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Foot & Ankle Orthopaedics Jul 2023Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus,...
BACKGROUND
Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique.
METHODS
Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded.
RESULTS
The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found.
CONCLUSIONS
PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies.
LEVEL OF EVIDENCE
IV, prospective case series.
PubMed: 37590285
DOI: 10.1177/24730114231195049 -
Journal of Orthopaedic Surgery (Hong... 2022Hallux valgus (HV) is a common foot deformity for which several corrective surgical procedures, with different osteotomy sites, have been reported. The purpose of the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Hallux valgus (HV) is a common foot deformity for which several corrective surgical procedures, with different osteotomy sites, have been reported. The purpose of the present study was to systematically review randomized (RCTs) or controlled (CCTs) clinical trials and perform meta-analysis on outcomes of different osteotomy sites of the first metatarsal.
METHODS
An extensive literature search was conducted in PubMed and the Cochrane Library from January 1983 to July 2020. Studies were identified using the terms "hallux valgus" and "osteotomy". We included RCTs or CCTs comparing different locations of osteotomy for the first metatarsal bone (distal vs. mid-shaft, distal vs. proximal, and mid-shaft vs. proximal). The surgical outcomes included postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), American Orthopaedic Foot and Ankle Society (AOFAS) score, pain visual analog scale (VAS) score, perioperative complications and recurrence of deformity. We enrolled 10 studies with a total of 793 feet in the qualitative synthesis following full-text screening.
RESULTS
A majority of patients included in the enrolled trials showed mild to moderate deformity, with mean HVA <40°. Out of the 10 enrolled studies; six compared distal osteotomies with mid-shaft osteotomies and showed no significant differences in the surgical outcomes between the scarf and chevron groups; three RCTs compared distal osteotomies with proximal osteotomies with conflicting results, one RCT showed the superiority of proximal osteotomy while the other two RCTs showed equivalent outcomes; one study that compared between mid-shaft and proximal osteotomies showed equivalent outcomes between the groups.
CONCLUSION
For the management of mild to moderate HV deformity, we found no significant clinical and radiological differences between patients treated with scarf and chevron osteotomies. Further controlled trials comparing different sites of osteotomies for moderate to severe HV deformity are needed.
Topics: Hallux; Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Treatment Outcome
PubMed: 35836406
DOI: 10.1177/10225536221110473 -
Orthopaedics & Traumatology, Surgery &... Oct 2021Fifth metatarsal shaft osteotomy has demonstrated efficacy for bunionette. We adapted screwless 1st metatarsal scarf osteotomy to the 5th ray. The technique consists in...
Fifth metatarsal shaft osteotomy has demonstrated efficacy for bunionette. We adapted screwless 1st metatarsal scarf osteotomy to the 5th ray. The technique consists in short osteotomy, translation and diaphyseal bone-suture. We report the first 25 operated feet, with mean AOFAS score 58.4 preoperatively and 94.9 postoperatively at a mean 25 months' follow-up. These results were comparable to reported data, whatever the deformity.
Topics: Bunion, Tailor's; Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Prostheses and Implants; Treatment Outcome
PubMed: 33992833
DOI: 10.1016/j.otsr.2021.102960 -
Foot & Ankle Orthopaedics Jul 2023Hallux valgus (HV) is commonly treated with proximal or distal first metatarsal osteotomy. Despite good correction, these procedures have inherent risks such as...
BACKGROUND
Hallux valgus (HV) is commonly treated with proximal or distal first metatarsal osteotomy. Despite good correction, these procedures have inherent risks such as malunion, nonunion, metatarsal shortening, loss of fixation, and avascular necrosis. Suture button fixation has been used for HV treatment. It avoids the risks of corrective osteotomies while maintaining reduction of the intermetatarsal angle (IMA). The goal of this study was to assess the radiographic and functional outcomes of patients undergoing HV correction with a distal soft tissue procedure and proximal suture button fixation.
METHODS
The authors retrospectively reviewed the charts and radiographs of 22 patients who had undergone HV correction using a distal soft tissue correction and proximal fixation with a miniature suture button device (Mini TightRope; Arthrex, Inc, Naples, FL). Mean follow-up was 27.7 months. The IMA, hallux valgus angle (HVA), and sesamoid station were measured on radiographs obtained preoperatively as well as in the immediate postoperative period and at final follow-up. Preoperative and postoperative Short Form-36 (SF-36) and Foot and Ankle Ability Measure (FAAM) scores were collected. Postoperative complications, and any additional operative procedures performed were also recorded.
