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Journal of Orthopaedic Case Reports Jun 2023The commonly performed procedure for treating severe hallux valgus is proximal metatarsal osteotomy or first tarsometatarsal arthrodesis combined with a soft tissue...
INTRODUCTION
The commonly performed procedure for treating severe hallux valgus is proximal metatarsal osteotomy or first tarsometatarsal arthrodesis combined with a soft tissue procedure in which the severe intermetatarsal angle (IMA) is corrected using proximal metatarsal osteotomy or first tarsometatarsal arthrodesis; although a severe hallux valgus angle (HVA) can be corrected using the soft tissue procedure alone, the correction ability is low. Therefore, the more severe the hallux valgus is, the more difficult it is to correct.
CASE REPORT
A 52-year-old woman (height, 142 cm; weight, 47 kg) with severe hallux valgus with an HVA of 80° and an IMA of 22° was treated with a combination of the distal metatarsal and proximal phalangeal osteotomies fixated using K-wires, which was a modification of Kramer's and Akin's procedures, without a soft tissue procedure. The concept behind this technique is that distal metatarsal osteotomy primarily corrects the hallux valgus, and when the correction is insufficient, the proximal phalanx osteotomy complements it, which ensures that the first ray is approximately straight. After 4.1 years of follow-up, the HVA and IMA were 16° and 13°, respectively.
CONCLUSION
Distal metatarsal and proximal phalangeal osteotomies without a soft tissue procedure were effective in treating a patient with severe hallux valgus with an HVA of 80°.
PubMed: 37398536
DOI: 10.13107/jocr.2023.v13.i06.3684 -
International Orthopaedics Sep 2013Despite recent advances in pharmacological management of rheumatoid arthritis, forefoot deformity, with its symptoms, remains a common problem, often requiring operative... (Review)
Review
Despite recent advances in pharmacological management of rheumatoid arthritis, forefoot deformity, with its symptoms, remains a common problem, often requiring operative treatment. Typical deformities in these patients comprise hallux valgus and deformity of the lesser metatarsophalangeal (MTP) joints and toes. With regard to the lesser rays the standard operative procedure, advocated for the disabling forefoot pain in these patients, remains metatarsal head resection. It should be considered that with increasing success of pharmacological treatment the degree of forefoot deformity in these patients is becoming less and that resection of the lesser MTP joints is becoming more and more superfluous. This supports a trend towards metatarsal head-preserving surgery. The optimal treatment of the hallux deformity remains unclear. Fusion of the first MTP joint is, generally, recommended. This article will discuss the current surgical options in rheumatoid forefoot pathology.
Topics: Arthritis, Rheumatoid; Biomechanical Phenomena; Foot Deformities, Acquired; Humans; Range of Motion, Articular
PubMed: 23892468
DOI: 10.1007/s00264-013-2014-2 -
Journal of Foot and Ankle Research Oct 2023This prospective study aimed to test the reliability and validity of hallux valgus angle (HVA) measurement on smartphone digital photographs compared with the standard...
BACKGROUND
This prospective study aimed to test the reliability and validity of hallux valgus angle (HVA) measurement on smartphone digital photographs compared with the standard radiographic evaluation.
METHODS
Twenty Seven female patients (45 feet) with forefoot deformity were evaluated with weight-bearing anteroposterior foot radiographs and smartphone photographs. Radiographic hallux valgus angle (rHVA) was measured on digital radiographs. Two different photographic HVA measurement methods were used. In the first, the longitudinal axes of the first metatarsal and proximal phalanx were determined, and the angle between these axes was measured (pHVA), similar to the radiographic method. In the other method, the angle of the margo medialis pedis was measured on the photograph (pMMP). Two independent observers performed all measurements twice on two different occasions. Reliability analysis was performed using the interclass correlation coefficient. Agreement between the measurements was tested using Bland-Altman analysis.
RESULTS
The repeated rHVA, pHVA and pMMP measurements showed excellent intra and inter-observer reliability, with ICC values above 0.900. The mean rHVA, pHVA, and pMMP were statistically similar (p:0.929, 27.03°±8.7°, 27.11°±8.8° and 26.5°±9.0° respectively). The mean difference between the rHVA and pHVA was - 0.07°±5.1° (range, --9.67 to 9.56°), and the mean difference between the rHVA and pMMP was 0.53°±4.4° (range, -9.76° to 8.22°). There was a strong positive correlation between both photographic methods and radiographic measurements (rho = 0.809, p = 0.001 and rho = 0.872, p = 0.001). In the Bland Altman plot, the upper and lower LOAs (95%CI) ranged from - 10.11° to 9.93° for rHVA and pHVA, and from - 8.26° to 9.33° for rHVA and pMMP. Linear regression analysis showed a proportional bias for pHVA but not for the pMMP (p:0.010 versus p:0.633, respectively). The range of the mean difference (prediction interval) between the pMMP and rHVA was 17.59° and 20° for pHVA and rHVA. Simple linear regression showed that the rHVA was predicted by the following equation: rHVA = 4.73 + 0.84 × pMMP (r2 = 0.761, p < 0.001).
