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The Journal of Foot and Ankle Surgery :... 2022Hallux valgus is associated with balance deficits, and has been implicated as an independent risk factor for falls in older adults. However, it is unknown what effect...
Hallux valgus is associated with balance deficits, and has been implicated as an independent risk factor for falls in older adults. However, it is unknown what effect hallux valgus surgery has on static and dynamic (i.e., while walking) balance in older adults. We enrolled 13 middle-aged and older aged adults (mean age 54.3 ± 12.7 years, range 47 to 70) who underwent isolated hallux valgus surgery and followed them for 12 months. Preoperative and postoperative gait and balance performance was assessed using non-invasive body worn sensors with standardized and validated testing protocols. Visual analog scale (VAS) for pain and radiographic angles were also assessed. All subjects reported improvements in pain (VAS mean change -38.3 ± 10.3 mm), and all subjects demonstrated improvements in their hallux valgus angles and first/second intermetatarsal angles (mean change 16.3 ± 8.8°, and 5.5 ± 3.0°, respectively). While standing in full tandem, center of mass (COM) sway was improved upon by 59% at 1 year postoperative (p < .05, paired t-test). While most gait parameters demonstrated little change postoperatively, patients tended to spend less time in double support (p = .08, paired t-test), while gait variability increased by 55% (p = .03, paired t-test) and medial-lateral sway while walking increased by 43% (p = .08, paired t-test) 12 months postoperatively. Balance improved after hallux valgus surgery in our population, particularly when subjects were forced to rely on their operative foot for support (e.g., full tandem). Patients also seemed to walk with greater variability in stride velocity and with greater medial-lateral sway postoperatively, suggesting perhaps increased ambulatory confidence after successful hallux valgus surgery.
Topics: Aged; Bunion; Child, Preschool; Gait; Hallux Valgus; Humans; Middle Aged; Osteotomy; Pain; Treatment Outcome
PubMed: 34961679
DOI: 10.1053/j.jfas.2021.11.019 -
Cleveland Clinic Journal of Medicine Jan 2000The incidence, prevalence, and severity of foot conditions increase with age. Teaching patients simple preventive techniques is crucial. Recognition, treatment, and... (Review)
Review
The incidence, prevalence, and severity of foot conditions increase with age. Teaching patients simple preventive techniques is crucial. Recognition, treatment, and prevention of common foot complaints--i.e., toenail problems, infections, corns and calluses, injuries, flat feet, bunions, arthritis of the toes, and toe and joint deformities--are reviewed.
Topics: Adult; Age Factors; Aged; Antifungal Agents; Foot Deformities, Acquired; Foot Diseases; Hallux Valgus; Humans; Keratosis; Nails, Ingrown; Onychomycosis; Shoes; Tinea Pedis
PubMed: 10645676
DOI: 10.3949/ccjm.67.1.45 -
The Journal of Foot and Ankle Surgery :... 2023The research results are inconsistent that assessing whether the increased obliquity of the distal articular surface of the medial cuneiform leads to an increase in... (Review)
Review
The research results are inconsistent that assessing whether the increased obliquity of the distal articular surface of the medial cuneiform leads to an increase in hallux valgus angle. Thus, this study investigated the relationship between distal medial cuneiform obliquity and hallux valgus by measuring various angles in weightbearing anteroposterior radiographs of the foot. In total, 679 feet of 538 patients with the radiographs were included in the study. We measured radiographic parameters including hallux valgus angle, first to second intermetatarsal angle, metatarsus adductus angle, first metatarsus cuneiform angle, distal medial cuneiform angle, and first proximal metatarsal articular angle. The surface morphology (flat or curved) of the first tarsometatarsal joint was also recorded. Our results analysis revealed a weak negative correlation between distal medial cuneiform angle and both hallux valgus angle and first to second intermetatarsal angle, contrary to our assumption. So we believe that distal medial cuneiform angle was relatively constant and it cannot be used as a characteristic angle for quantifying hallux valgus. First metatarsus cuneiform angle was a characteristic indicator of hallux valgus and was positively correlated with its severity (p < .000), indicating that it can be used to measure the size of hallux valgus. It can also be used as a reference factor for the first metatarsal osteotomy in clinical bunion orthopedics. First tarsometatarsal joint morphology was unrelated to hallux valgus, whereas metatarsus adductus angle, and first proximal metatarsal articular angle should be considered in hallux valgus.
