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PubMedDate not supplied

Hallux rigidus: the long-term results of dorsal wedge osteotomy and arthrodesis in adults.

A variety of treatments are recommended for hallux rigidus. These include arthrodesis of the first metatarsophalangeal joint and dorsal wedge osteotomy of the proximal phalanx. This latter operation is not commonly performed in adults. A retrospective review of a series of 10 osteotomies and 20 arthrodeses after an average of 12 years for hallux rigidus in the adult was undertaken. Patients were assessed at a follow-up clinic and their foot pressures were analyzed. Although the two groups were not matched, some conclusions could be drawn. Both operations were successful in terms of pain relief. Complications were more common after arthrodesis. Callosities were more common after arthrodesis. A greater duration of load occurs toward the fifth metatarsal after arthrodesis. A greater force occurs under the first metatarsal after an osteotomy rather than an arthrodesis. It was concluded that the dorsal wedge osteotomy is an alternative operation for hallux rigidus in the adult, provided that there is some plantarflexion possible at the metatarsophalangeal joint. It is recommended as a procedure to preserve movement at the metatarsophalangeal joint to prevent callosities. If the osteotomy fails to relieve symptoms, then an arthrodesis can be performed as a salvage procedure.

Adolescent↗
PubMedDate not supplied

The modified Jones procedure for pes cavovarus with claw hallux.

The purpose of this study is to describe long-term outcomes of the modified Jones procedure for pes cavovarus with claw hallux deformity. Jones originally described an isolated transfer of the extensor hallucis longus tendon. However, this technique does not correct and stabilize the claw hallux deformity. Therefore, this operation has been modified to include arthrodesis of the interphalangeal joint of the hallux, distal stump tenodesis of extensor hallucis longus with brevis tendon, and osteotomy of the base of the first metatarsal in cases of fixed or structural deformity. Twenty-four feet in twenty-one patients were evaluated with a 4-year average follow-up. Results were rated as good, fair, of poor based on correction of deformity, absence of pain, and metatarsophalangeal joint motion. Poor results were observed in 21% of feet and were related to first metatarsal dorsiflexion, pseudoarthrosis of interphalangeal joint fusion, and recurrent pain under the first metatarsal head.

Adolescent↗
PubMedDate not supplied

The Valenti procedure for hallux limitus: a long-term follow-up and analysis.

A retrospective analysis of the long-term efficacy of the Valenti procedure for hallux limitus was performed from 1989 to 1997. A total of 33 patients (36 procedures) were selected, surveyed, and examined. Preoperative and postoperative radiographic evaluations and levels of function and pain were obtained from medical records. Complications and patient satisfaction data were collected and reviewed. The patients were evaluated clinically and radiographically. The average age of the patient at the time of surgery was 50.6 years (range, 35-75 years) with an average follow-up of 4.16 years (range, 1-9 years). The average grade of hallux limitus/rigidus was grade II. Five patients were classified as grade I, 23 as grade II, five as grade III, and none as grade IV, based on the modified Drago/Regnauld grading system. Subjective results were calculated based on the American Orthopedic Foot and Ankle Society clinical rating system. Twenty-two patients were rated as having an excellent result, 11 had good results, two had fair results, and one patient had a poor result. We conclude that the Valenti arthroplasty for symptomatic hallux rigidus/limitus is a good procedure for arthritic and degenerated first metatarsophalangeal joints where implant arthroplasty, osteotomy, or arthrodesis are not viable options. Advantages include increased range of motion, decreased postoperative pain, technical ease of performance, maintenance of intrinsic musculature, and rapid return to closed footgear.

Adult↗
PubMed2004

[Hallux valgus--an atavism?].

