Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “HALLUX VALGUS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 325 records · Page 18Linked to original sources
PubMed1996

[Magerl's subcapital osteotomy in the treatment of hallux valgus].

The distal metatarsal osteotomy according to Magerl allows correction of a hallux valgus deformity by lateral and plantar displacement as well as by pronation and variasation. The length of the first metatarsal can be adjusted by the depth of the cut at the resection or by a slightly oblique osteotomy. If necessary, soft tissue release and/or a osteotomy of the first proximal phalanx can be done to relocate the sesamoids under the head of the first metatarsal. A review of 118 foot operations in 75 patients demonstrated a very good or good result in about 75%. Radiological examination showed sufficient lateralisation of the metatarsal head. Evaluating the length of the first metatarsal and the amount of variation, the results were less satisfying. The metatarsophalangeal angles could be corrected by 14 degrees and the intermetatarsal angles by 7 degrees on average. The sophisticated operative procedure limits the use of this technique as a standard procedure.

Aged↗
PubMed1997

[The utility of digital infiltration of mepivacaine and ketorolac in postoperative analgesia of the unilateral hallux valgus].

OBJECTIVES: To determine whether locally injected ketorolac provides analgesia additional to that of mepivacaine, and also to prevent, diminish or delay the peripheral hypersensitivity response of postoperative pain. PATIENTS AND METHODS: Prospective, randomized, double-blind study of 72 patients scheduled for surgery to correct unilateral hallux valgus. Group 1 (n = 24) received median infiltration at the first metatarsus of 5 ml of 2% mepivacaine and 1 ml (30 mg) of ketorolac. Group 2 (n = 21) received local infiltration of 5 ml of 2% mepivacaine and 1 ml of saline solution. Group 3, the control group (n = 27) received the same solution as did group 2, plus 30 mg of ketorolac intravenously. The postoperative analgesia prescribed was 10 mg of ketorolac orally every 8 hours. Pain was measured on a visual analog scale (VAS) 0, 1, 4, 8 and 24 hours after surgery. Time elapsed until the appearance of pain, number of ketorolac pills consumed and overall patient satisfaction were recorded. RESULTS: There were no differences in anthropometric characteristics. Time until pain appeared was significantly longer in group 1 than in groups 2 and 3 (14.66 +/- 7.19, 5.90 +/- 2.27 and 8.70 +/- 5.02 hours, respectively). The VAS scores were significantly lower in group 1 after the fourth postoperative hour. Analgesic consumption was significantly lower in group 1. CONCLUSIONS: Infiltration of 30 mg of ketorolac along with mepivacaine delays the appearance of postoperative pain and diminishes it in the first 24 hours after surgery to correct hallux valgus, in comparison with infiltration of mepivacaine alone plus intravenous ketorolac.

Adult↗
PubMed1996

Modified Mitchell bunionectomy for management of adolescent hallux valgus.

This retrospective review was performed to determine results and to present a new operative method, a modified Mitchell procedure, used to treat 13 adolescents with a total of 21 bunions. The average age of the patients was 14 years, 6 months. The average clinical followup period was 31 months. The average preoperative valgus angle was 35 degrees (range, 21 degrees-65 degrees); the average preoperative intermetatarsal angle was 14 degrees (range, 7 degrees-22 degrees). The early operative result for 17 feet (81%) was satisfactory; deformity, pain, or stiffness recurred in 4 feet (19%). At the time of the last clinic visit, the average hallux valgus angle was 15 degrees (range, 3 degrees-43 degrees); the average intermetatarsal angle was 7 degrees (range, 2 degrees-18 degrees). No instances of malunion, nonunion, infection, avascular necrosis, or transfer metatarsalgia occurred. This modification of the Mitchell procedure is an effective management option for mild to moderate adolescent hallux valgus.

Adolescent↗
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↗
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↗
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↗
PubMed1991

Comparison of Chevron osteotomy and modified McBride bunionectomy for correction of mild to moderate hallux valgus deformity.

