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The Journal of Foot and Ankle Surgery :... 2021This study aimed to determine whether the degree of pes planus was associated with hallux valgus severity and hallux valgus surgery outcomes. A total of 122 feet were...
This study aimed to determine whether the degree of pes planus was associated with hallux valgus severity and hallux valgus surgery outcomes. A total of 122 feet were retrospectively analyzed after hallux valgus surgery. The hallux valgus angle, inter-metatarsal angle, lateral talo-first metatarsal angle, calcaneal pitch, and talonavicular coverage angle were measured. The Foot and Ankle Outcome Score and Foot Function Index were evaluated. A significant correlation between radiographic parameters of pes planus and hallux valgus severity, radiographic outcomes, Foot and Ankle Outcome Score, and Foot Function Index were not noted. The hallux valgus angle and inter-metatarsal angle changed significantly after the surgery (p < .001 and p < .001, respectively); however, a significant difference was not noted between the pes planus and non-pes planus groups (p = .279 and p = .632, respectively). A significant interaction between the time points and groups was not observed with respect to the hallux valgus angle (p = .311) and inter-metatarsal angle (p = .417). Multivariable logistic regression revealed that none of the radiographic parameters for pes planus affected hallux valgus recurrence. Pes planus in adult patients is not significantly associated with hallux valgus severity and recurrence, radiographic outcomes, or clinical scores.
Topics: Adult; Flatfoot; Hallux Valgus; Humans; Metatarsal Bones; Radiography; Retrospective Studies
PubMed: 33229243
DOI: 10.1053/j.jfas.2020.06.030 -
Foot and Ankle Clinics Sep 2020Minimal incision surgical principals rely on the soft tissue envelope to maintain stability that is supplemented by a variety of clinically recommended fixation methods.... (Review)
Review
Minimal incision surgical principals rely on the soft tissue envelope to maintain stability that is supplemented by a variety of clinically recommended fixation methods. The extended distal first metatarsal osteotomy has renewed interest because of the ability to laterally translate, angulate, and rotate the metatarsal head in proper alignment with the sesamoids to a neutral alignment. The soft tissue envelope of capsule, ligaments, and tendons will re-align once the bone deformity is corrected. The periosteum is maintained to provide a biologic scaffold for new bone formation and must be minimally disrupted during the intervention."
Topics: Hallux Valgus; Humans; Joint Prosthesis; Minimally Invasive Surgical Procedures; Osteotomy; Prosthesis Implantation
PubMed: 32736736
DOI: 10.1016/j.fcl.2020.05.011 -
Foot and Ankle Surgery : Official... Jan 2021Scarf osteotomy has been widely used to restore axial orientation of the first ray in the treatment of hallux valgus deformity. The aim of the study was to present our...
BACKGROUND
Scarf osteotomy has been widely used to restore axial orientation of the first ray in the treatment of hallux valgus deformity. The aim of the study was to present our radiological outcomes of bunion reconstruction, identify surgical complications in early follow-up, and assess to what extent a shortening of the first metatarsal is present after surgery as a possible cause of postoperative metatarsalgia.
METHODS
We enrolled 106 patients (118 feet) and assessed patients' pre- and postoperative measurements of hallux valgus and intermetatarsal angles on weightbearing X-ray images. Three different methods of measuring metatarsal length were compared and early postoperative complications noted.
RESULTS
Hallux valgus angle decreased significantly by an average of 18.7 degrees and the intermetatarsal angle by 7.8 degrees. Using three methods of measuring metatarsal length, all showed significant shortening of the first metatarsal. Mean relative lengthening of the second metatarsal averaged 0.45mm. The Coughlin method showed the highest interrater reliability (ICC=0.96).
CONCLUSIONS
Significant reduction of the hallux valgus angle and intermetatarsal angle was demonstrated with a low complication rate. There was significant shortening of the first metatarsal. The Coughlin method clearly demonstrated an excellent interrater reliability.
