Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “HALLUX VALGUS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 451 records · Page 25Linked to original sources
PubMed1975

The Mitchell distal metatarsal osteotomy in the treatment of hallux valgus.

Many of the fair and poor results are directly traceable to errors in technique. Patient selection is also important. The operation can be done in adolescents since there is no growth plate at the distal end of the first metatarsal. We do not currently recommend this procedure for those over 60, for those with first metatarsophalangeal osteoarthritis or hallux rigidus or for those with moderate or severe rheumatoid arthritis. For these patients we usually do a Keller excisional arthroplasty. Our use of the osteotomy-bunionectomy operation for the patient with hallux valgus with an associated metatarsalgia or short first metatarsal has now become more cautious. We feel that the operation is not indicated for those with significant preoperative metatarsalgia, especially if the first metatarsal is shorter than the second, or for those whose first metatarsal is more than 4 or 5 millimeters shorter than the second, regardless of preoperative metatarsalgia. In these patients a McBride procedure or a proximal opening-wedge osteotomy is done.

Adolescent↗
PubMedDate not supplied

Fixation of the chevron osteotomy with an absorbable copolymer pin for treatment of hallux valgus deformity.

This study investigated the use of a bioabsorbable pin made of an oriented poly-L-lactic acid/polyglycolic acid (82:18 ratio) copolymer to fix distal chevron osteotomies in 15 patients (18 feet), with an average follow-up of 18 months. This material absorbs faster than poly-L-lactic acid and slower than poly-p-dioxanone, 2 bioabsorbable polymers that have a clinical history in fixation of distal chevron osteotomies. The average intermetatarsal angle significantly decreased from 11.9+/-1.7 degrees to 0.9+/-3.8 degrees (P < .001) while the average hallux valgus angle significantly decreased from 19.4+/-4.7 degrees to 6.2+/-6.4 degrees (P < .001). The preoperative American Orthopaedic Foot and Ankle Society's hallux-metatarsophalangeal-interphalangeal score averaged 44.6+/-15.1, which increased significantly to 87.4+/-14.9 (P < .001) postoperatively. In 1 procedure, a giant cell granuloma developed that was treated with debridement. Overall, these results were comparable to those derived from the use of other methods of fixation used for bunionectomies.

Absorbable Implants↗
PubMedDate not supplied

Traumatic hallux valgus following rupture of the medial collateral ligament of the first metatarsophalangeal joint: a case report.

Metatarsophalangealjoint injuries of the great toe are receiving increasing attention in athletes. Significant disability and long-term morbidity can result from these focal injuries. The entity known as turf-toe is widely recognized. Rupture of the medial collateral ligament of the first metatarsophalangeal joint is less common. A case of traumatic rupture of the medial collateral ligament in the great toe of a soccer player, which progressed to hallux valgus deformity, is presented.

Adolescent↗
PubMedDate not supplied

[Significance of transverse forefoot stabilization in the treatment of hallux valgus. Comparative study of clinical/radiologic short-term results].

72 feet of 56 patients were treated by Brandes operation, modified by using a distally attached capsular-periosteal flap from 1984 till 1986 at the Orthopedic Clinic of the University of Vienna. On 41 of these feet an additional cerclage fibreuse according to Lelievre was done. This group had a significantly better correction of the hallux valgus angle with 17 degrees as compared to 8 degrees in the group without cerclage fibreuse. The correction of the intermetatarsal angle was also significantly better with 5 degrees as compared to 1 degree. Only through cerclage fibreuse was it possible to stabilize the sesamoids in the transversal as well as in the longitudinal direction. We found no improvement of subjective well-feeling after the cerclage fibreuse, but a significantly better correction and mobility in the metatarsal-sesamoid joint and the metatarsal-phalangeal joint.

Adult↗
PubMed1989

Hallux valgus and metatarsus adductus: the surgical dilemma.

