Una vez hemos entendido que los aspectos rotacionales son importantes en la deformidad del hallux valgus, nos tenemos que preguntar cómo los podemos medir?

Existen dos formas actualmente para la medición de los aspectos rotacionales de la cabeza del metatarsiano. La radiografía y el TAC en carga.

El método más sencillo es la radiografía de frente que puede valorar la rotación de la cabeza con el morfología de la misma;
Un estudio muy interesante de Pablo y Emilio Wagner nos acercan a esta medición. La forma lateral de la cabeza del metatarsiano nos puede indicar el grado de pronación.

El TAC en carga permite valorar a la vez que medir la deformidad rotacional del hallux valgus y el complejo sesamoideo.
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CONCLUSIÓN.

La valoración de las deformidades que se producen en el hallux valgus son importantes para entender y valorar el mejor tratamiento así conseguir los mejores resultados.
Los aspectos rotacionales son muy importantes en la aparición de la deformidad del hallux. La pronación que se produce y el desplazamiento de los sesamoideos son determinantes para valorar la mejor técnica quirúrgica.

Recientemente se están realizando técnicas quirúrgicas para la corrección rotacional como la  técnica de Lapiplasty la técnica PROMO o la técnica que estamos desarrollando conocida como DROMO ( distal rotational metatarsal osteotomy  )

​Foot and ankle surgery using the anesthetic WALANT technique, which in English refer to
the acronym (Wide Awake Local Anesthesia No Tourniquet) has proven good
results in hand surgery.

This technique is based on local and locoregional infiltration of lidocain plus epinephrine / adrenaline in the foot and ankle. Surgery does not need blood expression or compression tourniquet.

Infiltration of the anesthetic solution with epinephrine has been shown to
safe in thousands of hand surgical procedures.

The WALANT technique is performed in the surgical area without the need for preoperative studies
 or pre-anesthesia assessment.
This technique substantially reduces the costs associated with the procedure

Advantages of the Walant technique in foot and ankle surgery.
-Ischemia tourniquet is not used, which improves patient comfort in the surgical procedure.
-Improvement of the total time of the surgical procedure due to the lack of assembly
of tourniquet and ischemia.
-The possibility of active movement during surgery allows to assess aspects of stability of the repair or synthesis in the intraoperative period and to make changes to improve the final results of the surgery.

Is the use of adrenaline-epinephrine safe in hand or foot surgery?
The WALANT technique is frequently performed in hand surgery such as carpal tunnel syndrome, trigger fingers and especially in flexor tendon reconstructions or repair.

No cases of digital necrosis have been reported at doses as high as 1: 1000

Surgical indications with Walant technique on the foot and ankle.
We are currently using the Walant technique for all forefoot surgery (chevron osteotomy, scarf, weil osteotomies, MTF arthrodesis ...)
We also use Walant's technique for Achilles pathology, both Achilles tendon ruptures where the tension and stability of reconstruction and degenerative tendinopathies can be assessed.

Walant's anesthetic technique for foot and ankle surgery
Initially, the patient is premedicated with 1 -2mg of midazolam
Walant's solution is infiltrated with lidocaine. epinephrine, bicarbonate and saline. 0.1 cc epinephrine (1: 100000) 5cc Lidocaine 2%, 5cc saline, 2cc bicarbonate.

Here we show the Walant foot and ankle technique