-
JBJS Essential Surgical Techniques Mar 2016An isolated subtalar arthrodesis through a sinus tarsi approach with cannulated screw fixation is safe, reproducible, and effective for specific hindfoot pathology in...
INTRODUCTION
An isolated subtalar arthrodesis through a sinus tarsi approach with cannulated screw fixation is safe, reproducible, and effective for specific hindfoot pathology in adults.
STEP 1 PREOPERATIVE PLANNING
Perform a comprehensive clinical and radiographic assessment.
STEP 2 PATIENT POSITIONING
Position the patient supine on the operating table with a bump under the ipsilateral hip, to internally rotate the involved leg.
STEP 3 INCISION
Mark a longitudinal incision from just inferior to the tip of the lateral malleolus and extending toward the base of the 4th metatarsal.
STEP 4 APPROACH
Expose the subtalar joint by reflecting the extensor digitorum brevis and protecting the peroneal tendons.
STEP 5 JOINT PREPARATION
Meticulously prepare the subtalar joint using osteotomes and curets down to healthy bleeding subchondral bone.
STEP 6 REDUCTION AND FIXATION
Reduce the subtalar joint into 5° of valgus and fix it with cannulated screws.
STEP 7 WOUND CLOSURE
Meticulously close the wound in layers and place the lower leg in a well-padded plaster back slab with the ankle in a neutral position.
STEP 8 POSTOPERATIVE CARE
The operatively treated leg is kept immobilized and non-weight-bearing for the first 6 weeks.
RESULTS
Numerous retrospective articles have reported high fusion rates and good functional outcomes after isolated subtalar arthrodesis, for all indications.
PubMed: 30237922
DOI: 10.2106/JBJS.ST.15.00065 -
Journal of Healthcare Engineering 2020Metatarsal pain is a common pathological outcome in patients with a hallux valgus (HV) deformity. However, the relationship between the degree of HV deformity and...
Metatarsal pain is a common pathological outcome in patients with a hallux valgus (HV) deformity. However, the relationship between the degree of HV deformity and metatarsal pain has not been systematically examined. The purpose of the present study was to investigate the correlation between metatarsal pain and the degree of HV deformity. Between October 2017 and September 2018, 512 HV patients (944 feet) participated in an evaluation of their HV angle (HVA) using X-ray images. The participants were divided into four groups corresponding to their HVA (<15°, 15° to 20°, 21° to 40°, or >40°). Load rate, impulse, contact duration, and contact area were measured and recorded as dynamic gait parameters using the RsScan system. Data were evaluated using SPSS statistical software. The visual analog scale (VAS) was used to assess metatarsal pain. For the four HV deformity groups, the peak value of impulse and contact duration was concentrated on the second and third metatarsals (Meta2 and Meta3) ( < 0.05); contact area was also shown on metatarsals 1, 2, and 5 ( < 0.05). Metatarsal pain on Meta2 had the highest VAS score (VAS: 6.57), followed by Meta3 (Mean VAS: 5.72). In the HV > 40° group, the load location on Meta2 was transferred to Meta1. The percent of pain attributed to Meta2 and Meta3 was also increased in this group. These findings illustrated that metatarsal pain was primarily located on Meta2 and Meta3 in the different degrees of HV deformity. This information can provide the location to target for pain relief and help guide further rehabilitation.
Topics: Adult; Aged; Biomechanical Phenomena; Female; Hallux Valgus; Humans; Male; Metatarsal Bones; Middle Aged; Pain
PubMed: 32300473
DOI: 10.1155/2020/8929153 -
EFORT Open Reviews Jun 2021There is some confusion in the terminology used when referring to MIS (Minimal invasive surgery) or percutaneous surgery. The correct term to describe these procedures... (Review)
Review
There is some confusion in the terminology used when referring to MIS (Minimal invasive surgery) or percutaneous surgery. The correct term to describe these procedures should be percutaneous (made through the skin) and MIS should be reserved for procedures whose extent is between percutaneous and open surgery (e.g. osteosynthesis). Minimal incision surgery may be distinguished in first, second and third generation minimal incision surgery techniques.First generation MIS hallux valgus surgery is mainly connected with the Isham procedure; an intraarticular oblique and incomplete osteotomy of the head of the first metatarsal without fixation.The Bösch osteotomy and the SERI are classified as second generation MIS hallux surgery. They are both transverse subcapital osteotomies fixed with a percutaneous medial K-wire inserted into the medullary canal. For all these procedures, intraoperative fluoroscopic control is necessary.Open hallux valgus surgery can be divided into proximal, diaphyseal and distal osteotomies of the first metatarsal. Reviewing the available literature suggests minimally invasive and percutaneous hallux valgus correction leads to similar clinical and radiological results to those for open chevron or SCARF osteotomies. First generation minimally invasive techniques are primarily recommended for minor deformities. In second generation minimally invasive hallux valgus surgery, up to 61% malunion of the metatarsal head is reported. Once surgeons are past the learning curve, third generation minimally invasive chevron osteotomies can present similar clinical and radiological outcomes to open surgeries. Specific cadaveric training is mandatory for any surgeon considering performing minimally invasive surgical techniques. Cite this article: 2021;6:432-438. DOI: 10.1302/2058-5241.6.210029.
