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Foot & Ankle International Oct 2018Operative treatment of juvenile hallux valgus (JHV) has a high recurrence rate. The aim of this study was to better understand the pattern of radiographic deformity. (Comparative Study)
Comparative Study
BACKGROUND
Operative treatment of juvenile hallux valgus (JHV) has a high recurrence rate. The aim of this study was to better understand the pattern of radiographic deformity.
METHODS
Standing radiographs of 93 feet in 57 patients with JHV, and 50 feet in 36 normal patients were measured. Measurements included: hallux valgus angle (HVA), first metatarsal physis status (open or closed), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), Meary's angle, medial cuneiform angle (MCA), relative first to second metatarsal length ratio (1:2 MT ratio), cuneiform obliquity (CO), and congruency of the metatarsophalangeal joint (MTPJ). JHV groups were defined as normal (HVA 0-15 degrees), mild-moderate (HVA 15-35), or severe (HVA > 35) and were analyzed.
RESULTS
Seventy of 93 feet (75%) with JHV presented with mild-moderate JHV (average HVA of 26.2 ± 5.6 degrees), and 23 feet (25%, 23/93) presented with severe JHV (average HVA of 41.9 ± 5.3 degrees). Multivariable analysis determined that DMAA ( P < .001), MCA ( P = .04), and congruency ( P < .001) were independently associated with JHV and its severity (normal vs mild-moderate vs severe). Severe JHV cases had larger DMAA ( P = .01), larger IMA ( P = .01), larger 1:2 MT ratio ( P = .02), and were less frequently congruent ( P = .03) compared with mild-moderate JHV cases.
CONCLUSION
Deformity in JHV was highly correlated with both the proximal and distal morphology of the first metatarsal and medial cuneiform. Severe JHV was associated with increased bony deformity and increased incongruity of the MTPJ. Treatment should be individualized, but JHV treatment algorithms can take this information into account.
LEVEL OF EVIDENCE
Level III, comparative study.
Topics: Adolescent; Child; Female; Hallux Valgus; Humans; Male; Metatarsal Bones; Metatarsophalangeal Joint; Tarsal Bones
PubMed: 30070585
DOI: 10.1177/1071100718789696 -
Foot & Ankle Specialist May 2023Recurrence after surgical correction of hallux valgus may be related to coronal rotation of the first metatarsal. The scarf osteotomy is a commonly used procedure for...
BACKGROUND
Recurrence after surgical correction of hallux valgus may be related to coronal rotation of the first metatarsal. The scarf osteotomy is a commonly used procedure for correcting hallux valgus but has limited ability to correct rotation. Using weight-bearing computed tomography (WBCT), we aimed to measure the coronal rotation of the first metatarsal before and after a scarf osteotomy, and correlate these to clinical outcome scores.
METHODS
We retrospectively analyzed 16 feet (15 patients) who had a WBCT before and after scarf osteotomy for hallux valgus correction. On both scans, hallux valgus angle (HVA), intermetatarsal angle (IMA), and anteroposterior/lateral talus-first metatarsal angle were measured using digitally reconstructed radiographs. Metatarsal pronation angle (MPA), alpha angle, sesamoid rotation angle, and sesamoid position were measured on standardized coronal WBCT slices. Preoperative and postoperative (12 mo) clinical outcome scores (Manchester Oxford Foot Questionnaire and Visual Analogue Scores) were captured.
RESULTS
Mean HVA was 28.6 ± 10.1° preoperatively and 12.1 ± 7.7° postoperatively (P < .001). Mean IMA was 13.7 ± 3.8° preoperatively and 7.5 ± 3.0° postoperatively (P < .001). Before and after surgery, there were no significant differences in MPA (11.4 ± 7.7 and 11.4 ± 9.9°, respectively; P = .75) or alpha angle (10.9 ± 8.0 and 10.7 ± 13.1°, respectively; P = .83). There were significant improvements in sesamoid rotation angle (SRA) (26.4 ± 10.2 and 15.7 ± 10.2°, respectively; P = .03) and sesamoid position (1.4 ± 1.0 and 0.6 ± 0.6, respectively; P = .04) after a scarf osteotomy. There were significant improvements in all outcome scores after surgery. Poorer outcome scores correlated with greater postoperative MPA and alpha angles (r = .76 (P = .02) and .67 (P = .03), respectively).
CONCLUSION
A scarf osteotomy does not correct first metatarsal coronal rotation, and worse outcomes are linked to greater postoperative metatarsal rotation. Rotation of the metatarsal needs to be measured and considered when planning hallux valgus surgery. Further work was needed to compare postoperative outcomes with rotational osteotomies and modified Lapidus procedures when addressing rotation. 4.
