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PubMed1986

Experiences with the chevron (V-)osteotomy on adolescent hallux valgus.

The results of a distal chevron (V-)osteotomy in 31 adolescent patients are reported. The distal V-osteotomy of the first metatarsal appeared to provide excellent correction of hallux valgus deformities. The surgical technique and the advantages over other forms of distal osteotomy are described. The authors recommend that distal V-osteotomy be considered as an alternative to other forms of distal osteotomy when treating hallux valgus in adolescents and growing children.

Adolescent↗
PubMed1981

Hallux valgus--etiology, anatomy, treatment and surgical considerations.

The etiology of hallux valgus, method of patient selection, technique of carrying out a modified McBride procedure, and possible surgical pitfalls associated with the procedure are discussed. The results of the McBride procedure and the limitations that the authors feel should be placed upon the procedure were stressed. The authors believe that the modified McBride procedures is biomechanically sound and offers patients a most satisfactory correction of their deformity. The procedure has a very low incidence or postoperative complications, and if a complication arises, the surgeon has many good alternatives with which to correct the problem.

Biomechanical Phenomena↗
PubMed1990

Regnauld procedure for hallux valgus.

Between 1975 and 1986, 75 female patients with painful hallux valgus deformity underwent 100 Regnauld procedures. Of these 75 patients, 50 patients underwent unilateral surgery and 25 patients had simultaneous bilateral surgery. The average age of our patient was 45 years. These operations were performed by two different orthopedic surgeons. Over 90% of our patients were satisfied with the operation. Eighty-five percent had no pain, had a satisfactory cosmetic result, and had no complaints about their footwear. Only one patient had severe problems with high heels. Mobility and radiographic evaluation did not correspond with the clinical results. This type of procedure can be performed as an alternative to the Keller-procedure in the middle-aged or elderly patient with no severe arthritis and no osteoporosis.

Adult↗
PubMed2001

Outcome study of hallux valgus surgery--an AOFAS multi-center study.

Three hundred and eleven patients have been enrolled in a multi-center prospective study evaluating the outcome of hallux valgus surgery by the members of the American Orthopaedic Foot and Ankle Society. One hundred seventy-nine of these patients have completed six-month follow-up questionnaires, and 195 have completed 12-month questionnaires. The AAOS Lower Limb Outcomes Data Collection Questionnaire and the Foot and Ankle Outcomes Data Collection Questionnaire were used to assess patients' perceptions of their results. Both of these instruments are validated lower extremity instruments. They contain the SF-36 instrument as well as questions relating to lower extremity function. At six- and 12-month follow-up, significant improvement has been noted in the patients' SF-36 physical function scores, role physical scores, and bodily pain scores. Role emotional scores were increased at six months but returned to baseline at 12 months. The scores for physical health and pain and satisfaction with symptoms for the lower extremity have significantly improved. The global foot and ankle score and shoe comfort score from the foot and ankle module have also significantly improved. This outcome study is the first to focus on the patient's perception of results of hallux valgus surgery and demonstrates a significant improvement in pain, function, and satisfaction after bunion surgery performed by members of the American Orthopaedic Foot and Ankle Society.

Adolescent↗
PubMedDate not supplied

A method of predicting the degree of functional correction of the metatarsus primus varus with a distal lateral displacement osteotomy in hallux valgus.

Metatarsus primus varus may be an important pathologic component in hallux valgus deformity. The correction of the pathologic intermetatarsal angle M1 M2 is essential for providing an acceptable alignment of the hallux. The distal lateral displacement osteotomy of the first metatarsal (Chevron or Mitchell) provides correction of the intermetatarsal angle M1 M2. The present paper describes a simple method of calculating preoperatively the maximum possible correction through such osteotomies. This method, based on the measurement of the length of the first metatarsal and the width at the osteotomy site, projects the amount of correction and, furthermore, provides the limits of angular correction through such osteotomies performed distally.

Foot Deformities, Acquired↗
PubMed1999

Mobility of the first tarsometatarsal joint in relation to hallux valgus deformity: anatomical and biomechanical aspects.

