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Willegger M, Veljkovic A, Bouchard M. Correction of the Juvenile Hallux Valgus. Foot Ankle Clin 2025; 30:315-328. [PMID: 40348464 DOI: 10.1016/j.fcl.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2025]
Abstract
The correction and treatment of juvenile hallux valgus (JHV) remains a topic of controversy and confusion, but, at the same time, this distinct pathology serves as a basis for innovation. The variety of clinical and radiographic presentation of pediatric bunion deformities poses a challenge for the treating surgeon, who will need an armamentarium of surgical procedures to address JHV deformities. Historically, high rates of recurrence after JHV corrections as well as surgical failure have been reported.
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Affiliation(s)
- Madeleine Willegger
- Department of Orthopedics and Trauma Surgery, Division of Orthopedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Andrea Veljkovic
- Department of Orthopaedics, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia V6T 1Z4, Canada
| | - Maryse Bouchard
- Department of Surgery, Division of Orthopaedics, University of Toronto, Hospital for Sick Children, Toronto, Ontario M5S 1A1, Canada
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Kim B, Kim WS, Park Y, Park MS, Sung KH. Comparison Between Calcaneal Lengthening Osteotomy and Calcaneo-Stop Procedure in the Surgical Treatment of Idiopathic Flatfoot in Children: Retrospective Cohort Study. Foot Ankle Int 2025:10711007251322471. [PMID: 40390339 DOI: 10.1177/10711007251322471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2025]
Abstract
BACKGROUND This retrospective cohort study aimed to compare the radiographic and clinical outcomes after calcaneal lengthening (CL) osteotomy and calcaneo-stop (C-stop) procedures in children with flatfoot deformity. METHODS We enrolled 127 children (223 feet) who underwent CL osteotomy (165 feet) or C-stop procedures (58 feet) for flatfoot deformity between May 2003 and December 2022. The Oxford Ankle-Foot Questionnaire (OAFQ) was administered preoperatively and postoperatively. Radiographic assessments, including the anteroposterior (AP) talus-first metatarsal angle, AP talus-second metatarsal angle, talonavicular coverage angle, lateral talus-first metatarsal angle, naviculocuboid overlap, calcaneal pitch angle, and calcaneocuboid joint subluxation, were conducted on preoperative, postoperative, and final foot-ankle standing radiographs. Radiologic and clinical outcomes were compared between the 2 groups. RESULTS The immobilization period was significantly longer in the CL group than in the C-stop group (P < .001). All radiographic parameters improved significantly after surgery in both groups. However, between the postoperative period and the final follow-up, AP talus-second metatarsal angle and naviculocuboid overlap significantly increased in both groups, and talonavicular coverage angle significantly increased in the CL group. Additionally, calcaneocuboid subluxation developed after surgery in the CL group but significantly improved at the final follow-up (P < .001). There was no significant difference in complication rates between the 2 groups (P = .521). Major complications, including nonunion of the osteotomy site and Achilles tendon rupture, occurred in 6 feet (3.6%) in the CL group and overcorrection of deformity in 1 foot (1.7%) in the C-stop group. All domains and total scores on the OAFQ significantly improved after surgery in both groups. CONCLUSION Both CL osteotomy and the C-stop procedure showed satisfactory radiologic and clinical outcomes for correcting pediatric flatfoot deformities. Clinicians should take into account that the C-stop procedure is less invasive, and requires a shorter immobilization period compared with CL osteotomy, but it necessitates a secondary procedure for screw removal.
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Affiliation(s)
- Bokyung Kim
- Seoul National University College of Medicine, Seoul, Korea
| | - Woo Sub Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Youngmi Park
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seoul, Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
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Caravelli S, Vocale E, Di Ponte M, Fuiano M, Massimi S, Zannoni F, Zaffagnini S, Mosca M. SERI Technique for Isolated Juvenile Hallux Valgus Patients: A Retrospective Evaluation With Mid-term to Long-term Follow-up. Foot Ankle Spec 2025; 18:58-63. [PMID: 36113025 DOI: 10.1177/19386400221121409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Many different operative procedures have been described to treat hallux valgus, but many of them are inappropriate for active, skeletally immature patients. This retrospective evaluation aimed to show the efficacy of SERI (Simple, Effective, Rapid, Inexpensive) technique in young patients affected by mild to moderate hallux valgus deformity at a mid-term to long-term follow-up. METHODS All patients were clinically and radiographically evaluated, independently by 2 researchers, by American Orthopaedic Foot and Ankle Society (AOFAS) Hallux-Metatarsophalangeal-Interphalangeal score and radiographic examination. RESULTS Twenty-nine feet, undergone SERI procedure, have been reviewed at a mean follow-up of 5 years. The mean AOFAS score was significantly improved from 59.7 preoperatively to a mean value of 90.7 at last follow-up. Mean correction degrees have been recorded for both angles (hallux valgus angle [HVA] -13.7° and intermetatarsal angle [IMA] -6.7°). CONCLUSIONS The SERI technique represents a powerful surgical procedure for the treatment of painful, mild to moderate, juvenile hallux valgus. Recurrence and complication rate make this surgical approach effective, repeatable, and safe. LEVEL OF EVIDENCE Level IV, Retrospective case series.