Hallux varus in the presence of metatarsus adductus is a complex clinical entity that requires careful evaluation and preoperative planning. The metatarsus adductus complicates the picture by accentuating the effect of the intermetatarsal angle and also creates compensatory pronation. Transpositional osteotomies of the first metatarsal are difficult to perform in patients with an adducted forefoot and mild increase in intermetatarsal angle. Surgical therapy generally requires aggressive osteotomies of the first ray to decrease its medial prominence. Total metatarsus adductus correction should be considered in patients with severe deformity.

Child↗
PubMed1989

Wilson's osteotomy for the treatment of hallux valgus.

One hundred oblique distal first metatarsal osteotomies (Wilson's) were reviewed at an average of five years and two months following surgery. In 96 feet there was pain over the bunion or first metatarsophalangeal joint preoperatively. This pain was eliminated in 85 feet and improved in nine feet. Second metatarsalgia present preoperatively was relieved in five of seven feet, but 19 feet developed second metatarsalgia following surgery. The majority of patients were pleased with the outcome of the surgery. No significant complications were noted. The surgical technique of Wilson's first metatarsal osteotomy for hallux valgus is straight-forward and produces a predictably excellent result.

Adolescent↗
PubMed1999

[The long-term result of implant arthroplasty for hallux valgus deformity in rheumatoid arthritis].

We have reviewed the results of reconstruction of the forefoot in rheumatoid patients with arthroplasty using a Swanson flexible hinge toe implant for the great toe and with resection arthroplasty for the lateral four toes. The follow-up averaged 8 years (range, 5-11 years). All patients were female and an average age was 52 (range, 31-72 years). Preoperative and postoperative hallux valgus angle (HVA), the angles between the axes of the first and second metatarsal shafts (M1-M2) and the first and fifth metatarsal shafts (M1-M5) were measured radiographically. Breakage of the implant and radiolucencies around the implant on X-ray were evaluated. Preoperative average HVA, M1-M2 and M1-M5 were 31, 10, and 30 respectively. Postoperative average HVA, M1-M2, and M1-M5 were 17, 10, and 28 respectively. Breakage of the implant was present in 77% of the feet and the radiolucencies around the implant was present in 63% of the feet. Although only one foot was performed revision surgery for severe pain and breakage of the implant, more than 95% of the feet obtained pain relief. We found that this type of operation was very effective in relieving pain in rheumatoid patients.

Adult↗
PubMed2005

[Popliteal fossa sciatic nerve block for ambulatory hallux valgus surgery: comparison of lateral and posterior approaches].

OBJECTIVE: The aim of this study was to assess the efficacy, effectiveness, technical difficulty, and clinical usefulness of the popliteal sciatic peripheral nerve block for unilateral hallus valgux surgery and to compare the posterior and lateral approaches. We also aimed to investigate patient comfort during the procedure. MATERIALS AND METHODS: This prospective, randomized trial enrolled 60 patients scheduled for unilateral hallux valgus surgery. The patients were randomly assigned to groups of 30 patients to receive a nerve block by either a posterior or lateral approach. A nerve stimulator was used to locate the response of the two branches forming the sciatic nerve--the posterior tibial nerve and the common peroneal nerve. Then, 20 mL of 0.5% ropivacaine was injected for each nerve. Variables analyzed were efficacy, complications, quality and duration of postoperative analgesia, degree of comfort while the technique was being performed, and level of satisfaction. RESULTS: The level of comfort was good for 19 patients (70%) in the posterior approach group and for 29 (97%) in the lateral approach group (P<0.05). Level of satisfaction was good or very good for 93% and 96% of the patients in the posterior and lateral approach groups, respectively. Block efficacy was excellent for 48 patients (80%), good for 9 (15%), and poor for 3 (5%), with no significant differences between the groups. CONCLUSION: Both the posterior and lateral approaches provide easy access to the sciatic nerve for performing a block. The rate of success is high and postoperative analgesia is good, with no noteworthy complications. However, the lateral approach is more comfortable for the patient.