Hypermobility of the first tarsometatarsal (TMT 1) joint is suggested to be an important factor in the cause and progression of hallux valgus deformity. Hypermobility of the TMT 1 joint is tested clinically in the sagittal plane, but an important deformation also exists in the transversal plane: metatarsus primus varus. This in vitro study was undertaken to investigate the relation between the mobility of the TMT 1 joint in these two planes and to investigate the correlation of the mobility with morphological variables. A second aim was to study the possible stabilizing effect of the tibialis anterior muscle, flexor hallucis longus muscle, and peroneus longus muscle on the TMT 1 joint. Nine embalmed human specimens were tested under standardized conditions. A 30-N force was applied to the head of the first metatarsal (MT 1) to pull in either the dorsal or medial direction. To simulate muscle force, 21 N was applied to the three tendons: all seven possible combinations of muscle action were tested in each plane of motion. Angular displacements were measured using 2-dimensional LED video registration. TMT 1 mobility is a relevant factor in MT 1 mobility in the sagittal and transversal planes, the peroneus longus has a stabilizing effect on this joint, and the effect of the flexor hallucis longus on this joint is different in both planes. When considering a Lapidus procedure for surgically correcting a hallux valgus, the mobility of MT 1 in the transversal plane should also be assessed, but so far no objective clinical test in this plane has been described.

Aged↗
PubMed2026

K-wire versus screw fixation in Scarf-Akin osteotomy for hallux valgus: A retrospective cohort study.

BACKGROUND: Retention of metal implants after Scarf-Akin osteotomy (SAO) may cause irritation and psychological discomfort, often necessitating a hardware removal procedure. This study aimed to introduce K-wire fixation, allowing for outpatient removal, and to compare it with screw fixation. METHODS: This retrospective study included 64 patients with hallux valgus, comprising 32 in the K-wire fixation group and 32 in the screw fixation group. Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS), and patient satisfaction. Radiographic parameters included hallux valgus angle(HVA), intermetatarsal angle(IMA), and distal metatarsal articular angle(DMAA). RESULTS: Both groups showed significant clinical and radiographic improvement (P&#x202f;<&#x202f;0.01). No significant between-group differences were observed in the other clinical or radiographic outcomes (P&#x202f;>&#x202f;0.05). Treatment costs were significantly lower in the K-wire group (P&#x202f;<&#x202f;0.001). CONCLUSIONS: K-wire fixation provides clinical and radiographic outcomes comparable to screw fixation, while avoiding the need for an additional procedure to remove the implant. LEVEL OF EVIDENCE: Level III.

Humans↗
PubMed1995

[Hallux valgus treated by shortening of the first phalanx with trans-epiphyseal impaction and adductor plasty. Apropos of 49 cases with 5-years follow-up].

PURPOSE OF THE STUDY: 49 cases of hallux-valgus were treated by a shortening of the phalanx with impaction according to the technic described by Regnauld, associated with a plasty of the adductor. Patients were evaluated with a follow-up greater than 5 years. MATERIAL AND METHODS: 32 female and 5 male patients were treated. 63 per cent patients were between 30 and 60 years old. The preoperative average of metatarsus varus was 12 degrees 1. The length of first metatarsal was inferior to the second in 30 cases. The preoperative average of first phalange valgus was 30 degrees. Every operated foot had an Egyptian morphotype. Sesamoids were consistently dislocated. Associated lesion were: 19 flat feet, 10 round fore-feet, 9 clinodactylies treated during the same procedure. RESULTS: They were evaluated according 3 Groulier's criteria: the correction of deformation, static disturbances, and professional activities. The phalangeal valgus was corrected in 37 cases (72 per cent). 33 feet were painless (67 per cent). The dorsal flexion of the first toe was superior to 60 degrees in 38 cases (77 per cent). Metatarsus varus was consistently reduced. 2 permanent metatarsalgia and 4 plantar corns persisted. 76 per cent of operated patients were able to wear shoes normally with a normal perimeter of walking. At X-ray examination, the head of first metatarsal was unchanged in all cases. The joint space was normal in 39 cases (79 per cent). The base of first phalanx was normal in 25 cases (51 per cent). 37 feet had centered sesamoïds. In total, we noticed: 37 very good and good results (72 per cent), 8 moderate results (17 per cent), bad results (9 per cent). DISCUSSION: The operative technic gives a stable shortening of the first phalanx without material and allows the early weight bearing. The abductor of the great toe is a stronger muscle than adductor, allows rotational correction and the alignment of the first phalanx on the first metatarsal. We agree with criteria of bad prognosis proposed by Groulier: age, valgus flat foot, the duration and the importance of deformation, the presence of osteoarthritis. CONCLUSION: The abductor plasty and soft tissue operation contributes to the durable correction of hallux valgus. Shortening must preserve the vascularization of the proximal end of the phalangeal. This operation should be reserved for young patients, without signs of articular cartilage degeneration and having an Egyptian foot.

