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PubMed2005

[Hands and feet of Simian primates: an attempt at morphological characterization].

The carpal height, the length of the metacarpus, the metatarsus, and of all the phalanges of 269 simians were measured, then for each specimen, converted to percentage taking the 3rd metacarpus as the reference unit. They were then compared despite differences between specimens. The average values were determined for the different species, subspecies or families. Mathematical ratios were established: height of the carpus divided by the 3rd metacarpus, carpus divided by the 1st metacarpus, 1st ray of the hand divided by the 2nd, 1st ray of the hand divided by the 1st ray of the foot. CONCERNING THE HAND: For little monkeys, the length of the carpus and the medial metacarpus were similar to those observed in humans. Colobinae exhibited a relatively short thumb column. The length of the thumb was slightly shorter for the platyrrhinii and cercopithecinae, especially macacus. Some hapalidae had a relatively longer thumb than humans. All of their medial fingers were longer than those observed in humans. The big monkeys had a smaller carpus and thumb column, sometimes much smaller than in humans, with a similar length for the metacarpi and the medial fingers, except for gibbons, whose medial fingers were longer. CONCERNING THE FOOT: The 1st ray in humans is nearly as long as the 2nd toe, the other toes being very short. The 1st ray of the hallux of all monkeys was always longer than the ray of the thumb, but shorter than the hallux of humans. The other metatarsi of little monkeys were similar to those in humans, except for the platyrrhinii which had a shorter 2nd metatarsus. The lateral toes, which were much longer than in humans, were very similar to fingers though slightly longer, except for platyrrhinii with much longer toes. The big monkeys had very short metatarsi and slightly smaller lateral toes than humans.

Animals↗
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↗
PubMedDate not supplied

Radiographic measurements of patients with juvenile hallux valgus compared with age-matched controls: a cohort investigation.

The purpose of this study was to investigate radiographic measurements in a cohort of patients with juvenile hallux valgus (with a hallux valgus angle > 15 degrees ) using standardized weightbearing x-rays compared with an age-matched control group. First metatarsal protrusion distance, metatarsus primus adductus angle, metatarsus adductus, first metatarsal cuneiform angle, calcaneal inclination angle, and talocalcaneal angles were assessed with discriminant functional analysis. A total of 37 sets of data were analyzed from patients with a mean age of 13.45 +/- 1.75 years. The study identified 2 significant components of juvenile hallux valgus: a positive first metatarsal protrusion distance (P <.001) and metatarsal primus adductus angle (P = .002). Discriminant functional analysis was then used to determine the best predictors of juvenile hallux valgus. This analysis allowed only 1 variable, metatarsal protrusion distance, as a predictor of whether juvenile hallux valgus was present (P < .001), with 94.3% accuracy. This study showed that a positive metatarsal protrusion distance is a significant component of juvenile hallux valgus.

Adolescent↗
PubMed1989

[Torsion --a new concept in construction of sports shoes. Motion excursion of the foot in athletic stress--anatomical and biomechanical observations and their effects on construction of sports shoes].

In recent years several construction elements resulted in an increasing stiffening of the sport shoe so that the foot was partly forced to make its own movements inside the shoe. A new sport shoe concept is presented basing on the results of anatomic and biomechanical studies, its innovative feature being decoupling of the foot movement between the calcaneal part of the foot and the metatarsus (= torsion). The foot is given an opportunity to transmit its freedom of movement in the longitudinal axis of the foot to the shoe without the shoe acting as a lever, this goal being achieved by a limited liberation of the metatarsal pronation/supination and a controlled uncoupling of the metatarsus from the calcaneal part of the foot.

Ankle Joint↗
PubMedDate not supplied

[Pathogenesis and treatment of pes adductus].

Based on the literature and our own 143 patients the etiopathogenesis and treatment of metatarsus varus are discussed. The exact scientific proof is still lacking, whether there does exist, besides of the congenital mostly severer metatarsus varus, a slight exogen postnatal form with spontaneous healing, without or with a preceding permanent prone position of the infants. A fixed adductus position of the forefoot represents the indication for stepwise correction of the deformity by means of a plaster cast and additional wedging. It is necessary to produce a slight overcorrection including the typical valgus heel. Afterwards we are striving for strengthening of the foot abductors in order to gain an equilibrium of the musculature as in the treatment of club feet. Our own techniques of correction are demonstrated as well as the results.

