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At least 415 records · Page 23Linked to original sources
PubMed2006

[Oral analgesia versus posterior tibial nerve block for postoperative pain in ambulatory open hallux valgus surgery: a randomized clinical trial].

INTRODUCTION: This trial assessed the safety and efficacy of a continuous posterior tibial nerve block in the ankle provided in the patient's home by elastomeric pump infusion of 0.375% ropivacaine after ambulatory hallux valgus surgery. MATERIAL AND METHODS: Patients were randomized to 2 groups of 20 each to receive either the conventional oral analgesia prescribed by our team after outpatient surgery (metamizole 575 mg/6 h p.o.) or perineural analgesia with a continuous infusion of 5 mL x h(-1) of 0.375% ropivacaine in the posterior tibial nerve. Surgery was performed under hyperbaric spinal anesthesia with mepivacaine and an injection of 0.25% bupivacaine into the joint. Both groups also received 50 mg/8 h p.o. of tramadol as rescue analgesia. Assessment during visits by the home care team 12, 24, and 48 hours after surgery included the following variables: pain on a visual analog scale (VAS, 0-10), sleep quality, need for rescue analgesia, acceptance of the technique, side effects and adverse events. Descriptive statistics were calculated and comparisons were performed with the Mann-Whitney U test; sleep quality and need for rescue analgesia were compared by applying the chi2 statistic with a test of linear trend. RESULTS: The perineural analgesia group had significantly lower VAS scores at 4, 12, and 24 hours and less need for rescue analgesia. No differences in sleep quality were found (P0.07). The incidence of side effects did not differ, and there were no readmissions. The patients expressed a high level of acceptance of the technique. CONCLUSION: Continuous perineural analgesia in the home setting was found to be effective and safe in our patients.

Ambulatory Surgical Procedures↗
PubMed1999

Cerclage fibreux in the treatment of hallux valgus.

Resection arthroplasty was performed in 62 feet, with follow-up at an average of 36 months (range, 17-68 months). All cases were performed using a combined cerclage fibreux. The mean age at operation was 61 years (range, 49-77 years). The mean score according to the hallux metatarsophalangeal-interphalangeal scale of the American Orthopaedic Foot and Ankle Society was 81 points (range, 25-100 points). Correction of the hallux valgus angle at follow-up averaged 23 degrees (range, 0-45 degrees). The first intermetatarsal angle had been corrected an average of 3 degrees (range, 0-14 degrees). Transfer metatarsalgia was encountered in eight patients. No hallux varus or cock-up deformity was detected.

Aged↗
PubMed1990

Keller's arthroplasty and Mitchell osteotomy: a comparison with first metatarsal osteotomy of the long-term results for hallux valgus deformity in the younger female.

We have made a retrospective comparison between the results of 37 Keller's arthroplasties and 36 distal transverse first metatarsal osteotomies performed in female patients between the ages of 25 and 50 years, for the treatment of hallux valgus. The choice of operation depended on the policy of the consultant responsible for treatment, but analysis of the preoperative findings showed that the two groups were similar, allowing comparative assessment of Keller's procedure in the younger middle-aged patient. All patients were assessed 3 to 5 years after operation using an objective scoring system of symptoms, clinical examination, anteroposterior standing radiographs and walking footprints from a Harris Beath mat. The results following a Keller's arthroplasty were excellent in 7 (19%), good in 22 (60%), poor in 6 (16%), and needed revision in 2 cases (5%). In the osteotomy group, 11 (30.5%) were excellent, 19 (52.5%) were good, 5 (14%) were poor, and 1 (3%) required revision.

Adult↗
PubMedDate not supplied

Three-dimensional reconstruction of magnetic resonance images of a displaced flexor hallucis longus tendon in hallux valgus.

