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PubMed2000

Distal soft tissue correction for hallux valgus with proximal screw fixation of the first metatarsal.

These early results with short-term to medium-term followup demonstrate the effectiveness of this distal soft tissue procedure with proximal realignment in a subset of patients with moderate to severe hallux valgus and mobility of the first ray. With up to 2-year followup, the correction seems to hold with no significant recurrence and only mild increases in the hallux valgus and intermetatarsal angles with time. Obviously, longer-term followup with a larger group of patients is needed, but these early results are encouraging. In this group of patients, this procedure provides reliable correction of hallux valgus while possibly avoiding some of the morbidity of the different procedures for proximal osteotomy.

Bandages↗
PubMed1994

Hallux valgus due to cuneiform-metatarsal instability.

We present a biomechanical rationale for the treatment of severe hallux valgus deformity by realignment and arthrodesis of the first cuneiform metatarsal (CM) joint. We think that this severe hallux valgus deformity represents instability at the CM-1 articulation, since normal motion at that joint is very small. A forefoot compression test was used to assess the foot preoperatively. This was found not only to realign the first metatarsal, but also to align the metatarsophalangeal joint. A surgical procedure has evolved to include a transverse screw between the first and second metatarsal bases, as well as a second screw from first cuneiform to first metatarsal base, along with a small-volume bone graft of the CM-1 articulation. This is a modern variant of the Lapidus procedure.

Arthrodesis↗
PubMedDate not supplied

Normal and pathologic anatomy of hallux valgus.

The author reviews the pathologic entity of hallux valgus, using anatomic illustrations. Although this description is not considered to represent new information, foot surgeons must continue to appreciate the delicate biomechanical imbalances leading to this anomaly.

Hallux↗
PubMed2001

The grading of hallux valgus. The Manchester Scale.

This article describes a new, noninvasive method of assessing the severity of hallux valgus deformity by means of a set of standardized photographs. Six podiatrists were independently asked to grade the level of deformity of 13 subjects (26 feet) on a scale of 1 (no deformity) to 4 (severe deformity). The reliability of the four-point scale for the severity of hallux valgus was investigated by means of kappa-type statistics for more than two raters. The results showed that the grading method had excellent interobserver repeatability with a combined kappa-type statistic of 0.86, making it a suitable instrument for clinical and research purposes.

Foot↗
PubMed1985

Fixation of Hohmann's osteotomy for hallux valgus.

We modified Hohmann's (1923) osteotomy for hallux valgus by internal fixation of the metatarsal head with no need for a plaster cast. Five (2-10) years post-operatively, all 20 patients (32 feet) had complete relief and all but one was satisfied with the cosmetic result. However, we now routinely add osteotomies of the second and third metatarsal neck to prevent, albeit asymptomatic, callosities.

Adolescent↗
PubMed1976

[Operative treatment of hallux valgus].

A new method of operative treatment for hallux valgus consists in a derotational osteotomy of the first metatarsal bone and adductorotenotomy, that allows a correction of the deformity without an operation on the first metatarsophalangeal joint. A total of 67 patients were operated upon (81 operations). Late results were followed up in 48 patients (59 operations). Excellent and good results after the operation were noted in 47, satisfactory-in 10 and poor-in 2 observations. The operation is thought to be indicated in marked deformities.

Adult↗
PubMed1990

[The role of a shortening osteotomy of the first phalanges associated with soft-tissue release in the surgical treatment of hallux valgus].

The Authors report the results of 120 hallux valgus operated on 76 patients from January 1983 to June 1988. The operative procedure associated bunionectomy, tenotomy of the abductor hallucis which was resected from the base of the first phalanx and from the lateral sesamoid, shortening osteotomy of the proximal phalanx and finally adjustment of the sesamoids under the head of the first metatarsal. When there was an important metatarsus varus, a basilar osteotomy of the first metatarsal was associated (10 cases about 120). The results were appreciated functionally (pain, range of motion, easiness for putting on one's shoes) and anatomically (radiological correction of the deformity). The total result included anatomical and functional results. Anatomically, 110 feet had sesamoids perfectly adjusted (that is 92.5 per cent), 9 had an inadequate adjustment (first degree). The metatarsus varus was always improved except 3 cases; in these cases a basilar metatarsal osteotomy would have to be performed. The valgus of the big toe was corrected in 88 per cent of the cases (104 feet had a valgus lower than 15 degrees). A varus of the big toe was found in 6 cases (5 per cent). One was lower than 5 degrees; it was nevertheless included with the good results (very well endured). 5 were more than 10 degrees and were included with the poor results. Finally, we took notice of 4 degenerative changes of the first metatarso-phalangeal joint. The total results found 90 per cent of good and very good results, 6 per cent of fair results and 4 per cent of poor results.