In biology, atavism is generally understood as a biological phenomenon which brings to sight a recurrent phenotypic character which was lost for extinct generations. Phylogenic evolution of homo sapiens demonstrates today that the first plantar ray in tetrapods has always been a very stable ray and the lateral foot experienced a progressive adduction to the talo-metatarsal axis, together with a remodeling of the lateral column of the foot and a progressive valgus of the calcaneus beneath the talus. The foot appears as a strongly modified extremity, starting at a prehensile foot organ, common to our ancestors. In homo sapiens, the hand became a very mobile, less loaded organ, while the foot became a rather less mobile, but more loaded organ. The first ray, distal to Lisfranc's ligament, has no ligamentous structure holding it to the second ray. Stability is thus precarious and controlled by extrinsic and intrinsic muscles. Passive mobility of the tarso-metatarsal joints has been studied in vitro and in vivo. A relationship between unstable or hypermobile first ray and relevant Hallux valgus deformity has been demonstrated. Factors which facilitate the deformity are a long hallux and a functional equinus of the foot. Clinical pathology includes metatarsalgia, hammer toes, together with metatarsus primus varus and shortened gastrocnemii. Logical treatment of relevant and painful deformity includes tarso-metatarsal fusion with or without fusion to the second metatarsus. Osteotomies seem less secure in severe cases on the long run. In conclusion, Hallux valgus cannot be considered as an atavism because clinical history and findings do not correspond to the archaic prehensile foot and its evolution, but rather do correspond to a weak spot on a (still) fragile, often overloaded, phylogenetically young organ.

Child↗
PubMedDate not supplied

[Pressure distribution after scarf osteotomy for hallux valgus surgery].

AIM: This study evaluates the pressure distribution, the radiological and clinical results in patients before surgery and 6 months after scarf osteotomy for hallux valgus. METHODS: 29 patients were examined before surgery and 6 months after surgery for symptomatic hallux valgus. Pedographic analysis was performed by dividing the footprint of the patients into 8 regions of interest. For each region the maximum mean pressure and the peak pressure were evaluated. Moreover, clinicofunctional results (AOFAS score) and radiological results were evaluated. RESULTS: 6 months postoperatively, maximum mean pressure increased significantly under the medial forefoot where as the peak pressure in this region revealed indifferent results. Significant improvement of clinicofunctional results and a significant reduction of the intermetatarsal and metatarsophalangeal angle could be seen. CONCLUSION: These results confirm the clinical and radiological findings of other studies, but this study shows for the first time an increase of pressure under the first ray of the foot after hallux valgus surgery and an adaptation to the pressure distribution of normal feet.

Adult↗
PubMedDate not supplied

[The modified Ludloff osteotomy for correction of severe metatarsus primus varus with hallux valgus deformity].

AIM: The present study investigates the clinical and radiological mid-term results of the modified Ludloff osteotomy, a proximal metatarsal osteotomy for surgical correction of severe metatarsus primus varus with hallux valgus deformity. METHOD: 70 feet in 67 patients from 25 to 78 years (average age 56 years) were included in this prospective study. The patients were evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot metatarsophalangeal interphalangeal score, which was used preoperatively and at an average follow-up of 37 +/- 6 months. Weight-bearing foot radiographs were analysed according to AOFAS guidelines and statistical evaluation was made with the Wilcoxon signed-rank test. RESULTS: The average AOFAS score improved significantly (p < 0.0001) from 55.2 +/- 15.2 points preoperatively to 86.6 +/- 15.2 points at follow-up. Preoperatively, all patients complained of pain (20.2 +/- 9.6 points) which had improved significantly (p < 0.0001) at the latest follow-up (37.3 +/- 5.7 points). The average hallux valgus angle (HVA) was 37 +/- 8 degrees preoperatively and improved significantly to 12 +/- 11 degrees at follow-up (p = 0.0001). The intermetatarsal angle (IMA) improved significantly from 18 +/- 2 degrees preoperatively to 8 degrees +/- 4 degrees after 37 +/- 6 months (p = 0.0002). The sesamoid position improved significantly from preoperative to follow-up (p = 0.0003). Radiographic evaluation of the patients indicated that all examined osteotomies had healed after 37 +/- 6 months. CONCLUSION: This prospective investigation at intermediate follow-up using currently available outcome measures suggests that the Ludloff osteotomy is a suitable procedure for the surgical correction of severe metatarsus primus varus (IMA > 15 degrees ) with hallux valgus deformity.

Adult↗
PubMedDate not supplied

[Correction of high-grade sesamoid bone dislocation in hallux valgus using Austin's osteotomy with and without lateral soft tissue release].

