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Foot & Ankle Orthopaedics Apr 2019Hallux valgus is a common condition that results from a complex positional deformity of the first ray. The bunion or medial prominence that results from the lateral... (Review)
Review
Hallux valgus is a common condition that results from a complex positional deformity of the first ray. The bunion or medial prominence that results from the lateral deviation and pronation of the hallux is only one component of the 3-dimensional deformity. Hallux valgus can lead to considerable pain and altered joint mechanics. The precise biomechanical etiology remains under debate. Predisposing factors include female sex, age, constricting footwear, and family history. Metatarsus adductus, equinus contracture, hammertoe deformity, and pes planus often coexist with hallux valgus. Nonoperative treatment involves patient education, shoe modifications, toe pads and positioning devices, and activity modifications. Surgery is considered in patients who fail nonoperative treatment with the goal of pain relief, correction of the deformity, improved first ray stability, and improved quality of life. More than 100 different procedures have been described to treat hallux valgus; they include combinations of soft tissue balancing, metatarsal osteotomies, and fusion of either the metatarsophalangeal (MTP) or tarsometatarsal (TMT) joint. The choice of procedures depends on the severity and location of the deformity as well as surgeon preference. Recent advances in operative techniques include minimally invasive surgery and correction of rotational deformity.
PubMed: 35097321
DOI: 10.1177/2473011419838500 -
Orthopaedics & Traumatology, Surgery &... Feb 2022Juvenile hallux valgus is one of the most common pathologies of the forefoot in children and adolescents. Nevertheless, its treatment is still controversial. This... (Review)
Review
Juvenile hallux valgus is one of the most common pathologies of the forefoot in children and adolescents. Nevertheless, its treatment is still controversial. This deformity has some distinct anatomical features, particularly a lateral tilt of the articular facet of the head of the first metatarsal and congenital metatarsus adductus, which often occur in combination. Some mediocre surgical treatment results can be explained by the lack of correction of all these factors when we approach the problem as we would in adults. A double osteotomy to correct the DMAA and varus of the first metatarsal is a good solution in most cases with satisfactory functional outcomes. A percutaneous approach seems efficient in the pediatric population, given that the periosteum and growth plates, which are very active in younger children, help the osteotomies to heal and remodel. Guided growth surgery - using this approach is a viable alternative in this age bracket. Finally, minimally invasive surgery for juvenile hallux valgus allows another surgery to be done on minimally or undamaged tissues if needed later on.
Topics: Adolescent; Adult; Child; Foot; Growth Plate; Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Treatment Outcome
PubMed: 34871795
DOI: 10.1016/j.otsr.2021.103168 -
Orthopaedics & Traumatology, Surgery &... Feb 2020Congenital pathologies of the forefoot encompass two broad entities with vastly different treatments and prognosis: malformations, which occur during the embryonic... (Review)
Review
Congenital pathologies of the forefoot encompass two broad entities with vastly different treatments and prognosis: malformations, which occur during the embryonic period and cause anatomical defects, and deformations, which occur during the fetal period on a foot that is configured normally. These deformities are more easily cured when they occur later during the fetal period. When the anomaly is bilateral, a genetic origin must be considered. There are two main entities under the term "deformity": metatarsus adductus and skewfoot (aka "Z"-foot or serpentine foot). Within malformations are brachydactyly (transverse defects), longitudinal defects, syndactyly, polydactyly, clinodactyly and macrodactyly. Among other forefoot abnormalities are hallux valgus, which rarely presents in congenital form, and for which conservative treatment is sometimes sufficient. Also in this group are sequelae of amniotic band constriction, forefoot anomalies secondary to the treatment of congenital pathologies (talipes equinovarus and congenital vertical talus) and nail-related pathologies (ingrown toe nail and incorrect nail position).
