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Foot and Ankle Clinics Sep 2020The windswept foot remains a reconstructive challenge. The hallux valgus associated with the medially displaced lesser metatarsal heads is hard to correct. Either the... (Review)
Review
The windswept foot remains a reconstructive challenge. The hallux valgus associated with the medially displaced lesser metatarsal heads is hard to correct. Either the lesser metatarsal heads need to be displaced laterally or the deformity accepted. With the deformity, all the toes tend to be aligned into valgus with the position of the flexor and extensor tendons. Several treatment alternatives exist and may require a combination of open and percutaneous surgery. The authors think that, in severe metatarsus adductus, proximal correction of the first, second, and third metatarsals is required.
Topics: Arthrodesis; Bone Malalignment; Foot Deformities; Humans; Metatarsus Varus; Minimally Invasive Surgical Procedures; Osteotomy; Toes
PubMed: 32736739
DOI: 10.1016/j.fcl.2020.05.005 -
Journal of Orthopaedic Science :... Oct 2023Studies have shown that the first metatarsal contributes to hallux valgus. The proximal phalanx, another factor that defines the hallux valgus angle, also contributes to...
BACKGROUND
Studies have shown that the first metatarsal contributes to hallux valgus. The proximal phalanx, another factor that defines the hallux valgus angle, also contributes to the development of hallux valgus. There have been no reports on the use of computed tomography to evaluate bone morphology of the proximal phalanx. The purpose of this study was to analyze the morphology and deformity of the proximal phalanx and its relationship to hallux valgus using computed tomography, and to consider the indications for proximal phalanx surgery in hallux valgus.
METHODS
Patients who consulted at our clinic for foot and ankle disorders and underwent both weight-bearing radiography and computed tomography between May 2019 and March 2022 were included in the study. The hallux valgus angle, sesamoid subluxation, first metatarsal length, proximal phalanx length, metatarsal-proximal phalanx ratio, proximal phalanx valgus angle, metatarsal-proximal phalanx angle, proximal phalanx rotation angle, and distal phalanx-proximal phalanx angle were measured. These parameters were compared between the hallux valgus and control groups. In the hallux valgus group, the hallux valgus and proximal phalanx valgus angles were measured and compared using weight-bearing radiographs.
RESULTS
A total of 83 feet in 65 patients were diagnosed with hallux valgus (hallux valgus group; mean age of 68.0 ± 13.8 years) and 30 feet in 22 patients without hallux valgus (control group; mean age of 67.0 ± 25.8 years) were included in the study. The proximal phalanx length, metatarsal-proximal phalanx ratio and angle, and distal phalanx-proximal phalanx angle were significantly greater in the hallux valgus group than in the control group. However, the proximal phalanx valgus and rotation angles were not significantly different between the groups.
CONCLUSION
Since there was no significant difference in the proximal phalanx morphology, except length, between the hallux valgus and control groups, the indications for osteotomy of the proximal phalanx should be carefully considered.
PubMed: 37852898
DOI: 10.1016/j.jos.2023.09.010 -
Journal of Clinical Orthopaedics and... Feb 2021Planovalgus deformity in cerebral palsy is disabling for the child in terms of increased energy expenditure during the gait cycle. The lever arm function of the foot is...
PURPOSE OF STUDY
Planovalgus deformity in cerebral palsy is disabling for the child in terms of increased energy expenditure during the gait cycle. The lever arm function of the foot is lost due to midfoot break and the achilles tendon is at a disadvantage being unable to lift the body weight during push-off. We evaluated the results of calcaneal lengthening osteotomy in such patients with clinical, radiological and gait parameters.
METHODS
17 spastic feet in a sample of 10 children were included in our study. The children were classified according to the GMFCS classification system and clinical parameters such as heel valgus and heel rise tests, radiological angles such as Talo-calcaneal angle and Talo-navicular coverage angle on AP view and Calcaneal pitch angle, calcaneus-5th metatarsal angle and talus-1st metatarsal angle on lateral view were measured. Video gait analysis was performed to observe knee progression angle in mid stance and peak knee flexion angle in mid and terminal stance.
RESULTS
Improvement was noted clinically in the heel valgus angle (preop-12.06°, postop-5.12°) and radiological parameters showed an improved coverage of the talus by navicular with simultaneous lifting of the medial longitudinal arch. Gait analysis showed decreased knee flexion trend in mid and terminal stance phase with better restoration of the knee axis.
CONCLUSION
Calcaneal lengthening osteotomy with peroneus brevis lengthening corrects almost all aspects of planovalgus deformity with an improved gait pattern without disturbing joint range of motion. It is a safe procedure for GMFCS grade 1 and 2 patients without much complications.
