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International Journal of Environmental... Jul 2022Hallux valgus (HV) is one of the most common forefoot deformities, and its prevalence increases with age. HV has been associated with poor foot function, difficulty in...
BACKGROUND
Hallux valgus (HV) is one of the most common forefoot deformities, and its prevalence increases with age. HV has been associated with poor foot function, difficulty in fitting footwear and poor health-related quality of life. The aims of this study were to design and develop an easy-to-use measurement device for measuring hallux valgus angle (HVA) in patients with HV and to assess the measurement reliability of the newly designed measurement device.
METHODS
A manual measurement device for measuring HVA was designed and developed to test on patients with HV. Two measuring methods, i.e., test-retest and intra-observer measurements, were used to evaluate the repeatability and reliability of the newly designed measurement device. In the test-retest measurements, a total of 42 feet from 26 patients with HV were repeatedly measured by the same researcher using the manual measurement device every 3 weeks over a period of 12 months. The measurement reliability of the newly designed measurement device was analysed based on the collected HVA data. In the intra-observer measurements, a total of 22 feet from the same group of HV patients were measured by the same researcher using the manual measurement device and by a consultant using X-ray measurement for comparison. The intraclass correlation coefficient (ICC) was used to determine the correlation of measurements between the manual measurement device and X-ray measurement.
RESULTS
The mean of the difference between the two repeat measurements of HVA using the newly designed manual device was 0.62°, and the average of ICC was 0.995, which indicates excellent reliability. The ICC between X-ray and the average of twice-repeated manual measurements was 0.868, with 95% CI (0.649, 0.947) ( = 0.000). When the relationship in HVA between X-ray measurement and manual measurement using the new device was regressed as a linear relationship, the regression equation was y = 1.13x - 4.76 (R = 0.70).
CONCLUSIONS
The newly designed measurement device is easy to use, with low-cost and excellent reliability for HVA measurement, with the potential for use in clinical practice.
Topics: Foot; Hallux Valgus; Humans; Quality of Life; Radiography; Reproducibility of Results
PubMed: 35897475
DOI: 10.3390/ijerph19159108 -
Scientific Reports Oct 2022The aim of the study was to compare the shape of the feet, the mobility of the metatarsophalangeal and interphalangeal joints and the flexibility of the calf muscles in...
The aim of the study was to compare the shape of the feet, the mobility of the metatarsophalangeal and interphalangeal joints and the flexibility of the calf muscles in older women with hallux valgus versus middle-aged women with and without this deformation to identify the presence of features which correlate particularly strongly with hallux valgus, and on which prophylaxis and conservative treatment should focus. The study involved 201 women: 92 aged 60-84 years with hallux valgus of both toes, 78 aged 38-59 with hallux valgus of both toes, and 31 aged 38-57 years with correctly shaped feet. The intensity of pain in the foot, the valgus angle of the big toe and fifth toe, the longitudinal and transverse arches of the foot, the symmetry of foot load with body weight, toe joint mobility and muscle flexibility were analysed. Both groups of women with hallux valgus differed from women with normal feet in the height of the transverse arch, the extent of dorsal extension in the first metatarsophalangeal joint and plantar flexion in the first interphalangeal joint. Older women were additionally characterised by reduced plantar flexion in the metatarsophalangeal joint of the big toe, limited flexibility of the soleus and gastrocnemius muscles as well as less pain in the toe area than in the foot itself. The most characteristic changes which were observed in older women with hallux valgus are a limited range of motion in the MTP and IP joints of the big toe, a reduced transverse arch and increased restriction of calf muscle flexibility.
Topics: Middle Aged; Female; Humans; Aged; Hallux Valgus; Metatarsophalangeal Joint; Foot; Toe Joint; Pain
PubMed: 36316449
DOI: 10.1038/s41598-022-23113-z -
Acta Ortopedica Mexicana 2021The hallux valgus is a very frequent and complex orthopedic pathology. It involves the bone and soft tissue structures of the first toe. There are multiple techniques...
INTRODUCTION
The hallux valgus is a very frequent and complex orthopedic pathology. It involves the bone and soft tissue structures of the first toe. There are multiple techniques described for the alignment of the first toe. All technics aim to restore the normal angulation of the toe while using a stable osteotomy through a painless surgical procedure. The minimal invasive techniques have been growing in acceptance since the year 2000, as a viable surgical alternative to treat this pathology.
MATERIAL AND METHODS
We included patients with a diagnostic of mild or moderate hallux valgus on whom a minimal invasive procedure was performed to correct the deformity of the first toe. We performed a distal Reverdin/Isham osteotomy on the first metatarsal and an akin osteotomy in the proximal phalanx, a lateral capsular release and a abductor tenotomy. These patients were followed for 24 months after their surgery.