PubMed: 34267933
DOI: 10.1302/2058-5241.6.210029 -
Joint Diseases and Related Surgery 2020This study aims to evaluate the radiological and functional outcomes of hallux valgus patients treated with distal oblique metatarsal osteotomy technique.
OBJECTIVES
This study aims to evaluate the radiological and functional outcomes of hallux valgus patients treated with distal oblique metatarsal osteotomy technique.
PATIENTS AND METHODS
Twenty-six feet of 22 patients (4 males, 18 females; mean age 46.2±18 years; range, 16 to 70 years) who were diagnosed as hallux valgus between March 2013 and April 2016 and who underwent distal oblique metatarsal osteotomy were included in this retrospective study. American Orthopedic Foot and Ankle Society/Hallux Metatarsophalangeal-Interphalangeal Scale (AOFAS/HMIS) was used for clinical and functional evaluation. The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position, first metatarsal length and forefoot bone and soft tissue width were measured for radiological evaluation.
RESULTS
The mean follow-up time was 33.1±9.8 months. The AOFAS/HMIS score increased significantly postoperatively (p=0.001). In the footwear section of the AOFAS/HMIS, the median preoperative score of 5 (range, 0-5) increased to 10 (range, 5-10) at the postoperative period (p=0.001). Hallux valgus angle, IMA, DMAA, and first metatarsal length significantly decreased when compared to preoperative measurements. Forefoot bone width also decreased significantly from 9.3 cm (range, 7.5-11.5 cm) to 8.8 cm (6.8-10.3 cm) (p=0.001).
CONCLUSION
Distal oblique metatarsal osteotomy is a safe method for hallux valgus deformity. Forefoot width reduction, decrease of soft tissue tension, sesamoid reduction, and plantar fascia relaxation are the crucial benefits of this method.
Topics: Adolescent; Adult; Aged; Female; Hallux Valgus; Humans; Metatarsal Bones; Middle Aged; Osteotomy; Range of Motion, Articular; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 32160500
DOI: 10.5606/ehc.2020.71298 -
International Orthopaedics Sep 2013Proximal first metatarsal osteotomies are recommended for the surgical treatment of moderate to severe hallux valgus deformity. This study aimed to compare correction of... (Review)
Review
PURPOSE
Proximal first metatarsal osteotomies are recommended for the surgical treatment of moderate to severe hallux valgus deformity. This study aimed to compare correction of intermetatarsal and hallux valgus angles and complications of proximal crescentic, Ludloff, proximal opening wedge, proximal closing wedge, proximal chevron and other proximal first metatarsal osteotomies.
METHODS
A systematic search for the keywords "(bunion OR hallux) AND (proximal OR crescentic OR basilar OR opening OR closing OR shelf OR Ludloff) AND osteotomy" in the online databases MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews was performed.
RESULTS
There was a mean correction of hallux valgus angle of 20.1° [confidence interval (CI) 18.7-21.4] and of intermetatarsal angle of 8.1° (CI 7.7-8.9). The overall complication rate reached 18.7 %.
CONCLUSIONS
The results of this study reveal higher corrective power of proximal osteotomies compared to meta-analysis data on diaphyseal osteotomies.