INTRODUCTION: Aim of this study was to analyze if, using the Austin technique for correction of hallux valgus deformity, the additional soft tissue procedure is capable to achieve better correction of the sesamoid subluxation, the hallux valgus angle and the intermetatarsal angle. PATIENTS AND METHODS: 19 patients with 20 feet operated according to the original Austin technique and 26 patients with 28 feet operated according to a modified technique with lateral soft tissue release both with a preoperative sesamoid subluxation grade 3 were compared with the help of a standardized questionnaire in respect to clinical and radiological results. RESULTS: Analyzing the clinical outcome of the two procedures, there was no statistical difference. Comparison of the radiological results revealed a significantly better correction of the sesamoid position and a better correction of hallux valgus and intermetatarsal angle by using the additional soft tissue procedure. DISCUSSION: The lateral soft tissue procedure with release of the adductor hallucis, dissection of the deep transverse plantar ligament and mobilisation of the sesamoids is capable of a significantly better correction of the sesamoid position. Only a combination of osseus and soft tissue correction is capable to correct the pathomechanism and to guarantee long lasting results.

Adult↗
PubMedDate not supplied

[Sesamoid bone complex and hallux valgus deformity. A retrospective analysis of 82 Mitchell osteotomies].

The aim of the operative treatment of the hallux valgus deformity is to correct the medial luxation of the first metatarsal head out of the sesamoid complex, the restoration of a congruent joint, the patient after treatment should be painfree. 82 patients were available for an independent clinical and radiological review. The median follow up was 32 months. The evaluation of the results are based on objective and subjective assessment of the patients as well as on radiographic criteria, such as hallux valgus angle, intermetatarsal angle, shortening of the first metatarsal bone, subluxation, lateral positioning of the osteotomized MT I-head and position of the sesamoid complex. Depending on the degree of "lateralisation" of the sesamoid complex seven groups were defined: 0/0, 1/0, 1/1, 2/1, 2/2. 2/3, 3/3 following Appel. Following objective criteria 61% of the patients were evaluated excellent or good, following subjective criteria 77% were evaluated excellent or good. Isolated parallel shifting seems to be sufficient in mild forms of hallux valgus (sesamoid complex group 2/2 or less), while the severe subluxation in the metatarsophalangeal joint (sesamoid complex group 2/3, 3/3) requires an additional lateral wedge osteotomy.

Adolescent↗
PubMedDate not supplied

A comparative study of foot morphology between Filipino and Japanese women, with reference to the significance of a deformity like hallux valgus as a normal variation.

In order to investigate the shape and size differences in feet caused by daily footwear, a comparative study was conducted on foot morphology in two populations. The data from six measurements in general physique and 18 measurements in the feet and their contours were obtained from 34 Filipino women in Isabela Province and 40 Japanese women in Tokyo. Despite the fact that the Tokyo women had larger physique than the Isabela women, there were no significant differences in foot size between two groups. Both relative size of foot for general physique and intragroup deviation of foot proportion were larger in the Isabela women than those in the Tokyo women. In comparing foot contour, many measurements relating particularly to foot proportion, represented by angles, showed significant differences between the two groups. In gross observation some of the Isabela women showed marked deformity of the grand toe to the lateral side, "like a hallux valgus' without any complaints. In principal-component analysis (PCA), CP1 was interpreted as size factor, CP2 was considered as position of foot axis, CP3 and CP4 were estimated as degree of angle between foot axis and ball axis. Means of individual score by PCA showed a completely inverse pattern between Isabela and Tokyo women. The differences in foot morphology recognized in these two groups were considered from the point of view of differences of daily footwear, which have not changed in the Philippines but have changed dramatically in Japan since World War II. We concluded that the deformity like a hallux valgus, frequently found in previous generations of Japanese who used to wear traditional footwear, geta and zori, must have been a healthy deformity, however, the pathological deformity hallux valgus is observed only in the Isabela women of today.

Adult↗
PubMed1996

The podiatric treatment of hallux abducto valgus and its associated condition, bunion, with Tagetes patula.

To assess the effectiveness of marigold therapy using Tagetes patula preparations, a double-blind placebo-controlled trial was designed to be carried out over a period of eight weeks. Sixty patients were entered in the trial. Twenty patients with bilateral hallux abducto valgus and its associated condition, bunion, were randomly selected from 37 subjects for group A. For group B, 40 patients with unilateral hallux abducto valgus and bunion were randomly selected from 69 subjects and subdivided into groups Ba and Bb. Patients with ulcerated conditions, those on medication and those who had undergone surgery for the condition were excluded. The results obtained were highly significant (P < 0.001), suggesting that T. patula preparations, plus protective pad, were effective in reducing the width of the lesion and level of pain of hallux abducto valgus.

Hallux Valgus↗
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↗
PubMed2001

Outcomes following cheilectomy and interpositional arthroplasty in hallux rigidus.

