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At least 235 records · Page 13Linked to original sources
PubMed1991

Roentgenographic assessment in hallux valgus.

Which simple roentgenographic angle should be used to assess medial (varus) deviation of the first metatarsal in cases of hallux valgus has been a topic of debate. Measurements were made from roentgenograms of 100 symptomatic feet in women with hallux valgus. These were compared with similar measurements obtained from symptomatic normal feet of women of a similar age distribution. The hallux valgus angle was associated with medial deviation of the first metatarsal measured by all three of the parameters defined and tested, i.e., the intermetatarsal, metatarsus primus varus, and metatarsus omnis varus angles. Of these, the best measure was the intermetatarsal angle, which in the hallux valgus feet differed significantly from controls more than the other measurements. No evidence was found to support any concept of second metatarsal deviation from normal.

Adolescent↗
PubMed1989

Stress fracture of the lateral metatarsals following double-stem silicone implant arthroplasty of the hallux metatarsophalangeal joint.

Stress fractures of the lateral metatarsal bones occur frequently and are most commonly seen following repetitive trauma. However, such fractures rarely occur after reconstructive operations involving the hallux metatarsophalangeal joint. The authors report four patients who developed a lateral metatarsal stress fracture during the first year following use of a double-stem silicone implant to reconstruct the hallux and, in addition in the case of one patient, the second metatarsophalangeal joint. An analysis of all these patients established the incidence of this complication to be 3%. The etiology of these fractures appears to be an overloading of the lateral metatarsals secondary to some shortening of the hallux metatarsal or in reestablishing motion to the hallux metatarsophalangeal joint. All fractures healed without complication and did not result in further forefoot symptoms or deformities. However, this complication should be suspected when lateral metatarsalgia develops following silicone implant arthroplasty because roentgenograms initially may be normal.

Adolescent↗
PubMedDate not supplied

Metatarsus primus elevatus and the etiology of hallux rigidus.

One hundred twenty radiographs of the foot were evaluated for hallux abductus angle, lateral talometatarsal angle, and metatarsus primus elevatus position. Mean elevatus position of the first metatarsal above the second metatarsal was approximately 7.0 mm. First ray elevation was a consistent finding in all data groups studied, including controls. The presence of hallux abducto valgus or hallux rigidus did not affect the degree of first ray elevation present. The majority of radiographs studied lacked evidence of joint disease. Therefore, the common practice of evaluating radiographic elevatus as a surgical criteria to predict the possible development of hallux rigidus should be strongly discouraged.

Hallux↗
PubMed1995

Modified distal metatarsal osteotomy for hallux valgus.

Sixty-three feet in 44 patients with a hallux valgus, which had been operated on using a modified distal osteotomy were reviewed after a mean follow-up of 4.6 years. A modification of Mitchell's and Mommsen's osteotomies was used without any fixation material. The mean correction of the intermetatarsal angle was 2.6 degrees and of the hallux valgus angle 5.2 degrees. Good subjective result was achieved in 90% of the feet. In six (9.5%) cases the hallux valgus angle was worse after the operation. The method used seems to be too unreliable to be continued. Patient selection was found to be of great importance. Hallux valgus angle of more than 40 degrees was less suitable for this kind of operation.

Adult↗
PubMed1994

The operative treatment of acquired hallux varus.

Forty two patients (45 feet) who underwent operative correction of acquired hallux varus were retrospectively evaluated. The causes of hallux varus included complications after hallux valgus surgery (36), trauma (3), rheumatoid arthritis (3), unknown (2), and osteoarthritis (1). The methods of surgical correction were determined by the underlying etiology, the age and activity level of the patient, and the site of primary deformity. Surgical corrections included medial soft tissue release alone (2), medial soft tissue release combined with tendon transfer (17), metatarsal osteotomy with (1) or without (1) additional tendon transfer, arthrodesis (17), and resection arthroplasty (7). The tendon transfers used included a split extensor hallucis longus (6), an extensor hallucis longus transfer in combination with interphalangeal joint arthrodesis (7), and an extensor hallucis brevis (4). All patients were evaluated at a mean of 3.8 years (range, 1-7 years) after surgery. Pain, problems with shoe wear, and metatarsophalangeal joint instability, if present preoperatively, were improved in all treatment groups. An algorithm for the operative management of hallux varus is presented.

