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Clinical Case Reports Sep 2015We describe additional phenotypic features in a boy and his mother. Both manifested the phenotypic/genotypic correlation of oto-palato-digital syndrome type II. The...
We describe additional phenotypic features in a boy and his mother. Both manifested the phenotypic/genotypic correlation of oto-palato-digital syndrome type II. The mother's radiographs showed wormian bones of the skull, and paranasal bossing, her feet showed bilateral fusion of the cuboid with the lateral cuneiform bone with subsequent development of metatarsus varus associated with dysplastic distal phalanges.
PubMed: 26401283
DOI: 10.1002/ccr3.317 -
Orthopaedics & Traumatology, Surgery &... Oct 2015First-ray metatarsophalangeal arthrodesis is a classic surgical procedure in the treatment of severe hallux valgus, hallux rigidus, revision surgery, and inflammatory...
INTRODUCTION
First-ray metatarsophalangeal arthrodesis is a classic surgical procedure in the treatment of severe hallux valgus, hallux rigidus, revision surgery, and inflammatory arthritis. The objective of this study was to verify if metatarsophalangeal plate arthrodesis could correct the M1M2 intermetatarsal angle.
MATERIAL AND METHODS
This prospective and continuous series (June 2007 to March 2011) included 208 patients (48% severe and/or arthritic hallux valgus, 18% hallux rigidus, 16% rheumatoid forefoot, 13% surgical revision of the first ray, 5% hallux varus), with a mean age of 62.4±9.9 years (range, 19-87 years). All the patients were operated on by a senior surgeon with the same technique: spherical avivement of the joint surfaces using reamers, osteosynthesis with an anatomic plate (Fyxis-Biotech™) in Ti.6Al.4 V alloy prebent to 5° with a phalangeal arm to receive an oblique metatarsophalangeal screw in compression, in addition to four 2.7-mm nonlocking dorsal screws. The full-scale preoperative and intraoperative angle measurements were taken on AP and lateral X-rays of the weightbearing foot, as related to the etiology and the severity of the preoperative metatarsus varus (M1M2<15°, M1M2 15-19°, M1M2≥20°). The statistical analysis was done using the StatView software.
RESULTS
The mean follow-up was 18.6±12.4 months (range, 2-76 months). Nearly all of the arthrodesis patients (97%) achieved bone union, and 5% of the plates were removed. The M1P1 angle decreased from 33.8±19.7° (range, -45° to -67°) preoperatively to 13.3±5.3° (range, 0-32°) at the last follow-up, and the M1M2 angle from 14.2±5.4°(range, 0-26°) to 6.5±2.3° (range, 0-12°). The preoperative M1M2 angle was <15° in 97 patients, 15-19° for 78 patients, and ≥20° for the 33 others; at the last follow-up it was 5.8±2.1° (range, 0-10°), 6.7±2.2° (0-10°), and 8.1±2.4° (3-12°), respectively. No correction of the metatarsus varus was demonstrated in relation to etiology. The M1M2 angle was >10° in only two patients (one case of rheumatoid arthritis and one case of severe hallux valgus): 0.9%.
DISCUSSION
These results show that isolated metatarsophalangeal arthrodesis of the first ray can correct metatarsus varus even in substantial deformations in any etiology.
LEVEL OF PROOF
Level II cohort study.
Topics: Adult; Aged; Aged, 80 and over; Arthrodesis; Bone Plates; Bone Screws; Female; Hallux Rigidus; Hallux Valgus; Humans; Male; Metatarsal Bones; Metatarsophalangeal Joint; Middle Aged; Prospective Studies; Retrospective Studies; Titanium; Treatment Outcome; Young Adult
PubMed: 26315348
DOI: 10.1016/j.otsr.2015.06.021 -
Acta Ortopedica Mexicana 2013To show that the modified scarf osteotomy for hallux valgus surgery provides a greater basal contact surface, which results in more stability and less complications for... (Clinical Trial)
Clinical Trial
OBJECTIVES
To show that the modified scarf osteotomy for hallux valgus surgery provides a greater basal contact surface, which results in more stability and less complications for the management of the metatarsus primus varus, and helps define its indications.
MATERIAL AND METHODS
Longitudinal, ambispective trial conducted between 2005 and January 2012 in patients with hallux valgus and metatarsus primus varus, with a statistical analysis using Student's T test to compare the preoperative and postoperative values of the American Orthopaedic Foot & Ankle Society scale.
