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PubMed1993

[Study of fore foot pressure distribution in the foot with hallux valgus].

Forefoot pressure measurements were performed by means of Musgrave Footprint system on both 20 healthy subjects (40 feet) and 31 patients with hallux valgus (45 feet). The results showed that the peak pressure under the 1st and 2nd metatarsal heads in the foot with hallux valgus was increased significantly (P < 0.01). The peak pressure under the great toe was decreased with an increasing hallux valgus angle, and the both of them were in negative correlation (r = -0.32, P < 0.05). The clinical significance of these findings was discussed.

Adolescent↗
PubMed1995

Measuring hallux valgus: a comparison of conventional radiography and clinical parameters with regard to measurement accuracy.

To assess the repeatability and error of conventional x-ray measurements, intra- and interobserver evaluations of measurement accuracy were done on 20 preoperative and 40 postoperative (20 chevron and 20 proximal osteotomy) x-rays of hallux valgus patients. Standard x-rays showed an average interobserver error of measurement of 6.4 degrees for the hallux valgus angle, 5.4 degrees for the intermetatarsal angle, and 2.0 mm for the intermetatarsal distance. The intraobserver error did not differ greatly. The repeatability and error of two clinical measurements, ball circumference, and dorsal to plantar range of motion of the first metatarsophalangeal joint were evaluated for 20 healthy volunteers. The ball circumference had an average measurement error of 1.1 cm, whereas the dorsal and plantar range of motion of the great toe had an average measurement error of 12 degrees in dorsiflexion and 16 degrees in plantarflexion. In both clinical and radiographic parameters, linear measurements were more accurate than angular measurements. Although x-rays are of value in hallux valgus surgery, standard x-rays are less accurate than previously assumed. Small changes produced by osteotomies may be hidden by the postoperative measurement error. The results of hallux valgus surgery should primarily be evaluated clinically. When clinical and radiological evaluations are made, linear measurements may be preferable.

Female↗
PubMed2000

Scarf osteotomy for hallux valgus correction. Local anatomy, surgical technique, and combination with other forefoot procedures.

At first, scarf osteotomy can be technically demanding. The aim of the author has been to develop an efficient technique, make it easier and more accurate, and to achieve immediate reproducibility of results. Neither the skin incision nor the length of the osteotomy result in postoperative edema, whereas the strong fixation enables very early functional recovery. Complications are rare and avoidable. The sum of the scarf's advantages results in a reliable surgical procedure. The scarf osteotomy is extremely versatile, because it allows a wide range of fragment displacement. This is why the scarf is not a single osteotomy but several. This means its indications are broad, from mild to the most advanced deformities, including arthritic, juvenile, iatrogenic, and even rheumatoid hallux valgus. The contraindications of scarf osteotomy are a very large hallux valgus deformity with a very thin first metatarsal; extremely deformed MPT joint, and hallux valgus combined with a severe pes planus and hypermobility of the first metatarsal (the Lapidus procedure is preferable at this stage). Finally, we should remember the two following points: 1. Whatever the indication, the scarf first metatarsal osteotomy is only one of the four steps necessary for correcting hallux valgus deformity: a) MTP lateral release, b) Scarf osteotomy, c) medial capsulorraphy, and d) great toe proximal osteotomy. 2. The scarf is just one element of the different procedures, including the Weil lesser ray osteotomy, which allow precise forefoot management according to each static disorder. These techniques have very significantly extended the indications for most static disorders where corrective surgery preserves the joints and their mobility.

Combined Modality Therapy↗
PubMed2005

Foot pressure measurement differences between boys and girls with reference to hallux valgus deformity and hypermobility.

