|
1
|
Lalevee M, Beaudet P, Saffarini M, Agu C, Van Rooij F, Barbachan Mansur NS, Carvalho K, Dibbern K, de Cesar Netto C. Coronal Plane Alignment of the Medial Column in Isolated Hallux Valgus, Isolated Flatfoot, and Combined Hallux Valgus-Flatfoot. Foot Ankle Int 2025; 46:236-245. [PMID: 39825780 DOI: 10.1177/10711007241308580] [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: 01/20/2025]
Abstract
BACKGROUND To provide improved treatment for hallux valgus (HV), we sought to understand more about the pathophysiologic connection between flatfoot deformity and HV by comparing coronal plane alignment of the medial column of the foot for patients with isolated HV, isolated flatfoot, and combined HV-flatfoot vs controls. METHODS This study retrospectively assessed a consecutive series of 33 patients with combined symptomatic and radiographic HV and flatfoot, 33 isolated symptomatic HV, 33 isolated symptomatic flatfoot, and 33 controls. The medial column alignment was assessed in the coronal plane using 3-dimensional weightbearing computed tomography (WBCT); rotation was measured for the navicular, medial cuneiform, and first metatarsal (M1). The position of the first naviculocuneiform (NC) and tarsometatarsal (TMT) joints were determined. RESULTS M1 intrinsic pronation was significantly greater in patients with combined HV-flatfoot (-12.0 ± 7.0 degrees; P < .001), isolated HV (-12.1 ± 6.6 degrees; P < .001), and isolated flatfoot (-11.8 ± 8.5 degrees; P < .001), compared with control patients (-19.4 ± 6.7 degrees). TMT was significantly more pronated in patients with combined HV-flatfoot (30.9 ± 6.2 degrees) compared with isolated flatfoot (25.3 ± 9.3 degrees; P = .007), and control (25.9 ± 5.2 degrees; P = .005), as it was in patients with isolated HV (33.2 ± 8.2 degrees) compared with isolated flatfoot (P < .001), and control (P < .001). NC was significantly more supinated in patients with combined HV-flatfoot (-23.7 ± 3.9 degrees) compared to isolated flatfoot (-18.0 ± 9.8 degrees; P = .001), and control (-18.0 ± 4.5 degrees; P < .001), as it was for patients with isolated HV (-24.8 ± 7.1 degrees) compared with isolated flatfoot (P = .003), and control (P < .001). CONCLUSION In our study, we found that patients with isolated HV, isolated flatfoot, or combined HV-flatfoot presented a similar increase in M1 intrinsic pronation of approximately 7.5 degrees, compared with controls. Moreover, patients with isolated HV or combined HV-flatfoot had greater TMT pronation and NC supination, compared with patients with isolated flatfoot and controls.
Collapse
Affiliation(s)
- Matthieu Lalevee
- CETAPS UR3832, Research Center for Sports and Athletic Activities Transformations, University of Rouen Normandy, Mont-Saint-Aignan, France
- Department of Orthopedic Surgery, Rouen University Hospital, Rouen, France
| | | | - Mo Saffarini
- Clinique Trénel, Ste Colombe, France
- ReSurg SA, Nyon, Switzerland
| | | | - Floris Van Rooij
- Clinique Trénel, Ste Colombe, France
- ReSurg SA, Nyon, Switzerland
| | | | - Kepler Carvalho
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Kevin Dibbern
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Marquette University, Milwaukee, WI, USA
| | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Department of Orthopedic Surgery, Duke University, Durham, NC, USA
| |
Collapse
|
|
2
|
Ruberto P, Calori S, Bocchino G, Giuliani A, Vitiello R, Forconi F, Malerba G, Maccauro G. Utilisation of the minimally invasive chevron akin (mica) osteotomy for severe hallux valgus: a systematic review. Musculoskelet Surg 2024:10.1007/s12306-024-00869-3. [PMID: 39432225 DOI: 10.1007/s12306-024-00869-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 10/02/2024] [Indexed: 10/22/2024]
Abstract
BACKGROUND AND AIM Hallux valgus is the most common forefoot disease that can cause pain and be disabling for the patient. Many surgical procedures have been described to correct this deformity; over the last years, the minimally invasive Chevron and Akin osteotomies (MICA) technique has become very popular. The aim of this review was to assess if MICA technique is a reliable procedure for treating severe hallux valgus. METHODS A systematic review was performed according to the Preferred Reporting Items for systematic Reviews and Meta-Analysis (PRISMA) guidelines. The keywords were searched in PubMed Medline and Cochrane library. To minimise the number of missed studies, no filters were applied to the search strategy. To be considered for this review, the articles needed to comply with the following inclusion criteria: Minimally invasive Chevron and Akin osteotomy (MICA) for severe hallux valgus (HVA > 40°, IMA > 16°), patient age over 18 years and minimum follow-up of 6 months. RESULTS Following the PRISMA flow chart 7 studies met the inclusion criteria and were taken into consideration in the review. We reached a population of 582 patients for a total of 676 feet. Males and females were 64 and 518, respectively. The mean age was 54.15 ± 8.25. The mean follow-up was 23.74 ± 9.60 months. All the studies reported an improvement in clinical results, in terms of function and quality of life. Radiological variables, mostly IMA and HVA, assessed pre- and postoperatively showed significant improvement in all studies included. CONCLUSIONS Despite the limited number of published studies in the literature, the available evidence reveals good clinical outcomes and high levels of patient satisfaction. Percutaneous surgery for severe hallux valgus can achieve great deformity correction with reasonable rates of residual deformity. Patient satisfaction and quality of life following third-generation MICA surgery is very high.
Collapse
Affiliation(s)
- P Ruberto
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. GemelliIRCSS, 00168, Rome, Italy.
- Department of Orthopaedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168, Rome, Italy.
- First Department of Orthopaedics and Traumatology, Azienda Ospedaliera Specialistica Dei Colli"CTO, 80131, Naples, Italy.
| | - S Calori
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. GemelliIRCSS, 00168, Rome, Italy
- Department of Orthopaedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168, Rome, Italy
| | - G Bocchino
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. GemelliIRCSS, 00168, Rome, Italy
- Department of Orthopaedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168, Rome, Italy
| | - A Giuliani
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. GemelliIRCSS, 00168, Rome, Italy
- Department of Orthopaedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168, Rome, Italy
| | - R Vitiello
- Department of Orthopaedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168, Rome, Italy
- Clinic Villa Stuart, 00135, Rome, Italy
| | - F Forconi
- Clinic Villa Stuart, 00135, Rome, Italy
| | - G Malerba
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. GemelliIRCSS, 00168, Rome, Italy
- Department of Orthopaedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168, Rome, Italy
| | - G Maccauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. GemelliIRCSS, 00168, Rome, Italy
- Department of Orthopaedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168, Rome, Italy
| |
Collapse
|
|
3
|
Zhao R, Wang G, Li F, Wang J, Zhang Y, Li D, Liu S, Li J, Song J, Wei F, Wang C. Developing Machine Learning-Based Predictive Models for Hallux Valgus Recurrence Based on Measurements From Radiographs. Foot Ankle Int 2024; 45:1000-1008. [PMID: 38872342 DOI: 10.1177/10711007241256648] [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: 06/15/2024]
Abstract
BACKGROUND Machine learning (ML) is increasingly used to predict the prognosis of numerous diseases. This retrospective analysis aimed to develop a prediction model using ML algorithms and to identify predictors associated with the recurrence of hallux valgus (HV) following surgery. METHODS A total of 198 symptomatic feet that underwent chevron osteotomy combined with a distal soft tissue procedure were enrolled and analyzed from 2 independent medical centers. The feet were grouped according to nonrecurrence or recurrence based on 1-year follow-up outcomes. Preoperative weightbearing radiographs and immediate postoperative nonweightbearing radiographs were obtained for each HV foot. Radiographic measurements (eg, HV angle and intermetatarsal angle) were acquired and used for ML model training. A total of 9 commonly used ML models were trained on the data obtained from one institute (108 feet), and tested on the other data set from another independent institute (90 feet) for external validation. Optimal feature sets for each model were identified based on a 2000-resample bootstrap-based internal validation via an exhaustive search. The performance of each model was then tested on the external validation set. The area under the curve (AUC), classification accuracy, sensitivity, and specificity of each model were calculated to evaluate the performance of each model. RESULTS The support vector machine (SVM) model showed the highest predictive accuracy compared to other methods, with an AUC of 0.88 and an accuracy of 75.6%. Preoperative hallux valgus angle, tibial sesamoid position, postoperative intermetatarsal angle, and postoperative tibial sesamoid position were identified as the most selected features by several ML models. CONCLUSION ML classifiers such as SVM could predict the recurrence of HV (an HVA >20 degrees) at a 1-year follow-up while identifying associated predictors in a multivariate manner. This study holds the potential for foot and ankle surgeons to effectively identify individuals at higher risk of HV recurrence postsurgery.
