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PubMed1986

The relationship of abnormal foot pronation to hallux abducto valgus--a pilot study.

Abnormal foot mechanics is the most common cause of hallux abducto valgus. To date no quantitative data regarding the relationship between abnormal foot mechanics and the degree of hallux abducto valgus has been presented. An outline of the abnormal foot mechanics responsible for hallux abducto valgus is described along with a technique for measuring the extent of abnormal function. A common intrinsic abnormality responsible for hallux abducto valgus is described along with its diagnosis and orthotic treatment.

Adult↗
PubMed1980

Mechanics of the hallux valgus foot and the effect of Keller's operation.

Using a system for measuring the load distribution under the foot, patients with hallux valgus were compared, before and after undergoing Keller's operation, with a group of normal subjects. Preoperatively the patients showed reduced loading under all their toes and increased loading under their lateral metatarsal heads; the decrease under the hallux was found to correlate with an increase in hallux valgus angle. Postoperatively there was a further decrease in loading under the hallux and an increase under the first metatarsal head.

Adolescent↗
PubMedDate not supplied

Management of hallux limitus with distraction of the first metatarsophalangeal joint.

This article describes a joint-preserving and joint-restoring procedure for the management of hallux limitus and hallux rigidus. The procedure uses a minirail external fixator to obtain distraction with or without arthrotomy of the first metatarsophalangeal joint. This procedure aims to restore joint function through elimination of the pathologic forces involved in hallux limitus and hallux rigidus. Both intrinsic and extrinsic muscular imbalances are reduced. Follow-up of 133 patients treated in this manner since 1997 demonstrates excellent long-term results.

Arthrodesis↗
PubMedDate not supplied

Biomechanical risk factors associated with neuropathic ulceration of the hallux in people with diabetes mellitus.

In this study of people with diabetes mellitus and peripheral neuropathy, it was found that the feet of patients with a history of hallux ulceration were more pronated and less able to complete a single-leg heel rise compared with the feet of patients with a history of ulceration elsewhere on the foot. The range of active first metatarsophalangeal joint dorsiflexion was found to be significantly lower in the affected foot. Ankle dorsiflexion, subtalar joint range of motion, and angle of gait differed from normal values but were similar to those found in other studies involving diabetic subjects and were not important factors in the occurrence of hallux ulceration. These data indicate that a more pronated foot type is associated with hallux ulceration in diabetic feet. Further studies are required to evaluate the efficacy of footwear and orthoses in altering foot posture to manage hallux ulceration.

Biomechanical Phenomena↗
PubMedDate not supplied

Effects of rearfoot-controlling orthotic treatment on dorsiflexion of the hallux in feet with abnormal subtalar pronation: a preliminary report.

The aim of this study was to determine whether the treatment of abnormal subtalar pronation restores functional (as opposed to structural) limited dorsiflexion of the first metatarsophalangeal joint (functional hallux limitus). We studied 16 feet of eight individuals with abnormal subtalar pronation. Orthoses were made for all of the feet, and hallux dorsiflexion was measured during weightbearing. Each patient was unshod without the orthosis, unshod with the orthosis fitted on the same day, and unshod with the orthosis fitted approximately 5 months later. The results suggest that in functional hallux limitus caused by abnormal subtalar pronation, hallux dorsiflexion will gradually be restored by the use of foot orthoses to control the abnormal subtalar pronation.

Adult↗
PubMed1989

Modified V-Y capsulorrhaphy in hallux abducto valgus surgery.

The two-stage capsular closure modification of the V-Y capsulorrhaphy in hallux abducto valgus surgery is a technique for restoring the soft tissue anatomical relationships of the first metatarsophalangeal joint in a bunion deformity. The first stage of the V-Y capsulorrhaphy corrects the plantar and lateral deviation of the abductor hallucis tendon. The second stage of the V-Y capsulorrhaphy closure allows for the correction of abductus and valgus rotation of the hallux. Inasmuch as each element of the soft tissue deformity in hallux abducto valgus deformity is corrected individually, greater precision can be applied to each constituent of the hallux abducto valgus deformity.

Cartilage, Articular↗
PubMed1999

Tricorrectional bunionectomy for hallux abducto valgus. A comprehensive outcome study.

