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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, Zielli SO, Abdi P, Artioli E, Arceri A, Vannini F, Faldini C. Severe hallux valgus can be treated using a distal metatarsal osteotomy: Results of 144 cases treated with the SERI technique. Foot Ankle Surg 2023; 29:455-461. [PMID: 37468358 DOI: 10.1016/j.fas.2023.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/11/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE Aim of this study is to analyze the clinical and radiographic results of the simple, effective, rapid and inexpensive (SERI) technique, a linear distal metatarsal osteotomy, for treating severe hallux valgus (HV). METHODS Clinical outcomes were assessed pre- and postoperatively using the AOFAS, MOxFQ and VAS score. Pre and postoperative HV angle (HVA) and intermetatarsal angle (IMA) were measured. RESULTS 117 consecutive patients for a total of 144 feet were included. Pre and postoperatively, mean AOFAS changed from 44.8 ± 16.7 to 89 ± 10.3 (p < .001), mean MOxFQ changed from 76.2 ± 15.8 to 23.4 ± 7.9 (p < .001) and mean VAS score improved from 6.7 ± 2.1 to 1.5 ± 1.5 (p < .001). HVA diminished from 40.6° ± 6.9 preoperatively to 16.0° ± 7.3 postoperatively (p < .001). IMA decreased from 15.1° ± 2.8 preoperatively to 6.5° ± 2.4 postoperatively (p < .001). The main complication reported was stiffness (10.4 %). CONCLUSION SERI technique applied to severe HV showed positive clinical and radiological outcomes. A careful patient selection and a low grade first MTPJ arthritis are essential to obtain favorable results. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Antonio Mazzotti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Simone Ottavio Zielli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Pejman Abdi
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Elena Artioli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alberto Arceri
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesca Vannini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
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Del Balso C, Taylor MA, Ching M, Lawendy AR, Sanders DW. Preoperative photography improves patient satisfaction following hallux valgus surgery. Foot Ankle Surg 2022; 28:492-496. [PMID: 34980572 DOI: 10.1016/j.fas.2021.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/16/2021] [Accepted: 12/27/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patient satisfaction is variable following hallux valgus (HV) surgery. This prospective, blinded, randomized trial endeavored to determine whether showing patients a preoperative photograph would improve satisfaction following HV corrective surgery. METHODS Adult patients undergoing HV surgery were randomized to a picture group (P) or a no picture group (NP). P-group patients were shown their preoperative photograph for 5 min at each postoperative visit. Outcome measures included the Foot Function Index (FFI), the Foot Ankle Outcome Score (FAOS), and a patient satisfaction questionnaire. RESULTS Twenty-nine patients were enrolled in the study (15P, 14 NP). At 3, and 6 months postoperatively, patients in the P-group were more likely to be completely satisfied with the appearance of their foot. There were no differences between groups with respect to postoperative HVA, IMA, or FFI, and FAOS scores. CONCLUSION Patient satisfaction is increased following hallux valgus corrective surgery by reminding patients of the preoperative appearance of their foot through the use of photographs. LEVEL OF EVIDENCE Level I, randomized control trial.
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Affiliation(s)
- Christopher Del Balso
- Western University, London Health Sciences Centre - Victoria Hospital, Department of Surgery, Division of Orthopaedic Surgery, London, Ontario, Canada.
| | - Michel A Taylor
- Hughston Clinic Tennessee, Nashville, Tennessee, United States
| | - Michael Ching
- Western University, London Health Sciences Centre - Victoria Hospital, Department of Surgery, Division of Orthopaedic Surgery, London, Ontario, Canada
| | - Abdel Rahman Lawendy
- Western University, London Health Sciences Centre - Victoria Hospital, Department of Surgery, Division of Orthopaedic Surgery, London, Ontario, Canada
| | - David W Sanders
- Western University, London Health Sciences Centre - Victoria Hospital, Department of Surgery, Division of Orthopaedic Surgery, London, Ontario, Canada
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Meyr AJ, Doyle MD, King CM, Kwaadu KY, Nasser EM, Ramdass R, Theodoulou MH, Zarick CS. The American College of Foot and Ankle Surgeons® Clinical Consensus Statement: Hallux Valgus. J Foot Ankle Surg 2022; 61:369-383. [PMID: 34706857 DOI: 10.1053/j.jfas.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Andrew J Meyr
- Clinical Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
| | - Matthew D Doyle
- Silicon Valley Reconstructive Foot and Ankle Fellowship - Palo Alto Medical Foundation, Mountain View, CA
| | - Christy M King
- Residency Director, Kaiser San Francisco Bay Area Foot & Ankle Residency Program and Attending Surgeon, Kaiser Foundation Hospital, Oakland, CA
| | - Kwasi Y Kwaadu
- Clinical Associate Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA
| | | | - Roland Ramdass
- Residency Training Committee, INOVA Fairfax Medical Campus, Fairfax, VA
| | - Michael H Theodoulou
- Chief Division of Podiatric Surgery, Cambridge Health Alliance, and Instructor of Surgery, Harvard Medical School, Boston, MA
| | - Caitlin S Zarick