LEVEL OF EVIDENCE
Level IV.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Young Adult; Hallux Valgus; Metatarsal Bones; Osteotomy; Reproducibility of Results; Treatment Outcome; Weight-Bearing
PubMed: 31980384
DOI: 10.1016/j.fas.2020.01.002 -
Joint Diseases and Related Surgery May 2023In this review, we discuss the efficacy and safety of biodegradable magnesium screws compared to titanium screws in the treatment of hallux valgus (HV) in patients... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
In this review, we discuss the efficacy and safety of biodegradable magnesium screws compared to titanium screws in the treatment of hallux valgus (HV) in patients undergoing distal metatarsal osteotomy (DMO).
MATERIALS AND METHODS
Eligible scientific articles published prior to October 2022 were retrieved from the PubMed, Springer, ScienceDirect, and Cochrane Library databases. The terms used for searching included "hallux valgus", "distal metatarsal osteotomies", and "bioabsorbable magnesium screw" which were limited in the title or abstract through the text. The title and abstract were checked one by one to exclude the non-related studies. For primary identified studies and relevant systematic reviews, the full texts were accessed and browsed to finally include the eligible studies. No restriction was set on publication language and publication status.
RESULTS
Two randomized-controlled trials (RCTs) and three non-RCTs that met the inclusion criteria were included. There was no significant difference in the American Orthopaedic Foot and Ankle Society (AOFAS) score, postoperative HV angle (HVA), intermetatarsal angle (IMA), Visual Analog Scale (VAS) score, soft tissue irritation, implant fracture, reoperation, and infection rates between two groups.
CONCLUSION
Bioabsorbable magnesium compression screws show comparable clinical or radiological results to titanium compression screws in the treatment of HV in patients undergoing DMO.
Topics: Humans; Titanium; Magnesium; Treatment Outcome; Metatarsal Bones; Absorbable Implants; Hallux; Hallux Valgus; Osteotomy; Bone Screws
PubMed: 37462631
DOI: 10.52312/jdrs.2023.1026 -
Foot & Ankle International Oct 2015The technique of double first metatarsal osteotomies was first developed in response to the high frequency of recurrence noted in the treatment of severe adolescent...
BACKGROUND
The technique of double first metatarsal osteotomies was first developed in response to the high frequency of recurrence noted in the treatment of severe adolescent congruent hallux valgus deformities. The concept behind the use of this technique is that it allows the individual correction of each component of the deformity. We have modified the technique for use in adult hallux valgus where the majority of deformities are incongruent deformities and the distal chevron osteotomy is used primarily for its additional translational properties rather than purely to correct the distal metatarsal articular angle (DMAA). We report on a series of double first metatarsal osteotomies (basal opening wedge and distal chevron osteotomy) with Akin osteotomy in the treatment of moderate to severe adult hallux valgus deformity.
METHODS
All patients presenting to our institution with a hallux valgus deformity and treated with this procedure between 2008 and 2013 with a minimum of 1 year of follow-up were identified. Data were obtained through review of case notes, electronic charts, and digital imaging. A total of 50 feet in 48 patients underwent double first metatarsal osteotomy with Akin osteotomy. Three patients were excluded due to loss to follow-up, leaving 47 feet in 45 patients with a mean follow-up of 45 months (range, 14-60 months). Of these 43 (96%) were female and the mean age was 56 years (range, 35-70 years).
RESULTS
The mean preoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), DMAA, sesamoid position, and lateral first metatarsotalar angle were 42 degrees (range, 32-52 degrees), 18 degrees (range, 6-26 degrees), 12 degrees (range, 4-26 degrees), stage 6 (range, 4-7), and 2 degrees of dorsiflexion (range, 20 degrees of dorsiflexion to 4 degrees of plantar flexion), respectively. The mean postoperative HVA, IMA, DMAA, sesamoid position, and lateral first metatarsotalar angle were 7 degrees (range, 2 to 24 degrees), 4 degrees (range, 4-14 degrees), 6 degrees (range, 10-22 degrees), stage 2 (range, 1-5) and 6 degrees of plantar flexion (range, 8 degrees of dorsiflexion to 18 degrees of plantar flexion), respectively. The osteotomies consolidated at a mean of 7 weeks (range, 5-9 weeks). There were no cases of delayed union or nonunion. Of the cohort, 45 (96%) stated that they were satisfied overall with the results of their surgery and would have it again. The mean postoperative summary index Manchester-Oxford Foot Questionnaire (MOXFQ) score was 12.9 (range, 0-60.9) out of 100 at a mean follow-up of 45 months (range, 14-60 months). For the minority of cases, 8 (17%), that had preoperative scoring, the summary index MOXFQ score was 73.7 (range, 29.7-100).
