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PubMed1994

Characteristics of adolescent hallux abducto valgus. A retrospective review.

The authors review 63 surgical cases of adolescent hallux abducto valgus in 54 patients from the Foot and Ankle Institute of the Pennsylvania College of Podiatric Medicine over a 7-year period. Twenty-five closing base wedge and capital osteotomies were evaluated for radiographic changes. Three quarters of a group of 65 patients with adolescent hallux abducto valgus were found to have an abnormally high metatarsus adductus angle. Patients who had a closing base wedge osteotomy had higher preoperative radiographic angles for the intermetatarsal, metatarsus adductus, hallux abductus, and proximal articular set angles as well as the tibial sesamoid position. Those patients had 4.49 degrees more intermetatarsal angle correction than the patients who had a capital osteotomy. Implications for evaluation and treatment are discussed.

Adolescent↗
PubMedDate not supplied

Long-term follow-up of the Green-Watermann osteotomy for hallux limitus.

The authors undertook a retrospective analysis of the long-term efficacy of the Green-Watermann procedure for the treatment of painful hallux limitus or rigidus. Questionnaires were sent to 80 consecutive patients who had such procedures performed between 1990 and 1999. Medical records and radiographs were reviewed for the 32 patients who completed the questionnaires, representing 40 Green-Watermann procedures. Twenty-four patients were able to return for clinical evaluation. The average length of follow-up was 4 years (range, 1 to 10 years). The questionnaires addressed pain before and after surgery, function after surgery, complications, and overall impression and satisfaction. Nearly all of the patients (30 of 32; 94%) reported that surgery had significantly relieved their hallux joint pain, and a slightly smaller proportion (28 of 32; 88%) felt that their chief complaints were at least 70% improved. Clinical evaluation revealed adequate range of motion at the first metatarsophalangeal joint. It is concluded that the Green-Watermann procedure is an effective treatment approach for hallux limitus and rigidus, resulting in a significant reduction in pain, an increase in function, and a high degree of patient satisfaction.

Adult↗
PubMed2002

The association of hallux limitus with the accessory navicular.

Hallux limitus is one of the most prevalent, debilitating disorders of the first metatarsophalangeal joint, and it has many proposed etiologies. This article reviews these etiologies, focusing primarily on the pes planus foot. The pes planus foot type is often associated with symptomatic hallux limitus and the accessory navicular. This article discusses this correlation, although a causal relationship has not been proven. The prevalence and classification of the accessory navicular are also discussed. Clinical cases involving symptomatic hallux limitus occurring concomitantly with an accessory navicular are reviewed, including radiographic findings, symptoms, and surgical treatment.

Adolescent↗
PubMedDate not supplied

Plantar pressure and joint motion after the Youngswick procedure for hallux limitus.

The effects of the Youngswick osteotomy on plantar peak pressure distribution in the forefoot are presented for 17 patients (23 feet) with mild-to-moderate hallux limitus deformity and 23 control subjects (23 feet). During 2 years of follow-up, the operation produced a significant increase in the range of dorsiflexion of the first metatarsophalangeal joint in these patients, reaching near-normal values. Preoperative and postoperative measurements, using a pressure-distribution measurement system, show that peak pressure beneath the hallux and the first metatarsal head remained unchanged. However, peak pressure was significantly increased beneath the second metatarsal head and decreased beneath the fifth metatarsal head. These findings suggest that the foot functioned in a less inverted manner postoperatively. Compared with normal feet, hallux limitus feet demonstrated significantly higher peak pressure beneath the fourth metatarsal head preoperatively and postoperatively.

Adult↗
PubMed2000

[Surgical treatment of hallux valgus in children and adolescents: 46 cases treated with the Mitchell technique].

PURPOSE OF THE STUDY: The aim of this study is to discuss special features of hallux valgus in children and assess place of a surgical procedure in some patients. MATERIAL AND METHOD: A retrospective study of 40 children (46 feet) operated for hallux valgus was conducted. An etiology was identified in 10 per cent of cases and 90 per cent were considered as idiopathic. From a clinical and radiological analysis of 46 feet, we describe the anatomical particularities and the indications of the surgical treatment. The Mitchell's technique is described in detail. The correction of the metatarsal varus and the metatarsophalangial valgus was obtained without breaking off the growth plate of the first metatarsus. RESULTS: Clinically, results were satisfactory in 84 per cent of the cases. Radiologically, results were excellents in 45 per cent and good in 35 per cent. DISCUSSION AND CONCLUSION: Hallux valgus in the child is often underestimated; operative treatment should be proposed in some patients. Mitchell's technique gives good results with an early and simply correction.

