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PubMed1999

Hindfoot alignment of hallux valgus evaluated by a weightbearing subtalar x-ray view.

A new radiographic view was proposed to evaluate alignment of the hindfoot under weightbearing condition. The ankle joint and the middle and posterior facets of the subtalar joint were clearly visualized in all radiographs. A comparative study was made of 104 feet with hallux valgus in 58 female patients and 67 normal feet in 57 normal female subjects (control group). The mean value of the angle between the axis of the tibia and a line on the surface of the ankle joint on the talus was significantly larger in the group with hallux valgus than in the control group. Likewise, the mean value of the angle between the axis of the tibia and a line on the surface of the posterior facet of the subtalar joint on the calcaneus in the group with hallux valgus was 95.3 degrees, significantly larger than the 87.9 degrees in the control group. These findings showed that the ankle joint and the posterior facet of the subtalar joint in hallux valgus have valgus deviation. The hindfoot in a foot with hallux valgus has a tendency toward pronation. No previous study has measured the inclination of the posterior facet of the subtalar joint directly in weightbearing.

Adolescent↗
PubMed2006

Medial deviation of the first metatarsal in incipient hallux valgus deformity.

BACKGROUND: The aim of this study was to determine whether excessive medial deviation of the first metatarsal (excessive intermetatarsal angle) is present in the initial phase of hallux valgus. METHODS: The intermetatarsal angle between the first and second metatarsals (1-2 IMA) was radiographically studied in 49 normal feet and in 49 feet with mild hallux valgus deformity. RESULTS: The results demonstrated a statistically significant difference in the mean intermetatarsal angle between the two groups (8.76 degrees in normal feet; 9.98 degrees in affected feet). However, we believe that is not clinically significant. Other authors, comparing the 1-2 IMA in patients with or without more advanced hallux valgus, reported greater differences than those obtained in this study. CONCLUSIONS: Excessive medial deviation of the first metatarsal is not a causal factor but rather a consequence of hallux valgus deformity.

Adult↗
PubMed1976

[The etiology of hallux valgus].

Modifications of the forefoot in weightbearing are conductive to hallux valgus, some are congenital and constitutional: supination of the forefoot, adductus of the metatarsal bones, metatarsus varus primus brevis. Others are acquired: transversal flatfoot. Measurement of the different angles observed on a dorsi-plantar X-ray in relation to the external and internal limits of the Lisfranc joint has an etiological signification. To look for changes in the weightbearing configuration of the foot, an element in the formation of hallux valgus, is of use in the choice of a method of correction.

Body Weight↗
PubMed1997

Proximal metatarsal osteotomy in hallux valgus correction: a comparison of crescentic and chevron procedures.

We retrospectively evaluated the results of 50 hallux valgus reconstructions in 36 patients for moderate to severe deformities, performed by the senior author (F. M. T.). All feet were treated at the metatarsophalangeal joint with a distal soft tissue realignment. The first 25 feet were corrected proximally with a crescentic osteotomy fixed with an AO screw; these cases had an average follow-up of more than 5 years (range, 40-141 months). The second 25 feet underwent a basal osteotomy with a proximally directed chevron osteotomy; these cases had an average follow-up of 21.4 months (range, 12-33 months). The average hallux valgus correction in the crescentic osteotomy group went from 37.6 degrees to 11.4 degrees, and in the chevron osteotomy group, the hallux valgus angle was reduced from 31.3 degrees to 11.6 degrees. The intermetatarsal angle in the crescentic group was corrected from 16.2 degrees to 6 degrees, and in the chevron group the intermetatarsal angle was reduced from 15.1 degrees to 5.4 degrees. The fibular sesamoid subluxation was reduced from 92% to 24% in the crescentic group and from 88% to 18% in the chevron group. All patients were assessed using the American Orthopaedic Foot and Ankle Society scale, in which 100 points are used to compare pre- and postoperative pain, function and range of motion, shoewear comfort and activity levels, and alignment. In the crescentic group, the score improved from 46.8 points to 93.1 points; in the chevron group, the score changed from 53.4 points to 92.7 points. In all parameters studied, there were no statistically significant differences using the Student's t-test. We conclude that the two operative techniques offer equivalent results, which are excellent and predictable. The proximal chevron osteotomy is technically easier, eliminates the proximal dorsal scar, and does not require postoperative metal removal.