- Assistant Professor, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
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Risk factors for recurrence of hallux valgus deformity after minimally invasive distal linear metatarsal osteotomy. J Orthop Sci 2022; 27:435-439. [PMID: 33431255 DOI: 10.1016/j.jos.2020.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recurrence of hallux valgus deformity is a complication following surgical treatment of hallux valgus. This study was performed to identify risk factors for recurrence of hallux valgus deformity after minimally invasive distal linear metatarsal osteotomy (DLMO). METHODS Sixty-seven patients (100 feet) with mild to severe hallux valgus who underwent DLMO from 2007 to 2018 were retrospectively investigated. Their average age at the time of surgery was 54 years (range, 18-88 years). The average follow-up duration was 46 months. The feet were divided into two groups: with and without recurrence. A multivariate analysis was performed to identify the risk factors for recurrence of deformity based on preoperative and 3-month postoperative radiographic parameters. RESULTS Recurrence of deformity was found in 18 (18%) of the 100 feet at the final follow-up. The preoperative hallux valgus angle and 3-month postoperative hallux valgus angle, intermetatarsal angle, round sign positivity, and sesamoid position grade were significantly greater in the recurrence group than in the non-recurrence group. The logistic regression analysis revealed that a 3-month postoperative hallux valgus angle of ≥13.5°, positive round sign, and grade ≥2 sesamoid position were significantly associated with recurrence of deformity. CONCLUSIONS The present findings can help to identify patients at higher risk of recurrence of hallux valgus deformity after DLMO and to modify their surgical procedures.
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Clinical and radiological outcomes of modified Mitchell's osteotomy using three-point fixation for hallux valgus. INTERNATIONAL ORTHOPAEDICS 2021; 46:249-253. [PMID: 34468787 DOI: 10.1007/s00264-021-05200-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study examined the clinical and radiographic outcomes of modified Mitchell's osteotomy using three-point fixation with a full-thread headless screw. This technique was described to resolve the problem of excessive shortening and overshifting of the metatarsal. METHODS A total of 33 feet of 26 patients underwent modified Mitchell's osteotomy with three-point fixation for hallux valgus. Clinical and radiographic outcomes were assessed preoperatively and at specific time points of follow-up by using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale, hallux valgus angle (HVA), and intermetatarsal angle (IMA). RESULTS The global AOFAS scale score (0-100) significantly improved from 50.7 ± 9.9 preoperatively to 84.4 ± 8.7 at the final follow-up. The HVA significantly improved from 30.2 [Formula: see text]± 6.0 [Formula: see text] to 9.0 [Formula: see text] ± 5.0 [Formula: see text], and the IMA significantly improved from 14.2 [Formula: see text] ± 2.6 [Formula: see text] to 5.1 [Formula: see text] ± 2.0 [Formula: see text]. None of the patients experienced nonunion and transfer metatarsalgia. Complications were observed in two feet, and one foot had recurrence of hallux valgus. CONCLUSION Modified Mitchell's osteotomy using three-point fixation with a full-thread headless screw is a reliable alternative treatment for hallux valgus, even in patients with severe deformities.
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Ayoubi R, Darwish M, Aouad D, Maalouly J, Hanna J, Abboud G, Cortbawi C. Modified Mitchell technique for treating hallux valgus: Retrospective case series on a Middle-Eastern population and literature review. Ann Med Surg (Lond) 2021; 65:102259. [PMID: 33996042 PMCID: PMC8091872 DOI: 10.1016/j.amsu.2021.102259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction The hallux valgus deformity is a complex deformity of the first ray of the foot, with more than 100 procedures developed for its treatment. The aim of this retrospective study was to assess the clinical and radiographic outcomes of a modified Mitchell's technique. Methods Between 2007 and 2018, 75 patients underwent the procedure. Clinical results were assessed by the AOFAS score. Radiological studies were evaluated by measuring pre-operative and post-operative HVA and IMA angles as well as the relative shortening of the first metatarsal. Results Of the initial 75 patients, 42 patients remained eligible with a total of 67 feet. The mean age and follow-up were 47.8 and 5.2 years respectively. Global AOFAS score improved from 45.3 to 88.8 (p < 0.01). Mean HVA and IMA improved from 37.0 to 10.2 (p < 0,01) and 12.1 to 5.6 (p < 0.01), respectively. The mean metatarsal shortening was 3.0 mm (p < 0.01). The statistical analysis showed no significant correlation between preoperative HVA and IMA angles with postoperative shortening, metatarsalgia, AOFAS scores nor the difference between the preoperative and postoperative AOFAS scores. Conclusion Short- and long-term outcomes of this modified Mitchell's osteotomy have been reported. Compared to other studies, these modifications proved to result in very good clinical and radiological outcomes even in severe cases with HVA>40. It has shown to be reliable, reproducible, and cost-efficient with low complication rates. We would like to highlight the importance of proper patient selection, limited soft tissue stripping, and adherence to the proposed surgical steps to avoid unwanted complications.