Adolescent↗
PubMed2000

Correction of hallux valgus. Metatarsal osteotomy versus excision arthroplasty.

The long-term retrospective results (followup range, 10-22 years) of an uncontrolled series of basal metatarsal closing wedge osteotomies and Keller's excision arthroplasties performed in patients 14 to 40 years of age are analyzed. In the osteotomy group, 34 patients (50 feet) were available for clinical review and 26 patients (37 feet) were available for radiologic review. In the Keller group, 24 patients (37 feet) were reviewed clinically and 23 patients (34 feet) were reviewed radiologically. Patients were assessed using the Hallux Metatarsophalangeal Interphalangeal Scale of the American Foot and Ankle Society, an additional clinical score, weightbearing radiographs, the patient's record, and clinical investigation. Statistical analysis revealed significantly better results of the clinical and radiologic outcomes after osteotomy. In the osteotomy group, the first metatarsal was elevated dorsally in 14 feet (38%). The incidence of varus deformities was higher with basal osteotomy (18% versus 5.4%). Metatarsalgia occurred similarly in both groups (28% versus 27%). It is known that these techniques should be applied to different patient populations. However, they formerly were used for the same indication. This long-term analysis shows that the Keller arthroplasty should be abandoned for the treatment of hallux valgus in young and active patients. The basal metatarsal closing wedge osteotomy is conceptually the correct treatment for hallux valgus deformity for the younger patient; nevertheless, it is technically demanding and is associated with a higher risk of failure. The long-term results of both procedures are unacceptable for the patient and the surgeon. The short and middle-term results of the newer basal type osteotomies, such as the proximal crescentic osteotomy, the proximal chevron osteotomy, or the proximal oblique osteotomy combined with distal soft tissue releases, suggest a more satisfying long-term outcome.

Adult↗
PubMed2000

Distal soft tissue correction for hallux valgus with proximal screw fixation of the first metatarsal.

These early results with short-term to medium-term followup demonstrate the effectiveness of this distal soft tissue procedure with proximal realignment in a subset of patients with moderate to severe hallux valgus and mobility of the first ray. With up to 2-year followup, the correction seems to hold with no significant recurrence and only mild increases in the hallux valgus and intermetatarsal angles with time. Obviously, longer-term followup with a larger group of patients is needed, but these early results are encouraging. In this group of patients, this procedure provides reliable correction of hallux valgus while possibly avoiding some of the morbidity of the different procedures for proximal osteotomy.

Bandages↗
PubMed2001

[Recurrent hallux valgus treated with metatarsophalangeal arthrodesis. A series of 32 patients].

PURPOSE OF THE STUDY: We reviewed a series of 32 cases of recurrent hallux valgus treated by great toe metatarsophalangeal arthrodesis with a minimal 5-year follow-up. MATERIAL AND METHOD: Mean delay from the first surgical procedure and revision surgery was 11 years. All patients complained of forefoot pain. The average angle of the phalangeal valgus was 39 degrees. Sixteen patients had metatarsalgia. The first toe metatarsophalangeal joint was evaluated according to Regnauld's classification: two grade 1, eight grade 2a, six grade 2b, sixteen grade 3. Arthrodesis was fixed with an axial screw and associated with adductor hallux plasty. Outcome was assessed at a minimum 5-year follow-up according to Kitaoka's criteria. RESULTS: Seventy-eight percent of the patients were pain free at last follow-up. Valgus deviation of the great toe was corrected with an average angle of 19 degrees. The arthodesis healed in 90.6% of the cases. Statistical analysis showed the importance of great toe valgus pre- and postoperatively and at last assessment. Final outcome was poor in the oldest patients. The overall outcome was rated good in 84% of the cases, average in 6% and poor in 10%. DISCUSSION: Arthrodesis of the great toe is not a disabling surgery. Interphalangeal osteoarthritis may occur due to joint overuse (12 cases). Kitaoka's series compared outcome after arthrodesis with that after conservative surgery and reported better results with arthrodesis. Revision surgery for hallux valgus using great toe metatarsophalangeal arthrodesis remains an acceptable alternative.

Adult↗
PubMed2001

[Anatomical-functional rating system related to pedobarographic examination of the foot in patients treated operatively for hallux valgus].

Author undertook a trial of elaboration of rating system for evaluation of the operating treatment results of hallux valgus, in relation to pedobarographic examination performed with the use of computed platform PEL-38. 335 feet in 173 patients (females) treated operatively due to hallux valgus in Orthopaedic Department of Wrocław Medical University in years 1975-1990 were examined. Those patients were operated on according to Keller, Dega and McBride method. There was elaborated anatomical-functional rating system for the foot. In this system different variables were incorporated such as: pain within foot, physical activity, walking ability, footwear requirements, hallux valgus angle, callus related to forefoot, bunion and MTP joint's ROM. There were distinguished 4 grades of results: excellent, good, fair and poor, in accordance to number of points achieved. Basing on comparison of pedobarographic examination results with results of the rating system, definite relation between mentioned above evaluating systems was not found.