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Affiliation(s)
- Silvio Caravelli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Emanuele Vocale
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Di Ponte
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mario Fuiano
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Simone Massimi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Zannoni
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano Mosca
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Yang F, Wu C, Wang J, Mei G, Zou J, Xue J, Su Y, Ma X, Zhang J, Shi Z. Subtalar arthroereisis for simultaneous treatment of flexible pes planus during surgical correction of hallux valgus. Eur J Med Res 2025; 30:44. [PMID: 39844259 PMCID: PMC11753030 DOI: 10.1186/s40001-025-02299-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Accepted: 01/15/2025] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND Scarf osteotomy is a well-established procedure for hallux valgus, yet recurrence rates range from 3.6% to 10%. Pes planus, which often coexisting with hallux valgus, is a risk factor for recurrence. This study aimed to evaluate the effectiveness of simultaneous correction of hallux valgus and flexible pes planus. METHODS A total of 85 feet with hallux valgus associated with adult flexible pes planus were retrospectively reviewed. All patients were treated with scarf osteotomy (SO). Subtalar arthroereisis using a HyProCure implant (SOH) was performed to correct hindfoot valgus based on shared decision-making. We collected and compared pre- and at least 2 year postoperative clinical outcomes (American Orthopaedic Foot & Ankle Society (AOFAS) forefoot, hindfoot score, Visual Analog Scale (VAS) pain intensity) and radiographic outcomes (hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary's angle, talonavicular coverage angle (TNCA), and calcaneal pitch (CP) angle in both groups. RESULTS Of the cases reviewed, 51 feet were allocated to SO group, and 34 feet were in SOH group. Recurrence frequency was 5 feet (9.8%) in the SO group, while no recurrences were reported in the SOH group. There was no significant difference in AOFAS forefoot and VAS scores between the groups, However, the SOH group demonstrated significant improvement in AOFAS hindfoot scores and CP angle, as well as a greater reduction in Meary's angle and TNCA, compared to the SO group. Changes in HVA and IMA did not differ significantly between the groups. Three feet in the SOH group experienced sinus tarsi pain, which resolved after removal of the HyProCure implant. CONCLUSIONS Subtalar arthroereisis with a HyProCure implant is an effective treatment option for adult flexible pes planus associated with scarf osteotomy for hallux valgus, leading to a steady improvement in the patients forefoot deformity and increased patient satisfaction at least 2 years postoperatively.
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Affiliation(s)
- Fan Yang
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, 200233, China
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Chenglin Wu
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, 200233, China
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Jiazheng Wang
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, 200233, China
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Guohua Mei
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, 200233, China
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Jian Zou
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, 200233, China
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Jianfeng Xue
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, 200233, China
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Yan Su
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, 200233, China
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Xin Ma
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, 200233, China.
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai, China.
| | - Jieyuan Zhang
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, 200233, China.
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai, China.
| | - Zhongmin Shi
- National Center for Orthopaedics, Shanghai Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, 200233, China.
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai, China.
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Gu W, Fu S, Wang C, Song G, Shi Z, Zhang H. Outcomes of Simultaneous Correction of Adult Hallux Valgus and Flexible Pes Planus Deformities. Orthopedics 2025; 48:37-43. [PMID: 39699165 DOI: 10.3928/01477447-20241213-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2024]
Abstract
BACKGROUND There is a high correlation between hallux valgus and pes planus deformity. We sought to evaluate the outcomes of simultaneous Scarf osteotomy and extraosseous talotarsal stabilization (EOTTS) for correcting adult hallux valgus with flexible pes planus deformity. MATERIALS AND METHODS This retrospective study enrolled patients who had hallux valgus deformity with flexible pes planus and underwent combined Scarf osteotomy and EOTTS from January 2018 to October 2021. The hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary's angle, calcaneal pitch, and lateral talocalcaneal angles were assessed preoperatively and at 1-year follow-up. Clinical outcomes were evaluated using the visual analog scale (VAS) score for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, and the Maryland foot score (MFS). Complications were recorded. RESULTS This study included 25 patients, 19 women and 6 men, with a mean age of 44.3 years. The mean follow-up period was 14.6 months. The mean HVA, IMA, Meary's angle, calcaneal pitch, and lateral talocalcaneal angles improved significantly at 1-year follow-up (P<.001). The mean VAS score decreased from 5.8 to 1.0, whereas the mean AOFAS forefoot score and MFS increased from 52.3 to 88.9 and 61.2 to 89.3, respectively, at 1-year follow-up (P<.001). Two patients had arthroereisis implant removal as a consequence of sinus tarsi pain. No other complications were seen during the follow-up. CONCLUSION Management of hallux valgus with flexible pes planus deformity with combined Scarf osteotomy and EOTTS can achieve satisfactory clinical and radiologic results with low complication and recurrence rates. [Orthopedics. 2025;48(1):37-43.].
