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PubMedDate not supplied

Stress fractures of the lesser metatarsals after a Wilson osteotomy for correction of hallux valgus deformity.

This article describes a patient with lesser-metatarsal stress fractures resulting from an oblique Wilson displacement first metatarsal osteotomy. The shortening of the first metatarsal forces the lesser metatarsals to bear the weight previously borne by the first ray and increases the compression stress on the adjacent metatarsal heads. The proximal displacement of the osteotomy must be minimized in order to limit the risk of stress fracture of the lesser metatarsals.

Female↗
PubMed1997

Combination chevron plus Akin osteotomy for hallux valgus: should age be a limiting factor?

Current literature consistently precludes the chevron osteotomy for bunion correction in patients older than age 50 years. We retrospectively reviewed 47 patients (73 bunions) with an average age of 62 years (range, 55-81 years old) who had a chevron-Akin double osteotomy. The mean follow-up was 4 years, 6 months (range, 2 years, 3 months to 8 years, 2 months). The overall satisfaction rate was 95%. No significant pain or stiffness in the first metatarsophalangeal joint occurred in comparison with other bunion procedures. Radiographic results were better for patients with a preoperative intermetatarsal angle of less than 15 degrees and tibial sesamoid position of less than or equal to 2. We disagree with the current recommendation that age older than 50 years is a contraindication to a chevron procedure. The Akin osteotomy adds additional intraoperative correction of the hallux angulation and rotation; thus, the chevron-Akin double osteotomy is a useful combination procedure. We recommend this procedure for the mild to moderate bunion deformity even in elderly patients.

Age Factors↗
PubMed1994

[Short-term results in hallux valgus surgery using a V-shaped osteotomy of the first metatarsal head].

At the Orthopaedic Department of the hospital in Zwettl between January 1988 and August 1990 a total of 35 operations according to Austin were made. The group comprised 33 patients, 30 women and 3 men. The follow-up period was 7 to 38 months, on average 23.4 months. In 24 instances the operation was performed on the right, in 11 instances on the left foot. Indications, surgical technique and results are discussed in detail.

Female↗
PubMed1993

[Corrective possibilities by subcapital metatarsal osteotomy in the management of hallux valgus and metatarsus primus valgus].

The extent of correction achievable by inclined subcapital osteotomy of the metatarsus I. was studied in 100 cases of the deformation. The different angular values and dimensions were compared in the X-ray plates taken pre- and postoperatively and the clinical changes of the patients were evaluated on the basis of subjective complaints and objective symptoms. The angular limit values of the performability of osteotomy were determined. In deformations larger than the limit values wedge and half-wedge osteotomy, basisosteotomy, respectively, are the expedient methods.

Age Factors↗
PubMed1987

Gait analysis before and after osteotomy for hallux valgus.

Twenty-one female patients with bunions were treated by Mitchell osteotomy. Nineteen had clinically excellent or good results. This included no pain on walking, normal ambulation, and improved appearance. Two patients were dissatisfied. By using an instrumented treadmill the gait function was tested before and a median of 6 1/2 months after operation. No significant improvements or losses were found in a large series of gait parameters. The benefits of operation were not due to an improved gait function and other factors must have influenced the final result.

Adult↗
PubMed1991

[Possibilities of therapy of hallux valgus et rigidus in a private hospital (Swanson great toe implant)].

In 1983 we decided to use Swanson's great toe implants in selected cases after previous clinical examinations and X-ray tests, especially the stemmed or the stemmed hinge great toe implant based on Swanson/Weil and the Swanson silastic HP double stemmed flexible hinge toe implant. Thus 97 patients were operated between 1983 and 1989. Of these patients 82 were recently examined once again. In 80.5% of all cases good to very good results were achieved concerning functional or cosmetic aspects, X-ray tests and the patient's well-being.

Hallux Valgus↗
PubMed1996

Hallux valgus surgery. Morton and Lapidus were right!

More than 60 years ago an anatomist, Dudley Morton, and an orthopaedic surgeon, Paul Lapidus, independently published similar theories that implicated excessive mobility of the first metatarsal in forefoot dysfunction. Morton first studied in detail the evolution of the foot leading to bipedal gait and then examined the feet of many of his students in an attempt to correlate his tentative assumptions with the presence of or lack of symptoms. Morton's analysis of forefoot dysfunction provides the foundation of modern surgical procedures that restore normal forefoot balance and function to asymptotic feet.

