia:
Epidural block

Procedure:
The patient was taken to the operating room and placed under appropriate anesthesia. The operative site was prepped and draped in the usual sterile fashion. An incision was made over the dorsal medial surface of the great toe and carried down through skin and subcutaneous tissues. Small veins were electrocoagulated and divided. The nerves were retracted to the side. A longitudinal incision was made into the joint capsule and the capsule was sharply elevated away from the exostosis on the medial side of the first metatarsal and from around the base of the proximal phalanx. The exostosis was excised using an osteotome and smoothed with a rongeur. There was a groove worn in the head of the metatarsal adjacent to the medial eminence, but fortunately this was the only area of degeneration noted in the joint. Rather than sacrifice the base of the proximal phalanx, I elected to do a soft tissue procedure.

An incision was made between the first and second toes taking care to avoid the neurovascular bundle and nerves. A relaxing incision was made in the contracted transverse metatarsal ligament on the lateral side of the joint. This allowed for full correction of the hallux valgus deformity previously noted. The toe was placed in the corrected position and pinned with a smooth Steinmann pin. The lateral wound was then irrigated and closed in layers with absorbable Vicryl. Attention was then turned back to the medial side where redundant capsular and transverse ligamentous tissues were excised until normal tissue tension was approximated. The wound was then thoroughly irrigated and the capsule and subcutaneous tissue closed with 0 Vicryl. The skin was closed with 5-0 Vicryl and a cap was placed on the protruding pin. The patient tolerated the procedure well and left the operating room in stable condition.