Casts, Surgical↗
PubMed2002

A quantitative analysis of sensory function in lumbar radiculopathy using current perception threshold testing.

STUDY DESIGN: Peripheral sensory functions in patients with radiculopathy resulting from lumbar disc herniation and in control individuals were analyzed using current perception threshold testing. OBJECTIVE: To evaluate the severity of sensory disturbance quantitatively in patients with lumbar radiculopathy. SUMMARY OF BACKGROUND DATA: Subjective evaluation of the severity of sensory disturbance associated with spinal disorders using conventional methods often is difficult. Current perception threshold evaluation is a recently proposed method for studying peripheral nerve dysfunction. This is a quantitative sensory test for analyzing functions of A-beta, A-delta, and C fibers. METHODS: In this study, 48 patients with lumbar radiculopathy resulting from lumbar disc herniation were examined. The mean age of the patients was 37.9 years. All the patients had pain distribution from the compression of one lumbar nerve root (L5 or S1), and unequivocal unilateral disc herniation of the corresponding level was shown by magnetic resonance imaging. Eleven healthy volunteers were used as control subjects. Their mean age was 38.2 years. Current perception threshold evaluation using a Neurometer device was performed at three frequencies: 2000, 250, and 5 Hz. The stimulus sites were located on the dorsal side of the first metatarsus (the L5 dermatome) and the dorsal side of the fifth metatarsus (the S1 dermatome). These sites were investigated on both legs in all the patients and control subjects. The intensity of pain was scored using a visual analog scale. RESULTS: In the control group, there were no significant differences in current perception threshold values at any frequency between the left and right legs. In the patient group, the current perception threshold values in the affected legs were significantly higher than those in the contralateral legs at all frequencies. The current perception threshold values in the affected legs in the patient group were significantly higher than those in the control subjects at 2000 and 250 Hz, whereas there were no significant differences at 5 Hz. The current perception threshold values in the affected legs were significantly higher in patients with hypesthesia than in those without hypesthesia at 2000 and 250 Hz, and in patients with severe pain than in those with less pain at 5 Hz. CONCLUSIONS: Current perception threshold testing showed that the functions of A-beta, A-delta, and C fibers deteriorated in patients with lumbar radiculopathy. This technique may be useful for quantifying sensory nerve dysfunction in patients with radiculopathy.

Adolescent↗
PubMed2005

Variability of extraarticular tibial rotation references for total knee arthroplasty.

Anatomic reference axes that determine rotational alignment of the tibial component have not been established. To assess variability of three anatomic reference axes (a new tibial anteroposterior axis that we proposed, the transmalleolar axis of the ankle, and the second metatarsus bone axis of the foot), we measured the angles between a defined anteroposterior axis of the tibia (a line perpendicular to the transepicondylar axis) and each of the three axes in 57 knees of healthy subjects using computed tomography scans. The angle between the defined anteroposterior axis and our proposed anteroposterior axis (a line connecting the middle of the posterior cruciate ligament and the medial edge of the patellar tendon attachment) averaged -0.2 degrees +/- 2.8 degrees (range, -5.5 degrees -6.3 degrees). The angle between the defined anteroposterior axis and the transmalleolar axis averaged 25.9 degrees +/- 9 degrees (range, 8 degrees -49.4 degrees), and the angle between the defined anteroposterior axis and the second metatarsus bone axis averaged 5.2 degrees +/- 10 degrees (range, -21.9 degrees -24 degrees). The variability of the anteroposterior axis was less than than the other reference axes. These data indicate that our proposed tibial anteroposterior axis is more reliable for determining rotational alignment of the tibial component in total knee arthroplasty.

Adult↗
PubMed1997

Metacarpal and metatarsal fractures in dogs.

Metacarpal fractures were more common than metatarsal fractures in this retrospective study of 37 dogs. Fractures of one metacarpal or metatarsal bone occurred in 24 per cent of the dogs, two metacarpal bones in 16 per cent, three metacarpal or metatarsal bones in 19 per cent, and four metacarpal or metatarsal bones in 41 per cent. Eighty-seven per cent of the dogs with fractures of four bones had fracture displacement or malalignment of at least one digit. Progressive fracture healing usually occurred irrespective of stabilisation method. For malaligned fractures, however, external coaptation did not consistently improve alignment. Fracture alignment was consistently improved by open reduction and internal fixation of acute fractures with bone plates. Fractures of four bones occurred most often in the distal metacarpus as opposed to the proximal metatarsus. Therefore, open reduction and internal fixation may be more commonly indicated for severe metacarpal fractures, because fracture displacement or axial malalignment was significantly associated with fractures of the mid or distal regions of the metacarpus or metatarsus (P = 0.052).