PubMed: 33717872
DOI: 10.1016/j.jcot.2020.08.024 -
Foot and Ankle Surgery : Official... Jun 2022Transfer metatarsalgia is a potential complication of hallux valgus surgery. This study aimed to investigate the shortened first metatarsal length and elevation and to...
BACKGROUND
Transfer metatarsalgia is a potential complication of hallux valgus surgery. This study aimed to investigate the shortened first metatarsal length and elevation and to compare groups with and without second transfer metatarsalgia after Scarf osteotomy.
METHODS
The first metatarsal length of 123 feet was measured via the Maestro's method using the metatarsal axial length and the relative second metatarsal protrusion to the first metatarsal. Metatarsal elevation was measured using the first metatarsal angle.
RESULTS
Second transfer metatarsalgia occurred after Scarf osteotomy in 11 (8.9%) feet. When baseline characteristics were considered in propensity score matching, the 11 feet were compared with the 33 feet in the control group. The group with transfer metatarsalgia showed a more shortened first metatarsal axial length (-4.1 ± 1.8 mm vs. -2.5 ± 2.2 mm, p = 0.032), a significantly longer relative second metatarsal protrusion (+5.8 ± 2.6 mm vs. +1.2 ± 2.6 mm, p < 0.001), and a significantly lower first metatarsal angle (18.1 ± 4.3° vs. 21.5 ± 4.0°, p = 0.012) than the control group postoperatively.
CONCLUSIONS
To avoid iatrogenic transfer metatarsalgia, first metatarsal length shortening should be minimized to at least less than 4.0 mm. Furthermore, the metatarsal parabola should be retained.
Topics: Hallux Valgus; Humans; Iatrogenic Disease; Metatarsal Bones; Metatarsalgia; Osteotomy; Treatment Outcome
PubMed: 34838426
DOI: 10.1016/j.fas.2021.11.005 -
Journal of Pain Research 2022To investigate the risk factors for hallux valgus complicated with pain under the second metatarsal and construct an effective model and method for predicting hallux...
OBJECTIVE
To investigate the risk factors for hallux valgus complicated with pain under the second metatarsal and construct an effective model and method for predicting hallux valgus complicated with pain under the second metatarsal based on risk factors.
METHODS
A total of 545 patients with hallux valgus who were admitted to our hospital were divided randomly into a training set and a validation set. The demographic characteristics, imaging indices and gait test indices of the patients were collected. The risk factors were identified by univariate and multivariate logistic regression analyses. A risk prediction model for hallux valgus with pain under the second metatarsal was established, and the area under the curve (AUC) of the receiver operating characteristic and a decision curve analysis were used for verification and identification. The value of the model was tested in the verification group.
RESULTS
Second metatarsal length, second metatarsal peak pressure, hallux valgus angle (HVA), intermetatarsal angle 1-2 (IMA1-2) and weight were the risk factors for hallux valgus complicated with pain under the second metatarsal. Based on the weighting of these seven risk factors, a prediction model was established. The AUC of the prediction model was 0.84 (95% confidence interval [CI]: 0.802~0.898, < 0.05), and the results of a Hosmer-Lemeshow test showed a good degree of calibration ( = 10.62, > 0.05). The internal validation of the AUC was 0.83 (95% CI: 0.737-0.885, < 0.05). The model had obvious net benefits when the threshold probability was 10%-70%.
CONCLUSION
Second metatarsal length, second metatarsal peak pressure, HVA, IMA1-2 and weight were the risk factors for hallux valgus combined with second metatarsal pain. The risk prediction model for hallux valgus complicated with pain under the second metatarsal based on these seven variables was proven effective.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
PubMed: 36394054
DOI: 10.2147/JPR.S386315 -
Annals of the Royal College of Surgeons... Jan 2022Akin osteotomies are commonly fixed with a screw or staple. Hardware-related symptoms are not uncommon. We compared the outcomes and costs of the two implants. (Comparative Study)
Comparative Study
INTRODUCTION
Akin osteotomies are commonly fixed with a screw or staple. Hardware-related symptoms are not uncommon. We compared the outcomes and costs of the two implants.
METHODS
We evaluated 74 Akin osteotomies performed in conjunction with first metatarsal osteotomy for hallux valgus. The osteotomy was fixed with a headless compression screw in 39 cases and a staple in 35 cases. We looked at the implant-related complications, removal of metalwork, revision, non-union and cost. Pre- and postoperative hallux valgus interphalangeal (HI) angles and length of the proximal phalanx were measured.