By using three-dimensional magnetic resonance image reconstruction, lateral displacement of the flexor hallucis longus tendon and sesamoid bones was made clearly visible in a living patient. This finding supports a biomechanical model related to disturbed muscle balance at the first metatarsophalangeal joint, which could play an important role in the pathogenesis of hallux valgus and metatarsus primus varus.

Computer Simulation↗
PubMed1999

The effect of hallux valgus correction on chronic plantar ulceration. A case report.

Plantar pressure-measurement technology may provide the clinician with valuable objective information for monitoring the effects of therapeutic intervention on the foot. The use of this technology is described in the preoperative and postoperative assessment of a patient undergoing hallux valgus surgery for the treatment of a chronic neuropathic skin ulcer over the medioplantar aspect of her first metatarsophalangeal joint.

Aged↗
PubMedDate not supplied

The Mitchell and Scarf osteotomies for hallux valgus correction: a retrospective, comparative analysis using plantar pressures.

A retrospective analysis was performed to describe the effects of Mitchell and Scarf osteotomies on plantar pressure distribution and their relevance to the clinical outcome. This study evaluated 28 patients who underwent operations for moderate to severe hallux valgus deformities over a period of 3 years at 2 different centers. Twenty-two Mitchell and 22 Scarf osteotomies were performed on 28 patients with a mean follow-up of 23 months (13-62 months). The average postoperative American Orthopaedic Foot and Ankle Society scores after Mitchell and Scarf osteotomies were 74 and 84, respectively. A control group of 15 individuals with 20 healthy feet were included for comparison. The plantar pressures were documented with the Musgrave footplate. The pressure distributions under the first metatarsal head were within normal limits in both study groups compared with the control group (P = .77). After Mitchell osteotomies, deficient load bearing was noted under the hallux (P = .007), coupled with overloading of the second and third metatarsal heads (P = .01). But after the Scarf procedures, increased weight bearing was noted at the heel (P = .04) and midfoot (P = .09), with better load distribution under the hallux. However, it was not comparable with the control group. Correlation of American Orthopaedic Foot and Ankle Society scores and pressure variables demonstrated a significant positive correlation with hallux loading (P = .001). This study demonstrates that adequate hallux loading is imperative for a better outcome of the procedure. Mitchell and Scarf osteotomies do not restore the load-bearing function of the foot to normal, whereas hallux loading plays an important role for a better outcome of the procedure.

Adolescent↗
PubMed1989

Shaft osteotomies in hallux valgus reduction.

Osteoplasty of the first metatarsal is a form of "plastic surgery" of bone. It is technically demanding and requires a thorough knowledge of anatomy and morphology of bone. Direct dissection techniques are recommended rather than layering, which unnecessarily devascularizes the tissues. Understanding the principles of osteosynthesis and absolute stability is important and will allow the surgeon confidence in knowing that these operative procedures can be performed safely with a high degree of predictability in the correction. These procedures open a new area for consideration in the management of the hallux valgus deformity with intermediate IM angle deformities.

Hallux Valgus↗
PubMed1988

[So-called minimal intervention in hallux valgus].

A comparison between isolated removal of the pseudoexostosis (Schede) and the combined procedure of proximal transfer of the adductor tendon added to pseudoexostosis removal proved the importance of dissection of the adductor, but failed to demonstrate any advantage of the transfer and shortening of this muscle. Neither procedure improved the metatarsal angle permanently. The hallux valgus angle showed a strong tendency of recurrence after the Schede procedure. Both procedures produced a high rate of subjective satisfaction of over 90%, notwithstanding the objective results.

Bursitis↗
PubMed2005

Goniometric versus computerized angle measurement in assessing hallux valgus.