Topics: Humans; Hallux Valgus; Metatarsus Varus; Hallux; Metatarsal Bones; Bunion; Osteotomy
PubMed: 36973143
DOI: 10.1053/j.jfas.2022.06.009 -
Foot & Ankle Specialist Feb 2024Hallux valgus is a common condition with a complex etiology resulting in numerous treatment options. Recurrence of the deformity can occur following correction. Surgical...
BACKGROUND
Hallux valgus is a common condition with a complex etiology resulting in numerous treatment options. Recurrence of the deformity can occur following correction. Surgical technique and possibly also postoperative care play a role in reducing recurrence rates. This article highlights a postoperative surgical dressing technique which allows for semirigid support during the immediate postoperative period.
METHODS
A wooden tongue depressor placed along the medial border of the hallux comprises the primary support for the dressing. The rigidity of the tongue depressor allows for the hallux to be drawn toward the depressor, encouraging neutral alignment of the hallux. Dressings are removed 2 weeks postoperatively, with new dressings applied in similar fashion and maintained in place until 6 weeks postoperatively.
RESULTS
Based upon our observations, our surgical dressing technique provides sufficient support following hallux valgus correction surgery while being straightforward to replicate without the need for frequent dressing changes. The dressing materials are of negligible cost and are typically readily available. No associated wound complications have been observed.
CONCLUSIONS
We present an easily replicable and affordable option for postoperative hallux valgus correction surgical dressings.
LEVELS OF EVIDENCE
Level V: Expert Opinion.
Topics: Humans; Hallux Valgus; Splints; Osteotomy; Metatarsophalangeal Joint; Bunion; Bandages; Treatment Outcome
PubMed: 37154096
DOI: 10.1177/19386400231169376 -
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 -
Pain Mar 2014When a clinical trial of an analgesic produces a negative finding, it is important to consider the influence (if any) of experimental error on the validity of that... (Comparative Study)
Comparative Study Review
A comparison of the clinical and experimental characteristics of four acute surgical pain models: dental extraction, bunionectomy, joint replacement, and soft tissue surgery.
When a clinical trial of an analgesic produces a negative finding, it is important to consider the influence (if any) of experimental error on the validity of that result. Although efforts to identify and minimize experimental error in chronic pain investigations have begun in earnest, less work has been performed on the optimization of acute pain methodology. Of the acute surgical pain methodology articles that have been published over the last decade, almost all focus on either the dental or bunion model. Analgesics are typically evaluated in a variety of surgical models that eventually include hospital-based models (eg, joint replacement and soft tissue surgery). Every surgical procedure has unique clinical characteristics that must be considered to optimize study design and conduct. Much of the methodological knowledge garnered from bunion and dental studies is applicable to other surgical models, but some extrapolations are hazardous. The purposes of this review were (1) to qualitatively describe the clinical and experimental characteristics of the 4 classic surgical models: dental extraction, bunionectomy, joint replacement, and soft tissue surgery; and (2) to quantitatively compare the models by analyzing 3 factors: effect size, enrollment rate, and demographics. We found that the dental extraction and bunionectomy models had higher assay sensitivity than the joint replacement and soft tissue surgery models. It is probable that this finding is secondary to the superior experimental conditions under which the dental and bunion models are executed (utilization of few centers that have the ability to reduce surgical, anesthetic, and postoperative confounders).
Topics: Acute Pain; Analgesics; Arthroplasty, Replacement; Controlled Clinical Trials as Topic; Hallux Valgus; Humans; Pain, Postoperative; Randomized Controlled Trials as Topic; Subcutaneous Tissue; Tooth Extraction
PubMed: 24012952
DOI: 10.1016/j.pain.2013.09.002 -
International Journal of Paleopathology Dec 2021Hallux valgus, the lateral deviation of the great toe, can result in poor balance, impaired mobility and is an independent risk factor for falls. This research aims to...