Topics: Child; Foot Deformities, Congenital; Global Health; Humans; Incidence; Metatarsal Bones; Radiography
PubMed: 31648997
DOI: 10.1016/j.otsr.2019.03.021 -
Foot and Ankle Clinics Mar 2020Hallux valgus is an extremely common and often disabling deformity. In addition to valgus deformity of the hallux, varying degrees of varus and supination of the first... (Review)
Review
Hallux valgus is an extremely common and often disabling deformity. In addition to valgus deformity of the hallux, varying degrees of varus and supination of the first metatarsal and instability in the metatarsophalangeal and metatarsocuneiform joints are frequently present. Because of the complexity and multiplicity of deformities, surgical techniques and fixation methods continue to be developed to obtain better results. Recent studies have focused on correcting pronation of the first metatarsal as a way of correcting and equalizing the metatarsal sesamoid bones in a more horizontal and stable position, possibly minimizing the chance of recurrence of the deformity.
Topics: Fracture Fixation, Internal; Hallux Valgus; Humans; Metatarsal Bones; Osteotomy
PubMed: 31997750
DOI: 10.1016/j.fcl.2019.10.006 -
Instructional Course Lectures 2020The management of bunion deformities in adolescent patients is often a source of consternation for orthopaedic surgeons. Reports of recurrence and surgical failure along...
The management of bunion deformities in adolescent patients is often a source of consternation for orthopaedic surgeons. Reports of recurrence and surgical failure along with a multitude of procedures to choose from create a wariness to manage the problem surgically. The biggest challenge in managing this problem is a lack of understanding by orthopaedic surgeons that adolescent bunions and adult bunions frequently arise from two distinct etiologies. The main difference between the two is that unlike adult bunion deformities, the hallux metatarsophalangeal joint in the adolescent bunion is congruent as the deformity is caused by a dysplasia of the metatarsal head. This dysplasia results in a valgus orientation of the first metatarsal articular surface (ie, elevated DMAA [distal metatarsal articular angle]). The recognition of this difference has implications for the evaluation and treatment of these deformities in adolescents.
Topics: Adolescent; Bunion; Hallux Valgus; Humans; Metatarsal Bones; Metatarsophalangeal Joint; Osteotomy
PubMed: 32017738
DOI: No ID Found -
Der Orthopade May 2017Hallux valgus is one of the most common deformities of the lower extremity. Multiple etiologies have been discussed, and various techniques have been described. The... (Review)
Review
Hallux valgus is one of the most common deformities of the lower extremity. Multiple etiologies have been discussed, and various techniques have been described. The SCARF osteotomy is indicated for moderate to severe hallux valgus deformities. The technique historically used by carpenters allows immediate postoperative weight bearing and also entails the possibility to correct the distal metatarsal articular angle by rotation of the osteotomy. The SCARF osteotomy has also been successfully used in revision surgeries.
Topics: Evidence-Based Medicine; Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Plastic Surgery Procedures; Treatment Outcome
PubMed: 28405709
DOI: 10.1007/s00132-017-3423-5 -
Foot & Ankle International May 2022Failure to identify and correct malrotation of the first metatarsal may lead to recurrent hallux valgus deformity. We aimed to identify the proportion of hallux valgus...
BACKGROUND
Failure to identify and correct malrotation of the first metatarsal may lead to recurrent hallux valgus deformity. We aimed to identify the proportion of hallux valgus patients with increased first metatarsal pronation using weightbearing computed tomography (WBCT) and to identify the relationship with conventional radiographic measurements.
METHODS
WBCT scans were analyzed for 102 feet with a hallux valgus angle (HVA) and intermetatarsal angle (IMA) greater than or equal to 16 and 9 degrees, respectively. Metatarsal pronation angle (MPA), alpha angle, sesamoid rotation angle (SRA), and sesamoid position were measured on standardized coronal WBCT slices. Pronation was recorded as positive. Hindfoot alignment angle (HAA) was assessed using dedicated software. Pearson correlation and multiple regression analyses were used to assess differences between groups.