Collapse
Affiliation(s)
- Rui Zhao
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Guobin Wang
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Fengtan Li
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jinchan Wang
- Department of Dermatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuan Zhang
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Dong Li
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Shen Liu
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jie Li
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Jiajun Song
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Fangyuan Wei
- Department of Hand and Foot Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
- Engineering Research Center of Chinese Orthopaedic and Sports Rehabilitation Artificial Intelligent, Ministry of Education, Beijing, China
| | - Chenguang Wang
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| |
Collapse
|
|
4
|
Okuda R, Tanaka K, Shima H. Proximal Supination Osteotomy for Hallux Valgus: Comparison of Clinical and Radiologic Outcomes for the Most Severe Deformities. Foot Ankle Int 2024; 45:141-149. [PMID: 38063154 DOI: 10.1177/10711007231210809] [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: 02/13/2024]
Abstract
BACKGROUND There is little available information regarding the difference in outcomes between severe hallux valgus (S-HV), defined as 40 degrees ≤ hallux valgus angle (HVA) < 50 degrees, and what we consider to be "super-severe HV" (SS-HV), defined as >50 degrees, following a proximal metatarsal osteotomy. We aimed to retrospectively compare the outcomes of a proximal metatarsal osteotomy in S- and SS-HV. METHODS The series consisted of 57 female patients (57 feet) treated with a proximal supination osteotomy for symptomatic S- and SS-HV (33 and 24 feet, respectively). The outcome measures included radiographic parameters and for 45 patients included the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) score, and a visual analog scale pain score (VAS-PS) preoperatively and at a minimum follow-up of 12 months with a median of 26 months. No significant differences were found in age, body mass index, and the duration of follow-up between patients with S-HV and SS-HV (P > .10 for all comparisons) with the numbers available. RESULTS Preoperative HVA in patients with S- and SS-HV was significantly improved at the final follow-up (P < .0001 for both comparisons). No significant differences in postoperative HVA and IMA were observed between patients with S- and SS-HV (P = .51 and .50, respectively). All 5 preoperative subscale scores of SAFE-Q in patients with S- and SS-HV significantly improved postoperatively (P < .01 for all comparisons). Preoperative VAS-PS in patients with S- and SS-HV significantly improved postoperatively (P < .0001 and <.009, respectively). There were no significant differences in preoperative and postoperative scores of all the SAFE-Q subscales and VAS-PS between patients with S-HV and SS-HV (P > .10 for all) with the numbers available. CONCLUSION We found for this patient group that a proximal supination osteotomy can achieve a large correction for SS-HV as well as S-HV and significantly improve radiologic and clinical outcomes in SS-HV. The outcomes between patients with S- and SS-HV were not different in this series. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Ryuzo Okuda
- Department of Orthopaedic Surgery, Rakusai-Shimizu Hospital, Kyoto, Japan
| | - Kei Tanaka
- Department of Orthopaedic Surgery, Rakusai-Shimizu Hospital, Kyoto, Japan
| | - Hiroaki Shima
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| |
Collapse
|
|
5
|
Del Vecchio JJ, Dealbera ED, Chemes LN, Slullitel G, Calvi JP, Dalmau-Pastor M. A Radiologic Triangle Sign for Percutaneous Adductor Tendon Release (PATR): Cadaveric Study and Case Series. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241241269. [PMID: 38559393 PMCID: PMC10981861 DOI: 10.1177/24730114241241269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Background Combining osteotomies and soft tissue procedures is believed to reduce sesamoids in their anatomical position and maintain long-term correction when treating hallux valgus deformity. This study determines if a radiologic association exists between a radiolucent sign and a full percutaneous adductor tendon release (PATR), including a cadaveric study and a consecutive case series. Another aim was to determine the intra- and interobserver reliability of these observations. Methods A prospective observational study was made between 2018 and 2019. First, a PATR was done on cadaveric specimens and, after the procedures, dissected to correlate what was seen fluoroscopically. The clinical group included 39 feet that presented mild-to-moderate HV deformity and were treated with percutaneous osteotomies associated with PATR. Results Observers 1 and 2 saw a radioscopic radiolucent sign in 100% of cadavers and the patient population. They also observed a triangle-shaped image with an incidence of 75%, which we have named the "triangle sign." Conclusion The triangle sign may be helpful in the intraoperative confirmation of PATR and latero-plantar capsule release using this percutaneous technique. Level of Evidence Level II, development of diagnostic criteria.
Collapse
Affiliation(s)
- Jorge Javier Del Vecchio
- Head Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro–Hospital Universitario, Ciudad Autónoma de Buenos Aires (CABA), Argentina
- Department of Kinesiology and Physiatry, Universidad Favaloro, CABA, Argentina
- MIFAS (Minimally Invasive Foot and Ankle Society) by GRECMIP, Merignac, France
| | - Eric Daniel Dealbera
- Foot and Ankle Section, Fundación Favaloro–Hospital Universitario, Buenos Aires, Ciudad Autónoma de Buenos Aires (CABA), Argentina
| | - Lucas Nicolás Chemes
- Foot and Ankle Section, Fundación Favaloro–Hospital Universitario, Buenos Aires, Ciudad Autónoma de Buenos Aires (CABA), Argentina
| | - Gastón Slullitel
- Department of Foot and Ankle Surgery, Institute of Orthopedics “Dr. Jaime Slullitel,” Santa Fe, Argentine
| | - Juan Pablo Calvi
- Department of Foot and Ankle Surgery, Institute of Orthopedics “Dr. Jaime Slullitel,” Santa Fe, Argentine
| | - Miki Dalmau-Pastor
- MIFAS (Minimally Invasive Foot and Ankle Society) by GRECMIP, Merignac, France
- Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| |
Collapse
|
|
6
|
Lalevée M, Barbachan Mansur NS, Lee HY, Ehret A, Tazegul T, de Carvalho KAM, Bluman E, de Cesar Netto C. A comparison between the Bluman et al. and the progressive collapsing foot deformity classifications for flatfeet assessment. Arch Orthop Trauma Surg 2023; 143:1331-1339. [PMID: 34859296 DOI: 10.1007/s00402-021-04279-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/24/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Bluman et al., flatfoot classification is based on posterior tibial tendon (PTT) dysfunction leading to a chronological appearance of several foot deformities. An expert consensus recently proposed a new classification named Progressive Collapsing Foot Deformity (PCFD) in which the focus was shifted to five different independent foot and ankle deformities and their flexibility or rigidity. The aim of this study was to compare Bluman and PCFD classifications. We hypothesize that both classifications will be reliable and that the PCFD classification will allow a larger distribution of the different types of foot deformity. MATERIALS AND METHODS We performed a retrospective IRB-approved study including 92 flatfeet. Three foot and ankle surgeons reviewed patient files and radiographs to classify each foot using both classifications. Bluman classification was performed one time as initially described and a second time after removing the Angle of Gissane sclerosis sign. Interobserver reliabilities were determined with Fleiss' kappa values. RESULTS Interobserver reliabilities of Bluman and PCFD classifications were, respectively, substantial 0.67 and moderate 0.55. PCFD Class C and D reliabilities were, respectively, slight 0.07 and fair 0.28. The 276 readings were spread into 10 substages in Bluman and 65 subclasses in PCFD. The progressivity of the Bluman classification prevented the combination of flexible hindfoot valgus (II Bluman, 1A PCFD), midfoot abduction (IIB, 1B) and medial column instability (IIC, 1C) which was frequent in our study (112/276 readings, 40.6%). By removing the Angle of Gissane sclerosis sign from the Bluman classification, the prevalence of stage III decreased from 44.2 to 10.1%. CONCLUSIONS Bluman and PCFD classifications were reliable. The PCFD classification showed a larger distribution of different types of flatfeet but Classes C and D need better definition. The progressivity of Bluman classification causes inconsistencies and Gissane angle sclerosis sign is inappropriately used and might lead to incorrect surgical indications.
Collapse
Affiliation(s)
- Matthieu Lalevée
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA, 52242, USA.,Department of Orthopedic Surgery, Rouen University Hospital, 37 Boulevard Gambetta, 76000, Rouen, France
| | - Nacime Salomao Barbachan Mansur
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA, 52242, USA.,Department of Orthopedics and Traumatology, Paulista School of Medicine, Federal University of Sao Paulo, São Paulo, SP, Brazil
| | - Hee Young Lee
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA, 52242, USA
| | - Amanda Ehret
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA, 52242, USA
| | - Tutku Tazegul
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA, 52242, USA
| | - Kepler Alencar Mendes de Carvalho
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA, 52242, USA
| | - Eric Bluman
- Orthopedic Surgery, Brigham Health, 75 Francis Street, Boston, MA, 02115, USA.,Brigham and Women's Faulkner Hospital, Orthopaedic Center, 1153 Centre Street, Suite 5 South, Boston, MA, 02130, USA
| | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA, 52242, USA.
| |
Collapse
|
|
7
|
Kim M, Lee HS, Choi YR, Kim J, Chee CG, Hong SH. Long Hallucal Tendon Force Vectors and First Metatarsophalangeal Deformity After Hallux Valgus Surgery. Foot Ankle Int 2023; 44:159-166. [PMID: 36661233 DOI: 10.1177/10711007221144046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Recurrence is one of the most common complications following hallux valgus surgery. Moreover, hallux varus occurs in cases of overcorrection. We aimed to quantitatively measure, using radiographic examination, the dynamics of the soft tissues that act on deformities (recurrence of valgus and occurrence of varus) after the surgery. METHODS This retrospective single-institution study included 60 patients (98 feet) who underwent hallux valgus surgery between 2009 and 2018. According to radiographic findings of the foot under weightbearing conditions at postoperative month 1, we examined the tendons' pathway and calculated the forces on the first metatarsophalangeal joint, which we termed the deformity force angle (DFA). We compared whether there was a significant difference in DFAs between the groups in which deformities occurred and those in which deformities did not occur after correction. In addition, the DFA was compared to known radiographic measurements of hallux valgus recurrence (hallux valgus angle, distal metatarsal articular angle, intermetatarsal angle, and sesamoid position) to assess association with recurrence. RESULTS We observed a significant difference in the DFA between patients with and without hallux valgus recurrence (P < .001) and between those with and without hallux varus (P < .001) based on standing radiographs taken at a minimum of 6 months postoperation. For predicting the deformities, the areas under the curve were 0.863 (hallux valgus recurrence) and 0.831 (hallux varus occurrence), respectively, which was greater than other factors evaluated. The DFA values greater than 9.5 degrees and less than 5.5 degrees were associated with the recurrence of valgus and occurrence of varus, respectively. CONCLUSION In our study, DFA was associated with hallux valgus recurrence when it exceeded 9.5 degrees and hallux varus when it was less than 5.5 degrees. Moreover, in the hallux valgus surgery we performed, a DFA from 5.5 to 9.5 degrees appeared to be a "safe zone" for preventing early deformity after surgery. LEVEL OF EVIDENCE Level III, prognostic.
Collapse
Affiliation(s)
- Minsoo Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Seong Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Rak Choi
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeongho Kim
- Department of Mathematics, Research Institute for Natural Sciences, Hanyang University, Seoul, Korea.,Jeongho Kim is now affiliated to Department of Applied Mathematics, Kyung Hee University, Seoul, Korea
| | - Choong Guen Chee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hyup Hong
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
|
8
|
Maeda N, Ikuta Y, Tashiro T, Arima S, Morikawa M, Kaneda K, Ishihara H, Brand A, Nakasa T, Adachi N, Urabe Y. Quantitative evaluation of the vertical mobility of the first tarsometatarsal joint during stance phase of gait. Sci Rep 2022; 12:9246. [PMID: 35655091 PMCID: PMC9163033 DOI: 10.1038/s41598-022-13425-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/24/2022] [Indexed: 11/09/2022] Open
Abstract
We determined how the in vivo mobility of the first tarsometatarsal (TMT) joint can be quantified during gait. Twenty-five healthy participants (12 females) with no history of foot disorders were included. Non-invasive ultrasound (US) with a three-dimensional motion analysis (MA) system was used to evaluate the kinematic characteristics of first TMT joint during stance phase of gait. US probe was positioned longitudinally above the first TMT joint and adjusted to its proximal dorsal prominence. Gait analysis was conducted by the MA system starting with the activation of B-mode US video at 80 frames per second and 60-mm depth for simultaneous capture. During stance phase, the first metatarsal was translated dorsally with respect to the medial cuneiform, returning to a neutral level at toe-off in all subjects. During middle stance phase, the medial cuneiform was stable in males but displaced in the plantar direction in females and was the primary contributor to the differences in sagittal mobility observed between groups. Quantitatively measuring sagittal mobility of the first TMT joint could be useful for the early detection of foot abnormalities. The dynamic characteristics of the medial cuneiform during gait in healthy females may be associated with a high prevalence of hallux valgus.