RESULTS
Our patients had an adequate correction angular correction, for a distal osteotomy. They had a good pain control, with an adequate mobility in the postoperative period. The patients presented an adequate personal satisfaction, 87% of them had good results. We found an important and statistically significant improvement in the Kitaoka scale.
CONCLUSION
The minimal invasive technics for the correction of mild or moderated hallux valgus are a good alternative. Our patients are satisfied with the functional, and cosmetic results.
Topics: Follow-Up Studies; Hallux Valgus; Humans; Metatarsal Bones; Minimally Invasive Surgical Procedures; Treatment Outcome
PubMed: 35139587
DOI: No ID Found -
Medicina (Kaunas, Lithuania) May 2023: Hallux valgus is one of the most common chronic foot complaints, with prevalences of over 23% in adults and up to 35.7% in older adults. However, the prevalence is... (Review)
Review
: Hallux valgus is one of the most common chronic foot complaints, with prevalences of over 23% in adults and up to 35.7% in older adults. However, the prevalence is only 3.5% in adolescents. The pathological causes and pathophysiology of hallux valgus are well-known in various studies and reports. A change in the position of the sesamoid bone under the metatarsal bone of the first toe is known to be the cause of the initial pathophysiology. : The relationships between the changes in the location of the sesamoid bone and each radiologically measured angle and joint congruency in the hallux valgus remain as yet unknown. Therefore, this study investigated the relationships of sesamoid bone subluxation with the hallux valgus angle, intermetatarsal angle, and metatarsophalangeal joint congruency in hallux valgus patients. The goal is to know the hallux valgus angle, the intermetatarsal angle, and metatarsophalangeal joint congruency's correlation with hallux valgus severity and prognosis by revealing the relationship between each measured value and sesamoid bone subluxation. : We reviewed 205 hallux valgus patients who underwent radiographic evaluation and subsequent hallux valgus correction surgery in our orthopedic clinic between March 2015 and February 2020. Sesamoid subluxation was assessed using a new five-grade scale on foot radiographs, and other radiologic measurements were assessed, such as hallux valgus angle, the intermetatarsal angle, distal metatarsal articular angle, joint congruency, etc. : Measurements of the hallux valgus angle, interphalangeal angle, and joint congruency exhibited high interobserver and intraobserver reliabilities in this study. They also showed correlations with sesamoid subluxation grade.
Topics: Adolescent; Humans; Aged; Hallux Valgus; Foot; Metatarsal Bones; Orthopedic Procedures; Sesamoid Bones; Retrospective Studies; Treatment Outcome
PubMed: 37241108
DOI: 10.3390/medicina59050876 -
Journal of Orthopaedic Surgery (Hong... 2023Evolving evidence and improved instrumentation have led to increasing importance of minimally invasive surgery (MIS) surgery in the treatment of hallux valgus deformity....
BACKGROUND
Evolving evidence and improved instrumentation have led to increasing importance of minimally invasive surgery (MIS) surgery in the treatment of hallux valgus deformity. This study aims to investigate the current trends of the practice of MIS hallux valgus surgery in the Asia Pacific region.
METHOD
A survey was sent via email to 30 fellowship-trained foot and ankle surgeons in 11 Asia Pacific countries, all registered with their respective national orthopaedic societies. The survey consisted of 8 questions and was designed to assess surgeon experience with MIS hallux valgus surgery, including common contraindications, satisfaction levels, learning curves and post-operative rehabilitation after MIS hallux valgus surgery.
RESULTS
The vast majority of surgeons (63%) performed MIS hallux valgus surgery. However, only 18% of surgeons performed MIS surgery in more than half of their hallux valgus cases. A severe deformity was the most common contraindication (81%), followed by the instability of the first tarsometatarsal joint (50%), and abnormal DMAA (Distal Metatarsal Articular Angle) (38%). There was no statistically significant difference between the satisfaction score of MIS versus open surgery (-value 0.1). The median number of cases the surgeons needed to perform before they considered themselves comfortable performing the surgery was 10 cases (range 1-100). Most surgeons allowed full weight bearing at 4-6 weeks after surgery.
CONCLUSIONS
MIS hallux valgus surgery is gaining popularity in the Asia Pacific region, with the majority of surgeons adopting this practice. The fact that severe deformity is seen as the most frequent contraindication and that MIS surgery is still not the most popular alternative demonstrates that surgeons are still circumspect when it comes to MIS surgery. Surgeons can use the findings of this study to guide their adoption of MIS practices in hallux valgus surgery and gauge well they perform in comparison to their counterparts in the Asia Pacific region.
