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PubMed1997

Hallux valgus in young patients: long-term results after McBride operation.

The development of symptomatic hallux valgus deformities at an early age is rather uncommon and usually treated non-operatively. However, if surgical treatment is indicated, only so-called physiological procedures, especially e.g. McBride's soft-tissue realignment, should be considered. From 1970 to 1990, 11 patients aged 12-20 years underwent McBride's procedure, giving a total of 21 feet. For 9 of these patients (17 feet), the average follow-up was 14 years and consisted of patient's history, radiographs and physical examination. All in all, the outcome was judged as good in 10 of 17 feet, satisfying in 2 of 17 feet and dissatisfying in 5 of 17 feet by both patients and surgeon. This conspicuous variation in success rate will be discussed by means of two examples.

Adolescent↗
PubMedDate not supplied

[The Akin-New method for surgery of hallux valgus. 1-year results of a covered surgical method].

A new technique of operation on hallux valgus according to the method of Akin (1925) was introduced to us by Dr. Theodore O. New in 1983. From small skin incisions the removal of the bunion and a corrective osteotomy of the phalanx are accomplished. The results of the operation in 72 out of a total of 77 operated feet one year after operation are reviewed. By the patients 40 (55%) of the results were judged as excellent (A), 23 (32%) as good (B) and 9 (13%) as not satisfying (C). The results of objective assessment were less favorable. 11 (15%) excellent (A) and 34 (48%) good (B) were opposed by 27 (37%) non satisfying results. These are attributed to the stringent rules of judgment and the lack of experience in suitable indications. Saving the metatarsophalangeal joint, minimal postoperative pain and early rehabilitation are advantages of this technique.

Adult↗
PubMed1995

Surgical treatment of hallux valgus by reconstruction of metatarsal arch and modified McBride operation (40 cases report).

72 feet with hallux valgus among 40 patients treated by reconstruction of metatarsal arch and modified McBride operation are reported in this paper. After an average of 4.5 years of postoperative follow-up, the results showed an overall 9 degrees and 3 degrees correction of the hallux abductus angle and the intermetatarsal angle, respectively. 95% of the cases of bunions disappeared, 66% calli under the heads of the first and second metatarsal disappeared, and 91% patients were satisfied with the changes of their feet appearance.

Adult↗
PubMed2001

Surgery for hallux valgus. The expectations of patients and surgeons.

Two-hundred patients who had undergone surgery for hallux valgus were interviewed in an attempt to study the different variables which may have contributed to the success of their surgery. These data were compared to the results obtained by using clinically applied scores. To obtain data on surgeons' expectations, 186 members of two national orthopaedic foot societies were interviewed in order to quantify the importance and value of these variables in prognosis. The main interest of the patients is a painless great toe which, when wearing conventional shoes, gives no problems. They also wish to have their bursitis and bunion treated in order to regain their ability to walk as much as they wish. Surgeons are not only specially interested in pain and shoe problems but also in restoring an adequate range of motion in the metatarsophalangeal joint (MTP), removal of the bunion and the treatment of tender callosities. We found that the correction of footwear problems, alleviation of pain and restoration of adequate walking are the most important factors influencing the outcome of surgery. It was surprising that these expectations are only partly revealed by using clinical foot scores.

Adult↗
PubMed1983

[Ludloff's osteotomy in hallux valgus surgery].

The oblique osteotomy of metatarsale I according to Ludloff allows good and various corrections in hallux valgus deformities. Various modifications of the osteotomy are described. In case of simultaneous osteoarthritis of the metatarsophalangeal joint the additional resection according to Keller-Brandes is recommended.

Hallux Valgus↗
PubMed1986

Biomechanics of hallux valgus and spread foot.

In this biomechanical study a model is introduced of the force phenomena which seem to dominate in the hallux valgus complex during standing and push-off. The model was verified by measuring the forces under the big toe in three directions with the help of a force plate. It is shown that the force in the musculus flexor hallucis longus is accompanied by unfavorable side effects when the hallux shows a valgus position. On the basis of the biomechanics in this article, arthrodesis of the first metatarsophalangeal joint could be recommended as suitable treatment.

