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PubMedDate not supplied

Arthrodesis of the hallux interphalangeal joint using a diagonally placed 2-mm. cortical bone screw.

Arthrodesis of the interphalangeal joint of the hallux is quite often needed in conjunction with first metatarsophalangeal joint interpositional arthroplasty. With the exception of two cited techniques, the authors believe all previously described methods of achieving interphalangeal joint arthrodesis are inconsistent in their results and in their ability to be performed in conjunction with first metatarsophalangeal joint procedures. The authors, therefore, sought a more practical, efficacious method of achieving hallux interphalangeal joint arthrodesis in the presence of first metatarsophalangeal joint implants, while still using ASIF-AO compressive technique. Presented is their technique of hallux IPJ arthrodesis using a diagonally placed 2-mm. cortical bone screw.

Arthrodesis↗

PubMed1989

Pathologic anatomy of hallux abducto valgus.

HAV is a joint deformity that has some very characteristic anatomic features but that may be developed from a variety of interactive causes, both anatomic and functional. In the normal condition, the first metatarsal bone and hallucal phalanges form an axial array of bones. At the first metatarsophalangeal joint this arrangement is stabilized by a set of muscles whose tendons surround the joint. The pathology is associated with the deviation of the bones from their axial position and the related destabilization of the muscle group around the joint, specifically: (1) The hallux deviates and rotates laterally, while the first metatarsal deviates medially and also rotates laterally to some degree. (2) Deviation of the two main segments of the joint causes tearing and weakening of the medial capsular fibers and pulls the sesamoid bones and metatarsal head away from their normal plantar articulation. (3) Abnormal articulation of the sesamoid bones under the crista and pressure of the medial capsular wall cause erosion of cartilage and subchondral bone on the metatarsal head. (4) Deviation of the hallux redistributes the tendon insertions in relation to the joint axes of motion such that they serve to aggravate the deviation. (5) The deviated position of the hallux and eccentric actions of the tendons create a reaction force on the metatarsal head that serves to further medially displace the first metatarsal bone.

Hallux Valgus↗

PubMed1982

[Hallux rigidus arthrosis and gout].

In general, hallux rigidus arthrosis is said to occur in patients suffering from gout more frequently than average, and it should be valued as a symptom of chronic gout. But as a reevaluation of this problem shows, no criteria can be stated as to causal relationship between hyperuricemia (or gout) and hallux rigidus arthrosis. Obesity has to be considered a connecting link between both of them, and it is accelerating their genesis. Hallux rigidus arthrosis represents, like the arthrosis of Heberden the most frequent possibility for confusing it with gout.

Calcium↗

PubMed1981

Hallux disorder and metatarsal alignment.

The results of surgical procedures to correct hallux valgus have thus far been unpredictable. Hitherto the problem has been approached on the horizontal plane (i.e., from the dorsoplantar point of view), but the author has devised a new apparatus for measuring and recording the weight-bearing frontal alignment (WFA). Abnormal positions of the metatarsal heads, observed from the front, may cause pain in the forefoot, and hallux valgus may contribute to the problem. Analysis of the WFA before a surgical operation enables the surgeon to select the proper procedure for each foot and simultaneously to correct the defects in the horizontal and frontal planes. WFA analysis also enables the surgeon to avoid grave errors in choosing a surgical procedure. After hallux rigidus surgery, the forefoot tends to be more pronated than before and although painless, is predisposed to metatarsalgia. if the WFA is known, this can be avoided.

Biomechanical Phenomena↗

PubMed1981

The mechanics of normal and hallux valgus feet--a quantitative study.

Accurate measurements of the vertical load under areas of the foot were made with a computerized instrumentation system. In a study of 148 normal feet, the normal force distribution and its variation with age was quantified. This showed the hallux to be important in sharing the load on the first ray. comparative studies of feet with hallux valgus before and after Keller's operation showed the changes that accompany reduced hallux loading. A model of the foot was used to calculate the force across the metatarsophalangeal joint and the forces and moments acting on the metatarsals.

Adolescent↗

PubMed1994

Staged arthrodesis for salvage of the septic hallux metatarsophalangeal joint.

Failed surgery at the hallux metatarsophalangeal joint may present substantial difficulties in treatment, especially when complicated by infection. This retrospective study reviews the staged treatment of 5 patients with complications of hallux valgus surgery associated with sepsis of the metatarsophalangeal joint. The initial salvage treatment included debridement with placement of an antibiotic cement spacer and either an intramedullary Kirschner wire (4 patients) or an external fixator (1 patient). At the second stage procedure, the spacer and fixation were removed, and an autogenous tricortical iliac crest graft was inserted into the joint. All patients had clinical control of joint sepsis. Pseudoarthrosis occurred at the proximal end of the tricortical graft in 2 patients. Patients were evaluated at an average of 28 months after the fusion. Staged arthrodesis appears to be a satisfactory approach to postoperative sepsis of the hallux metatarsophalangeal joint.