CONCLUSIONS
Although measuring HVA through smartphone photographs is reliable, it is not a valid prediction method.
LEVEL OF EVIDENCE
Level II, diagnostic assessment.
Topics: Humans; Female; Hallux Valgus; Smartphone; Reproducibility of Results; Prospective Studies; Foot; Metatarsal Bones
PubMed: 37840128
DOI: 10.1186/s13047-023-00670-8 -
Journal of Clinical Orthopaedics and... Jul 2022Hallux Valgus (HV) is a complex deformity involving the first ray of the forefoot and a common cause of forefoot pain. Several radiological measurements such as Hallux...
INTRODUCTION
Hallux Valgus (HV) is a complex deformity involving the first ray of the forefoot and a common cause of forefoot pain. Several radiological measurements such as Hallux Valgus Angle (HVA), First Metatarsophalangeal Angle (IMA) and Distal metatarsal articular angle (DMAA) exist to calculate the severity of HV and direct patient management. However, these are angular measurements are prone to error with variable intra- and inter-observer reliability.
PURPOSE
To describe a new radiological linear hallux valgus offset (LHVO) to measure HV deformity.
PATIENT AND METHODS
We performed a retrospective cohort study looking at Antero-posterior, weight-bearing foot radiographs of 100 consecutive patients with forefoot pain referred to our foot and ankle clinic. Demographic details, clinical indication, HVA (hallux valgus angle) and LHVO were measured for each patient and data were analyzed using the student t-test. Intraclass Correlation Coefficient (ICC) analysis was evaluated to assess the intra-class reliability between observers.
RESULTS
There was a female predominance of approximately 2:1, with 51.3 years (range 13-86 years). There was a statistically significant difference of LHVO between normal and hallux valgus cohorts with a p-value of 0.0001. The LHVO gave moderate intra-observer and inter-observer reliability on ICC analysis of 0.7.
CONCLUSION
The LHVO can be an additional measure of assessing severity of hallux valgus. In contrary to the traditional angular measurements, this linear measure is easier to calculate and reproducible on plain, weight bearing radiographs. LHVO measurement has shown a moderate inter-observer reliability in the study to complement traditional radiological evaluation of hallux valgus alignment.
PubMed: 35619938
DOI: 10.1016/j.jcot.2022.101898 -
Revista Brasileira de Ortopedia Aug 2021To present the clinical and radiographic results of hallux valgus surgical correction using four percutaneous techniques, chosen according to a predefined...
To present the clinical and radiographic results of hallux valgus surgical correction using four percutaneous techniques, chosen according to a predefined radiographic classification. We prospectively evaluated 112 feet in 72 patients with hallux valgus operated over the course of 1 year. Percutaneous distal soft tissue release (DSTR) and the Akin procedure (DSTR-Akin) were performed in mild cases. In mild to moderate hallux valgus with distal metatarsal joint angle > 10°, we added the Reverdin-Isham (RI) osteotomy. In moderate cases with joint incongruity, we performed the percutaneous chevron (PCH). Finally, a Ludloff-like percutaneous proximal osteotomy fixed (PPOF) with a screw was proposed in severe cases with an intermetatarsal angle (IMA) > 17°. According to these criteria, 26 DSTRs-Akin, 36 PCHs, 35 RIs, and 15 PPOFs were performed. The mean follow-up was of 17.2 months (range: 12 to 36 months). The mean age at operation was 58.8 years (range: 17 to 83 years), and 89% of the patients were female. The mean preoperative hallux valgus angle (HVA) and the IMA decreased from 21° to 10.2° and from 11.2° to 10.3° respectively in the DSTR-Akin. In the RI, the mean HVA decreased from 26.6° to 13.7°, and the IMA, from 11.2° to 10.3°; in the PCH, the mean HVA decreased from 31° to 14.5°, and the IMA decreased 14.9° to 10.7°; as for the PPOF, the mean HVA decreased from 39.2° to 17.7°, and the IMA, from 11.8° to 6.8°. The average ankle and hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) increased from 49.2 to 88.6. The rate of complications was of 11%. Our treatment protocol does not differ much from the classic ones, with similar results as well. We have as advantages less aggression to soft tissues and better cosmetic results. Level of Evidence: level IV, prospective case series.
PubMed: 34483396
DOI: 10.1055/s-0040-1721367 -
Foot & Ankle Orthopaedics Jan 2020Hallux valgus can alter load bearing in the foot leading to abnormal forces on the second toe. The purpose of this study was to determine demographic and radiographic...