Adolescent↗
PubMed2000

Modified lapidus procedure for the treatment of hypermobile hallux valgus.

The intermediate outcome of patients who underwent a modified Lapidus procedure for the treatment of hallux valgus secondary to a hypermobile first ray was evaluated with an outcome tool to determine if their pain and functional status were improved. We evaluated 31 feet in 26 patients who underwent a modified Lapidus procedure. All working patients (100%) returned to full-time work. Six patients were retired and one was unemployed prior to surgery. There was an average of eight months until sports or unlimited activities were performed, and an average 16 weeks until conventional shoes could be worn. All patients but one (96%) were satisfied with the surgery and knowing their results would have the surgery again. Postoperative pain relief satisfaction was totally satisfied in 19 patients, satisfied with reservations in six patients, and not satisfied in one patient. Postoperative appearance satisfaction was totally satisfied in 21 patients and satisfied with reservations in five patients. Postoperative joint motion was no noticeable stiffness in 22 patients, noticeable stiffness but not bothersome in three patients, and stiffness that impairs activity in one patient (two feet). In the radiographic measurements, there was an average improvement of 10 degrees in the hallux valgus angle, 10 degrees in the intermetatarsal angle, two degrees in the lateral metatarsal-floor angle and two grades in the sesamoid position. Complications experienced were five recurrent deformities, two metatarsalgias, and one deep vein thrombosis. One of the five recurrences became symptomatic and required a revision.

Adult↗
PubMed2004

Hallux valgus and first ray mobility: a cadaveric study.

BACKGROUND: Several studies have demonstrated that patients with hallux valgus (HV) deformities have increased first ray sagittal mobility. However, the change in mobility that occurs after surgical correction of HV deformities has not been extensively evaluated. This study was done to determine if surgical realignment of the first ray in cadaver specimens with a proximal crescentic osteotomy and distal soft tissue reconstruction (DSTR) would reduce the first ray sagittal motion as measured with an external-type micrometer (the Klaue device). METHODS: Twelve fresh-frozen below-knee cadaver specimens with an HV deformity (HV angle > 15 degrees, 1-2 IM angle > 9 degrees) were used for the study. Standardized simulated weightbearing radiographs were obtained before and after the surgical correction of the deformity. The first ray sagittal motion was measured with an external micrometer (Klaue device) before correction of the HV deformity and after the procedure. All specimens had correction of the hallux valgus deformity with a DSTR and proximal crescentic osteotomy. Internal fixation was applied to secure the osteotomy site. RESULTS: The HV angle was corrected from a mean of 28.6 degrees to a mean of 11.0 degrees. The 1-2 IM angle was corrected from a mean of 12.9 degrees to a mean of 6.8 degrees. The average preoperative first ray sagittal motion was 11.0 mm (range, 8.5 mm to 13.5 mm). After the surgical repair, the mean sagittal first ray motion was significantly decreased (p <.0005) to a mean of 5.2 mm (range, 3.5 mm to 7.5 mm). CONCLUSION: After correction of HV deformities with a DSTR and a proximal crescentic osteotomy, first ray mobility in cadaver specimens was significantly reduced. The stabilization of first ray mobility that occurred immediately after surgical correction despite leaving the capsule of the first metatarsocuneiform (MC) joint undisturbed suggests that extrinsic anatomic features may play a role in first ray mobility. Additionally, stability of the first ray may be restored with a bunion procedure that does not sacrifice the first MC joint.

Aged↗
PubMed2001

Surgical treatment for hallux valgus with painful plantar callosities.

