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PubMed1984

Extensor hallucis longus transfer for hallux varus deformity.

The hallux varus deformity results from a dynamic imbalance of the tendons that cross the first metatarsophalangeal joint. This condition most frequently occurs after McBride-type operative treatment for hallux valgus. A new procedure, developed to correct this imbalance, involves transferring the extensor hallucis longus beneath the first intermetatarsal ligament into the base of the proximal phalanx, along with an arthrodesis of the first interphalangeal joint. This procedure in fifteen affected great toes gave over-all satisfactory correction of the hallux varus deformity.

Adult↗
PubMed1981

The etiology of hallux valgus in Japan.

Until recent years, hallux valgus did not exist in Japan. Changing customs and styles of footwear during the past ten years have led to an increasing number of patients with the classic hallux valgus deformity. These are not mild deformities, but are painful and require surgical correction. The ratio of the width to the length of the foot is similar in both sexes and was measured in children up to the age of 14. Coincidentally, at about that time students may freely wear any type of fashionable shoe. We conclude, therefore, that the hallux valgus deformities we are now seeing with greater frequency are caused, at least in part, by the change in footwear.

Adult↗
PubMed1981

The prevalence of hallux valgus in three South African populations.

The prevalence of hallux valgus and its relationship to the metatarsal angles have been assessed in females between the ages of 2 and 20 years in three populations: an urban White community, an urban Black community and a rural Black Community. By the age of 10 years the mean hallux angle is significantly greater in the White girls than in girls in the two Black groups. The angle between the first and second metatarsals is greater in the White than in the black children and this difference increases throughout childhood and adolescence. It is suggested that young White girls may be predisposed to the abnormality of hallux valgus by having significantly greater metatarsal angles.

Adolescent↗
PubMed1980

A comparison of the prevalence of hallux valgus in three South African populations.

The prevalence of hallux valgus and its relationship to the metatarsal angles and the shape of the foot have been assessed in women over 50 years of age from three populations: an urban White community, an urban Black comunity, and a rural Black community. Hallux valgus was significantly more common in the Whites than in either of the Black groups; there was no significant difference in the prevalence in rural and urban Blacks. Likewise, the angle between the first and second metatarsals was significantly greater in White women (mean 10,80 degrees) than in Black women (mean 8,21 degrees for urban Blacks and 7,05 degrees for rural Blacks). From this study it could be deduced whether the increased metatarsal angle was the cause of the more frequent appearance of hallux valgus in White women.

Black or African American↗
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↗
PubMed1996

Clinical and radiological results after Austin bunionectomy for treatment of hallux valgus.

The results of the Austin osteotomies for hallux valgus deformity performed at the Orthopedic Hospital Gersthof were reviewed at least 1 year after surgery. Of the 53 consecutive patients (66 operations) with an average follow-up of 24.3 months, 49 patients (62 feet) were interviewed. Of the reviewed patients 86.6% achieved good or excellent clinical results. The complication rate was 8%, including hallux varus n (3), superficial n (1) and deep n (1) wound infections, hypoaesthesia n (2), and reflex sympathetic dystrophy n (1). There was one case of avascular necrosis of the first metatarsal head and none of non-union. The Austin osteotomy is a safe and effective treatment of mild and moderate hallux valgus deformity.

Adolescent↗
PubMed1999

Congenital absence of the lateral metatarso-phalangeal sesamoid bone of the human hallux: a case report.

A case of congenital absence of the lateral metatarsophalangeal sesamoid bone of the hallux is reported, in a 47-year-old woman. The lateral sesamoid bone was absent on the right hallux, and extremely reduced on the left hallux. The normal intersesamoidean crest and both sesamoidean grooves of the metatarsal head were absent. Physical examination was normal, and no functional disturbance resulted from this variant. Only two previous cases have been found in the literature. It must be distinguished from a total resorption due to an infectious process, or from an absence due to surgical excision. This absence can be related to the general tendency of disappearance of the sesamoid bones within hominoid primates.

Ankle Injuries↗
PubMed2005

The Ludloff osteotomy for correction of hallux valgus.