Collapse
Affiliation(s)
- Noriaki Maeda
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
- Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan.
| | - Tsubasa Tashiro
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Satoshi Arima
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Masanori Morikawa
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Kazuki Kaneda
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Honoka Ishihara
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Andreas Brand
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical Private University Salzburg, Salzburg, Austria
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
- Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
- Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Yukio Urabe
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| |
Collapse
|
|
9
|
Lee HY, Barbachan Mansur NS, Lalevée M, Dibbern KN, Myerson MS, Ellis SJ, Femino JE, de Cesar Netto C. Intra- and Interobserver Reliability of the New Classification System of Progressive Collapsing Foot Deformity. Foot Ankle Int 2022; 43:582-589. [PMID: 34852647 DOI: 10.1177/10711007211058154] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Historical concept of flatfoot as posterior tibial tendon dysfunction (PTTD) has been questioned. Recently, the consensus group published a new classification system and recommended renaming PTTD to Progressive Collapsing Foot Deformity (PCFD). The new PCFD classification could be effective in providing comprehensive information on the deformity. To date, there has been no study reporting intra- and interobserver reliability and the frequency of each class in PCFD classification. METHODS This was a single-center, retrospective study conducted from prospectively collected registry data. A consecutive cohort of PCFD patients evaluated from February 2015 to October 2020 was included, consisting of 92 feet in 84 patients. Classification of each patient was made using characteristic clinical and radiographic findings by 3 independent observers. Frequencies of each class and subclass were assessed. Intraobserver and inteobserver reliabilities were analyzed with Cohen kappa and Fleiss kappa, respectively. RESULTS Mean sample age was 54.4, 38% was male and 62% were female. 1ABC (25.4%) was the most common subclass, followed by 1AC (8.7%) and 1ABCD (6.9%). Only a small percentage of patients had isolated deformity. Class A was the most frequent component (89.5%), followed by C in 86.2% of the cases. Moderate interobserver reliability (Fleiss kappa = 0.561, P < .001, 95% CI 0.528-0.594) was found for overall classification. Very good intraobserver reliability was found (Cohen kappa = 0.851, P < .001, 95% CI 0.777-0.926). CONCLUSION Almost half (49.3%) of patients had a presentation dominantly involving the hindfoot (A) with various combinations of midfoot and/or forefoot deformity (B), (C) with or without subtalar joint involvement (D). The new system may cover all possible combinations of the PCFD, providing a comprehensive description and guiding treatment in a systematic and individualized manner, but this initial study suggests an opportunity to improve overall interobserver reliability. LEVEL OF EVIDENCE Level III, retrospective diagnostic study.
Collapse
Affiliation(s)
- Hee Young Lee
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Nacime Salomao Barbachan Mansur
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.,Department of Orthopedics and Traumatology, Paulista School of Medicine, Federal University of Sao Paulo, SP, Brazil
| | - Matthieu Lalevée
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.,Department of Orthopaedic Surgery, Rouen University Hospital, Rouen, France
| | - Kevin N Dibbern
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Mark S Myerson
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Scott J Ellis
- Department of Orthopedic Surgery, Foot and Ankle, Hospital for Special Surgery, New York, NY, USA
| | - John E Femino
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | | | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
|
10
|
Joint-Preserving Surgery for Forefoot Deformities in Patients with Rheumatoid Arthritis: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084093. [PMID: 33924481 PMCID: PMC8068870 DOI: 10.3390/ijerph18084093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 11/17/2022]
Abstract
The combination of first metatarsophalangeal joint arthrodesis and resection arthroplasty of all lesser metatarsal heads has been historically considered the golden standard treatment for rheumatoid forefoot deformities. However, as recent improved management of rheumatoid arthritis have reduced progression of joint destruction, the surgical treatments for rheumatoid forefoot deformities have gradually changed from joint-sacrificing surgery, such as arthrodesis and resection arthroplasty, to joint-preserving surgery. The aim of this literature review was to provide current evidence for joint-preserving surgery for rheumatoid forefoot deformities. We focused on the indications, specific outcomes, and postsurgical complications of joint-preserving surgery in this review.
Collapse
|
|
11
|
Biz C, Maso G, Malgarini E, Tagliapietra J, Ruggieri P. Hypermobility of the First Ray: the Cinderella of the measurements conventionally assessed for correction of Hallux Valgus. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:47-59. [PMID: 32555076 PMCID: PMC7944838 DOI: 10.23750/abm.v91i4-s.9769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 12/27/2022]
Abstract
Background and aim of the work: hypermobility of the first ray (FRH) began to be considered as a pathological entity from Morton’s studies and was associated as a primary cause of hallux valgus (HV). Currently, this relationship is in discussion, and various authors consider FRH as a consequence of the deformity. The purpose of this narrative review is to summarise the most influential publications relating to First Ray Mobility (FRM) to increase knowledge and promote its conventional assessment during clinical practice. Methods: papers of the last century were selected to obtain a homogeneous and up-to-date overview of I-MTCJ mobility and HV, as well as their relationship and management. Results: in recent years, FRH was studied from a biomechanical and pathophysiologic point of view. There is still not enough data regarding the aetiology of FRM. The higher rate of instability found in HV lacks an explanation of which is the cause and which is the effect. However, the Lapidus arthrodesis is still a valid method in cases of FRH and HV, even if is not rigorously indicated to treat both. When approaching FRH, radiographic or clinical findings are mandatory for the right diagnosis. Conclusions: FRM is an important factor that must be considered in routine clinical practice and prior and post HV surgery, as much as the conventional parameters assessed. Surgeons should consider performing I-MTCJ arthrodesis only if strictly necessary, also paying attention to soft tissue balancing. Improving the measurement of FRH could be useful to determine if it is a cause or effect of the HV deformity. (www.actabiomedica.it)
Collapse
Affiliation(s)
- Carlo Biz
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy.
| | - Giacomo Maso
- Orthopaedic, Traumatological and Oncological Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, DiSCOG, University of Padova, via Giustiniani 2; 35128 Padova, Italy.
| | - Enrico Malgarini
- Orthopaedic, Traumatological and Oncological Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, DiSCOG, University of Padova, via Giustiniani 2; 35128 Padova, Italy.
| | - Jacopo Tagliapietra
- Orthopaedic, Traumatological and Oncological Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, DiSCOG, University of Padova, via Giustiniani 2; 35128 Padova, Italy.
| | - Pietro Ruggieri
- Orthopaedic, Traumatological and Oncological Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, DiSCOG, University of Padova, via Giustiniani 2; 35128 Padova, Italy.
| |
Collapse
|
|
12
|
Abstract
The hallux valgus is one of the most challenging foot and ankle deformities to correct. The current concept is to consider the hallux valgus as a triplane deformity, and the parameters in transverse, sagittal, and frontal planes must be considered. The hallux valgus angle, intermetatarsal angle, tibial sesamoid position, and lateral edge of the first metatarsal head are valuable parameters to evaluate to understand the magnitude of the deformity. Diaphyseal corrections, such as scarf, and proximal interventions, such as crescentic osteotomy and Lapidus arthrodesis, are the most powerful techniques to address triplane deformity, because they are able to correct all misalignments.
Collapse
|
|
13
|
Abstract
The interaction between hypermobility and hallux valgus remains both contemporary and incendiary. The difficulty in setting clinical and radiological parameters to diagnose and the complexity of questions that circumnutate the philosophy among etiology and denouement, fires up the debate regarding these conditions. Outcomes among procedures that address or neglect ray instability are still used as argument for any group of believers or nonbelievers. Through proving the true existence of hypermobility and its relationship with bunions, our colleges and professors have produced an incredible amount of excellent data that helped us better comprehend the hallux valgus syndrome in a general manner.
Collapse
Affiliation(s)
- Nacime Salomão Barbachan Mansur
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Sao Paulo Federal University, 715 Napoleao de Barros Street-1st Floor, Vila Clementino, São Paulo, São Paulo 04038002, Brazil.
| | - Caio Augusto de Souza Nery
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Sao Paulo Federal University, 715 Napoleao de Barros Street-1st Floor, Vila Clementino, São Paulo, São Paulo 04038002, Brazil
| |
Collapse
|
|
14
|
Conti MS, Willett JF, Garfinkel JH, Miller MC, Costigliola SV, Elliott AJ, Conti SF, Ellis SJ. Effect of the Modified Lapidus Procedure on Pronation of the First Ray in Hallux Valgus. Foot Ankle Int 2020; 41:125-132. [PMID: 31617413 DOI: 10.1177/1071100719883325] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux valgus (HV) is a triplanar deformity of the first ray including pronation of the first metatarsal with subluxation of the sesamoids. The purpose of this study was to investigate if a first tarsometatarsal fusion (modified Lapidus technique), without preoperative knowledge of pronation measured on weightbearing computed tomographic (CT) scans, changed pronation of the first metatarsal and determine if reduction of the sesamoids was correlated with changes in first metatarsal pronation. METHODS Thirty-one feet in 31 patients with HV who underwent a modified Lapidus procedure had preoperative and at least 5-month postoperative weightbearing CT scans and radiographs. Differences in preoperative and postoperative pronation of the first metatarsal using a 3-dimensional computer-aided design, HV angle, and intermetatarsal angle (IMA) were calculated using Wilcoxon signed-rank tests. After dividing patients into groups based on sesamoid station, Kruskal-Wallis H tests were used to compare first metatarsal pronation between the groups. RESULTS The mean preoperative and postoperative pronation of the first metatarsal was 29.0 degrees (range 15.8-51.1, SD 8.7) and 20.2 degrees (range 10.4-32.6, SD 5.4), respectively, which was a mean change in pronation of the first ray of -8.8 degrees (P < .001). There was no difference in pronation of the first ray when stratified by postoperative sesamoid position (P > .250). The average preoperative and postoperative IMA was 16.7 degrees (SD 3.2) and 8.8 degrees (SD 2.8), which demonstrated a significant change (P < .001). CONCLUSIONS The modified Lapidus procedure was an effective tool to change pronation of the first ray. Reduction of the sesamoids was not associated with postoperative first metatarsal pronation. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
| | - Joseph F Willett
- University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, USA
| | | | - Mark C Miller
- University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, USA
| | | | | | | | | |
Collapse
|
|
15
|
Comparison of Two Different Approaches to Treat a Hallux Valgus Deformity: Intramedullary Self-Locked Plates and Herbert Screws. MEDICINA-LITHUANIA 2019; 55:medicina55090595. [PMID: 31527463 PMCID: PMC6780400 DOI: 10.3390/medicina55090595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 11/16/2022]
Abstract
Background and objectives: Hallux valgus is a complex deformity of the first metatarsophalangeal joint characterized by varus deformity of the first metatarsal bone, valgus deformity of the big toe, and lateral deviation of the extensor tendons and sesamoid bones. Several surgical methods have been described for correction of the deformity. Different materials have been used for the fixation of osteotomy. We compared the functional, radiological, and pain results of intramedullary self-locked plates and Herbert screws for the treatment of a hallux valgus deformity. Materials and Methods: Distal metatarsals were treated with self-locking intramedullary plate–screw systems in 18 feet from 12 patients (Group 1) and with Herbert screws in 18 feet from 12 patients (Group 2). The hallux valgus angle (HVA) and intermetatarsal angle (IMA) in patients of Group 1 and 2 were examined radiologically during the pre- and postoperative periods. We also determined the American Orthopedic Foot and Ankle Society (AOFAS), EQ-5D General Life Quality Scale, and Visual Analogue Scale (VAS) scores during the pre- and postoperative periods and compared the scores between groups. Results: Post hoc test results of HVA and IMA angles measured after the operation were significantly higher in Group 2 than in Group 1. In each group, the AOFAS scores during the preoperation period were significantly lower than those during the postoperation period (p < 0.001). According to the post hoc test results, the VAS scores after the operation were significantly higher in Group 2 than in Group 1 (p < 0.001). Conclusions: For the surgical treatment of hallux valgus, operations using self-locked plates compared to a single screw are superior in terms of providing rigid stability and for functional, radiological, and pain scores.