BACKGROUND: Previous studies that compared foot pressures in boys and girls found that girls had greater peak pressures under the hallux than did boys. Only one of these studies considered plantar pressure measurements in children. The purpose of the study was to investigate the effect of gender on foot pressure measurements in children. METHODS: This is a comparative study using the F-Scan pressure platform (F-Mat; Texscan Boston, MA) on a sample of children attending a podiatric clinic. Pressure measurements and temporal parameters were measured in 61 children between the ages of 5 and 16 years. Associations between joint hypermobility and hallux valgus angle also were investigated. RESULTS: Girls were found to have significantly greater peak pressure under the hallux, faster timing of heel contact to first metatarsal head loading, and a more medially placed center of pressure trajectory. No associations were found between these significant variables and hypermobility scores or hallux valgus angle. CONCLUSION: The results indicate that there are differences in pressure measurements between boys and girls, but the reasons for these remain unclear. Differences in pressure measurements in the feet of boys and girls may be useful in establishing the cause of foot pathologies for which a prevalence has been shown in boys or girls, such as hallux valgus deformity, which is known to be more frequent in females of all ages.

Adolescent↗
PubMed1995

Comparative radiographic analysis of parameters in feet with and without hallux valgus.

This study involved the radiographic examination of 118 feet from 110 urban African female patients. Fifty-two of the 118 feet showed radiographic evidence of hallux valgus (valgus angle > 15 degrees). The parameters compared between feet with and without hallux valgus were sesamoid position, pes planus deformity, metatarsal length, and the cuneiform-metatarsal articulation. All radiographs were standardized, weightbearing anteroposterior and lateral views. The results were statistically analyzed. The findings showed no difference between the hallux valgus and control groups with respect to sesamoid position relative to the second metatarsal, incidence of pes planus, relative length of the first metatarsal, and the first metatarsal-medial cuneiform articulation.

Adult↗
PubMed1991

Juvenile hallux valgus with compensated metatarsus adductus. Case report.

The authors describe a case report of a patient with compensated metatarsus adductus and juvenile hallux valgus bilaterally. Treatment included closing base wedge abductory osteotomies of metatarsals one through five, modified McBride bunionectomy, Evans calcaneal osteotomy, and a percutaneous tendo Achillis lengthening. The patient maintained excellent correction on the right foot after 6 years. Hallux valgus recurred on the left foot after 2 years. The authors attribute this recurrence to a significant internal femoral torsion on the left leg. The significance of superstructural deformities on juvenile hallux valgus is discussed.

Age Factors↗
PubMed2001

Evaluation of the longitudinal arch of the foot with hallux valgus using a newly developed two-dimensional coordinate system.

The purposes of the present study were to establish a method for the evaluation of the longitudinal arch, using a two-dimensional coordinate system, and to clarify the main point of flattening of the foot in patients with hallux valgus. Measurements on a weight-bearing lateral radiograph of the foot were performed in 186 feet of 110 women with symptomatic hallux valgus and in 93 normal feet of 72 women. A two-dimensional coordinate system was used to perform the measurements. In this coordinate system, the line connecting the lowest point of the first metatarsal head and the lowest point (O) of the calcaneus is fixed as the x-axis, and the line that is perpendicular to the x-axis and intersects the x-axis at point O is fixed as the y-axis. The mean values of the y-coordinates at the points of the medial longitudinal arch of the foot in the patients with hallux valgus were significantly lower than those in the normal subjects (P < 0.001). The values were noticeably lower at points on the navicular. However, no change was observed in the posterior talus body. The new coordinate system indicated that the main points of flattening of the foot in patients with hallux valgus were the plantar flexion of the talus and the sinking of the navicular.

Adolescent↗
PubMedDate not supplied

[Pressure distribution after scarf osteotomy for hallux valgus surgery].

AIM: This study evaluates the pressure distribution, the radiological and clinical results in patients before surgery and 6 months after scarf osteotomy for hallux valgus. METHODS: 29 patients were examined before surgery and 6 months after surgery for symptomatic hallux valgus. Pedographic analysis was performed by dividing the footprint of the patients into 8 regions of interest. For each region the maximum mean pressure and the peak pressure were evaluated. Moreover, clinicofunctional results (AOFAS score) and radiological results were evaluated. RESULTS: 6 months postoperatively, maximum mean pressure increased significantly under the medial forefoot where as the peak pressure in this region revealed indifferent results. Significant improvement of clinicofunctional results and a significant reduction of the intermetatarsal and metatarsophalangeal angle could be seen. CONCLUSION: These results confirm the clinical and radiological findings of other studies, but this study shows for the first time an increase of pressure under the first ray of the foot after hallux valgus surgery and an adaptation to the pressure distribution of normal feet.