Adult↗

PubMedDate not supplied

Continuous passive motion as an alternative treatment for iatrogenic hallux limitus.

The use and effect of continuous passive motion (CPM) was evaluated for 10 patients suffering from iatrogenic hallux limitus. All patients had previous hallux valgus corrective surgery. After their initial evaluation, patients were instructed to begin CPM therapy at home for a minimum of 4 hr. a day and were instructed to increase range of motion (ROM) as tolerated. CPM was used for 4 weeks. ROM was measured on day 0, 28, 48, 90. There were significant increases in mean extension (p < 0.025) and mean flexion (p < 0.05). All patients reported a decrease in pain and stiffness of the first metatarsophalangeal joint. Seven of the 10 patients treated with CPM had increases in ROM. Three patients, all of whom had first metatarsal elevatus, required an additional surgical procedure. Patients suffering from iatrogenic hallux limitus with no associated first metatarsal elevatus can utilize CPM as a viable alternative to return to functional ROM.

Contracture↗

PubMedDate not supplied

Extensor hallucis longus tendon transfer for correction of hallux varus.

The authors describe radiographic results from nine patients in whom hallux varus was repaired by transferring the extensor hallucis longus tendon (EHLT) under the deep transverse intermetatarsal ligament into the proximal-lateral base of the proximal phalanx. X-ray films revealed clinically significant changes in biomechanical relations, specifically in the hallux abductus angle. No clinically significant changes were seen in the intermetatarsal angle. The EHLT transfer procedure described is a valuable surgical alternative for correction of iatrogenic hallux varus deformity when combined with the appropriate adjunctive procedures.

Foot Deformities↗

PubMed1996

Distal chevron osteotomy with intra-articular lateral soft-tissue release for treatment of moderate to severe hallux valgus deformity.

We retrospectively reviewed the results of 32 patients (38 feet), with hallux valgus angles between 35 degrees and 60 degrees, who were treated by standard distal chevron osteotomy and intra-articular lateral soft tissue release. The average follow-up period was 5.2 years (4-7 years). The preoperative intermetatarsal angle averaged 14.4 degrees, and the postoperative angle averaged 7.7 degrees. The preoperative hallux valgus angle averaged 42.7 degrees, and the postoperative angle averaged 18.8 degrees. Subjectively, the satisfaction rate in terms of symptom improvement, cosmetic appearance and function was over 90%. Avascular necrosis of the first metatarsal head was not found in our series, which indicated that additional lateral soft tissue release is not contraindicated in combination with chevron osteotomy. Based on the level of satisfaction in our series, we conclude that the combination of distal chevron osteotomy and intraarticular lateral soft tissue release has broader application than the chevron osteotomy alone for patients with hallux valgus deformity.

Hallux Valgus↗

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↗

PubMed2001

Osteotomy of the hallux proximal phalanx.

Osteotomy of the proximal phalanx appears to be used more frequently and with increasing indications. It rarely is indicated as the only surgical procedure and often is combined with a secondary procedure. In hallux valgus surgery, a proximal or distal metatarsal osteotomy often is used, and in hallux rigidus, a cheilectomy usually is added. The advantage of a proximal phalanx osteotomy is that it enables an extra-articular correction, which avoids breaching the metatarsophalangeal joint. This extra-articular correction may prevent joint stiffness and long-term joint changes.

Combined Modality Therapy↗

PubMed2003

Muscular imbalances resulting in a clawed hallux.

A clawed hallux is a deformity of the great toe resulting from a muscular imbalance. Using a cadaveric foot-loading frame, we quantitatively assessed the role of the peroneus longus (PL), extensor hallucis longus (EHL), and flexor hallucis longus (FHL) on position and pressure distribution of the first ray by simulating muscle imbalances. The experimental protocol included applying seven different combinations of simulated disproportionate loads ("overpulls") for these three muscles using midstance force values derived from the literature. This study quantified the angular change in the joints of the first ray and measured the plantar pressure beneath the head of the first metatarsal and the hallux. The results indicated that the peroneus longus was statistically the greatest contributor to the elevation of plantar pressure beneath the first metatarsal, while the EHL and FHL were primarily responsible for the angular changes resulting in the clawed hallux deformity.

Aged↗

PubMed1991

Functional hallux rigidus in the rheumatoid foot.

Hallux rigidus results from arthritic involvement of the first metatarsophalangeal joint. The authors have observed loss of motion at this joint in patients with rheumatoid arthritis in the absence of hallux valgus or joint destruction. A hyperextension deformity of the interphalangeal joint has also been observed, with a painful callus beneath it. The first metatarsophalangeal joint appears normal on roentgenograms, and passive motion of the joint is normal when it is examined clinically. The loss of first metatarsophalangeal motion is functional, and stems from muscle spasm of the great toe intrinsic muscles in an effort to relieve pressure on the lesser metatarsal heads. The interphalangeal hyperextension may develop secondary to "functional hallux rigidus."