OBJECTIVE: Correction of a symptomatic hallux valgus deformity. INDICATIONS: A hallux valgus deformity in which the intermetatarsal angle I-II exceeds 15 degrees and the shaft of the first metatarsal is broad enough to allow a rotational osteotomy. CONTRAINDICATIONS: Hypermobility of the first ray. Severe osteoporosis. Degenerative arthritis of the first metatarsophalangeal joint. SURGICAL TECHNIQUE: Longitudinal incision over the first intermetatarsal space. Division of the metatarsosesamoid ligament together with the tendon of the adductor hallucis muscle. Opening of the lateral articular capsule of the first metatarsophalangeal joint allowing a tension-free realignment of the head of the first metatarsal with the sesamoids. Medial longitudinal incision along the first metatarsal starting over the medial cuneiform bone and ending at the proximal phalanx of the great toe. Oblique osteotomy of the proximal two thirds of the first metatarsal in a proximal dorsal to distal plantar direction and lateral rotation of the distal fragment around a proximally placed 3-mm AO screw. Additional fixation with one BOLD screw. Trimming of the protruding bone and of bunion. Medial metatarsophalangeal capsulorraphy. RESULTS: Between September 1998 and October 1999, 76 feet underwent a Ludloff osteotomy. Patients were followed up clinically and radiographically for 36 months (24-56 months). The mean hallux valgus angle was reduced from 37 degrees to 14 degrees and the mean intermetatarsal angle I-II from 18 degrees to 9 degrees. Using a four-point scale 81% of the patients were satisfied or very satisfied with the result of the operation. 95% of them felt no or very mild pain.

Adult↗
PubMed1996

[Treatment of hallux valgus. Distal soft-tissue procedures and proximal metatarsal osteotomy].

Correction of the hallux valgus deformity is dependent upon recognition of the specific anatomic deformity, followed by selection of a procedure that addresses the specific deformity. A hallux valgus deformity with a subluxated metatarsophalangeal joint has a soft tissue and bony component, both of which need to be corrected, or a recurrence may result. The distal soft tissue procedure addresses the lateral soft tissue contracture by releasing the adductor hallucis, lateral joint capsule and transverse metatarsal ligament. The capsule is medially elongated and the medial eminence needs to be excised. When metatarsus adductus is present, a proximal metatarsal osteotomy should be carried out to correct the bony deformity. If the intermetatarsal angle is not corrected adequately, a recurrence of the hallux valgus is likely since a soft tissue procedure alone could not be expected to correct the bony deformity created by the increased intermetatarsal angle. Postoperatively the correction needs to be supported with a firm compression dressing for 8 weeks to be sure the corrected alignment is maintained until healing of the soft tissues and osteotomy occurs.

Hallux Valgus↗
PubMed1996

[Resection arthroplasty in the treatment of hallux valgus].

Sixty-six feet operated on for hallux valgus in 1984 were reviewed. Keller-Brandes' operation was performed in all cases, together with Lelièvre's "fibrous cerclage" and flexor hallucis longus tendon anchoring to the sesamoid pad, as described by A. Viladot. In most cases, satisfactory clinical correction was achieved and the patients could wear standard shoes. More than half of the cases presented partial limitation of movement at the first metatarsophalangeal joint; however, flexion power of the big toe was preserved, and the range of motion was wide enough to allow a painless and limp-free gait. Radiologically, good correction of the angle between the first and second metatarsals and the metatarsophalangeal angle was obtained, but all cases presented proximal displacement of sesamoid bones. A baropodometric study showed that the toe-off phase of the gait does not change after this operation. In our series, central metatarsalgia was present in 17 feet; however, it did not compromise the functional result and was easily relieved with orthopaedic devices. Four feet showed radiographic images, suggesting necrosis of the first metatarsal head; all four were asymptomatic. The only case that required reoperation was the one that developed hallux varus deformity. The Keller-Brandes-Lelièvre-Viladot procedure is still a simple and effective method for the surgical treatment of hallux valgus in elderly people with osteoarthritis at the first metatarsophalangeal joint.

Adult↗
PubMed1996

[Juvenile hallux valgus].

