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[Effects of taping therapy on the deformed angle of the foot and pain in hallux valgus patients].

PURPOSE: This study was to examine the effects of Taping therapy on the deformed angle of the foot and pain in hallux valgus patients. METHOD: The subjects were 24 feet from 15 patients who were diagnosed withhallus valgus at the orthopedic department of K University Hospital in Seoul. Taping therapy was conducted 15 times overall during a four-week period. Data was analyzed using descriptive statistics and t-test. RESULT: The deformed angle of the foot of the hallus valgus patients significantly improved from 21.95 (4.38) to 18.75 (4.80) after Taping therapy. Pain significantly decreased from 4.73 (1.56) to 3.45 (2.21) after Taping therapy. CONCLUSION: The result shows that Taping therapy is effective in improving the deformed angle of the foot and in decreasing pain in the hallux valgus patients.

Adult↗

Comparison between manual and computer-assisted measurements of hallux valgus parameters.

BACKGROUND: The aim of this study was to determine if there are intraobserver and interobserver differences in reliability when measuring hallux valgus angles (HVA), 1-2 intermetatarsal angles (IMA), and distal metatarsal articular angles (DMAA) manually compared to computer-assisted means. Our hypothesis was that the measurements taken by computer-assisted methods of these three forefoot angles would be superior in consistency and accuracy compared to manual measurements. METHODS: Four examiners studied 20 weightbearing anteroposterior radiographs of patients with hallux valgus. Manual measurements were taken on photographic prints using a goniometer and a fine point pen. Computer-assisted measurements were taken on digitized images using computer software. Three sets of measurements by both of these methods were taken 1 week apart. RESULTS: There was no statistically significant difference between digital and manual measurements for any of the three angles measured (p .05). However, the reliability of measurements within a range of 5 degrees for both methods was 70.6% for HVA, 84% for 1-2 IMA, and 59% for DMAA. CONCLUSION: There were no significant differences in interobserver and intraobserver reliability in measuring 1-2 IMA and HVA, regardless of the method of measurement; however, there was a significant difference in interobserver reliability when measuring the DMAA either on computer or manually (p = <.05).

Diagnosis, Computer-Assisted↗

Wilson osteotomy stabilised by means of internal fixation for the treatment of hallux valgus.

The results achieved in 20 patients (32 feet) who underwent Wilson's osteotomy of the first metatarsal for the treatment of hallux valgus were reviewed. In all cases the osteotomy site was stabilised with one or two cortical screws. The patients' average age was 50.7 years (range: 34-74 years) and they were followed for a mean period of 33.1 months (range 12-63 months). The average AOFAS score was 85.5 (range: 62-100) at the final follow-up and in 84.4% of the cases the final outcome was very satisfactory as far as symptomatic improvement was concerned. Wilson's osteotomy stabilised with cortical screws was found to reliably give satisfactory correction of the hallux valgus and first intermetatarsal angles, while allowing safe patient mobilisation and early weight bearing. This effectively resulted in shorter rehabilitation time, early return to work or normal activities and a very satisfactory functional outcome.

Adult↗

The influence of personality traits on the subjective outcome of operative hallux valgus correction.

We studied prospectively the influence of personality traits on the subjective outcome of a chevron osteotomy in 42 patients with hallux valgus. The mean age of patients was 48.3 (20-70) years. Personality traits were evaluated by the means of the Freiburg Personality Inventory (FPI-R). Three months postoperatively 37 patients were satisfied, and five patients not satisfied with the operative procedure. The preoperative AOFAS Score improved from an average of 48.7 (30-65) points to 87.9 (50-100) points. A comparison of satisfied and dissatisfied patients revealed statistically significant differences in the personality traits aggressiveness (p=0.003), extraversion (p=0.001) and health worries (p=0.04). The postoperative hallux valgus angle was 12.2+/-7.8 degrees and 13.4+/-8.3 degrees (p=0.74) among satisfied and not satisfied patients, respectively, and the intermetatarsal angle (I-II) was 7.4+/-2.5 degrees and 7.6+/-4 degrees (p=0.89), respectively. The results suggest that the patient's subjective result after the operative correction may be influenced by some individual, personality profiles.