The Modified Mitchell Technique has been shown to be reliable, reproducible, and cost-efficient with low complication rates. The addition of intra-articular lateral soft tissue release, preventing a lateral incision, decreasing wound and soft tissue complications. The use of autologous bone graft adjacent to the osteotomy stump helps improve union.
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Affiliation(s)
- Rami Ayoubi
- Department of Orthopedic Surgery and Traumatology Saint Georges University Medical Center, Balamand University, P.O.Box 166378 Achrafieh, Beirut, 1100 2807, Lebanon
| | - Mohammad Darwish
- Department of Orthopedic Surgery and Traumatology Saint Georges University Medical Center, Balamand University, P.O.Box 166378 Achrafieh, Beirut, 1100 2807, Lebanon
| | - Dany Aouad
- Department of Orthopedic Surgery and Traumatology Saint Georges University Medical Center, Balamand University, P.O.Box 166378 Achrafieh, Beirut, 1100 2807, Lebanon
- Corresponding author. St Georges University Medical Center, Beirut, Achrafieh, St Georges Street, Lebanon.
| | - Joseph Maalouly
- Department of Orthopedic Surgery and Traumatology Saint Georges University Medical Center, Balamand University, P.O.Box 166378 Achrafieh, Beirut, 1100 2807, Lebanon
| | - Jason Hanna
- Department of Orthopedic Surgery and Traumatology Saint Georges University Medical Center, Balamand University, P.O.Box 166378 Achrafieh, Beirut, 1100 2807, Lebanon
| | - Ghadi Abboud
- Department of Medical Imaging Saint Georges University Medical Center, Balamand University, P.O.Box 166378 Achrafieh, Beirut, 1100 2807, Lebanon
| | - Chawki Cortbawi
- Department of Orthopedic Surgery and Traumatology Saint Georges University Medical Center, Balamand University, P.O.Box 166378 Achrafieh, Beirut, 1100 2807, Lebanon
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Women after Bilateral Surgical Correction of Hallux Valgus Do Not Show Improvement in Spatiotemporal Gait Parameters at 18 Weeks Postoperatively. J Clin Med 2021; 10:jcm10040608. [PMID: 33562797 PMCID: PMC7914673 DOI: 10.3390/jcm10040608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Hallux valgus (HV) is a gait-altering orthopedic deformity, somewhat more prevalent in women, which often affects both limbs. Although surgery is a commonly applied treatment, there is no consensus in the literature on how invasive HV correction affects spatiotemporal gait parameters, or how quickly improvement can be expected. We investigated gait parameters in female HV patients who underwent bilateral surgical correction of hallux valgus, both preoperatively and 18 weeks following surgery (a timeframe relevant from the perspective of physical therapy), and also in relation to a non-HV control group. Methods: A total of 23 women aged 40–70 years, with moderate to severe HV deformity in both feet, were assessed preoperatively and 18 weeks postoperatively, and an age-matched control group of 76 healthy women was also assessed. A total of 22 spatiotemporal parameters were collected during 30 s walks over an electronic walkway (Zebris Medical System). Results: Of the 22 parameters analyzed, significant differences between the preoperative experimental and control groups were found only in 4 parameters (Velocity, Right step time, Total double support and Stride time), but in 16 parameters between the postoperative experimental and control groups (the greatest impact being found for: Left and Right Step time, Stride time, Cadence, Right Foot rotation, Left Step length (% leg length) and Stride length (% leg length)). Conclusions: Women after bilateral HV correction did not exhibit improved (i.e., more normal) gait parameters at 18 weeks postoperatively; rather, they showed more gait abnormalities than preoperatively. These findings urge longer-term planning of postoperative rehabilitation, involving continual evaluation of gait improvement.
