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Journal of Orthopaedic Surgery and... Feb 2023Amputation of the second toe is associated with destabilization of the first toe. Possible consequences are hallux valgus deformity and subsequent pressure ulcers on the...
BACKGROUND
Amputation of the second toe is associated with destabilization of the first toe. Possible consequences are hallux valgus deformity and subsequent pressure ulcers on the lateral side of the first or on the medial side of the third toe. The aim of this study was to investigate the incidence and possible influencing factors of interdigital ulcer development and hallux valgus deformity after second toe amputation.
METHODS
Twenty-four cases of amputation of the second toe between 2004 and 2020 (mean age 68 ± 12 years; 79% males) were included with a mean follow-up of 36 ± 15 months. Ulcer development on the first, third, or fourth toe after amputation, the body mass index (BMI) and the amputation level (toe exarticulation versus transmetatarsal amputation) were recorded. Pre- and postoperative foot radiographs were evaluated for the shape of the first metatarsal head (round, flat, chevron-type), the hallux valgus angle, the first-second intermetatarsal angle, the distal metatarsal articular angle and the hallux valgus interphalangeal angle by two orthopedic surgeons for interobserver reliability.
RESULTS
After amputation of the second toe, the interdigital ulcer rate on the adjacent toes was 50% and the postoperative hallux valgus rate was 71%. Neither the presence of hallux valgus deformity itself (r = .19, p = .37), nor the BMI (r = .09, p = .68), the shape of the first metatarsal head (r = - .09, p = .67), or the amputation level (r = .09, p = .69) was significantly correlated with ulcer development. The interobserver reliability of radiographic measurements was high, oscillating between 0.978 (p = .01) and 0.999 (p = .01).
CONCLUSIONS
The interdigital ulcer rate on the first or third toe after second toe amputation was 50% and hallux valgus development was high. To date, evidence on influencing factors is lacking and this study could not identify parameters such as the BMI, the shape of the first metatarsal head or the amputation level as risk factors for the development of either hallux valgus deformity or ulcer occurrence after second toe amputation.
TRIAL REGISTRATION
BASEC-Nr. 2019-01791.
Topics: Male; Humans; Middle Aged; Aged; Aged, 80 and over; Female; Hallux Valgus; Ulcer; Reproducibility of Results; Osteotomy; Toes; Metatarsal Bones; Amputation, Surgical; Diabetes Mellitus
PubMed: 36782206
DOI: 10.1186/s13018-023-03577-z -
Foot & Ankle Orthopaedics Jul 2022The modified Lapidus procedure (first metatarso-cuneiform fusion) is a powerful technique for correcting triplanar deformity in hallux valgus. Although traditionally...
BACKGROUND
The modified Lapidus procedure (first metatarso-cuneiform fusion) is a powerful technique for correcting triplanar deformity in hallux valgus. Although traditionally fixed with cross-screws (CS), growing awareness of intercuneiform stability and pronation deformity has led to fixation using a plate and first metatarsal-second cuneiform (1MT-2C) screw fixation (PS). We investigated Lapidus patient cohorts using CS vs PS fixation to understand patient-reported outcomes, angular and rotational correction, and complication rates.
METHODS
We retrospectively reviewed cases of modified Lapidus for hallux valgus by a single surgeon. Patients were divided into CS or PS groups according to fixation. All patients had preoperative Patient Reported Outcome Measurement Information System (PROMIS) scores and minimum 12 months of follow-up. PROMIS scores in 6 key domains were compared within and between groups. Radiographic assessment of hallux valgus angle and intermetatarsal angle were performed on pre- and postoperative XR. Pronation of the first ray was measured on pre- and postoperative weightbearing computed tomography.
RESULTS
We compared 42 patients with PS fixation to 43 with CS fixation. Both groups had significant improvement in hallux valgus angle and intermetatarsal angle ( < .001), with no difference between groups. PS patients experienced a greater correction of first metatarsal pronation, an average reduction of 11 degrees, compared to 8 degrees in the CS group ( < .039). Both cohorts experienced improvement in PROMIS physical function, pain interference, pain intensity, and global physical function. There were no differences in PROMIS score improvements between the cohorts. The CS group started weightbearing at 6 weeks vs 3.6 weeks for the PS group. Complication and revision rates were similar.