Adult↗
PubMed1993

[Biomechanical investigation of the sesamoid bones of the hallux].

Extensive research has been done on disorders of the sesamoid bone of the hallux. However, reports on the mechanism of the disorder are few and a comprehensive assessment of the biomechanical role played by the sesamoid bone has not been done. In an effort to elucidate the role of the sesamoid bone, we have developed a force sensor which utilizes the capacitance method, and evaluated the biomechanical aspects of fatigue fracture associated with it. Three frozen stored human limbs were thawed at room temperature. The force between the sesamoid bone and the first metatarsal head was measured using force sensors which were placed on the bilateral sesamoid bones. Measurements were also taken at varying loads and angles of dorsiflexion of the MTP (metatarsophalangeal) joint of the hallux from 0 degrees to 60 degrees at increments of 10 degrees. This was done by applying weights ranging from 0 to 4 kg to the first metatarsal head at increments of 1 kg. Load and angle of dorsiflexion of the MTP joint were found to be correlated with the degree of compression force between the hallux sesamoid bone and the first metatarsal head; the load applied affected the force to a greater extent than did the angle. Dorsiflexion of the MTP joint of the hallux had no effect on the amount of compression force between the medial and lateral sesamoid bones, but the increase in compression force became pronounced when the angle of dorsiflexion exceeded 30 degrees.

Biomechanical Phenomena↗
PubMed1998

Long-term results after Mitchell osteotomy in children and adolescents with hallux valgus.

The current study elucidates the quality of long-term results after hallux valgus correction by Mitchell osteotomy in children and adolescents. Eight female and 1 male hallux valgus patient with a total of 16 bunion deformities underwent a Mitchell procedure in the period 1970 to 1985, and were reinvestigated in December 1994 (at an average of 16 years later). Their ages at operation ranged from 9 to 20 years (average 16 years). Patients' data were subdivided into subjective and objective criteria. Subjective parameters such as pain, shoe fitting, mobility and cosmesis were assessed by interview. Objective data were obtained from reports, radiographs and physical examination. Owing to the lack of established and recommended scores, we developed our own evaluation pattern. Overall outcome was judged as good in 69%, satisfying in 12% and dissatisfying in 19% by both patients and surgeon. In our experience, Mitchell osteotomy is an appropriate method for young hallux valgus patients, especially in forefeet with rigid malformation or moderately severe hallux valgus and metatarsus primus varus. Extensive metatarsal shortening should be excluded preoperatively in order to avoid postoperative metatarsalgia.

Adolescent↗
PubMed2000

The effect of rearfoot eversion on maximal hallux dorsiflexion. A preliminary study.

Functional hallux limitus has been recently described as an etiologic factor in postural complaints. Eversion of the rearfoot has been theoretically linked to decreased hallux dorsiflexion, although there have been no scientific studies on this subject to date. This study was undertaken to investigate the relationship between rearfoot eversion and hallux dorsiflexion; the results show that hallux dorsiflexion is decreased with rearfoot eversion in a static setting.

Adult↗
PubMed2005

[Endoprosthetic replacement of hallux rigidus].

Replacement of the first metatarsophalangeal joint (MTP1) is still controversial when compared with MTP1 fusion in treating hallux rigidus and other disabling conditions of the MTP1 joint. Prospective studies concerning endoprosthetic replacement of the MTP1 joint are not available yet. Nevertheless, better understanding of biomechanics and tribology show favour towards total endoprosthesis. Some currently available models are described (Toefit-Plus, Roto-glide, ReFlexion, Bio-Action, Moje). Furthermore the authors report their results with 30 Toefit-Plus total endoprostheses. Five complications (16.6%) included two dislocations of total prostheses and three bone fissures. In 3 of 14 cases (21%) with a 3-year follow-up, revision surgery was necessary (subluxation, persistent pain, recurrence of hallux rigidus). Of 11 cases (63%) with a 4-year follow-up, 7 revealed secondary loss of range of motion. A more aggressive postoperative treatment with early weight bearing and regular push-off of the first ray is recommended. Based on our results, MTP1 replacement should be indicated restrictively (hallux rigidus, no experiments in cases of important first ray insufficiency).