Collapse
|
|
16
|
Min BC, Chung CY, Park MS, Choi Y, Koo S, Jang S, Lee KM. Dynamic First Tarsometatarsal Instability During Gait Evaluated by Pedobarographic Examination in Patients With Hallux Valgus. Foot Ankle Int 2019; 40:1104-1109. [PMID: 31215243 DOI: 10.1177/1071100719850802] [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 This study aimed to investigate the pedobarographic characteristics of tarsometatarsal instability and to identify factors associated with pedobarographic first tarsometatarsal instability in patients with hallux valgus. METHODS Fifty-seven patients (mean age, 59.7 years; standard deviation, 11.4 years; 6 men and 51 women) with a hallux valgus angle (HVA) greater than 15 degrees were included. All patients underwent a pedobarographic examination along with weightbearing anteroposterior (AP) and lateral foot radiography. Radiographic measurements were compared between the 2 groups with and without pedobarographic first tarsometatarsal instability. The association between the radiographic and pedobarographic parameters of the first tarsometatarsal instability was analyzed using the chi-square test. Binary logistic regression analysis was performed to identify significant factors affecting pedobarographic first tarsometatarsal instability. RESULTS The HVA (P < .001), intermetatarsal angle (P = .001), and AP talo-first metatarsal angle were significantly different between the pedobarographically stable and unstable tarsometatarsal groups. There was no significant association between radiographic and pedobarographic instability of the first tarsometatarsal joint (P = .924). The HVA was found to be the only significant factor affecting pedobarographic tarsometatarsal joint instability (P = .001). CONCLUSION The pedobarographic examination has possible clinical utility in evaluating first tarsometatarsal joint instability in patients with hallux valgus. Patients with a greater HVA should be assessed for the presence of first tarsometatarsal instability, and the necessity of the Lapidus procedure should be considered. LEVEL OF EVIDENCE Level III, comparative study.
Collapse
Affiliation(s)
- Byung Cho Min
- 1 Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea
| | - Chin Youb Chung
- 1 Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea
| | - Moon Seok Park
- 1 Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea
| | - Young Choi
- 2 Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Pusan, Korea
| | - Seungbum Koo
- 3 Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejon, Korea
| | - Seonpyo Jang
- 1 Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea
| | - Kyoung Min Lee
- 1 Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea
| |
Collapse
|
|
17
|
Walley KC, Roush EP, Stauch CM, Kunselman AR, Saloky KL, King JL, Lewis GS, Aynardi MC. Three-Dimensional Morphometric Modeling Measurements of the Calcaneus in Adults with Stage IIB Posterior Tibial Tendon Dysfunction: A Pilot Study. Foot Ankle Spec 2019; 12:316-321. [PMID: 30168360 DOI: 10.1177/1938640018796618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The pathophysiology of adult-acquired flatfoot deformity (AAFD) is not fully explained by degeneration of the posterior tibial tendon alone. While a shortened or dysplastic lateral column has been implicated in flatfoot deformity in pediatrics, there is no study that has quantified the degree of dysplasia in adults with a stage IIb flatfoot deformity, or if any exists at all. Methods: An institutional radiology database was queried for patients with posterior tibial tendon dysfunction (PTTD) who had computed tomography (CT) performed. Controls were patients receiving CT scan for an intra-articular distal tibia fracture without preexisting foot or calcaneal pathology. Clinical notes, physical examination, and weightbearing radiographs were used to find patients that met clinical criteria for stage IIb PTTD. Morphometric measurements of the calcanei were performed involving the length of the calcaneal axis (LCA), height of the anterior process (HAP), and length of the anterior process (LAP). All measurements were performed independently by separate observers, with observers blinded to group assignment. We considered a difference of ±4 mm as our threshold. Results: 7 patients and 7 controls were available for reconstruction and analysis. On average, the LCA was 3.1 mm shorter in patients with stage IIb PTTD compared with controls (P < .05). The LAP was shorter in PTTD patients compared with controls 3.4 mm (P < .001). Conclusions: Our results support the hypothesis that the calcaneus of adult patients with stage IIb AAFD is dysplastic when compared with healthy controls, which further supports the utility of lateral column lengthening. Levels of Evidence: Level III: Case-control study.
Collapse
Affiliation(s)
- Kempland C Walley
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute (KCW, EPR, CMS, KLS, JLK, GSL, MCA) Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.,Department of Public Health Sciences (ARK) Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Evan P Roush
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute (KCW, EPR, CMS, KLS, JLK, GSL, MCA) Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.,Department of Public Health Sciences (ARK) Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Christopher M Stauch
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute (KCW, EPR, CMS, KLS, JLK, GSL, MCA) Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.,Department of Public Health Sciences (ARK) Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Allen R Kunselman
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute (KCW, EPR, CMS, KLS, JLK, GSL, MCA) Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.,Department of Public Health Sciences (ARK) Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Kaitlin L Saloky
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute (KCW, EPR, CMS, KLS, JLK, GSL, MCA) Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.,Department of Public Health Sciences (ARK) Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jesse L King
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute (KCW, EPR, CMS, KLS, JLK, GSL, MCA) Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.,Department of Public Health Sciences (ARK) Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Gregory S Lewis
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute (KCW, EPR, CMS, KLS, JLK, GSL, MCA) Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.,Department of Public Health Sciences (ARK) Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Michael C Aynardi
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute (KCW, EPR, CMS, KLS, JLK, GSL, MCA) Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.,Department of Public Health Sciences (ARK) Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| |
Collapse
|
|
18
|
Stith A, Dang D, Griffin M, Flint W, Hirose C, Coughlin M. Rigid Internal Fixation of Proximal Crescentic Metatarsal Osteotomy in Hallux Valgus Correction. Foot Ankle Int 2019; 40:778-789. [PMID: 30994364 DOI: 10.1177/1071100719842800] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate outcomes utilizing a low-profile titanium plate and screw construct for rigid fixation of first ray proximal crescentic osteotomies in the treatment of hallux valgus. METHODS Forty-eight patients (53 feet) with mild to severe hallux valgus were prospectively enrolled and completed 12-month follow-up. All were treated with a proximal crescentic osteotomy, fixed with a low-profile titanium plate, distal soft tissue correction, with or without an Akin osteotomy. Recorded outcomes included change in first ray dorsiflexion angles, need for hardware removal, radiographic and clinical evaluation, pain, and American Orthopaedic Foot & Ankle Society (AOFAS) scores. RESULTS All patients achieved radiographic union of their osteotomy. An Akin osteotomy was performed in 83% of patients. Seventeen feet (32%) had hardware removed. First ray dorsiflexion angles increased from a mean of 1.6 degrees preoperatively to 5.0 degrees postoperatively (P < .001). Dorsal malunion, defined as change in dorsiflexion angle greater than 1 standard deviation above the mean, occurred in 7 feet. The mean hallux valgus angle improved from 29 to 9 degrees (P < .001). The mean 1-2 intermetatarsal angle decreased from 14 to 6 degrees (P < .001). The first metatarsophalangeal joint range of motion decreased from 77 to 59 degrees (P < .001). The mean visual analog scale score improved from 4 to 0.7 (P < .0001). The mean AOFAS score improved from 55 to 89 points (P < .001). CONCLUSION Proximal crescentic metatarsal osteotomy, fixed with a low-profile titanium plate and screw construct, with distal soft tissue repair, and Akin osteotomy as indicated, was a safe and reliable method for operative treatment of hallux valgus. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
- Andrew Stith
- 1 Saint Alphonsus Medical Group, Coughlin Foot & Ankle Clinic, Boise, ID, USA
| | - Debbie Dang
- 1 Saint Alphonsus Medical Group, Coughlin Foot & Ankle Clinic, Boise, ID, USA
| | | | - Wesley Flint
- 1 Saint Alphonsus Medical Group, Coughlin Foot & Ankle Clinic, Boise, ID, USA
| | - Christopher Hirose
- 1 Saint Alphonsus Medical Group, Coughlin Foot & Ankle Clinic, Boise, ID, USA
| | - Michael Coughlin
- 1 Saint Alphonsus Medical Group, Coughlin Foot & Ankle Clinic, Boise, ID, USA
| |
Collapse
|
|
19
|
[Clinical examination of the foot]. DER ORTHOPADE 2019; 48:541-552. [PMID: 31127331 DOI: 10.1007/s00132-019-03748-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A systematic clinical examination of the foot, including a structured medical history, is essential for the diagnostics of foot disorders. The foot and ankle, with a total of 28 bones and numerous joints, require a variety of musculotendinous and neuromuscular structures for stabilization and faultless gait. Almost all anatomical structures of the foot are easily accessible for a manual clinical examination due to the sparse soft tissue covering. This requires differentiated and well-founded anatomical knowledge as well as examination experience to be able to distinguish a normal finding from a pathological abnormality. The examination of the contralateral foot is always necessary. A targeted supplementary imaging examination completes the diagnosis.