CONCLUSION
A plate and 1MT-2C screw fixation provides safe, robust fixation of Lapidus procedure and prevents instability through the intercuneiform joint. We observed similar improvement in PROMIS compared with patients treated with cross-screws. Complications did not increase despite the PS group weightbearing much earlier. PS patients achieved greater first ray rotational correction.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.
PubMed: 36199381
DOI: 10.1177/24730114221127001 -
Clinics in Orthopedic Surgery Sep 2022Plantar fasciitis is a common cause of heel pain affecting 10% of the general population. This study aimed to investigate the specific symptoms in patients with plantar...
BACKGROUND
Plantar fasciitis is a common cause of heel pain affecting 10% of the general population. This study aimed to investigate the specific symptoms in patients with plantar fasciitis using the Foot and Ankle Outcome Score (FAOS) questionnaire and their relationship with demographic and radiographic factors.
METHODS
We retrospectively analyzed 73 consecutive patients (mean age, 53.8 ± 10.0 years; 20 men and 53 women) with plantar fasciitis who had visited our foot and ankle clinic and undergone weight-bearing foot X-ray examinations. Their demographic data, anteroposterior and lateral talo-first metatarsal angles, intermetatarsal and hallux valgus angles, and responses to the FAOS questionnaire were recorded.
RESULTS
The quality-of-life subscale showed the lowest score of all FAOS subscales. Age was significantly correlated with quality of life ( = 0.297, = 0.011), and body mass index was correlated with the function in sports and recreational activities ( = -0.251, = 0.032). Age and body mass index were statistically significantly correlated with calcaneal spur size ( = 0.274, = 0.027 and = 0.324, = 0.008, respectively). The calcaneal spur size was significantly correlated with pain ( = -0.348, = 0.004), function in daily living ( = -0.410, = 0.001), and function in sports and recreational activities ( = -0.439, < 0.001).
CONCLUSIONS
Demographic factors were associated with specific symptoms in patients with plantar fasciitis. Calcaneal spur size was the only radiographic parameter correlated with symptoms. These findings help communicate with patients, set appropriate treatment goals, and evaluate treatment effectiveness.
Topics: Adult; Body Mass Index; Fasciitis, Plantar; Female; Heel Spur; Humans; Male; Middle Aged; Pain; Quality of Life; Retrospective Studies
PubMed: 36061842
DOI: 10.4055/cios21263 -
Journal of Clinical Orthopaedics and... 2020Numerous publications of the late 20th century have presented the radiological outcome of open technique for distal metatarsal osteotomy for mild to moderate hallux...
BACKGROUND
Numerous publications of the late 20th century have presented the radiological outcome of open technique for distal metatarsal osteotomy for mild to moderate hallux valgus and the clinical outcomes by means of well-established scoring systems which have been published and make these open techniques today's benchmark and gold standard. Minimally invasive procedures reduce surgical trauma because they are performed without large incisions, and injury to the soft tissues is limited. This has the theoretical advantages of improved recovery and decreased rehabilitation times. There is however limited literature to prove the same for minimally invasive surgery for hallux valgus.Our aim was thus to pool all available comparative literature on minimally invasive hallux valgus surgery done for mild to moderate hallux valgus versus open surgical approaches.
METHODS
A PubMed, Embase and Scopus search was performed using the keywords ('hallux valgus' OR bunion) AND ('minimally invasive' OR percutaneous) AND osteotomy. A total of 473 records were identified and out of which nine studies were included in the final review.
RESULTS
Most available studies are either randomized control trials, or prospective cohort studies providing good level of evidence. Radiological analysis showed similar correction with both MIS and open osteotomies. In functional analysis results were different with open techniques providing better results in terms of AOFAS score. (p < 0.0001). VAS score and complication rate were similar in both groups.
DISCUSSION/CONCLUSION
We conclude that based on available literature MIS provides equivalent radiological outcomes with respect to open surgery but functionally despite the promising results (good to excellent in most series), the outcomes in terms of function are not as good as open surgery. MIS techniques provide satisfactory outcomes for mild-to-moderate severity of hallux valgus though not as good as open surgery. There is evolving literature for this relatively new procedure. Longer duration of follow up and bigger numbers would allow for more meaningful data analysis and conclusions to be drawn as more studies come forward.
PubMed: 32405192
DOI: 10.1016/j.jcot.2020.04.016 -
Journal of Clinical Medicine Nov 2023Various modifications of distal chevron metatarsal osteotomy (DCMO) have been introduced for correcting moderate hallux valgus deformity; however, the amount of...