Adult↗
PubMed1993

Radiographic features that enable assessment of first metatarsal rotation: the role of pronation in hallux valgus.

This study describes a method of detecting first metatarsal pronation on the basis of the movement of the inferior tuberosity of the base of 20 cadaveric first metatarsals at 0 degrees, 10 degrees, 20 degrees and 30 degrees pronation. On pronation, the inferior tuberosity of the base of the first metatarsal moved lateral to the mid-line axis. At 10 degrees, the tuberosity pointed to the junction of the inner third and outer two-thirds of a line between the midpoint and lateral tubercle of the base. At 20 degrees, it pointed to the junction of the inner two-thirds and outer third of that line. At 30 degrees, it pointed to the outer margin of the lateral third. Using these features, the amount of first metatarsal pronation in 100 consecutive weight-bearing views of feet was recorded and plotted against the corresponding intermetatarsal angles in those feet. Four of 43 patients with an intermetatarsal angle of less than 9 degrees had pronation greater than 10 degrees, 48 of 57 patients with an intermetatarsal angle greater than 9 degrees had pronation greater than 10 degrees (P < 0.001). As intermetatarsal angles increase, the amount of first metatarsal pronation increases (r = 0.69). Pronation and varus deviation of the first metatarsal are linked; both alter the tendon balance maintaining proximal phalanx alignment and lead to the development of hallux valgus.

Hallux Valgus↗
PubMed2006

Mitchell and Wilson metatarsal osteotomies for the treatment of hallux valgus: comparison of outcomes two decades after the surgery.

BACKGROUND: At short-term followup, the Mitchell osteotomy appears to provide more symptomatic improvement than the Wilson osteotomy. We compared the outcomes of the two procedures two decades after the surgeries. METHODS: In a two-center retrospective study, 30 patients (35 feet) who had Mitchell osteotomies and 28 patients (35 feet) who had Wilson osteotomies were evaluated 20 to 22 years after surgery for correction of the hallux valgus angle (HVA) and intermetatarsal (IMA) angle, changes in the shortening of the first metatarsal and improvement in the overall status (a composite radiographic and clinical outcome according to Bonney and McNab). RESULTS: With adjustment for the preoperative values and surgical center (analysis of covariance), the HVA (degrees) had a higher correction in the Mitchell group (p = 0.075), while IMA was comparably corrected by the two methods. Shortening of the first metatarsal was greater in the Wilson group (Mitchell-Wilson = -1.93, 95% CI -2.69 to -1.17, p < 0.001). Before the surgery, overall status was graded "poor" or "good" in all feet (28/7 Mitchell, 29/6 Wilson). After the surgery, the status was graded "excellent" or "good" (29/6) in the Mitchell group, and "excellent," "good" or "poor" (25/7/3) in the Wilson group. The status was improved by at least one grade-level in all 35 feet in the Mitchell group and in 31 of 35 feet in the Wilson group. With stratification for the preoperative status, the proportion of "improvements" was higher in the Mitchell group (Mitchell-Wilson = 11.1%, 95% CI 0.7 to 21.5%, p = 0.036). In an alternative analysis (logistic regression), with adjustment for the preoperative status, center, and IMA values, the Mitchell method also appeared superior in this outcome (likelihood ratio test p = 0.021). CONCLUSIONS: As assessed 20 to 22 years after the surgery, the Mitchell osteotomy resulted in less shortening of the first metatarsal in a somewhat greater proportion of feet with an improved overall status than the Wilson method.

Adolescent↗
PubMed1994

Chevron osteotomy for hallux valgus not improved by additional adductor tenotomy. A prospective, randomized study of 84 patients.