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ZIELLI SO, MAZZOTTI A, CASSANELLI E, ARTIOLI E, LEIGHEB M, ARCERI A, LANGONE L, FALDINI C. Return to sport after subtalar arthroeresis for flexible pediatric flatfoot: a systematic review of the literature. MINERVA ORTHOPEDICS 2024; 75. [DOI: 10.23736/s2784-8469.24.04391-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Zanchini F, Catani O, Sergio F, Boemio A, Sieczak A, Piscopo D, Risitano S, Colò G, Fusini F. Role of lateral soft tissues release in percutaneous hallux valgus correction: A medium term retrospective study. World J Orthop 2023; 14:843-852. [PMID: 38173806 PMCID: PMC10758593 DOI: 10.5312/wjo.v14.i12.843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/12/2023] [Accepted: 11/17/2023] [Indexed: 12/15/2023] Open
Abstract
BACKGROUND In the field of minimally invasive surgery (MIS) for the treatment of hallux valgus (HV), different techniques have begun to emerge in the literature concerning the distal osteotomy of the first metatarsal bone, the synthesis or not of the metatarsal head, the possible association with lateral soft tissues release (LSTR) and osteotomy of the base of the first phalanx. AIM To evaluate the role of LSTR on percutaneous HV correction, evaluating functional and radiographical results. METHODS From January 2012 to May 2016 a total of 396 patients with mild to moderate symptomatic HV treated with the MIS technique were included in this retrospective study. The technique provides no internal fixation (WOS). Patients were divided into the LSTR group and no LSTR group (LSTR N). This surgical procedure (LSTR) was reserved for insufficient HV angle (HVA) correction during fluoroscopic control. Patients were evaluated at each follow-up by two other authors after appropriate training by senior authors (first practitioners). Clinical evaluation was performed before surgery, 6 mo after surgery, and 48 mo follow-up. American Orthopaedic Foot and Ankle Society (AOFAS) and visual analog scale (VAS) score was used to evaluate pain and function, and complications were recorded. In addition, the incidence of relapses and the degree of joint range of motion (ROM) with the association with the LSTR (capsule, adductor tendon, phalanx-sesamoid ligament, and the deep transverse metatarsal ligament) were evaluated. Radiological parameters included HVA and intermetatarsal angle (IMA). Patient satisfaction was assessed. Student t-test and Fisher exact test were used to assess statistical analysis. RESULTS From our study it is clear that no differences in term of HVA, VAS, IMA correction, rate of complications, and AOFAS score were found between groups, while a significant improvement of the same variables was found in each group between pre and postoperative values. A significant improvement in ROM at 6 mo (P = 0.018) and 48 mo (P = 0.02) of follow-up was found in LSTR N group. Complications were rare in both groups. CONCLUSION LSTR procedure on percutaneous HV correction seems to increase postoperative joint stiffness with a comparable incidence of relapse and a low incidence of complications.
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Affiliation(s)
- Fabio Zanchini
- Division of Orthopaedics and Traumatology, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Clinical Orthopeadics, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Ottorino Catani
- Department of Foot Surgery, Casa di cura Santa Maria, Santa Maria Capua Vetere 81055, Italy
| | - Fabrizio Sergio
- Department of Foot an Ankle Surgery, Casa di cura Santa Maria, Santa Maria Capua Vetere 81055, Italy
| | - Alessia Boemio
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Clinical Orthopeadics, AOU Luigi Vanvitelli, Napoli 80138, Italy
| | - Angelo Sieczak
- Clinical Orthopeadics, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Davide Piscopo
- Clinical Orthopeadics, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Salvatore Risitano
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, Turin 10126, Italy
| | - Gabriele Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Alessandria 15121, Italy
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, Cuneo 12084, Italy
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Mazzotti A, Viglione V, Gerardi S, Artioli E, Rocca G, Faldini C. Subtalar arthroereisis post-operative management in children: A literature review. Foot (Edinb) 2023; 56:102037. [PMID: 37167704 DOI: 10.1016/j.foot.2023.102037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Subtalar arthroereisis is a minimally-invasive technique for the treatment of flexible flatfoot. Some issues regarding the procedure are still debated, such as post-operative management. The aim of this study is to offer a review of the pertaining literature to identify current post-operative protocols and describe possible differences among them. METHODS We searched the PubMed database for all papers related to subtalar arthroereisis in children specifying the post-operative protocols. After reviewing all studies according to excluding criteria, 50 articles were selected for analysis. RESULTS Based on the literature review, different post-operative protocols emerged in the treatment of patients undergoing subtalar arthroereisis, in particular regarding length of hospital stay, type and duration of immobilization, weight-bearing management, adopted rehabilitation scheme, sport resumption and implant removal. CONCLUSIONS The most important finding was the existence of a wide variety in post-operative management after subtalar arthroereisis in children, thus confirming that no clear consensus still exists in this field.