Various modifications of distal chevron metatarsal osteotomy (DCMO) have been introduced for correcting moderate hallux valgus deformity; however, the amount of correction may be limited, and complications, such as the recurrence of the deformity and avascular necrosis of the metatarsal head, have been a problem. This study aimed to present a modified 90-degree DCMO technique that overcomes the previously reported shortcomings and to report a successful short-term radiographic outcome. Sixty-eight consecutive patients who underwent the operation with our modified DCMO technique and twenty-two consecutive patients with the conventional DCMO technique (control group) were retrospectively analyzed. The radiographic measurements were evaluated preoperatively, at two months post operation, and at the final follow-up. Both groups showed a significant correction of the hallux valgus angle, first-second intermetatarsal angle, distal metatarsal articular angle, and sesamoid position at the final follow-up, while the amount of correction was significantly greater in the modified DCMO group. In both groups, there were no cases of complications such as avascular necrosis of the metatarsal head, nonunion, and surgical site infection appearing throughout the follow-up period. Therefore, the modified 90-degree DCMO technique is effective and safe, which could serve as a favorable option to treat moderate hallux valgus deformity.
PubMed: 37959367
DOI: 10.3390/jcm12216902 -
Journal of Musculoskeletal & Neuronal... Dec 2023To explore the application of 3D printed navigation template technology in severe Hallux valgus surgery.
OBJECTIVES
To explore the application of 3D printed navigation template technology in severe Hallux valgus surgery.
METHODS
Forty-eight patients with severe Hallux valgus were selected. There were 24 cases in the control group underwent hallux valgus osteotomy using traditional methods and fixed with fully threaded hollow screws during the surgery. There were 24 cases in the 3D group who underwent personalized osteotomy using 3D printing navigation template technology. Patients were followed up regularly for six months after surgery.
RESULTS
The surgery time of the 3D group was shorter than that of the control group, and the intraoperative bleeding was reduced (P<0.05). Compared with the preoperative data, the HVA and IMA significantly reduced immediately and 1, 3, and 6 months after surgery (P<0.05). The VAS scores decreased significantly, while the AOFAS and SF-36 scores increased (P<0.05). At three months and six months after surgery, the VAS score of the 3D group was lower than that of the control group, while the SF-36 score was higher (P<0.05). During the follow-up period, both groups had no recurrent cases or complications.
CONCLUSIONS
The 3D printing navigation template technology improves patients' prognosis, functional recovery, and quality of life.
Topics: Humans; Hallux Valgus; Treatment Outcome; Metatarsal Bones; Quality of Life; Radiography; Printing, Three-Dimensional; Retrospective Studies
PubMed: 38037363
DOI: No ID Found -
Clinics in Orthopedic Surgery Mar 2021Problems associated with hallux valgus deformity correction using Kirschner-wire (K-wire) fixation include pin pullout and loss of stability. These complications are... (Comparative Study)
Comparative Study
BACKGROUND
Problems associated with hallux valgus deformity correction using Kirschner-wire (K-wire) fixation include pin pullout and loss of stability. These complications are pronounced in the osteopenic bone, and few reports have focused on pin versus screw fixation. We examined the use of additional screw fixation to avoid these problems. The aim of this study was to compare outcomes of K-wire fixation (KW) and a combined K-wire and screw fixation (KWS).
METHODS
Two groups with hallux valgus deformity, who were treated with a proximal chevron metatarsal osteotomy (PCMO), were compared based on the fixation method used. The KW group included 117 feet of 98 patients, and the KWS group included 56 feet of 40 patients. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain score, American Orthopedic Foot & Ankle Society (AOFAS) hallux score, and patient satisfaction score were evaluated. Radiographically, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured.
RESULTS
The mean VAS score decreased from 6.3 preoperatively to 1.6 postoperatively in the KW group and from 5.7 preoperatively to 0.5 postoperatively in the KWS group ( < 0.001). The mean AOFAS scores of the KW and KWS groups improved from 59.4 and 58.2, respectively, to 88.9 and 95.3, respectively ( < 0.001). Eighty-five percent in the KW group and 93% in the KWS group were satisfied with surgery. Clinical differences were not significant. The mean HVAs decreased from 34.7° to 9.1° in the KW group and from 38.5° to 9.2° in the KWS group ( < 0.001). The mean IMA decreased from 14.5° (range, 11.8°-17.2°) to 6.4° (range, 2.7°-10.1°) in the KW group and from 18.0° (range, 14.8°-21.2°) to 5.3° (range, 2.5°-8.1°) in the KWS group ( < 0.001). When IMA values at the 3-month postoperative and the final follow-up were compared, the IMA was significantly increased only in the KW group ( < 0.001) and no difference was found in the KWS group ( = 0.280).