RESULTS
58 modified scarf osteotomies were performed in 46 patients; there were 12 bilateral patients. Mean age was 45 years; 43 patients were females (93.47%) and 3 were males (6.53%). Of the 58 scarf osteotomies, 54 feet did well (93.10%), 3 feet had relapse of the deformity (5.17%), and one had arthrosis of the metatarso-phalangeal joint (1.72%). The American Orthopaedic Foot & Ankle Society classification increased significantly from 40.65 to 82.26 (p < 0.0001).
CONCLUSIONS
The modified scarf osteotomy provides greater contact surface in its inverted basal aspect, thus providing more basal stability and therefore less complications. It is therefore a safe procedure capable of correcting the essential components of the hallux valgus and the metatarsus primus varus, provided the indications are precise, like cuneometatarsal instability, joint stiffness and hindfoot alteration, as this leads to hallux valgus relapse.
Topics: Female; Hallux Valgus; Humans; Longitudinal Studies; Male; Middle Aged; Osteotomy; Prospective Studies; Retrospective Studies
PubMed: 24701777
DOI: No ID Found -
The Bone & Joint Journal Apr 2014Metatarsus primus varus deformity correction is one of the main objectives in hallux valgus surgery. A 'syndesmosis' procedure may be used to correct hallux valgus. An...
Metatarsus primus varus deformity correction is one of the main objectives in hallux valgus surgery. A 'syndesmosis' procedure may be used to correct hallux valgus. An osteotomy is not involved. The aim is to realign the first metatarsal using soft tissues and a cerclage wire around the necks of the first and second metatarsals. We have retrospectively assessed 27 patients (54 feet) using the American Orthopaedic Foot and Ankle Society (AOFAS) score, radiographs and measurements of the plantar pressures after bilateral syndesmosis procedures. There were 26 women. The mean age of the patients was 46 years (18 to 70) and the mean follow-up was 26.4 months (24 to 33.4). Matched-pair comparisons of the AOFAS scores, the radiological parameters and the plantar pressure measurements were conducted pre- and post-operatively, with the mean of the left and right feet. The mean AOFAS score improved from 62.8 to 94.4 points (p < 0.001). Significant differences were found on all radiological parameters (p < 0.001). The mean hallux valgus and first intermetatarsal angles were reduced from 33.2° (24.3° to 49.8°) to 19.1° (10.1° to 45.3°) (p < 0.001) and from 15.0° (10.2° to 18.6°) to 7.2° (4.2° to 11.4°) (p < 0.001) respectively. The mean medial sesamoid position changed from 6.3(4.5 to 7) to 3.6 (2 to 7) (p < 0.001) according to the Hardy's scale (0 to 7). The mean maximum force and the force-time integral under the hallux region were significantly increased by 71.1% (p = 0.001), (20.57 (0.08 to 58.3) to 35.20 (6.63 to 67.48)) and 73.4% (p = 0.014), (4.44 (0.00 to 22.74) to 7.70 (1.28 to 19.23)) respectively. The occurrence of the maximum force under the hallux region was delayed by 11% (p = 0.02), (87.3% stance (36.3% to 100%) to 96.8% stance (93.0% to 100%)). The force data reflected the restoration of the function of the hallux. Three patients suffered a stress fracture of the neck of the second metatarsal. The short-term results of this surgical procedure for the treatment of hallux valgus are satisfactory.
Topics: Adolescent; Adult; Aged; Bone Wires; Female; Follow-Up Studies; Foot; Hallux Valgus; Humans; Male; Metatarsal Bones; Metatarsophalangeal Joint; Middle Aged; Pressure; Radiography; Retrospective Studies; Suture Techniques; Treatment Outcome; Weight-Bearing; Young Adult
PubMed: 24692618
DOI: 10.1302/0301-620X.96B4.32193 -
International Orthopaedics Sep 2013Hallux valgus is a complex deformity of the first metatarsophalangeal joint, with varus angulation of the first metatarsal, valgus deviation of the great toe and lateral...
PURPOSE
Hallux valgus is a complex deformity of the first metatarsophalangeal joint, with varus angulation of the first metatarsal, valgus deviation of the great toe and lateral displacement of the sesamoids and the extensor tendons. The aim of the surgery is to achieve correction of the varus deviation of the 1st metatarsal which is considered by some as the primary intrinsic predisposing factor to hallux valgus deformity.
METHODS
We retrospectively reviewed 85 patients (107 feet) who underwent an opening wedge osteotomy of the 1st metatarsal for correction of moderate to severe hallux valgus and metatarsus primus varus. A medially applied anatomic pre-contoured locking plate was used for fixation of the osteotomy.