A longitudinal outcome study of the tricorrectional bunionectomy with AO screw fixation for the correction of hallux abducto valgus was undertaken involving 84 consecutive patients (121 feet) with a mean age of 48.4 years who underwent the procedure over a 6-month period. Preoperative and postoperative measurements of forefoot angles were calculated, with the following mean results obtained: intermetatarsal angle of 14.46 degrees corrected to 5.72 degrees, hallux abductus angle of 26.38 degrees corrected to 11.65 degrees, proximal articular set angle of 19.85 degrees corrected to 6.06 degrees, and tibial sesamoid position of 4.75 corrected to 1.87. The average time to return to athletic shoes was 12.63 days. Postoperative complications were minor, with no delayed unions, malunions, hematomas, bone infections, or hallux varus. Long-term follow-up (mean, 21.33 months) using the American Orthopaedic Foot and Ankle Society's objective Hallux Metatarsophalangeal-Interphalangeal Scale revealed an overall mean score of 88.94 points out of a possible 100. An excellent mean result of 95 points out of a possible 100 on the subjective patient rating scale was also reported.

Adolescent↗
PubMed2002

A retrospective analysis of 772 patients with hallux limitus.

In this retrospective analysis of 772 patients with symptomatic hallux limitus, 428 patients (55%) were successfully treated with conservative care alone; of these 428 patients, 362 (84%) were treated with orthoses. Corticosteroid injections and a change in shoes allowed 24 patients (6% of conservatively treated patients) and 42 patients (10%), respectively, to have less discomfort and return to previous activity levels. Overall, 47% of the patients in this analysis were successfully treated with orthoses. Surgical procedures were performed on 296 patients (38% of all patients) who did not respond to conservative care. In this analysis, 48 of the patients (6% of all patients) who did not respond to conservative care either refused surgery or were not surgical candidates. These data are intended to provide podiatric physicians with expected outcomes for conservative care of hallux limitus. The etiology, symptoms, conservative management, and surgical treatments of hallux limitus and hallux rigidus are also reviewed.

Adolescent↗
PubMed2002

Sensitivity and specificity of the functional hallux limitus test to predict foot function.

Functional hallux limitus is an underrecognized entity that generally does not produce symptoms but can result in a variety of compensatory mechanisms that can produce symptoms. Clinically, hallux limitus can be determined by assessing the range of motion available at the first metatarsophalangeal joint while the first ray is prevented from plantarflexing. The aim of this study was to determine the sensitivity and specificity of this clinical test to predict abnormal excessive midtarsal joint function during gait. A total of 86 feet were examined for functional hallux limitus and abnormal pronation of the midtarsal joint during late midstance. The test had a sensitivity of 0.72 and a specificity of 0.66, suggesting that clinicians should consider functional hallux limitus when there is late midstance pronation of the midtarsal joint during gait.

Adult↗
PubMedDate not supplied

Clinical and biomechanical risk factors of patients diagnosed with hallux valgus.

The purpose of this study was to identify the clinical and plantar loading variables related to hallux valgus. Fifty-one healthy control subjects and 40 subjects with a diagnosis of moderate hallux valgus deformity of similar age and body weight were recruited for this study. Clinical measurements of pain, first metatarsophalangeal joint range of motion, and single-leg resting calcaneal stance position were obtained. Biomechanical measurements were obtained using a capacitive pressure platform. Plantar loading variables were calculated for seven regions of the plantar surface. A univariate analysis followed by a stepwise logistic regression was used to analyze the data. The results indicated that high values for pain, single-leg resting calcaneal stance position, hallux region peak pressure and force-time integral, and central forefoot region force-time integral increased the likelihood of hallux valgus.

Adult↗
PubMedDate not supplied

Proximal oblique crescentic osteotomy in hallux valgus.

Twenty-six patients with moderate-to-severe hallux valgus deformities were evaluated before and after treatment. All of the patients had incongruent great toe joints. The patients underwent modified proximal crescentic osteotomy, which was termed proximal oblique crescentic osteotomy. The results were evaluated at an average follow-up time of 55 weeks. Objective criteria were hallux valgus angle, intermetatarsal angle, shortening of the first metatarsal, and angulation at the osteotomy site. Clinical evaluation was made according to the rating system of the American Orthopaedic Foot and Ankle Society. The mean correction of the hallux valgus and intermetatarsal angles was 22.1 degrees and 9.9 degrees, respectively. Short-term results indicate that proximal oblique crescentic osteotomy is effective in the treatment of hallux valgus; its advantages over other procedures include its technical ease and low rate of complications.