The purpose of this study was to compare the results of the Chevron osteotomy to the DuVries' modification of the McBride procedure using identical criteria in two groups of patients. Thirty-two patients (48 feet) that had a Chevron osteotomy and 10 patients (17 feet) who had a modified McBride bunionectomy without metatarsal osteotomy for treatment of mild to moderate hallux valgus were retrospectively reviewed using subjective and objective criteria. Both groups were matched according to age, severity of deformity, and length of follow-up. Ninety-two percent of patients in the Chevron group and 88% of patients in the McBride group responded that they were either totally satisfied or improved regarding pain relief and appearance of the foot following surgery. Chevron osteotomy resulted in a statistically significant greater correction of the intermetatarsal 1-2 angle than did the McBride bunionectomy. Postoperative metatarsophalangeal joint range of motion was not significantly different for the two groups. Following Chevron osteotomy, five (10%) metatarsal heads exhibited radiographic changes of cyst formation and/or increased osteodensity and three (6%) of the osteotomies healed in a malunited position. One of the three metatarsal head malunions occurred in a patient that also had a lateral capsular release, however, none of the five cases that developed radiographic changes in the first metatarsal head was associated with a lateral capsular release. Lateral capsular release with the Chevron osteotomy did not improve the amount of correction of the hallux valgus deformity and it may be a contributing factor to instability at the osteotomy site leading to a valgus malunion.

Adult↗
PubMed1994

Distal chevron osteotomy with lateral release for treatment of hallux valgus deformity.

From 1986 to 1990, 42 feet in 30 patients had a combined chevron osteotomy and lateral release to correct their painful bunion deformity. Seventeen patients, 23 feet, were available for follow-up. The purpose of this study was to evaluate the outcome of this procedure and to determine the incidence of avascular necrosis. The patients were examined by an independent examiner, radiographs obtained, and questionnaires filled out. Avascular necrosis was determined using plain films read by a musculoskeletal radiologist who did not know the outcomes. The average age was 45 years at the time of the procedure. Average follow-up was 50 months. The preoperative intermetatarsal angle averaged 13 degrees and the hallux valgus angle averaged 31 degrees. At study follow-up, the intermetatarsal angle averaged 8 degrees and the hallux valgus angle averaged 17.5 degrees. The results were graded by the Mayo Clinic Forefoot Scoring System (75-point scale) and a subjective scoring system. Average postoperative Mayo Clinic score was 67. Fifteen feet were subjectively rated as excellent, six as good, and two as fair. Complications occurred in four feet. Hallux varus occurred in two feet, extension contracture in one foot, and an infection in one foot. None of the feet developed definite radiographic evidence of avascular necrosis. Distal chevron osteotomy combined with a lateral release for corrective bunion surgery has come under scrutiny, because of the risk of avascular necrosis of the first metatarsal head. However, our study showed no evidence of avascular necrosis on radiographs. In addition, 91% of patients had good to excellent results at an average 50-month follow-up.

Adult↗
PubMed1981

Osteotomy and fixation for hallux valgus.

Osteotomy is a good method for correcting a metatarsus varus and a hallux valgus if the first metatarsophalangeal joint has little or no arthritis, no luxation and is mobile. Osteotomy of the neck of the first metatarsal is recommended when the articular surface of the first metatarsophalangeal joint has a certain lateral obliquity. In these cases osteotomy of the base of the metatarsal, which exaggerates this obliquity, should be avoided. Osteotomy allows correction in all planes. As osteotomy of the diaphysis of the proximal phalanx is indicated in cases where the hallux is too long, is pronated, or if there is a phalanx valga. Internal fixation of these osteotomies with a lag screw has the advantage of maintaining the correction and allowing early mobilization. With the above-described technique, a physiologic as well as an aesthetic reconstruction may be obtained. The osteotomy must be performed very carefully in order to avoid the complications of recurrence of deformity, joint stiffness and pain.

Hallux↗
PubMedDate not supplied

[Review of 64 cases of hallux valgus surgically treated with the Keller-Lévière technique].

Sixty four cases of hallux valgus treated using the Keller-Lélièvre technique during the period from January 1982 to December 1987 are examined. The results achieved reveal the validity and limits of this surgical technique. Having established the prescriptions of the technique, it still represents the simplest and safest method for treating this affection in adult/old-aged patients.

Adult↗
PubMed1991

[Keller/Brandes surgical technique in the treatment of hallux valgus--indications, surgical method and results].