We retrospectively reviewed the results of a distal soft-tissue procedure and proximal crescentic osteotomy of the first metatarsal combined with a proximal shortening osteotomy of the second and/or third metatarsal. This was in patients who had hallux valgus with painful plantar callosities. The review covered seven years of procedures (1989-1996) in 12 patients (14 feet) averaging 53 years of age. Average follow-up was 52 months. All patients had pain at the first metatarsophalangeal joint and had metatarsalgia preoperatively. At follow-up, 11 feet had no pain at the first metatarsophalangeal joint, and three had some improvement of pain. Ten feet had no metatarsalgia, two had improvement of metatarsalgia, and two feet had transfer lesions postoperatively and required reoperation. The angle of hallux valgus averaged 40 degrees preoperatively and 13 degrees postoperatively. The intermetatarsal angle averaged 18 degrees preoperatively and 6 degrees postoperatively. Mean decreases in length of the second and third metatarsal after surgery were 5.4 mm and 4.8 mm, respectively. Our results suggested that this combined procedure for hallux valgus with painful plantar callosities may be successful, in carefully selected patients.

Adult↗
PubMed2006

A patient-based questionnaire to assess outcomes of foot surgery: validation in the context of surgery for hallux valgus.

BACKGROUND: A patient-based outcome measure with good measurement properties is urgently needed for use in clinical trials of foot surgery. METHODS: We evaluated an existing foot pain and disability questionnaire (the Manchester Foot Pain and Disability Questionnaire) for its suitability as an outcome measure in the context of hallux valgus corrective surgery. Interviews with patients led to initial changes, resulting in 20 candidate questionnaire items with five response categories each. These were tested in a prospective study of 100 patients (representing 138 foot operations) undergoing hallux valgus corrective surgery. Analysis of underlying factor structure, dimensionality, internal reliability, construct validity and responsiveness of the questionnaire items in relation to (i) SF-36 general health survey and (ii) American Orthopaedic Foot & Ankle Society (AOFAS) hallux clinical scale resulted in a final 16 item questionnaire (the 'Manchester-Oxford Foot Questionnaire' (MOXFQ)), consisting of three domains/scales: 'Walking/standing' (seven items), 'Pain' (five items) and 'Social interaction' (four items) each having good measurement properties. All three domains were unidimensional. CONCLUSIONS: The new 16-item MOXFQ has good measurement properties in the context of outcomes assessment of surgery for hallux valgus. Future studies should assess the MOXFQ in the context of surgery for other foot and ankle conditions.

Adult↗
PubMed2001

Comparative study between Wilson and Mitchell metatarsal osteotomies for the treatment of hallux valgus in adults.

Although Mitchell osteotomy and Wilson osteotomy are two popular methods for the treatment of hallux valgus, there are no studies directly comparing their results. Fifty-six patients (73 feet) who underwent a Wilson osteotomy and 30 patients (34 feet) who had a Mitchell osteotomy were followed for a mean period of 33.7 and 38.9 months, respectively. The results were comparable in terms of hallux valgus angle correction and first intermetatarsal angle correction, although symptomatic improvement was higher in the Mitchell group. Moreover, the incidence of postoperative metatarsalgia was significantly lower in the Mitchell group as compared to the Wilson group (11.8% vs 32.9%), while less time was required for the patients who underwent Mitchell osteotomy to return to work or normal activities postoperatively. The difference in symptomatic improvement, incidence of postoperative metatarsalgia and rehabilitation time was even more clearly in favor of the Mitchell group in patients over 55. The increased stability at the osteotomy site offered by the Mitchell osteotomy compared to Wilson osteotomy could be the reason why patients had a lower incidence of postoperative metatarsalgia and returned to their normal activities faster, thus giving a higher satisfaction rate.

Adolescent↗
PubMed2005

The modified Lapidus procedure for hallux valgus: a clinical and radiographic analysis.

BACKGROUND: Historically, the modified Lapidus procedure has been considered technically challenging, with high rates of complications, including nonunion and malunion. The purpose of this study was to review the clinical and radiographic results of this technique for the treatment of hallux valgus associated with first ray hypermobility, specifically examining patient satisfaction and the incidence of complications. METHODS: We retrospectively reviewed the results of the modified Lapidus procedure in 32 patients (38 feet). Evaluation included preoperative and postoperative questionnaires, physical examination, and radiographs. RESULTS: Complete clinical data was available for 29 patients (35 feet) and complete radiographic data for 29 patients (34 feet). Average age at surgery was 54 (range 27 to 84) years. Average followup was 42 months (range 29 to 93) months. Average preoperative visual analog pain score was 7.2 and postoperative 2.3 (p < 0.001). Average preoperative AOFAS Hallux MTP-IP Score was 44.8 and postoperative 87.3 (p < 0.001). Average preoperative intermetatarsal (IM) angle was 16 degrees, and the hallux valgus (HV) angle was 34 degrees. Postoperatively, the average IM angle was 6 degrees, the HV angle 11 degrees. There were no cases of nonunion or malunion. Complications included symptomatic hallux varus in two, recurrence of hallux valgus deformity in one, deep venous thrombosis in one, and failure of fixation in one patient. Twenty-four percent of patients (7 of 29) noted the subjective sensation of midfoot stiffness and 34% (10 of 29) noted forefoot stiffness. None of these patients thought that the stiffness was a disability. Ninety percent of patients (26 of 29) were satisfied with their foot function, and 86% (25 of 29) were satisfied with the cosmetic appearance of their foot. CONCLUSIONS: The modified Lapidus procedure results in a satisfactory clinical outcome in most patients. With meticulous operative technique, rigid internal fixation, and strict postoperative weightbearing restrictions, successful union can be achieved and complications can be minimized. Care should be taken to avoid hallux varus, and patients need to be counseled regarding a potentially long convalescent period and possible postoperative stiffness.