Collapse
|
|
20
|
Barg A, Harmer JR, Presson AP, Zhang C, Lackey M, Saltzman CL. Unfavorable Outcomes Following Surgical Treatment of Hallux Valgus Deformity: A Systematic Literature Review. J Bone Joint Surg Am 2018; 100:1563-1573. [PMID: 30234626 PMCID: PMC6636801 DOI: 10.2106/jbjs.17.00975] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgical correction of deformity plays a central role in the treatment of hallux valgus deformity. However, complications or unintended outcomes are frequently noted in clinical series. There has been no rigorous systematic review of studies reporting outcomes of surgical treatment for hallux valgus deformity, to the best of our knowledge. METHODS We performed a systematic review of studies reporting the outcomes of surgical correction for hallux valgus deformity. RESULTS A total of 229 studies met the inclusion criteria. The pooled rates of postoperative patient dissatisfaction and postoperative first metatarsophalangeal pain were 10.6% and 1.5%, respectively. The overall rate of recurrent deformity was 4.9%. CONCLUSIONS Hallux valgus surgery has been reported to have fairly consistent results and rates of complications or unfavorable outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Alexej Barg
- Department of Orthopaedics (A.B., J.R.H., and C.L.S.) and Division of Epidemiology, Department of Internal Medicine (A.P.P. and C.Z.), University of Utah, Salt Lake City, Utah,E-mail address for A. Barg:
| | - Joshua R. Harmer
- Department of Orthopaedics (A.B., J.R.H., and C.L.S.) and Division of Epidemiology, Department of Internal Medicine (A.P.P. and C.Z.), University of Utah, Salt Lake City, Utah
| | - Angela P. Presson
- Department of Orthopaedics (A.B., J.R.H., and C.L.S.) and Division of Epidemiology, Department of Internal Medicine (A.P.P. and C.Z.), University of Utah, Salt Lake City, Utah
| | - Chong Zhang
- Department of Orthopaedics (A.B., J.R.H., and C.L.S.) and Division of Epidemiology, Department of Internal Medicine (A.P.P. and C.Z.), University of Utah, Salt Lake City, Utah
| | - Mellanye Lackey
- Spencer S. Eccles Health Sciences Library, Salt Lake City, Utah
| | - Charles L. Saltzman
- Department of Orthopaedics (A.B., J.R.H., and C.L.S.) and Division of Epidemiology, Department of Internal Medicine (A.P.P. and C.Z.), University of Utah, Salt Lake City, Utah,E-mail address for C.L. Saltzman:
| |
Collapse
|
|
21
|
Ito K, Hosoda K, Shimizu M, Ikemoto S, Nagura T, Seki H, Kitashiro M, Imanishi N, Aiso S, Jinzaki M, Ogihara N. Three-dimensional innate mobility of the human foot bones under axial loading using biplane X-ray fluoroscopy. ROYAL SOCIETY OPEN SCIENCE 2017; 4:171086. [PMID: 29134100 PMCID: PMC5666283 DOI: 10.1098/rsos.171086] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/18/2017] [Indexed: 05/13/2023]
Abstract
The anatomical design of the human foot is considered to facilitate generation of bipedal walking. However, how the morphology and structure of the human foot actually contribute to generation of bipedal walking remains unclear. In the present study, we investigated the three-dimensional kinematics of the foot bones under a weight-bearing condition using cadaver specimens, to characterize the innate mobility of the human foot inherently prescribed in its morphology and structure. Five cadaver feet were axially loaded up to 588 N (60 kgf), and radiographic images were captured using a biplane X-ray fluoroscopy system. The present study demonstrated that the talus is medioinferiorly translated and internally rotated as the calcaneus is everted owing to axial loading, causing internal rotation of the tibia and flattening of the medial longitudinal arch in the foot. Furthermore, as the talus is internally rotated, the talar head moves medially with respect to the navicular, inducing external rotation of the navicular and metatarsals. Under axial loading, the cuboid is everted simultaneously with the calcaneus owing to the osseous locking mechanism in the calcaneocuboid joint. Such detailed descriptions about the innate mobility of the human foot will contribute to clarifying functional adaptation and pathogenic mechanisms of the human foot.
Collapse
Affiliation(s)
- Kohta Ito
- Department of Mechanical Engineering, Faculty of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama 223-8522, Japan
- Authors for correspondence: Kohta Ito e-mail:
| | - Koh Hosoda
- Department of System Innovation, Graduate School of Engineering Science, Osaka University, Toyonaka, Japan
| | - Masahiro Shimizu
- Department of System Innovation, Graduate School of Engineering Science, Osaka University, Toyonaka, Japan
| | - Shuhei Ikemoto
- Department of System Innovation, Graduate School of Engineering Science, Osaka University, Toyonaka, Japan
| | - Takeo Nagura
- School of Medicine, Keio University, Tokyo, Japan
| | | | | | | | | | | | - Naomichi Ogihara
- Department of Mechanical Engineering, Faculty of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama 223-8522, Japan
- Authors for correspondence: Naomichi Ogihara e-mail:
| |
Collapse
|
|
22
|
Thomas M, Jordan M. [Proximal corrective osteotomy : Correction of hallux valgus deformity]. DER ORTHOPADE 2017; 46:414-423. [PMID: 28382375 DOI: 10.1007/s00132-017-3413-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Severe symptomatic hallux valgus deformities are usually not treatable with conservative methods in the long-term. Surgical treatment currently aims for mechanical restitution of the first ray with preserved mobility of the first metatarsophalangeal (MTP 1) joint and with low risk of recurrence after surgery. Keeping these aims in mind the surgical methods consist of osteotomy at the proximal part of the first metatarsal bone with a high potential for correction of the deformity. Surgical interventions at the midshaft level of the first metatarsal are only useful if the anatomical shape of the metatarsal shows a wide shaft, which allows a large shift in the osteotomy. In all other cases of severe hallux valgus deformity two different surgical principles are currently used and recommended: 1. proximal or basal osteotomy of the first metatarsal bone in all cases with a preserved MTP 1 and tarsometatarsal (TMT-1) joint without signs of instability. 2. Arthrodesis of the TMT-1 joint in all cases of instability or degenerative changes with an intact MTP 1 joint, the so-called Lapidus arthrodesis. This article gives an overview over the most important and widely used surgical techniques for correction of severe hallux valgus deformities. Emphasis is placed on the different osteosynthesis techniques and the recommended postoperative regimens. The advantages and disadvantages of the most frequently employed osteotomy techniques are discussed based on the current literature and the authors own experience.
Collapse
Affiliation(s)
- M Thomas
- Abteilung für Fuß- und Sprunggelenkschirurgie, Hessingpark-Clinic, Hessingstr. 17, 86199, Augsburg, Deutschland.
| | - M Jordan
- Abteilung für Fuß- und Sprunggelenkschirurgie, Hessingpark-Clinic, Hessingstr. 17, 86199, Augsburg, Deutschland
| |
Collapse
|
|
23
|
Abstract
Hallux valgus deformity is one of the most common diseases in foot and ankle surgery. Satisfactory outcomes tend to be achieved only through operative correction. However, selection of the optimal surgical strategy is always a controversial topic, and the rate of dissatisfied patients postoperativelyis still very high. It is well known that there are various pathological changes in hallux valgus deformity, so it is impossible to use one specific procedure to solve all the problems. It requires a careful preoperative physical examination and radiographic assessment to choose the best operation for each kind of deformity according to each pathalogical change, combined with good postoperative dressing, immobilization and proper rehabilitation and follow up, to improve surgical outcomes and reduce postoperative rate of complication and dissatisfaction. In order to achieve these goals, a Consensus on the Operative Correction of Hallux Valgus has been developed by the Foot and Ankle Working Committee, Orthopaedic Branch, Chinese Association of Orthopaedic Surgeons. Foot and ankle surgeons following this consensus must be fully aware of their patients' desires, carefully evaluate different pathological processes and clinical symptoms and be skilled in various procedures. Then these procedures can be easily selected, converted and combined based on preoperative plans and intraoperative conditions.
Collapse
|
|
24
|
Abstract
Three-dimensional (3-D) printing offers many potential advantages in designing and manufacturing plating systems for foot and ankle procedures that involve small, geometrically complex bony anatomy. Here, we describe the design and clinical use of a Ti-6Al-4V ELI bone plate (FastForward™ Bone Tether Plate, MedShape, Inc., Atlanta, GA) manufactured through 3-D printing processes. The plate protects the second metatarsal when tethering suture tape between the first and second metatarsals and is a part of a new procedure that corrects hallux valgus (bunion) deformities without relying on doing an osteotomy or fusion procedure. The surgical technique and two clinical cases describing the use of this procedure with the 3-D printed bone plate are presented within.
Collapse
|
|
25
|
Abstract
Hallux valgus deformity is a very common pathological condition which commonly produces painful disability. It is characterised as a combined deformity with a malpositioning of the first metatarsophalangeal joint caused by a lateral deviation of the great toe and a medial deviation of the first metatarsal bone. Taking the patient’s history and a thorough physical examination are important steps. Anteroposterior and lateral weight-bearing radiographs of the entire foot are crucial for adequate assessment in the treatment of hallux valgus. Non-operative treatment of the hallux valgus cannot correct the deformity. However, insoles and physiotherapy in combination with good footwear can help to control the symptoms. There are many operative techniques for hallux valgus correction. The decision on which surgical technique is used depends on the degree of deformity, the extent of degenerative changes of the first metatarsophalangeal joint and the shape and size of the metatarsal bone and phalangeal deviation. The role of stability of the first tarsometatarsal joint is controversial. Surgical techniques include the modified McBride procedure, distal metatarsal osteotomies, metatarsal shaft osteotomies, the Akin osteotomy, proximal metatarsal osteotomies, the modified Lapidus fusion and the hallux joint fusion. Recently, minimally invasive percutaneous techniques have gained importance and are currently being evaluated more scientifically. Hallux valgus correction is followed by corrective dressings of the great toe post-operatively. Depending on the procedure, partial or full weight-bearing in a post-operative shoe or cast immobilisation is advised. Post-operative radiographs are taken in regular intervals until osseous healing is achieved. Cite this article: Fraissler L, Konrads C, Hoberg M, Rudert M, Walcher M. Treatment of hallux valgus deformity. EFORT Open Rev 2016;1:295-302. DOI: 10.1302/2058-5241.1.000005.
Collapse
|
|
26
|
Robinson C, Bhosale A, Pillai A. Footwear modification following hallux valgus surgery: The all-or-none phenomenon. World J Methodol 2016; 6:171-180. [PMID: 27376022 PMCID: PMC4921948 DOI: 10.5662/wjm.v6.i2.171] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 03/31/2016] [Accepted: 04/22/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To define footwear outcomes following hallux valgus surgery, focusing on patient return to comfortable and heeled footwear and patterns of post-operative footwear selection.