Adult↗
PubMed1996

Comparison of bioabsorbable pins and Kirschner wires in the fixation of chevron osteotomies for hallux valgus.

A retrospective review of the medical records and radiographs of 32 consecutive patients, totaling 52 extremities with chevron osteotomies for hallux valgus, was conducted to compare K wire fixation with absorbable (poly-p-dioxanone) pin fixation. Each group comprised 21 feet, with a mean clinical follow-up of 35.6 months (25.6-50.5 months) in the K wire group and 23.1 months (13.7-28.8 months) in the absorbable pin group. Demographics as well as final clinical follow-up scores (hallux-metatarsophalangeal-interphalangeal scale and visual analogue scores) were similar in both groups. Postoperative hallux valgus and intermetatarsal angles were similar in both groups. No complications, such as osteolysis for inflammatory sinus formation, occurred in the absorbable pin group. Two patients in the K wire group had a malunited osteotomy and two patients had a retained K wire at final follow-up. Our experience suggests that poly-p-dioxanone pins are at least as effective as K wires, and the previous reports of inflammatory sinus formation and osteolysis are not a significant concern in the fixation of chevron osteotomies for hallux valgus.

Adult↗
PubMed1998

Role of medical capsule and transverse metatarsal ligament in hallux valgus deformity.

The role of the medial capsule and transverse metatarsal ligament in hallux valgus deformity including stability of the first metatarsophalangeal and adjacent joints was investigated in vitro. The three-dimensional positions of the proximal phalanx, first metatarsal, and second metatarsal before and after sectioning the medial capsule and metatarsal ligament were measured using a magnetic tracking system. Valgus deformity of the hallux increased with medial capsule sectioning an average of 22.3 degrees +/- 6 degrees. Valgus deformity of the hallux increased with medial capsule and metatarsal ligament sectioning an average of 27.4 degrees +/- 9.1 degrees. Valgus deformity of the hallux did not change significantly after sectioning the metatarsal ligament only. No significant changes were found in varus and eversion of the first metatarsal, in valgus of the second metatarsal, in the distance between first and second metatarsal heads after sectioning the medial capsule, or in the metatarsal ligament. This study shows the importance of the medial capsule in hallux valgus deformity. The transverse ligament did not contribute substantially to cause the deformity.

Aged↗
PubMed1991

A Chevron-Akin double osteotomy for correction of hallux valgus.

Chevron osteotomy of the distal metatarsal combined with Akin osteotomy of the proximal phalanx is described for treatment of painful hallux valgus. Sixteen patients (24 feet) who underwent the Chevron-Akin osteotomy were retrospectively reviewed by questionnaire, physical examination, and comparison of preoperative and postoperative standing X-rays. After a mean follow-up of 29 months, there was 95% satisfaction with regard to pain relief and appearance of the foot. Good postoperative range of motion of the great toe was recorded subjectively and objectively. Mean improvement of the first intermetatarsal angle was 4.1 degrees (P = 0.05). The average preoperative hallux valgus angle was 27 degrees (range 13-40 degrees). Mean improvement with the double osteotomy was 14.3 degrees (P = 0.05). There was no significant shortening of the first ray with the double osteotomy. Degenerative changes of the first metatarsophalangeal joint were seen in two feet with intra-articular extension of the Akin osteotomy. One malunion occurred with shifting of the Chevron osteotomy after pin removal. The Chevron-Akin osteotomy compares favorably with the isolated distal Chevron osteotomy. In this series there was no compromise of joint motion, and a superior correction of the hallux valgus deformity was obtained.