Adolescent↗
PubMed1993

[Hallux valgus--the Dega surgical technic].

The author gives an account of one possible approach to the surgical treatment of valgus deformities of the toe. He corrects by the described subcapital wedge-shaped osteotomy of the first metatarsal bone the valgus deviation of the toe in the first metatarsophalangeal joint and at the same time he remodels the metatarsal arch of the foot. The surgical procedure is described and the results of operations, incl. complications, are evaluated. During check-up examinations some 85% of the patients found the results of the operation satisfactory. 13.5% of the patients reported pain when burdening the extremity. 12% of the patients reported difficulties with selection of footwear. Objective examination revealed in 9.5% of the patients revalgization.

Adolescent↗
PubMedDate not supplied

Mitchell osteotomy for hallux valgus: long-term follow-up and gait analysis.

In this retrospective study of 96 Mitchell first-metatarsal osteotomies performed on 69 patients with an average follow-up of 7 years, we found that more than 86% were completely satisfied and that the procedure was equally effective in all age groups. Excessive first metatarsal shortening, dorsiflexion of the osteotomy, and failure to correct the intermetatarsal angle to 10 degrees or less correlated with poorer results. This study demonstrates a relationship between metatarsal shortening and osteotomy plantarflexion. Gait analysis demonstrated that these patients do not have normal foot mechanics postoperatively.

Adolescent↗
PubMed1989

Proximal closing wedge osteotomy and adductor tenotomy for treatment of hallux valgus.

After 2 to 4 years, 25 patients (27 feet) who had a proximal closing wedge osteotomy of the first metatarsal and an adductor tenotomy were reviewed. A total of 20 patients (22 of 27 feet) were completely satisfied; 5 patients not completely satisfied had metatarsalgia because of dorsal displacement of the first metatarsal head. Radiographic measurements showed a narrowing of the forefoot rather than a large change in the intermetatarsal angle. The recovery period was long, an average of 11 weeks. Pin inflammation occurred in 5 patients and incisional neuromas in 2 patients. The risk of these complications must be taken into consideration when using this operation.

Adult↗
PubMed1984

Chevron osteotomy for the treatment of hallux valgus.

Seventy-six chevron osteotomies with follow-up periods ranging from six months to eight years were reviewed. The majority of patients had pain over the bunion prior to operation, and 27 also presented with second metatarsalgia. After surgery there was a marked decrease of pain in the first metatarsophalangeal joint, and in 18 feet the second metatarsalgia was either eliminated or markedly decreased. Most patients were pleased with the appearance of the feet after surgery, but almost one-third of the women complained of difficulty in wearing high heels. The surgical technique is straightforward, but careful attention to detail is necessary to obtain a consistent and satisfactory result.

Adult↗
PubMed1996

Clinical and radiographic evaluation of Wilson osteotomy for hallux valgus.

Thirty-two Wilson osteotomies (26 patients) were evaluated after a mean follow-up time of 20 months. According to the classification of Bonney and MacNab, there were 90% good and excellent results. There was no correlation between the patient's appraisal of the result and the clinical result based on objective, functional, and radiographic data. The occurrence of metatarsalgia or callosities did not correlate with shortening or angulation. If there was a tendency to recurrence, there was a greater loss of correction with a longer duration of follow-up. In addition, patients over 50 seemed to have a greater tendency to recurrence than younger patients.

Adolescent↗
PubMed2001

Distal osteotomy for bunionectomy and hallux valgus correction.

Distal osteotomies are the original osteotomies performed in the first metatarsal for bunion surgery. Many of these can be fashioned to improve an abnormal DMAA. Correction of an abnormally wide first-second IM angle is a goal of the newer procedures. Lateral transposition at the osteotomy site first performed by Mitchell helps accomplish this goal. The chevron modification improves stability and offers sufficient correction for mild-to-moderate deformities. Fixation is recommended after metatarsal osteotomy. The distal chevron procedure has been associated with lower degrees of correction, but the risk of transfer metatarsalgia is minimized. Shortening is less likely compared with some distal osteotomies but can occur. Advanced age is not a contraindication for distal metatarsal osteotomy. Avascular necrosis is highly unusual after this procedure.