Adult↗

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↗

Hallux valgus and cartilage degeneration in the first metatarsophalangeal joint.

This study relates the extent of cartilage lesions within the first metatarsophalangeal joint to hallux valgus. We prospectively examined 265 first metatarsophalangeal joints of 196 patients with a mean age of 54.2 years at operation for the existence of cartilage lesions. Grade I lesions were found in 41 feet (15.5%), grade II in 82 (30.9%), grade III in 51 (19.3%), grade IV in 20 (7.5%). Only 71 (26.8%) showed no cartilage lesion. Cartilage lesions were found within the metatarsosesamoid and metatarsophalangeal compartments in 66 feet (34.0%), within the metatarsophalangeal compartment in 26 (13.4%) and within the metatarsosesamoid compartment in 102 (52.6%). A statistically significant correlation was found between the grade of cartilage lesion and the hallux valgus angle, both for the changes within the metatarsophalangeal and the metatarsosesamoid joints.

Adult↗

Hallux valgus in ballet dancers: a myth?

Among dancers it is widely believed that ballet dancing induces hallux valgus. Revision of radiographs of 63 active and 38 retired dancers of both sexes showed no increase in the valgus angulation of the hallux compared with that of nondancers.

Adolescent↗

Treatment of hallux valgus in adolescents by the chevron osteotomy.

Between 1978 and 1984, 20 adolescent patients underwent 35 chevron osteotomies of the first metatarsal for correction of painful hallux valgus. After an average follow-up of 64 months, 85% of the patients expressed overall satisfaction. The cosmetic effect was the most satisfactory result (90%), followed by relief of pain (85%) and lack of limitations in footwear (65%). Radiographic evaluation did not seem to correlate with the final clinical result. The chevron osteotomy is a reasonable operative procedure for correction of hallux valgus in adolescents.

Adolescent↗

Prospective, randomized comparison of proximal crescentic and proximal chevron osteotomies for correction of hallux valgus deformity.

In this study, intermetatarsal angle (IMA) correction, functional outcome, and healing time for the proximal crescentic and proximal chevron osteotomies in moderate to severe hallux valgus deformity were prospectively compared. Seventy-five patients (97 feet) were prospectively randomized to either a proximal crescentic or proximal chevron osteotomy for the correction of moderate to severe hallux valgus deformity with associated metatarsus primus varus. Criteria for study entry included age (adult patients), IMA greater than or equal to 13 degrees, persistent symptoms despite nonoperative treatment, and minimum follow-up of 12 months. Twenty-nine patients (41 feet) in the crescentic group and 37 patients (43 feet) in the chevron group returned for follow-up at an average of 24 and 20 months, respectively. Good results were achieved with both procedures. No statistically significant differences were found with respect to correction of the IMA or to functional outcome between the two groups. Results held true irrespective of patient age, severity of disease, or bilateral involvement. A statistically significant shorter healing time of the first metatarsal was found after proximal chevron osteotomy. Other potential benefits of the chevron procedure included avoidance of dorsiflexion of the first metatarsal, tendency toward less shortening of the first metatarsal, and more medial distribution of tibial sesamoids following surgery, all of which may reduce the potential for development or persistence of transfer lesions.

Adult↗

Salvage treatment of failed hallux valgus operations with proximal first metatarsal osteotomy and distal soft-tissue reconstruction.

We reviewed the results of 15 patients (16 feet) in whom a hallux valgus procedure had failed. Salvage was by proximal crescentic first metatarsal osteotomy with distal soft-tissue reconstruction. Results based on a clinical scale considering the level of pain, activity limitations, support requirement, footwear limitations, and alignment were good in 11, fair in two, and poor in three. Patients were satisfied with the results in 10 feet, satisfied with reservations in four feet, and dissatisfied in two feet. Complications were: transfer metatarsalgia in three, hallux varus in one, and osteotomy nonunion in one. One of the patients required reoperation to bone graft a proximal osteotomy. Metatarsal osteotomy was helpful in the salvage treatment of recurrent, symptomatic hallux valgus when the first metatarsophalangeal joint was functional and painless.