BACKGROUND
Hallux valgus can alter load bearing in the foot leading to abnormal forces on the second toe. The purpose of this study was to determine demographic and radiographic factors associated with second ray hammertoes in hallux valgus using 3-dimensional weightbearing CT scans.
METHODS
Seventy-one patients who underwent a modified Lapidus procedure for hallux valgus with preoperative weightbearing CT scans were separated into 2 groups: (1) hallux valgus only (47 feet) and (2) hallux valgus with second ray hammertoe (29 feet). Preoperative age, body mass index (BMI), sex, hallux valgus angle (HVA), intermetatarsal angle (IMA), absolute and effective metatarsal (MT) lengths, ratios between metatarsal lengths, Meary angle, metatarsus adductus angle (MAA), and pronation were measured. Mean values of continuous variables were compared and both simple and multivariable logistic regression models were used to evaluate associations between variables and hammertoe occurrence.
RESULTS
Patients in the hammertoe group were found to be significantly older and have higher BMIs, HVAs, effective second MT lengths, IMAs, and more apex plantar Meary angles (all < .05). The multivariable analysis demonstrated that a higher IMA and a more apex plantar Meary angle were the only significant predictors of second ray hammertoe risk ( = .03 and = .01, respectively) once corrected for age and BMI.
CONCLUSION
Significant associations were found between older age, higher BMI, and more severe deformity and the occurrence of hammertoe in hallux valgus patients. These results may help clinicians counsel hallux valgus patients about the risk of developing an advanced hammertoe deformity.
LEVEL OF EVIDENCE
Level III, retrospective comparative series.
PubMed: 35097369
DOI: 10.1177/2473011420909088 -
Clinics in Orthopedic Surgery Jun 2024Rheumatoid arthritis (RA) is a chronic autoimmune disorder that frequently causes forefoot deformities. Arthrodesis of the first metatarsophalangeal joint is a common...
BACKGROUND
Rheumatoid arthritis (RA) is a chronic autoimmune disorder that frequently causes forefoot deformities. Arthrodesis of the first metatarsophalangeal joint is a common surgery for severe hallux valgus. However, joint-preserving surgery can maintain the mobility of the joint. This study aimed to investigate the clinical and radiographic outcomes of distal chevron metatarsal osteotomy (DCMO) for correcting hallux valgus deformity associated with RA.
METHODS
Between August 2000 and December 2018, 18 consecutive patients with rheumatoid forefoot deformities (24 feet) underwent DCMO for hallux valgus with/without lesser toe surgery. Radiological evaluations were conducted, assessing the hallux valgus angle, the intermetatarsal angle between the first and second metatarsals, and the Sharp/van der Heijde score for erosion and joint space narrowing. Clinical outcomes were quantified using a visual analog scale for pain and the American Orthopaedic Foot and Ankle Society forefoot scores to measure function and alignment.
RESULTS
The mean hallux valgus angle decreased from 38.0° (range, 25°-65°) preoperatively to 3.5° (range, 0°-17°) at the final follow-up ( < 0.05). The mean intermetatarsal angle decreased from 14.9° (range, 5°-22°) preoperatively to 4.3° (range, 2°-11°) at the final follow-up. ( < 0.05). Regarding the Sharp/van der Heijde score, the mean erosion score (0-10) showed no significant change, decreasing from 3.83 (range, 0-6) preoperatively to 3.54 (range, 0-4) at the final follow-up ( = 0.12). Recurrent hallux valgus was observed in 1 patient and postoperative hallux varus deformity was observed in 2 feet. Spontaneous fusion of the metatarsophalangeal joint developed in 1 case.
CONCLUSIONS
DCMO resulted in satisfactory clinical and radiographic outcomes for correcting RA-associated hallux valgus deformity.
Topics: Humans; Hallux Valgus; Arthritis, Rheumatoid; Female; Middle Aged; Osteotomy; Male; Aged; Adult; Retrospective Studies
PubMed: 38827764
DOI: 10.4055/cios23184 -
Foot and Ankle Surgery : Official... Oct 2022Bosch osteotomy for hallux valgus (HV) deformity has advantages of reduction both the operating time and surgical dissection, and may be performed bilaterally and with...
Bilateral and concomitant pathology' surgeries do not affect the outcomes of mini-open distal linear metatarsal osteotomy (Bosch osteotomy) with manipulation for hallux valgus deformity.
BACKGROUND
Bosch osteotomy for hallux valgus (HV) deformity has advantages of reduction both the operating time and surgical dissection, and may be performed bilaterally and with fewer complications than other surgical procedures as well as early weight-bearing. However, there are few reports on the effects of bilateral simultaneous surgery, simultaneous surgery on concomitant pathologies, and the preoperative HV angle on the postoperative results. The present assessed the factors that might affect the improvement in clinical outcomes following mini-open Bosch osteotomy with manipulation to treat HV deformity.