Topics: Humans; Hallux Valgus; Treatment Outcome; Osteotomy; Minimally Invasive Surgical Procedures; Metatarsophalangeal Joint; Metatarsal Bones
PubMed: 37458528
DOI: 10.1177/10225536231180332 -
Foot & Ankle International Oct 2022The Lapidus procedure corrects hallux valgus first ray deformity. First tarsometatarsal (TMT) fusion in patients with hallux valgus deformity using minimally invasive...
BACKGROUND
The Lapidus procedure corrects hallux valgus first ray deformity. First tarsometatarsal (TMT) fusion in patients with hallux valgus deformity using minimally invasive surgery (MIS) is a new technique, but comparative outcomes between MIS and open techniques have not been reported. This study compares the early radiographic results and complications of the MIS with the open procedure in a single-surgeon practice.
METHODS
47 MIS patients were compared with 44 open patients. Radiographic measures compared preoperatively and postoperatively were the intermetatarsal angle (IMA), hallux valgus angle (HVA), foot width (FW), distal metatarsal articular angle (DMAA), sesamoid station (SS), metatarsus adductus angle (MAA), first metatarsal to second metatarsal length, and elevation of the first metatarsal. Early complications were recorded, as well as repeat surgeries.
RESULTS
The mean follow-up was 82 (range, 31-182) months for the open group and 29 (range, 14-47) months for the MIS group. In both techniques, postoperative measures (IMA, HVA, DMAA, FW, and sesamoid station) were significantly improved from preoperative measures. When comparing postoperative measures between both groups, the IMA was significantly lower in the open group (4.8 ± 3.6 degrees vs 6.4 ± 3.2 degrees, < .05). Differential between pre- and postoperative measures for both techniques were compared, and the open group was associated with more correction than the MIS group for IMA (12.4 ± 5.3 degrees vs 9.4 ± 4.4 degrees, = .004) and HVA (25.5 ± 8.3 degrees vs 20 ± 9.9 degrees, = .005). Wound complication and nonunion rates trended higher in the open group (4 vs 0) ( = .051).
CONCLUSION
Both techniques resulted in good to excellent correction. However, the open technique was associated with lower postoperative IMA values and more correction power for IMA and HVA, than the MIS.
Topics: Bunion; Hallux Valgus; Humans; Metatarsal Bones; Metatarsophalangeal Joint; Osteotomy; Radiography; Retrospective Studies; Treatment Outcome
PubMed: 35880322
DOI: 10.1177/10711007221112088 -
Journal of Orthopaedic Surgery (Hong... 2022Radiographic assessment of hallux valgus is an essential process. Residual rotational deformity was shown associated with higher recurrent rate. This study aims to...
Radiographic assessment of hallux valgus is an essential process. Residual rotational deformity was shown associated with higher recurrent rate. This study aims to comprehensively assess reliability of measurement of various parameters from plain films and weight-bearing CT scan. A total of 40 pre-operative plain radiographs, 40 post-operative plain radiographs, and 37 weight-bearing CT scan were evaluated to determine reliability of hallux valgus parameters. TSP and head shape representing coronal plane deformity showed lower inter-observer reliability compared to other parameters using for transverse plane evaluation especially in post-operative period. (post-op TSP amongst 3 assessors: κ = 0.386, 0.520, 0.340; post-op head shape: κ = 0.374, 0.375, 0.295) Using α angle for evaluation 1 metatarsal rotation in weight-bearing CT scan demonstrated very good reliability for inter-observer (ICC = 0.853 (95% CI = 0.715-0.925)) and intra-observer (ICC = 0.902 (95% CI = 0.844-0.939)). Weight-bearing CT scan can improve reliability in post-operative coronal plane assessment.
Topics: Hallux Valgus; Humans; Metatarsal Bones; Reproducibility of Results; Tomography, X-Ray Computed; Weight-Bearing
PubMed: 36113418
DOI: 10.1177/10225536221122309 -
Journal of Orthopaedic Surgery (Hong... 2022Finite element (FE) analysis and clinical follow-up were used to evaluate the efficacy of modified scarf osteotomy for moderate-to-severe hallux valgus (HV).
PURPOSE
Finite element (FE) analysis and clinical follow-up were used to evaluate the efficacy of modified scarf osteotomy for moderate-to-severe hallux valgus (HV).