Adult↗
PubMed1993

Late results of the Keller-Brandes operation for hallux valgus.

Evaluating the late results of the Keller-Brandes operation for hallux valgus in 100 feet on average 5.5 years after surgery, these were functionally and cosmetically satisfying to the patient in 90% of cases. In 97% pain was relieved completely or partially. On examination, however, 23% of the feet still had a clinical hallux valgus angle of more than 30 degrees. A dorsal extension-contracture which was found together with 50% or more of phalangeal resection was present in 6%. The power of plantar flexion of the big toe decreased with the extent of resection of the proximal phalanx. Resection of more than half of the proximal phalanx seems to be disadvantageous and should be avoided.

Adult↗
PubMed2005

Age-adjusted baseline data for women with hallux valgus undergoing corrective surgery.

BACKGROUND: Functional and health-related quality-of-life data on a population of patients with hallux valgus are lacking. Similarly, the correlation of the severity of the deformity with these measures is unknown. METHODS: Two hundred and eighty-five women with an average age of forty-nine years who were scheduled for bunion surgery were enrolled in the study. The patients completed a baseline American Academy of Orthopaedic Surgeons (AAOS) foot and ankle outcomes questionnaire, which includes the Short Form-36 (SF-36) and a specific lower-extremity section on the foot and ankle. Preoperative radiographic data with regard to the hallux valgus angle and the intermetatarsal angle were stratified into groups according to the severity of the deformity (mild, moderate, or severe). The data were then stratified into age-groups consistent with those reported for the SF-36, and the results were compared with the SF-36 scores for the general population. The global foot and ankle score and the shoe comfort score were compared with general population scores that were published previously. The severity of the preoperative deformity was correlated with the baseline scores. RESULTS: General health scores were noted to be relatively stable throughout the age-groups for patients with bunions, with the older groups demonstrating better scores than the general population. Bodily pain scores were consistently worse for patients with a bunion through all age-groups compared with the general population. The average global foot and ankle score and the shoe comfort score were significantly lower (p < 0.001 for both) for the patients with a bunion than for the general population. The severity of the preoperative deformity did not correlate with any of the outcome scores. CONCLUSIONS: The bodily pain score from the SF-36 appears to be a sensitive measure of problems experienced by patients undergoing bunion surgery. Surprisingly, the severity of the deformity as measured radiographically did not correlate with any of the fifteen scores measured. These data may serve as a baseline for clinical hallux valgus studies with use of the SF-36 or the AAOS outcomes questionnaire.

Age Factors↗
PubMedDate not supplied

[Resection-interposition arthroplasty in symptomatic hallux valgus: a revision of indication and technique].

AIM: Popularity of resection-interposition-arthroplasty is decreasing due to more specific procedures in hallux valgus surgery. Therefore we analysed the influence of preoperative parameters and technical details to reevaluate this classic procedure. METHOD: In a retrospective, clinical and radiological long-term study (mean 9.6 years) 62 operated feet were examined and the assessed parameters were analysed, with focussing on the negative results. For comparison negative and positive outcome was defined by a hallux-metatarsal-interphalangeal scale (HMIS) and a subjective rating score (SRS). RESULTS: Negative outcome, 34 % according to HMIS and 24 % according to SRS, was characterised in both scoring systems by pain (visual analogue scale), functional deficit (walking distance) and negative cosmetic result (hallux-valgus-angle) (p < 0.01 each). As negative predictive factors we observed an early degenerative arthritis (p < 0.05, HMIS) and a positive metatarsal index (p < 0.05, SRS). Unsatisfactory results were related to an increased resection level of the first phalanx when compared with good results (p < 0.01 in HMIS, p < 0.05 in SRS). CONCLUSION: Resection-interposition arthroplasty in symptomatic hallux valgus seems an inadequate procedure in cases with early arthritis or a positive metatarsal index. However, in accordance with these criteria good results are probable, if resection of the first phalanx does not exceed one third of length.