We investigated 106 feet in 84 patients in a prospective randomized series where the clinical and radiographic results of the original chevron osteotomy were compared to the same procedure with the addition of an adductor tenotomy in patients averaging 47 years of age and with a mean follow-up of 3 years. Clinically there was no difference in the satisfaction rate of the two groups, with 58 satisfied and partially satisfied in the 62 operated by chevron osteotomy alone, and 42 of 44 in the group where adductor tenotomy was added. The hallux valgus angle decreased by 7.5 degrees in the group operated with chevron osteotomy and by 9.8 degrees (P 0.04) when an adductor tenotomy was added. The major objective factor affecting satisfaction was the attainment of a decreased ball circumference, shown by the fact that dissatisfied patients had a greater postoperative ball circumference than both satisfied and partially satisfied patients, whereas there were no radiographic correlations to satisfaction. We cannot recommend adding adductor tenotomy to the chevron osteotomy.

Adolescent↗
PubMed1993

[Mitchell's osteotomy in the treatment of hallux valgus].

Ninety-one (91) Mitchell osteotomies on 63 patients (60 females and 3 males) were reviewed. The average follow-up was 40 months (min. 12, max. 70). The average age at the time of the surgery was 51 years (min. 20, max. 74). The presence of a apinful bunion justified the surgery in a majority of cases (92%). The clinical evaluation was done by an independent observer. Weight bearing X-rays of the feet were made in each case. The results show a satisfactory improvement of the pain in 92% of the cases. The patients were satisfied with the appearance of their foot in 93% of the cases. The average active articular range of motion was 47 degrees (min. 20 degrees, max. 120 degrees). The Das De scale showed 75% of excellent and good results. Twelve per cent (12%) of the patients presented residual metatarsalgia. We observed minor complications in 10 cases (11%). We report no cases of avascular necrosis, pseudarthrosis or infection. Clinico-radiological correlations were made. We obtained an average correction of 13 degrees (min. -5 degrees, max. 28 degrees) of the hallux valgus and 3.5 degrees (min. -7 degrees, max. 7 degrees) of the intermetatarsal angle. We recommend the Mitchell osteotomy as long as the indication criterias and the surgical technique are respected.

Adult↗
PubMed2002

[Personal experience with the basal wedge closed osteotomy of the first metatarsus in hallux valgus].

PURPOSE OF THE STUDY: The authors present their philosophy of the surgical treatment of metatarsus primus varus by oblique basal closed osteotomy of 1st metatarsal, evaluate and generalize the results achieved also with regard to the age of patients. MATERIAL: The evaluation covers a group of patients operated on for the mentioned static defect since 1995 with a minimal interval of 12 months after the surgery. From this general group a subgroup has been subsequently singled out of children and adolescents up to the age of 18. The general group included 24 patients in which 31 surgeries were performed. The subgroup of children and adolescents comprised 10 patients in which the surgery was performed in 12 feet. METHODS: Monitored in both group was age, sex, osteotomy laterality, the presence of distal operation. Post-operative monitoring focussed on the following data: the time interval after the operation, subjective satisfaction, range of motion of Ist metatarsophalangeal joint, the incidence of complications. Evaluation covered post-operative correction of individual angles and the shortening of Ist metatarsal by comparison of pre- and post-operative radiograph. RESULTS: Evaluated in the whole group were 22 patients, in the group of children and adolescents 8 patients, with average time interval of 3 years after the operation. On the basis of the surgery average correction of intermetatarsal angle by 10.5 degrees was achieved in both groups, average correction of valgosity by 18 degrees in the basic group and by 10 degrees in the group of adolescents. DISCUSSION: The results are evaluated globally on the basis of specialized literature. The authors present their philosophy of the solution of the issues of metatarsus primus varus as a static defect by different surgical techniques, formulate a clear strategy of the use of distal surgery and discuss its efficiency in relation to the patient's age. CONCLUSION: Oblique basal closed osteotomy of Ist metatarsal within a comprehensive solution of the static defect of hallux valgus is recommended to the broad orthopaedic public as a surgery which in view of the authors can bring good results in children and adolescents. In adults they recommend to indicate this surgery in the mentioned cases in combination with a distal operation.

Adolescent↗