CONCLUSIONS
We found a statistically significant difference in the decrease in IMA between the 2 groups. We recommend the combined pin and screw fixation in PCMO to enhance fixation stability and prevent potential hallux valgus correction loss.
Topics: Adult; Aged; Bone Screws; Bone Wires; Female; Hallux Valgus; Humans; Male; Middle Aged; Osteotomy; Pain Measurement; Surveys and Questionnaires; Young Adult
PubMed: 33747387
DOI: 10.4055/cios20003 -
Orthopaedic Surgery Nov 2022Hallux valgus (HV) is a common foot deformity, and recurrence is one of the most serious complications after HV correction. As a result, the surgical technique with a...
Outcomes of V-cut Osteotomy on the First Metatarsal Head Combined with Fixation in Mortise-shaped Bone Groove-Plasty and Akin Osteotomy on the First Toe for Hallux Valgus Correction.
OBJECTIVE
Hallux valgus (HV) is a common foot deformity, and recurrence is one of the most serious complications after HV correction. As a result, the surgical technique with a lower recurrence rate is a dream. The purpose of the article should be to observe the correction effect of hallux valgus using a novel "V-cut" osteotomy on the first metatarsal head combined with fixation in mortise-shaped bone groove-plasty technique.
METHODS
Twenty-three consecutive patients (40 feet) with HV were included from March 2019 to May 2020, who were all treated using single screw fixation with V-cut osteotomy on the first metatarsal head combined with mortise-shaped metatarsal bone groove-plasty and Akin osteotomy on the first toe for hallux valgus correction. With a mean follow-up time of 21.7 months, the visual analogue scale (VAS) score and American Orthopedic Foot and Ankle Society (AOFAS) forefoot score and the changes of the hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA) were evaluated during the clinical follow-up. The paired t test was used for analytical statistics.
RESULTS
The VAS score improved from 6.78 ± 1.74 to 1.87 ± 1.45 and the AOFAS score improved from 53.9 ± 12.3 preoperatively to 94.7 ± 6.8 in the latest follow-up postoperatively (P < 0.01). Besides, the HVA improved from 30.0 ± 6.1° to 5.7 ± 2.8° (P < 0.01); the IMA changed from 13.1 ± 2.8° into 3.3 ± 1.6° (P < 0.01); and the DMAA ameliorated from 27.0 ± 8.4° to 5.9 ± 3.5° (P < 0.01). Only five toes had slight numbness and stiffness in early postoperative period, and these symptoms disappeared completely at 6 months after the surgery. Only one foot was corrected to excess. One screw stern protruding beneath the skin happened, which needed secondary screw removal under local anesthesia.
CONCLUSIONS
Single screw fixation with V-cut osteotomy on the first metatarsal head combined with fixation in mortise-shaped metatarsal bone groove-plasty and Akin osteotomy on the first toe is an effective way with low recurrence rate for HV correction.
Topics: Humans; Metatarsal Bones; Hallux Valgus; Radiography; Treatment Outcome; Osteotomy; Toes
PubMed: 36178077
DOI: 10.1111/os.13528 -
PloS One 2020Hallux valgus is the most common forefoot deformity and affects the transverse arch structure and its force loading patterns. This study aims to clarify the differences... (Comparative Study)
Comparative Study
BACKGROUND
Hallux valgus is the most common forefoot deformity and affects the transverse arch structure and its force loading patterns. This study aims to clarify the differences in the transverse arch structure and the force under the metatarsal heads individually, between normal feet and hallux valgus feet, and between hallux valgus feet with pain and without pain. We further test the association between the parameters of the transverse arch and hallux valgus angle and between the parameters and pain in hallux valgus.