METHODS: Surgical intervention is indicated for symptomatic cases of hallux valgus unresponsive to conservative methods, with favourable reported outcomes. The return to various types of footwear post-operatively is reflective of the degree of correction achieved, and corresponds to patient satisfaction. Patients are expected to return to comfortable footwear post-operatively without significant residual symptoms. Many female patients will additionally attempt to return to high-heeled, narrow toe box shoes. However, minimal evidence exists to guide their expectations. Sixty-five female hallux valgus patients that had undergone primary surgery between 2011 and 2013 were retrospectively identified using our hospital surgical database. Patients were reviewed using a footwear-specific outcome questionnaire at a mean 18.5 mo follow-up.
RESULTS: Eighty-six percent of patients were able to return to comfortable footwear post-operatively with minimal discomfort. Of those intending to resume wearing heeled footwear, 62% were able to do so, with 77% of these patients wearing these as or more frequently than pre-operatively. No significant difference was observed between pre- and post-operative heel size. Mean time to return to heeled footwear was 21.4 wk post-operation. Cosmetic outcomes were very high and did not adversely impact footwear selection.
CONCLUSION: We report high rates of return to both comfortable and heeled shoes in female patients following primary hallux valgus surgery. We observed an “all-or-none phenomenon” where patients rejected a return to heeled footwear unless able to tolerate them at the same frequency and heel size as pre-operatively. A minority of patients were unable to return to comfortable footwear post-operatively, which had adverse ramifications on their quality-of-life. We recommend that the importance of managing patient expectations through appropriate pre-operative counselling be emphasized in forefoot surgery.
Collapse
|
|
27
|
Singh D, Biz C, Corradin M, Favero L. Comparison of dorsal and dorsomedial displacement in evaluation of first ray hypermobility in feet with and without hallux valgus. Foot Ankle Surg 2016; 22:120-4. [PMID: 27301732 DOI: 10.1016/j.fas.2015.05.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 05/24/2015] [Accepted: 05/30/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hypermobility of the first ray, a probable primary cause of hallux valgus, has traditionally been evaluated in the dorsal direction only although the first tarso-metatarsal joint allows movement in a dorso-medial direction. MATERIALS AND METHODS 600 feet, divided according to the presence or absence of hallux valgus, were evaluated for both dorsal and dorso-medial displacement using a Klaue device. RESULTS In the control group, the mean first ray displacement was 7.2mm (4.2-11.3) in the dorsal direction (sagittal plane) and 8.3mm (4.0-12.6) in the 45° dorso-medial direction. In the hallux valgus group, the mean first ray mobility was 9.8mm (5.2-14.1) in the dorsal direction compared to a mean of 11.0mm (5.9-16.2) in the 45° dorso-medial direction. CONCLUSION It is a paradox that hypermobility of the first ray is measured in only a dorsal (vertical) direction whereas a hallux valgus angle and an intermetatarsal angle are only measured in a transverse plane. Furthermore, the weightbearing foot pronates during gait and the first metatarsal is displaced in a dorsomedial direction rather than a pure dorsal direction. It is suggested that measurement hypermobility of the first ray at a 45° dorso-medial direction is more appropriate.
Collapse
Affiliation(s)
- Dishan Singh
- Royal National Orthopaedic Hospital, Stanmore, Middelesex HA7 4LP, United Kingdom.
| | - Carlo Biz
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128 Padova, Italy.
| | - Marco Corradin
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128 Padova, Italy.
| | - Laura Favero
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128 Padova, Italy.
| |
Collapse
|
|
28
|
Akpinar E, Buyuk AF, Cetinkaya E, Gursu S, Ucpunar H, Albayrak A. Proximal Intermetatarsal Divergence in Distal Chevron Osteotomy for Hallux Valgus: An Overlooked Finding. J Foot Ankle Surg 2016; 55:504-8. [PMID: 26923689 DOI: 10.1053/j.jfas.2016.01.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Indexed: 02/03/2023]
Abstract
The goal of distal chevron osteotomy for hallux valgus is to restore proper first-toe joint alignment by performing lateral translation of the distal first metatarsal fragment (the metatarsal head). We hypothesized that in some patients this procedure might also result in involuntary medial translation of the proximal first metatarsal fragment, which we called proximal intermetatarsal divergence. The aim of the present study was to compare the pre- and postoperative radiographs of patients with hallux valgus to determine whether we could identify proximal intermetatarsal divergence. We retrospectively compared the pre- and postoperative radiographs of 29 feet in 28 patients treated with distal chevron osteotomy. Two different methods were used to measure the intermetatarsal angles: the anatomic intermetatarsal angle (aIMA) and the mechanical intermetatarsal angle (mIMA). The maximum intermetatarsal distance (MID) was also measured. We defined proximal intermetatarsal divergence as a postoperative increase in the aIMA or MID, coupled with a decrease in the mIMA. For data analysis, we divided the patients into low-angle (mild deformity) and high-angle (severe deformity) groups, according to their preoperative mIMA. The mean ± standard deviation patient age was 41 ± 14 years. In the low-angle group, the mean mIMA decreased (from 10.91° to 7.00°), the mean aIMA increased (from 11.80° to 13.55°), and the mean MID increased (from 17.97 mm to 20.60 mm; p = .001, for all). In the high-angle group, the mean mIMA decreased (from 14.30° to 6.90°; p = .001), the mean aIMA decreased (from 14.77° to 13.54°; p = .06), and the mean MID decreased (from 20.74 mm to 20.37 mm; p = .64). The results of our study suggest that proximal intermetatarsal divergence might occur after distal chevron osteotomy for hallux valgus, primarily in patients with a low preoperative mIMA.
Collapse
Affiliation(s)
- Evren Akpinar
- Orthopedist, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, İstanbul, Turkey.
| | - Abdul Fettah Buyuk
- Orthopedist, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, İstanbul, Turkey
| | - Engin Cetinkaya
- Orthopedist, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, İstanbul, Turkey
| | - Sarper Gursu
- Orthopedist, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, İstanbul, Turkey
| | - Hanifi Ucpunar
- Orthopedist, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, İstanbul, Turkey
| | - Akif Albayrak
- Orthopedist, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
|
29
|
Ikoma K, Ohashi S, Maki M, Kido M, Hara Y, Kubo T. Diagnostic Characteristics of Standard Radiographs and Magnetic Resonance Imaging of Ruptures of the Tibialis Posterior Tendon. J Foot Ankle Surg 2016; 55:542-6. [PMID: 26872525 DOI: 10.1053/j.jfas.2016.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Indexed: 02/03/2023]
Abstract
The present study aimed to diagnose complete rupture (CR) and longitudinal rupture (LR) of the posterior tibial tendon (PTT) from the magnetic resonance imaging findings in patients with PTT dysfunction and to analyze and compare the radiographs from each group to identify radiographic indicators related to the progression of PTT injury that would allow the radiographic diagnosis of CR. We evaluated 32 feet in 27 patients with PTT dysfunction (mean age 66.5, range 49 to 82, years). Radiographs were used to acquire weightbearing anteroposterior images of the foot, which were used to measure the talonavicular coverage angle. Lateral images of the foot were also acquired with the patients in the standing position. These were used to measure the lateral talometatarsal angle, calcaneal pitch angle, and medial cuneiform-fifth metatarsal height. From the axial MRI findings, the patients were divided into a CR group and an LR group, and the radiographic attributes of the CR group were analyzed. Of the 32 feet in 27 patients, 12 feet (37.5%) in 11 patients displayed CR and 20 feet (62.5%) in 18 patients displayed LR. The talonavicular coverage angle was 48.3° ± 17.3° in the CR group and 33.6° ± 13.6° in the LR group (p = .012), and the talometatarsal angle was -28.8° ± 22.5° in the CR group and -25.4° ± 14.4° in the LR group (p = .596). The calcaneal pitch angle was 10.4° ± 6.7° in the CR group and 10.2° ± 8.0° in the LR group (p = .935). Finally, the medial cuneiform-fifth metatarsal height was -4.2 ± 7.1 mm in the CR group and 2.1 ± 4.7 mm in the LR group (p = .005). When a medial cuneiform-fifth metatarsal height of ≤0 mm or talonavicular coverage angle of ≥50° was used as the diagnostic criterion for CR on weightbearing radiographs, the sensitivity was 71.4%, specificity 88.9%, and diagnostic accuracy 81.3%; hence, we believe these to be satisfactory diagnostic criteria for CR.
Collapse
Affiliation(s)
- Kazuya Ikoma
- Associate Professor, Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Suzuyo Ohashi
- Assistant Professor, Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Maki
- Assistant Professor, Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masamitsu Kido
- Assistant Professor, Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yusuke Hara
- Assistant Professor, Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshikazu Kubo
- Professor, Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
|
30
|
Seng C, Chunyin Ho D, Chong KW. Restoring Sesamoid Position in Scarf Osteotomy: A Learning Curve. J Foot Ankle Surg 2015; 54:1089-92. [PMID: 26321652 DOI: 10.1053/j.jfas.2015.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Indexed: 02/03/2023]
Abstract
Incomplete reduction of the sesamoid is a known risk factor for recurrence of the deformity after scarf osteotomy for correction of hallux valgus. The purpose of the present study was to determine whether a learning curve exists for successfully restoring the sesamoid position in scarf osteotomy. We reviewed 71 consecutive cases (71 feet) of scarf osteotomy performed on female patients during a 2.5-year period by the same surgeon. The cases were divided into 3 groups according to the date of surgery, with the first 24 cases assigned to group 1, the next 24 to group 2, and the last 23 to group 3. We compared the median sesamoid position of the 3 groups at 6 weeks postoperatively and patient reported satisfaction at 6 months postoperatively. The sesamoid position ranged from 1 to 7, using the Hardy and Clapham classification system. The median sesamoid position for all patients had improved from 7 preoperatively to 2 postoperatively. The postoperative sesamoid position was significantly better for the second and third groups than for the first (p < .05), and 92% of the patients were satisfied with the procedure. We have concluded that a learning curve to optimally restoring the position of the sesamoid in scarf osteotomy is present and that this has a direct effect on reducing the risk of recurrence of the deformity.
Collapse
Affiliation(s)
- Chusheng Seng
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
| | - Derek Chunyin Ho
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Keen Wai Chong
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| |
Collapse
|
|
31
|
Abstract
We present a discussion on the use of proximal first-ray osteotomies in the surgical treatment for hallux valgus as a valid option compared with first-tarsometatarsal arthrodesis. Recent and historical literature tells us that stability of the first ray is a function of the alignment and reestablishment of retrograde stabilizing forces at the first tarsometatarsal joint. This realignment and stabilization may be accomplished with the use of distal soft tissue and proximal osteotomy procedures.
