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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 -
Journal of Healthcare Engineering 2020Metatarsal pain is a common pathological outcome in patients with a hallux valgus (HV) deformity. However, the relationship between the degree of HV deformity and...
Metatarsal pain is a common pathological outcome in patients with a hallux valgus (HV) deformity. However, the relationship between the degree of HV deformity and metatarsal pain has not been systematically examined. The purpose of the present study was to investigate the correlation between metatarsal pain and the degree of HV deformity. Between October 2017 and September 2018, 512 HV patients (944 feet) participated in an evaluation of their HV angle (HVA) using X-ray images. The participants were divided into four groups corresponding to their HVA (<15°, 15° to 20°, 21° to 40°, or >40°). Load rate, impulse, contact duration, and contact area were measured and recorded as dynamic gait parameters using the RsScan system. Data were evaluated using SPSS statistical software. The visual analog scale (VAS) was used to assess metatarsal pain. For the four HV deformity groups, the peak value of impulse and contact duration was concentrated on the second and third metatarsals (Meta2 and Meta3) ( < 0.05); contact area was also shown on metatarsals 1, 2, and 5 ( < 0.05). Metatarsal pain on Meta2 had the highest VAS score (VAS: 6.57), followed by Meta3 (Mean VAS: 5.72). In the HV > 40° group, the load location on Meta2 was transferred to Meta1. The percent of pain attributed to Meta2 and Meta3 was also increased in this group. These findings illustrated that metatarsal pain was primarily located on Meta2 and Meta3 in the different degrees of HV deformity. This information can provide the location to target for pain relief and help guide further rehabilitation.
Topics: Adult; Aged; Biomechanical Phenomena; Female; Hallux Valgus; Humans; Male; Metatarsal Bones; Middle Aged; Pain
PubMed: 32300473
DOI: 10.1155/2020/8929153 -
Scientific Reports Jun 2023An excess of body weight can produce morphological changes in the feet of children. The aim of this study was to assess the morphological differences of the foot in...
An excess of body weight can produce morphological changes in the feet of children. The aim of this study was to assess the morphological differences of the foot in children based on their body mass index and to determine the risk factors for the development of a hallux valgus in childhood and adolescence. One Thousand Six Hundred Seventy-Eight children (5-17 years) were classified as group with obesity, overweight, and normal weight. Lengths, widths, heights and angles of both feet was measured with a 3D scanner. The risk of developing hallux valgus was calculated. Group with overweight and obesity presented longer feet (p = 0.00), wider metatarsals (p = 0.00) and wider heels (p = 0.00). Arch height was lower (p > 0.01) in the group with obesity, and the hallux angle was greater in the group with normal weight (p < 0.05). The relative risk of a lateral hallux deviation increases with age, foot length and heel width (Exp (B) > 1). Children with overweight and obesity had longer and wider feet. The arch height was higher in children with overweight, and lower in children with obesity. Age, foot length, and heel width could be risk factors for the development of hallux valgus, while metatarsal width and arch height could be protective factors. Monitorization of the development and characterization of the foot in childhood as a clinical tool could help professionals to early identify the patients presenting risk factors and prevent future deformities and other biomechanical conditions in adulthood by implementing protecting measures.
Topics: Adolescent; Humans; Child; Hallux Valgus; Overweight; Metatarsal Bones; Metatarsus; Obesity
PubMed: 37291171
DOI: 10.1038/s41598-023-36301-2 -
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 -
Joint Diseases and Related Surgery 2020This study aims to evaluate the radiological and functional outcomes of hallux valgus patients treated with distal oblique metatarsal osteotomy technique.
OBJECTIVES
This study aims to evaluate the radiological and functional outcomes of hallux valgus patients treated with distal oblique metatarsal osteotomy technique.
PATIENTS AND METHODS
Twenty-six feet of 22 patients (4 males, 18 females; mean age 46.2±18 years; range, 16 to 70 years) who were diagnosed as hallux valgus between March 2013 and April 2016 and who underwent distal oblique metatarsal osteotomy were included in this retrospective study. American Orthopedic Foot and Ankle Society/Hallux Metatarsophalangeal-Interphalangeal Scale (AOFAS/HMIS) was used for clinical and functional evaluation. The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position, first metatarsal length and forefoot bone and soft tissue width were measured for radiological evaluation.
RESULTS
The mean follow-up time was 33.1±9.8 months. The AOFAS/HMIS score increased significantly postoperatively (p=0.001). In the footwear section of the AOFAS/HMIS, the median preoperative score of 5 (range, 0-5) increased to 10 (range, 5-10) at the postoperative period (p=0.001). Hallux valgus angle, IMA, DMAA, and first metatarsal length significantly decreased when compared to preoperative measurements. Forefoot bone width also decreased significantly from 9.3 cm (range, 7.5-11.5 cm) to 8.8 cm (6.8-10.3 cm) (p=0.001).
CONCLUSION
Distal oblique metatarsal osteotomy is a safe method for hallux valgus deformity. Forefoot width reduction, decrease of soft tissue tension, sesamoid reduction, and plantar fascia relaxation are the crucial benefits of this method.