Adult↗
PubMed2003

Diaphyseal nutrient foramina in the first metatarsals in normal and hallux valgus feet: location and surgical implications.

We examined 47 first metatarsals from amputated lower limbs to determine the situation of the main diaphyseal nutrient foramina (NFs) in normal and hallux valgus feet. All the NFs, excepting one, were in a plantar-fibular location. The NF situation was analyzed by means of the foraminal index and three minimum distances: from NF to proximal extremity, from NF to the shaft dorsal face (NFDS) and from NF to the border of the cartilaginous coating of the metatarsal head. We found a constant location of the NF in the middle of the total metatarsal length and sexual dimorphism in NFDS (lower in females); there were no differences by side, neither by digital or metatarsal types, nor between normal and hallux valgus types. Vascular complications in some osteotomies are discussed. In the surgical design, the NF situation can be estimated from either the total or physiological metatarsal length by means of the corresponding equations as reported here.

Adult↗
PubMed2005

Arthrodesis of the first tarsometatarsal joint for correction of the advanced splayfoot accompanied by a hallux valgus.

OBJECTIVE: Arthrodesis of the first tarsometatarsal joint for the treatment of a painful splayfoot with the aim to restore a normal weight bearing on the first ray. Correction of hallux valgus deformity. INDICATIONS: Advanced splayfoot deformity with a first intermetatarsal angle > 18 degrees. Hypermobility of the first tarsometatarsal joint with reduced weight bearing on the first ray and development of a transfer metatarsalgia. Painful, primary or secondary osteoarthritis of the first tarsometatarsal joint. Recurrence of splayfoot deformity after previous attempt at surgical correction. Elevation of the first ray such as after developmental clubfoot. Metatarsus primus varus deformity accompanied by hallux valgus in the presence of a hypermobile flatfoot. CONTRAINDICATIONS: Minimal or moderate splayfoot deformity with a first intermetatarsal angle < 17 degrees and a clinically stable first tarsometatarsal joint. Untreated hindfoot deformities such as flatfoot combined with heel valgus. Inability to use walking aids for postoperative partial weight bearing. Insufficient circulation of forefoot. SURGICAL TECHNIQUE: Dorsomedial incision overlying the first tarsometatarsal joint. Splitting of the extensor aponeurosis medial to the tendon of the extensor hallucis longus. Subperiosteal exposure of the first tarsometatarsal joint. Opening of the joint. Judicious removal of articular cartilage and resection of a laterally based bony wedge from the medial cuneiform for correction of the increased first intermetatarsal angle. Manual correction of the splayfoot with concomitant plantar displacement of the base of the first metatarsal. Selection of properly fitting fixed-angle plate and internal fixation. Soft-tissue correction at the first metatarsophalangeal joint or metatarsal neck osteotomy to realign the articular surface of the first metatarsal head. RESULTS: Clinical and radiologic results based on 56 patients (64 feet) followed up for an average of 8.2 months. COMPLICATIONS: one reflex sympathetic dystrophy, four nonunions of the first tarsometatarsal joint (6.2%). Radiologic evidence of consolidation at a mean of 9 weeks. Improvement of the first intermetatarsal angle from 20.4 degrees to 11.2 degrees. Pressure measurement showed a significantly improved load-carrying capacity of the first ray. The score of the American Orthopaedic Foot and Ankle Society improved significantly (p < 0.01) from 51 to 92 points.