Juvenile bunions have different etiologies and require specific operative approaches. Any operative procedure to correct a juvenile hallux valgus deformity should correct all the components of the deformity, i.e. pronation of the hallux, the increased hallux valgus angle, the enlarged medial eminence, the increased intermetatarsal angle, and hypermobility or obliquity of the first metatarso-cuneiform joint with the intention of decreasing the rate of recurrence.

Adolescent↗
PubMed2006

Course of damage to the hallux over 5 years after forefoot resection arthroplasty in rheumatoid arthritis patients.

A retrospective study of 34 feet from 20 consecutive patients with rheumatoid arthritis was performed to investigate the development of damage to the hallux over 5 years after forefoot resection arthroplasty. Radiographically we analysed changes in two valgus angles and the interphalangeal joint (IP) damage of the hallux. These parameters were measured preoperatively, 12 months postoperatively, and at the latest follow-up. Although the average HVA (between the first metatarsal and the proximal phalanx) significantly decreased from 38.7 degrees preoperatively to 8.66 degrees postoperatively, the angle increased to 23.0 degrees during the first 12 months following surgery. Further deterioration of the angle at the last follow-up was not detected (25.3 degrees ; P=0.252). The average IPV (between the proximal phalanx and the distal phalanx) angle significantly increased from 6.65 degrees preoperatively to 12.1 degrees 12 months postoperatively and thereafter slightly increased to 13.3 degrees at the latest follow-up. The average of the Sharp/van der Heijde score of the IP joint significantly increased from 5.71 preoperatively to 8.58 12 months postoperatively and thereafter slightly increased to 9.65 at the latest follow-up. The deterioration and destruction process of the hallux after resection arthroplasty occurred soon after surgery, and the progression of the deformity was temporary.

Adult↗
PubMed2005

Joint replacement in the hallux metatarsophalangeal joint.

Joint replacement of the hallux metatarsophalangeal joint has not enjoyed the same success as hip and knee arthroplasties. Silastic implants have achieved a high patient satisfactory rate but have caused many complications, including silicone synovitis and lymph node inflammation. Metal and polyethylene hemiarthroplasties and total toe replacements seem to be more promising although results are preliminary. Problems with these implants seem to be related to soft tissue instability of the joint; patients who have hallux rigidus have more success than patients who have hallux valgus or rheumatoid arthritis. Severe complications can be treated with removal and synovectomy or arthrodesis, depending on the length and alignment of the foot, as well as the functional demands of the patients. It would be beneficial to have more data on these implants so that improvements can be made in design and patient selection.

Arthroplasty, Replacement↗
PubMedDate not supplied

A prospective comparison of clinical, radiographic, and intraoperative features of hallux rigidus: short-term follow-up and analysis.

Forty-seven patients (50 feet) underwent surgical intervention for symptomatic hallux rigidus between February 1998 and April 1999. Thirty-eight patients (41 feet) returned at 1 year for follow-up evaluation. Each foot was graded according to a four-stage hybrid radiographic grading system. At 1-year follow-up, 10 patients were classified as grade I, 17 as grade II, 12 as grade III, and 2 as grade IV. Subjective evaluation was based on a modified American Orthopaedic Foot and Ankle Surgery hallux metatarsophalangeal-interphalangeal 100-point scale. A pre- and postoperative objective physical examination and radiographic analysis were performed. Statistically significant differences between preoperative and postoperative values were found to exist for each portion of the subjective evaluation (p = .000); nonweightbearing dorsiflexion (p = .001); simulated weightbearing dorsiflexion (p = .003); metatarsal protrusion distance and angle of deviation of the second metatarsophalangeal joint (p = .000); and talar-first metatarsal angle (p = .015). For this specific patient population, the short-term results of surgical intervention for hallux rigidus provided subjective patient improvement and satisfaction, as well as a statistically significant but functionally minimal increase in first metatarsophalangeal joint dorsal range of motion. Additionally, in the 19 patients who underwent a periarticular decompression osteotomy, the intended correlation of plantar transposition of the capital fragment and offsetting the longitudinal shortening of the first metatarsal did not exist.

Adolescent↗
PubMedDate not supplied

Applications of the opening wedge cuneiform osteotomy in the surgical repair of juvenile hallux abducto valgus.