Surgical management of hallux rigidus remains controversial. Arthrodesis is considered the gold standard. However, many patients are reluctant to undergo fusion. This paper reviews two commonly used procedures that are reasonable alternatives. A retrospective review of 19 patients (24 feet) with grade 2 osteoarthritis and 11 patients (11 feet) with grade 3 osteoarthritis was performed. The patients with grade 2 osteoarthritis were managed with a cheilectomy and the patients with grade 3 osteoarthritis with an interpositional arthroplasty. All patients were individually assessed with a subjective questionnaire, physical exam, AOFAS hallux scale, SF-36 and pedobarographic analysis. Cheilectomy patients (51.9 years) were younger than interpositional arthroplasty (59 years). Follow up between the interpositional arthroplasties (2.0 years) and cheilectomies (2.1 years) were comparable. Postoperative motion, visual analogue pain scale and SF-36 scores were comparable between groups. Cheilectomies had a higher mean AOFAS score (77.3) than interpositional arthroplasties (71.6). Weakness of the great toe was reported in 72.7% of interpositional arthroplasty patients compared to only 16.7% of patients with a cheilectomy. Patient satisfaction was 87.5% in cheilectomies and 72.7% in interpositional arthroplasties. Pedobarographic analysis demonstrated a decreased load under the great toe with increased weight transfer to the lesser metatarsal heads in all patients. The weight transfer to the lesser metatarsal heads was greatest in patients with interpositional arthroplasty. Management of moderate hallux rigidus with a cheilectomy and phalangeal osteotomy is a reliable method of relieving pain and improving function. Management of severe osteoarthritis of the joint with an interpositional arthroplasty should be considered a salvage procedure with less reliable results.

Adult↗
PubMed2001

Crescentic proximal metatarsal osteotomy for moderate to severe hallux valgus: a mean 12.2 year follow-up study.

The senior author's (R.C.) first 25 patients (37 feet) treated with a combination proximal crescentic osteotomy and distal soft-tissue reconstruction made up the patient cohort. All 25 patients were reviewed at a minimum of one year post-op (short-term follow-up) and 20/25 (31/37 feet) were reviewed again at a mean 12.2 years (range 11.4 to 13.0 yrs) post-op (long-term follow-up). This allowed for a comparison of short- and long-term results and led to a long-term follow-up rate of 84% (31/37 feet, mean 12.2 yrs). Clinical, radiographic and patient outcome measures were obtained and compared pre-op and at short- and long-term follow-up. The mean preoperative hallux valgus (HVA) and intermetatarsal angles (IMA) were 37degrees and 16 degrees respectively. The mean HVA correction was 24 degrees and IMA correction 10 degrees at long-term follow-up with no tendency toward recurrence. Sesamoid position and first MTP subluxation was markedly improved postoperatively and the correction was maintained at long-term follow-up. Patients were asked about their satisfaction in terms of pain, appearance and motion. At long-term follow-up, more than 90% of patients were completely satisfied with pain and motion and greater than 80% with their appearance. Ninety-four percent of patients said they would have the operation again. The AOFAS clinical rating scale for the hallux was calculated retrospectively for pre-op and short-term follow-up and prospectively for long-term follow-up. The mean pre-op score was 37/100 (16 to 60) which significantly improved to 92/100 (67 to 100) at both follow-up periods, suggesting no evidence of decrease in outcome over time. Complications included two patients (5%) that were over-corrected into varus (one symptomatic, one asymptomatic), and four patients (11%) that were undercorrected, developing asymptomatic recurrences (>10 degrees increase HVA) at long-term follow-up. In addition, two patients (5%) developed new transfer lesions postoperatively, likely related to technical error (one varus overcorrection, one dorsiflexion malunion). In conclusion, the long-term results, with a mean follow-up of 12.2 years, of the resection realignment procedure for moderate to severe hallux valgus are generally excellent and the complication rate is low and acceptable. Attention to detail, avoiding both undercorrection, which can lead to recurrence, and overcorrection, which can cause symptomatic varus, is essential.

Adult↗
PubMed2001

Mobility of the first tarsometatarsal joint in hallux valgus patients: a radiographic analysis.