Age Factors↗
PubMed1990

Correction of hallux valgus with metatarsocuneiform stabilization.

51 feet in 30 patients were evaluated clinically and radiographically an average of 27.6 months after undergoing a modified McBride bunionectomy with a metatarsocuneiform stabilization. An inlay block of bone was used after achieving corrected position of the first metatarsal. The retrospective review included an anteroposterior x-ray, in which definite trabecular bridging was present in only 25.5% of the cases. The metatarsocuneiform joint was asymptomatic regardless of its x-ray appearance. The average intermetatarsal angle was reduced from 14.6 degrees to 8.7 degrees. This procedure attempts to restore near-normal anatomy, thereby preventing transfer metatarsalgia from shortening or elevation of the first metatarsal. Acceptable correction is possible in both moderate and severe deformities.

Adult↗
PubMed1983

A new operation for hallux valgus.

A distal oblique osteotomy on the first metatarsal, with lateral displacement of the metatarsophalangeal joint and internal fixation with a compression screw, was performed. No splint or plaster was used. The operation is relatively simple and effective. Pain and discomfort during a short healing period are minimal. Forty-nine feet were operated on in 42 patients by eight surgeons. The patients were advised to bear full weight after six weeks. Return to unlimited work was possible after six weeks. The complications were superficial infection in one case and screws entering the metatarsophalangeal joint in two cases. One patient complained of metatarsalgia after the operation, but all other patients were satisfied after follow-up periods ranging from three months to six years.

Adolescent↗
PubMedDate not supplied

Chevron osteotomy for hallux valgus.

The chevron osteotomy for realignment of the first metatarsal head in metatarsus primus varus deformity has been utilized at the Mayo Clinic since 1976 on 26 feet (18 patients). Follow-up evaluation disclosed excellent relief of pain, good cosmetic correction, and overall patient satisfaction. Radiographic evaluation demonstrated reduction in the angle between the phalanx and the metatarsal bone of the great toe as well as narrowing of the forefoot with a decreased angle between the first and the second metatarsal bones. The stability of the osteotomy, the technical ease, and the absence of secondary difficulties such as transfer metatarsalgia make this procedure preferable when osteotomy of the distal portion of the first metatarsal bone is used for correction of moderate deformity.

Adolescent↗
PubMed1991

[Osteotomy of the base of the first metatarsal bone in the treatment of hallux valgus].

Authors performed in 1979 through 1991 in the Orthopaedic Department of the Semmelweis University of Medicine 47 osteotomies on the base of the first metatarsal bone in 37 patients. After the operation the intermetatarsal angle was in average under 10 and the metatarsophalangeal angle under 20 degrees. In chosen cases and with careful surgical technique good result can be obtained from the osteotomy of the base of the first metatarsal bone. The technique is not complicated, the osteotomy is healed quickly and well and the internal fixation makes early mobilization possible. It can and should be carried out in cases in which the intermetatarsal angle exceeds 10 degrees. After its performance, if necessary, operation beside the metatarsophalangeal joint may also be carried out.

Adolescent↗
PubMed2002

Keller resection arthroplasty for treatment of hallux valgus deformity: increased correction with fibular sesamoidectomy.

Thirty-eight patients (50 feet) were treated with Keller resection arthroplasties combined with fibular sesamoidectomies. Thirty-six patients were females (48 feet) and two were males (two feet). Their ages ranged from 55 to 87 years and averaged 68.4 years. Preoperative metatarsophalangeal (MTP) angles averaged 34 degrees (range, 10 to 55 degrees) and intermetatarsal (IM) angles averaged 15 degrees (range, 8 to 27 degrees). All patients were evaluated at an average of three years after surgery. An average correction of 18 degrees in the MTP angle and 6 degrees in the IM angle were obtained. At follow-up, 76% of patients had no pain, 14% had mild pain, and 10% had moderate pain; 76% had no activity limitations, 22% had recreational limitations, and 2% had daily limitations. Ninety-five percent of patients were satisfied with the results of their surgery.

Aged↗