Adult↗
PubMed2024

Congenital hallux valgus occurs in Fibrodysplasia Ossificans Progressiva and BMPR1B-associated dysplasia: an important distinction.

BACKGROUND: Fibrodysplasia Ossificans Progressiva (FOP; OMIM #135100) is an ultrarare genetic disorder characterised by congenital bilateral hallux valgus (CBHV), intermittent soft tissue swellings and progressive heterotopic ossification. We report a three-month-old girl with great toe abnormalities similar to FOP, in whom comprehensive clinical workup and genetic investigations illustrates an alternative diagnosis. CASE PRESENTATION: A three-month-old girl presented with CBHV. The antenatal period was unremarkable, she was born by spontaneous vaginal delivery with an uneventful subsequent course, except for maternal concern of her bent toes which received reassurance from several health professionals. Her mother's persisting concerns were explored via the internet and social media leading her to request referral to an expert bone centre for consideration of FOP. On examination, she was thriving, there was no dysmorphism, subcutaneous lumps, skeletal or extra-skeletal deformity except for shortened great toes with lateral deviation of the proximal and distal phalanges. FOP was a feasible diagnosis, for which CBHV is highlighted as an early sign. A cautionary potential diagnosis of FOP was counselled, including advice to defer intramuscular immunisations until genetic results available. Genetic investigation was undertaken through rapid whole genomic sequencing (WGS), with analysis of data from a skeletal dysplasia gene panel, which demonstrated no ACVR1variants. The only finding was a heterozygous variant of unknown significance in BMPR1B (c1460T>A, p.(Val487Asp)), which encodes a bone morphogenic receptor involved in brachydactyly syndromes A1, A2 and D and acromesomelic dysplasia 3 (only the latter being an autosomal recessive condition). CONCLUSION: This report highlights that CBHV serves as a vital diagnostic indicator of FOP and affected infants should be considered and investigated for FOP, including precautionary management whilst awaiting genetic studies. The second educational aspect is that CBHV may not represent a generalised skeletal disorder, or one much less significant than FOP. Receptor-ligand BMP and Activins mediated interactions are instrumental in the intricate embryology of the great toe. Recognition of non-FOP conditions caused by alterations in different genes are likely to increase with new genomic technology and large gene panels, enhancing understanding of bone signaling pathways.

Humans↗
PubMed1994

[Hallux valgus. A prospective study of staple fixation in Mitchell's osteotomy].

Twenty-two feet (17 patients) with hallux valgus were operated with a distal osteotomy of the first metatarsal bone ad modum Hawkins, Mitchell and Hedrick (1945). Fixation of the osteotomy was achieved using two staples driven into the bone by a pneumatic stapler (3M). Postoperatively the patients were treated without plaster bandage in a heel-shoe for two weeks and then allowed full weight bearing. There were two superficial infections, but no deep ones. Within six weeks all the osteotomies had healed without any secondary dislocation. Two staples had to be removed in local anaesthesia after healing. Staple fixation gives adequate support during healing of the osteotomy and allows early mobilisation without the need of a plaster bandage.

Adolescent↗
PubMed2004

Transarticular distal soft-tissue release with an arthroscopic blade for hallux valgus correction.

The few reported anatomic studies have proved the inconsistency of distal soft-tissue release for hallux valgus correction with both the open (dorsal) and transarticular approaches. Anatomic dissections were performed in 15 fresh-frozen human anatomic lower extremity specimens to evaluate the efficacy of the transarticular soft-tissue release utilizing an arthroscopic blade. The features of the arthroscopic blade, such as continuous cutting surface in all edges, increased length as compared with the No. 15 scalpel blade, and flexibility that permits bending without the likelihood of breakage, substantially increase its efficacy during the transarticular soft-tissue release, allowing for complete release of the lateral sesamoid ligament, lateral metatarsophalangeal capsule, and the adductor hallucis tendon insertion onto the proximal phalangeal base. Based on these observations, the authors recognized the inherent limitations of the transarticular approach for complete adductor release from the lateral sesamoid. Transarticular release including the lateral sesamoid ligament, lateral metatarsophalangeal capsule, and the adductor hallucis tendon insertion onto the proximal phalangeal base utilizing the arthroscopic blade is a versatile, reproducible, safe, and easy technique that should be expected to have decreased morbidity and improved cosmesis compared with the open approach.