Adolescent↗

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

We evaluated the results of distal osteotomy of shortening the first metatarsal head with internal fixation of shape memory metal compression staple for hallux valgus in 26 feet of 17 women with a mean age of 41.0 years (30-65 years). The time for return to light work averaged 18.2 days, and to full work and normal walking 40.3 days after the operation. 16 patients (25 feet) had complete pain relief. Only in one foot, the pain was transferred under the 2nd metatarsal head. The appearance of the feet was markedly improved and the width of the forefeet was decreased by a mean of 0.92 cm after the operation. All of the patients were satisfied with the appearance of their feet. Radiographic analysis of feet showed that all osteotomies united, and the average angle of hallux valgus was improved from 30.1 degrees to 16.0 degrees, with the mean intermetatarsal angle of 11.2 degrees-6.5 degrees. No external fixation of plaster splintage was used 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 stage.

Adult↗

Hallux valgus correction with metatarsal osteotomy: effect of a lateral distal soft tissue procedure.

The purpose of this study was to compare the results of hallux valgus correction using a proximal metatarsal osteotomy with or without a lateral distal metatarsophalangeal soft tissue procedure. This procedure included release of the lateral joint capsule and transfer of the adductor tendon into the neck of the metatarsal. Two groups of patients were reviewed retrospectively. In the first group (17 patients and 25 feet), a proximal closing wedge osteotomy and an Akin osteotomy were performed. In the second group (22 patients and 31 feet), in addition to the osteotomies, the adductor tendon and lateral capsule were released from the sesamoid and the adductor tendon was sutured into the neck of the first metatarsal. Exostectomy and plication of the medial capsule were done in all cases. Physical examination at follow-up revealed significantly more first metatarsophalangeal stiffness in the second group. The average arc of motion was 62 degrees in the first group and 46 degrees in the second. Radiographically, however, results were significantly better in the second group. The average intermetatarsal angle was 9.6 degrees for group 1 and 6.1 degrees for group 2. The average hallux valgus angle was 15 degrees for group 1 and 10 degrees in group 2. Complications included three pin tract infections and four dorsal malunions. The lateral distal soft tissue procedure ensured a more reliable correction of the bunion deformity. However, it resulted in a significant amount of postoperative first metatarsophalangeal stiffness.

Adolescent↗

Large displacement distal chevron osteotomy for the correction of hallux valgus deformity.

In order to assess outcomes and complications, a retrospective study of 38 bunionectomy cases with large displacement distal chevron osteotomy (greater than or equal to 40% lateral translation) for hallux valgus was performed. Follow-up ranged from 12 to 130 months (average, 31 months). Subjective analysis consisting of the American Orthopedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale was performed. Preoperative and postoperative radiographic intermetatarsal (IM) angles and hallux abductus angles were measured and compared. The average postoperative AOFAS score was 93.5. The average preoperative IM angle was 15.03 degrees (range 8 degrees-24 degrees) and the average postoperative IM angle was 4.84 degrees (range, -1 degree-11 degrees). The average preoperative hallux abductus angle was 29.39 degrees (range, 16 degrees-53 degrees) compared to the average postoperative hallux abductus angle of 11.39 degrees (range, 2 degrees-28 degrees). It was found that an average lateral translation of 9.8 mm was able to achieve a relative change of the IM angle of 10 degrees. Evidence is presented that supports the fact that large displacement distal chevron osteotomies can be safely performed for the correction of metatarsus primus varus greater than 15 degrees associated with hallux valgus.

Adolescent↗

Hallux valgus in the younger patient: the structural abnormality.

Standardised radiographs of the weight-bearing foot were analysed in fifty young patients undergoing osteotomy of the first metatarsal for hallux valgus. True metatarsus primus varus was not found more frequently than in a control series. The intermetatarsal angle was significantly greater in affected feet compared with controls. The structural abnormality in hallux valgus in the young is therefore due to a valgus disposition of the second and subsequent metatarsals, rather than varus inclination of the first metatarsal.

Adolescent↗

[Keller-Brandes operation: long-term outcome in young patients with hallux valgus].