RESULTS
The mean preoperative IMA and HVA were 16.9 and 32.6 degrees, respectively. The mean immediate postoperative IMA was 5.2 degrees ( < .0001) and the mean HVA was 9.8 degrees ( < .0001). At final follow-up, the mean IMA was 8.2 degrees ( < .0001) and the mean HVA was 16.7 degrees ( < .0001). The average change in HVA from preoperative to final follow-up was 16.0 degrees and the average change in IMA from preoperative to final follow-up was 8.6 degrees ( < .0001). Sesamoid station assessment at the 2-week follow-up showed that 22 patients (100%) were in the normal position group; at final follow-up, 17 patients (77%) had normal position and 5 patients (23%) had displaced position. Although there were no clinically symptomatic recurrences, asymptomatic radiographic recurrence was noted in 5 patients (23%) who had a final HVA >20 degrees. All components of the FAAM and the SF-36 showed improvement from preoperative to final follow-up, although these changes were not statistically significant. Three patients experienced complications, including an intraoperative second metatarsal fracture, a postoperative second metatarsal stress fracture, and a postoperative deep vein thrombosis.
CONCLUSION
The use of a distal soft tissue procedure in conjunction with proximal suture button fixation is a safe and effective procedure for treating symptomatic HV deformity. Our results show that this technique can correct the IMA, HVA, and sesamoid station without the need for osteotomy.
LEVEL OF EVIDENCE
Level IV.
PubMed: 37655934
DOI: 10.1177/24730114231195342 -
Medical Engineering & Physics Sep 2021A thorough understanding of the influence of the foot skeletal structure on hallux valgus (HV) is required for HV prevention. We developed a system using a 3D foot...
BACKGROUND
A thorough understanding of the influence of the foot skeletal structure on hallux valgus (HV) is required for HV prevention. We developed a system using a 3D foot scanner on a smartphone to clarify the relationships between foot features and HV risk.
METHODS
Two-dimensional video images were recorded on a smartphone, sent to a computer or cloud server, and used to construct a 3D foot-feature model, considering 10 foot features associated with HV. The participants (419 individuals, aged 40-89 years) stood with their toes 12 cm apart and heels 8 cm apart during video recording. The height and weight were measured for body-mass index calculation.
RESULTS
Age-dependent foot-feature variations were observed slightly for males and distinctively for females. For females, the great toe-first metatarsal head-heel (GFH) angle associated with HV increased with age, i.e., the GFH angle increased with age, suggesting that HV increased with age. Multiple regression analysis revealed that the features determining the GFH angle are the second toe-heel-navicular angle, bone distance axis, and transverse arch length and height. The adjusted coefficients of determination were 0.54 and 0.52 for males and females, respectively.
CONCLUSION
This approach enables simple foot structure assessment for HV risk evaluation.
Topics: Female; Foot; Hallux Valgus; Humans; Male; Metatarsal Bones; Regression Analysis; Smartphone
PubMed: 34479698
DOI: 10.1016/j.medengphy.2021.08.001 -
La Tunisie MedicaleHallux valgus is a deformity of the forefoot involving a phalangeal valgus and a metatarsal adductus. In most cases its correction requires surgical treatment with... (Review)
Review
BACKGROUND
Hallux valgus is a deformity of the forefoot involving a phalangeal valgus and a metatarsal adductus. In most cases its correction requires surgical treatment with different types of osteotomies. The best known is Scarf osteotomy.
AIM
To study the effet of Scarf osteotomy on distal metatarsal articular angle (DMAA) as well as the validitiy of this angle and the value of its correction after review of the literature.
METHODS
It was a retrospective study including patients operated on for severe hallux valgus by a Scarf osteotomy. The clinical assessment was based on the the American-Orthopedic-Foot-and-Ankle-society (AOFAS) score. Radiologically, we calculated the metatarsophalangeal angle, the inter-metatarsal angle and the DMAA. This assessment was performed preoperatively and one year postoperatively.
RESULTS
We collected 37 cases of evolved hallux valgus. The average AOFAS score went from 60.7 to 85.8 / 100 postoperatively with a gain of 25 points. We've noted a significant correction of the 3 angular measurements at one year postoperatively (the metatarsophalangeal angle, the inter-metatarsal angle and the DMAA) which went from 38.8° to 20.5°, from 17° at 10° and 13.5° to 8.5° respectively (p<0.05).
