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PubMedDate not supplied

A comparison between Chevron and Mitchell osteotomies for hallux valgus.

A retrospective study of 15 Mitchell and 15 Chevron osteotomies was undertaken in order to compare the efficacy of these two procedures in the correction of hallux valgus. Patient satisfaction, clinical findings, and roentgenographic measurements were all carefully evaluated after follow-up periods of 21 +/- 5 months for the Chevron and 34 +/- 8 months for the Mitchell procedures. Differences observed were a better correction of the angle between the first and second metatarsals by the Mitchell osteotomy (2.3 vs 5.5 degrees) and a tendency to loose the correction in the immediate postoperative period for the Chevron osteotomy. However, no clinical superiority could be demonstrated, nor did patient satisfaction differ in the two techniques. The authors conclude that these procedures give essentially equivalent results. Although the outcome was generally considered satisfactory by the patient, nearly 40% of both groups had metatarsalgia in the lateral rays, which stresses the importance of carefully considering load distribution across the foot in planning any corrective surgery.

Adult↗
PubMedDate not supplied

Power staple fixation in hallux valgus surgery: a preliminary report.

The authors describe a relatively new power staple device for foot surgery. Their preliminary review has been very favorable, as studied in 40 cases of hallux valgus repair. Their discussion includes the indications, contraindications, and potential for future use in the foot.

Hallux Valgus↗
PubMed2002

The first intermetatarsal angle in hallux valgus: an analysis of measurement reliability and the error involved.

In view of the importance placed on the first intermetatarsal angle in the assessment of surgical intervention in hallux valgus, we assessed the reliability with which one measures this angle. The study involved 10 observers of varying experience measuring the angle using a standard technique on 10 weightbearing AP X-rays of the foot on three separate occasions. The margin of error in measuring the angle was +/-3.60 degrees with a 95% confidence interval. Increasing and averaging the number of readings per observer or the readings of a number of observers, reduces the error. Experience doesn't improve reliability. In conclusion, improvement in the reliability of the measurements can be achieved by careful technique, performing the measurements at least twice, and averaging them.

Hallux Valgus↗
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↗
PubMed2005

Osteotomies for hallux valgus correction.

A variety of metatarsal osteotomies has been described since the first report by Gernet in 1836. Many of these osteotomies were abandoned throughout the years. Because one procedure is not capable of correcting all types of hallux valgus deformities, an algorithm, as a guideline, is preferable. This article presents a choice of metatarsal osteotomies for correction of hallux deformities based on clinical and biomechanical research.

Hallux Valgus↗
PubMed2006

Stimulating popliteal catheters for postoperative analgesia after hallux valgus repair.

Stimulating catheters have been recently introduced in clinical practice. We assessed the efficacy of stimulating and nonstimulating catheter placement for pain control and local anesthetic requirements after hallux valgus repair with continuous sciatic popliteal nerve block in this comparative, randomized, blinded-to-observer study of 48 patients. A stimulating catheter was placed in groups S-125 and S-0625. The same catheter was inserted without stimulation in group NS-125. An infusion of 0.125% levobupivacaine was given in groups S-125 and NS-125, whereas 0.0625% levobupivacaine was used in group S-0625. All patients received an infusion of the test drug at a basal rate of 3 mL/h, with the possibility of an additional bolus of 3 mL every hour. Verbal analog scale (VAS) scores for pain were assessed between 6-8 h and between 19-23 h postoperatively. Multiple attempts were required for catheter insertion in all patients in groups S-125 and S-0625. Lower median (range) VAS scores for pain (0-100 points) were found in group S-125 at 6-8 h postoperatively when compared with groups S-0625 and NS-125: 5 (0-17.5) versus 60 (15-80) and 70 (25-80), respectively (P < 0.05); and lower VAS scores for pain were also found in group S-125 at 19-23 h when compared with group NS-125: 0 (0-0) and 7.5 (0-10), respectively (P < 0.05). Fewer patients required IV opioid analgesia in group S-125 than in groups S-0625 and NS-125: 0, 5, and 7 patients, respectively (P < 0.05). We conclude that efficacy in pain control was increased with stimulating catheter placement.