Animals↗
PubMed1996

Kinematics of the distal hindlimb during stance phase in the fast trotting standardbred.

Fast trotting Standardbred horses were filmed along a straight on an oval dirt track. Five consecutive stance phases were analysed to describe the planar kinematics of the distal hindlimb. The rapid changes in the geometry of the distal hindlimb that occur during the early stance phase were studied. The hoof segment was initially braked vertically and moved in the direction of the horse. The hoof moved forward on the track surface for more than 20% of the stance time (ST). Two specific deviations in the otherwise smooth course of the fetlock joint angle appeared at 16 and 29% of ST. Tarsal angular joint displacement was, on the other hand, more smooth throughout the stance phase. Segment angular velocity was greatest in the proximal pastern segment, while the metatarsus was almost totally braked in its forward rotation during the early stance. Tibial angular velocity was more smooth and greater than that of the metatarsus. Initial vertical braking of the hoof was related to the rapid rotation of the proximal pastern segment, while the metatarsal and proximal pastern segment angular velocities decreased as the hoof was braked horizontally. Also coincident with horizontal braking of the hoof was an increase in the angular velocity of the tibial segment. It was concluded that the horizontal as well as the vertical braking of the hoof affect the disto-proximal braking of the segments of the distal hindlimb during the early stance phase. The early stance phase changes in the distal hindlimb suggest rapid changes in the internal forces of the limb and should be of importance to the orthopaedic health of Standardbred trotters. These rapid changes at the fetlock joint and hock joint during the early stance may be important in lameness as excessive rapid and repetitive loading and movement are thought to induce joint damage (Radin et al. 1991).

Animals↗
PubMed2002

Three-dimensional kinematics of the tarsal joint at the trot.

The tarsal joint is a common site of injury for many sport horses. Understanding the biomechanics of this complex joint begins with developing a clear picture of the kinematics during normal locomotion. This study describes the 3D kinematics of the tarsal joint by measuring the motion of the tibia and third metatarsus in 4 sound Quarter Horses with targets attached directly to the bones via steel pins. The objective was to determine if the tarsus had significant motion outside the tarsocrural joint. Two Steinmann pins were inserted into the lateral side of the right hindlimb and marker triads were fixed to the end of each pin. 3D motion of the bones was recorded as each subject trotted in hand. Three rotations were expressed using an attitude vector based on the finite helical angle method. Three translations were calculated as the motion of the tibia relative to the third metatarsus. Angular and translation data were mostly coupled with flexion angle. Internal/external rotation during stance and translations during swing showed evidence of noncoupled motion. Although the majority of tarsal motion occurs in the tarsocrural joint, there is evidence that translations and rotations occur in other locations within the tarsal joint and that some of these are related to the tarsal joint 'snapping' phenomenon. This research provides a set of reference 3D kinematics which will aid in the study of the aetiology and mechanical effects of tarsal joint lameness.

Animals↗
PubMed2001

Single absorbable polydioxanone pin fixation for distal chevron bunion osteotomies.

The distal chevron osteotomy is a well-established technique for correction of symptomatic mild to moderate metatarsus primus varus with hallux valgus deformity. Fixation of the osteotomy ranges from none to bone pegs, Kirschner wires, screws, or absorbable pins. We evaluated one surgeon's (J.K.D.) results of distal chevron osteotomy fixation with a single, nonpredrilled, 1.3-mm poly-p-dioxanone pin and analyzed any differences in patients with unilateral or bilateral symptomatic metatarsus primus varus with hallux valgus deformities. All osteotomies healed without evidence of infection, osteolysis, nonunion, or necrosis. Equal correction was achieved in unilateral and bilateral procedures. The technique is quick and easy, and adequate fixation is achieved.

Adult↗
PubMed2003

Hallux valgus in men. Part II: First ray mobility after bunionectomy and factors associated with hallux valgus deformity.