Adult↗
PubMedDate not supplied

[Hallux valgus: a therapy concept and its outcome from 1993 to 1996].

INTRODUCTION: Aim of this study is to present the treatment concept and the results of hallux valgus surgery of our department. PATIENTS AND METHODS: The criteria for decision making are 1st intermetatarsal angle, congruency of the first metatarsophalangeal joint and sesamoid position. According to our concept we performed between 1993 and 1996 42 Chevron osteotomies for mild, 138 Chevron with lateral soft tissue release (Chevron + LSR) for moderate and 93 basal crescentic (Mann) osteotomies with lateral soft tissue release for severe hallux valgus deformities. RESULTS: 31 Chevron, 118 Chevron with lateral soft tissue release and 80 basal crescentic osteotomies (Mann) were seen at an average follow up of 19 months (12-29) after a Chevron, respectively. 16 months (12-43) after Chevron with lateral soft tissue release and 18 months (12-32) after a basal crescentic osteotomy. 83% of all patients classified the results of the surgery as "very satisfactory" and "satisfactory". The average hallux valgus angle was corrected from preoperatively. 25.3 degrees (Chevron), 29.9 degrees (Chevron + LSR) and 41.8 degrees (Mann) to 16.5 degrees (Chevron), 12.1 degrees (Chevron + LSR) and 14.1 degrees (Mann) at final follow up, the average first intermetatarsal angle was corrected from preoperatively 12.1 degrees (Chevron), 14.0 degrees (Chevron + LSR) and 17.4 degrees (Mann) to 7.9 degrees (Chevron), 5.8 degrees (Chevron + LSR) and 7.8 degrees (Mann) at final follow up. CONCLUSION: Our analysis of the three osteotomies revealed that with this differentiated concept we were able to achieve excellent and good results in more than 80% of our patients. Only with a treatment plan that includes different procedures to address the various stages of hallux valgus can one achieve the optimum result for the patient.

Adult↗
PubMed2000

The chevron osteotomy for correction of hallux valgus. Comparison of findings after two and five years of follow-up.

BACKGROUND: The chevron osteotomy, an accepted method for the correction of mild and moderate hallux valgus, is generally advocated for patients younger than the age of fifty years. The purposes of this prospective study were to compare the short-term (two-year) and intermediate-term (five-year) results of this operation with respect to patient satisfaction, flexion and extension of the metatarsophalangeal joint, maintenance of correction, and development of arthrosis and to determine whether the effectiveness of the procedure was limited by age. METHODS: Between April 1991 and September 1992, the chevron osteotomy was performed for the treatment of mild-to-moderate hallux valgus deformity in sixty-six consecutive feet. Forty-three patients (fifty-seven feet) were available for follow-up at both two and five years postoperatively. The two-year and five-year clinical assessments were based on the American Orthopaedic Foot and Ankle Society's hallux-metatarsophalangeal-interphalangeal scale. RESULTS: Between the two-year and five-year follow-up evaluations, there was only a minimal change in overall patient satisfaction, and the average score on the hallux-metatarsophalangeal-interphalangeal scale was unchanged. The passive range of motion of the first metatarsophalangeal joint decreased between the preoperative assessment and the two-year follow-up evaluation and was unchanged at the five-year follow-up evaluation. Radiographic evaluation showed no changes in the hallux valgus or intermetatarsal angle between the two-year and five-year evaluations, although the number of feet with arthrosis of the metatarsophalangeal joint increased slightly, from eight to eleven. Patients aged fifty years or older did as well as younger patients. CONCLUSIONS: At these two follow-up periods, the chevron osteotomy was found to be a reliable procedure for the correction of mild and moderate hallux valgus deformity, and outcome did not differ on the basis of age.

Case-Control Studies↗
PubMed1991

Hallux valgus repair. DuVries modified McBride procedure.

