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Clinics in Podiatric Medicine and... Oct 2018Hallux valgus is a common condition that results in lateral deviation of the hallux and medial deviation of the metatarsal. When conservative management fails, surgical... (Review)
Review
Hallux valgus is a common condition that results in lateral deviation of the hallux and medial deviation of the metatarsal. When conservative management fails, surgical management is often necessary. More than 150 procedures have been described, and most recommend an open approach. More recently, a minimally invasive approach to bunion correction has gained popularity among surgeons. The authors have been performing a minimally invasive percutaneous method of bunion correction with positive outcomes. This article presents case examples and a systematic approach for correction of this common foot condition.
Topics: Female; Hallux Valgus; Humans; Middle Aged; Minimally Invasive Surgical Procedures; Osteotomy
PubMed: 30223949
DOI: 10.1016/j.cpm.2018.05.002 -
Instructional Course Lectures 2020The management of bunion deformities in adolescent patients is often a source of consternation for orthopaedic surgeons. Reports of recurrence and surgical failure along...
The management of bunion deformities in adolescent patients is often a source of consternation for orthopaedic surgeons. Reports of recurrence and surgical failure along with a multitude of procedures to choose from create a wariness to manage the problem surgically. The biggest challenge in managing this problem is a lack of understanding by orthopaedic surgeons that adolescent bunions and adult bunions frequently arise from two distinct etiologies. The main difference between the two is that unlike adult bunion deformities, the hallux metatarsophalangeal joint in the adolescent bunion is congruent as the deformity is caused by a dysplasia of the metatarsal head. This dysplasia results in a valgus orientation of the first metatarsal articular surface (ie, elevated DMAA [distal metatarsal articular angle]). The recognition of this difference has implications for the evaluation and treatment of these deformities in adolescents.
Topics: Adolescent; Bunion; Hallux Valgus; Humans; Metatarsal Bones; Metatarsophalangeal Joint; Osteotomy
PubMed: 32017738
DOI: No ID Found -
The Journal of Foot Surgery 1992The authors explain the sequential development of a bunion beginning with hallux abducto valgus, then hypertrophy of the dorsomedial tubercle, followed by proximal... (Review)
Review
The authors explain the sequential development of a bunion beginning with hallux abducto valgus, then hypertrophy of the dorsomedial tubercle, followed by proximal articular set angle adaptation. This manuscript emphasizes the importance of transverse plane motion and the pull of the tibial sesamoid metatarsal ligament, and adductor hallucis tendon in the formation of a bunion.
Topics: Hallux Valgus; Humans; Tendons
PubMed: 1573166
DOI: No ID Found -
The Journal of Foot and Ankle Surgery :... 2005The tailor's bunion is a painful bony prominence on the lateral aspect of the fifth metatarsal head that occurs in many individuals, but seldom causes symptoms. This... (Review)
Review
The tailor's bunion is a painful bony prominence on the lateral aspect of the fifth metatarsal head that occurs in many individuals, but seldom causes symptoms. This article reviews the current literature regarding the presentation, etiology, and management of the tailor's bunion. The first line of management should be conservative, with advice on shoe wear. Orthotics may be useful if a symptomatic tailor's bunion results from excessive subtalar joint pronation. Operative management, indicated when symptoms are not controlled nonoperatively, aims to decrease foot width and the prominence of the tailor's bunion. Procedures can be grouped into resections and distal, diaphyseal, and proximal osteotomies. A distal osteotomy is recommended if medial translation of the head for one-third of the width of the metatarsal shaft produces a normal fourth-fifth intermetatarsal angle. A proximal osteotomy can be performed in the face of larger deformities. The management of recurrent tailor's bunion is still controversial. If the recurrence is due to under-correction, or if the initial procedure was not the best suited to that particular patient, then revision surgery may be helpful, after the cause of the failure has been established. Although unpopular, resection should be considered as the final salvage procedure.
Topics: Foot Deformities; Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Radiography; Treatment Outcome
PubMed: 15940605
DOI: 10.1053/j.jfas.2005.02.005 -
Journal of Pediatric Orthopedics Jan 2023The operative management of the juvenile bunion has not enjoyed the same level of success as its adult counterpart leading to the concern that we do not fully understand...
BACKGROUND
The operative management of the juvenile bunion has not enjoyed the same level of success as its adult counterpart leading to the concern that we do not fully understand what differentiates these 2 deformities. This study aims to (1) characterize the radiographic and pedobarographic features commonly encountered in the juvenile bunion and (2) determine which of these radiographic or pedobarographic parameters correlate with patient-reported outcome (PRO) scores at the time of presentation.