BACKGROUND: Digital workstations with high-resolution monitors are replacing standard radiographs for image evaluation and interpretation. Radiographic angles in the foot have been evaluated for interobserver and intraobserver reliability with plain films, but use of digital workstations has not been validated. Because the 1-2 intermetatarsal (IM) and hallux valgus (HV) angles help determine the most appropriate bunion procedure, the reliability of these measurements is important. METHODS: The HV and 1-2 IM angles were evaluated on preoperative radiographs of 25 patients who subsequently underwent bunion procedures. A standardized technique using a film marker and goniometer on plain film was compared with use of a mouse and computerized angle measurement software at a digital workstation. Three foot and ankle surgeons conducted these measurements at various intervals. Completion of three readings of each radiograph in each format by each observer totaled 1,800 measurements. RESULTS: Computerized measurement gave better overall reliability. For the HV angle, interobserver agreement (measurements within 2 degrees) improved from 66% with plain films to 81% with the digital workstation (p < 0.001). Intraobserver agreement increased from 72% to 80%. The 1-2 IM angle was similarly reliable with both methods for inter- and intraobserver agreement. CONCLUSIONS: This study validates the use of computer-assisted angle measurement on digital radiographs for assessment of HV and 1-2 IM angles. Computerized measurement may result in more reliable readings because it eliminates the error inherent with use of a goniometer and facilitates adjustment of radiographic lines on the computer to ensure correct alignment.

Diagnosis, Computer-Assisted↗
PubMed1992

Custom-molded orthotics in postoperative hallux valgus immobilization.

Bunion surgery is one of the most frequently performed operations on the foot. The majority of established procedures use some form of soft tissue manipulation with or without an osteotomy as the means of achieving correction. Long-term success depends on operative technique and adequate postoperative immunobilization. The authors describe a custom-molded thermoplast splint that effectively maintains hallux position in the healing phase of hallux valgus surgery. It is easy to construct, comfortable to wear, and has several advantages over other forms of immobilization.

Hallux Valgus↗
PubMed1995

Potential for recurrence of hallux valgus after a modified Hohmann osteotomy: a biomechanical analysis.

On the basis of a biomechanical model the present study investigates whether a foot-widening effect, which may result in recurrence of bunions, can be demonstrated in operated patients. Therefore, the medial deviation of the first metatarsal head as a result of flexion forces on the hallux was measured in eight patients with clinical idiopathic hallux valgus, who underwent a modified Hohmann osteotomy, and in eight "normal" persons. We found that (1) before osteotomy, all forefeet broadened while pressing the big toe downward, and (2) after surgery, widening of the forefeet on average had significantly diminished, but still existed, which might explain the development of recurrences. (3) After surgery, the patients showed a slight, but statistically nonsignificant, decrease (from 37 N to 25 N) of the isometrically determined average maximal applicable flexion force. These abnormal hallux loads may cause, or result from, a deviation in gait pattern.

Adult↗
PubMedDate not supplied

Metatarsocuneiform arthrodesis for management of hallux valgus and metatarsus primus varus.

Sixty-seven closing wedge arthrodesis procedures of the first metatarsocuneiform joint were performed in 41 females and 12 males. Follow-up averaged 28 months (range 16-49 months) and was performed in 51 of 53 patients with a questionnaire, clinical examination, and comparison of pre- and postoperative weightbearing radiographs. The average hallux valgus angle was 34.5 degrees (range 20 degrees-75 degrees) and was corrected to 13.0 degrees (range-10 degrees-22 degrees) postoperatively. The average intermetatarsal angle was 14.3 degrees (range 9.5 degrees-34 degrees) and was corrected to an average of 5.8 degrees (range 0 degrees-12 degrees) postoperatively. Complications included seven superficial pin tract infections, three symptomatic dorsal bunions, one of which required repeat surgery, seven nonunions, one of which was symptomatic, one hallux varus, and three neuromas of the deep peroneal nerve. The range of motion of the hallux metatarsophalangeal joint was 85% of normal postoperatively. A total of 77% of the patients were totally relieved, 15% partially relieved, and 8% not relieved with respect to pain, comfort, appearance of the foot, and shoewear following surgery. The specific indications for performing this operation are discussed.

Adolescent↗