The DuVries modification of the McBride procedure was investigated in 72 feet in 47 patients with hallux valgus deformity. Overall, the patient satisfaction rate was 92%. The hallux valgus averaged 32 degrees preoperatively, and 16 degrees postoperatively. The intermetatarsal angle averaged 14 degrees preoperatively and 9 degrees postoperatively. Anatomic realignment of the remaining tibial sesamoid was achieved in 28% of the feet. As a result of realignment of the first metatarsophalangeal joint, the intractable plantar keratosis beneath the second metatarsal head was resolved in 19 of 20 feet. Six patients developed a hallux varus deformity that averaged 7.5 degrees. All cases of hallux varus had medial displacement of the tibial sesamoid. The number of patients who could withstand unrestricted shoe wear increased from ten patients preoperatively to 30 patients postoperatively. The patient activity level increased in two thirds of the cases. The distal soft-tissue procedure produces the most predictable correction in patients with a hallux valgus deformity measuring less than 30 degrees. In more severe deformities, a proximal metatarsal osteotomy should be added to the procedure.

Adolescent↗
PubMed2001

[Anatomical-functional rating system related to pedobarographic examination of the foot in patients treated operatively for hallux valgus].

Author undertook a trial of elaboration of rating system for evaluation of the operating treatment results of hallux valgus, in relation to pedobarographic examination performed with the use of computed platform PEL-38. 335 feet in 173 patients (females) treated operatively due to hallux valgus in Orthopaedic Department of Wrocław Medical University in years 1975-1990 were examined. Those patients were operated on according to Keller, Dega and McBride method. There was elaborated anatomical-functional rating system for the foot. In this system different variables were incorporated such as: pain within foot, physical activity, walking ability, footwear requirements, hallux valgus angle, callus related to forefoot, bunion and MTP joint's ROM. There were distinguished 4 grades of results: excellent, good, fair and poor, in accordance to number of points achieved. Basing on comparison of pedobarographic examination results with results of the rating system, definite relation between mentioned above evaluating systems was not found.

Activities of Daily Living↗
PubMed2002

[Use of grommet for Swanson flexible hinge toe implant arthroplasty for hallux valgus deformity of rheumatoid arthritis].

OBJECTIVES: We reviewed the results of arthroplasty of the great toe with hallux valgus in rheumatoid patients, using a Swanson flexible hinge toe implant protected by grommet. MATERIALS AND METHODS: Sixteen patients (26 feet) with rheumatoid arthritis were operated on from 1996 to 1999. (fifteen women, one man). The average age was 59.8 years (range, 48-73 years). The average follow-up period was 3.0 years (range, 1.0-4.5 years). In each patient, the hallux valgus angle (HVA) was measured before and after surgery, and implant breakage and radiolucency around the implant were evaluated on radiographs. RESULTS: Average HVA was 47.7 degrees preoperatively and 19.3 degrees postoperatively. No implant breakage was observed in 76.9% of the feet. Radiolucency of more than 2 mm was observed in only 3.8% of the feet. CONCLUSIONS: These findings suggest that arthroplasty using a Swanson flexible hinge toe implant with a grommet is useful for treatment of hallux valgus in rheumatoid patients.

Aged↗
PubMedDate not supplied

[Sesamoid bone complex and hallux valgus deformity. A retrospective analysis of 82 Mitchell osteotomies].

The aim of the operative treatment of the hallux valgus deformity is to correct the medial luxation of the first metatarsal head out of the sesamoid complex, the restoration of a congruent joint, the patient after treatment should be painfree. 82 patients were available for an independent clinical and radiological review. The median follow up was 32 months. The evaluation of the results are based on objective and subjective assessment of the patients as well as on radiographic criteria, such as hallux valgus angle, intermetatarsal angle, shortening of the first metatarsal bone, subluxation, lateral positioning of the osteotomized MT I-head and position of the sesamoid complex. Depending on the degree of "lateralisation" of the sesamoid complex seven groups were defined: 0/0, 1/0, 1/1, 2/1, 2/2. 2/3, 3/3 following Appel. Following objective criteria 61% of the patients were evaluated excellent or good, following subjective criteria 77% were evaluated excellent or good. Isolated parallel shifting seems to be sufficient in mild forms of hallux valgus (sesamoid complex group 2/2 or less), while the severe subluxation in the metatarsophalangeal joint (sesamoid complex group 2/3, 3/3) requires an additional lateral wedge osteotomy.

Adolescent↗
PubMedDate not supplied

McBride's operation for hallux valgus can be used in patients older than 30 years.

