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A series of 39 surgeries for hallux valgus has been analyzed. All cases had deformity exceeding 40 degrees (mean 61 degrees). Metatarsal I osteotomy has been supplemented with soft tissue reconstruction. McBride reconstruction and second toe extensors transfer were done in 32 cases; the best results were achieved in this group of patients.
Authors present own experience after use surgical correction technique in order to heal the complex hallux valgus deformity. In period 1999-2002 we used this technique on 5 patients (4 females, 1 male) with 6 surgical procedures (1 female had bilateral treatment). Indications for surgical treatment were functional problems and x-ray angle between the first and second metatarsals as well as valgus angle of the first metatarsophalangeal joint which were much higher. Pre-surgical, possibility of correction angle was exact by x-ray planing. The same examination was done after surgical treatment. After surgical care and rehabilitation program all patients had well biomechanical foot relation and they had not previous functional problems.
At the University of Vienna Department of Orthopaedics, 26 feet in 21 patients were treated with a basal osteotomy for hallux valgus associated with metatarsus primus varus. In 85% of the cases, a satisfactory result was achieved. Critical analysis revealed shortening of the first metatarsal and elevation of its head, which resulted in excess lateral straining of the foot and metatarsalgia. In 15 cases, osteoarthritis in the metatarsocuneiform joint was also increased. Given these results, an osteotomy that prevents shortening of the first metatarsal and elevation of the head of the first metatarsal, or one that takes these facts into account, seems ideal.
This article is a retrospective study comparing the efficacy of Regnauld arthroplasty to first ray osteotomies for the treatment of hallux valgus. One hundred consecutive cases of Regnauld arthroplasties were compared with 100 consecutive first ray osteotomies. One hundred fourty-one patients were available for follow-up, and based on clinical/radiographic examinations, 72 were treated with the osteotomy protocol (group A) and 69 with Regnauld arthroplasty (group B). Age at surgery, clinical symptoms, and preoperative radiologic findings were similar for the 2 groups; there was a preponderance of female patients (90%). The average follow-up was 49 months in group A and 51 months in group B. Clinical evaluation showed in the osteotomy group a more stable correction (79% v 49%), greater pain reduction (measured in a visual analog scale from 0 = pain free to 10 = deep intolerable pain), increased residual articular excursion of the first metatarsophalangeal joint (27 degrees of active dorsiflexion from neutral position v 8 degrees ), and less presence of central metatarsalgia (15% v 34%) (P <.05). The radiographic evaluation expressed more stable correction values in group A for the following parameters: joint preservation, sesamoid position, intermetatarsal angle (7 degrees v 12 degrees ), abduction angle of the hallux (14 degrees v 20 degrees ), and proximal articular set angle (8 degrees v 18 degrees ) (P <.05).
Between 1 October 1997 and 1 November 1998, 43 patients (59 feet) were treated with a standard Mitchell's osteotomy for hallux valgus. Of these, 26 patients (36 feet) were treated postoperatively in a forefoot plaster. The other 17 patients (23 feet) were treated with a wooden soled shoe. There was no significant difference between the 2 groups for age, indication for surgery, pre-operative deformity or grade of the operating surgeon. There was no significant difference in the mean time immobilised, mean time to union or complications. The patients were interviewed by telephone after a mean follow-up of 9.4 months. There was no significant difference in results between the 2 groups. This suggests that a forefoot plaster following Mitchell's osteotomy is unnecessary. Postoperative mobilisation in a wooden soled shoe can be used as an alternative.
Between December 1996 and February 1999, 197 operations for the correction of hallux valgus by the percutaneous technique of Bösch were performed in 156 patients (41 bilateral) at the Cardinal G. Panico Hospital (Tricase, Italy). Most operations were performed using local anesthesia. Unsupported weight bearing was nearly always allowed on the first postoperative day and a simple functional bandage was used for six weeks. One hundred forty three patients (39 bilateral) were available for follow-up evaluation (182 feet) at an average follow-up of 16.4 months. Clinical results and radiographic evaluation of these patients showed that 89% were fully satisfied with their result. Thus, it appears that the distal osteotomy of the first metatarsal using the technique of Bösch, combined, if necessary, with other procedures on the lateral metatarsals, is a satisfactory operation. Important features of this procedure include short operating time, low incidence of complications, and high patient compliance.
