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PubMed1984

Arthrodesis of the first metatarsophalangeal joint for hallux valgus in rheumatoid arthritis.

We reviewed the results of reconstruction of the fore part of the foot in rheumatoid patients by arthrodesis of the first metatarsophalangeal joint. The follow-up averaged 4.1 years (range, 2.0 to 7.25 years). Eighteen feet in eleven women were operated on. Twelve feet underwent total reconstruction of the fore part: arthrodesis of the first metatarsophalangeal joint and excision of all of the lesser metatarsophalangeal joints. Six feet underwent subtotal reconstruction, which included arthrodesis of the first metatarsophalangeal joint. The results were classified as excellent in fourteen feet, good in two, and fair in two. There were no poor results. Metatarsophalangeal bone fusion was achieved in all but one foot (fusion rate, 94 per cent). The one fibrous ankylosis was painless, with satisfactory function. Interphalangeal degenerative joint disease was a radiographic but not a clinical sequela. Arthrodesis of the first metatarsophalangeal joint provided stability that permanently corrected deformity, permitted the patients to wear ordinary shoes, and, in combination with excisional arthroplasty of involved lesser metatarsophalangeal joints, relieved disabling pain in the fore part of the foot.

Adult↗
PubMed1997

An anatomical basis for the degree of displacement of the distal chevron osteotomy in the treatment of hallux valgus.

The purpose of this study was to define the amount of lateral displacement of the chevron osteotomy to obtain a 50% displacement of the capital fragment. While mathematical analyses exist to predict the degree of correction of the intermetartarsal 1-2 angle with a distal metatarsal osteotomy, no guidelines exist regarding the degree of displacement (translation) that allows sufficient bone contact to enhance union and maintain stability of the osteotomy. We have addressed this concern based on anatomical parameters. The mean metatarsal width of the male specimens measured at 15 mm from the medial osteochondral junction was 15.3 mm (range, 13-18 mm; standard deviation, 1.6). The mean width among the female specimens was 14.5 mm (range, 11-18 mm; standard deviation, 1.6). This difference was statistically significant (P = 0.003). From the results of this study, we have concluded that when using a distal metatarsal osteotomy of the chevron type, in 97.5% of the cases the distal fragment can be translated laterally 6.0 mm in males and 5.0 mm in females to displace it 50% of its diameter.

Adult↗
PubMed1994

Hallux valgus, first metatarsal pronation and collapse of the medial longitudinal arch--a radiological correlation.

In a previous study we developed a model to assess first metatarsal pronation based on the position of the inferior tuberosity of its base and showed a significant relationship between first metatarsal pronation and the intermetatarsal angle (r = 0.69, p < 0.001). The present study was undertaken to correlate first metatarsal pronation with the height of the medial longitudinal arch in an attempt to define the clinical significance of this new finding. The weight-bearing anteroposterior and lateral radiographs of the feet of 50 patients (100 feet; 36 females patients of mean age 38 years, 14 males patients of mean age 40 years) were reviewed, and in each case, the patient's age, sex, intermetatarsal angle, amount of first metatarsal pronation and medial longitudinal arch angle were recorded by independent observers. A significant relationship was demonstrated between first metatarsal pronation and the height of the medial longitudinal arch (r = 0.93, p < 0.0001). Less marked association was observed between intermetatarsal angles and first metatarsal pronation (r = 0.71, p < 0.001). Multivariate analysis of patient age, sex, intermetatarsal angle and medial longitudinal arch angle against metatarsal pronation showed that the single most dominant variable affecting metatarsal pronation was the height of the medial longitudinal arch.

Adult↗
PubMed2002

Keller procedure and chevron osteotomy in hallux valgus: five-year results of different surgical philosophies in comparable collectives.

We evaluated 97 Keller procedures and 64 chevron osteotomies, both combined with the "Cerclage fibreux" distal soft-tissue procedure, with a minimum follow-up period of five years to assess the limits of indications of these two different operations. We then formed two subgroups providing a statistical midrange of the metatarsophalangeal angle, intermetatarsal angle I-II and degree of arthrosis of the first metatarsophalangeal joint to obtain comparable collectives of 40 Keller and 36 chevron procedures. The postoperative AOFAS score averaged 85.4 for the Keller procedure and 83.0 for chevron patients. The metatarsophalangeal angle was improved to an average of 11.0 degress and 13.9 degrees, the intermetatarsal angle to values of 8.8 degrees and 9.4 degrees, respectively. The patient's overall satisfaction rated "very satisfied" and "satisfied" in 92.5% and 94.4%, respectively. The main reason for dissatisfaction was pain. Compared to the literature, the good long-term results in this series following resection arthroplasty are attributed to the routine use of the "Cerclage fibreux" technique. This contemporary type of the Keller procedure is still a valuable surgical procedure for older patients with minor functional expectations. Excellent outcome after chevron osteotomy was not only seen in younger patients with minor deformities, but also in an older population. The chevron osteotomy should not be restricted to younger patients. The combination of the chevron distal metatarsal osteotomy with a distal soft-tissue procedure does not increase the risk of clinically manifest avascular necrosis of the metatarsal head and helps to correct higher metatarsophalangeal and intermetatarsal angles.