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Affiliation(s)
- Antonio Mazzotti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy.
| | - Valentina Viglione
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - Simone Gerardi
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - Elena Artioli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - Gino Rocca
- IRCCS Istituto Ortopedico Rizzoli, Pediatric Orthopedics and Traumatology, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - Cesare Faldini
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy
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The Minimally Invasive SERI Osteotomy for Pediatric Hallux Valgus. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010094. [PMID: 36670645 PMCID: PMC9856383 DOI: 10.3390/children10010094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/23/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023]
Abstract
Hallux valgus (HV), one of the most common forefoot pediatric pathologies, is characterized by lateral deviation of the big toe and medial displacement of the first metatarsal bone. Different surgical techniques have been described to correct the deformity, but no consensus has been reached regarding the best surgical option. The aim of this retrospective study was to report the results of the SERI technique in 58 pediatric HV of 45 consecutive patients. Pre- and postoperative VAS, AOFAS score, HVA, IMA and DMAA were collected. Preoperatively 3 patients (5.2%) had a mild deformity, 52 patients (89.6%) had moderate deformity and 3 patients (5.2%) had severe deformity according to Coughlin et al. Mean VAS score decreased from 5.2 ± 2.2 preoperatively to 0.8 ± 0.4 postoperatively. Mean AOFAS score improved from 68.1 ± 6.8 (range 59−75) preoperatively to 96.3 ± 3.2 (range 88−100) postoperatively, mean HVA reduced from 28.4° preoperatively to 13.2° postoperatively, mean IMA decreased from 15.2° preoperatively to 9.5° postoperatively (p < 0.01); mean DMAA decreased from 13.7° preoperatively to 8.2° postoperatively (p < 0.01). SERI technique showed satisfactory results when treating mild to severe pediatric HV deformity. No major complications were reported.
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Phisitkul P, Mansur NSB, Netto CDC. Failed Surgery for Achilles Tendinopathy. Foot Ankle Clin 2022; 27:431-455. [PMID: 35680298 DOI: 10.1016/j.fcl.2021.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Treatments of Achilles tendinopathy continue to evolve. The body of literature is inadequate to provide a comprehensive guide to evaluation and treat failed surgeries. Issues related to failed surgical treatment may be divided into infection/wound issue, mechanical failure, and persistent pain. Awareness of the potential problems described in this article will allow surgeons to have a foundation in clinical assessment and making accurate diagnoses. Various surgical treatment options are available and should be executed carefully to treat individualized patient conditions.
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Affiliation(s)
- Phinit Phisitkul
- Tri-state Specialists, LLP, 2730 Pierce Street #300, Sioux City, IA 51104, USA.
| | - Nacime Salomao Barbachan Mansur
- Department of Orthopaedics and Rehabilitation, University of Iowa Carver College of Medicine, 200 Hawkins Drive, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA 52242, USA
| | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa Carver College of Medicine, 200 Hawkins Drive, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA 52242, USA
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Cho SH, Chung CY, Park MS, Sung KH, Choi JH, Koo S, Lee KM. Intrasubject Radiographic Progression of Hallux Valgus Deformity in Patients With and Without Metatarsus Adductus: Bilateral Asymmetric Hallux Valgus Deformity. J Foot Ankle Surg 2022; 61:17-22. [PMID: 34229914 DOI: 10.1053/j.jfas.2020.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/14/2020] [Accepted: 05/25/2020] [Indexed: 02/03/2023]
Abstract
This study was to analyze intrasubject radiographic progression of the hallux valgus deformity by comparing the mildly and severely affected sides in patients with bilateral asymmetric hallux valgus in the whole group as well as the metatarsus adductus and the nonmetatarsus adductus subgroups. A total of 186 patients with bilateral asymmetrical hallux valgus deformity with a difference of 5° or greater in the hallux valgus angle were included, and 11 radiographic measurements were analyzed. The radiographic differences between the mildly and severely affected sides were compared. Correlation between the changes in the hallux valgus angle and those in other measurements was analyzed, and multiple regression analyses were performed. The anteroposterior talo-second metatarsal angle showed no significant difference between the mildly and severely affected sides. Changes in the intermetatarsal angle and sesamoid rotation angle were significantly associated with the progression of hallux valgus angle in the whole group as well as the nonmetatarsus adductus subgroup. Change in the intermetatarsal angle (p = .006) was the significant factor associated with the progression of hallux valgus angle in the metatarsus adductus subgroup. The anteroposterior talo-second metatarsal angle might be useful in evaluating the overall foot shape in the hallux valgus deformity. Progression of the hallux valgus deformity might be pathophysiologically different between those with and without metatarsus adductus.