From 1988 to 1995, 96 patients (161 feet) underwent a modified Mitchell distal metatarsal osteotomy performed for mild-to-moderate hallux valgus. On AP x-rays of the standing foot, the average intermetatarsal angle was corrected from 15 degrees to 9 degrees, and the first metatarsophalangeal angles were corrected from an average of 41 degrees to 15 degrees. Criteria for evaluation of clinical results included relief of pain, appearance of foot, and shoe wear. After an average follow-up of 38 months, the overall satisfaction rate was 92.5%. Complications included 13 pin tract infections, two delayed unions, and two correction losses. The most common late sequela was transfer metatarsalgia of the lesser toes, which occurred in 20 feet (12.4%), leading to some dissatisfaction. The Mitchell osteotomy can be used on cases with less than 20 degrees of intermetatarsal angle, offering a stable construct with easy postoperative care.
Thirty patients who had had a total of fifty-one Mitchell procedures to correct adolescent hallux valgus deformities were examined clinically and radiographically an average of seven years (range, three to seventeen years) after the operation. The average age of the patients at the time of the operation was fifteen years (range, ten to nineteen years). The result was excellent in nineteen feet, good in sixteen, fair in six, and poor in ten. The fair and poor results were associated with recurrence of the deformity, stiffness (real or perceived), and unsightly scars. The cause of the fair and poor results was inadequate correction at the time of the operation in six feet and loss of fixation in two; the loss of fixation resulted in one recurrence and one malunion. The remaining eight patients who had a fair or poor result were not totally satisfied and had reservations about more than one of three categories (relief of discomfort, appearance, or range of motion). Seventeen feet had a plantar callosity beneath the second metatarsal head, suggesting increased load-bearing by the second metatarsal. Although sixteen callosities caused no symptoms at the most recent follow-up evaluation, the long-term implications of this altered pattern of weight-bearing are unknown.
A prospective trial is reported which compares distal osteotomy of the first metatarsal with Keller's arthroplasty in the treatment of adult hallux valgus. A total of 33 patients attended for review at least three years after operation. Symptomatic improvement, as assessed by patient satisfaction, pain relief, cosmetic improvement and restoration of function, was similar in the two groups. Objective measurement showed that the range of movement of the metatarsophalangeal joint was better maintained after osteotomy, as was the relationship of the sesamoid bones to the head of the first metatarsal. Correction of the valgus deformity also was significantly better in the patients who underwent osteotomy and in these patients the first intermetatarsal angle was reduced to within normal limits. There was no evidence that initial degenerative changes or subluxation at the metatarsophalangeal joint compromised a successful result from osteotomy.
PURPOSE OF THE STUDY: The aim of this study was to analyze the results of surgical treatment of hallux valgus using scarf osteotomy in children and adolescents. MATERIAL AND METHOD: Twelve children and adolescents (19 feet) operated on with scarf osteotomy were reviewed retrospectively with a mean follow-up of 15 months. Clinical and radiographic results were assessed. RESULTS: We obtained 10 good results (asymptomatic cases), 9 poor with residual symptoms such as pain or cosmetic problems. Two populations could be identified considering the metatarsus varus and distal metatarsal angle. Those with metatarsus varus >/= 10 degrees or normal distal metatarsal angle had good results. Those without metatarsus varus had poor results. There was no disturbance of growth. DISCUSSION: Scarf osteotomy can be used in children without risk of hindering growth. Nevertheless, good results can be achieved only in cases of true metatarsus varus and normal distal metatarsal angle. In other cases, a different osteotomy of the first metatarsal would be preferable.
In a five-year period, 153 feet in 101 patients were treated by a Wilson's osteotomy of the first metatarsal for hallux valgus. Postoperative support was provided by either a below-knee or a forefoot plaster, and was continued for either three weeks or six weeks. The results showed overall success in 91% with no significant difference between the four groups. We suggest that a forefoot plaster for three weeks is adequate support after a Wilson's osteotomy.