CONCLUSIONS
The double first metatarsal osteotomy (basal opening wedge and distal chevron osteotomy) with Akin osteotomy provides powerful correction and facilitates correction of the individual components of the hallux valgus deformity. The individual osteotomies that make up this procedure are familiar to the majority of foot and ankle surgeons, thus limiting the associated learning curve.
LEVEL OF EVIDENCE
Level IV, retrospective case series.
Topics: Adolescent; Adult; Age Factors; Aged; Cohort Studies; Female; Hallux Valgus; Humans; Male; Metatarsal Bones; Middle Aged; Osteotomy; Pain Measurement; Prognosis; Radiography; Range of Motion, Articular; Recovery of Function; Retrospective Studies; Severity of Illness Index; Sex Factors; Treatment Outcome
PubMed: 26109608
DOI: 10.1177/1071100715589173 -
The Journal of Foot and Ankle Surgery :... 2023Hallux valgus is a complex condition understood to involve pathomechanics in all 3 of the cardinal planes. Despite this, the bulk of its historical evaluation has been...
Hallux valgus is a complex condition understood to involve pathomechanics in all 3 of the cardinal planes. Despite this, the bulk of its historical evaluation has been in the transverse plane, and one might argue that the traditional and more commonly performed univariate and bivariate analyses within the literature do not comprehensively describe the potential interrelationships between the planes during perioperative assessment. Therefore this investigation aimed to evaluate relationships between common radiographic parameters measured in the three cardinal planes by means of a multivariate regression analysis. Serial analyses utilizing the first intermetatarsal angle, hallux valgus angle, tibial sesamoid position, proximal articular set angle, Engel's angle, first metatarsal inclination angle, and the sesamoid rotation angle were performed with varying dependent and independent variables. The tibial sesamoid position (p < .001) and proximal articular set angle (p = .014) were found to be independently associated with the first intermetatarsal angle, while the hallux valgus angle (p = .712), Engel's angle (p = .646), first metatarsal inclination angle (p = .097), and sesamoid rotation angle (p = .099) were not. The tibial sesamoid position (p = .003), proximal articular set angle (p < .001), Engel's angle (p = .006), and sesamoid rotation angle (p = .003) were found to be independently associated with the hallux valgus angle, while the first intermetatarsal angle (p = .712) and first metatarsal inclination angle (p = .400) were not. The first intermetatarsal angle (p < .001), hallux valgus angle (p = .003), and proximal articular set angle (p = .015) were found to be independently associated with the tibial sesamoid position, while Engel's angle (p = .400), the first metatarsal inclination angle (p = .088), and the sesamoid rotation angle (p = .649) were not. These findings appear to question a direct relationship between the first intermetatarsal angle and hallux valgus angle, as well as potentially infer a relationship between the frontal plane with the hallux valgus angle.
Topics: Humans; Hallux Valgus; Radiography; Bunion; Metatarsal Bones; Multivariate Analysis; Retrospective Studies
PubMed: 36496338
DOI: 10.1053/j.jfas.2022.11.003 -
International Journal of Environmental... Jul 2022Hallux valgus is a common foot and ankle disease, for which numerous surgical procedures were introduced. So, understanding the mechanism of deformity reduction is...
Hallux valgus is a common foot and ankle disease, for which numerous surgical procedures were introduced. So, understanding the mechanism of deformity reduction is important to select the proper method. Intermetatarsal angle (IMA) determines the severity of hallux valgus, which is influenced by the translated metatarsal head and the reduction of the first tarsometatarsal joint. We hypothesized that both of the mechanisms simultaneously contribute to the correction of IMA. Hallux valgus (70 feet) operated with a Scarf osteotomy with the Akin procedure were reviewed. Hallux valgus angle (HVA), IMA (mechanical and anatomical), hallux valgus interphalangeal angle (HVIP), distal metatarsal articular angle (DMAA), and sesamoid position were checked. The ratio of contributions to the IMA changes were calculated and compared. When the individual contributions by metatarsal head translation and first tarsometatarsal joint reduction were compared, metatarsal head translation contributed by 82%, whereas first tarsometatarsal joint reduction contributed by 18%. Both were responsible for mechanical IMA correction. However, IMA change by metatarsal head translation was a major correction mechanism compared to anatomical IMA change by first tarsometatarsal joint reduction.