Juvenile hallux abducto valgus is a complex deformity of multifactoral etiology. The vast majority of cases, however, present as symptomatic or progressive misalignment of the first metatarsophalangeal joint with accompanying: 1) flexible flatfoot with anterior-medial imbalance, 2) medial column adductus, and 3) metatarsus primus adductus as a result of hyperobliquity of the first metatarsocuneiform joint (Lynch, F. R. Applications of the opening wedge cuneiform osteotomy in the surgical repair of juvenile hallux abducto valgus. Podiatry Tracts 5:173-187, 1987). Biplane cuneiform osteotomy, in conjunction with bicorrectional first metatarsal head osteotomy, was carried out a total of 48 times, in 44 patients, over a 5-year period of time. Patients averaged in age from 11 to 16 years old, with an average age of 13.2 years old. There were 44 females and no males, and the procedure was performed 18 times on the left foot, and 30 times on the right. Postoperative observations include decrease in the first intermetatarsal angle and hyperobliquity of the first metatarsocuneiform joint, decrease in medial column adductus, and stabilization of the anteromedial imbalance associated with the flexible flatfoot. Accordingly, the use of the biplane cuneiform osteotomy addresses the deformity at its apex and eliminates the primary contributory and etiologic factors responsible for its occurrence. It is thus invaluable in the surgical repair of juvenile hallux abducto valgus.

Adolescent↗
PubMedDate not supplied

Cheilectomy, chondroplasty, and sagittal "Z" osteotomy: a preliminary report on an alternative joint preservation approach to hallux limitus.

The surgical correction of hallux limitus can be most rewarding for both patient and surgeon when marked degenerative changes exist in older individuals. Many foot and ankle surgeons would perform an implant arthroplasty in a patient over 60 years of age with hallux limitus or rigidus. In a patient without gross first metatarsophalangeal joint arthrosis, but with limitation in range of motion, the literature is replete with biomechanically sound surgical options. However, surgical repair of the moderate-to-severe arthritic first metatarsophalangeal joint in younger individuals remains quite a challenge. The authors present the use of a sagittal plane "Z" osteotomy of the proximal phalanx along with cheilectomy and chondroplasty for the treatment of hallux limitus and rigidus in the young, active patient.

Adolescent↗
PubMedDate not supplied

Evaluation of Wagdy's technique for treatment of hallux valgus by double-V osteotomy.

Seventy-nine feet in 71 patients with hallux valgus were treated by double-V Wagdy osteotomy of the first metatarsal head. Sixty-eight per cent were totally free of pain with acceptable cosmetic appearance. Excellent and good results were obtained in 97.5% of the cases. The mean postoperative decrease of the intermetatarsal angle was 1.8 degrees and of the hallux valgus angle 22 degrees. The operation is technically simple and stable without internal fixation. It restores the length of the hallux and reduces the possible complications of nonunion, avascular necrosis, shortening of the first metatarsal, and appearance of new bone formation at the medial aspect of the osteotomy site.

Adult↗
PubMedDate not supplied

Modified Jones procedure for post-polio claw hallux deformity.

A prospective study was carried out on 12 patients with postpoliomyelitis clawing of the hallux treated by a modified Jones procedure using Kirschner wire for the interphalangeal joint fusion. The purpose of this study was to evaluate the outcome of a modified Jones procedure in the treatment of postpolio claw hallux deformity. All the patients had symptoms related to the claw hallux deformity; foot biomechanics and gait were affected. Patients were assessed both pre- and postoperatively using Axer's criteria. Mean follow-up was 32 months. Ten patients had very good results and two patients had fair results. The transferred extensor hallucis longus became loose in two patients who had a coexistent tight Achilles tendon. Recurrence of medial cavus deformity occurred 3 months after the operation in both of these patients. This was treated by shortening the transferred extensor hallucis longus after elongating the tight Achilles tendon. No pseudoarthrosis of the interphalangeal joint was identified. When the Jones procedure is performed, the motor power of the extensor hallucis longus should be Medical Research Council Grade V before transfer. The Achilles tendon should be evaluated for equinus preoperatively and lengthened when equinus deformity is present in order to avoid residual foot deformities.

Adolescent↗