RESULTS
The mean IMA was decreased from 15.8 (range 12-22) degrees to 7.8 (range 0-12) degrees. The mean pre-operative HVA was 39 (range 21-52) degrees and the mean postoperative HVA was 11.8 (6-19) degrees. The pre-operative AOFAS score was 52 (SD 3.1) and the postoperative score was 85 (SD 5.2).
CONCLUSION
The proximal opening wedge metatarsal osteotomy is a safe, effective and reproducible technique for correction of moderate to severe hallux valgus deformity. The use of a locking plate provides enough control at the fragments, enhancing healing of osteotomy and maintenance of the correction even with a violated proximal lateral cortex.
Topics: Adult; Aged; Bone Plates; Female; Hallux Valgus; Humans; Male; Middle Aged; Osteotomy; Radiography; Retrospective Studies; Young Adult
PubMed: 23873174
DOI: 10.1007/s00264-013-2019-x -
Acta Medica (Hradec Kralove) 2012Adolescent hallux valgus (HV) is a progressive deformity of adolescent age consisting of metatarsus primus varus and hallux valgus. It has a high recurrence rate after...
Adolescent hallux valgus (HV) is a progressive deformity of adolescent age consisting of metatarsus primus varus and hallux valgus. It has a high recurrence rate after conventional surgical correction. Ten feet in nine patients (two males, seven females) were treated surgically with the Peterson Newman bunion procedure, with a minimum follow-up of one year. During the final follow-up all these patients had no complaints of pain, joint stiffness or limping. Even though the patients had some mild loss of range of movements at the MTPjoints 4-6 degrees compared to preoperative value, it did not cause any functional impairment and all were satisfied with the final outcome. The double ostetomy for treatment ofhallux valgus is technically precise procedure, provides excellent correction and stability and has low rate of recurrence of deformity. We had an excellent outcome in 10 feet in our study without residual deformity or complications.
Topics: Adolescent; Adult; Female; Hallux Valgus; Humans; Male; Metatarsal Bones; Osteotomy; Young Adult
PubMed: 22696934
DOI: 10.14712/18059694.2015.73 -
Poultry Science Jan 2012An experiment was conducted to test the hypothesis that the growth rate of broilers influences their susceptibilities to bone abnormalities, causing major leg problems....
An experiment was conducted to test the hypothesis that the growth rate of broilers influences their susceptibilities to bone abnormalities, causing major leg problems. Leg angulations, described in the twisted legs syndrome as valgus and bilateral or unilateral varus, were investigated in 2 subpopulations of mixed-sex Arkansas randombred broilers. Valgus angulation was classified as mild (tibia-metatarsus angle between 10 and 25°), intermediate (25-45°), or severe (> 45°). Body weight was measured at hatch and weekly until 6 wk of age. There were 8 different settings of approximately 450 eggs each. Two subpopulations, slow growing (bottom quarter, n = 581) and fast growing (top quarter, n = 585), were created from a randombred population based on their growth rate from hatch until 6 wk of age. At 6 wk of age, tibial dyschondroplasia incidences were determined by making a longitudinal cut across the right tibia. The tibial dyschondroplasia bone lesion is characterized by an abnormal white, opaque, unmineralized, and unvascularized mass of cartilage occurring in the proximal end of the tibia. It was scored from 1 (mild) to 3 (severe) depending on the cartilage plug abnormality size. Mean lesion scores of left and right valgus and tibial dyschondroplasia (0.40, 0.38, and 0.06) of fast-growing broilers were higher than those (0.26, 0.28, and 0.02) of slow-growing broilers (P = 0.0002, 0.0037, and 0.0269), respectively. Growth rate was negatively associated with the twisted legs syndrome and a bone abnormality (tibial dyschondroplasia) in this randombred population.
Topics: Animals; Bone Anteversion; Bone Retroversion; Chickens; Female; Incidence; Male; Osteochondrodysplasias; Poultry Diseases; Tibia
PubMed: 22184429
DOI: 10.3382/ps.2011-01599 -
The Journal of Bone and Joint Surgery.... Aug 2011We reviewed the outcome of distal chevron metatarsal osteotomy without tendon transfer in 19 consecutive patients (19 feet) with a hallux varus deformity following...
