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Frontiers in Surgery 2022In recent years, minimally invasive surgery (MIS) for hallux valgus has emerged and gained popularity. To date, evidence on the benefits of MIS for hallux valgus is...
PURPOSE
In recent years, minimally invasive surgery (MIS) for hallux valgus has emerged and gained popularity. To date, evidence on the benefits of MIS for hallux valgus is still controversial. This updated meta-analysis aimed to comprehensively evaluate the efficiency of MIS vs. open surgery for hallux valgus.
METHODS
A systematic literature search of PubMed, Embase, and the Cochrane Library was performed. Two independent reviewers conducted data extraction and analyzed data with R software. Data were presented with risk ratio (RR) and standardized mean difference (SMD) along with 95% confidence interval (CI).
RESULTS
A total of 22 studies in which there were 790 ft treated with the MIS procedure and 838 ft treated with an open procedure were included. The correction of sesamoid position was better in the MIS group. The post-operative distal metatarsal articular angle (DMAA) of the MIS group was lower. There was less pain at the early phase in the MIS group. The MIS group had a shorter surgery time and shorter hospitalization time compared with the open group. Our meta-analysis revealed no statistically significant difference in hallux valgus angle (HVA), first intermetatarsal angle (IMA), the first metatarsal shortening, the American Orthopedic Foot and Ankle Society (AOFAS) score, visual analog scale (VAS) score at the final follow-up or complication rate (when all studies were considered). When taking into consideration only randomized controlled trial (RCT), the AOFAS score was higher in the MIS group while HVA, IMA, DMAA, and complication rate remained no significance. Post-operative IMA of the MIS group was significantly lower when only studies reporting the second-generation (2G) MIS were included. When just studies adopting the third-generation (3G) MIS were included, the HVA and DMAA were lower in the MIS group.
CONCLUSION
The MIS procedures were more effective than open surgeries in the treatment of hallux valgus. Moreover, the MIS group achieved better radiologic and clinical outcomes compared with the open group.
PubMed: 35388365
DOI: 10.3389/fsurg.2022.843410 -
International Journal of Environmental... Apr 2021: Hallux valgus (HV) deformity is a common, potentially debilitating deformity. And evidence with high-quality for the conservative treatments of HV deformity is still... (Meta-Analysis)
Meta-Analysis Review
: Hallux valgus (HV) deformity is a common, potentially debilitating deformity. And evidence with high-quality for the conservative treatments of HV deformity is still required.; AIMS: To compare the effects of different conservative treatments for hallux valgus deformity by using the method of network meta-analysis.; : A systematic review and network meta-analysis of randomized controlled trials identified by searching PubMed, EMBASE, MEDLINE, OVID, and CINAHL. The included studies should have the characteristics that: (1) participants with hallux valgus deformity of any age (2) conservative treatments (3) Reported the hallux valgus (HVA), the intermetatarsal angle (IMA), the score of the Visual Analog Scale, and the score of Foot Function Index.; : 11 studies were included in this review. The agreement between reviewers reached a kappa value of 0.75. The results of the network meta-analysis showed that a combination of exercise and toe separator, night splints, and dry needling are most likely to be the best choice for reducing the hallux valgus angle (HVA) and intermetatarsal angle, and toe separators (with or without exercise), dry needling, and manipulation (with or without ice treatment) have advantages in improving the subjective feeling of patients.; : Multi-disciplinary conservative treatments have a great potential for hallux valgus deformity. More research with high-quality is needed to give a comprehensive and reasonable scheme of a holistic and long-term treatment protocol.
Topics: Conservative Treatment; Hallux Valgus; Humans; Network Meta-Analysis; Pain Measurement; Radiography; Retrospective Studies; Treatment Outcome
PubMed: 33917568
DOI: 10.3390/ijerph18073841 -
Journal of Foot and Ankle Research Sep 2023Though hallux valgus is a common foot deformity, the integrated information on its global prevalence and incidence is relatively lacking. The aim of this research was to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Though hallux valgus is a common foot deformity, the integrated information on its global prevalence and incidence is relatively lacking. The aim of this research was to assess the global prevalence and incidence of hallux valgus, thus providing reliable data reference for clinical practice.