CONCLUSION
The literature has shown that there is no consensus regarding the effect of HV surgery on the DMAA. As for the accuracy, reproducibility and interest of correcting this angle we deduce that the DMAA is an interesting measure in the pathology of HV. Its correction seems not to be necessary in order not to hamper the correction of metatarsus varus. But in cases where the preoperative DMAA is high (> 15 °), efforts should be made to correct it to avoid recurrence.
Topics: Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Reproducibility of Results; Retrospective Studies
PubMed: 35822335
DOI: No ID Found -
Foot & Ankle Orthopaedics Jul 2023Although percutaneous surgery for the treatment of hallux valgus is popular in Europe, there is sparse English written literature documenting its efficacy. This study...
Republication of "Percutaneous Basal Closing Wedge Osteotomy of the First Metatarsal in the Treatment of Moderate to Severe Hallux Valgus and Its Short-Term Clinical Outcomes".
BACKGROUND
Although percutaneous surgery for the treatment of hallux valgus is popular in Europe, there is sparse English written literature documenting its efficacy. This study described the operative techniques using percutaneous basal closing wedge osteotomy of the first metatarsal in correction of moderate to severe hallux valgus (HV) and its short-term clinical outcomes. We postulated that satisfactory correction of hallux valgus (HV) angle, intermetatarsal (IM) angle, and patients' clinical outcomes could be achieved with this technique.
METHODS
We conducted a retrospective review of 25 feet in 23 patients who underwent a percutaneous basal closing wedge osteotomy of the first metatarsal (MT1) combined with a mini-open modified McBride procedure and mini-open resection of medial eminence. Follow-up averaged 21.5 months. Radiographic outcomes included pre- and postoperative HV angle, IM angle, absolute and relative shortening of MT1, and time to union. American Orthopaedic Foot & Ankle Society (AOFAS) scores were compared between pre- and postoperatively.
RESULTS
The average HV angle improved from 39.4 (range, 29-58.3) degrees preoperatively to 14.7 (range, 0.1-23.2) degrees postoperatively ( < .05). IM angle improved from 14.9 (range, 6.7-22.4) degrees to 6.6 (range, 0.9-14.8) degrees ( < .05). The average absolute shortening was 3.8 (range, 0.27-12.91) mm and the relative shortening was 0.8 (range, 0.05-1.91) mm. There was no delayed union or malunion at the osteotomy site. The average AOFAS score improved from 39 (range, 12-50) to 81 (range, 70-93) ( < .05).
CONCLUSIONS
Satisfactory hallux valgus deformity correction and patients' outcomes were achieved with this technique. Our results are similar to results reported in other studies using open techniques. There was no malunion or delayed union of the osteotomy.
LEVEL OF EVIDENCE
Level IV, case series study.
PubMed: 37506108
DOI: 10.1177/24730114231188113 -
Annals of Ibadan Postgraduate Medicine Apr 2024This article aimed to review the main currently described lines and angles and gather them in a single article and arrange them in a systematic way to facilitate the...
OBJECTIVE
This article aimed to review the main currently described lines and angles and gather them in a single article and arrange them in a systematic way to facilitate the process of assessment of the pediatric foot for deformities.
METHODS
The review was a scoping literature review. Electronic database websites such as PubMed, Europe PMC, Cochrane Library, and Google Scholar in addition to some books on anatomy and human movements biomechanics, diagnostic radiology, and orthopedics were searched for relevant articles for the topic of the present review. No statistical analysis was applied in this review.
RESULTS
Data from thirty articles included in this review were arranged into different subheadings. In the anteroposterior view (AP), assessment of the hindfoot deviation was by the AP talo-calcaneal angle (Kite's angle); the forefoot and midfoot for abduction and adduction alignment was by the AP talo-first metatarsal angle, the talo-second metatarsal angle, the calcaneo-second metatarsal angle, the calcaneofifth metatarsal angle; the forefoot and midfoot rotation was by observing the normal proximal convergence of the metatarsal bones axes. In the lateral view, assessment of the hindfoot sagittal plane alignment was by the lateral tibio-calcaneal angle; hindfoot varus or valgus deviation by the lateral talo-calcaneal angle; talus bone alignment by talar declination angle and the tibio-talar angle; calcaneal bone alignment by the calcaneal inclination angle and the tibio-calcaneal angle, the midfoot and forefoot sagittal plane alignment for the plantar arch by the lateral talo-first metatarsal -Meary's- angle, the calcaneal inclination angle, and the lateral calcaneofirst metatarsal -Hibbs- angle; forefoot and midfoot rotational alignment by observing the overlap shadows of the metatarsals' shafts and drawing their axes.