Topics: Adolescent; Adult; Aged; Female; Hallux Valgus; Humans; Metatarsal Bones; Middle Aged; Osteotomy; Range of Motion, Articular; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 32160500
DOI: 10.5606/ehc.2020.71298 -
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 -
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 -
Clinics in Orthopedic Surgery Jun 2024Rheumatoid arthritis (RA) is a chronic autoimmune disorder that frequently causes forefoot deformities. Arthrodesis of the first metatarsophalangeal joint is a common...
BACKGROUND
Rheumatoid arthritis (RA) is a chronic autoimmune disorder that frequently causes forefoot deformities. Arthrodesis of the first metatarsophalangeal joint is a common surgery for severe hallux valgus. However, joint-preserving surgery can maintain the mobility of the joint. This study aimed to investigate the clinical and radiographic outcomes of distal chevron metatarsal osteotomy (DCMO) for correcting hallux valgus deformity associated with RA.
METHODS
Between August 2000 and December 2018, 18 consecutive patients with rheumatoid forefoot deformities (24 feet) underwent DCMO for hallux valgus with/without lesser toe surgery. Radiological evaluations were conducted, assessing the hallux valgus angle, the intermetatarsal angle between the first and second metatarsals, and the Sharp/van der Heijde score for erosion and joint space narrowing. Clinical outcomes were quantified using a visual analog scale for pain and the American Orthopaedic Foot and Ankle Society forefoot scores to measure function and alignment.
RESULTS
The mean hallux valgus angle decreased from 38.0° (range, 25°-65°) preoperatively to 3.5° (range, 0°-17°) at the final follow-up ( < 0.05). The mean intermetatarsal angle decreased from 14.9° (range, 5°-22°) preoperatively to 4.3° (range, 2°-11°) at the final follow-up. ( < 0.05). Regarding the Sharp/van der Heijde score, the mean erosion score (0-10) showed no significant change, decreasing from 3.83 (range, 0-6) preoperatively to 3.54 (range, 0-4) at the final follow-up ( = 0.12). Recurrent hallux valgus was observed in 1 patient and postoperative hallux varus deformity was observed in 2 feet. Spontaneous fusion of the metatarsophalangeal joint developed in 1 case.
CONCLUSIONS
DCMO resulted in satisfactory clinical and radiographic outcomes for correcting RA-associated hallux valgus deformity.
Topics: Humans; Hallux Valgus; Arthritis, Rheumatoid; Female; Middle Aged; Osteotomy; Male; Aged; Adult; Retrospective Studies
PubMed: 38827764
DOI: 10.4055/cios23184 -
Strategies in Trauma and Limb... 2023Juvenile hallux valgus (JHV) is a forefoot deformity that causes pain and functional limitation. Treatment poses a challenge in terms of the optimal technique and timing... (Review)
Review
BACKGROUND
Juvenile hallux valgus (JHV) is a forefoot deformity that causes pain and functional limitation. Treatment poses a challenge in terms of the optimal technique and timing of intervention. A systematic review of the literature on the use of growth modulation in treating JHV was conducted.
MATERIALS AND METHODS
The literature review was performed using PubMed and EMBASE searches for articles investigating growth modulation in the treatment of JHV published before December 1st, 2021. Seven articles were included in the final review that matched the inclusion and exclusion criteria. The primary outcomes included the degree of correction of hallux valgus angle and intermetatarsal angle. A qualitative assessment of the articles was done due to the heterogeneity of the growth modulation methods used in these articles.
RESULTS
A total of 135 feet from 78 patients were included from the reviewed articles. Growth modulation methods included temporary screw lateral hemiepiphysiodesis of the first metatarsal, lateral drilling hemiepiphysiodesis of the first metatarsal, and a trephine plug removal of the lateral epiphysis followed by cancellous bone graft insertion. The degree of correction of the hallux valgus and intermetatarsal angles were found to be statistically significant in all studies, regardless of the technique.
CONCLUSION
Growth modulation for JHV by lateral hemiepiphysiodesis using minimally invasive techniques produced favourable radiologic outcomes with some evidence of clinical improvement. Larger, prospective and comparative studies with objective clinical outcome measures may further consolidate this surgical approach as a mean to treating this deformity.
HOW TO CITE THIS ARTICLE
AlZeedi M, Park JP, Marwan Y, . Growth Modulation for the Treatment of Juvenile Hallux Valgus: A Systematic Review of Literature. Strategies Trauma Limb Reconstr 2023;18(1):51-55.
PubMed: 38033921
DOI: 10.5005/jp-journals-10080-1579 -
Cureus Aug 2020Polymetatarsia is an atavistic anomaly characterised by one or more additional metatarsals. Usually found with a supernumerary digit (polydactyly), polymetatarsia...
Polymetatarsia is an atavistic anomaly characterised by one or more additional metatarsals. Usually found with a supernumerary digit (polydactyly), polymetatarsia without polydactyly is a rare variant. We report a case of a 34-year-old male with polymetatarsia within the first intermetatarsal spaces of both feet without polydactyly. Clinically, moderate dorsal spur formation was visible, and compressive pain from ankylosed additional metatarsals within the first intermetatarsal spaces was exhibited. Treatment involved resection of his additional metatarsals with concomitant correction of his hallux valgus deformities and bilateral second brachymetatarsia. He reported a reduction in pressure and pain that was maintained until his discharge appointment at six weeks postoperatively. Resection of additional metatarsals may provide effective pain relief in symptomatic patients.
PubMed: 32944449
DOI: 10.7759/cureus.9730