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Li C, Lu L, Zhang Y, Ai-Xin-Jue-Luo QC, Wang ZT, Wang JF. F-Shaped Osteotomy Combined with Basal Opening Wedge Osteotomy for Severe Hallux Valgus. Orthop Surg 2019; 11:604-612. [PMID: 31419060 PMCID: PMC6712405 DOI: 10.1111/os.12505] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/03/2019] [Accepted: 06/17/2019] [Indexed: 12/16/2022] Open
Abstract
Objective To evaluate the safety and effectiveness of osteotomy adjacent to the articular surface of the metatarsal head combined with basal opening wedge osteotomy for severe hallux valgus. Methods The double osteotomy procedure was carried out in 56 patients (72 feet) with severe hallux valgus deformity, with an average follow‐up of 25 months from March 2010 to February 2019. Hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), intermetatarsal angle (IMA), and distal articular set angle (DASA) were measured for all patients via weight‐bearing anteroposterior (AP) X‐ray images. In addition, the American Orthopedic Foot & Ankle Society (AOFAS) scale was used for evaluating the function of the hallux. Results The HVA, IMA, and DMAA reduced from 49.30 ± 6.60, 19.33 ± 4.70, and 29.85 ± 10.96 to 13.19 ± 6.10, 5.97 ± 3.13, and 5.63 ± 3.44, respectively (P < 0.01). DASA decreased from 4.33 ± 2.34 to 4.08 ± 1.91 and did not show a statistically significant difference (P = 0.48). Among the 72 feet, 69 feet healed normally, and 3 feet had bone resorption at the osteotomy edges. No cases of bone sclerosis, bone necrosis, bone nonunion, or ankylosis were observed. On average, the AOFAS score improved from 34.66 ± 12.07 (preoperative) to 88.78 ± 5.73 (postoperative). Conclusions The proposed double osteotomy procedure can maintain the match metatarsophalangeal joints without ischemic necrosis of bones, and is demonstrated to be safe, effective, and feasible for correcting severe hallux valgus.
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Affiliation(s)
- Chang Li
- Department of Hand and Foot Microsurgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Liang Lu
- Department of Orthopaedics, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Yu Zhang
- Department of Sports Medicine and Adult reconstructive surgery, Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| | - Qi-Cheng Ai-Xin-Jue-Luo
- Department of Hand and Foot Microsurgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Zhen-Tang Wang
- Department of Hand and Foot Microsurgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Jun-Feng Wang
- Department of Hand and Foot Microsurgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
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Minimally invasive distal linear metatarsal osteotomy combined with selective release of lateral soft tissue for severe hallux valgus. J Orthop Sci 2018; 23:557-564. [PMID: 29573864 DOI: 10.1016/j.jos.2018.02.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 02/06/2018] [Accepted: 02/22/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Minimally invasive techniques for hallux valgus have been widely used to treat mild to moderate hallux valgus deformities. The purpose of this study was to evaluate the clinical and radiographic outcomes of distal linear metatarsal osteotomy (DLMO), which is one of the minimally invasive techniques, for severe hallux valgus. METHODS 95 patients (141 feet) with severe hallux valgus underwent DLMOs. Lateral soft tissue release (LSTR) was performed at the same time for the cases selected by an original manual test. The satisfaction level, the Japanese Society of Surgery of the Foot (JSSF) hallux scale score, and weight-bearing radiographs of the foot were assessed preoperatively and after more than 24 months. In addition, the clinical and radiographic outcomes were compared among three groups divided by the kind of LSTR: no LSTR; manual correction; and open release through skin incision. RESULTS Although the first metatarsal bone was significantly shortened, dorsiflexed, and elevated on postoperative radiographs, the rate of satisfaction was 87.2% (123/141), and the mean JSSF hallux scale score improved significantly from 60.4 (44-73) to 90.4 (65-100). The mean hallux valgus and intermetatarsal angles also improved significantly from 45.5° (40.0-60.0°) to 10.3° (-28.0-40.9°) and from 19.9° (14.0-28.7°) to 8.3° (-1.6-18.5°), respectively. Delayed union (18 feet), metatarsalgia (16 feet), recurrence (22 feet), and hallux varus (22 feet) were observed, and they were more obvious in DLMO combined with open release through a skin incision. CONCLUSIONS DLMO combined selectively with LSTR is an effective procedure for correcting severe hallux valgus. However, the indication for open release with DLMO should be considered carefully.
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Biz C, Fosser M, Dalmau-Pastor M, Corradin M, Rodà MG, Aldegheri R, Ruggieri P. Functional and radiographic outcomes of hallux valgus correction by mini-invasive surgery with Reverdin-Isham and Akin percutaneous osteotomies: a longitudinal prospective study with a 48-month follow-up. J Orthop Surg Res 2016; 11:157. [PMID: 27919259 PMCID: PMC5139107 DOI: 10.1186/s13018-016-0491-x] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Minimally invasive surgery (MIS) represents one of the most innovative surgical treatments of hallux valgus (HV). However, long-term outcomes still remain a matter of discussion within the orthopaedic community. The purpose of this longitudinal prospective study was to evaluate radiographic and functional outcomes in patients with mild-to-severe HV who underwent Reverdin-Isham and Akin percutaneous osteotomy, following exostosectomy and lateral release. METHODS Eighty patients with mild-to-severe symptomatic HV were treated by MIS. Clinical evaluation was assessed preoperatively, as well as at 3 and 12 months after surgery and at final follow-up of 48 months, using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux grading system. Patient satisfaction and complications were recorded. Computer-assisted measurement of antero-posterior radiographs was taken preoperatively, as well as at 3 and 12 months after surgery and at 48-month follow-up, analysing the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA) and the tibial sesamoid position. Also, the bridging bone/callus formation was evaluated at the different radiographic follow-ups, while the articular surface congruency and the metatarsal index were calculated only preoperatively and at the last follow-up. Patient satisfaction was assessed using the visual analogue score (VAS). Statistical analysis was carried out using the paired t test. Statistical significance was set at p < 0.05. RESULTS The mean AOFAS score was 87.15 points at the final follow-up of 48 months, and the VAS score was 8.35/10. The post-operative radiographic assessments showed a statistically significant improvement compared with preoperative values. The mean corrections of each angular value at the last follow-up were as follows: IMA 3.90°, HVA 12.50°, DMAA 4.72° and a tibial sesamoid position of 1.10. The articular surface was congruent in 77 (96.25%) cases and incongruent only in 3 (3.75%). The complete healing of the osteotomies was achieved in all series at 3-month follow-up. However, the results obtained in the correction of the severe HV deformities were less encouraging. CONCLUSIONS Minimally invasive surgery with Reverdin-Isham and Akin percutaneous osteotomy, in combination with previous exostosectomy and subsequent lateral soft-tissue release, is a safe, effective and reliable procedure for correction of mild-to-moderate HV. However, it requires a long learning curve because of the inherent difficulty of the mixed different surgical procedures. TRIAL REGISTRATION ClinicalTrials.gov PRS Protocol Registration and Results System: NCT02886221.