CONCLUSION
Drawing certain lines and angles with a systematic approach to assess different regions of the foot in the radiographic films of children can facilitate the process of assessment of the foot (as a whole) for deformities.
PubMed: 38939887
DOI: No ID Found -
BMC Musculoskeletal Disorders Jan 2022There has been a paucity of literature revealing the discrepancy between self-recognition about hallux valgus (HV) and radiographically-evaluated foot configuration....
BACKGROUND
There has been a paucity of literature revealing the discrepancy between self-recognition about hallux valgus (HV) and radiographically-evaluated foot configuration. Knowing this discrepancy will help to make a comparative review of the findings of previous literatures about epidemiological studies about the prevalence of HV.
QUESTIONS/PURPOSES
(1) Is there a discrepancy between radiographically-assessed and self-recognized HV in the general population? (2) What factors affect the self-recognition of HV in the general population?
METHODS
The fifth survey of the Research on Osteoarthritis/Osteoporosis against Disability study involved 1996 participants who had undergone anterior-posterior radiography of bilateral feet and answered a simple dichotomous questionnaire on self-recognition of HV. Measurements of the HV angle (HVA), interphalangeal angle of the hallux (IPA), and intermetatarsal angle between 1st and 2nd metatarsals (IMA) were performed using radiographs. Radiographic diagnosis of HV was done using the definition of hallux valgus angle of 20° or more. After univariate comparison of the participant backgrounds and radiographic measurements between participants with or without self-recognition of HV, multivariable logistic regression analysis was conducted in order to reveal independent factors affecting self-recognition.
RESULTS
Significant difference was found between the prevalence of radiographically-assessed and self-recognized HV (29.8% vs. 16.5%, p < 0.0001). The prevalence of self-recognized HV increased with the progression of HV severity from a single-digit percentage (normal grade, HVA < 20°) up to 100% (severe grade, HVA ≥ 40°). A multivariable logistic regression analysis demonstrated that HVA, IMA, and female sex were independent positive factors for self-recognition of HV (HVA [per 1° increase]: OR, 1.18; 95% CI, 1.15-1.20; p < 0.0001; IMA [per 1° increase]: OR, 1.15; 95% CI, 1.09-1.20; p < 0.0001; and female sex [vs. male sex]: OR, 3.47; 95% CI, 2.35-5.18; p < 0.0001).
CONCLUSIONS
There was a significant discrepancy between radiographically-assessed and self-recognized HV which narrowed with the progressing severity of HV. HVA, IMA, and female sex were independent positive factors for self-recognition of HV. Attention needs to be paid to potentially lowered prevalence of HV in epidemiological studies using self-reporting based on self-recognition.
Topics: Bunion; Female; Foot; Hallux; Hallux Valgus; Humans; Male; Metatarsal Bones; Retrospective Studies
PubMed: 34983473
DOI: 10.1186/s12891-021-04978-z -
Journal of Orthopaedic Case Reports Jun 2023The commonly performed procedure for treating severe hallux valgus is proximal metatarsal osteotomy or first tarsometatarsal arthrodesis combined with a soft tissue...
INTRODUCTION
The commonly performed procedure for treating severe hallux valgus is proximal metatarsal osteotomy or first tarsometatarsal arthrodesis combined with a soft tissue procedure in which the severe intermetatarsal angle (IMA) is corrected using proximal metatarsal osteotomy or first tarsometatarsal arthrodesis; although a severe hallux valgus angle (HVA) can be corrected using the soft tissue procedure alone, the correction ability is low. Therefore, the more severe the hallux valgus is, the more difficult it is to correct.
CASE REPORT
A 52-year-old woman (height, 142 cm; weight, 47 kg) with severe hallux valgus with an HVA of 80° and an IMA of 22° was treated with a combination of the distal metatarsal and proximal phalangeal osteotomies fixated using K-wires, which was a modification of Kramer's and Akin's procedures, without a soft tissue procedure. The concept behind this technique is that distal metatarsal osteotomy primarily corrects the hallux valgus, and when the correction is insufficient, the proximal phalanx osteotomy complements it, which ensures that the first ray is approximately straight. After 4.1 years of follow-up, the HVA and IMA were 16° and 13°, respectively.
CONCLUSION
Distal metatarsal and proximal phalangeal osteotomies without a soft tissue procedure were effective in treating a patient with severe hallux valgus with an HVA of 80°.
PubMed: 37398536
DOI: 10.13107/jocr.2023.v13.i06.3684