Over a 10-year period, 46 feet with hallux valgus in 36 patients were treated with the McBride procedure. The median age was 35 years. At follow-up of 2 to 11 years after operation, a reduction in the hallux valgus angles, the intermetatarsal angles and the width of the forefeet was found. In patients older than 30 years there were significant reductions. In patients younger than 30 years, the reduction was not significant. The rate of problems with daily footwear was reduced from 36 of 46 feet to 13 of 38 feet. The authors noted few problems and a high rate of satisfied patients, despite the age. In 37 of 46 feet the overall result was found satisfactory by the patients. The authors find that McBride's operation can be used for hallux valgus, also in patients above 30 years, in spite of the generally accepted restriction to younger individuals.

Adolescent↗
PubMed2004

Clinical results with the Ludloff osteotomy for correction of adult hallux valgus.

BACKGROUND: Biomechanically, the Ludloff osteotomy fixed with lag screw compression has been shown to be more rigid than proximal crescentic and other proximal first metatarsal osteotomies for correction of symptomatic hallux valgus with a moderate to severe increase in the first intermetatarsal angle. The Ludloff osteotomy may, therefore, have a lower incidence of dorsal malunion and transfer metatarsalgia than other proximal first metatarsal osteotomies, such as the crescentic or chevron. METHODS: We reviewed the results of 82 consecutive cases of moderate to severe hallux valgus deformities corrected with the Ludloff oblique metaphyseal-diaphyseal osteotomy of the first metatarsal combined with a distal soft-tissue procedure and medial eminence resection. RESULTS: Follow-up was possible in 70 cases (85%) at an average of 30 months (range, 18 to 42 months). Preoperatively, the mean hallux valgus and first intermetatarsal angles were 31 degrees and 16 degrees, respectively. Postoperatively, these values improved to an average of 11 degrees and 7 degrees. In the sagittal plane, the first metatarsal was plantarflexed by an average of 1 mm, and there were no symptomatic transfer lesions of the second metatarsal. The mean AOFAS hindfoot score improved from 54 to 91 points. Complications included prominent hardware requiring removal (5), hallux varus (4), delayed union (3), superficial infection (3), and neuralgia (3). CONCLUSIONS: The use of the Ludloff oblique first metatarsal osteotomy resulted in excellent correction of the first intermetatarsal angle in patients with moderate to severe hallux valgus. With the plane of the osteotomy and rigidity of fixation, immediate ambulation was possible with minimal risk of dorsiflexion malunion of the first metatarsal.

Adult↗
PubMed1992

Tricorrectional bunionectomy for surgical repair of juvenile hallux valgus.

The authors propose the use of the tricorrectional bunionectomy as an alternate correction of severe deformity in juvenile hallux valgus. In the past, hallux valgus surgery in juveniles has been avoided. A follow-up study of the tricorrectional bunionectomy as the surgical treatment for juvenile bunion deformity in seven patients is presented.

Adolescent↗
PubMed1991

Rupture of the flexor hallucis longus after hallux valgus surgery: case report and comments on technique for adductor release.

A case of flexor hallucis longus (FHL) rupture following hallux valgus surgery is reported here. The authors conjecture that the FHL rupture was caused by a partial laceration of the FHL at the time of the surgical hallux valgus correction. The authors treated the painful problem by surgically debriding the distal stump of the FHL from under the first metatarsophalangeal joint (MP) and tenodesing that the proximal stump to the flexor digitorum longus (FDL). The authors describe a technique that minimizes the complications of an adductor tenotomy associated with a distal chevron type of hallux valgus correction.

Adult↗
PubMed1992

McBride's operation for hallux valgus. A 2-11-year follow-up of 46 cases.

During a 10-year period, 46 feet with hallux valgus in 36 patients were operated on a.m. McBride. At the follow-up examination a median of 9 (2-11) years after the operation, a reduction in the hallux valgus angle from 32 degrees to 26 degrees and in the intermetatarsal angle from 13 degrees to 10 degrees was found; but on analyzing the single parts of the operation, we found that the result was only significant in those patients that had had the original procedures done, i.e., tenotomy and reattachment of the conjoined tendon, lateral capsulotomy, and lateral sesamoidectomy. McBride's operation for hallux valgus should be performed as described by the originator of the method.

Adolescent↗
PubMed1999

[Evaluation of the Scarf osteotomy in hallux valgus related to distal metatarsal articular angle: a prospective study of 79 operated cases].