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Affiliation(s)
- Carlo Biz
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy.
| | - Michele Fosser
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy
| | - Miki Dalmau-Pastor
- Human Anatomy and Embryology Unit, Experimental Pathology and Therapeutics Department, University of Barcelona, Barcelona, Spain.,Health Sciences Faculty of Manresa, University of Vic-Central University of Catalunya, Barcelona, Spain
| | - Marco Corradin
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy
| | - Maria Grazia Rodà
- Orthopaedic and Trauma Unit, Padua Hospital, via Giustiniani 2, Padova, Italy
| | - Roberto Aldegheri
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy
| | - Pietro Ruggieri
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy
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Lucas y Hernandez J, Golanó† P, Roshan-Zamir S, Darcel V, Chauveaux D, Laffenêtre O. Treatment of moderate hallux valgus by percutaneous, extra-articular reverse-L Chevron (PERC) osteotomy. Bone Joint J 2016; 98-B:365-73. [DOI: 10.1302/0301-620x.98b3.35666] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Aims The aim of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a percutaneous extra-articular reverse-L chevron (PERC) osteotomy. Patients and Methods A total of 38 patients underwent 45 procedures. There were 35 women and three men. The mean age of the patients was 48 years (17 to 69). An additional percutaneous Akin osteotomy was performed in 37 feet and percutaneous lateral capsular release was performed in 22 feet. Clinical and radiological assessments included the type of forefoot, range of movement, the American Orthopedic Foot and Ankle (AOFAS) score, a subjective rating and radiological parameters. The mean follow-up was 59.1 months (45.9 to 75.2). No patients were lost to follow-up. Results The mean AOFAS score increased from 62.5 (30 to 80) pre-operatively to 97.1 (75 to 100) post-operatively. A total of 37 patients (97%) were satisfied. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and the proximal articular set angle. The range of movement of the first metatarsophalangeal joint improved significantly.. There was more improvement in the range of movement in patients who had fixation of the osteotomy of the proximal phalanx. Conclusion Preliminary results of this percutaneous approach are promising. This technique is reliable and reproducible. Its main asset is that it maintains an excellent range of movement. Take home message: The PERC osteotomy procedure is an effective approach for surgical management of moderate hallux valgus which combines the benefits of percutaneous surgery with the versatility of the chevron osteotomy whilst maintaining excellent first MTPJ range of motion. Cite this article: Bone Joint J 2016;98-B:365–73.