RESULTS
Mean HVA was 29.8±9.4 degrees and mean IMA was 14.1±3.7 degrees. Mean MPA was 11.9±5.8 (range 0-26) degrees and mean alpha angle was 11.9±6.8 (range -3 to 29) degrees. In a previous study, we demonstrated the upper limit of normal MPA as 16 degrees and alpha angle as 18 degrees. Based on these criteria, we identified abnormal metatarsal pronation in 32 feet (31.4%). We found a strong positive correlation between SRA and HVA/IMA ( = 0.67/0.60, respectively, < .001). IMA and HAA weakly correlated with MPA and alpha angle (IMA: = 0.26/0.27, respectively, < .01; HAA: = 0.26/0.27, respectively, < .01). Regression analyses suggested that increasing IMA was the most significant radiographic predictor of increased pronation. In this cohort, there was no correlation between HVA or sesamoid position and MPA / alpha angle (HVA: = .36/.12, respectively, sesamoid position, = .86/.77, respectively).
CONCLUSION
In this cohort of 102 feet that met plain radiographic criteria for hallux valgus deformity, first metatarsal pronation was found abnormal in 31.4% of patients. We found a weak association between the IMA and hindfoot valgus, but not the HVA.
Topics: Bunion; Hallux Valgus; Humans; Metatarsal Bones; Retrospective Studies; Rotation
PubMed: 35135368
DOI: 10.1177/10711007211064609 -
Foot and Ankle Clinics Sep 2014Recurrent metatarsalgia has a multifactorial etiology. The analysis of the cause is critical in planning appropriate treatment. Understanding etiology helps understand... (Review)
Review
Recurrent metatarsalgia has a multifactorial etiology. The analysis of the cause is critical in planning appropriate treatment. Understanding etiology helps understand the mechanism of prevention, which is the best treatment. Recurrent metatarsalgia is often due to poor technique or poor understanding of the underlying problem. In hallux valgus surgery, recurrent metatarsalgia can be a problem of position of the first metatarsal after an inappropriate or poorly done first metatarsal osteotomy or a problem of gastrocnemius tightness not previously recognized. The best treatment is to restore the normal anatomy but that is not always possible, and surgery on affected rays could be the solution.
Topics: Hallux Valgus; Humans; Metatarsalgia; Osteotomy; Recurrence
PubMed: 25129352
DOI: 10.1016/j.fcl.2014.06.005 -
EFORT Open Reviews Jun 2021There is some confusion in the terminology used when referring to MIS (Minimal invasive surgery) or percutaneous surgery. The correct term to describe these procedures... (Review)
Review
There is some confusion in the terminology used when referring to MIS (Minimal invasive surgery) or percutaneous surgery. The correct term to describe these procedures should be percutaneous (made through the skin) and MIS should be reserved for procedures whose extent is between percutaneous and open surgery (e.g. osteosynthesis). Minimal incision surgery may be distinguished in first, second and third generation minimal incision surgery techniques.First generation MIS hallux valgus surgery is mainly connected with the Isham procedure; an intraarticular oblique and incomplete osteotomy of the head of the first metatarsal without fixation.The Bösch osteotomy and the SERI are classified as second generation MIS hallux surgery. They are both transverse subcapital osteotomies fixed with a percutaneous medial K-wire inserted into the medullary canal. For all these procedures, intraoperative fluoroscopic control is necessary.Open hallux valgus surgery can be divided into proximal, diaphyseal and distal osteotomies of the first metatarsal. Reviewing the available literature suggests minimally invasive and percutaneous hallux valgus correction leads to similar clinical and radiological results to those for open chevron or SCARF osteotomies. First generation minimally invasive techniques are primarily recommended for minor deformities. In second generation minimally invasive hallux valgus surgery, up to 61% malunion of the metatarsal head is reported. Once surgeons are past the learning curve, third generation minimally invasive chevron osteotomies can present similar clinical and radiological outcomes to open surgeries. Specific cadaveric training is mandatory for any surgeon considering performing minimally invasive surgical techniques. Cite this article: 2021;6:432-438. DOI: 10.1302/2058-5241.6.210029.
PubMed: 34267933
DOI: 10.1302/2058-5241.6.210029 -
Foot and Ankle Clinics Jun 2018
Topics: Hallux Valgus; Humans; Metatarsal Bones
PubMed: 29729804
DOI: 10.1016/j.fcl.2018.03.001