Topics: Hallux Valgus; Humans; Hyperplasia; Metatarsal Bones; Metatarsophalangeal Joint; Osteotomy; Radiography; Retrospective Studies; Treatment Outcome
PubMed: 35886095
DOI: 10.3390/ijerph19148243 -
Foot and Ankle Clinics Mar 2020The hallux valgus is one of the most challenging foot and ankle deformities to correct. The current concept is to consider the hallux valgus as a triplane deformity, and... (Review)
Review
The hallux valgus is one of the most challenging foot and ankle deformities to correct. The current concept is to consider the hallux valgus as a triplane deformity, and the parameters in transverse, sagittal, and frontal planes must be considered. The hallux valgus angle, intermetatarsal angle, tibial sesamoid position, and lateral edge of the first metatarsal head are valuable parameters to evaluate to understand the magnitude of the deformity. Diaphyseal corrections, such as scarf, and proximal interventions, such as crescentic osteotomy and Lapidus arthrodesis, are the most powerful techniques to address triplane deformity, because they are able to correct all misalignments.
Topics: Arthrodesis; Fluoroscopy; Hallux Valgus; Humans; Intraoperative Period; Metatarsal Bones; Osteotomy; Postoperative Period
PubMed: 31997740
DOI: 10.1016/j.fcl.2019.10.007 -
The Journal of Foot and Ankle Surgery :... 2022This investigation aimed to better understand the complex relationship of common radiographic measurements performed during the perioperative evaluation of the hallux...
This investigation aimed to better understand the complex relationship of common radiographic measurements performed during the perioperative evaluation of the hallux valgus deformity while accounting for interactions and potential interdependence. Several analyses utilizing the first intermetatarsal angle, hallux valgus angle, tibial sesamoid position, Engel's angle, subject age and subject gender were performed with varying independent and dependent variables. The hallux valgus angle (p < .001), tibial sesamoid position (p < .001), and Engel's angle (p < .001) were found to be independently associated with the first intermetatarsal angle. The first intermetatarsal angle (p < .001), tibial sesamoid position (p < .001), and Engel's angle (p < .001) were found to be independently associated with the hallux valgus angle. This suggests that there is significant interdependence of these variables during a preoperative radiographic examination. However, only the change in tibial sesamoid position (p < .001) was found to be independently associated with the change in the first intermetatarsal angle following surgical correction, while no studied variables were found to be independently associated with the change in hallux valgus angle following surgical correction. This suggests that correction of the intermetatarsal angle and tibial sesamoid position might not always reliably predict correction of the hallux valgus angle following surgical intervention. It might also suggest that additional procedures beyond metatarsal osteotomies are required to reliably correct the hallux valgus angle in some deformities. It is hoped that this investigation adds to the body of knowledge with respect to the perioperative radiographic evaluation of the hallux valgus deformity.
Topics: Bunion; Hallux; Hallux Valgus; Humans; Metatarsal Bones; Multivariate Analysis; Radiography; Retrospective Studies
PubMed: 34953670
DOI: 10.1053/j.jfas.2021.11.014 -
Clinics in Podiatric Medicine and... Jul 2017Arthrodesis of the first metatarsal-phalangeal joint has been proposed for treatment of severe hallux valgus, end-stage hallux rigidus, rheumatoid arthritis, and... (Review)
Review
Arthrodesis of the first metatarsal-phalangeal joint has been proposed for treatment of severe hallux valgus, end-stage hallux rigidus, rheumatoid arthritis, and revision of failed surgery due to the perceived safety and efficacy. This article discusses the principles of first metatarsal-phalangeal joint arthrodesis in primary and revision situations, joint preparation, configurations of osteosynthesis, and common complications, including salvage of nonunion and revision of malunion with realignment osteotomy.
Topics: Arthrodesis; Foot Deformities; Humans; Internal Fixators; Joint Diseases; Metatarsophalangeal Joint; Postoperative Complications; Reoperation; Salvage Therapy
PubMed: 28576190
DOI: 10.1016/j.cpm.2017.02.002