PubMed: 37243475
DOI: 10.1177/19386400231172248 -
Der Orthopade May 2017The hallux valgus represents combined bony and soft tissue pathology. In addition to known bony surgical procedures, addressing the soft tissue with regard to the... (Review)
Review
The hallux valgus represents combined bony and soft tissue pathology. In addition to known bony surgical procedures, addressing the soft tissue with regard to the anatomical structures, the surgical technique and the extent of correction are discussed.The goal of the operation is the restoration of the physiological balance between the active and passive stabilizing factors of the MTP-I-joint. The joint capsule, the ligaments and the tendons of the first ray act directly as stabilizing structures, whereas the hind foot and the position of the upper ankle have an indirect influence on the MTP-I-joint.The present work gives an overview of the pathoanatomy of the MTP-I-joint in the hallux valgus pathology. The individual anatomical structures are presented with regard to their physiological and pathological influence and the possible therapeutic options.
Topics: Arthroplasty; Evidence-Based Medicine; Hallux Valgus; Humans; Joint Instability; Ligaments; Metatarsal Bones; Metatarsophalangeal Joint; Osteotomy; Plastic Surgery Procedures; Tendons; Treatment Outcome
PubMed: 28349173
DOI: 10.1007/s00132-017-3412-8 -
The Journal of the American Academy of... May 2020Hallux valgus deformity is a progressive forefoot deformity consisting of a prominence derived from a medially deviated first metatarsal and laterally displaced great... (Review)
Review
Hallux valgus deformity is a progressive forefoot deformity consisting of a prominence derived from a medially deviated first metatarsal and laterally displaced great toe, with or without pronation. Although there is agreement that the deformity is likely caused by multifactorial intrinsic and extrinsic factors, the best method of operative management is debated despite the creation of basic algorithms. Our understanding of the deformity and the development of newer techniques is continuously evolving. Here, we review the general orthopaedic principles of operative decision-making and management of hallux valgus deformity.
Topics: Decision Making; Hallux Valgus; Humans; Metatarsal Bones; Orthopedic Procedures; Toes
PubMed: 32073471
DOI: 10.5435/JAAOS-D-19-00324 -
Foot & Ankle International Mar 2022The purpose of this study was to determine if a postoperative decrease in first metatarsal pronation on 3-dimensional imaging was associated with changes in...
BACKGROUND
The purpose of this study was to determine if a postoperative decrease in first metatarsal pronation on 3-dimensional imaging was associated with changes in patient-reported outcomes as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) physical function, pain interference, and pain intensity domains or recurrence rates in patients with hallux valgus (HV) who undergo a first tarsometatarsal fusion (modified Lapidus procedure).
METHODS
Thirty-nine consecutive HV patients who met the inclusion criteria and underwent a modified Lapidus procedure had preoperative and ≥2-year postoperative PROMIS scores and had first metatarsal pronation measured on preoperative and at least 5-month postoperative weightbearing CT scans were included. Multivariable regression analyses were used to investigate differences in the change in PROMIS domains preoperatively and 2 years postoperatively between patients with "no change/increased first metatarsal pronation" and "decreased first metatarsal pronation." A log-binomial regression analysis was performed to identify if a decrease in first metatarsal pronation was associated with recurrence of the HV deformity.
RESULTS
The decreased first metatarsal pronation group had a significantly greater improvement in the PROMIS physical function scale by 7.2 points ( = .007) compared with the no change/increased first metatarsal pronation group. Recurrence rates were significantly lower in the decreased first metatarsal pronation group when compared to the no change/increased first metatarsal pronation group (risk ratio 0.25, = .025).
CONCLUSION
Detailed review of this limited cohort of patients who underwent a modified Lapidus procedure suggests that the rotational component of the HV deformity may play an important role in outcomes and recurrence rates following the modified Lapidus procedure.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.
Topics: Hallux Valgus; Humans; Metatarsal Bones; Patient Reported Outcome Measures; Pronation; Retrospective Studies
PubMed: 34612760
DOI: 10.1177/10711007211046938 -
EFORT Open Reviews Aug 2016Hallux valgus deformity is a very common pathological condition which commonly produces painful disability. It is characterised as a combined deformity with a...