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Affiliation(s)
- J. Lucas y Hernandez
- Bordeaux University Hospital, Centre
Médico-chirurgical Universitaire du Pied, place Amélie
Raba-Léon, Bordeaux, France
| | - P. Golanó†
- University of Barcelona, Human
and Embriology Unit, Dept of experimental pathology
and therapeutics, University of Barcelona, Spain
| | - S. Roshan-Zamir
- Western Health, Western
Health, Gordon Street, Footscray, Victoria, 3011, Australia
| | - V. Darcel
- Robert Picqué Military Hospital, 351
Route de Toulouse, 33140 Villenave-d'Ornon, France
| | - D. Chauveaux
- Bordeaux University Hospital, Centre
Médico-chirurgical Universitaire du Pied, place Amélie
Raba-Léon, Bordeaux, France
| | - O. Laffenêtre
- Clinique Geoffroy St Hilaire, 59
rue Geoffroy St Hilaire, Paris, France
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Chopra S, Moerenhout K, Crevoisier X. Subjective versus objective assessment in early clinical outcome of modified Lapidus procedure for hallux valgus deformity. Clin Biomech (Bristol, Avon) 2016; 32:187-93. [PMID: 26711534 DOI: 10.1016/j.clinbiomech.2015.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 10/25/2015] [Accepted: 11/24/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Studies have assessed the outcome of hallux valgus surgeries based on subjective questionnaires, usually the American Orthopaedic Foot and Ankle Society Score, and radiographic results reporting good to excellent outcome at 6-12 months postoperatively. However, contrasting results were reported by gait studies at 12-24 months postoperatively. In a previous study, we found nine gait parameters which can describe the altered gait in hallux valgus deformity. This study aimed, to assess the outcome of modified Lapidus at 6 months postoperatively, using gait assessment method, to determine if the nine specified gait parameters effectively relates with the clinical scores and the radiological results or add information missed by these commonly used clinical assessments. METHOD We assessed 21 participants including 11 controls and 10 patients with moderate to severe hallux valgus deformity. The patient group was followed 6 months postoperatively. The ambulatory gait assessment was performed utilizing pressure insoles and inertial sensors. Clinical assessment includes foot and ankle questionnaires along with radiographic results. Comparison was made using non parametric tests, P<0.05. FINDINGS Altered gait patterns, similar to the preoperative outcome, persisted at 6 months postoperatively when compared to controls. The foot and ankle ability measure score showed an outcome comparable to the gait results. In contrast, the American Orthopaedic Foot and Ankle Society Score and radiographic results showed significant improvement. INTERPRETATION Study supports the reliability of nine defined gait parameters in assessing the outcome of hallux valgus surgeries. The existing clinical assessment overestimates the functional outcome at the early postoperative phase.
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Affiliation(s)
- S Chopra
- Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Department of Orthopaedic Surgery and Traumatology, Pierre-Decker 4, CH-1011 Lausanne, Switzerland.
| | - K Moerenhout
- Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Department of Orthopaedic Surgery and Traumatology, Pierre-Decker 4, CH-1011 Lausanne, Switzerland.
| | - X Crevoisier
- Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Department of Orthopaedic Surgery and Traumatology, Pierre-Decker 4, CH-1011 Lausanne, Switzerland.
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14
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Chopra S, Moerenhout K, Crevoisier X. Characterization of gait in female patients with moderate to severe hallux valgus deformity. Clin Biomech (Bristol, Avon) 2015; 30:629-35. [PMID: 25841314 DOI: 10.1016/j.clinbiomech.2015.03.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 03/19/2015] [Accepted: 03/21/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hallux valgus is one of the most common forefoot problems in females. Studies have looked at gait alterations due to hallux valgus deformity, assessing temporal, kinematic or plantar pressure parameters individually. The present study, however, aims to assess all listed parameters at once and to isolate the most clinically relevant gait parameters for moderate to severe hallux valgus deformity with the intent of improving post-operative patient prognosis and rehabilitation. METHODS The study included 26 feet with moderate to severe hallux valgus deformity and 30 feet with no sign of hallux valgus in female participants. Initially, weight bearing radiographs and foot and ankle clinical scores were assessed. Gait assessment was then performed utilizing pressure insoles (PEDAR) and inertial sensors (Physilog) and the two groups were compared using a non-parametric statistical hypothesis test (Wilcoxon rank sum, P<0.05). Furthermore, forward stepwise regression was used to reduce the number of gait parameters to the most clinically relevant and correlation of these parameters was assessed with the clinical score. FINDINGS Overall, the results showed clear deterioration in several gait parameters in the hallux valgus group compared to controls and 9 gait parameters (effect size between 1.03 and 1.76) were successfully isolated to best describe the altered gait in hallux valgus deformity (r(2)=0.71) as well as showed good correlation with clinical scores. INTERPRETATION Our results, and nine listed parameters, could serve as benchmark for characterization of hallux valgus and objective evaluation of treatment efficacy.
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Affiliation(s)
- S Chopra
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Orthopaedic Surgery and Traumatology, Pierre-Decker 4, CH-1011 Lausanne, Switzerland.
| | - K Moerenhout
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Orthopaedic Surgery and Traumatology, Pierre-Decker 4, CH-1011 Lausanne, Switzerland.
| | - X Crevoisier
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Orthopaedic Surgery and Traumatology, Pierre-Decker 4, CH-1011 Lausanne, Switzerland.