Activities of Daily Living↗
PubMed2002

Relation between hallux valgus deformity and lumbar and lower extremity biomechanics.

Hallux valgus (HV) is a static subluxation of the first metatarsophalangeal joint with lateral deviation of the great toe and medial deviation of the first metatarsal. Our aim was to evaluate the interference of HV deformity with changes in lumbar lordosis and some foot deformities. Twenty HV patients and 20 healthy subjects were selected for the study. Hallux valgus angle, metatarsus primus varus (MPV), metatarsus omnis varus (MOV), first intermetatarsal (1.IMT), second metatarsal (2. MT) and hallux interphalangeal (HIP) angles were estimated from the anteroposterior foot X-rays. Lumbosacral (LSA) and sacrohorizontal angles (SHA) were measured from lateral lumbar x-rays and pes planus was detected from lateral and anteroposterior ankle and foot radiographs. There was a significant difference between HV angle mean values of two groups. MPV, MOV, 1.IMT, 2. MT and HIP angles did not show significant difference between groups. HV angle was found to be correlated with MPV. HIP angle was found to be correlated with LSA and SHA, indicating a relation with lordosis. HV and pes planus were correlated with each other. HV also showed weak correlation with hyperlordosis. Transmission of variations in body mechanics through pelvis and lower extremity plays an important role for certain foot deformities. Some factors affecting HV development are correctable; early diagnosis and treatment of MPV and pes planus, suggesting healthy rather than fashionable footwear and preventing obesity may lower HV incidence.

Adult↗
PubMed2002

[Surgical treatment of recurrent hallux valgus].

PURPOSE OF THE STUDY: Little work has been reported on the treatment of recurrent hallux valgus. We reviewed 64 cases after surgical treatment in order to ascertain the cause of recurrence, results of the treatment given, and deduce therapeutic options and indications. MATERIAL AND METHODS: Fifty-nine patients had 64 recurrent hallux valgus bunions. Mean age of the patients was 58 years, 54 women and 5 men. The clinical and radiographic preoperative work-up led to two categories of treatments. In 35 cases, conservative treatment was used to re-align the axis by procedures on the soft tissues either alone or in combination with MacBride tendon transfers, metatarsal osteotomies, or osteotomies to shorten the first phalange. In 29 cases, metatarsophalangeal arthrodesis was used. Patient satisfaction, pain, deformation, shoe wearing and activity were recorded at follow-up. The same radiological parameters were used postoperatively to assess anatomic results. RESULTS: Mean follow-up was more than 6 years (range 2-18 years). The subjective result was good in 52 cases. The objective result was good in 50 cases and poor in 14 (including 7 cases with insufficient correction). The results were analyzed by type of treatment. DISCUSSION: The preoperative analysis demonstrated that recurrence is due to insufficient initial treatment which must take into account all the components leading to the deformation. Arthrodesis gave a good result in 83% of the cases and conservative treatment gave a good result in 71%. Thus, in our opinion, no one type of treatment of recurrent hallux valgus can be applied for all patients. Nevertheless, conservative treatment should associate complementary procedures that can be deduced from the clinical and radiological analysis.

Adult↗
PubMed2002

[Use of grommet for Swanson flexible hinge toe implant arthroplasty for hallux valgus deformity of rheumatoid arthritis].

OBJECTIVES: We reviewed the results of arthroplasty of the great toe with hallux valgus in rheumatoid patients, using a Swanson flexible hinge toe implant protected by grommet. MATERIALS AND METHODS: Sixteen patients (26 feet) with rheumatoid arthritis were operated on from 1996 to 1999. (fifteen women, one man). The average age was 59.8 years (range, 48-73 years). The average follow-up period was 3.0 years (range, 1.0-4.5 years). In each patient, the hallux valgus angle (HVA) was measured before and after surgery, and implant breakage and radiolucency around the implant were evaluated on radiographs. RESULTS: Average HVA was 47.7 degrees preoperatively and 19.3 degrees postoperatively. No implant breakage was observed in 76.9% of the feet. Radiolucency of more than 2 mm was observed in only 3.8% of the feet. CONCLUSIONS: These findings suggest that arthroplasty using a Swanson flexible hinge toe implant with a grommet is useful for treatment of hallux valgus in rheumatoid patients.

Aged↗
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↗
PubMedDate not supplied

Cheilectomy: still a useful technique for grade I and grade II hallux limitus/rigidus.