METHODS
A systematic review of global hallux valgus research publications concerning its prevalence and incidence was performed based on six electronic databases ((PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), China Online Journals and CQVIP)) from their inception to November 16, 2022. The search terms included "hallux valgus or bunion and prevalence or incidence or epidemiology." All languages were included. Data were extracted by country, continent, age group, gender and other information. The risk of bias was assessed by the Joanna Briggs Institute Critical Appraisal Instrument for Studies Reporting Prevalence Data by using random-effects models to synthesize available evidence.
RESULTS
A total of 45 studies were included in the meta-analysis. The overall pooled estimated prevalence was 19% (95% CI, 13% to 25%) (n=186,262,669) for hallux valgus. In subgroup meta-analyses, the prevalence of hallux valgus was 21.96% (95% CI, 10.95% to 35.46%) in Asia, 3% (95% CI, 0% to 15%) in Africa, 18.35% (95% CI, 11.65% to 26.16%) in Europe, 29.26% (95% CI, 4.8% to 63.26%) in Oceania, and 16.1% (95% CI, 5.9% to 30.05%) in North America, respectively. The pooled prevalence of hallux valgus by gender was 23.74% (95% CI, 16.21% to 32.21%) for females and 11.43% (95% CI, 6.18% to 18%) for males. The prevalence was 11% (95% CI, 2% to 26%) in individuals younger than 20 years old, 12.22% in adults aged 20-60 years (95% CI, 5.86% to 20.46%) and 22.7% in elderly people aged over 60 years (95% CI, 13.1% to 33.98%).
CONCLUSION
This research provided the global prevalence and incidence of hallux valgus in terms of its spatial, temporal, and population distribution. The global estimated pooled prevalence and incidence of hallux valgus was 19%. A higher prevalence of hallux valgus was found in females, Oceania countries, and among people aged over 60 years. Due to the high heterogeneity of the included studies, the findings should be interpreted with caution.
Topics: Adult; Aged; Female; Male; Humans; Middle Aged; Young Adult; Hallux Valgus; Incidence; Prevalence; Bunion; China
PubMed: 37726760
DOI: 10.1186/s13047-023-00661-9 -
Orthopaedics & Traumatology, Surgery &... Oct 2021The percutaneous treatment of bunionette deformity has been demonstrated as a reliable and satisfying technique with low risk of complications. However, there are some...
PURPOSE
The percutaneous treatment of bunionette deformity has been demonstrated as a reliable and satisfying technique with low risk of complications. However, there are some obvious variations in the surgical technique and perioperative protocol. The purpose of this study is to analyze the currently used techniques and to look for some agreements.
HYPOTHESIS
There are some points of agreement in surgical technique and perioperative protocol when using a percutaneous technique to treat bunionette deformity.
METHODS
A survey was sent to 50 orthopedic surgeons with specific experience in percutaneous techniques. The questions were related to different aspects of the surgical bunionette procedure and the perioperative protocol.
RESULTS
A response rate of 92.0% was obtained. Several points of agreement were found. A condylectomy is rarely used while an osteotomy is performed in almost all procedures. This osteotomy is single (95.7%), complete (66.2-72.7%) and performed with a Shannon long burr (73.9%). The location of the osteotomy depends of the deformity (63.0%).
DISCUSSION
This study demonstrates some consensus in the use of the surgical technique and the perioperative protocol. The percutaneous oblique osteotomy is the preferred technique while a condylectomy is only rarely used.
LEVEL OF EVIDENCE
V, Survey study.
Topics: Bunion, Tailor's; Consensus; Humans; Metatarsal Bones; Minimally Invasive Surgical Procedures; Osteotomy
PubMed: 33187868
DOI: 10.1016/j.otsr.2020.03.029 -
Australian Journal of General Practice Nov 2020Bunions are a common complaint, particularly among older female patients. They are characterised by progressive deformity at the metatarsophalangeal joint, resulting in...
BACKGROUND
Bunions are a common complaint, particularly among older female patients. They are characterised by progressive deformity at the metatarsophalangeal joint, resulting in a painful dorsomedial prominence. This may cause difficulties with shoe wear and contribute to falls in the elderly.