Arthroscopy↗
PubMed1990

[Outcome of various hallux valgus operations].

By means of a consultation with patients is reported about satisfaction and quotes of success at 195 hallux valgus deformity-operations. As a most used method has proved the 2/3 resection according Brandes, which has a high quotes of success. It is reported and discussed about alternative operations, which more respect different variations and claims of feet.

Adult↗
PubMed2005

Reliability of radiological and cosmetic measurements in hallux valgus.

PURPOSE: To evaluate the reliability of angular, linear, and sesamoid position measurements on preoperative and postoperative radiographs in hallux valgus (HV), as well as cosmetic foot appearance. MATERIAL AND METHODS: Radiographs and photographs from 100 patients undergoing HV surgery were evaluated by two independent observers. RESULTS: Interobserver and intraobserver agreements for HV angle using coefficient of repeatability measures were 4.4 degrees and 3.7 degrees, respectively. Intraclass correlation coefficient measures within and between agreements were 0.97 for HV angle. For intermetatarsal distance, interobserver and intraobserver values were 0.90 and 0.94 when measuring from the midline of each metatarsal and 0.75 and 0.92 when measuring between cortices. Using the visual analog scale to evaluate esthetic appearance, interobserver and intraobserver agreements were 0.59 and 0.79, respectively. Sesamoid position values were also measured. Interobserver and intraobserver kappa values for preoperative and postoperative evaluations with two established methods (Mann or Smith) were 0.47 and 0.70 or 0.65 and 0.75, respectively. CONCLUSION: Intraobserver reliability was higher than interobserver for intermetatarsal distance, cosmetics, and sesamoid position. Angular measurements were more accurate than linear. Esthetic evaluation was less reliable than radiographic, except in the case of sesamoid position measurements.

Adolescent↗
PubMedDate not supplied

The oblique proximal phalangeal osteotomy in the correction of hallux valgus.

An oblique proximal phalangeal osteotomy is introduced as an alternative to the Akin procedure for the treatment of hallux valgus. It consists of a single oblique osteotomy directed from proximal-dorsal to plantar-distal. A retrospective review of 32 patients who underwent 36 oblique proximal osteotomies is presented. The mean follow-up was 11 months (range, 3 to 21 months). Pre- and postoperative radiographic measurements of the distal articular set angles showed an average correction angle of 12 degrees (range, 7 degrees to 22 degrees; SD = 2.99). Mean range of first metatarsophalangeal joint motion was 82% of the preoperative value when combined with distal metatarsal osteotomy, and 87% of the preoperative value without a distal metatarsal osteotomy. Time to clinical and radiographic healing averaged 5 weeks (range, 4 to 8 weeks). The average amount of phalangeal shortening was 1 mm (range, 0 to 2 mm). There were no delayed or nonunions. Subjective assessment conducted by retrospective review of 19 patients at 6 months postoperatively showed that 17 were completely satisfied (90%), 1 was satisfied (5%), and 1 fairly satisfied (5%). Nineteen would have the surgery again (1 with reservations). Eighteen were very satisfied with appearance and 1 was improved. Fourteen returned to shoe gear at weeks 6 to 8, and 5 returned at weeks 8 to 12. Eighteen were satisfied with pain relief and 1 was improved. The study indicates that the oblique proximal phalangeal osteotomy is an effective, reliable, and technically simple procedure for correction of deformities of the proximal phalanx. The advantages include minimal shortening, ease of adjustability, and a construct conducive to rigid fixation.

Adult↗
PubMed1979

Metatarsophalangeal fusion for hallux valgus: indications and effect on the first metatarsal ray.

Arthrodesis of metatarsophalangeal joint was performed in 31 cases of severe hallux valgus. With the surgical technique used, which is described in detail, internal fixation and plaster cast immobilization were not necessary. Analysis of the results suggested that the operation is indicated for severe deformities in elderly patients, preferably women. The basic metatarsal deformity was corrected by the procedure.

Adult↗
PubMed1975

The use of footprints in assessing the results of operations for hallux valgus. A comparison of Keller's operation and arthrodesis.