Cheilectomy, as applied to hallux limitus/rigidus, is described as resection of the dorsal osteophytes and lateral/medial margins of the first metatarsal, as well as the dorsal lip of the base of the proximal phalanx. Forty-seven patients underwent unilateral cheilectomy, with an average follow-up of 3.5 years, and an average patient age of 52 years. Dependent upon the progressive nature of the disease, the results varied with the most beneficial results in the early stages of hallux limitus/hallux rigidus, which include symptoms, re-operation, and range of motion. The indications for cheilectomy are hallux limitus/rigidus in grade I or grade II without sesamoid disease. Late grade II or grade III with sesamoid disease and degenerative joint disease are also described in terms of surgical treatment. The advantages of cheilectomy include early range of motion and rapid decrease in clinical symptoms; cheilectomy obviates the need for healing at an osteotomy site. The disadvantages include not addressing the underlying etiology, potential joint destruction, slippage, or pseudo-articulation at the joint's end range of dorsiflexion. It is not indicated in later stages of the disease.

Adult↗
PubMed2005

[The results of treatment of hallux valgus with subcapital osteotomy of the first metatarsal bone].

This paper presents results of wedge subcapital osteotomy of the first metatarsal bone with lateral and plantar translation of the distal fragment in 47 feet (44 women age 37-72) operated for hallux valgus deformity. Bone fragments were stabilized with Kirschner wire introduced obliquely from lateral side of the head to the shaft. Protruding out of the skin part of the wire between I and II toe was shaped parallel to the lateral side of hallux preventing from valgisation. The mean AOFAS score improved from the preoperative value of 49 points to 86 points postoperatively. Hallux valgus angle improved from the mean preoperative value of 38 degrees to 17 degrees after operation. The mean postoperative AOFAS score in the group with major deformity (over 40 degrees valgity and 14 degrees intermetatarsal angle) was 76 points. Proposed method of stabilization allows limited activity without fear of correction loss during bone healing. Clinical and radiological results are similar to other authors' results, indicating that subcapital osteotomy gives satisfactory results in correction of medium grade deformity and disappointing results in severe deformities.

Adult↗
PubMed1991

[Hallux valgus and hypermobility of the first ray--causal treatment using tarso-metatarsal reorientation arthrodesis].

Today, bunion surgery is still very controversial. Considering that a bunion deformity is actually a result of multiple possible causes, the rationale of the currently applied techniques has not been conclusively demonstrated. Multiple techniques are still applied with uncertain outcome, as shown by the not insignificant recurrence rate. The tarsometatarsal reorientation arthrodesis addresses the deficient anteromedial buttress which is due to the most often concomittent hypermobile first ray. This is an important aspect of treating hallux valgus deformity and includes the sagittal alignment besides the horizontal reposition of the metatarsal over the sesamoid complex. Since in hallux valgus, the first metatarsal looses its position also by the insufficiency of the intrinsic musculature and the ligamento-capsular structures, the arthrodesis regulates the elasticity of the multiarticular first ray within the sagittal plane. Recurrences are less likely after this operation, even when performed on the adolescent hallux which is known as very difficult to be treated successfully.

Arthrodesis↗
PubMed1991

Minimal incision tenotomy for hallux interphalangeal joint extensus.

The spoon-toe hallux deformity causing symptomatic hallux pathology can be corrected through a minimal incision stab tenotomy of the extensor hallucis longus tendon that is usually performed at the level of the interphalangeal joint. This procedure is recommended rather than a traditional tenoplasty because it creates very little disability, successfully reduces the deformity, has low incidence of complications, and produces lasting results in maintaining the correction. The procedure can be used as both a solo procedure or in conjunction with other procedures on the hallux.

Adult↗
PubMed1990

The modified Wilson osteotomy for hallux valgus.

The modified Wilson osteotomy for hallux valgus is a double oblique osteotomy through the metatarsal shaft. The distal fragment is displaced laterally and plantarward. The lateral displacement corrects the varus position of the metatarsal, while the plantar displacement prevents the distal fragment from tilting dorsally into a metatarsus elevatus deformity that could produce metatarsalgia. Seventy-four cases of hallux valgus treated by this method were reviewed five years postoperatively. Sixty-six cases (89%) were graded as satisfactory and eight (11%) as unsatisfactory. Roentgenographic analysis in 61 cases showed the operation had reduced the hallux valgus angle by an average of 15 degrees and the intermetatarsal angle by an average of 4 degrees. The operation shortened the first metatarsal by an average of 5 mm. Although this caused callosities on the forefoot, it did not produce metatarsalgia. The operation is technically uncomplicated and yields a high percentage of satisfactory results.

Adolescent↗