OBJECTIVE
The aim of this article is to discuss the aetiology, non-operative and operative management of bunions, as well as indications for referral.
DISCUSSION
Initial treatment of symptomatic bunions should be non-operative. Accommodative footwear is important. There is evidence supporting the use of nonsteroidal anti-inflammatory drugs, orthotics, splints/braces and toe spacers. However, these may not provide long-term relief, and referral to an orthopaedic surgeon is recommended if the patient has a painful prominence, has exhausted non-operative treatment and is a suitable operative candidate. Cosmesis alone is not an indication for operative management. Smoking is a relative contraindication to surgery, and cessation is recommended. In paediatric or adolescent patients (juvenile bunion), surgery should be delayed until skeletal maturity.
Topics: Bunion; Humans; Metatarsophalangeal Joint
PubMed: 33123707
DOI: 10.31128/AJGP-07-20-5541 -
Workplace Health & Safety Mar 2023Prolonged standing environments constitute an occupational risk factor for nurses, particularly for developing foot and ankle disorders. The definitions and potential... (Review)
Review
BACKGROUND
Prolonged standing environments constitute an occupational risk factor for nurses, particularly for developing foot and ankle disorders. The definitions and potential relationship to hours spent walking or standing are poorly understood. This scoping review aimed to synthesize the main disorders found on nurses' ankles and feet, their prevalence, the influence of hours spent walking or standing, and gender differences.
METHODS
This review followed a previously published protocol. Primary and secondary studies were retrieved from relevant databases from December 2020 to March 2021. Potential articles were collated to Mendeley, and two independent reviewers assessed the title and abstracts. Studies meeting inclusion criteria were included. Two researchers retrieved and reviewed the full text of these studies independently. A predetermined extraction tool was used to retrieve relevant data, summarized in a tabular and narrative format.
FINDINGS
The most common disorder was pain, followed by numbness, burning feet, bunions, structural deformities, and calluses. Prevalence differed among studies, depending on settings and specific local policies. Various foot and ankle disorders and related variables have been found, with clear gaps that may be addressed in the future.
CONCLUSION/APPLICATIONS TO PRACTICE:
Few studies have focused on nurses' foot and ankle disorders. Mapping signs and symptoms may contribute to the future development of preventive interventions for nurses' workplaces.
Topics: Humans; Ankle; Foot Diseases; Standing Position; Walking; Pain; Nurses
PubMed: 36637114
DOI: 10.1177/21650799221137646 -
The Journal of Foot and Ankle Surgery :... 2021Successful deformity correction utilizing first metatarsophalangeal (MTP) fusion for hallux valgus with concomitant degenerative changes of the first MTP joint is well...
Successful deformity correction utilizing first metatarsophalangeal (MTP) fusion for hallux valgus with concomitant degenerative changes of the first MTP joint is well documented. Currently, there is limited discussion in the literature focusing on triplanar correction of the first MTP arthrodesis. Presented is a novel approach for triplane correction and fusion of the first MTP joint utilizing a biplanar locked plating system.
Topics: Arthrodesis; Bunion; Hallux Valgus; Humans; Metatarsophalangeal Joint; Treatment Outcome
PubMed: 34148800
DOI: 10.1053/j.jfas.2021.05.006 -
Foot & Ankle Orthopaedics Jul 2023The modified Lapidus (ML) is a powerful procedure for correction of hallux valgus (HV) with emerging techniques. Studies considering patient-reported outcomes,...
BACKGROUND
The modified Lapidus (ML) is a powerful procedure for correction of hallux valgus (HV) with emerging techniques. Studies considering patient-reported outcomes, radiographic measures, complications, and implant costs are currently limited.
METHODS
Retrospective cohort with prospectively collected Patient Reported Outcome Information System Physical Function (PROMIS-PF) Computerized Adaptive Test (CAT) scores, radiographic parameters (intermetatarsal angle, IMA; hallux valgus angle, HVA; and tibial sesamoid position, TSP), complications, and total operative time and implant costs were reviewed from 2014 to 2019.