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Affiliation(s)
- Sung Hee Cho
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul national University Bundang Hospital, Seongnam, Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul national University Bundang Hospital, Seongnam, Korea
| | - Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul national University Bundang Hospital, Seongnam, Korea
| | - Ji Hye Choi
- Department of Orthopaedic Surgery, Seoul national University Bundang Hospital, Seongnam, Korea
| | - Seungbum Koo
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejon, Korea
| | - Kyoung Min Lee
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejon, Korea.
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Abstract
Treatment of juvenile hallux valgus can be challenging. Initial treatment with conservative measures is appropriate until exhausted. Surgical treatment should be delayed until after skeletal maturity when possible. Before any intervention, a thorough understanding of the whole patient and any underlying systemic contributors to their hallux valgus, in addition to the radiographic foot parameters, is imperative. Careful and individualized surgical planning should be done to optimize results and decrease the risk for recurrence.
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Affiliation(s)
- Susan T Mahan
- Department of Orthopaedics and Sports Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Emily O Cidambi
- Department of Orthopaedics, Rady Children's Hospital, UC San Diego Medical School, 3020 Children's Way, MC 5062, San Diego, CA 92123, USA
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Touloupakis G, Ghirardelli S, Del Re M, Indelli PF, Antonini G. First metatarsal extracapsular osteotomy to treat moderate hallux valgus deformity: the modified Wilson-SERI techinique. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021173. [PMID: 33682834 PMCID: PMC7975944 DOI: 10.23750/abm.v92i1.10662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/09/2020] [Indexed: 12/05/2022]
Abstract
From February 2017 to December 2018, 20 patients (a total of 20 feet) had undergone the proposed modified Wilson-SERI osteotomy technique, for moderate hallux valgus. The mean age of patients was 58,25 years (range 19 to 78). The hallux valgus angle (HVA), the intermetatarsal angle between first and second metatarsal bone (IMA) and the distal metatarsal articular angle (D.M.A.A) were measured. The feet were assessed based on the scoring system used by Broughton and Winson and by the American Orthopedic Foot and Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale. All twenty one patients were followed up postoperatively for a minimum of 12 months. No patient was lost at follow-up. The mean HVA angle decreased significantly from 31,1° before surgery (range 22.9°-40°SD 5.0) at 11,2° (range 2.5° to 22.0°SD 5.3) at twelve months follow up. The mean IMA angle decreased significantly from 12,5° (range 8.0°-18.6°SD 3.8) before surgery at 7,4° (range 3.4°-14.0°SD 2.5) at twelve months follow up. The mean DMMA angle decreased significantly from 15.1° (range 5.3° to 20.0°SD 4.4) before surgery at 7,4 °(1.5° - 10.7°SD 2.5) at twelve months follow up. The mean score according to the AOFAS forefoot was increased from 22,1 (range 13-30 SD 5.0) to 88,2 (Range 77-96 SD 5.2) (p<0.0001). No complications, like dislocations, avascular necrosis of the first metatarsal and deep venous thrombosis, were observed in the post-operative period. We consider the Wilson-Seri procedure as a low cost minimal invasive and stable technique that could be a valid alternative to the various metatarsal osteotomies in the treatment of moderate hallux valgus deformity. Short term results at twelve months after surgery are quite satisfactory but further studies are necessary, to better comprehend an overall outcome of such approach in the long run.
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Affiliation(s)
- Georgios Touloupakis
- Department of Orthopedics and Traumatology, San Carlo Borromeo Hospital, Milan, Italy.
| | - Stefano Ghirardelli
- Department of Orthopedics and Traumatology, San Carlo Borromeo Hospital (Milan, Italy) .
| | - Matteo Del Re
- Department of Orthopedics and Traumatology, San Carlo Borromeo Hospital (Milan, Italy) .
| | - Pier Francesco Indelli
- Department of Orthopaedic Surgery and Bioengineering, Stanford University School of Medicine and the Palo Alto Veterans Affairs Health Care System (PAVAHCS), (Palo Alto, CA, USA.).
| | - Guido Antonini
- Department of Orthopedics and Traumatology, San Carlo Borromeo Hospital (Milan, Italy).