Combined Modality Therapy↗
PubMed1998

[Surgical therapy of hallux valgus in the young and middle-aged female].

OBJECTIVE: To correct hallux valgus in the young or middle-aged female. METHOD: Through dissecting foot specimens with hallux valgus we found that the intrinsic factor that caused hallux valgus was a "capstan" like mechanism of pressure. In order to eliminate the mechanism of the deformity, we cut off the link between the adductoris hallucis and the hallux completely. The tendon of adductoris hallucis was sutured to the fascial flap of hallucis bursa passing through a hole in the caput of the metatarsus. By this way the adductoris hallucis was fixed to the 1st metatarsus strongly, thus it pulled the 1st metatarsus directly. RESULTS: Twenty feet received this operation. 18 feet were followed up for 0.5-4 years. The rate of excellent and good results was 100%. CONCLUSION: This operation by suturing the adductoris hallucis with the fascial flap of the hallucis bursa not only can relieve pain but also restore the normal appearance of the foot.

Adult↗
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↗
PubMed2000

Scarf osteotomy for correction of hallux valgus. Historical perspective, surgical technique, and results.

The Scarf osteotomy has proven to be a versatile and powerful procedure to correct various degrees of hallux valgus deformity. Through modifications of bone-cut lengths and in combination with a phalangeal osteotomy, most hallux valgus deformities can be addressed. In cases of extreme hypermobility of the first ray or arthrosis of the first metatarsocuneiform joint, the Lapidus operation may be more appropriate. Hallux valgus rigidus or hallux valgus with severe rheumatoid joint disease usually requires alternative procedures. The results of the Scarf osteotomy compare favorably with the results reported for other popular bunion surgeries. When choosing a procedure, the clinician should consider that the Scarf osteotomy allows the patient to ambulate postoperatively without a cast or the use of crutches, to return to bathing and a closed athletic shoe in one week, and to have bilateral surgery, which maintains cost-effectiveness and returns the patient to his or her desired lifestyle more quickly. It has been said that surgery is both a science and an art. The author often believes that bunion surgery is more art than science, hence the success of so many procedures in one surgeon's hands and the failure in another's hands. The Scarf bunionectomy is a technically demanding procedure that has a large learning curve. Once mastered, however, the Scarf bunionectomy can provide a predictable and satisfying outcome for both patient and foot surgeon.

Bone Screws↗
PubMed2003

[Use of a silicone metatarsophalangeal joint endoprosthesis in hallux rigidus over a 15-year period].

PURPOSE OF THE STUDY: The aim of this retrospective study was to evaluate the results of a Swanson type, two stem, flexible silicone prosthesis used for first metatarsophalangeal joint replacement in hallux rigidus. MATERIAL AND METHODS: Between June 1987 and December 2001, we implanted this prosthesis in 145 first toes of 128 patients. This group comprised 83 women (96 replacements) and 45 men (49 replacements); the average age of the group was 49.5 (range, 17 to 82) years. Check-ups carried out in 2002 included clinical and X-ray examination and a questionnaire. Eighty-nine patients presented themselves (63 women and 26 men) and eight patients responded to the questionnaire only. A total of 97 patients (with 108 replacements) were checked up at an average follow-up of 4.75 years (range, 7 months to 15 years). In the questionnaire, we sought information on the patient's satisfaction with the arthroplasty and pain in the joint at rest and when walking in shoes or barefooted. On clinical examination, we assessed the range of motion in the first metatarsophalangeal joint and covering skin status. In X-ray films, we measured the toe axis, replacement status and position, and recorded the presence of bone proliferation. RESULTS: Of the 97 patients, 38 (43 replacements) were free from any pain; of the remaining 59 patients (65 replacements), 22 experienced pain of varying intensity at rest, 56 (60 replacements) had pain when walking in shoes and 44 (46 replacements) experienced pain when walking barefooted. Satisfaction with the surgical outcome was reported by 85 patients (with 94 operations), which is nearly 79%. Clinical examination showed that, post-operatively, flexion and extension were on average 11 degrees (range, 0 to 30 degrees) and 19 degrees (5 to 50 degrees), respectively. Post-operative infection was recorded in two cases and a pressure sore in the scar in six cases. Only one case required repeat surgery. X-ray examination revealed hallux valgus in 23 cases, failed replacement in six, and osteolytic areas in the vicinities of the distal and the proximal stem were found in 14 and 3 cases, respectively. Calcifications around the implant were recorded in 15 cases and osteophytes were present on the lateral sides of the proximal big toe phalanx and the resected head of the first metatarsal in 65 cases. DISCUSSION: Several methods have been available for treatment of hallux rigidus. Resection arthroplasty is used most frequently, with interposition arthroplasty second in rank. The osteotomy of either the first metatarsal or the proximal phalanx is preferred in younger patients. Cheilectomy, i.e., removal of dorsal osteophytes involving excision of about 25% of the dorsal part of the head of the first metatarsal, is also a common method, as well as its combination with different types of osteotomy. Total replacement of the first metatarsophalangeal joint is less frequent because neither metal nor hemiphalangeal implants had good outcomes. Flexible silicone two-stem prostheses have been appreciated by the patients but clinical results have been inconsistent; because of frequent failure they have not often been used. The subjective evaluation by our patients was in agreement with assessments reported by other authors; however, our results of clinical examination determining the range of motion were better. Although the average range of motion was not very high (30 degrees), the proportion of our patients in whom the minimal motion was less than 15 degrees was only 11% and this value was markedly lower than reported by other authors. Also our radiographs showed failed implants less frequently than reported in the literature. CONCLUSIONS: Based on favorable subjective assessments by the patients and a low number of failed implants, this technique can be regarded as an appropriate therapy for middle-aged patients with a diagnosis of hallux rigidus, even though it may not permit a large range of motion in the joint affected.

