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Journal of the American Academy of... Jun 2020Hallux valgus deformity is a multiplanar deformity, where the rotational component has been recognized over the past 5 to 10 years and given considerable importance.... (Review)
Review
Hallux valgus deformity is a multiplanar deformity, where the rotational component has been recognized over the past 5 to 10 years and given considerable importance. Years ago, a rounded shape of the lateral edge of the first metatarsal head was identified as an important factor to detect after surgery because a less rounded metatarsal head was associated to less recurrence. More recently, pronation of the metatarsal bone was identified as the cause for the rounded appearance of the metatarsal head, and therefore, supination stress was found to be useful to achieve a better correction of the deformity. Using CT scans, up to 87% of hallux valgus cases have been shown to present with a pronated metatarsal bone, which highlights the multiplanar nature of the deformity. This pronation explained the perceived shape of the metatarsal bone and the malposition of the medial sesamoid bone in radiological studies, which has been associated as one of the most important factors for recurrence after treatment. Treatment options are discussed briefly, including metatarsal osteotomies and tarsometatarsal arthrodesis.
Topics: Bunion; Hallux; Hallux Valgus; Humans; Metatarsal Bones; Pronation
PubMed: 32656482
DOI: 10.5435/JAAOSGlobal-D-20-00091 -
Foot & Ankle International Apr 2021Rotation of the first metatarsal (M1) as a potential etiological factor of hallux valgus (HV) deformity was described relatively early in the description of HV... (Review)
Review
Rotation of the first metatarsal (M1) as a potential etiological factor of hallux valgus (HV) deformity was described relatively early in the description of HV pathoanatomy. However, because biplanar radiographs have been the standard method for imaging HV, clinicians primarily developed measurement methods and corrective operations confined to 2 dimensions, medial-lateral and inferior-superior. Recently, as our understanding of HV pathoanatomy has further developed, aided in part by advanced imaging technology, M1 rotation about its axis ("axial rotation") and its implications for HV deformity and treatment has reemerged. The goal of this review is to summarize M1 rotation in HV from a historical perspective, to present the current understanding of its potential role in the etiology/pathogenesis of HV, and to summarize relevant imaging and operative considerations with respect to M1 rotation. Level III, systematic review.
Topics: Bunion; Hallux; Hallux Valgus; Humans; Metatarsal Bones; Rotation
PubMed: 33764800
DOI: 10.1177/1071100721997149 -
Orthopaedics & Traumatology, Surgery &... Feb 2022Juvenile hallux valgus is one of the most common pathologies of the forefoot in children and adolescents. Nevertheless, its treatment is still controversial. This... (Review)
Review
Juvenile hallux valgus is one of the most common pathologies of the forefoot in children and adolescents. Nevertheless, its treatment is still controversial. This deformity has some distinct anatomical features, particularly a lateral tilt of the articular facet of the head of the first metatarsal and congenital metatarsus adductus, which often occur in combination. Some mediocre surgical treatment results can be explained by the lack of correction of all these factors when we approach the problem as we would in adults. A double osteotomy to correct the DMAA and varus of the first metatarsal is a good solution in most cases with satisfactory functional outcomes. A percutaneous approach seems efficient in the pediatric population, given that the periosteum and growth plates, which are very active in younger children, help the osteotomies to heal and remodel. Guided growth surgery - using this approach is a viable alternative in this age bracket. Finally, minimally invasive surgery for juvenile hallux valgus allows another surgery to be done on minimally or undamaged tissues if needed later on.
Topics: Adolescent; Adult; Child; Foot; Growth Plate; Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Treatment Outcome
PubMed: 34871795
DOI: 10.1016/j.otsr.2021.103168 -
Foot and Ankle Clinics Jun 2018Postoperative recurrence of hallux valgus is a relatively common complication and is associated with unsatisfactory surgical outcomes. Risk factors for postoperative... (Review)
Review
Postoperative recurrence of hallux valgus is a relatively common complication and is associated with unsatisfactory surgical outcomes. Risk factors for postoperative recurrence include a round lateral edge of the first metatarsal head (a positive round sign) and incomplete reduction of the sesamoids. These risk factors may relate to residual pronation of the first metatarsal following surgery. A novel technique of a proximal supination osteotomy, in which varus and pronation of the first metatarsal can be corrected simultaneously, can achieve significant correction in moderate or severe hallux valgus deformity and a low rate of hallux valgus recurrence.