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Dygut J, Piwowar P, Detyna J, Popiela T, Kogut W, Boroń W, Dudek P, Piwowar M. Correction of foot deformities with hallux valgus by transversal arch restoration. Biocybern Biomed Eng 2020. [DOI: 10.1016/j.bbe.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bittar CÍK, Cliquet A, Reis AMD, FlÔr BMDASS, Bertazzo DÉPC, Dezan MFR. PEDIATRIC FLEXIBLE VALGUS FLATFOOT CORRECTION BY ARTHROEREISIS. ACTA ORTOPEDICA BRASILEIRA 2020; 28:212-215. [PMID: 33144834 PMCID: PMC7580296 DOI: 10.1590/1413-785220202805234176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective: This article aimed to evaluate the efficacy of arthroereisis using synthetic polyethylene implants to correct excessive valgus deformity in pediatric patients with flexible valgus flatfoot. Methods: Retrospective study of 20 pediatric patients with flexible valgus flatfoot, totaling 23 feet, between five and 14 years old, operated between January 2009 and July 2016. Clinical evaluations were performed by the Valenti podoscopic classification and the American Orthopaedic Foot & Ankle Society criteria, based on radiographic images and podoscopic analysis. These patients underwent surgical treatment with the introduction of a synthetic implant in the sinus tarsi. Multiple linear regression analysis with Backward selection of variables, angles of pre and postoperative of radiographic images of the patients submitted to arthroereisis were performed. Results: The arthroereisis with interposition of synthetic material was satisfactory, considering that 91% of the cases presented clinical and radiographic improvement, with correction of angles and improvement in deformity degrees. Two cases presented implant loosening. The variables of the Bordelon and Pitch angles significantly influenced (p < 0,05) the improvement of the correction of deformity degrees. Conclusion: The arthroereisis with the interposition of synthetic polyethylene material showed to be an effective technique for flexible flatfoot in symptomatic pediatric patients. Level of Evidence II, Prognostic studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.
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Catani O, Fusini F, Zanchini F, Sergio F, Cautiero G, Villafañe JH, Langella F. Functional outcomes of percutaneous correction of hallux valgus in not symptomatic flatfoot: a case series study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020065. [PMID: 32921761 PMCID: PMC7716970 DOI: 10.23750/abm.v91i3.8294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 11/24/2019] [Indexed: 11/30/2022]
Abstract
Hallux valgus (HV) and Pes Planus (PP) are two common conditions characterized by aesthetic dissatisfaction with or without pain. The aim of the study was to assess clinical and functional outcomes at two years follow-up of percutaneous surgery in patients with HV and concomitant not-symptomatic PP. From January 2014 to May 2015 a total of 12 females and 2 males (14 feet) were enrolled in the study (mean age 41.9±13.28). The inclusion criteria were patients with HV surgically treated with the percutaneous approach, mild or moderate not symptomatic PP at 24 months follow-up. Percutaneous distal metatarsal osteotomy and exostectomy is performed for all patients and followed by a weekly bandage. American Orthopaedic Foot and Ankle Society (AOFAS) score for HV (AOFAS-HV), patient satisfaction, and preoperative and postoperative X-ray at 6 weeks follow-up were evaluated. Numerical data are reported as the mean± SD and 95% confidence intervals. The pre-operative hallux valgus angle (HVA) was 30.14°±11.26°, the post-operative HVA was 18.36°±10.13 with a mean correction of 11.79°±2.67° with p<0.0001. Mean AOFAS-HV increased from 42.07±10.82 pre-operatively to 83±8.96 post-operatively with p<0.0001. One out of 14 patients had recurrence of HV without needing revision surgery at the last follow-up. All patients were satisfied with the clinical outcomes. Our results suggested that percutaneous osteotomy with the mini-burr is an effective treatment for patients with HV despite PP presence, even if the mean functional score was slightly worse when compared with the literature.
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Affiliation(s)
- Ottorino Catani
- Department of Foot an Ankle Surgery, Minerva Clinic, Santa Maria Capua a Caserta, Vetere, Italy.
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, ASL CN1, Mondovì, Italy.
| | - Fabio Zanchini
- Clinical Orthopaedics, University of Campania "Luigi Vanvitelli", via L. de Crecchio 4, Naples, Italy..
| | - Fabrizio Sergio
- Department of Foot an Ankle Surgery, Minerva Clinic, Santa Maria Capua a Caserta, Vetere, Italy.
| | - Giovanni Cautiero
- Clinical Orthopaedics, University of Campania "Luigi Vanvitelli", via L. de Crecchio 4, Naples, Italy..
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The Biomechanical Relationship between Hallux Valgus Deformity and Metatarsal Pain. JOURNAL OF HEALTHCARE ENGINEERING 2020; 2020:8929153. [PMID: 32300473 PMCID: PMC7136777 DOI: 10.1155/2020/8929153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/27/2019] [Indexed: 11/17/2022]
Abstract
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) (P < 0.05); contact area was also shown on metatarsals 1, 2, and 5 (P < 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.