PURPOSE: To determine the 1st ray mobility following a distal soft-tissue procedure with proximal osteotomy (DSTP-PMO) and any associated factors. METHODS: A retrospective study of 30 men (35 feet) was performed. First ray mobility, ankle dorsiflexion, pes planus, and metatarsus adductus were evaluated at the final follow-up. All internal fixation was routinely removed at six to eight weeks postoperatively. Standard radiographs were evaluated and angular measurements were calculated on all feet. RESULTS: The mean follow-up was 78 months. No cases of degenerative arthritis of the 1st MTC joint were noted on follow-up radiographs. DSTP-PMO resulted in a mean postoperative 1st ray mobility of 4.9 mm (range, 2.5 to 8). In those feet evaluated following bunion correction, there was no correlation with pes planus, limited ankle dorsiflexion or metatarsus adductus. The preoperative hallux valgus angle and 1-2 intermetatarsal angle correlated with toe pronation and a positive family history. Twenty-two patients had an AOFAS score of 90-100, seven of 80-89 and one less than 69. CONCLUSION: Hallux valgus in this group of male patients was not associated with limited ankle dorsiflexion or pes planus. Men with toe pronation and a positive family history had a greater hallux valgus deformity than those without after a distal soft tissue repair with proximal first metatarsal osteotomy. There was no evidence of first ray hypermobility after a DSTP-PMO.

Achilles Tendon↗
PubMed2003

Hallux rigidus: demographics, etiology, and radiographic assessment.

PURPOSE: The purpose of the study was to evaluate the demographics, etiology, and radiographic findings associated with hallux rigidus in patients treated surgically over a 19-year period in a single surgeon's practice. METHODS: Patients treated for hallux rigidus by cheilectomy and metatarsophalangeal joint fusion were identified from 1981 to 1999. Patients who had diabetes, inflammatory arthritis, infectious arthritis, crystalline arthritis, multiple forefoot deformities, neuromuscular disorders, or had died were excluded. A chart review and evaluation of preoperative radiographs were completed on all eligible patients. All identified patients were invited for a follow-up examination that included standard and stress radiographs, range-of-motion testing, Harris mat study, gait analysis, first ray mobility measurement, and standardized questionnaire assessment. RESULTS: One hundred ten of 114 (96.5%) patients with a diagnosis of hallux rigidus returned for the final evaluation. Eighty cheilectomy patients (93 feet) and 30 arthrodesis patients (34 feet) were evaluated. The mean age at onset in the current study was 43 years (13-70 years) and only six patients developed symptoms at an age of less than 20 years. Hallux rigidus was graded based on a five-grade clinical-radiographic system. The mean follow-up was 8.9 years. Ninety-five percent of patients with a positive family history had bilateral disease at the final follow-up. At the initial examination in the current study, 81% of patients had radiographic and clinical evidence of unilateral disease, but at the final follow-up 79% of patients had radiographic and clinical evidence of bilateral disease. Eleven percent of patients in the present series had pes planus based on either a positive Harris mat study and/or heel valgus. There was no evidence of an Achilles or gastrocnemius tendon contracture. Radiographic analysis found that the concurrent presentation of hallux valgus and hallux rigidus was not common. Ninety-three of 127 feet (73%) had a chevron or flat metatarsophalangeal joint. Thirty-five feet were noted to have mild or moderate metatarsus adductus. A long first metatarsal was no more common in patients with hallux rigidus than in the general population. The mean first ray elevatus was 5.5 mm and was well within acceptable limits of normal. The mean first ray mobility was 5 mm in arthrodesis patients and 5.8 mm in cheilectomy patients. CONCLUSION: Hallux rigidus was not associated with elevatus, first ray hypermobility, a long first metatarsal, Achilles or gastrocnemius tendon tightness, abnormal foot posture, symptomatic hallux valgus, adolescent onset, shoewear, or occupation. Hallux rigidus was associated with hallux valgus interphalangeus, bilateral involvement in those with a familial history, unilateral involvement in those with a history of trauma, and female gender. Metatarsus adductus was more common in patients with hallux rigidus than in the general population but a clear correlation was not found. Additionally, a flat or chevron-shaped metatarsophalangeal joint was more common in hallux rigidus patients.

Adolescent↗
PubMed2004

The Lapidus procedure: a prospective cohort outcome study.