Arthrodesis↗
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↗
PubMedDate not supplied

Keller procedure for the treatment of resistant plantar ulceration of the hallux.

A retrospective chart review was performed on 11 patients (13 feet) who underwent a modified Keller procedure for the treatment of recalcitrant neuropathic diabetic ulcers to the plantar aspect of the hallux between 1994 and 1998 to evaluate the postoperative results and complications. Diabetic patients with hallux rigidus, adequate vascular status, documented peripheral neuropathy, and at least 6 months of conservative care for treatment of a Wagner grade I and II ulceration were included in the study. Patients with active soft tissue infections or osteomyelitis were excluded. All primary ulcers healed within 6 months postoperatively. After 1-year of follow-up, 8 feet remained completely free of ulcers and 5 transfer ulcers occurred. Four infections developed; 3 from the surgical wound and 1 from a transfer ulcer. Based on these findings, the modified Keller procedure may be an appropriate intervention for hallux ulcerations provided the surgeon and the patient are aware of its limitations and possible outcomes.

Aged↗
PubMed1997

Acquired hallux varus.

Acquired hallux varus most commonly occurs after hallux valgus surgery. Sagittal plane, coronal plane, and varus deformities are present at the metatarsophalangeal joint. Evaluation of both the metatarsophalangeal and interphalangeal joints for mobility is necessary in surgical decision making. Not all patients require surgery. The anatomy, incidence, pathogenesis, evaluation, classification, and treatment of acquired hallux varus are discussed in this review.

Adult↗
PubMed1977

The hallux and rheumatiod arthritis.

The purpose of this report is to consider involvement of the great toe by rheumatoid arthritis, defining significant deformities, describing clinical patterns and discussing the pathomechanics of these findings, in what is an ongoing disease. 200 consecutive patients admitted to hospital with classical or definite rheumatoid arthritis were screened for pain or deformity of the great toe. Feet that had undergone previous surgery or had other underlying pathology were excluded from the series. 194 feef were found to have halluceal involvement. Although hallux valgus was the commonest deformity it was found in combination with other significant deformities in many cases. Hallux rigidus was an important lesion in this series as was interphalangeal hyperextension. Other important lesions encountered were metatarsus primus varus and medial rotation of the toe; their relationship to hallux valgus is discussed.

Arthritis, Rheumatoid↗
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↗
PubMed1975

Acquired hallux varus: a preventable and correctable disorder.

Acquired hallux varus deformity of either the static or the dynamic type results from surgery to correct hallux valgus deformity and the accompanying bunion. The dynamic type is disfiguring, uncomfortable, and disappointing to the patient and surgeon alike. Linear as well as rotational forces are at work to produce the deformity. When recognized early, before fixation of the first digit has occurred in the deviated and clawed position, resection of the base of the proximal phalanx will correct the deformity. More radical treatment is required in the patient who is treated late. The experience with seven feet of five patients with acquired hallux varus deformity is presented here.

Adult↗
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↗
PubMed1991

Iatrogenically induced hallux varus.

Hallux varus is not uncommon after hallux valgus surgery. Through understanding of its cause, this deformity may be easily avoided with thorough preoperative evaluation, meticulous and deliberate intraoperative technique, and early postoperative diagnosis. By recognizing these factors, one can significantly reduce the predilection toward hallux varus. Once the diagnosis has been made, aggressive treatment is warranted, in the hope of minimizing the complexity of joint disorientation and surgical repair.

Hallux↗
PubMedDate not supplied

Hallux varus--surgical correction and review of the literature.

Acquired hallux varus may follow correction of hallux abducto valgus by the modified McBride procedure. The authors discuss correction of both acquired and congenital hallux varus and show pre- and postoperative illustrations of both types.

Foot Deformities, Acquired↗