METHODS
Women's feet (105 feet) were divided into normal group (NORM) and hallux valgus group (HVG); and further into subgroups: hallux valgus without pain (HV Pain (-)) and hallux valgus with pain (HV Pain (+)). Transverse arch height and metatarsal heads height were measured using weight-bearing ultrasound imaging. Force under the metatarsal heads was measured using force sensors attached directly on the skin surface of the metatarsal heads. The measurements were taken in three loading positions: sitting, quiet standing and 90% weight shift on the tested foot. Differences between the groups were compared using Student t-test and Wilcoxon Exact test. Multivariate logistic analysis with adjustment for physical characteristics was also conducted.
RESULTS
Transverse arch height was significantly higher in HVG than in NORM in all positions; there were no significant differences between HV Pain (+) and HV pain (-). Lateral sesamoid was significantly higher in HVG and HV Pain (+) than in NORM and HV Pain (-) respectively when bearing 90% of the body weight unilaterally. There was a trend of higher forces under the medial forefoot without significant difference. Transverse arch height and lateral sesamoid height were associated with the hallux valgus angle, while lateral sesamoid height was associated with forefoot pain in hallux valgus deformity.
CONCLUSIONS
This study shows the differences in the transverse arch structure between normal feet and feet with hallux valgus, and between hallux valgus feet with and without pain. This finding is noteworthy when considering future treatments of painful feet, notably the height of the lateral sesamoid which seems to play a role in forefoot pain.
Topics: Aged; Female; Hallux Valgus; Humans; Metatarsal Bones; Middle Aged; Multivariate Analysis; Pain; Radiographic Image Interpretation, Computer-Assisted; Ultrasonography; Weight-Bearing
PubMed: 31917790
DOI: 10.1371/journal.pone.0226914 -
Orthopaedic Surgery Oct 2019To report the radiological and clinical outcomes of the modified scarf osteotomy for the treatment of hallux valgus deformity in adolescents.
OBJECTIVE
To report the radiological and clinical outcomes of the modified scarf osteotomy for the treatment of hallux valgus deformity in adolescents.
METHODS
This retrospective study analyzed 21 patients (31 feet) who underwent a modified scarf osteotomy for correcting juvenile hallux valgus deformity between March 2015 and January 2017. There were 3 male (3 feet) and 18 female (28 feet) patients. The average age at the time of surgery was 28.6 years (range, 20-35). Patients were postoperatively followed up in the outpatient department for 12-18 months. Clinical and radiological assessments were performed preoperatively and postoperatively at 1 year. Moreover, postoperative complications were recorded. Statistical analyses for differences between preoperative and postoperative values were performed.
RESULTS
All the 21 patients were postoperatively followed up for 12-18 months, with an average of 13.2 ± 2.5 months. Clinical assessment showed that the American Orthopaedic Foot and Ankle Society score was increased from preoperative 58.0 ± 5.8 to postoperative 94.2 ± 6.6 points, respectively, and the visual analog scale score was remarkably decreased from preoperative 6.0 ± 2.0 to postoperative 1.5 ± 2.0 points at 1 year follow-up. Further radiological assessment showed that the hallux valgus angle was 37.5° ± 9.2°, 14.1° ± 6.5°, and 14.5° ± 6.5° before surgery, half a year after surgery, and 1 year after surgery, respectively; the intermetatarsal angle was 14.1° ± 4.4°, 4.8° ± 3.2°, and 5.5° ± 4.9°, respectively; and the distal metatarsal articular angle was 31.0° ± 3.5°, 7.2° ± 2.3°, and 7.5° ± 2.1°, respectively. They were significantly improved at half a year after surgery and 1 year after surgery compared to those before surgery. Complications occurred in two patients (9.5%) who had numbness on the skin of the edge of the medial incision, and the symptoms were relieved after 10 months. There was no clinical recurrence in all patients. One of the 31 feet had hallux varus, which was corrected in a second operation. Notably, a postoperative radiograph of a typical case whose both feet had hallux valgus deformity and underwent modified scarf osteotomy and additional Akin osteotomy showed adequate correction of the hallux valgus angle (HVA, 11°), intermetatarsal angle (IMA, 6°), and distal metatarsal articular angle (DMAA, 8°) on left foot compared to preoperative HVA (28°), IMA (13°), and DMAA (35°).
CONCLUSION
The modified scarf osteotomy can effectively correct the adolescent hallux valgus deformity, which is worth popularizing.
Topics: Adult; Disability Evaluation; Female; Hallux Valgus; Humans; Male; Metatarsal Bones; Osteotomy; Pain Measurement; Radiography; Retrospective Studies; Young Adult
PubMed: 31663288
DOI: 10.1111/os.12539