Hallux valgus deformity is a very common pathological condition which commonly produces painful disability. It is characterised as a combined deformity with a malpositioning of the first metatarsophalangeal joint caused by a lateral deviation of the great toe and a medial deviation of the first metatarsal bone.Taking the patient's history and a thorough physical examination are important steps. Anteroposterior and lateral weight-bearing radiographs of the entire foot are crucial for adequate assessment in the treatment of hallux valgus.Non-operative treatment of the hallux valgus cannot correct the deformity. However, insoles and physiotherapy in combination with good footwear can help to control the symptoms.There are many operative techniques for hallux valgus correction. The decision on which surgical technique is used depends on the degree of deformity, the extent of degenerative changes of the first metatarsophalangeal joint and the shape and size of the metatarsal bone and phalangeal deviation. The role of stability of the first tarsometatarsal joint is controversial.Surgical techniques include the modified McBride procedure, distal metatarsal osteotomies, metatarsal shaft osteotomies, the Akin osteotomy, proximal metatarsal osteotomies, the modified Lapidus fusion and the hallux joint fusion. Recently, minimally invasive percutaneous techniques have gained importance and are currently being evaluated more scientifically.Hallux valgus correction is followed by corrective dressings of the great toe post-operatively. Depending on the procedure, partial or full weight-bearing in a post-operative shoe or cast immobilisation is advised. Post-operative radiographs are taken in regular intervals until osseous healing is achieved. Cite this article: Fraissler L, Konrads C, Hoberg M, Rudert M, Walcher M. Treatment of hallux valgus deformity. 2016;1:295-302. DOI: 10.1302/2058-5241.1.000005.
PubMed: 28660074
DOI: 10.1302/2058-5241.1.000005 -
The Journal of Foot and Ankle Surgery :... 2024The use of bioabsorbable magnesium (Mg) screws is new in foot surgery. Their relative merit over conventional titanium screws has not yet been proven. This prospective...
The use of bioabsorbable magnesium (Mg) screws is new in foot surgery. Their relative merit over conventional titanium screws has not yet been proven. This prospective case series study was conducted to compare the clinical and radiological outcomes of bioabsorbable Mg screws and titanium screws. A consecutive series of patients (n = 60; 11 men and 49 women) underwent corrective hallux valgus surgery. The minimum follow-up period was 1 year. The assessment was based on a patient questionnaire, including the American Orthopedic Foot and Ankle Society (AOFAS) hallux valgus score, visual analog scale, patient's global impression of change (PGIC), and fifth metatarsus circumference (IF5C). The radiographic assessment included the intermetatarsal and hallux valgus angles, as well as time to osteotomy union and hardware failure. At 1 year, similar results were obtained radiographically. The healing of the osteotomies was significantly faster in the Mg group. Hardware failure was common in the Mg group (5/26) than in the TI group (0/34) but hardware removal was more common in the TI group (6/34) versus the MG group (0/26). IF5C increased by 8 ± 2 mm in the Mg group. The AOFAS and PGIC scores at 6 months were similar. Validated foot scores and radiographic analysis indicated that there was no detectable difference between the groups. The fast achievement of osteotomy union compensates for a high rate of hardware failure, resulting in patient satisfaction and avoiding reoperation for hardware removal.
Topics: Male; Humans; Female; Magnesium; Titanium; Hallux Valgus; Bone Screws; Radiography; Metatarsal Bones; Treatment Outcome; Retrospective Studies
PubMed: 37699499
DOI: 10.1053/j.jfas.2023.09.002 -
The Journal of Foot and Ankle Surgery :... 2023The research results are inconsistent that assessing whether the increased obliquity of the distal articular surface of the medial cuneiform leads to an increase in... (Review)
Review
The research results are inconsistent that assessing whether the increased obliquity of the distal articular surface of the medial cuneiform leads to an increase in hallux valgus angle. Thus, this study investigated the relationship between distal medial cuneiform obliquity and hallux valgus by measuring various angles in weightbearing anteroposterior radiographs of the foot. In total, 679 feet of 538 patients with the radiographs were included in the study. We measured radiographic parameters including hallux valgus angle, first to second intermetatarsal angle, metatarsus adductus angle, first metatarsus cuneiform angle, distal medial cuneiform angle, and first proximal metatarsal articular angle. The surface morphology (flat or curved) of the first tarsometatarsal joint was also recorded. Our results analysis revealed a weak negative correlation between distal medial cuneiform angle and both hallux valgus angle and first to second intermetatarsal angle, contrary to our assumption. So we believe that distal medial cuneiform angle was relatively constant and it cannot be used as a characteristic angle for quantifying hallux valgus. First metatarsus cuneiform angle was a characteristic indicator of hallux valgus and was positively correlated with its severity (p < .000), indicating that it can be used to measure the size of hallux valgus. It can also be used as a reference factor for the first metatarsal osteotomy in clinical bunion orthopedics. First tarsometatarsal joint morphology was unrelated to hallux valgus, whereas metatarsus adductus angle, and first proximal metatarsal articular angle should be considered in hallux valgus.