Topics: Hallux Valgus; Humans; Osteotomy
PubMed: 23884327
DOI: 10.1007/s00264-013-2012-4 -
Journal of the American Academy of... Jun 2020Hallux valgus deformity is a multiplanar deformity, where the rotational component has been recognized over the past 5 to 10 years and given considerable importance.... (Review)
Review
Hallux valgus deformity is a multiplanar deformity, where the rotational component has been recognized over the past 5 to 10 years and given considerable importance. Years ago, a rounded shape of the lateral edge of the first metatarsal head was identified as an important factor to detect after surgery because a less rounded metatarsal head was associated to less recurrence. More recently, pronation of the metatarsal bone was identified as the cause for the rounded appearance of the metatarsal head, and therefore, supination stress was found to be useful to achieve a better correction of the deformity. Using CT scans, up to 87% of hallux valgus cases have been shown to present with a pronated metatarsal bone, which highlights the multiplanar nature of the deformity. This pronation explained the perceived shape of the metatarsal bone and the malposition of the medial sesamoid bone in radiological studies, which has been associated as one of the most important factors for recurrence after treatment. Treatment options are discussed briefly, including metatarsal osteotomies and tarsometatarsal arthrodesis.
Topics: Bunion; Hallux; Hallux Valgus; Humans; Metatarsal Bones; Pronation
PubMed: 32656482
DOI: 10.5435/JAAOSGlobal-D-20-00091 -
Journal of Pain Research 2022To investigate the risk factors for hallux valgus complicated with pain under the second metatarsal and construct an effective model and method for predicting hallux...
OBJECTIVE
To investigate the risk factors for hallux valgus complicated with pain under the second metatarsal and construct an effective model and method for predicting hallux valgus complicated with pain under the second metatarsal based on risk factors.
METHODS
A total of 545 patients with hallux valgus who were admitted to our hospital were divided randomly into a training set and a validation set. The demographic characteristics, imaging indices and gait test indices of the patients were collected. The risk factors were identified by univariate and multivariate logistic regression analyses. A risk prediction model for hallux valgus with pain under the second metatarsal was established, and the area under the curve (AUC) of the receiver operating characteristic and a decision curve analysis were used for verification and identification. The value of the model was tested in the verification group.
RESULTS
Second metatarsal length, second metatarsal peak pressure, hallux valgus angle (HVA), intermetatarsal angle 1-2 (IMA1-2) and weight were the risk factors for hallux valgus complicated with pain under the second metatarsal. Based on the weighting of these seven risk factors, a prediction model was established. The AUC of the prediction model was 0.84 (95% confidence interval [CI]: 0.802~0.898, < 0.05), and the results of a Hosmer-Lemeshow test showed a good degree of calibration ( = 10.62, > 0.05). The internal validation of the AUC was 0.83 (95% CI: 0.737-0.885, < 0.05). The model had obvious net benefits when the threshold probability was 10%-70%.
CONCLUSION
Second metatarsal length, second metatarsal peak pressure, HVA, IMA1-2 and weight were the risk factors for hallux valgus combined with second metatarsal pain. The risk prediction model for hallux valgus complicated with pain under the second metatarsal based on these seven variables was proven effective.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
PubMed: 36394054
DOI: 10.2147/JPR.S386315 -
Joint Diseases and Related Surgery May 2023In this review, we discuss the efficacy and safety of biodegradable magnesium screws compared to titanium screws in the treatment of hallux valgus (HV) in patients... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
In this review, we discuss the efficacy and safety of biodegradable magnesium screws compared to titanium screws in the treatment of hallux valgus (HV) in patients undergoing distal metatarsal osteotomy (DMO).
MATERIALS AND METHODS
Eligible scientific articles published prior to October 2022 were retrieved from the PubMed, Springer, ScienceDirect, and Cochrane Library databases. The terms used for searching included "hallux valgus", "distal metatarsal osteotomies", and "bioabsorbable magnesium screw" which were limited in the title or abstract through the text. The title and abstract were checked one by one to exclude the non-related studies. For primary identified studies and relevant systematic reviews, the full texts were accessed and browsed to finally include the eligible studies. No restriction was set on publication language and publication status.
RESULTS
Two randomized-controlled trials (RCTs) and three non-RCTs that met the inclusion criteria were included. There was no significant difference in the American Orthopaedic Foot and Ankle Society (AOFAS) score, postoperative HV angle (HVA), intermetatarsal angle (IMA), Visual Analog Scale (VAS) score, soft tissue irritation, implant fracture, reoperation, and infection rates between two groups.