The Keller/Brandes operation for the correction of hallux valgus consists of a resection of the base of the first phalanx and narrowing of the forefoot by resection of the exostosis of the first metatarsal head and reduction of the luxated sesamoid complex, thus reducing the metatarsus primus varus. The indication to this procedure is given in the elder patient with arthritic changes in the first metatarsophalangeal joint. Though this operation is "mutilating", we have found favourable results in the recent literature as in 50 of our patients being very good and good in 82%, moderate in 8% and poor in 10% of the cases. In order to obtain a good result we emphasize the importance of a correct indication, adequate preoperative measures, a perfect operative technique and a well guided postoperative management.

Follow-Up Studies↗
PubMed2002

Intra- and inter-observer reliability of the distal metatarsal articular angle in adult hallux valgus.

There is some uncertainty as to whether the distal metatarsal articular angle (DMAA) is a real entity or just radiographic artifact and whether it can be reliably measured. If it is intrinsic to the bone, it should not change with bone position. If it is clinically useful, it should be reproducible. Pre-operative and post-operative radiographs of 32 patients undergoing a proximal bony procedure of the first ray were evaluated independently by three foot and ankle specialists in order to determine the intra and inter-observer reliability of the distal metatarsal articular angle (DMAA). In addition, the hallux valgus angle (HVA), intermetatarsal angle (IMA) and joint congruency/subluxation were determined. We used ANOVA (Scheffe's F-test) to determine reliability of the angular measurements; a p value of less than 0.05 indicates poor reliability and a p value of greater than 0.05 indicates reliability. Intra-observer reliability was good for all angular measurements (HVA, IMA, DMAA pre-op, and DMAA post-op) with p values ranging from 0.33 to 0.95. Inter-observer reliability of the HVA and IMA was good (p=0.63 and p=0.32). Inter-observer reliability of the pre-op DMAA approached statistically poor reliability (p=0.09) and the post-op DMAA reliability was poor (p=0.002). The DMAA reduced after the proximal procedure as measured by all observers, and averaged a reduction of 3.9 degrees. Weighted kappa analysis also revealed that there was poor agreement in the determination of congruency and subluxation (Kappa statistic ranged from 0.07 to 0.19). This study suggests that there may be limited value in the DMAA as a clinical measure as it varies with examiner and with the hallux valgus angle.

Adult↗
PubMed1999

Late results of modified Mitchell procedure for the treatment of hallux valgus.

From a total of 153 patients (251 feet), 64 (41.8%) patients, who had had 105 modified Mitchell procedures, were clinically and radiographically examined with follow-up periods ranging from 15 to 24 years (mean, 21 years). Mean age at operation was 41 years (range, 12-64 years). The classic double osteotomies, which diverged slightly toward the plantar surface and the distal fragment, shifted laterally, and angled plantarward, were fixed with a smooth Kirschner wire. In this way, it was possible to achieve a reduction in the first intermetatarsal angle from an average of 22.5 degrees preoperatively to 7.7 degrees postoperatively, and the hallux valgus angle changed from an average of 33 degrees to 17 degrees, with an average shortening of the first metatarsal of 5.4 mm and an average lateral displacement of the first metatarsal head of 4.5 mm. In 67 feet (64%), the results were graded good to excellent; in 23 feet (22%), satisfied; and in 15 feet (14%), poor. The results were worse than the results obtained on the same patient population with a follow-up ranging from 2 to 11 years, with 97% good-to-excellent results reported. Pain over bunion caused by recurrence of the hallux valgus deformity was the main reason for this late deterioration of the results.

Adolescent↗
PubMed1995

Distal first metatarsal osteotomy and adductor release as a treatment of hallux valgus.

A combined bony and soft tissue procedure is reported as a treatment of hallux valgus. Satisfactory subjective and objective results were obtained at an average follow-up of 49.6 months. There was a 21% incidence of avascular necrosis of the first metatarsal head, four out of the 38 patients (10.5%) having developed a varus deformity at follow-up.

Adult↗
PubMedDate not supplied

Modified Van Nes procedure for hallux valgus.

The authors describe a modification of the Van Nes procedure for correction of hallux valgus with associated metatarsus primus varus. This procedure results in the closing of the intermetatarsal angle and provides plantarflexion to the first metatarsal. The article includes preoperative criteria, presentation of the surgical technique, statistical review of 100 procedures, and a critical discussion. Also, a new angle is described to aid in the pre- and postoperative evaluation of radiographs.

Adolescent↗