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15
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Lee KB, Cho NY, Park HW, Seon JK, Lee SH. A comparison of proximal and distal Chevron osteotomy, both with lateral soft-tissue release, for moderate to severe hallux valgus in patients undergoing simultaneous bilateral correction. Bone Joint J 2015; 97-B:202-7. [DOI: 10.1302/0301-620x.97b2.34449] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Moderate to severe hallux valgus is conventionally treated by proximal metatarsal osteotomy. Several recent studies have shown that the indications for distal metatarsal osteotomy with a distal soft-tissue procedure could be extended to include moderate to severe hallux valgus. The purpose of this prospective randomised controlled trial was to compare the outcome of proximal and distal Chevron osteotomy in patients undergoing simultaneous bilateral correction of moderate to severe hallux valgus. The original study cohort consisted of 50 female patients (100 feet). Of these, four (8 feet) were excluded for lack of adequate follow-up, leaving 46 female patients (92 feet) in the study. The mean age of the patients was 53.8 years (30.1 to 62.1) and the mean duration of follow-up 40.2 months (24.1 to 80.5). After randomisation, patients underwent a proximal Chevron osteotomy on one foot and a distal Chevron osteotomy on the other. At follow-up, the American Orthopedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal interphalangeal (MTP-IP) score, patient satisfaction, post-operative complications, hallux valgus angle, first-second intermetatarsal angle, and tibial sesamoid position were similar in each group. Both procedures gave similar good clinical and radiological outcomes. This study suggests that distal Chevron osteotomy with a distal soft-tissue procedure is as effective and reliable a means of correcting moderate to severe hallux valgus as proximal Chevron osteotomy with a distal soft-tissue procedure. Cite this article: Bone Joint J 2015;97-B:202–7.
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Affiliation(s)
- K. B. Lee
- Chonnam National University Medical School
and Hospital, Gwangju, Korea
| | - N. Y. Cho
- Chonnam National University Medical School
and Hospital, Gwangju, Korea
| | - H. W. Park
- Chonnam National University Medical School
and Hospital, Gwangju, Korea
| | - J. K. Seon
- Chonnam National University Medical School
and Hospital, Gwangju, Korea
| | - S. H. Lee
- Chonnam National University Medical School
and Hospital, Gwangju, Korea
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Buciuto R. Prospective randomized study of chevron osteotomy versus Mitchell's osteotomy in hallux valgus. Foot Ankle Int 2014; 35:1268-76. [PMID: 25209122 DOI: 10.1177/1071100714550647] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We conducted a prospective randomized trial to compare the most popular osteotomy types of operative treatment of hallux valgus (HV) used in Norway, Mitchell's osteotomy (MO) and chevron osteotomy (CO). METHODS One hundred twenty adult female patients were prospectively randomized to treatment with either MO or CO. All operative procedures were performed with ankle block and with tourniquet applied. None of the patients received any antibiotic or antithrombotic prophylaxis. The follow-up period was 3 years. Clinical results were rated according to the American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating System (CRS). RESULTS HV in the MO group was reduced from 30 (range, 20 to 44) to 15 (range, 8 to 24) degrees and IM angle from 11 (range, 6 to 14) to 7 (range, 4 to 11) degrees. HV in the CO group was reduced from 31 (range, 22 to 42) to 16 (range, 6 to 24) degrees and IM angle from 14 (range, 8 to 20) to 6 (range, 2 to 10) degrees. Transfer metatarsalgia occurred in 36 (60%) patients and hammertoe in 6 (10%) patients in the MO group. In the CO group, metatarsalgia occurred in 5 patients. The median loss of postoperative HV correction was 4 (range, 2 to 10) degrees in mild deformity and 6 (6 to 10) degrees in moderate deformity. CONCLUSION Patients treated with CO had significantly better results for AOFAS CRS, number of postoperative complications, patient satisfaction, and length of sick leave for the employed patients. Based on our results, we consider that in female patients CO should be regarded as the first-line procedure for treatment of mild and moderate HV. LEVEL OF EVIDENCE Level I, prospective randomized study.
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Affiliation(s)
- Robert Buciuto
- Orthopaedic Department, St Olavs Hospital University Hospital, Trondheim, Norway
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17
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Wu DY. A retrospective study of 63 hallux valgus corrections using the osteodesis procedure. J Foot Ankle Surg 2014; 54:406-11. [PMID: 25435009 DOI: 10.1053/j.jfas.2014.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Indexed: 02/03/2023]
Abstract
Osteotomy procedures have been the most popular approach to hallux valgus deformity correction. Soft tissue approaches have, in general, been regarded as ineffective for moderate and severe hallux valgus deformities. Osteodesis is a soft tissue technique that has been shown to be effective in the past but is still seldom practiced. In the present report, we describe a retrospective study of 63 hallux valgus feet in 36 patients who had undergone the osteodesis procedure. Their mean age was 46 ± 12 years, and the mean follow-up period was 25.4 ± 9.6 months. The surgical technique consisted of metatarsus primus varus deformity correction by intermetatarsal cerclage sutures and hallux valgus deformity correction by rebalancing the ligaments. The first metatarsophalangeal angle improved from a mean of 32.5° ± 7.6° preoperatively to 18.4° ± 7° postoperatively, the first intermetatarsal angle improved from 14.6° ± 2.6° to 6.8° ± 1.8°, and the American Orthopaedic Foot and Ankle Society score improved from 59 ± 14 to 93 ± 8 points. The rate of patient satisfaction after surgery was 92% (33 of 36 patients, 59 of 63 feet). The complications included a second metatarsal stress fracture in 3 feet (5%), metatarsophalangeal joint medial subluxation in 3 feet (5%), and metatarsophalangeal joint stiffness in 5 feet (8%). This soft tissue, nonosteotomy procedure was a safe technique that effectively corrected hallux valgus and metatarsus primus varus deformities of various severities without osteotomy or fusion.