OBJECTIVE
Hallux valgus, the lateral deviation of the great toe, can result in poor balance, impaired mobility and is an independent risk factor for falls. This research aims to compare the prevalence of hallux valgus in subpopulations of medieval Cambridge, England, and to examine the relationship between hallux valgus and fractures to examine the impact of impaired mobility and poor balance caused by this condition.
MATERIALS
177 adult individuals from four cemeteries located in Cambridge, England.
METHODS
Human remains were macroscopically and radiographically assessed.
RESULTS
Hallux valgus was identified in 18 % of individuals and was significantly more common during the 14th-15th centuries than the 11th-13th centuries. The highest prevalence was observed in the friary (43 %), followed by the Hospital (23 %), the rurban parish cemetery (10 %), and the rural parish cemetery (3%). Fractures from falls were significantly more common in those with hallux valgus than those without.
CONCLUSION
The increased prevalence of hallux valgus identified in individuals from the 14th to 15th centuries coincided with the adoption of new footwear with pointed toes. Those that adopted this fashion trend appear to have been more likely to develop balance and mobility problems that resulted in an increased risk of falls.
SIGNIFICANCE
This is the first study to explore the relationship between foot problems and functional ability by studying hallux valgus in archaeological assemblages.
LIMITATIONS
Falls are complex and determining the mechanism of injury in human skeletal remains is not always possible.
FURTHER RESEARCH
Fracture prevalence rates may have been affected by biological factors and underlying pathological conditions.
Topics: Adult; Cemeteries; Fractures, Bone; Hallux Valgus; Humans; Risk Factors
PubMed: 34120868
DOI: 10.1016/j.ijpp.2021.04.012 -
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 and Ankle Surgery : Official... Dec 2022Minimally-invasive Chevron and Akin osteotomy (MICA) represents the third-generation percutaneous hallux valgus surgery which is characterized by an extra-articular...
BACKGROUND
Minimally-invasive Chevron and Akin osteotomy (MICA) represents the third-generation percutaneous hallux valgus surgery which is characterized by an extra-articular osteotomy, stable internal fixation and a high potential for correction. Compared to other percutaneous techniques of the foot, MICA is generally regarded as an advanced and demanding surgical procedure with a flat learning curve. The aim of this study is to analyze a single-surgeons experience with his first 50 consecutive MICA procedures.
METHODS
Between May 2018 and February 2021, 50 consecutive MICA procedures performed by the author with the "K-wires-First technique" were prospectively analyzed focusing on surgery duration, number of fluoroscopies, correction results and surgery-associated complications. A modification of the original MICA technique as described by its inaugurators Redfern and Vernois allows the use of a standard-sized C-arm and aims to reduce revison rates and conversion to open surgery by placing the guidewires prior to performing the osteotomy.
RESULTS
The average surgery time for all MICA procedures was 46.8 min (SD 12.1, range 31-90 min). The average amount of fluoro shots required to perform MICA was n = 126.6 (SD 40.8, range 65-231). Comparing the preoperative and 6-week postoperative radiographs, the IMA decreased after MICA by a mean of 10.8° from 16.2° to 5.4° and the HVA by a mean of 22.1° from 30.6° to 8.5°. One case required intraoperative conversion to open hallux correction. There were 4 feet in three patients with secondary screw removal of the Chevron fixation due to prominent proximal screw tips.
CONCLUSIONS
Although the learning curve of 3rd generation MICA is flat and requires specific training and intensive practice, the rate of complications is not elevated compared to other percutaneous hallux valgus techniques. Strict adherence to the principles of 3rd generation MICA with stable fixation and meticulous intraoperative control of each surgical step helps to reduce surgery-associated complications. The learning curve showed a continous improvement in regard to surgery time and use of fluoroscopy. After 40 procedures, the surgery time consistently dropped under 45 min and required less than 100 fluoro-shots. The modified surgical technique may help reduce Chevron screw mal-positioning when using large C-arm fluoroscopy for this procedure.
Topics: Humans; Learning Curve; Minimally Invasive Surgical Procedures; Hallux Valgus; Osteotomy; Radiography; Bunion; Treatment Outcome
PubMed: 35882575
DOI: 10.1016/j.fas.2022.07.006