In a retrospective study we compared the results of 31 Wilson and 31 Hohmann osteotomies of the first metatarsal in the treatment of hallux valgus. There were no differences between the two operations in terms of patient satisfaction, pain relief, appearance, footwear and walking ability. First metatarsal shortening was the same after both operations, and the degree of shortening was unrelated to either the clinical or the pedobarographic findings. Although the long-term radiographic changes after the Hohmann osteotomy were more worrying, the pedobarographic patterns tended to be worse after the Wilson osteotomy. There were no poor results and the numbers of feet with the same final grade were identical in each group. However, there was abnormal loading of the lateral metatarsal heads after both osteotomies when compared with the normal foot, and hallux-contact time during the stance phase was also significantly reduced after osteotomy.
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The position of the first metatarsal following a crescentic osteotomy for hallux valgus is a function of the size of the saw cut and orientation of the osteotomy. This study reports the effect of these variables, recommended technique, and potential pitfalls when using the crescent osteotomy. Using molded polyurethane foam metatarsals and a precision drill press which controlled the saw cuts, the following variables were studied: (1) orientation of the saw cut to the metatarsal, (2) the saw size (diameter of the saw relative to the shaft width of the osteotomy site), and (3) the direction toward which the crescent faces (proximal/distal). Best correction can be obtained if the saw diameter is larger than the diameter of the osteotomy site (allowing a greater degree of correction before impingement), the saw tip is tilted slightly toward the sesamoids (which ensures that the metatarsal does not rotate medially with correction), and the saw is rotated laterally to cause slight declination of the toe.
This study reports an analysis of a series of 316 cases of hallux valgus treated by a method derived from McBride's operation with some modifications and combined with bony procedures designed to correct abnormalities of bony architecture, in particular osteotomy to shorten an excessively long proximal phalanx. Two hundred feet were reviewed with a follow-up between 1 and 13 years. The results, which were satisfactory in 80 per cent of cases, were analysed according to the usual parameters of pain and deformity in relation to the pre-operative findings and the surgical methods used. The failures and complications were analysed. The results of this study makes it possible to determine the indications for and to appreciate the value and advisability of technical modifications.
The authors compared the long term follow-up (mean duration 19 years) of 96 patients operated on for hallux valgus, 52 by the McBride procedure, 46 by a Hohmann procedure. Clinical results considered 4 criteria: deformity, pain, mobility and satisfaction. Dorsoplantar weight bearing X-ray compared anatomical results. This study showed that patients were subjectively more satisfied after McBride operation (p = 0.0001) even if the deformity was radiologically better reduced by osteotomy (p = 0.006). This discrepancy between subjective and radiologic results was related to the fact that X-rays represent only the static morphologic reflect of a more complex pathologic entity: radiology can only partly explain the functional discomfort of the patients. The modified McBride procedure was better suited to patients presenting a painful HV. Osteotomy was more suited to bunions causing little pain. Indications for each of these procedures should be based more on patient's history and clinical examination than on X-rays.
This study reviewed the subjective, clinical and radiological outcome of 71 patients (84 feet) treated by scarf osteotomy for hallux valgus deformity at our institution from 1995 to 1998 with an average follow-up time of 22 months (range, 17 to 48 months). At the time of follow-up, 39% of the patients were very satisfied, 50% were satisfied and 11% were not satisfied. The mean AOFAS score raised significantly from 43 points (14-68) preoperatively to 82 points (39 to 100) at follow-up (p < 0.001). The radiological angles including M1-M2, M1-P1, M1-M5 and DMAA improved significantly (p < 0.001). Among the 16 complications recorded, seven (8%) were minor and nine (11%) required an additional procedure. The scarf osteotomy of the first metatarsal coupled with a lateral soft-tissue release and, in three-quarters of our cases, with a basal closing wedge varisation osteotomy of the first phalanx, resulted in overall high satisfaction rate as well as significant clinical and radiological improvements in our series. Nevertheless, the range of motion of the first MP joint remained low: 30 degrees to 74 degrees in 52 patients (62%) and <30 degrees in four patients (5%). Furthermore, the mobility of the first ray as well as the consequences of the procedure in the sagittal plane need to be assessed more accurately, and this may be achieved by incorporating measurement of the plantar pressures in the forefoot area into the global rating system.