Symptomatic Medial Exostosis of the Great Toe Distal Phalanx: A Complication Due to Over-correction Following Akin Osteotomy for Hallux Valgus Repair

The authors present the case of a 54-year-old female who developed a painful compression lesion localized to the medial aspect of the base of the distal phalanx of the great toe as a complication of hallux valgus surgery. Preoperative radiographic evaluation of the patient's foot revealed the first ray to be longer than the second, a 12° first intermetatarsal angle, a 33° hallux abductus angle, and an exostosis at the medial aspect of the base of the hallux that was not considered by the surgeon to be important. Correction of the hallux valgus deformity was performed with a combination of scarf and Akin osteotomies, and the intermetatarsal and hallux abductus angles reduced to 2° and 8°, respectively. By 2 months postoperative, the patient was complaining of pain at the medial aspect of the distal phalanx of the hallux associated with shoe pressure. The pain correlated both clinically and radiologically with the exostosis at the base of the distal phalanx, and had become symptomatic only after the hallux had been operatively realigned. At 6 months postoperative, percutaneous exostectomy was undertaken to remove the exostosis. Pain relief was complete, thereafter, and after 2 years of postoperative follow-up the patient remained pain free. The clinical importance of a medial exostosis localized to the base of the distal phalanx of the hallux must be taken into consideration whenever hallux valgus correction is undertaken, and this is particularly important whenever an Akin osteotomy is being considered. Level of Clinical Evidence: 4