BACKGROUND: Multiple reports are found in the literature about the surgical treatment of hallux valgus deformities. Few, however, are prospective outcome studies. The purpose of this study was to prospectively look at the functional outcome of patients with moderate and severe hallux valgus deformities (intermetatarsal angle of more than 14 degrees and a hallux valgus angle of more than 30 degrees) after the Lapidus procedure. METHODS: Indication for surgery and inclusion into the study was failure of nonoperative management for metatarsus primus varus and painful hallux valgus deformities. Data was collected using the AOFAS Hallux Metatarsophalangeal Interphalangeal Scale, Visual Analog Pain Scale, clinical examination, weightbearing radiographs, and a patient satisfaction questionnaire. Data was collected preoperatively, 6 weeks after surgery, 6 months after surgery, and then yearly. One hundred and five feet in 91 patients were followed for an average of 3.7 years (range, 18 months to 6.2 years). Sixty-two patients were female and 29 were male. The average age at surgery was 41 years (range, 20 years to 71 years). RESULTS: The AOFAS Hallux Metatarsophalangeal Interphalangeal Scale scores increased from 52 preoperatively to 87 points at most recent follow-up (p <.001). The average intermetatarsal angle preoperatively was 18 degrees and 8.2 degrees at most recent follow-up. Between the 1-year and 3.7-year follow-up visits, only.3-degree increase of the intermetatarsal angle was noted. The average hallux valgus angle preoperatively was 37 degrees and 16 degrees at most recent follow-up. Less than 1-degree increase in the hallux valgus angle was noted between the 1-year to 3.7-year follow-up visits. Complications included tarsometatarsal nonunion in seven patients. Five patients lost correction and all seven patients had a revision procedure done for pain. Removal of hardware was necessary in eight patients, minor wound problems occurred in two patients, superficial neuroma in two patients, and transfer metatarsalgia in four. CONCLUSIONS: The Lapidus procedure obviously is not the answer to all bunion deformities, but with proper technique and attention to detail it is an excellent alternative treatment for moderate to severe metatarsus primus varus and hallux valgus deformities.

Adult↗
PubMed2004

The obliquity of the first metatarsal base.

BACKGROUND: The degree of obliquity of the base of the first metatarsal is thought to predispose to metatarsus primus varus deformity. Radiographs currently are used to interpret the obliquity of the proximal first metatarsal but are subject to error. A 'normal' obliquity of the first metatarsal base has not yet been established. METHODS: Direct measurements of 77 human first metatarsals were used to establish mean values for the proximal first metatarsal obliquity angle with respect to age, gender, and ethnicity in this sample population. The overall length of the first metatarsal and the width of the base were measured. The measured values were compared in relation to age, gender, and ethnicity of the specimens. RESULTS: The overall mean obliquity angle was 3.42 degrees (range, -3 to 8 degrees, SD 2.54). The mean obliquity angle in females was 3.67 degrees (range, -3 to 8 degrees, SD 2.91). The mean obliquity angle in males was 3.30 degrees (range, -2 to 7 degrees, SD 2.24). Mean base obliquity angle in the African-American specimens was 3.0 degrees (range, 3 to 7 degrees, SD 2.59), while the average first obliquity angle in the Caucasian specimens was 3.83 degrees (range, -2 to 8 degrees, SD 2.34). The obliquity of the first metatarsal base increased with age from a mean of 3.5 degrees in the youngest group to 5.13 degrees in the oldest. CONCLUSIONS: Exaggerated obliquity of the first metatarsal base is a proposed cause for metatarsus primus varus. No average values had been established for the proximal first metatarsal obliquity. These mean values are useful in determining if pathologic obliquity is present. In this study group, the mean medial obliquity angle was 3.42 degrees.

Adult↗
PubMed2005

Proximal crescentic metatarsal osteotomy: the effect of saw blade orientation on first ray elevation.