Arthrodesis↗
PubMedDate not supplied

Mitchell osteotomy for adolescent hallux valgus.

Sixty-nine Mitchell osteotomies augmented with smooth-pin fixation and a trapezoidal step-off osteotomy to maintain ray length were performed on 46 adolescent patients with a painful hallux valgus deformity. Average follow-up time was 6 years. By using radiographic, clinical, and subjective patient data, we found an overall excellent or good result in 91% of cases. Nine feet were found to be cosmetically unsatisfactory, 11 required special shoewear, 10 had mild residual pain with high heels or strenuous running, and three had pain severe enough to restrict activities. Range of motion was normal in 56 feet, slightly decreased in 11 feet, and significantly reduced in two feet. We conclude that, given a success rate of 91%, this slightly modified Mitchell osteotomy is a satisfactory procedure for adolescent hallux valgus deformity with chronic bunion discomfort.

Adolescent↗
PubMedDate not supplied

[Intermediate results following subcapital metatarsal osteotomy in the therapy of hallux valgus with metatarsus primus varus].

71 feet were investigated after subcapital modified osteotomy of the metatarsus according to Kramer for an average follow-up period of 19 months. Mean improvement of the Hallux valgus angle was 10 degrees whereas the intermetatarsal angle was improved by 4 degrees on average. The high degree of satisfaction of patients (83%) with the outcome of this surgical method suggest its application in cases of medium metatarsus primus varus within hallux valgus deformations when the metatarso-phalangeal joint is not affected. In patients aged 50 years and older as well as in cases of MT I varus exceeding 18-20 degrees this operation should strictly be limited to the cases indicated above.

Adolescent↗
PubMedDate not supplied

First metatarsocuneiform arthrodesis and Reverdin-Laird osteotomy for treatment of hallux valgus: an intermediate-term retrospective outcomes study.

The authors present a retrospective study of 14 patients (20 feet) treated with first metatarsocuneiform arthrodesis and Reverdin-Laird osteotomy and distal soft tissue alignment for hallux valgus associated with hypermobility of the first ray and an increased proximal articular set angle. The purpose of this study was 3-fold: (1) to determine clinical outcome of this procedure combination, (2) to evaluate the effect of this procedure on the radiographic parameters of hallux valgus, and (3) to determine the degree of first ray shortening. At a mean 50.1 months postoperatively, patients were evaluated according to the American Orthopedic Foot and Ankle Society's Hallux-First Metatarsophalangeal-Interphalangeal Clinical Rating Scale. Preoperative and follow-up radiographs were compared for changes in the following measurements: 1-2 intermetatarsal angle (IMA), hallux abduction angle (HAA), proximal articular-set angle (PASA), and metatarsal protrusion distance (MPD). Statistical analysis using the Student t test showed a significant increase in total scores from a mean 43.6 to 92.6 of 100. A significant decrease was found in the IMA from a mean 16.9 degrees to 7.1 degrees, in the HAA from a mean 37.1 degrees to 5.2 degrees, in the PASA from a mean 20.3 degrees to 3.4 degrees (P <.001), and a significant change in the was found in the MPD of 7.7 mm (P <.001). Given the high rating scale scores, first ray shortening did not appear to hamper our patients' clinical outcome.

Adolescent↗
PubMedDate not supplied

The effect of temperature elevation during discontinuous use of rotatory burrs in the correction of hallux valgus.

The purpose of this study was 2-fold: to measure temperature elevation during exostectomy and osteotomies of the metatarsal head and the proximal phalanx in 78 patients (94 feet) with hallux valgus undergoing distal first metatarsal and proximal phalangeal osteotomies by minimal incision surgery; and to assess whether there was a relationship between working temperatures at operation and the overall thickness of the forefoot. The procedure included the use of rotary wedge burrs in discontinuous cutting bursts of less than 20 seconds for removal of the exostois, and the use of rotary triflute burrs used in discontinuous cutting bursts of less than 10 seconds for each osteotomy. The temperature of the bone surface was measured with a thermocouple and, when 38 degrees C was exceeded, the field was irrigated with saline solution. The temperature generated during the procedure was found to be significantly associated with the amount of bone removed from the metatarsal (Pearson's correlation coefficient, r = -0.101, P = .05). At the 6-week visit, thickness of the first metatarsal was greater in the group with temperature elevations > or =47 degrees C compared with the group with temperatures <47 degrees C. The Reverdin-Isham procedure by minimal incision surgery using rotatory triflute burs in discontinuous cutting bursts is an effective, reliable, and technically simple procedure for treating hallux valgus deformity. At follow-up, thickness of the foot at the level of the head of the first metatarsal was associated with heat generated during the use of rotary burs.