Adult↗
PubMed2006

Surgical treatment of hallux valgus: the Gibson-Piggott technique revisited.

More than 130 surgical procedures have been described to treat hallux valgus deformity. The "spike" first distal metatarsal osteotomy was first described by Gibson and Piggott in 1962. Despite having the advantage of using only patient's "material", this technique has been abandoned by most orthopaedic surgeons, due to fear of complications such as breaking of the bony peg and loosening of fixation at the osteotomy site. A group of surgeons at our hospital have performed 422 Gibson-Piggott procedures between 1985 and 2005 with consistently good results. This fact convinced us to "revisit" the procedure. Thirty seven consecutive patients (43 feet) who had surgery between July 2000 and December 2002 were randomly selected as "sample". A Questionnaire based on the American Orthopaedic Foot and Ankle Society (AFOS) Score was used for evaluation. Thirty three patients (36 feet), i.e. 89% responded to our survey. Average follow-up after surgery was 47 months (between 31 and 63 months). Results showed that 30 patients (91%) had no or only mild pain, 29 patients (88%) had no or only slight limitation in activities of daily living and 31 patients (94%) were able to use fashionable or comfortable shoes with no problems. When using numerical evaluation, 28 patients (85%) scored 65 or more points (from a total of 95 points), representing a good postoperative result, comparable with other "modern" distal metatarsal osteotomies. In conclusion, the Gibson-Piggott procedure was shown to be a valuable technique in the treatment of mild or moderate hallux valgus deformity.

Adult↗
PubMed1998

[Mitchell's osteotomy of hallux valgus].

45 patients were included in a prospective study to evaluate the results of Mitchell's osteotomy of hallux valgus. 43 patients complained of pain preoperatively. 44 patients were reviewed after one year, and excellent results were achieved in alleviating pain for 35 of these patients. Four patients developed metatarsalgia after surgery. There was a mean improvement in the hallux valgus angle of eight degrees. The mean shortening of the first metatarsal was 6 mm (1-12 mm). This shortening showed no correlation with postoperative pain. Signs of osteoarthrotic changes in the metatarsophalangeal joint were found in one patient and early signs of osteonecrosis of the first metatarsal head in two. We conclude that in spite of some serious complications this method produces satisfactory results and can be recommended when pain over the medial prominence is the main indication.

Adolescent↗
PubMed2003

Hallux valgus: immediate operation versus 1 year of waiting with or without orthoses: a randomized controlled trial of 209 patients.

Hallux valgus operations can not always be done immediately because of long waiting lists. In this study, 209 consecutive patients (mean age 48 years, 93% female) with a painful hallux valgus were randomized into 3 groups: immediate operation or 1 year waiting with or without foot orthoses. The follow-up period was 2 years. The main outcome measurement was the intensity of pain during walking. During the first year, 64/71, 0/69 and 4/69 patients were operated on in the surgery, orthosis and no orthosis groups, respectively, and during the 2-year follow-up, 66, 43 and 48, respectively. At the 1-year follow-up, the pain was least intense in the surgery group. At the 2-year follow-up, the intensity of pain was similar in all groups. The satisfaction with treatment was best in the surgery and orthosis groups. The total costs of care were similar in all groups. We conclude that immediate operation is superior to delayed operation or foot orthoses. However, if this is not possible because of limited possibilities for surgery, waiting for 1 year, with or without an orthosis, does not jeopardize the final outcome.

Costs and Cost Analysis↗