CONCLUSION
Bioabsorbable magnesium compression screws show comparable clinical or radiological results to titanium compression screws in the treatment of HV in patients undergoing DMO.
Topics: Humans; Titanium; Magnesium; Treatment Outcome; Metatarsal Bones; Absorbable Implants; Hallux; Hallux Valgus; Osteotomy; Bone Screws
PubMed: 37462631
DOI: 10.52312/jdrs.2023.1026 -
International Journal of Environmental... Jul 2022Hallux valgus is a common foot and ankle disease, for which numerous surgical procedures were introduced. So, understanding the mechanism of deformity reduction is...
Hallux valgus is a common foot and ankle disease, for which numerous surgical procedures were introduced. So, understanding the mechanism of deformity reduction is important to select the proper method. Intermetatarsal angle (IMA) determines the severity of hallux valgus, which is influenced by the translated metatarsal head and the reduction of the first tarsometatarsal joint. We hypothesized that both of the mechanisms simultaneously contribute to the correction of IMA. Hallux valgus (70 feet) operated with a Scarf osteotomy with the Akin procedure were reviewed. Hallux valgus angle (HVA), IMA (mechanical and anatomical), hallux valgus interphalangeal angle (HVIP), distal metatarsal articular angle (DMAA), and sesamoid position were checked. The ratio of contributions to the IMA changes were calculated and compared. When the individual contributions by metatarsal head translation and first tarsometatarsal joint reduction were compared, metatarsal head translation contributed by 82%, whereas first tarsometatarsal joint reduction contributed by 18%. Both were responsible for mechanical IMA correction. However, IMA change by metatarsal head translation was a major correction mechanism compared to anatomical IMA change by first tarsometatarsal joint reduction.
Topics: Hallux Valgus; Humans; Hyperplasia; Metatarsal Bones; Metatarsophalangeal Joint; Osteotomy; Radiography; Retrospective Studies; Treatment Outcome
PubMed: 35886095
DOI: 10.3390/ijerph19148243 -
Orthopaedics & Traumatology, Surgery &... Feb 2020Iatrogenic hallux varus is a dreaded complication of hallux valgus surgery, consisting in 1st-ray deformity in the form of medial malalignment of the 1st phalanx with... (Review)
Review
Iatrogenic hallux varus is a dreaded complication of hallux valgus surgery, consisting in 1st-ray deformity in the form of medial malalignment of the 1st phalanx with respect to the metatarsal axis. Such over-correction results from imbalance between excessive medial capsule retraction or tensioning and excessive lateral laxity or soft-tissue release. There may be loss of medial stability of bone origin due to excessive "exostosectomy" or excessive intermetatarsal angle closure. Following excessive lateral release, the imbalance gradually induces a varus deformity of the 1st phalanx due to traction by the medial muscles: abductor hallucis and medial head of flexor hallucis brevis inserting to the medial sesamoid. The deformity comprises 3 components, of varying importance: medial deviation of the hallux at the 1st metatarsophalangeal joint, supination of the phalanx, and interphalangeal flexion (i.e., claw deformity of the hallux). Treatment strategy is determined by the various clinical and radiological data explaining the postoperative hypercorrection. The clinical analysis is decisive, while radiology contributes more technical factors once the treatment option has been decided on. There are two main options for surgical revision to restore 1st ray propulsion: 1) static or dynamic reconstruction of the ligamentous structures, conserving metatarsophalangeal motion; or 2) metatarsophalangeal and/or interphalangeal fusion. Factors guiding choice are mainly range of motion, and reducibility of the metatarsophalangeal and interphalangeal deformity. We describe the procedures in detail, emphasizing the essential points for success. Joint sparing is to be sought in flexible deformities and young patients. Ligament reconstruction can be anatomic or palliative by tenodesis effect, which makes adjustment difficult. Alongside soft-tissue reconstruction, the metatarsal osteotomy should also be revised if the intermetatarsal angle has been unduly closed. Metatarsophalangeal fusion is the most reliable solution and is unavoidable if the joint is stiff or degenerative; it undoubtedly reduces risk of failure. LEVEL OF EVIDENCE: V, expert opinion.
Topics: Arthrodesis; Hallux Varus; Humans; Iatrogenic Disease; Metatarsophalangeal Joint; Osteotomy; Radiography
PubMed: 31521558
DOI: 10.1016/j.otsr.2019.05.018