Topics: Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Supination
PubMed: 29729800
DOI: 10.1016/j.fcl.2018.01.006 -
Foot and Ankle Clinics Mar 2020Avascular necrosis (AVN), nonunion, malunion, and metatarsophalangeal (MTP) osteoarthritis following hallux valgus osteotomies, as well as pathophysiology, diagnosis,... (Review)
Review
Avascular necrosis (AVN), nonunion, malunion, and metatarsophalangeal (MTP) osteoarthritis following hallux valgus osteotomies, as well as pathophysiology, diagnosis, prevention strategies, and treatment are discussed in this article. AVN and nonunion are very infrequent, and they can be effectively prevented taking into consideration local anatomy preservation, biomechanics, and patient comorbidities. Shortening, elevation, plantarflexion, varus/valgus, and rotational of the first metatarsal are the most common types of malunion. They can lead to pain, stiffness, deformity recurrence, and transfer metatarsalgia. MTP osteoarthritis can develop after metatarsal malunion or AVN. Treatment options include cheilectomy, osteotomies to correct malunions, and MTP arthrodesis.
Topics: Fractures, Malunited; Fractures, Ununited; Hallux Valgus; Humans; Osteoarthritis; Osteonecrosis; Osteotomy
PubMed: 31997743
DOI: 10.1016/j.fcl.2019.10.008 -
Foot and Ankle Clinics Jun 2020The combination of hallux valgus and metatarsus adductus presents a surgical challenge even for the experienced foot and ankle surgeon, as the position of the lesser... (Review)
Review
The combination of hallux valgus and metatarsus adductus presents a surgical challenge even for the experienced foot and ankle surgeon, as the position of the lesser metatarsals restricts the space for metatarsal head displacement. We describe the application of concepts of minimally invasive techniques to correct this deformity. Proximal metatarsal osteotomy to correct the position of lesser metatarsals, followed by minimally invasive bunion surgery, shows promising results. In a short series, proximal metatarsal osteotomy showed excellent correction of the deformity. At final follow-up, all the deformed feet consolidated in correct positions.
Topics: Fracture Fixation, Internal; Hallux Valgus; Humans; Metatarsus Varus; Minimally Invasive Surgical Procedures; Osteotomy
PubMed: 32381319
DOI: 10.1016/j.fcl.2020.02.001 -
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 and Ankle Surgery : Official... Jun 2022Hallux valgus is a common foot condition with numerous surgical techniques described. Minimally invasive surgery is becoming more popular, with resultant development of... (Review)
Review
BACKGROUND
Hallux valgus is a common foot condition with numerous surgical techniques described. Minimally invasive surgery is becoming more popular, with resultant development of suitable fixation devices. The aim of this systematic review was to evaluate the evidence on the use of intramedullary devices in hallux valgus first metatarsal corrective osteotomies, and describe clinical and radiological outcomes, with an overview of techniques and implants used.
METHODS
We searched PubMed, Medline, Embase and EMCare databases, conforming to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Radiological outcomes including the hallux valgus angle (HVA) and intermetatarsal angle (IMA) were recorded, as well as clinical outcome scores and complications. Methodological quality of included studies was assessed using the MINORS score.
RESULTS
Ten studies were included, comprising 696 feet in 745 patients. Data pooling and metanalysis was not possible due to overall low quality of evidence. Four implants were reported (Endolog, ISO Plate, V-Tek Plate, Link Fixator) and used with distal first metatarsal osteotomies, with improvement in HVA, IMA, and clinical outcome scores comparable to other fixation techniques. There were no reported cases of non-union. Complication rates were variable (all cause range of 0-21%) across all studies, with an overall low rate.