Collapse
Affiliation(s)
- Matthew D Sorensen
- Weil Foot & Ankle Institute, Golf River Professional Building, 1455 East Golf Road, Des Plaines, IL 60016, USA.
| | - Brian Gradisek
- Weil Foot & Ankle Institute, Golf River Professional Building, 1455 East Golf Road, Des Plaines, IL 60016, USA
| | - James M Cottom
- Coastal Orthopedics and Sports Medicine, Bradenton, FL, USA
| |
Collapse
|
|
32
|
Xu H, Jin K, Fu Z, Ma M, Liu Z, An S, Jiang B. Radiological characteristics and anatomical risk factors in the evaluation of hallux valgus in chinese adults. Chin Med J (Engl) 2015; 128:51-7. [PMID: 25563313 PMCID: PMC4837819 DOI: 10.4103/0366-6999.147810] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: There are no unified theories as to the anatomical changes that occur with hallux valgus, we investigated the radiological characteristics and anatomical risk factors for hallux valgus deformity in Chinese adults. Methods: We reviewed 141 patients with hallux valgus (206 feet; 15 males, 126 females; mean age, 58.5 years). These patients attended Peking University People's Hospital from April 2008 to March 2014. All feet had intact radiological data, obtained using the Centricity RIS/PACS system. We measured hallux valgus angle (HVA), 1–2 intermetatarsal angle (IMA), proximal articular set angle (PASA), distal articular set angle, hallux interphalangeal angle, metatarsocuneiform angle, size of the medial eminence of the distal first metatarsal, tibial sesamoid position, and joint congruity of the first metatarsophalangeal joint (MTPJ). Results: We found positive correlations between the HVA and IMA (r = 0.279, P < 0.01) and HVA and PASA (r = 0.358, P < 0.01), but not for IMA and PASA (P > 0.05). Feet were divided into three groups based on HVA severity. IMA (P < 0.05) and PASA (P < 0.05) in the mild group were significantly lower than that in the moderate and severe groups, with no significant difference determined for IMA or PASA between the moderate and severe groups (P > 0.05). Feet were then grouped based on the shape of the first metatarsal head. Using this grouping, HVA was significant higher in the rounded shape (19.92°) than in a flat shape (17.66°). The size of the medial eminence of the distal first metatarsal was positively correlated with HVA (r = 0.185, P < 0.01). The medial eminence in the moderate and severe groups was significantly larger than that in the mild group; moderate and severe groups were not significantly different. Conclusions: PASA enlargement is an adaptive change during early hallux valgus formation, and decompensation leads to subdislocation in the first MTPJ. A rounded first metatarsal head would thus predispose a foot to hallux valgus. Furthermore, bone proliferation at the medial eminence may also lead to early hallux valgus development.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Baoguo Jiang
- Department of Orthopedics, Peking University People's Hospital, Beijing 100044, China
| |
Collapse
|
|
33
|
Galli MM, McAlister JE, Berlet GC, Hyer CF. Enhanced Lapidus arthrodesis: crossed screw technique with middle cuneiform fixation further reduces sagittal mobility. J Foot Ankle Surg 2014; 54:437-40. [PMID: 25456344 DOI: 10.1053/j.jfas.2014.10.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Indexed: 02/03/2023]
Abstract
Persistent medial column sagittal mobility can be encountered despite successful first tarsometatarsal stabilization if fixation has been limited to the first tarsometatarsal joint. The purpose of the present cadaveric research was to quantify the effect of a third point of fixation from the base of the first metatarsal to the middle cuneiform compared with the traditional isolated first tarsometatarsal fixation. Ten matched pairs of below-the-knee specimens, with a known cause of death, sex, ethnicity, and age, height, weight, and body mass index at death, were used for our examination. Portable fluoroscopy aided with the accurate placement of all points of fixation. Measurements of movement were obtained using the validated Klaue device. The 20 matched below-the-knee specimens were from 10 cadavers (2 female and 8 male donors, aged 72.8 ± 9.3 years, body mass index 21.1 ± 4.2 kg/m(2)). The sagittal plane motion of the first ray was 7.45 ± 1.82 mm before fixation. With isolated first tarsometatarsal fixation, the sagittal motion decreased to 4.41 ± 1.51 mm and decreased further to 3.12 ± 1.06 mm, with the addition of middle cuneiform fixation. Statistically significant enhancement of the stability of sagittal first ray motion was noted with the addition of the first metatarsal to middle cuneiform pin, even after simulated Lapidus fixation. Our findings suggest that first metatarsal to middle cuneiform fixation can be beneficial if excessive sagittal motion is present after standard 2-point fixation and can play a role in the prevention of recurrence and complications.
Collapse
Affiliation(s)
| | | | - Gregory C Berlet
- Fellowship Director for Advanced Orthopedic Foot and Ankle Fellowship, Orthopedic Foot and Ankle Center, Westerville, OH
| | - Christopher F Hyer
- Fellowship Director for Advanced Foot and Ankle Surgical Fellowship, Orthopedic Foot and Ankle Center, Westerville, OH.
| |
Collapse
|
|
34
|
Wong DWC, Zhang M, Yu J, Leung AKL. Biomechanics of first ray hypermobility: An investigation on joint force during walking using finite element analysis. Med Eng Phys 2014; 36:1388-93. [PMID: 24726375 DOI: 10.1016/j.medengphy.2014.03.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 02/22/2014] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
Hypermobility of the first ray is suggested to contribute to hallux valgus. The investigation of first ray hypermobility focused on the mobility and range of motion that based on manual examination. The load transfer mechanism of the first ray is important to understand the development and pathomechanism of hallux valgus. In this study, we investigated the immediate effect of the joint hypermobility on the metatarsocuneiform and metatarsophalangeal joint loading through a reduction of the stiffness of the foot ligaments. A three-dimensional foot model was constructed from a female aged 28 via MRI. All foot and ankle bones, including two sesamoids and the encapsulated bulk tissue were modeled as 3D solid parts, linking with ligaments of shell elements and muscles connectors. The stance phase of walking was simulated by the boundary and loading conditions obtained from gait analysis of the same subject. Compared with the normal foot, the hypermobile foot had higher resultant metatarsocuneiform and metatarsophalangeal joint forces. The increases accounted for 18.6% and 3.9% body weight. There was also an abrupt change of metatarsocuneiform joint force in the medial-lateral direction. The predicted results represented possible risk of joint problems and metatarsus primus varus.
Collapse
|
|
35
|
Metatarsal Horizontal Angle Variety Information of Female with Different Hallux Valgus. JOURNAL OF BIOMIMETICS BIOMATERIALS AND BIOMEDICAL ENGINEERING 2014. [DOI: 10.4028/www.scientific.net/jbbbe.21.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hallux valgus is a common foot deformity with a multifactorial etiology. Factors associated with the development of hallux valgus (HV) are multifactorial and the etiology of hallux valgus remains unclear. The purpose of this study was to measure the biomechanical relationship between Hallux Valgus Angle (HVA), intermetatarsal Angle (IMA), Interphalangeal Angle (IPA), and metatarsal horizontal angle, in order to reveal the tendency of metatarsal horizontal angle along with hallux valgus angle increasing. Foot models of nine subjects are built through CT scan and editing software and calculated metatarsal horizontal angles using motion analysis system. It showed that with the increased of HVA, the metatarsal horizontal angle of the first to fifth was decreased. This method and results maybe have a new sight to reveal the characters of HV patients. Keywords: Hallux valgus; Metatarsal horizontal angle; Foot Models
Collapse
|
|
36
|
Abstract
Recurrence of hallux valgus deformity can be a common complication after corrective surgery. The cause of recurrent hallux valgus is usually multifactorial, and includes patient-related factors such as preoperative anatomic predisposition, medical comorbidities, compliance with postcorrection instructions, and surgical factors such as choice of the appropriate procedure and technical competency. For a successful outcome, this cause must be ascertained preoperatively. Although the algorithm to determine which intervention should be used is not unlike that of primary hallux valgus surgery, operative correction of hallux valgus recurrence can be challenging. This article discusses these challenges, complications, causes, and techniques.
Collapse
|
|
37
|
Glasoe WM, Jensen DD, Kampa BB, Karg LK, Krych AR, Pena FA, Ludewig PM. First Ray Kinematics in Women With Rheumatoid Arthritis and Bunion Deformity: A Gait Simulation Imaging Study. Arthritis Care Res (Hoboken) 2014; 66:837-43. [DOI: 10.1002/acr.22241] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 11/19/2013] [Indexed: 01/13/2023]
Affiliation(s)
| | | | | | - Lara K. Karg
- University of Minnesota Medical School; Minneapolis
| | | | | | | |
Collapse
|
|
38
|
Morris J, Ryan M. First metatarsal base osteotomies for hallux abducto valgus deformities. Clin Podiatr Med Surg 2014; 31:247-63. [PMID: 24685191 DOI: 10.1016/j.cpm.2013.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Proximal first metatarsal osteotomies have historically been associated with and limited to treatment of severe hallux valgus deformities. These procedures are powerful in deformity correction and overall realignment of first ray function because of their ability to correct closer to the deformity's origin. When considering all factors in bunion correction, they are good options for correction of a wide range of hallux abducto valgus deformities. This article discusses the use of proximal metatarsal osteotomies for correction of hallux valgus deformity, techniques to facilitate optimal outcome, and common complications of these osteotomies.
Collapse
Affiliation(s)
- Jason Morris
- University Foot and Ankle Institute, 2121 Wilshire Boulevard Suite 101, Santa Monica, CA 90403, USA.
| | - Michael Ryan
- Private Practice, 2021 Freeport Road, Arnold, PA 15068, USA
| |
Collapse
|
|
39
|
Burns PR, Mecham B. Biodynamics of hallux abductovalgus etiology and preoperative evaluation. Clin Podiatr Med Surg 2014; 31:197-212. [PMID: 24685187 DOI: 10.1016/j.cpm.2013.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Hallux abductovalgus (HAV) is a common but complex deformity. HAV is a combination of deformities and abnormalities. Because HAV is not from a single cause or pathologic process, controversies in description and potential treatments exist. Although many HAV deformities appear similar, no two are the same and thus cannot be treated the same surgically.