Hypermobility of the first tarsometatarsal (TMT 1) joint in the sagittal plane plays a role in the etiology and treatment of the hallux valgus complex. However, objective quantification of this mobility is still a problem. We performed a radiographic analysis of TMT 1 mobility in the sagittal plane in 94 hallux valgus patients aged 15 to 65 years. We examined 94 feet with symptomatic hallux valgus deformity requiring operative correction. Excluded were patients with osteoarthritis, inflammatory diseases or previous operations on the foot. The TMT 1 mobility was tested with a clinical test and by radiographic measurement using the modified Coleman block test. The mean mobility of the TMT 1 joint in the sagittal plane in the patient group was 12.9 degrees (SD 4.80). In addition, there was a statistically significant difference between two subgroups: patients with and without clinical TMT 1 hypermobility. No correlation of TMT 1 (hyper)mobility and radiographic second ray hypertrophy was found. This simple method can produce additional information to the clinical TMT 1 hypermobility test in the sagittal plane.

Adolescent↗
PubMed2002

Microscopic metallic wear and tissue response in failed titanium hallux metatarsophalangeal implants: two cases.

The membranes present at the implant-bone interface were retrieved from two patients with titanium single stem hallux implants that had failed. Both patients had pain and valgus deformity of the hallux, and radiographs showed a radiolucent shadow around the implant stem, with thinning of the dorsal cortex of the proximal phalanx in one patient. After removal of the implants, arthrodesis of the first metatarsophalangeal (MP) joint was performed. Histologic analysis of the membrane tissue at the implant-bone interface showed a synovial-like appearance. There was a fibrous tissue stroma adjacent to the bone surface, with multiple regions of scalloping covered by mononuclear cells. Fine metallic debris was seen throughout the fibrous tissue. Multinucleated foreign body giant cells were sparsely observed associated with fine particulate metallic wear debris similar to observations from failed total hip arthroplasties. The histologic appearance is evidence that foreign-body granulomatous infiltration associated with metallic wear debris may be a causative factor of peri-implant osteolysis leading to aseptic loosening and failure of titanium single stem hallux implants.

Aged↗
PubMed2002

Failure of hallux MP preservation surgery for rheumatoid arthritis.

Eight patients underwent surgery on 15 feet for rheumatoid forefoot problems. Thirteen of the 15 feet that were operated upon had an attempt to preserve the hallux metatarsophalangeal joint while resectional arthroplasty was performed on the lesser MP joints. All of the 13 feet that had the MP joint preserved had a well-preserved joint space preoperatively and no active signs of inflammation at the time of this procedure. Eight feet underwent a distal Chevron osteotomy to realign the great toe, two feet underwent an IP fusion as only the IP joint had evidence of erosive changes, and one foot underwent a combination of a Chevron osteotomy and a proximal phalangeal osteotomy (Akin procedure). Two patients had no surgery on their first ray as it was well aligned with no evidence of erosive changes. Of the 13 feet that did not have a fusion performed, 11 had development of a valgus deformity or inflammatory erosions. The average time to failure was 24 months (range, six to 36 months). The Chevron/Akin procedure remained successful at 18 months and one of the IP fusions was successful at six years after surgery. Although patients with rheumatoid forefoot disease may on occasion have a well-preserved hallux MP joint with minimal or no deformity and no active inflammation, with severe lesser toe involvement, most of these patients will fail a surgical procedure which does not involve fusion of the hallux MP joint.

Arthritis, Rheumatoid↗
PubMedDate not supplied

The intrinsic and extrinsic arterial supply to the proximal phalanx of the hallux.

The hallux is subject to numerous surgical procedures and very little is known about its blood supply. Arteriographic studies were performed in six cadaver specimens to identify the major arterial supply to the hallux. Discrepancies with now known anatomical models were discovered. In this study, the major arterial supply to the hallux appeared to originate from the lateral digital artery. In addition, two transverse digital arteries were noted to emit the nutrient arteries of the phalanges. Examination of other arteriographic studies sustained our results.

Angiography↗
PubMed1988

Hypermobility in hallux valgus.

Hypermobility has been implicated as one of the etiological components in common foot problems such as hallux valgus but has not been substantiated by experimental data. Twenty patients with symptomatic untreated hallux valgus and 20 controls were evaluated with a simple hypermobility scoring system. A statistically significant correlation was found to reveal that female patients aged 20 to 40 yr with symptomatic hallux valgus have a mild generalized hypermobility when compared to a similar group of control patients. The presence of such ligamentous laxity would seem to support the need for bony correction in such patients as soft tissue procedures would have a greater propensity for malalignment due to the underlying hypermobility in combination with everyday environmental stresses of trauma and overuse.

Adult↗