RESULTS
There was 100% union, no failure of fixation, no revision surgery and no delayed union in either group. The radiological prominence of screws was significant (=0.02), but there was no significant difference in soft-tissue irritation (=0.36) or removal of implants (=0.49). Two cortical breaches (5.8%) occurred in staple fixation and 4 (10.2%) in screw fixation (not statistically significant (NS), =0.50). The mean improvement in HI angle was 4.3° with screw fixation and 4.1° with staple fixation (NS, =0.69). The mean shortening of the proximal phalanx was 2.5mm with screw fixation and 2.3mm with staple fixation (NS, =0.64). The total cost was £1,925 for staple fixation and £4,290 for screw fixation.
CONCLUSIONS
Staple and screw fixation are reproducible modalities with satisfactory outcomes, but screw fixation is expensive. We conclude staple fixation is a cost-effective alternative.
Topics: Bone Screws; Female; Hallux Valgus; Humans; Male; Metatarsal Bones; Middle Aged; Osteotomy; Retrospective Studies; Sutures
PubMed: 34323127
DOI: 10.1308/rcsann.2021.0029 -
Foot and Ankle Clinics Dec 2019Metatarsus adductus (MA) is a congenital condition resulting in adduction of the forefoot at the tarsometatarsal joint, medial metatarsal deviation, supination of the... (Review)
Review
Metatarsus adductus (MA) is a congenital condition resulting in adduction of the forefoot at the tarsometatarsal joint, medial metatarsal deviation, supination of the hindfoot through the subtalar joint, and plantarflexed first ray. The exact underlying pathophysiology remains elusive. There is increasing evidence highlighting the importance of recognizing MA as an associated deformity that complicates management of hallux valgus (HV). Unfortunately, metatarsalgia and lesser toe pathology is also common in this population. We present a review regarding the epidemiology, pathomechanics, and a comprehensive surgical treatment algorithm to optimize the management of patients with MA, HV, lesser toe deformity, and metatarsalgia.
Topics: Foot Deformities, Congenital; Humans; Metatarsalgia; Osteotomy
PubMed: 31653370
DOI: 10.1016/j.fcl.2019.08.002 -
Foot and Ankle Clinics Mar 2020Complications following hallux valgus (HV) reconstruction will have an expected incidence of between 10% and 55% of cases. The more commonly reported complications... (Review)
Review
Complications following hallux valgus (HV) reconstruction will have an expected incidence of between 10% and 55% of cases. The more commonly reported complications include undercorrection/recurrence, overcorrection (hallux varus), transfer metatarsalgia, nonunion, malunion, avascular necrosis, arthritis, hardware removal, nerve injury, and ultimately patient dissatisfaction. The presence of arthritis will be an indication for fusion, whereas osteotomies will be the procedure of choice if the first metatarsophalangeal joint is healthy. Wide experience in primary HV surgery is advised before dealing with complex cases of failed HV surgery.
Topics: Hallux Valgus; Humans; Osteotomy
PubMed: 31997742
DOI: 10.1016/j.fcl.2019.10.011 -
International Orthopaedics Sep 2021Hallux varus is a classical complication of hallux valgus surgery with a medium rate of 6%. (Review)
Review
PURPOSE
Hallux varus is a classical complication of hallux valgus surgery with a medium rate of 6%.
MATERIAL AND METHODS
Methods of treatment are MTP1 fusion or conservative joint operations. Hallux varus results from imbalance between excessive medial capsule retraction or tensioning and excessive lateral laxity or soft-tissue release but also and mainly from an over displacement of the first metatarsal which reduces the intermetatarsal angle and thus leads to medial displacement of the great toe. A majority are well tolerated, but few need to be re-operated upon.
RESULTS
Factors guiding choice are mainly range of motion and reducibility of the first metatarsophalangeal joint and tendon balance. Joint sparing could be decided for a mobile and well balancesd MTP1 with two options, soft-tissue repairing such as tendon and ligament transfer and reverse osteotomies. The choice depends mainly on the radiological features as an unduly closed intermetarsal angle which leads to a reverse scarf or chevron osteotomy whatever previous surgery was or was not with an osteotomy.
CONCLUSION
Conservative treatment is tricky, and MTP1 fusion is still a reliable procedure which can be used widely.
Topics: Hallux; Hallux Valgus; Hallux Varus; Humans; Metatarsal Bones; Metatarsophalangeal Joint; Treatment Outcome
PubMed: 34279671
DOI: 10.1007/s00264-021-05143-w -
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