- Discussion:
- Silver procedure involves simple exostectomy;
- it is typically performed along w/ other
hallux valgus reconstructive procedures such as
chevron,
Mcbride, or
proximal osteotomy;
- in the case of a proximal osteotomy, the bone graft resected from the medial eminence may
be used as bone graft for an opening wedge proximal osteotomy;
- indications: younger pts w/ prominent "bunion" w/ mild IMA & HVA,
- if excessive medial metatarsal head eminence is excised, medial instability of MP joint results
because of deficient medial support;
- result is hallux varus;
- Technique:
- there is some controversey as to where and how to perform the resection;
-
resection at the saggital groove:
- some argue that the excision begins at the saggital groove, which is the groove between the normal
joint cartilage and the uncovered cartilage on the medial side of the eminence;
- others argue that the resection should not be performed thru sagittal groove, since the relative
position of this groove is variable;
- often w/ severe deformities, the saggital groove will be located at the center of the metatarsal head;
- w/ less severe deformities, the groove is located more medially;
- excessive resection of eminence, may result in medial subluxation of
sesamoids;
-
resection flush w/ medial border of foot:
- probably the better method is to resect the medial eminence flush w/ the medial border of the foot;
- some recommend that resection of medial eminence is performed flush w/ the medial aspect of metatarsal shaft;
- w/ this approach, however, a painful bony prominence may remain along the medial side of the foot;
- the saw blade should be directed from dorsal to plantar direction to give a more precise cut;