BACKGROUND: Moderate and severe hallux valgus deformities generally require a proximal metatarsal osteotomy to correct a widened intermetatarsal angle. Although excellent results have been reported using the proximal crescentic osteotomy, concerns have been raised about the incidence of postoperative dorsal malunion, which may lead to transfer lesions. The objectives of this paper were to evaluate the influence of saw blade angulation on the final position of the first metatarsal and to test a new technique used to ensure proper orientation of the osteotomy. METHODS: For part I of the study, 26 Sawbones specimens with hallux valgus deformities were corrected using a proximal crescentic osteotomy with the saw blade position incrementally rotated in the coronal plane. The sagittal change in the final position of the metatarsal was quantified radiographically and correlated to the saw blade orientation. For part II of the study, a Kirschner wire was placed in a vertical position into the medial cuneiform to serve as a guide for the crescentic saw blade in 13 cadaver feet with hallux valgus. Metatarsus primus elevatus was measured after surgical correction. RESULTS: Part I of the study demonstrated a highly linear relationship (R2=0.95) between first metatarsal elevation and the orientation of the saw blade. Every 10-degree of saw blade angulation resulted in a 2-mm change in the sagittal position of the first metatarsal. In part II of the study, the average change in metatarsus primus elevation for the 13 specimens after surgical correction of the hallux valgus deformity was only 1.1 mm (range -3.9 to +4.9 mm). Eleven of the 13 specimens had less than 2.5 mm of elevatus. CONCLUSION: Dorsal malunion of the first metatarsal after proximal crescentic osteotomy is a recognized complication. The final position of the hallux metatarsal is influenced by the coronal plane orientation of the saw. A new technique is described to aid the surgeon in proper alignment of the saw and help prevent excessive first ray elevation.

Cadaver↗
PubMed1993

Influence of metatarsal head displacement on metatarsal pressure distribution after hallux valgus surgery.

We reviewed 63 feet after plain subcapital osteotomy for simultaneous correction of hallux valgus and metatarsus primus varus. Results were evaluated clinically and by radiographs and force plate measurements. Eighty-three percent of the patients were satisfied with their surgery. The hallux valgus angle was improved by 9.3 degrees and the intermetatarsal angle by 6 degrees. The osteotomy resulted in a displacement of the metatarsal head in the lateral direction (10 mm) and in the plantar direction (11.3 mm). Normalization of the load distribution on the metatarsal head was achieved in the group with 11 to 15 mm of plantar displacement. Based on our results, we recommend plain subcapital osteotomy for hallux valgus deformities with moderate metatarsus primus varus. After correction of the intermetatarsal angle and sufficient plantar displacement a physiological distribution of load on the metatarsal head can be expected.

Adolescent↗
PubMed1995

Roger A. Mann Award. Juvenile hallux valgus: etiology and treatment.

In an 11-year retrospective study of 45 patients (60 feet) with juvenile hallux valgus, a multiprocedural approach was used to surgically correct the deformity. A Chevron osteotomy or McBride procedure was used for mild deformities, a distal soft tissue procedure with proximal first metatarsal osteotomy was used for moderate and severe deformities with MTP subluxation, and a double osteotomy (extra-articular correction) was used for moderate and severe deformities with an increased distal metatarsal articular angle (DMAA). The average hallux valgus correction was 17.2 degrees and the average correction of the 1-2 intermetatarsal angle was 5.3 degrees. Good and excellent results were obtained in 92% of cases using a multiprocedural approach. Eighty-eight percent of patients were female and 40% of deformities occurred at age 10 or younger. Early onset was characterized by increased deformity and an increased DMAA. Maternal transmission was noted in 72% of patients. An increased distal metatarsal articular angle was noted in 48% of cases. With subluxation of the first MTP joint, the average DMAA was 7.9 degrees. With a congruent joint, the average DMAA was 15.3 degrees. In patients where hallux valgus occurred at age 10 or younger, the DMAA was increased. First metatarsal length was compared with second metatarsal length. While the incidence of a long first metatarsal was similar to that in the normal population (30%), the DMAA was 15.8 degrees for a long first metatarsal and 6.0 degrees for a short first metatarsal. An increased DMAA may be the defining characteristic of juvenile hallux valgus. The success of surgical correction of a juvenile hallux valgus deformity is intimately associated with the magnitude of the DMAA. Moderate and severe pes planus occurred in 17% of cases, which was no different than the incidence in the normal population. No recurrences occurred in the presence of pes planus. Pes planus was not thought to have an affect on occurrence or recurrence of deformity. Moderate and severe metatarsus adductus was noted in 22% of cases, a rate much higher than that in the normal population. The presence of metatarsus adductus did not affect the preoperative hallux valgus angle or the average surgical correction of the hallux valgus angle. Constricting footwear was noted by only 24% of patients as playing a role in the development of juvenile hallux valgus. There were six recurrences of the deformities and eight complications (six cases of postoperative hallux varus, one case of wire breakage, and one case of undercorrection).

Adolescent↗