Aged↗
PubMed1992

Juvenile hallux valgus. A conservative approach to treatment.

A conservative method consisting of use of a thermoplastic splint at night as well as passive and active exercises was used for the treatment of hallux valgus in fifty-six children and teen-agers who were between one month and sixteen years old. The splint was remodeled periodically. At the time of follow-up, which ranged from two to six years, the metatarsophalangeal joint angle or the intermetatarsal angle, or both, had improved in approximately half of the feet. No recurrences were detected among the patients who improved.

Adolescent↗
PubMed2003

Scarf osteotomy for hallux valgus repair: the dark side.

HYPOTHESIS/PURPOSE: The Scarf osteotomy has gained popularity as treatment of choice in parts of Europe and is based on sound structural principles. The excellent results reported by others could not, however, be reproduced by the author and the results are presented. METHODS: From January 1997 to June 1997 the Scarf osteotomy was selected in 20 consecutive patients (12 female and eight male patients, ages 18 to 60, mean: 41 years) with moderate metatarsus primus varus (IMA 13 to 20 degrees) and hallux valgus deformities (less than 40 degrees). The AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale, visual analog scale and patient satisfaction were monitored prior to surgery, six and 12 months post-op. The patients were treated in a short leg cast, non-WB for two weeks followed by four weeks partial WB in a cast shoe. Routine post-bunion rehabilitation followed once the radiological and clinical diagnosis of healing was made. RESULTS: Multiple complications were encountered. The most common was "troughing" of the metatarsal with loss of height. This occurred in seven patients (35%). Other complications include delayed union (5%), rotational malunion (30%), proximal fracture (10%), infection (5%) and early recurrence of deformity in 25%. All 20 patients were available for follow-up at six months, and 19 of 20 at 12 months. The AOFAS score pre-op was a mean of 53. At six months a mean of 54 (19 to 69) and at 12 months 62 (24-100). Forty-five percent (9/20) were unsatisfied at one year and would not recommend the surgery to a friend. CONCLUSIONS/SIGNIFICANCE: The Scarf osteotomy has multiple potential pitfalls and should probably be reserved for moderate bunions in young people with good bone quality. There are multiple potential problems and the salvage of a failed Scarf osteotomy is difficult.

Adolescent↗
PubMed1997

Proximal osteotomy in hallux valgus, long-term results of 167 operated feet. A retrospective study.

A total of 167 feet in 125 patients were treated with a proximal osteotomy of the first metatarsal for hallux valgus. In addition, in 115 feet a resection of the base of the proximal phalanx was conducted, and in 25 feet the head of some lesser metatarsal bone was resected. Eight years (range 5-10 years) postoperatively the patients were sent a questionnaire concerning the present state of their feet. In all, 105 patients (142 feet) replied, and 63% stated that they felt no pain in their feet at all. Indeed, 86% of the patients indicated that, everything considered, the operation was worthwhile. The most common complaint was the difficulty of finding shoes to fit; 22.5% of the patients stated that they had a hard time with this. The average preoperative metatarsophalangeal angle was 38 degrees, reduced by 22 degrees postoperatively. The average preoperative first intermetatarsal angle was 15 degrees, reduced by 5 degrees after the operation. In the statistical analysis, no correlation between the preoperative body mass index, the hallux angle, the first intermetatarsal angle, the reduction achieved in the above mentioned angles by the operation, and patient satisfaction was found.

Adult↗
PubMed2006

Stimulating or conventional perineural catheters after hallux valgus repair: a double-blind, pharmaco-economic evaluation.