We reviewed the outcome of distal chevron metatarsal osteotomy without tendon transfer in 19 consecutive patients (19 feet) with a hallux varus deformity following surgery for hallux valgus. All patients underwent distal chevron metatarsal osteotomy with medial displacement and a medial closing wedge osteotomy along with a medial capsular release. The mean hallux valgus angle improved from -11.6° pre-operatively to 4.7° postoperatively, the mean first-second intermetatarsal angle improved from -0.3° to 3.3° and the distal metatarsal articular angle from 9.5° to 2.3° and the first metatarsophalangeal joints became congruent post-operatively in all 19 feet. The mean relative length ratio of the metatarsus decreased from 1.01 to 0.99 and the mean American Orthopaedic Foot and Ankle Society score improved from 77 to 95 points. In two patients the hallux varus recurred. One was symptom-free but the other remained symptomatic after a repeat distal chevron osteotomy. There were no other complications. We consider that distal chevron metatarsal osteotomy with a medial wedge osteotomy and medial capsular release is a useful procedure for the correction of hallux varus after surgery for hallux valgus.
Topics: Adult; Aged; Female; Hallux Valgus; Hallux Varus; Humans; Metatarsus; Middle Aged; Osteotomy; Patient Satisfaction; Prospective Studies; Radiography; Recurrence; Treatment Outcome; Young Adult
PubMed: 21768632
DOI: 10.1302/0301-620X.93B8.26430 -
TheScientificWorldJournal Mar 2011The aetiology and form of hallux valgus (HV) is varied with many corrective procedures described. We report a 39-year-old woman, previously treated with a Chevron...
The aetiology and form of hallux valgus (HV) is varied with many corrective procedures described. We report a 39-year-old woman, previously treated with a Chevron osteotomy, who presented with recurrent right HV, metatarsus primus varus, and associated bunion. Osteotomies were performed at two levels as a revisional procedure. This report highlights (1) limitations of the Chevron osteotomy and (2) the revisional procedure of the two level osteotomies: (i) proximal opening-wedge basal osteotomy and (ii) distal short Scarf with medial closing wedges. If a Chevron osteotomy is used inappropriately, for example, in an attempt to correct too large a deformity, it may angulate laterally causing a malunion with an increased distal metatarsal articular angle. Secondly, it is feasible to correct this combined deformity using a combination of proximal opening-wedge and distal short Scarf osteotomies.
Topics: Adult; Female; Hallux Valgus; Humans; Osteotomy; Radiography; Reoperation
PubMed: 21442142
DOI: 10.1100/tsw.2011.66 -
Clinical Orthopaedics and Related... Aug 2010The Scarf osteotomy was described as a technique to correct a metatarsus primus varus in primary hallux valgus surgery, but it is unclear whether the technique could...
BACKGROUND
The Scarf osteotomy was described as a technique to correct a metatarsus primus varus in primary hallux valgus surgery, but it is unclear whether the technique could correct recurrent hallux valgus when an initial procedure failed to provide any or an adequate lateral displacement of the metatarsal head.
QUESTIONS/PURPOSES
We asked whether the Scarf osteotomy could reduce pain, improve the AOFAS score, reduce the deformity, and prevent further recurrence when used as a revision procedure.
PATIENTS AND METHODS
Of 41 patients (45 feet) we treated for failed initial operations, we retrospectively reviewed 35 (39 feet) who underwent a Scarf osteotomy. We administered a VAS for pain and the AOFAS score preoperatively and postoperatively. Preoperative and postoperative radiographs were taken to assess the hallux valgus angle [HVA] and intermetatarsal angle [IMA]. The minimum followup was 24 months (mean, 42 months; range, 24-89 months).
RESULTS
The mean VAS for pain improved from 5.9 to 0.4 points. The mean AOFAS score improved from 56 to 90 points. The radiographic evaluation showed improvement of the mean HVA from 30 degrees to 8 degrees and improvement of the IMA from 13 degrees to 4 degrees. Complications included one asymptomatic recurrence with a 20 degrees -HVA, one overcorrection with a 3 degrees-varus deformity, and pain attributable to irritation caused by screws in five patients.
CONCLUSIONS
As a revision procedure the Scarf osteotomy clinically and radiographically corrected recurrent hallux valgus recurrence in most patients.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Topics: Adult; Aged; Bone Malalignment; Female; Forefoot, Human; Hallux Valgus; Humans; Male; Metatarsal Bones; Middle Aged; Osteotomy; Pain; Pain Measurement; Radiography; Range of Motion, Articular; Reoperation; Retrospective Studies; Secondary Prevention; Treatment Outcome
PubMed: 20496024
DOI: 10.1007/s11999-010-1363-z