Forefoot Deformity Correction Surgery

Abstract

As forefoot deformities are a prevalent condition associated with invalidating pain syndromes and gait deterioration, numerous surgical techniques have been developed to correct these deformities. Most forefoot deformity surgery is performed to correct a hallux valgus or “bunion” deformity but lesser toe deformities such as hammer, claw, and mallet toe can also be addressed during these procedures.

In the preoperative setting, weight-bearing radiographs are essential to evaluate the forefoot deformity and assist in the pre-operative decision-making. Multiplane deformities can be assessed more accurately by performing weight-bearing computed tomography (WBCT); associated stress lesions or joint degeneration can be detected on SPECT/CT imaging.

Postoperative imaging is used in the case of recurrent pain or deformity after correction surgery. Possible complications include superficial and deep infections, complex regional pain syndrome, non-union of the arthrodesis or osteotomies, metatarsalgia and metatarsal stress fractures, avascular necrosis, MTP joint degeneration, and hardware-related pain. If plain X-rays do not identify the reason for recurrent pain, second-line imaging modalities such as SPECT/CT or MRI imaging can be performed to detect the occult pain generator. In this chapter, we present three cases where SPECT/CT is used in the postoperative setting and aids in the diagnosis of a metatarsal stress fracture, complex regional pain syndrome, and hallux rigidus, respectively.