BACKGROUND: We prospectively evaluated direct analgesia-related costs of continuous sciatic nerve block using either a stimulating or conventional catheter after hallux valgus repair. METHODS: The perineural catheter was inserted through a stimulating introducer either blindly (group Conventional, n= 38) or while stimulating via the catheter (group Stimulating, n= 38). Nerve block was induced with 25 ml of mepivacaine 15 mg/ml, and was followed 3 h later by a patient-controlled infusion of ropivacaine 2 mg/ml (basal infusion: 3 ml/h; incremental dose: 5 ml; lock-out time: 30 min). Rescue tramadol [100 mg intravenous (i.v.)] was given if required. Local anesthetic consumption, need for rescue tramadol and post-operative nausea and vomiting (PONV) treatment, and patient's satisfaction were recorded during first 24-h infusion. Cost calculations were based on the acquisition cost of drugs and devices. RESULTS: Both techniques were similarly effective, but local anesthetic consumption and need for rescue analgesics were lower in the Stimulating group [respectively, 120 vs. 153 ml (P= 0.004) and 21% vs. 60% (P= 0.001)]. The analgesia-related costs for 24 h were similar when 100-ml bags of ropivacaine 2 mg/ml were used (66 euro vs. 67 euro; P= 0.26). When 200-ml bags of ropivacaine were used, the analgesia-related costs were higher in the Stimulating group than the Conventional group (75 euro vs. 55 euro; P= 0.0005). CONCLUSIONS: Direct costs of continuous sciatic nerve block ranged from 55 to 75 euro. Stimulating catheters reduced local anesthetic consumption and need for rescue analgesics. This was only cost effective when 100-ml bags of 2 mg/ml ropivacaine were used, while the cheapest combination was the use of conventional catheters and 200-ml bags of ropivacaine.

Adult↗
PubMed1999

[Hallux valgus treated by Scarf osteotomy of the first metatarsus and the first phalanx associated with an adductor plasty. Apropos of 50 cases with a 2-year follow up].

PURPOSE OF THE STUDY: Fifty hallux-valgus were treated with Scarf Osteotomy of the first metatarsal, associated to a phalangeal varisation or shortening osteotomy and an adductor plasty. Patients were evaluated with a minimum follow-up of two years. MATERIAL AND METHODS: Forty five females and two males were operated with an average age of fifty years. The pre operative metatarsus varus was of 15 degrees 8. Mean alignment of metatarsal bar was 31 degrees 4. The cuneo-metatarsal joint was twenty two times spheric and twenty eight times plane. The average metatarso-phalangeal great toe valgus was 39 degrees 8. RESULTS: They were appreciated with a minimal follow-up of two years, according to the 3 Groulier's criteria: correction of deformation, statics troubles, functional activity. The metatarsus varus improved with an average of 10 degrees 4, as well as the alignment of the metatarsal bar (25 degrees). The post operative average phalangeal valgus was 22 degrees 7. These results were statistically significant. Cuneo-metatarsal joint type did not influenced final result. Articular joint line was normal in 64% of cases. Global result was excellent or good in 70%, passable in 22%, and bad in 8% of cases. DISCUSSION: Scarf Osteotomy of the first metatarsal allows complete correction of metatarsus varus. The surgical approach can be proposed at every age. There are no vascular trouble or arthrosis worsening. It must be completed with a phalangeal varisation or shortening osteotomy and adductor plasty.

Adolescent↗
PubMed1987

Late results after correction of hallux valgus deformity by basilar phalangeal osteotomy.

In a long-term follow-up study (average, 10.7 years) of 222 patients (351 feet), the results after proximal phalangeal osteotomy (the Akin procedure) for hallux valgus deformity were found to be unsatisfactory, both subjectively and objectively. The range of motion in the metatarsophalangeal joint was limited postoperatively in 90 per cent of the patients, and in 21 per cent there was recurrence of deformity. The appearance of the foot was poor in 75 per cent. Only 53 per cent of the patients expressed satisfaction with the result of the operation. There was a direct relationship between the development of subluxation or dislocation of the metatarsophalangeal joint and postoperative dissatisfaction of the patient. We concluded that the operation is biomechanically unsound because it does not address the principal mechanical factors that are responsible for the deformity: abnormal function of the adductor hallucis and the abnormal intermetatarsal angle. The Akin procedure is indicated only in combination with other operations that are designed to correct the two cited abnormalities.