Adult↗

PubMed1991

The anatomy of a human foot with missing toes and reduplication of the hallux.

Detailed dissection of a malformed human foot was performed so that the skeletal and soft tissue anomalies in the foot could be compared and contrasted with those found in three previous specimens that we have dissected. The specimen described here consisted of a foot with a reduplicated hallux and two missing toes. Study of the bones revealed a wide medial metatarsal that articulated with a reduplicated hallux. There were two complete lateral toes with normal bones. Two toes and their metatarsals were missing with no remnants. The arterial pattern was similar to those seen previously by us. The dorsalis pedis artery was absent and the plantar arch was abnormal in that it did not terminate with a dorsal anastomosis. There was an extra lateral branch of the medial plantar artery. The digital arteries to the missing toes were also missing. The nerves of the foot were normal with the exception of an extra lateral branch from the medial plantar nerve. As with the arteries, the nerves to the missing toes were also missing. The muscles and tendons on the dorsal surface of the foot were all present but several of the tendons were inserted in abnormal locations in apparent response to the abnormal bone pattern. Most of the muscles and tendons of the plantar surface were present with the exception of the flexor hallucis longus and brevis muscles. Several of the remaining tendons apparently were influenced by the abnormal skeletal pattern and the missing muscles to become inserted on or near the replicated phalanges of the hallux. The anatomy of this specimen suggests that the teratogenic event occurred when specification of the limb bud mesoderm cells had progressed to the level of the distal tarsus and was located in the region that normally would have formed the metatarsals and phalanges of Toes 2 and 3. Further, we propose that the association between skeletal anomalies and arterial deficiencies has aetiological significance. We hypothesise that the abnormal arterial pattern put the limb at risk of teratogenic damage by reducing the number of collateral blood supply routes and that some event, such as extravasation of blood or embolisation, compromised the blood flow in the remaining blood vessels. These events could have resulted in both general shortening of the limb and the specific defects observed in this foot.

Arteries↗

PubMed1989

Surgical management of hallux limitus and rigidus in the young patient.

As demonstrated in a recent survey, hallux limitus and rigidus are often the presenting complaints of our young population. Normal first metatarsophalangeal joint function depends not only on an intact articulation but also sesamoidal mobility and the capacity for the first metatarsal to plantarflex. Whereas acute or chronic microtrauma can impair articular surfaces, first metatarsal plantarflexion can be limited in cases of hypermobility, excessive metatarsal length, immobility of the first metatarsocuneiform joint, or metatarsus primus elevatus. Conservative therapy can be more effective in relieving the symptoms of hallux limitus or rigidus in young patients; however, surgical intervention is often necessary or desirable. The choice of surgical procedure should be based on the etiology of the deformity, as well as the degree of articular degeneration. It is the senior author's opinion that young patients with hallux limitus or rigidus are best served by the performance of cheilectomy with osteotomies designed to create an internal rocker bar mechanism. Procedures designed to shorten or plantarflex the first metatarsal should be reserved for obvious cases of excessive metatarsal length or elevation.

Adult↗

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 < 0.01). No significant between-group differences were observed in the other clinical or radiographic outcomes (P > 0.05). Treatment costs were significantly lower in the K-wire group (P < 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↗

PubMed2005

Orthotic management for disorders of the hallux.

Most disease conditions that affect the hallux are amenable to conservative treatment. Most of the literature that addresses the treatment of hallux rigidus, bunions, sesamoid problems, and arthritis focus on surgical management, although operative indications stress the need for attempted conservative treatment of these processes. This article reviews the technical considerations that are required for successful orthotic management of disease of the first ray. Mechanical terminology and principles of management are reviewed and examples of orthotic prescriptions for specific disease entities are included to facilitate communication between the orthopedist and orthotist.

Hallux Rigidus↗

PubMed2004

[Correction of acquired metatarsus elevatus and hallux flexus: technique used in nine cases].

Nine cases of acquired metatarus elevatus or horizontalization of the first metatarsal with hallux flexus (dorsal bunion) were treated surgically associating: plantar wedge resection of the base of the first metatarsal or the first cuneiform; distal disinsertion of the long hallux flexor which was then positioned under the base of the first metatarsal and finally fixed on the distal dorsal segment of the metatarsophalangeal capsule; distal disinsertion of the anterior tibial tendon and tenodesis of the posterior tibial tendon. Weight bearing was allowed after pinning for one Month to position the axis of the first ray. Morphological results, recorded at 11 Years follow-up (mean) were satisfactory. There were no recurrent deformations and no residual instability of the first ray. The only observation was a minimal stiffness of the metatarsophalangeal joint with no tendency to degeneration.

Adult↗