PURPOSE: Aim of this retrospective study was to analyse the long term results (10-16 years) after Keller-Brandes' operation for correction of hallux valgus in the younger patient. METHODS: From 1980 to 1986 fifty-one patients (77 feet) at the age of 40 years or younger at the time of surgery (19-40 years, [symbol: see text] 34 years), were operated according to a resection-arthroplasty at our institution. 24 patients (37 feet) were evaluated retrospectively after 10 to 16 years (median: 13 years) in respect to their clinical outcome. Radiological evaluation was performed preoperatively in 23 feet and in 34 feet at follow up. Analysis was performed using a standardized questionnaire based on the HMIS-Score of the American Foot and Ankle Society, an additional clinical score, weight-bearing radiographs, the patient's record and clinical investigation inclusive pedobarographic analysis. RESULTS: Seventy-six % of the patients revealed very good or good subjective overall results. The HMIS-Score revealed excellent or good results in only 57%. Cosmetic was rated very good or good in 64%, 70% of the patients were painfree. Average ROM of the MTP I-joint ranged from 25 degrees flexion to 45 degrees extension. Radiological analysis at follow up: hallux valgus angle-correction: 28 degrees to 19 degrees, no change of the intermetatarsal angle (11 degrees), proximal shift of sesamoids: 9.4 mm to 14.4 mm, neoarticulation gap: 0-2 mm in 23 feet and 3-5 mm in 11 feet, arthritis of IP-joint: 82%: none; 18%: moderate; correction of sesamoid position: 1.7 to 1.4. Metatarsalgia was observed in 27% (10 feet). CONCLUSION: Lateral weight transfer to the lesser metatarsal heads is caused by defunction of the great toe postoperatively which may lead to metatarsalgia (transfer-metatarsalgia). Besides pain relief younger patients require satisfying functional and cosmetic long-term results. To be capable of meeting these requirements, adequate joint preserving procedures like basal or distal metatarsal osteotomies conjuncted with soft tissue procedures should be preferred in respect to the grade of the deformity.

Adult↗

Correction of juvenile hallux valgus deformity associated with metatarsus primus adductus using epiphysiodesis technique.

A 4.5-year follow-up retrospective study on the use of epiphysiodesis procedure for juvenile hallux valgus deformity and metatarsus primus adductus deformity shows a good reduction of deformity in nine patients with minimal change in one patient that can be explained due to the timing of the procedure. This is a minor operation for juvenile bunion deformities, using epiphyseal arrest techniques. The only complication to this procedure was one case with a noted metatarsus primus elevatus due to incomplete epiphyseal arrest from dorsal to plantar. This procedure has been found to be a safe and effective way of dealing with juvenile hallux valgus deformity when metatarsus primus adductus is the deforming force. It should be stated that in all cases a follow-up biomechanical examination and casting for orthotics took place and to date no complications, other than what has been previously mentioned, has occurred. I shall continue to perform this procedure where indicated and shall report my findings as they become available.

Adolescent↗

Distal metatarsal osteotomy for adolescent hallux valgus.

This is a review of 55 metatarsal osteotomies for hallux valgus and metatarsus primus varus in patients under 15 years of age. The results were analysed after the patients were reviewed clinically and radiologically. Complications of the osteotomies and the factors that caused them are discussed. Poor results, irrespective of the type of osteotomy, were due to excessive shortening of the first metatarsal and/or dorsal tilting of the metatarsal head. In both instances there was persistent metatarsalgia.

Adolescent↗

Percutaneous distal osteotomy of the first metatarsal (PDO) for the surgical treatment of hallux valgus.

The authors report their experience in the treatment of hallux valgus by percutaneous distal osteotomy (PDO) of the first metatarsal. Surgery is performed under truncular anaesthesia, in day-surgery, and weight-bearing is allowed immediately. Between January 2001 and December 2002 this procedure was used to treat 83 patients (90 feet). Long-term clinical and radiographic follow-up revealed the percentage of excellent results, in line with open surgery. Post-surgical complications are also considerably reduced, with better patient compliance.

Female↗