Adult↗
PubMed2000

Hallux valgus correction by the method of Bösch: a new technique with a seven-to-ten-year follow-up.

Subcapital osteotomy of the first metatarsal is used as the treatment of choice for the correction of hallux valgus. The advantages are a short operation time, no soft tissue procedures, secure union, avoidance of metatarsal head (MTH) necrosis and a varus malalignment. An alternative temporary fixation of hallux valgus also having an arthrosis is performed with a specially developed angle plate (Synthes-Stratec, Austria) with the skin incision lengthened to 1-cm. Adequate displacement of the MTH over the sesamoid bones provides a permanent satisfying result even without an operation on the abductor or the adductor. This article reviews 98 feet of 64 patients who were examined in a follow-up study from the initial 114 cases that were operated. The mean follow-up time was 8 years and 9 months.

Adolescent↗
PubMed1996

[Treatment of hallux valgus by varus osteotomy of the first phalanx associated with adductor plasty].

PURPOSE OF THE STUDY: Sixty two hallux valgus treated by first phalanx varus osteotomy associated to adductor hallux plasty were reviewed with a minimum follow-up of 4 years. MATERIAL AND METHODS: 48 females and 2 males were operated. Average age was 46 years. The forefoot was grecian 40 times. The pre-operative metatarsus varus was at an average of 14.2 degrees when the metatarso-phalangeal valgus was 33.3 degrees. The interphalangeal valgus was 8.25 degrees. The first phalanx base lateral translation measured an average of 5.8 mm. Sesamoids were always dislocated. 36 patients were treated in the same operative time, using this associated approach at different level. RESULTS: Results were evaluated according to 3 Groulier's criteria. In 10 cases, a post-operative pain persisted. Shoe wearing continually improved. The great toe valgus was corrected in 31 cases (50 per cent). The correction was partial in 20 cases (32.3 per cent) but on radiographs, only 34 cases (54.8 per cent) conserved a normal joint space. The first phalanx base lateral translation only improved partially. It measured an average of 408 mm. The global result was good in and very good, 67 per cent, while patients subjective estimation was good or very good in 90.3 per cent. DISCUSSION: The study of this series of first phalanx varus osteotomy associated to adductor plasty shows lateral subluxation partial correction, factor of long term modification on articular metatarso-phalangeal joint space. The adductor plasty associated to abductor disinsertion showed a results improvement compared with other published series. CONCLUSION: The first phalanx varus osteotomy associated to adductor plasty should be limited to moderate hallux valgus deformity with interphalangeal valgus and without any major articular incongruity.

Adult↗
PubMed1992

The modified Mayo procedure combined with basal valgus osteotomy of the first metatarsal for severe hallux valgus.

The modified Mayo procedure corrects valgus deformity of the great toe secondary to osteoarthritis in the first metatarsophalangeal joint. Basal osteotomy of the first metatarsal to correct metatarsus primus varus and to maintain correction of the valgus deformity may be performed simultaneously. We retrospectively reviewed the results in 55 of 70 feet treated by this combined procedure. The average duration of follow-up was 4.2 years (range 0.5-6 years) and the average age at operation was 63 years (range 45-80 years). The results were either very good or good in 82%, moderate in 14%, and poor in 4%. Our technique of basal osteotomy of the first metatarsal is a simple and effective procedure to correct metatarsus primus varus and may restore the distal transverse arch. It should be considered as a possible method of treatment when the intermetatarsal angle is greater than 10 degrees.

Adult↗