One hundred and seventy feet have been reviewed after operations for hallux valgus; eighty-five had had arthrodesis of the first metatarso-phalangeal joint and eighty-five had had Keller's operation. Footprints were made in order to assess the patterns of weight-bearing on the big toe and on the lesser metatarsal heads. After arthodesis the big toe bore weight in 80 per cent compared with 40 per cent after Keller's operation. The ability to bear weight on the big toe is related to the presence of metatarsalgia and excessive weight-bearing on the lesser metatarsal heads. These complicaitons were seen more commonly after Keller's operation (particularly when more than one-third of the phalanx had been excised) than after arthrodesis.

Arthrodesis↗
PubMedDate not supplied

Metatarsalgia in hallux valgus deformity: a pedographic analysis.

The purpose of this study was to analyze the plantar loading patterns in patients with hallux valgus (HV) with and without symptoms of metatarsalgia in order to find predictive pressure variabilities which are likely to result in metatarsalgia. Two groups of subjects (100 feet) volunteered for this study. Both groups provided the diagnosis of HV deformity. Group A (50 feet) exhibited a metatarsalgia symptomatology, whereas group B was asymptomatic. Plantar loading patterns were assessed using the two-step method and data were collected by the use of a capacitive pressure measurement platform. For each patient, 10 acceptable trials were collected. For the analysis, the foot was divided into six plantar regions: heel, midfoot, medial forefoot, lateral forefoot, medial toe, and lateral toe. Maximal peak pressure (PP, N/cm2), pressure-time integral (P/T integral, N/cm2*s), and force-time integral (%) were calculated. In group A, loading patterns (PP, P/T integral) of the lateral forefoot were significantly higher than in group B. The mediolateral pressure transfer from the big toe to the lateral metatarsal region was significantly greater in group A compared to group B. Regarding the lateral forefoot, a pressure time integral < 10 N/cm2*s was indicative of asymptomatic HV feet, whereas in symptomatic HV feet, a pressure time integral >28 N/cm2*s was observed. These results were statistically significant at the p < .01 level.

Biomechanical Phenomena↗
PubMedDate not supplied

Components of the Wilson osteotomy that are effective on hallux valgus repair.

Wilson osteotomy of the first metatarsal is a technically simple and reliable operation for the correction of the hallux valgus (HV) deformity. The major anatomic components of the osteotomy are the osteotomy angle and the distance of the osteotomy to the first metatarsophalangeal (MTP) joint. Lateralization of the first metatarsal head is the rationale for correction of the deformity. The main disadvantage of the technique is the considerable shortening of the first metatarsal. The relation between the amount of HV correction, first metatarsal shortening, and the anatomic parameters of the osteotomy was evaluated. Radiographs of 46 feet of 32 patients were retrospectively evaluated after an average follow-up period of 31.4 months. From the preoperative, early postoperative, and last control radiographs, the amount of HV correction, first metatarsal shortening, the osteotomy angle, the distance of the osteotomy to the first MTP joint, and lateralization of the first metatarsal head were measured. The presented study indicated that the osteotomy angle and the lateral displacement of the metatarsal head have a significant correlation with the amount of HV correction. Distance of the osteotomy to the first MTP joint has no relevance with the repair of the deformity. A positive linear correlation was present between the osteotomy angle and the first metatarsal shortening. Because the amount of first metatarsal shortening has significant influence over the clinical result, the main aim in a Wilson osteotomy should be maximum lateral displacement of the metatarsal head with a minimum osteotomy angle.

Adolescent↗
PubMed1994

Radiographic measurement of hallux valgus in the rheumatoid arthritic foot.

OBJECTIVE: To develop a method which is objective and quantifiable, as well as reliable and valid for measuring the severity and progression of hallux valgus deformity (HVD). HVD is defined as an increase in the hallux abductus angle (HAA). METHODS: HAA drawn on plain anterioposterior radiographs of the foot was measured in 94 patients with rheumatoid arthritis. The intra and interrater reliability were analyzed. RESULTS: Findings were significant with interclass correlation coefficients ranging from 0.9 to 0.99. Detection of changes in HAA using this method were comparable to the judgment of a panel of experienced clinicians. CONCLUSION: This method is useful in detecting progression of HVD.

Arthritis, Rheumatoid↗