Adolescent↗
PubMed1992

Repair of hallux valgus with a distal soft-tissue procedure and proximal metatarsal osteotomy. A long-term follow-up.

We retrospectively reviewed the results for seventy-five patients (109 feet) in whom a hallux valgus deformity had been corrected with the release of the distal soft tissues, excision of the medial eminence, plication of the medial part of the capsule, and proximal crescentic osteotomy of the first metatarsal. The patients were followed for an average of thirty-four months (range, twenty-four to fifty-six months). The preoperative hallux valgus angle averaged 31 degrees, and the postoperative angle averaged 9 degrees. The preoperative intermetatarsal angle averaged 14 degrees and the postoperative angle, 6 degrees. Ninety-three per cent of the patients were satisfied with the result of the procedure. They stated that, given the same circumstances, they would have the operation again. The most common complication was hallux varus, which occurred in thirteen feet (nine patients). The other complications included recurrence of the hallux valgus in two feet, pain under a fibular sesamoid in one foot, and a tailor's bunion that was unrelated to the operation in one foot. Only five of forty-eight feet that had had a symptomatic plantar keratosis beneath the second metatarsal head preoperatively remained symptomatic postoperatively.

Adolescent↗
PubMedDate not supplied

First metatarsal head shape in juvenile hallux abducto valgus.

A round first metatarsal head has been implicated as a predisposing factor in hallux abducto valgus. The shape of one hundred first metatarsal heads was analyzed on 50 weightbearing dorsoplantar x-rays of 10-year-old children with a hallux abductus angle in excess of 15 degrees and osteophytic thickening of the first metatarsophalangeal joint. The metatarsals were subjectively described as either round or square. A measurement technique was then devised to quantify in millimeters the difference between the two types. Using chi-square analysis, a very strong statistical association (p less than 0.001) was found between the subjective assessment and the objective measurement. A weak relationship was found between the metatarsal head shape and the degree of hallux abducto valgus (HAV) (r = -0.294). While the trend of this correlation is consistent with accepted wisdom, that is, the squarer the metatarsal head the less the hallux abducto valgus, the association is not strong enough to scientifically confirm it. This finding along with the presence of so many square metatarsal heads in children with advanced HAV indicates that assessment of metatarsal head shape has little place in the scientific assessment of first metatarsophalangeal joint pathology.

Child↗
PubMedDate not supplied

Gait analysis in hallux valgus.

The solar pressure zones were analyzed in the feet of 66 patients suffering from hallux valgus, together with 60 normal subjects. The EMED Gait Analysis System was used. In the hallux valgus group, the maximum pressure was found to be increased significantly in the small toe region and more proximally situated, close to the metatarsophalangeal joint. In the normal subjects, the maximum pressure was increased significantly in the first, second, third, and fourth metatarsal and heel regions. In general, the hallux valgus group had smaller contact areas compared to the control group. The increased pressure in the small toe region, together with the smaller contact areas manifested by the hallux valgus group, were interpreted in this work as being the possible causes of the metatarsalgia seen in patients with the deformity.

Female↗