Collapse
Affiliation(s)
- Patrick R Burns
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, 2100 Jane Street, RTMB N7100, Pittsburgh, PA 15203, USA.
| | - Brandon Mecham
- Podiatric Medicine and Surgery Residency, University of Pittsburgh Medical Center, 2100 Jane Street, RTMB N7100, Pittsburgh, PA 15203, USA
| |
Collapse
|
|
40
|
|
|
41
|
Takata Y, Matsuoka S, Okumura N, Iwamoto K, Takahashi M, Uchiyama E. Standing balance on the ground -the influence of flatfeet and insoles. J Phys Ther Sci 2014; 25:1519-21. [PMID: 24409010 PMCID: PMC3885829 DOI: 10.1589/jpts.25.1519] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 06/24/2013] [Indexed: 12/26/2022] Open
Abstract
[Purpose] The aim of this study was to determine whether insoles change standing balance on the ground in normal and flat-footed subjects. [Subjects] Twenty subjects with flatfeet and 20 subjects with normal feet were included in this study. [Methods] Body sway was evaluated based on the center of pressure while subjects stood on the ground. Body sway was measured during upright standing with the feet 10 cm apart for 30 seconds. The total locus length and the area of body sway were then measured using a zebris system. Measurements were made under three sets of conditions: using BMZ insoles, which supported the cuboid; using Superfeet insoles, which supported the medial longitudinal arch; and with no insoles. [Results] The 3 insole conditions were compared. On level ground, the total locus length for the Superfeet insole was significantly less than those for the BMZ insole and no insole. [Conclusion] On level ground, Superfeet feet insoles were effective in stabilizing standing balance in both flat-footed and normal-footed subjects.
Collapse
Affiliation(s)
- Yuichi Takata
- Department of Physical Therapy, Faculty of Human Science, Hokkaido Bunkyo University, Japan ; Graduate School of Health Sciences, Sapporo Medical University, Japan
| | - Shinji Matsuoka
- Department of Physical Therapy, Faculty of Human Science, Hokkaido Bunkyo University, Japan
| | - Nobuhisa Okumura
- Department of Occupational Therapy, Faculty of Human Science, Hokkaido Bunkyo University, Japan
| | - Koji Iwamoto
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, Japan
| | | | - Eiichi Uchiyama
- Division of Physical Therapy, Sapporo Medical University, Japan
| |
Collapse
|
|
42
|
Yamaguchi S, Tanaka Y, Shinohara Y, Taniguchi A, Sasho T, Takahashi K, Takakura Y. Anatomy of hallux valgus in rheumatoid arthritis: radiographic analysis using a two-dimensional coordinate system. Mod Rheumatol 2014. [DOI: 10.3109/s10165-012-0739-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
|
43
|
He Y, Peng D. Comment on Schuh et al.: Angular correction and complications of proximal first metatarsal osteotomies for hallux valgus deformity. INTERNATIONAL ORTHOPAEDICS 2013; 38:667. [PMID: 24363109 DOI: 10.1007/s00264-013-2205-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 11/13/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Yi He
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People's Republic of China
| | | |
Collapse
|
|
44
|
Schuh R, Willegger M, Holinka J, Ristl R, Windhager R, Wanivenhaus AH. Response to the comment on Schuh et al.: Angular correction and complications of proximal first metatarsal osteotomies for hallux valgus deformity. INTERNATIONAL ORTHOPAEDICS 2013; 38:669-70. [PMID: 24292285 DOI: 10.1007/s00264-013-2206-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 11/13/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Reinhard Schuh
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria,
| | | | | | | | | | | |
Collapse
|
|
45
|
Abstract
BACKGROUND Although not well understood, foot kinematics are changed with hallux valgus. OBJECTIVE The purpose of this study was to examine tarsal kinematics in women with hallux valgus deformity. DESIGN A prospective, cross-sectional design was used. METHODS Twenty women with (n=10) and without (n=10) deformity participated. Data were acquired with the use of a magnetic resonance scanner. Participants were posed standing to simulate gait, with images reconstructed into virtual bone datasets. Measures taken described foot posture (hallux angle, intermetatarsal angle, arch angle). With the use of additional computer processes, the image sequence was then registered across gait conditions to compute relative tarsal position angles, first-ray angles, and helical axis parameters decomposed into X, Y, and Z components. An analysis of variance model compared kinematics between groups and across conditions. Multiple regression analysis assessed the relationship of arch angle, navicular position, and inclination of the first-ray axis. RESULTS Both the hallux and intermetatarsal angles were larger with deformity; arch angle was not different between groups. The calcaneus was everted by ≥6.6 degrees, and the first ray adducted (F=44.17) by ≥9.3 degrees across conditions with deformity. There was an interaction (F=5.06) for the first-ray axis. Follow-up comparisons detected increased inclination of the first-ray axis over middle stance compared with late stance in the group with deformity. LIMITATIONS Gait was simulated, kinetics were not measured, and sample size was small. CONCLUSIONS There were group differences. Eversion of the calcaneus and adduction of the first ray were increased, and the first-ray axis was inclined 24 degrees over middle stance in women with deformity compared with 6 degrees in control participants. Results may identify risk factors of hallux valgus and inform nonoperative treatment (orthoses, exercise) strategies.
Collapse
|
|
46
|
Doty JF, Coughlin MJ. Hallux valgus and hypermobility of the first ray: facts and fiction. INTERNATIONAL ORTHOPAEDICS 2013; 37:1655-60. [PMID: 23892517 DOI: 10.1007/s00264-013-1977-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 06/09/2013] [Indexed: 10/26/2022]
Abstract
The aetiology of hallux valgus with regard to stability of the first metatarsocuneiform joint has historically been subject to much debate. Associations between the magnitude of the intermetatarsal angle and the hallux valgus angle have previously been established. Metatarsocuneiform joint coronal plane mobility is necessary for a concomitant increase in both of these angles. Although metatarsocuneiform joint hypermobility has been implicated in the development of a hallux valgus deformity, isolated sagittal plane instability has thus far not been proven to be a definitive cause.
Collapse
Affiliation(s)
- Jesse F Doty
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, TN 37403, USA.
| | | |
Collapse
|
|
47
|
Angular correction and complications of proximal first metatarsal osteotomies for hallux valgus deformity. INTERNATIONAL ORTHOPAEDICS 2013; 37:1771-80. [PMID: 23884327 DOI: 10.1007/s00264-013-2012-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 06/24/2013] [Indexed: 01/07/2023]
Abstract
PURPOSE Proximal first metatarsal osteotomies are recommended for the surgical treatment of moderate to severe hallux valgus deformity. This study aimed to compare correction of intermetatarsal and hallux valgus angles and complications of proximal crescentic, Ludloff, proximal opening wedge, proximal closing wedge, proximal chevron and other proximal first metatarsal osteotomies. METHODS A systematic search for the keywords "(bunion OR hallux) AND (proximal OR crescentic OR basilar OR opening OR closing OR shelf OR Ludloff) AND osteotomy" in the online databases MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews was performed. RESULTS There was a mean correction of hallux valgus angle of 20.1° [confidence interval (CI) 18.7-21.4] and of intermetatarsal angle of 8.1° (CI 7.7-8.9). The overall complication rate reached 18.7 %. CONCLUSIONS The results of this study reveal higher corrective power of proximal osteotomies compared to meta-analysis data on diaphyseal osteotomies.
Collapse
|
|
48
|
Efficacy of first metatarsophalangeal joint lateral release in hallux valgus surgery. Orthop Traumatol Surg Res 2013; 99:425-31. [PMID: 23648316 DOI: 10.1016/j.otsr.2013.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 11/22/2012] [Accepted: 01/25/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Lateral release of the sesamoid ligament complex is one of the key step to the surgical treatment of hallux valgus. Although numerous techniques are available to perform this procedure, there is no accepted consensus on the method of choice. The goal of this study was to evaluate the efficacy of sequential release of lateral soft tissue structures for correction of hallux valgus deformity. PATIENTS AND METHODS This study included 40 patients, mean age 50.9 years old (±17.4), with 49 hallux valgus deformities from mechanical causes. The first metatarsophalangeal angle (M1P1), the intermetatarsal angle (M1M2) and the position of the sesamoids in relation to mechanical axis of M (according to the Research Committee of the American Orthopedic Foot and Ankle Society) were determined on preoperative X-rays. During the procedure, lateral release was performed in several steps: sectioning the metatarsosesamoid suspensory ligament then sectioning the phalangeal insertional band (PIB) and complete detachment of the adductor on the fibular sesamoid ligament. We measured the changes in the M1P1 and M1M2 angles during this step-by-step release. RESULTS The M1P1 angle decreased during each step of release and went from 29.9° to 11.1° (P<0.001). The M1M2 decreased by 1.70° following medial capusolorrhaphy. Simple capsulorrhaphy reduced the hallux valgus deformity by 8.2° (44%). Release of the metatarsosesamoid suspensory ligament resulted in a decrease of 3.9° (or 21% of total release), release of the PIB in a decrease of 5.1° (27%) and complete detachment of the adductor in a decrease of 1.5° (8%). Thirty six percent of the sesamoids were reduced after metatarsosesamoid ligament resection, 56% after PIB release, and 60% after adductor release. DISCUSSION Lateral soft tissue release is ensured in most cases by sectioning the metatarsosesamoid suspensory ligament and the PIB. Release of the adductor from the fibular sesamoid has a limited effect. CONCLUSION Lateral soft tissue release should include sectioning the metatarsosesamoid suspensory ligament and detaching the PIB. This release should be enough to correct the deformity without performing any osteotomy in hallux valgus with M1P1<27° and M1M2<10°, as long as a stable medial plane can be obtained. LEVEL OF EVIDENCE Level IV.
Collapse
|
|
49
|
Sofka CM. Postoperative magnetic resonance imaging of the foot and ankle. J Magn Reson Imaging 2013; 37:556-65. [DOI: 10.1002/jmri.23792] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 07/27/2012] [Indexed: 11/06/2022] Open
|
|
50
|
Anatomy of hallux valgus in rheumatoid arthritis: radiographic analysis using a two-dimensional coordinate system. Mod Rheumatol 2012; 23:774-81. [PMID: 22930442 DOI: 10.1007/s10165-012-0739-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 08/01/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The purpose of this study is to compare the anatomy of rheumatoid hallux valgus with that of idiopathic hallux valgus from the standpoint of joint-preserving surgery. METHODS One hundred forty-eight feet of 81 rheumatoid patients were included. Feet with idiopathic hallux valgus and normal feet were compared as controls. Weight-bearing dorsoplantar radiographs of the feet were taken of each patient. A two-dimensional coordinate system was defined on the radiographic image, and 19 anatomic points of the forefoot were measured. RESULTS In rheumatoid hallux valgus, the first metatarsal head shifted medially as hallux valgus angle increased, which was similar to the deformity of idiopathic hallux valgus. Proximal deviation of the tips of the lesser toes, caused by clawing and dislocations of the metatarsophalangeal joints, occurred in rheumatoid hallux valgus. Specifically the tips of the second toes in rheumatoid hallux valgus were located more proximally than those in idiopathic hallux valgus irrespective of the severity of hallux valgus. CONCLUSIONS Corrective osteotomy of the first metatarsal is a reasonable procedure for rheumatoid hallux valgus. Additionally, correction of the second toe deformity to make a stable lateral support on the hallux may be another important factor for successful joint-preserving surgery.
Collapse
|