CONCLUSION
Intramedullary devices are viable and safe to use for hallux valgus first metatarsal osteotomies, with comparable radiological and functional outcomes to other techniques. Current evidence base is of low methodological quality, therefore high quality studies are required to further evaluate these devices.
Topics: Bunion; Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Treatment Outcome
PubMed: 35027311
DOI: 10.1016/j.fas.2021.12.010 -
Physical Therapy Jan 2010Hallux valgus is a progressive foot deformity characterized by a lateral deviation of the hallux with corresponding medial deviation of the first metatarsal. Late-stage... (Review)
Review
Hallux valgus is a progressive foot deformity characterized by a lateral deviation of the hallux with corresponding medial deviation of the first metatarsal. Late-stage changes may render the hallux painful and without functional utility, leading to impaired gait. Various environmental, genetic, and anatomical predispositions have been suggested, but the exact cause of hallux valgus is unknown. Evidence indicates that conservative intervention for hallux valgus provides relief from symptoms but does not reverse deformity. Part 1 of this perspective article reviews the literature describing the anatomy, pathomechanics, and etiology of hallux valgus. Part 2 expands on the biomechanical initiators of hallux valgus attributed to the first metatarsal. Theory is advanced that collapse of the arch with vertical orientation (tilt) of the first metatarsal axis initiates deformity. To counteract the progression of hallux valgus, we use theory to discuss a possible mechanism by which foot orthoses can bolster the arch and reorient the first metatarsal axis horizontally.
Topics: Biomechanical Phenomena; Disease Progression; Hallux Valgus; Humans; Metatarsal Bones; Orthotic Devices; Pronation; Supination
PubMed: 19926679
DOI: 10.2522/ptj.20080298 -
Foot & Ankle International May 2022Failure to identify and correct malrotation of the first metatarsal may lead to recurrent hallux valgus deformity. We aimed to identify the proportion of hallux valgus...
BACKGROUND
Failure to identify and correct malrotation of the first metatarsal may lead to recurrent hallux valgus deformity. We aimed to identify the proportion of hallux valgus patients with increased first metatarsal pronation using weightbearing computed tomography (WBCT) and to identify the relationship with conventional radiographic measurements.
METHODS
WBCT scans were analyzed for 102 feet with a hallux valgus angle (HVA) and intermetatarsal angle (IMA) greater than or equal to 16 and 9 degrees, respectively. Metatarsal pronation angle (MPA), alpha angle, sesamoid rotation angle (SRA), and sesamoid position were measured on standardized coronal WBCT slices. Pronation was recorded as positive. Hindfoot alignment angle (HAA) was assessed using dedicated software. Pearson correlation and multiple regression analyses were used to assess differences between groups.
RESULTS
Mean HVA was 29.8±9.4 degrees and mean IMA was 14.1±3.7 degrees. Mean MPA was 11.9±5.8 (range 0-26) degrees and mean alpha angle was 11.9±6.8 (range -3 to 29) degrees. In a previous study, we demonstrated the upper limit of normal MPA as 16 degrees and alpha angle as 18 degrees. Based on these criteria, we identified abnormal metatarsal pronation in 32 feet (31.4%). We found a strong positive correlation between SRA and HVA/IMA ( = 0.67/0.60, respectively, < .001). IMA and HAA weakly correlated with MPA and alpha angle (IMA: = 0.26/0.27, respectively, < .01; HAA: = 0.26/0.27, respectively, < .01). Regression analyses suggested that increasing IMA was the most significant radiographic predictor of increased pronation. In this cohort, there was no correlation between HVA or sesamoid position and MPA / alpha angle (HVA: = .36/.12, respectively, sesamoid position, = .86/.77, respectively).
CONCLUSION
In this cohort of 102 feet that met plain radiographic criteria for hallux valgus deformity, first metatarsal pronation was found abnormal in 31.4% of patients. We found a weak association between the IMA and hindfoot valgus, but not the HVA.
Topics: Bunion; Hallux Valgus; Humans; Metatarsal Bones; Retrospective Studies; Rotation
PubMed: 35135368
DOI: 10.1177/10711007211064609