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Affiliation(s)
- Daniel Yiang Wu
- Center for Non-Bone-Breaking Bunion Surgery, Hong Kong, Special Administrative Region, China.
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18
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Dux K, Smith N, Rottier FJ. Outcome after metatarsal osteotomy for hallux valgus: a study of postoperative foot function using revised foot function index short form. J Foot Ankle Surg 2013; 52:422-5. [PMID: 23651697 DOI: 10.1053/j.jfas.2013.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Indexed: 02/03/2023]
Abstract
The aim of the present study was to evaluate patients' perception of their functional outcome at 6 and 12 months after surgical correction for hallux valgus using the Foot Function Index Revised short form. A total of 59 patients underwent 68 osseous and soft tissue procedures for the correction of hallux valgus deformity from January 2009 through December 2010. The outcome analysis was based on the validated patient questionnaire, the Foot Function Index Revised. The preoperative data were collected on the day of the patient's surgery using the Foot Function Index Revised short-form questionnaire. The postoperative data were collected at 6 and 12 months after the patient's initial surgical date using the same validated questionnaire. The cumulative Foot Function Index Revised score and the scores in each subscale demonstrated statistically significant data at both 6 and 12 months of follow-up. On average, the Foot Function Index Revised scores had improved by 39% at 6 months and 50% at 12 months. The improvement in all scores indicated an improvement in health-related foot function after hallux valgus surgery, evidencing effective surgical intervention. Expectations are the best predictors of patient satisfaction, and the present study has provided statistically significant data to allow physicians to establish realistic outcomes after surgical correction for hallux valgus deformity.
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Affiliation(s)
- Katherine Dux
- Instructor, Podiatric Medicine and Surgery, Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Stritch School of Medicine, Maguire Center, Maywood, IL 60153, USA.
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19
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Huang SH, Cheng YM, Chen CH, Huang PJ. Modified Mitchell osteotomy with screw fixation for correction of hallux valgus. Foot Ankle Int 2012. [PMID: 23199860 DOI: 10.3113/fai.2012.1098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The authors have performed more than 1500 cases of a Mitchell osteotomy and traditionally used two crossed pins for fixation. The previous series showed some complications related to pin tract infection, pin migration, and transfer metatarsalgia. Since 2009, the authors have used a compression screw for fixation and made some technical modifications and the results are reported in this article. METHODS A total of 95 patients underwent a Mitchell ostotomy to correct hallux valgus deformity with fixation with multi-use compression (MUC) screws. Hallux valgus angle (HVA), intermetatarsal angle (IMA), the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale were measured preoperatively and postoperatively. RESULTS ~There were statistically differences between the preoperatively and postoperatively HVA, first IMA, and AOFAS hallux metatarsophalangeal-interphalangeal scores. Five patients (8/137 feet, 5.8%) underwent removal of the screw because of screw tip irritation. Eight patients (9/137 feet, 6.5%) had transfer metatarsalgia of the second metatarsal, with two of them caused by dorsal tilt of the metatarsal head. One patient (1/137 feet, 0.7%) had undercorrection. There was no superficial infection, deep infection, nonunion, or osteonecrosis of the first metatarsal head. CONCLUSION On the basis of the results observed in this study, it appears that the use of a multi-use compression screw provides satisfactory stabilization of the modified Mitchell osteotomy and was not associated with any serious complications. The modified technique also helped reduce transfer metatarsalgia.
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Affiliation(s)
- Shih-hao Huang
- Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
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Sarmah SS, Hossain FS, Mishra V. Effectiveness of the reverse camber shoe in postoperative hallux valgus surgery. Foot Ankle Spec 2012; 5:245-8. [PMID: 22715499 DOI: 10.1177/1938640012451314] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The reverse camber shoe (RCS) is commonly used for forefoot off-loading during mobilization after forefoot surgery. However, patient satisfaction and compliance may be affected because of the altered gait pattern that is conferred. The aim of this study was to investigate the patient-related factors associated with the compliance in the use of this device. The authors retrospectively reviewed a single surgeon series of 64 patients who underwent forefoot surgery and who were subsequently rehabilitated with early mobilization using the RCS. Data on patient age, arthritic comorbidities, adaptation to device, and symptoms during use were collected via a standardized postal questionnaire. In all, 39 patients complied with the use of the RCS for 8 weeks (group A), whereas 11 patients managed it for less than 6 weeks (group C). Also, 14 patients used the shoe for more than 6 weeks but less than 8 weeks (group B). The authors found that compliance in the use of the RCS is lower in older patients following forefoot surgery. This may be related to poor adaptation in the presence of preexisting arthritis.
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