METHOD
We retrospectively evaluated 42 patients (44 feet) who underwent modified rotational scarf osteotomy for moderate-to-severe HV at our institution between January 2010 and January 2019. Radiological indicators and subjective scores were recorded at different time points. To compare the results and elemental characteristics, a FE model of the metatarsophalangeal (MTP) joint that included anatomically realistic geometrical and structural characteristics was built. The biomechanical features and correction differences in dynamic loads as well as the incidence of troughing were estimated.
RESULTS
Both the hallux valgus angle (HVA) and intermetatarsal angle (IMA) showed significant improvement 6 weeks postoperatively ( < 0.05); additionally, the HVA increased from 6 weeks postoperatively to the last follow-up, while the IMA showed no significant changes ( > 0.05). The subjective scores significantly improved from the preoperative period to the last follow-up. The percentages of troughing and recurrence were remarkably low in our pilot study because of the innate stability of the modified rotated fixation.
CONCLUSION
Our preliminary findings suggest that modified rotational scarf osteotomy offers sufficient stability, correct HV deformity effectively, and good clinical outcomes for moderate to severe HV.
Topics: Humans; Hallux Valgus; Finite Element Analysis; Pilot Projects; Retrospective Studies; Osteotomy
PubMed: 36459594
DOI: 10.1177/10225536221143816 -
Arthritis Care & Research Jan 2015Hallux valgus (HV) has been linked to functional disability and increased risk of falls, but mechanisms underpinning functional disability are unclear. This study...
OBJECTIVE
Hallux valgus (HV) has been linked to functional disability and increased risk of falls, but mechanisms underpinning functional disability are unclear. This study investigated functional performance, muscle strength, and plantar pressures in adults with mild, moderate, and severe HV compared to controls, while considering the influence of foot pain.
METHODS
Sixty adults with HV (classified as mild, moderate, and severe on dorsalplantar radiographs) and 30 controls participated. Measures included hallux plantar flexion and abduction strength, walking performance, postural sway, and forefoot plantar pressures. Multivariate analysis of covariance and pairwise comparisons (P < 0.05 after Bonferroni adjustment) were used to investigate differences between groups, adjusting for age, sex, body mass index, and foot pain.
RESULTS
Hallux plantar flexion and abduction strength were significantly reduced in those with moderate (mean differences: plantar flexion -45.8 N, abduction -12.3 N; P < 0.001) and severe HV (plantar flexion -50.1 N; P < 0.001, abduction -11.2 N; P = 0.01) compared to controls. A significant reduction in hallux peak pressure and pressure-time integral was evident in moderate (peak pressure -90.8 kPa; P < 0.001) and severe HV (peak pressure -106.2 kPa; P < 0.001) compared to controls. Those with severe HV also demonstrated increased mediolateral postural sway in single leg stance compared to controls (3.5 cm; P = 0.01).
CONCLUSION
Moderate to severe HV is associated with reduced hallux plantar pressures and strength measures, while relatively normal function compared to controls was found in those with mild deformity. Greater understanding of specific functional deficits associated with different stages of HV will help inform clinical management and future research.
Topics: Adult; Aged; Cross-Sectional Studies; Female; Hallux Valgus; Humans; Male; Middle Aged; Muscle Strength; Postural Balance; Surveys and Questionnaires; Walking; Young Adult
PubMed: 24905860
DOI: 10.1002/acr.22380 -
Journal of Orthopaedic Research :... Aug 2015Radiographic angles are used to assess the severity of hallux valgus deformity, make preoperative plans, evaluate outcomes after surgery, and compare results between... (Comparative Study)
Comparative Study
Radiographic angles are used to assess the severity of hallux valgus deformity, make preoperative plans, evaluate outcomes after surgery, and compare results between different methods. Traditionally, hallux valgus angle (HVA) has been measured by using a protractor and a marker pen with hardcopy radiographs. The main objective of this study is to compare HVA measurements performed using a smartphone and a traditional protractor. The secondary objective was to compare the time taken between those two methods. Six observers measured major HVA on 20 radiographs of hallux valgus deformity with both a standard protractor and an Apple iPhone. Four of the observers repeated the measurements at least a week after the original measurements. The mean absolute difference between pairs of protractor and smartphone measurements was 3.2°. The 95% confidence intervals for intra-observer variability were ±3.1° for the smartphone measurement and ±3.2° for the protractor method. The 95% confidence intervals for inter-observer variability were ±9.1° for the smartphone measurement and ±9.6° for the protractor measurement. We conclude that the smartphone is equivalent to the protractor for the accuracy of HVA measurement. But, the time taken in smartphone measurement was also reduced.
Topics: Adult; Cell Phone; Female; Hallux Valgus; Humans; Middle Aged; Observer Variation; Radiography
PubMed: 25763918
DOI: 10.1002/jor.22872