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Kim HW, Park KB, Kwak YH, Jin S, Park H. Radiographic Assessment of Foot Alignment in Juvenile Hallux Valgus and Its Relationship to Flatfoot. Foot Ankle Int 2019; 40:1079-1086. [PMID: 31132894 DOI: 10.1177/1071100719850148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The relationship between juvenile hallux valgus (JHV) and flatfoot has not been clearly established. The aim of this study was to assess radiographic measurements in feet with JHV compared with matched controls and to investigate whether the foot alignment of JHV is related to flatfoot. METHODS We retrospectively reviewed 163 patients with JHV as defined as hallux valgus angle greater than 20 degrees and intermetatarsal greater than angle than 10 degrees. Patients with open physes of the feet and who had weight-bearing radiographs of the feet were included. Another 55 normal participants served as controls. Patients with JHV were divided into 2 subgroups: Group 1 included patients with asymptomatic JHV and group 2 consisted of those treated with correctional surgery for painful JHV. Twelve radiographic indices were analyzed, including calcaneal pitch angle, tibiocalcaneal angle, talocalcaneal angle, naviculocuboid overlap, talonavicular coverage angle, lateral talo-first metatarsal angle, anteroposterior talo-first metatarsal angle, metatarsus adductus angle, hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and first metatarsal cuneiform angle. The groups were compared by age, gender, and the above radiographic parameters. RESULTS There was no significant difference in hindfoot alignment of patients with JHV and controls. Naviculocuboid overlap (P <.001), lateral talo-first metatarsal angle (P = .002), and metatarsus adductus angle (P = .004) were significantly greater in patients with JHV than in controls, whereas the anteroposterior talo-first metatarsal angle (P = .026) was significantly less. Symptomatic and asymptomatic JHV patient subsets showed no significant radiologic differences. CONCLUSION Radiographic profiles in patients with JHV were inconsistent with regard to features of flatfoot, and foot alignment was unrelated to the presence of symptoms or degree of deformity in JHV. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Hyun Woo Kim
- 1 Division of Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kun Bo Park
- 1 Division of Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon Hae Kwak
- 1 Division of Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seokhwan Jin
- 1 Division of Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hoon Park
- 2 Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Dygut J, Piwowar P, Kogut W, Boroń W, Piwowar M. The transverse arch collapse correction as a path to foot toes alignment. BIO-ALGORITHMS AND MED-SYSTEMS 2018. [DOI: 10.1515/bams-2018-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
The study presents a fragment of pilot studies showing the reconstruction of the transverse arch of the foot using a specially constructed orthosis for this purpose. It involves the mechanical reinforcement of the effect by an orthosis, which pushes down the I, IV, and V metatarsal bones while elevating or blocking the fall of the near-immobile II and III metatarsal bones according to the “three-force” rule. The correction of the transverse arch of the foot runs simultaneously with the correction of hallux valgus (HV). As a result, the significant correction of HV and associated toe deformities was achieved. In stage I foot deformity, the reduction of HV was reduced from 19.1° before to 15.1° after putting on orthosis (p = 0.024). In stage II, the reduction was from 20.1° (before) to 16.2° (after; p = 0.032). Equally satisfactory results were obtained for the remaining angles of the metatarsal bones. In the future, the method can be suitable for patients undergoing preparation for corrective HV surgery and for maintaining postoperative HV results. It can be used preventively, for example, by women who frequently wear high-heeled shoes and by those who need to remain standing for prolonged periods of time.
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20
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Malagelada F, Sahirad C, Dalmau-Pastor M, Vega J, Bhumbra R, Manzanares-Céspedes MC, Laffenêtre O. Minimally invasive surgery for hallux valgus: a systematic review of current surgical techniques. INTERNATIONAL ORTHOPAEDICS 2018; 43:625-637. [DOI: 10.1007/s00264-018-4138-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
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Patient-perceived outcomes after subtalar arthroereisis with bioabsorbable implants for flexible flatfoot in growing age: a 4-year follow-up study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:707-712. [PMID: 29299766 DOI: 10.1007/s00590-017-2119-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 12/21/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE Results of subtalar arthroereisis in flexible flatfoot have been mainly reported in the literature using clinical or radiographical findings. However, the aim of this study is to evaluate the patient-perceived quality of life using self-reported questionnaires after subtalar arthroereisis using a bioabsorbable implant. METHODS Italian modified FFI and the SEFAS scores were submitted to a consecutive series of 173 patients who underwent surgical treatment for flatfoot deformity using a bioabsorbable endo-orthotic implant. Postoperative complication rates were assessed. Time needed to resume normal sports activities was recorded. RESULTS Mean population age was 11.2 years with slight variability between males and females. At a mean follow-up of 4 years, arthroereisis with bioabsorbable implants showed excellent results for the perception of the quality of life with an average result for FFI score of 4.5 and an average SEFAS score of 47.19. Time needed to resume sport activities was 4.7 months ± 0.2 with almost no difference between the groups. Four patients needed a second procedure for implant removal. CONCLUSION Arthroereisis using a bioabsorbable implant offers good results in terms of satisfaction and quality of life with a negligible rate of failures and patient complaints based on self-reported questionnaires. The patient reported high degrees of satisfaction, and their quality of life was not compromised at all by the procedure.