RESULTS
Seventy-three feet (68 patients) underwent bunion correction by ML with lag-screw fixation. Median age was 55.8 years (IQR 45.6, 53.9), 4 of 73 (5.5%) were male, 11 of 73 (15.1%) were smokers, and 15 of 73 (20.6%) were diabetic (median HbA1c 6.4% [IQR 6.0, 7.4], none insulin dependent, 5 of 15 with neuropathy). Complications included 6 of 73 (8.2%) wound issues resolved with topical or oral treatment, 9 of 73 (12.3%) painful or broken hardware requiring hardware removal. Two of 73 (2.7%) had persistent pain despite union. One of 73 (1.4%) was overcorrected and required first MTP arthrodesis. Of 3 nonunions (2.7%), 1 resolved with corrected hypothyroidism, 1 was asymptomatic and required no treatment, 1 had a hallux valgus recurrence and sought revision surgery elsewhere. Preoperative radiographic angles were HVA 35 degrees, IMA 14 degrees which improved at final postoperative follow up to HVA 10 degrees, IMA 6 degrees. Tibial sesamoid position improved from 6.05 ± 1.00 to 2.22 ± 1.38. Thirty-two patients had preoperative and 42 had 1-year postoperative outcomes. PROMIS-PF (51% collection rate) was 43 (IQR 37,52) preoperatively, 37 (31, 39) at 6 weeks, 46 (42, 51) at 3 months, and 49 (41, 53) at >360 days postoperatively. The drop in PROMIS-PF between preoperative and 6 weeks and the rise from 6 weeks to 3 months were statistically significant. Pre- and postoperative PROMIS-PF scores were not significantly different. Implant cost averaged US$146.
DISCUSSION/CONCLUSION
We report low complication rates and costs with high patient postoperative functional and radiographic outcomes. PROMIS-PF decreased acutely postoperatively but recovered and maintained high levels by 3 months postoperatively.
LEVEL OF EVIDENCE
Level IV, case series.
PubMed: 37786608
DOI: 10.1177/24730114231200482 -
BMC Musculoskeletal Disorders May 2021Hallux valgus deformity has been reported to be associated with increased postural sway. However, the direction and magnitude of postural sway associated with hallux...
BACKGROUND
Hallux valgus deformity has been reported to be associated with increased postural sway. However, the direction and magnitude of postural sway associated with hallux valgus remain inconclusive. We assessed the association between hallux valgus deformity and postural sway using a force plate.
METHODS
The subjects were 169 healthy volunteers, > 40 years old (63 males, 106 females, average age: 66.0 ± 12.4 years old), who took part in an annual medical examination. We investigated the photographic hallux valgus angle (°), total trajectory length of the gravity center fluctuation (mm), area of the center of pressure (mm), mediolateral and anteroposterior postural sway (mm) in a standing position with 2-legged stance and eyes open, hallux pain (Numerical Rating Scale), trunk and lower limb muscle mass (kg). We classified the subjects into a hallux valgus group (n = 44, photographic hallux valgus angle of 1 or both feet ≥ 20°) and a no hallux valgus group (n = 125, photographic hallux valgus angle of both feet < 20°) and analyzed the relationship between hallux valgus and postural sway.
RESULTS
The anteroposterior postural sway in the hallux valgus group (6.5 ± 2.8) was significantly greater than in the no hallux valgus group (5.4 ± 2.2, p = 0.014), and the lower limb muscle mass in the hallux valgus group (12.4 ± 2.2) was significantly smaller than in the no hallux valgus group (13.5 ± 3.2, p = 0.016). The total value of the photographic hallux valgus angle on both feet was positively correlated with the anteroposterior postural sway (p = 0.021) and negatively correlated with the lower limb muscle mass (p = 0.038). The presence of hallux valgus (p = 0.024) and photographic hallux valgus angle (p = 0.008) were independently related to the magnitude of anteroposterior postural sway.
CONCLUSIONS
Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway.
TRIAL REGISTRATION
2017 - 135. Registered 22 August 2017.
Topics: Adult; Aged; Bunion; Cross-Sectional Studies; Female; Foot; Hallux; Hallux Valgus; Humans; Male; Middle Aged
PubMed: 34059035
DOI: 10.1186/s12891-021-04385-4