Adult↗
PubMed1978

Basal osteotomy of the first metatarsal bone in hallux valgus: experiences with the use of AO plate.

In young patients with hallux valgus, osteotomy with excision of the exostosis is frequently indicated. The basal, laterally based wedge osteotomy, is relatively seldom used. However this operation may produce a considerable reduction of the metatarsus primus varus. We modified the method by adding a small AO plate to ensure stabilization. The series consisted of 36 patients, in whom 52 feet were operated on. Pain was the most frequent indication for seeking treatment. A followup was performed an average of 1.5 years postoperatively. The subjective results were good in 41 cases, fair in nine, and poor in one. Objectively the results were good in 42 cases and fair in nine. The mean period of work was seven weeks. The metatarsus varus angle was reduced from 14.8 degrees to 9.3 degrees and the hallux valgus angle from 33.2 degrees to 17.7 degrees. The distance between the first and second metatarsal bones was reduced from 13. 7 mm to 10.2 mm. A good functional and cosmetic result was achieved in most of the cases.

Adult↗
PubMed2001

Mobility of the first tarsometatarsal joint in hallux valgus patients: a radiographic analysis.

Hypermobility of the first tarsometatarsal (TMT 1) joint in the sagittal plane plays a role in the etiology and treatment of the hallux valgus complex. However, objective quantification of this mobility is still a problem. We performed a radiographic analysis of TMT 1 mobility in the sagittal plane in 94 hallux valgus patients aged 15 to 65 years. We examined 94 feet with symptomatic hallux valgus deformity requiring operative correction. Excluded were patients with osteoarthritis, inflammatory diseases or previous operations on the foot. The TMT 1 mobility was tested with a clinical test and by radiographic measurement using the modified Coleman block test. The mean mobility of the TMT 1 joint in the sagittal plane in the patient group was 12.9 degrees (SD 4.80). In addition, there was a statistically significant difference between two subgroups: patients with and without clinical TMT 1 hypermobility. No correlation of TMT 1 (hyper)mobility and radiographic second ray hypertrophy was found. This simple method can produce additional information to the clinical TMT 1 hypermobility test in the sagittal plane.

Adolescent↗
PubMedDate not supplied

Surgical treatment of hallux valgus deformity in rheumatoid arthritis: clinical and radiographic evaluation of modified Lapidus technique.

The authors evaluated a modified Lapidus technique for 21 rheumatoid hallux valgus deformities. The technique corrects the deformity by performing arthrodesis of the first tarsometatarsal joint and preservation of the first metatarsophalangeal (MTP) joint. The authors clinically studied patients' subjective improvement of pain and footwear comfort, as well as their satisfaction with the outcome of the surgery. The study also analyzed radiographic changes of the hallux valgus angle (HVA) and two intermetatarsal angles, one between the first and the second (M1/2) and the other between the first and the fifth (M1/5). They were measured before the surgery, 3 weeks after the surgery, and at the last follow-up. Pain relief was great or moderate in 17 feet and footwear comfort was improved in 16 feet. Fifteen patients were satisfied or satisfied with some reservations. The average HVA significantly decreased from 44.1 degrees preoperatively to 10.6 postoperatively and significantly increased again to 29.1 at the last follow-up. The average M1/2 and M1/5 significantly decreased postoperatively (from 13 to 8.3 and from 32.2 to 21.1, respectively), and the reduction of M1/2 remained at the last follow-up (8.7), while M1/5 significantly increased again (28.3). This modified Lapidus technique is a useful method for rheumatoid hallux valgus deformity, which can preserve the first MTP joint.

Aged↗
PubMed1976

[The McBride operation of hallux valgus in adolescents (author's transl)].

Severe Hallux valgus deformity in adolescents and young adults has been treated by the McBride operation in 53 cases during the period from 1965 to 1974. With 85% good results in our material this type of operation is very satisfactory. Other authors have made the same experience. The principles and technique of this soft tissue correction are described and the results of reexamination presented.

Adolescent↗