METHODS
Seventy patients with 110 feet were included. They were divided into groups as follows: unilateral and bilateral simultaneous surgery groups, Bosch osteotomy alone and simultaneous surgeries for concomitant pathologies groups, and preoperative HV angle< 40° and ≥ 40° groups. Subjective clinical outcome scores using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and the HV and intermetatarsal first and second metatarsal (M1M2) angles according to the anteroposterior (A-P) view of the weighted foot X-ray were assessed preoperatively and at 12 months after surgery.
RESULTS
The mean HV angle, M1M2 angle and all subscales of the SAFE-Q score showed significant improvement at 12 months after surgery, regardless of simultaneous bilateral surgery, simultaneous surgery for concomitant pathologies, or the preoperative HV angle. On comparing the groups, there were no significant differences in the HV angle at 12 months after surgery. Significant inferiority at 12 months after surgery was found in the intermetatarsal angle in the simultaneous surgery for concomitant pathologies group and in all subscales of the SAFE-Q score in the HV angle ≥ 40° group.
CONCLUSION
Mini-open Bosch osteotomy with manipulation for HV deformity demonstrated good results in both radiological assessments and subjective clinical scores at 12 months after surgery, even for simultaneous bilateral surgery, simultaneous concomitant pathologies' surgery, and severe HV deformity.
LEVEL OF EVIDENCE
Prognostic Level III, retrospective cohort study.
Topics: Bunion; Hallux; Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Retrospective Studies; Treatment Outcome
PubMed: 35190276
DOI: 10.1016/j.fas.2022.02.009 -
The Archives of Bone and Joint Surgery Mar 2021Several procedures and types of osteotomies have been described for hallux valgus (HV) correction. Percutaneous techniques may lead to an early regain of function...
BACKGROUND
Several procedures and types of osteotomies have been described for hallux valgus (HV) correction. Percutaneous techniques may lead to an early regain of function reducing morbidity and recovery time. In this study, we aimed to evaluate the clinical and radiographic outcomes of percutaneous hallux valgus (HV) correction.
METHODS
One hundred and twenty-four feet treated with the percutaneous technique between May 2011 and December 2015 were included in our study. All patients underwent resection of the medial metatarsal exostosis, complete first metatarsal distal osteotomy, adductor hallucis tendon release and Akin osteotomy of the proximal phalanx. Pre- and postoperative X-rays were clinically assessed.
RESULTS
The mean hallux valgus angle (HVA) and the intermetatarsal angle (IMA) decreased significantly from the preoperative assessment to the final follow-up. The AOFAS score improved from a mean preoperative value of 70.2 to 93.8 at the final follow-up.
CONCLUSION
Percutaneous complete distal osteotomy in hallux valgus correction is a safe, reliable and effective procedure for the correction of symptomatic mild hallux valgus. Nevertheless, it requires appropriate surgical experience and patient aftercare in order to achieve the best result.
PubMed: 34026939
DOI: 10.22038/abjs.2020.47336.2319 -
Orthopaedic Surgery Nov 2023To design appropriate orthosis for hallux valgus, a difficult foot condition that affects a quarter of the body's bones, we need to clarify the numerical biomechanical...
OBJECTIVE
To design appropriate orthosis for hallux valgus, a difficult foot condition that affects a quarter of the body's bones, we need to clarify the numerical biomechanical features, which have not been established in previous biomechanical studies. Therefore, we constructed a finite element model of the bunion foot to investigate the orthopaedic force compensation mechanism.
METHODS
A patient with moderate hallux valgus was recruited. CT imaging data in DICOM format were extracted for three-dimensional foot model reconstruction. In conjunction with the need for rapid design of bunion orthosis, a metatarsal force application sizing method based on an orthogonal test design was investigated. The orthogonal test design was used to obtain the hallux valgus angle (HVA) and the inter metatarsal angle (IMA) data for different force combinations. Based on the extreme difference analysis and analysis of variance of the test results, the influence of different force combinations on the bunion angle was quickly determined.
RESULTS
The results showed that the stress concentration occurred mainly in the first metatarsal bone. The distribution trend was in the medial and lateral middle of the bone and gradually decreased to the dorsal base of the bone body. The greatest stress occurs in the cartilage between the phalanges and metatarsals. In 25 groups of simulation experiments, HVA was reduced from 27.7° to 13°, and IMA was reduced from 12.5° to 7.3°.
CONCLUSION
Applying detailed orthopaedic force collocation to the first metatarsal column can effectively restore the mechanics and kinematics of hallux valgus, and provide a reference for the treatment of bunion valgus and the design of orthopaedic devices.
Topics: Humans; Hallux Valgus; Finite Element Analysis; Osteotomy; Bunion; Orthotic Devices; Treatment Outcome
PubMed: 37667965
DOI: 10.1111/os.13862