Topics: Humans; Hallux Valgus; Metatarsus Varus; Hallux; Metatarsal Bones; Bunion; Osteotomy
PubMed: 36973143
DOI: 10.1053/j.jfas.2022.06.009 -
Foot and Ankle Surgery : Official... Aug 2023Among the numerous surgical interventions for correcting hallux valgus deformity in skeletally immature patients, hemiepiphysiodesis is a simple technique with a low... (Review)
Review
BACKGROUND
Among the numerous surgical interventions for correcting hallux valgus deformity in skeletally immature patients, hemiepiphysiodesis is a simple technique with a low complication rate yet its effectiveness remains unclear. This systematic review evaluates hemiepiphysiodesis of the first metatarsal for treating juvenile hallux valgus (JHV) deformities with respect to radiological outcomes, postoperative clinical outcomes, and postoperative complications.
METHODS
EMBASE, MEDLINE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) database were searched from inception to September 15th, 2022, for studies investigating hemiepephysiodesis for JHV and its effect on clinical and radiological outcomes. The search, data extraction and methodologic assessment were performed in duplicate for all included studies.
RESULTS
Six studies out of 488 with a total of 147 feet in 85 patients were included in the final qualitative synthesis. The American Orthopaedic Foot & Ankle Society hallux metatarsophalangeal interphalangeal scale (AOFAS Hallux MTP-IP scale) was used in two studies. The mean pooled preoperative score was 62.2 ± 8.9 and improved to 88.6 ± 4.8 postoperatively in 33 patients. All six studies reported significant improvement in the hallux valgus angle (HVA) from mean preoperative angle of 29.2° ± 3.7-23.8° ± 4.5° postoperatively, while the intermetatarsal angle (IMA) preoperative and postoperative means corrected from 13.9° ± 1.1-11.4° ± 1.2°, respectively. Out of 147 feet, 21 (14.2%) had reported complications including recurrence and need for revision surgery.
CONCLUSION
This systematic review confirms that hemiepiphysiodesis of the first metatarsal in patients with JHV has improved clinical and radiological outcomes.
LEVEL OF EVIDENCE
Level IV, Systematic review.
Topics: Humans; Hallux Valgus; Hallux; Treatment Outcome; Osteotomy; Metatarsophalangeal Joint; Bunion; Metatarsal Bones; Retrospective Studies
PubMed: 37419765
DOI: 10.1016/j.fas.2023.06.010 -
Gait & Posture Oct 2021Hallux valgus orthoses are available in a wide range of designs and materials, but the effects of their design on functional performance have not been fully investigated.
BACKGROUND
Hallux valgus orthoses are available in a wide range of designs and materials, but the effects of their design on functional performance have not been fully investigated.
RESEARCH QUESTION
This present study aims to comprehensively analyze the immediate effects of soft and semi-rigid hallux valgus orthoses on balance, plantar pressure, hallux valgus angle, and subjective sensations.
METHODS
Sixteen female subjects have participated in the study, including 10 subjects with healthy feet and 6 with hallux valgus. Three conditions are tested, including in the barefoot and using two types of commercially available hallux valgus orthoses. The subjects participate in static and dynamic (walking) tests with the use of the Novel Pedar® system. The peak pressure values in the hallux, lateral toes, first metatarsophalangeal joint, 2-4th metatarsal heads, 5th metatarsal head, medial midfoot, lateral midfoot and rearfoot in the various foot conditions are examined and compared. The hallux valgus angle of each subject is measured based on their footprint. Their subjective feelings towards the orthoses are also evaluated. A repeated-measures analysis of variance, and independent-sample t-test are performed.
RESULTS
The correction of the hallux valgus angle is statistically significant when the subjects with hallux valgus use the orthoses. In comparing the two types of orthoses, the use of the orthosis made of soft materials results in correction in the hallux valgus angle and higher wear comfort, and lower plantar pressure in hallux area.
SIGNIFICANCE
The results provide insights into the design of hallux valgus orthoses, thus offering practical reference for the selection of hallux valgus orthosis with compromise between functional performance and wear comfort.
Topics: Female; Foot; Hallux Valgus; Humans; Metatarsal Bones; Orthotic Devices; Pressure
PubMed: 34537497
DOI: 10.1016/j.gaitpost.2021.09.174