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Kaufmann G, Handle M, Liebensteiner M, Braito M, Dammerer D. Percutaneous minimally invasive Akin osteotomy in hallux valgus interphalangeus: a case series. INTERNATIONAL ORTHOPAEDICS 2017; 42:117-124. [PMID: 28956114 DOI: 10.1007/s00264-017-3638-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Phalangeal Akin osteotomy of the greater toe is a frequently used surgical procedure for correcting hallux valgus interphalangeus deformity. However, previous research did not investigate percutaneous techniques of the Akin osteotomy. It was the aim of this study to investigate feasibility, corrective potential, and safety of a percutaneous minimally invasive Akin osteotomy. METHODS We present a series of 81 feet, in which a percutaneous Akin technique was performed using a high-speed burr but no fixation device. The most important outcome parameters were determined as the proximal to distal phalangeal articular angle (PDPAA) (corrective effect of the osteotomy), the osteotomy healing (full, partly, no visibility of the osteotomy gap), and the integrity of the lateral cortical hinge. RESULTS With regard to the main hypothesis we found significant changes in the PDPAA over the whole period of time (p < 0.001). Post-hoc tests determined that the PDPAA changed from 10° pre-operatively (Md, IQR 4.3) to 2.3° post-operatively (Md, IQR 3.7) (p < 0.001). Post-operatively no significant changes in PDPAA were found within the first six weeks and from six weeks to three months (no loss of correction). Osteotomy healing was satisfactory as well. Three months post-operatively, there were no patients with a fully visible osteotomy gap, 28.3% with a partly visible osteotomy gap, and 71.7% had no visible gap. Interestingly, we could not observe a statistically significant correlation between bone healing and the integrity of the lateral cortical hinge. CONCLUSION From our findings we conclude that the minimally invasive Akin osteotomy without osseous fixation provides effective deformity correction without significant loss of correction thereafter. This procedure appears to be safe with regard to osseous healing. Surprisingly, the healing process of the osteotomy showed no dependence on the integrity of the lateral cortical hinge. LEVELS OF EVIDENCE Therapeutic, Level IV, retrospective case series.
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Affiliation(s)
| | - Martin Handle
- Orthopaedic Department, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Michael Liebensteiner
- Orthopaedic Department, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Matthias Braito
- Orthopaedic Department, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Dietmar Dammerer
- Orthopaedic Department, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
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Faldini C, Mazzotti A, Panciera A, Perna F, Stefanini N, Giannini S. Bioabsorbable implants for subtalar arthroereisis in pediatric flatfoot. Musculoskelet Surg 2017; 102:11-19. [PMID: 28717988 DOI: 10.1007/s12306-017-0491-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/05/2017] [Indexed: 12/22/2022]
Abstract
Flatfoot is a common condition in growing-age patients. Despite its common presentation, nowadays surgical indications and treatments are still debated. Arthroereisis is a widely used technique, and several implants designs have been proposed over time. Despite the good results shown in the literature, the main drawback of these techniques has always been the need for a second surgery for implant removal. Bioabsorbable devices have been introduced to overcome this necessity.Correct approach to the patient, indications and contraindications and available studies on bioabsorbable implants for subtalar arthroereisis in pediatric flatfoot were analyzed in this narrative review. Even if only a few studies have been published in the literature, bioabsorbable implants showed good clinical results comparable to non-absorbable implants and with a rare necessity for implant removal or revision. When correct indications and proper surgical technique are followed, arthroereisis with bioabsorbable implants appears to be an effective solution for the treatment of pediatric flexible flatfoot.
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Affiliation(s)
- C Faldini
- 1st Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - A Mazzotti
- 1st Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - A Panciera
- 1st Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - F Perna
- 1st Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - N Stefanini
- 1st Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Giannini
- Professor Emeritus, Orthopeadics and Traumatology, University of Bologna - Alma Mater Studiorum, Bologna, Italy
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Long-term outcome of first metatarsophalangeal joint fusion in the treatment of severe hallux rigidus. INTERNATIONAL ORTHOPAEDICS 2016; 40:2401-2408. [PMID: 27542800 DOI: 10.1007/s00264-016-3277-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 08/03/2016] [Indexed: 12/30/2022]
Abstract
AIMS This study was aimed to study the arthrodesis of the first metatarsophalangeal joint using an oblique interfragmentary lag screw and dorsal plate as an effective option for the treatment of hallux rigidus. Few researchers have studied the outcome of this surgical method over a long follow-up period. PATIENTS AND METHODS We performed a retrospective review of 60 patients status post arthrodesis of the first metatarsophalangeal joint. The mean age was 68.5 years and average follow-up lasted for 47.3 months. Patients' satisfaction and functional outcomes were evaluated with the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale, the foot and ankle questionnaire, the Functional Foot Index, and dynamic pedobarography. RESULTS Fusion rate of 93.3 % was recorded; 6.7 % of the cases ended up with a painless pseudarthrosis and required no additional surgery. Pedobarographic measurements demonstrated first ray weight bearing function restoration. More physiological foot plantar pressure patterns were observed. Concerning the postoperative outcomes, 71.7 % of the patients were very satisfied and 18.3 % were satisfied. The American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale increased post-operatively from 40.9 to 79.3. CONCLUSION The arthrodesis of the metatarsophalangeal joint using transarticular screw and dorsal nonlocked plate is an effective method for the treatment of severe hallux rigidus with fair patient satisfaction rate and functional outcome.
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