Adolescent↗
PubMed2002

Hallux valgus in children: a 5-14-year follow-up study of 30 feet treated with a modified Mitchell osteotomy.

Between 1985 and 1995, 30 modified Mitchell osteotomies were performed in 18 children with hallux valgus, 12 bilateral and 6 unilateral. The mean age at surgery was 15 (10-18) years. The surgical modification consisted of diverging trapezoidal cuts, plantar displacement of the head, release of the lateral collateral ligament and the adductor insertion and Kirschner wire fixation of the osteotomy. At an average follow-up of 8 (5-14) years there were no nonunions, avascular necroses or recurrences. All the patients were satisfied with the cosmetic results, could use regular shoes and had no physical restrictions. Only 2 complained of occasional pain, thought to be secondary to transfer metatarsalgia. The presence of an open physis at the time of surgery did not affect the results.

Adolescent↗
PubMed2004

Postoperative immobilisation orthosis for surgically corrected hallux valgus.

A postoperative immobilisation orthosis was developed at the School of Physical Therapy and Rehabilitation, Department of Orthotics and Prosthetics, and applied from the first postoperative day as an alternative device for ambulation of patients who have undergone hallux valgus surgery while maintaining the corrected position. The orthosis is constructed with polyethylene thermoplastic sheet of 3mm thickness and Velcro. During the ambulation period, there was no complication or complaint due to its application and the position of the great toe was maintained. The time of the orthotic application was six weeks. The orthosis has allowed patients to walk with full weight bearing from the postoperative first day without any complication or recurrence.

Female↗
PubMed1978

[Avoidable surgical errors in hallux valgus surgery according to Brandes (author's transl)].

In postoperative follow-ups in a large number of patients who underwent Hallus valgus surgery according to Brandes, residual pain was found due to insufficient resection of the proximal phalanx. It is pointed out that the results of this frequent and beneficial Hallux valgus surgery can be improved by using a more subtile surgical technique. Figs. 1-5 show that errors continue to be made. If these errors can be avoided in the future this report will have fulfilled its purpose.

Hallux Valgus↗
PubMed1991

Day care surgery for the correction of hallux valgus.

This paper reports the experience of performing Wilson's osteotomy on a day care basis, and explores the potential and pragmatism of day surgery in orthopaedic practice. Fifty one patients (58 feet) were treated by a Wilson's osteotomy for the correction of hallux valgus. The results show an overall success with day care surgery and compare favourably with other series.

Adult↗
PubMed2006

A modified Hohmann method for hallux valgus and telescoping osteotomy for lesser toe deformities in patients with rheumatoid arthritis.

To preserve the function of metatarsophalangeal joints and to ensure forefoot stability in patients with rheumatoid arthritis (RA), we performed a modified Hohmann method for hallux valgus (HV) and telescoping osteotomy of lesser toe deformities instead of fusion of HV or resection of all metatarsal heads. From October 1995 through March 2001, 47 RA patients (90 feet) with severe HV and forefoot deformities were examined. The indication for the procedure in all the patients was disabling foot pain secondary to intractable plantar callosities below the lesser metatarsal heads, painful HV deformities, and the severe deviation of the sesamoid complex diagnosed by the basis of X-ray images. The HV and intermetatarsal (M1M2 and M1M5) angles and sesamoid complex were measured on the preoperative and postoperative roentgenograms. According to the results of a questionnaire survey, the patients were divided into three groups using the visual analogue scale; group 1: satisfied, group 2: fair and or no pain, group 3: dissatisfied. HV and M1M2 angles significantly improved compared between pre- and postoperative or preoperative and the follow-up periods. Out of the 47 patients, 78.9% were satisfied with the results of the operation and 8.9% were dissatisfied. Of these patients, 12.2% reported fair results. There were several complications, such as painful callosity, which was recurrent in seven feet, and delayed wound healing was observed in two out of 90 feet. A modified Hohmann method and abductor hallucis correction are effective in relieving pain and ensuring the bony union of the great toe in spite of severe osteoporosis.

Adult↗