PURPOSE OF THE STUDY: The hallux valgus surgery concerns many operative techniques. The purpose of this report was to evaluate the radiographic results of the Scarf osteotomy related to Distal Metatarsal Articular Angle (DMAA). MATERIAL AND METHODS: The Scarf osteotomy was performed on 79 feet with an hallux valgus deformity (75 females and 4 males from 16 to 82 years). Pre and postoperative weight-bearing X-rays were performed; We measured the Distal Metatarsal Articular Angle (DMAA), the intermetatarsal angle (M1-M2, M1-M5), the metatarsophalangeal angle, the obliquity of the metatarsocuneiform joint and the length of the first and second metatarsal. RESULTS: All parameters were statistically significantly improved by the surgery. However correction on the DMAA was not sufficient (from 14.6 degrees to 12.6 degrees although normal value is 6 degrees). We found a correlation between the metatarsophalangeal angle and the DMAA. DISCUSSION: The preoperative measures showed that the DMAA value increases with the value of the metatarsophalangeal angle; it is insufficiently decreased in comparison to the normal value. It has to be strongly taken in consideration in the preoperative evaluation. CONCLUSION: The preoperative DMAA value is the most important factor in the hallux valgus evaluation. It determines if Scarf or other operative technique are indicated. Its normalisation may provide less recurrences.

Adolescent↗
PubMed1992

Treatment of hallux valgus in China.

This is a review of the treatment of hallux valgus based on the paper material submitted to the First and Second Sino-American Conferences on Foot Disorders held in Beijing in 1987 and 1990. The data consisted of 676 cases (979 feet) from 10 major hospitals in China. There were 122 men and 554 women, giving a male to female ratio of 1:45. Sixty-nine (10%) cases had a family history of hallux valgus and 120 cases (18%) were associated with hammer toe deformity. The age ranged from 16-85 years with an average of 42. Among the 412 female cases (78.5%) at the age of 20-35, 339 (82.3%) had the history of wearing high heeled and narrow tipped shoes. Osteoarthritis changes of the first M-P joint were seen in 31 cases, all above the age of 60. 615 cases (90.9%) were treated surgically for pain relief and only 25 cases (3.7%) at the age of 20-30 had the deformity corrected for cosmetic purpose. The surgical procedures employed were bunionectomy (Silver's operation, 39 feet), Keller's operation (344 feet), McBride's operation (239 feet) and a variety of osteotomies of the first metatarsal (295 feet). Joplin and Lapidus operations were used by one author in 5 and 2 cases respectively. Overall excellent and good results were obtained in 609 cases (90%) during the follow-up of 1-14 years.

Adolescent↗
PubMed2006

Intermetatarsal angle after first metatarsophalangeal joint arthrodesis for hallux valgus.

BACKGROUND: First metatarsophalangeal (MTP) joint arthrodesis is commonly done for hallux valgus with an arthritic joint. In patients with a wide preoperative first intermetatarsal (IM) angle an important question is whether the metatarsus varus will be corrected by the first MTP joint fusion alone or whether an additional basal osteotomy is necessary. METHODS: The charts and radiographs of 20 patients who had arthrodesis of the first MTP joint were retrospectively reviewed. All 20 patients were female with a mean age of 54.2 (range 42 to 78) years. Either a Hallu-S plate (Integra Life Sciences, Nudeal, France) or two crossed screws were used to stabilize the arthrodesis. The IM angles were measured independently by two individuals on weightbearing preoperative, 6-week postoperative, and final followup films. The final followup radiographs were taken at an average of 13.7 (range 6 to 30) months after surgery. A Student t-test was used to evaluate the changes in the IM angle and interobserver variations. RESULTS: The mean preoperative IM angle was 16.65 (range 12 to 26) degrees. The mean postoperative IM angle was 10.35 (range 6 to 15) degrees. The mean IM angle at final followup was 8.67 (range 5 to 12) degrees. The mean change between preoperative IM angle and IM angle at final followup was 8.22 (range 4 to 14) degrees. This change of the IM angle was statistically significant (p < 0.0001). CONCLUSIONS: These results indicate that in patients with severe hallux valgus and first MTP joint degeneration arthrodesis can significantly correct the IM angle without the addition of a basal osteotomy.

Adult↗