METHODS
An IRB-approved retrospective analysis of prospectively enrolled patients between 10 and 18 years of age with bunion deformities was performed at a single pediatric institution over a 4-year period. Standardized weight-bearing radiographs were used to determine hallux valgus angle (HVA), intermetatarsal angle, sesamoid position (SP), distal metatarsal articular angle (DMAA), and other radiographic parameters. Pedobarographic analysis was used to determine peak pressure, contact area, contact time, and pressure-time integral within 11 plantar regions. Foot-specific PRO measures were administered at the initial presentation.
RESULTS
Thirty-two patients (57 feet) met the inclusion criteria of which56/57 feet (98.2%) had an elevated DMAA (average 21.4degreesĀ±8.9 degrees), and 51/57 (89.4%) had a congruent joint. The DMAA correlated positively with the HVA (r=0.734 P <0.001), intermetatarsal angle (r=0.439 P =0.001), and SP (r=0.627 P <0.001). Pedobarographic analysis (available in 15/32 patients) demonstrated that the HVA correlated with increased second metatarsal head peak pressure (r=0.667 P =0.011) and pressure-time integral (r=0.604 P =0.002), which in turn was strongly correlated with worse PROs. Conversely, increased first metatarsal head contact area correlated with improved PROs. Analysis of radiographic measurements demonstrated that HVA and lateralized SP correlated significantly with worse PRO scores.
CONCLUSIONS
Nearly all juvenile bunions have an elevated DMAA and a congruent joint. There is a clear correlation between the severity of radiographic and pedobarographic deformity and worse PRO scores at the time of presentation. We believe that the presence of elevated DMAA is the defining factor that differentiates the juvenile bunion from the deformity typically seen in adults.
LEVEL OF EVIDENCE
III.
Topics: Adult; Humans; Child; Retrospective Studies; Hallux Valgus; Metatarsal Bones; Metatarsophalangeal Joint; Radiography; Treatment Outcome
PubMed: 36224093
DOI: 10.1097/BPO.0000000000002277 -
The Southern Medical Record Feb 1898
PubMed: 36026425
DOI: No ID Found -
Instructional Course Lectures 1987While the surgeon may tend to use one procedure in the repair of a hallux valgus deformity, versatility is most important when treating the juvenile bunion. Using a... (Review)
Review
While the surgeon may tend to use one procedure in the repair of a hallux valgus deformity, versatility is most important when treating the juvenile bunion. Using a distal soft-tissue repair when subluxation is solely at the metatarsophalangeal joint is an acceptable approach. A metatarsal or cuneiform osteotomy is necessary if the intermetatarsal angle is abnormally large. It is important not to stretch the indications for a bunion technique in order to correct the hallux valgus deformity. If a more severe deformity is present, a more aggressive technique must be used to correct the abnormality. That varying success rates are reported with different techniques testifies to the fact that the juvenile bunion is not suited for a standard hallux valgus repair. The surgical technique used to repair a specific juvenile bunion depends upon the anatomic and physiologic abnormalities present in each patient.
Topics: Adolescent; Child; Hallux Valgus; Humans; Metatarsophalangeal Joint; Osteotomy; Radiography; Shoes; Toe Joint
PubMed: 3325551
DOI: No ID Found -
Foot and Ankle Clinics Jun 2016Current practice and controversies in UK bunion surgery are discussed. Patients tend to be offered a distally based metatarsal osteotomy, such as a chevron or scarf... (Review)
Review
Current practice and controversies in UK bunion surgery are discussed. Patients tend to be offered a distally based metatarsal osteotomy, such as a chevron or scarf osteotomy, for mild to moderate symptomatic bunions. Greater deformities are managed with a more extreme scarf, supplemented with a proximal phalangeal osteotomy. A proximal fusion in the form of the Lapidus-type procedure is still reserved for the most severe, hypermobile, or arthritic cases. Minimally invasive techniques for bunions have failed to disseminate into common UK practice. The trends in the United Kingdom regarding litigation, venous thromboembolism, and osteodesis for bunion surgery are also discussed.
Topics: Bunion; Hallux Valgus; Humans; Minimally Invasive Surgical Procedures; Osteotomy; United Kingdom; Venous Thromboembolism
PubMed: 27261802
DOI: 10.1016/j.fcl.2016.01.001 -
MMW Fortschritte Der Medizin Feb 2013
Review
Topics: Arthroplasty; Bunion, Tailor's; Hammer Toe Syndrome; Humans; Metatarsal Bones; Metatarsophalangeal Joint; Postoperative Care; Tendon Transfer; Toe Phalanges
PubMed: 23573767
DOI: 10.1007/s15006-013-0171-2 -
The Journal of Foot and Ankle Surgery :... 2023
Topics: Humans; Bunion; Hallux Valgus; Patient Reported Outcome Measures
PubMed: 37652639
DOI: 10.1053/j.jfas.2023.06.010