Akin/Phalangeal osteotomy

Akin/Phalangeal osteotomy:
Closing adductory wedge osteotomy of proximal phalanx of hallux. Primarily indicated for hallux valgus interphalangeus.

Wedge of bone is removed from base of proximal phalanx, leaving a small hinge of cortical bone on the lateral side  reduced the abducted alignment of the hallux on the metatarsal.
Can be combined with derotation (use an oblique osteotomy to remove plantar/medial wedge  varus stress to derotate)

Can be:
• Basal osteotomy: indicated for shorter great toe; performed through proximal metaphysis
• Shaft osteotomy

Rarely used as an isolated procedure as does not address ‘bunion’ deformity (does give the appearance of a ‘straighter’ hallux)

Indication – no degenerative disease in first MPJ; moderate to severe deformity – especially if DASA is increased (especially if hallux interphalangeal abductus is present)

Procedure:
• Incision midline over base of proimal phalanx
• Dissect periosteum to explore base of phalanx
• Reflect EDL and EHL tendons
• Closing wedge osteotomy with base of wedge 5-7mm distal for MPJ
• Fix with k-wire

Complications- injury to flexor hallucius longus tendon;

Other Bunion Surgery Procedures: