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PubMedDate not supplied

Hallux valgus surgery: a simple method for evaluating the first-second intermetatarsal angle in the presence of metatarsus adductus.

In hallux valgus surgery, the presence of metatarsus adductus complicates the evaluation of the first-second intermetatarsal angle(IMA) because it will produce an apparent reduction in the IMA because the second metatarsal is skewed closer to the first metatarsal. This can lead to an underestimation of how much the IMA should be reduced. The Kilmartin angle is a simple charting technique that will eliminate the influence of metatarsus adductus and indicate the true degree of metatarsus primus varus. This may facilitate better preoperative planning in hallux valgus surgery.

Foot Deformities, Congenital↗
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↗
PubMed1993

[Metatarsus primus double osteotomy, a logical and non-disabling surgical technique for treatment of hallux valgus].

The procedure known as the Metatarsus Primus Double Osteotomy ("L'ostéotomie métatarsienne bipolaire" of Schnepp-Carret) for the treatment of the hallux valgus is a logical, efficient and non-mutilating procedure. The technique consists in reducing the hallux valgus deformity by a subcapital bone wedge resection of the metatarsus primus. The bone wedge is then pinched into a second proximal osteotomy of the metatarsus primus, correcting the varus deformity in a valgus direction. This procedure is little known and is not even mentioned in the classic orthopedic literature of German and English language.

Bone Wires↗
PubMed1995

Radiographic analysis of hallux valgus. A two-dimensional coordinate system.

A new method was devised for the evaluation of medial and lateral splaying of the foot on dorsoplantar radiographs made while the patient is bearing weight. This method involves use of a two-dimensional coordinate system; the axis of the shaft of the second metatarsal is the x axis, the intersection of the x axis with the proximal end of the second metatarsal is the point of origin, and the perpendicular to the x axis that passes through the point of origin is the y axis. This method was used to study the radiographs of 177 feet of 112 female patients who had symptomatic hallux valgus and those of ninety-four normal feet of sixty-four female subjects. The site of origin of metatarsus primus varus in the patients who had hallux valgus was the first metatarsocuneiform joint. The great toe and first metatarsal of the patients who had hallux valgus were longer, on the average, than those of the normal subjects. However, the x coordinates at the tip of the great toe and at the end of the first metatarsal were larger only in the patients who were less than twenty years old, because of the progression of angulation of the great toe and of the first metatarsal in the older patients.

Adolescent↗
PubMedDate not supplied

Lapidus arthrodesis for management of hallux valgus--a retrospective review of 106 cases.

One hundred six patients who underwent a Lapidus arthrodesis for a symptomatic hallux valgus deformity, mainly with first ray hypermobility, were retrospectively reviewed. Radiograph and chart reviews were performed in addition to a patient survey completed at a mean 17 months postoperatively. Of the 78 patients who completed the survey, 70.5% were satisfied with the procedure; 80.2% would choose the same method again. Seven percent of patients were dissatisfied. Review of preoperative and 3-month postoperative radiographs showed a mean intermetatarsal angle reduction of 12.4 degrees . The average postoperative sesamoid position was 2.5, a 4.0 reduction from the preoperative mean value of 6.5. The complication rate was 5.7%, including 2 nonunions (1.8%) requiring a repeat surgery, 1 deep-vein thrombosis (0.9%), and 3 patients with complex regional-pain syndrome (2.7%). In 16% of patients, resolution of swelling and subjective complaints took longer than 3 months; 4.7% of patients developed sesamoiditis or metatarsalgia that resolved with conservative measures. Radiographic undercorrection was evident in 4.7% of patients. The results showed that the Lapidus procedure provided reliable correction in cases of severe hallux valgus with intermetatarsal angles >15 degrees and in those patients with first ray hypermobility.

Adolescent↗
PubMed2000

Scarf osteotomy for correction of hallux valgus. Surgical technique and results as compared to distal chevron osteotomy.

With the Scarf osteotomy, a good correction of moderate hallux valgus can be obtained, comparable to the distal or proximal Chevron or crecentic osteotomy. Correction of the IMA averages between 5 degrees to 6 degrees. When used in combination with an adductor release and proximal phalangeal osteotomy, the indication can be extended to severe hallux valgus deformities as long as there is no arthrosis at the MTP joint. The Scarf osteotomy, however, is certainly a more extensive surgical procedure, with a longer learning curve than a distal Chevron osteotomy. With more than 1000 Scarf procedures performed, the author has not encountered one delayed union, even in osteoporotic bone, or an avascular necrosis. In two cases a stress fracture was encountered in the first 3 months after surgery, but these healed uneventfully with partial weight bearing for 5 weeks.

Hallux Valgus↗
PubMed1987

The treatment of hallux valgus in runners using a modified McBride procedure.

We have carried out a modified McBride procedure in 21 patients with hallux valgus which caused pain during running. They have been followed up for a mean of 5.5 years. Metatarsophalangeal pain and metatarsalgia were relieved or significantly decreased in the majority of patients, but callosities beneath the second metatarsal head were not affected. When the angle between the first and second metatarsals did not exceed 14 degrees before operation, satisfactory correction could be obtained. In the absence of degenerative changes in the first metatarsophalangeal joint and with a moderate hallux valgus, a consistently good result was obtained in this group of active patients.

Adolescent↗
PubMedDate not supplied

Stabilization of the Chevron procedure for hallux valgus deformity with a capsuloperiostal flap.

This article reports on the use of a Chevron procedure in the treatment of hallux valgus for better stabilization of the osteotomy. This procedure was performed on 31 feet of 24 patients, Twenty-two of the patients were female and two were male. The average age was 41 and average follow-up time was 14 months. The average correction of the 1-2 intermetatarsal angle was 3.8 degrees and average correction of the hallux valgus angle was 15.3 degrees. On the follow-up, 93.5% of the feet were pain free and 81% did not have any discomfort with shoewear. There were two cases of superficial infection, and two patients complained of dysesthesia or hypoesthesia after the operation. Results revealed less correction loss, shorter union time, less metatarsophalangeal stiffness, and more postoperative patient tolerance. The authors attached the distally based "V"-shaped medial capsuloperiostal flap to the metatarsal shaft and, because of obtained stability, used no internal fixation or postoperative cast but only night splint, allowed weightbearing on the heel as soon as the patient tolerated it, and encountered no displacement of fragments, malunion, or recurrence of the deformity.

Adult↗
PubMed2003

[Analysis of results of treatment of hallux valgus by Dega osteotomy].

The evaluation included sixty eight feet (forty one patients) treated with Dega osteotomy for hallux valgus deformity. Patient's average age at the time of surgery was 47 years (ranging from 11 to 65). The average duration of follow-up was 4.5 years (ranging from 2 to 10). The clinical and X-ray examination found good results in 29% of cases, fair results in 59% and poor results in 12% of cases. Fair results were associated with persistent wide forefoot and shortening of first metatarsal bone. Poor results were associated with persistent valgus deformity of hallux, jatrogenic hallux varus (2 cases), shortening of first metatarsal bone amounting to more than 1.0 cm.

Adolescent↗
PubMed1980

A modification of the Lapidus operation for hallux valgus.

A modification of the Lapidus procedure to correct hallux valgus is described in which the length of the first metatarsal is maintained. One hundred and nineteen operations in 78 patients have been followed up for between two and 16 years. There were excellent or good results in 110 feet (92 per cent).

Bone Transplantation↗
PubMed2005

Minimally invasive hallux valgus correction: a technical note and a feasibility study.

Hallux valgus surgery aims to correct the nonphysiological angulation of the first ray and rebalance its function. Many techniques are reported, each with different indications depending on the pathoanatomy of the deformity. This article presents a minimally invasive distal metatarsal osteotomy technique, requiring no custom instrumentation. The operation is performed under direct vision and without fluoroscopy.

Adult↗
PubMed1980

The Mitchell distal metatarsal osteotomy for hallux valgus.

Seventy-two Mitchell distal metatarsal osteotomies for hallux valgus performed over a period of 10 years have been reviewed. Sixty-six (92 per cent) were graded as excellent or good. Retrospective radiographic analysis of 29 of these cases showed that the operation had reduced the intermetatarsal angles to within normal anatomical limits. No patient experienced a worsening of symptoms as a result of the operation.

Adolescent↗
PubMed1994

A controlled prospective trial of a foot orthosis for juvenile hallux valgus.

In a survey of 6000 children between 9 and 10 years of age, 122 were found to have unilateral or bilateral hallux valgus. These children were randomly assigned to no treatment or to the use of a foot orthosis. About three years later 93 again had radiography. The metatarsophalangeal joint angle had increased in both groups but more so in the treated group. During the study, hallux valgus developed in the unaffected feet of children with unilateral deformity, despite the use of the orthosis.

Child↗
PubMed1994

[The application radionuclide bone imaging in the treatment of hallux valgus].

Radionuclide bone imaging (RNBI) was performed by means of 99mTc-MDP on both 20 health subjects (40 feet) and 20 patients with hallux valgus (26 feet). The results showed that radioactivity intake were increased in second (or third) metatarsal of 26 feet of hallux valgus. The ratio of radioactivity of the lesion and contralateral normal site (D/N) had statistical difference (P < 0.01). Both the patient and normal groups RNBI is a highly sensitive study and valuable for the classification of diagnosis. It help for selection of surgical treatment, as to evaluate the results of the treatment.

Adolescent↗
PubMed2003

Lateral shifting of the first metatarsal head in hallux valgus surgery: effect on sesamoid reduction.

Thirty feet with hallux valgus (HV) having grade 2 and 3 sesamoid stations on AP radiographs were examined after Lindgren-Turan oblique distal metatarsal osteotomy with a minimum follow-up of 12 months. Adductor tendon release from the lateral sesamoid was not performed to determine the isolated effect of distal metatarsal osteotomy on metatarsosesamoidal reduction. Of the 30 feet, 20 (67%) had reduced and 10 (33%) unreduced sesamoids at the follow-up. Ultimately, distal metatarsal osteotomy (DMO) with lateral shifting of the first metatarsal head more than 7.2 mm was found to reduce the sesamoids in the great majority of the cases (95% CI 7.243-9.757). Sesamoid release is redundant for metatarsosesamoidal reduction if sufficient lateral shift of the first metatarsal head over the sesamoids is accomplished.

Adolescent↗
PubMed1982

Proximal metatarsal osteotomy in hallux valgus.

In order to obtain an optimal correction of hallux valgus and to prevent its recurrence, the authors have applied a surgical technique which combines a proximal valgus osteotomy of the first metatarsal bone with an excision of the pseudoexostosis and a distal soft tissue plasty at the first metatarsophalangeal joint. The procedure is based on an etiological theory regarding metatarsus primus varus as the primary cause of the deformity, which is in accordance with the opinion of many other authors. The osteotomy corrects the malposition of the first metatarsal bone thereby reducing the deformity and preventing its recurrence. The soft tissue plasty alleviates secondary contractures that prevent a full correction of the big toe. A series of 43 consecutive patients (46 feet) with a follow-up period of 5-44 months and extracted from a total number of 99 operated cases is presented. The result was excellent in 78 per cent, good in 11 per cent and poor in 11 per cent. The reason for a less than excellent result was almost always inadequate correction of the deformity, at the level of the first metatarsal bone, or the big toe, or both.

Adult↗
PubMed1981

The assessment of adolescent hallux valgus before and after first metatarsal osteotomy--clinical and walkway studies.

A comprehensive method of evaluating the feet of patients with adolescent hallux valgus both before and after surgical correction is described. Serial clinical, photographic and radiological studies were made and a dynamic assessment of gait was carried out using a load-sensitive walkway. Observations were made on 36 feet in which hallux valgus was treated by a modification of the Wilson oblique metatarsal osteotomy, with removal of a wedge of bone and screw fixation. In the first six months after operation, there was a lateral shift of the weight-bearing pattern in the forefoot and less weight was taken on the toes, but there was a tendency to return to the pre-operative distribution of weight during the next four years. Persistence of the lateral shift of weight-bearing appeared to result from elevation of the first metatarsal head secondary to shortening of the first metatarsal during the osteotomy. This can be avoided by deliberate depression of the first metatarsal head at the time of operation and fixation of the fragments in the required position with a screw.

Adolescent↗
PubMed1995

[Modified distal osteotomy of shortening the first metatarsal for treatment of hallux valgus].

The results of distal osteotomy of shortening the first metatarsal with internal fixation of shape, memory metal compression staple for hallux valgus were evaluated in 26 feet of 17 women with a mean age of 41.0 years (30-65 yrs). The average time for return to light work was 18.2 days, and to full work and normal walk 40.3 days after the operation. 16 patients (25 feet) had complete relief from pain. Only in one foot the pain was transferred under the 2nd metatarsal head. The appearance of the feet was apparently improved and the width of the forefeet was decreased in a mean 0.92cm after the operation. All of the patients were satisfied with the appearance of their feet. Radiographic analysis of feet showed that all the osteotomies united, the average angle of hallux valgus was improved from 30.1 degrees to 16.0 degrees and the mean intermetatarsal angle from 11.2 degrees to 6.5 degrees. This new technique allows no external fixation of plaster splintage and the distal fragment during healing of the osteotomy was stable. The time of bone healing was shortened and patients were allowed to bear weight at early time.

Adult↗