Adult↗
PubMed2004

Evaluation of Morton's theory of second metatarsal hypertrophy.

BACKGROUND: Originally introduced by Morton, the concept of hypertrophy of the medial cortex and the entire shaft of the second metatarsal as an objective sign of increased mobility of the first ray has not been subjected to much scrutiny. The goal of the current study was to assess the clinical relevance and reliability of radiographic measures of hypertrophy of the second metatarsal in relation to mobility of the first ray, pes planus, and tightness of the gastrocnemiussoleus in both control subjects and patients with diagnosed disorders of the forefoot. METHODS: Four study groups of forty-three subjects each were evaluated. The cohort included an asymptomatic control group as well as three groups made up of patients with symptoms and a diagnosis of hallux valgus, hallux rigidus, or interdigital neuroma. Mobility of the first ray (as measured with a device and method described by Klaue et al.), arch height, and ankle dorsiflexion were measured on physical examination. Plain weight-bearing radiographs and previously established equations were used to determine hypertrophy and the length of the second metatarsal, and the hallux valgus and first-second intermetatarsal angles were measured on plain radiographs as well. RESULTS: There was no significant difference between the control and symptomatic groups with regard to the values for hypertrophy of the second metatarsal. The patients with hallux valgus deformity had significantly greater mobility of the first ray (p < 0.001) compared with the controls. No correlation was found between values for hypertrophy of the second metatarsal and mobility of the first ray, the length of the first metatarsal, pes planus, or restricted ankle dorsiflexion. No correlation was found between mobility of the first ray and either pes planus or restricted ankle dorsiflexion. A weak correlation (r = 0.4) was noted between increased mobility of the first ray and the hallux valgus angle. CONCLUSIONS: Our findings do not support Morton's concept that medial cortical hypertrophy and increased shaft width of the second metatarsal are associated with increased mobility of the first ray or relative shortness of the first metatarsal. In addition, hypertrophy of the second metatarsal was not associated with either pes planus or restricted ankle dorsiflexion. We found the practice of using hypertrophy of the second metatarsal as an indicator of mobility of the first ray to be unreliable, and thus we consider it to be an inappropriate indication for arthrodesis of the first metatarsocuneiform joint in the treatment of hallux valgus deformity.

Adult↗
PubMed2001

Variation in diagnosis and management of common foot problems by GPs.

BACKGROUND: There are indications that the diagnosis and management of common foot problems vary widely in general practice. OBJECTIVES: Our aim was to explore the variation of GPs' diagnosis and management of common foot problems and the possible correlation between GPs' characteristics and their competence to diagnose correctly. METHODS: In a cross-sectional design, 90 GPs in The Netherlands were invited to complete a questionnaire regarding seven vignettes with common foot problems (hallux valgus, hallux rigidus, fasciitis plantaris, tarsal tunnel syndrome, metatarsalgia, corns and calluses, and rheumatoid arthritis), combined with questions covering diagnoses, management options and some GP characteristics. RESULTS: A total of 72 GPs responded (80%). They most often diagnosed hallux valgus (79%) and rheumatoid arthritis (86%) correctly, and most often hallux rigidus (37%) and tarsal tunnel syndrome (74%) incorrectly. GP characteristics did not correlate with their competence in diagnosing. The most frequently suggested management was referral to a podiatrist. The referral rate to medical specialists was low, except in the case of rheumatoid arthritis (79%). CONCLUSIONS: More than half of the GPs were competent in diagnosing vignettes of common foot problems. This diagnostic competence showed great variation and was not associated independently with GP characteristics. Educational programmes are recommended. Management showed less variation and often included referral to podiatrists. Further research into the effectiveness of specific treatments for different foot problems is recommended.

Adult↗
PubMedDate not supplied

Applications of the opening wedge cuneiform osteotomy in the surgical repair of juvenile hallux abducto valgus.

Juvenile hallux abducto valgus is a complex deformity of multifactoral etiology. The vast majority of cases, however, present as symptomatic or progressive misalignment of the first metatarsophalangeal joint with accompanying: 1) flexible flatfoot with anterior-medial imbalance, 2) medial column adductus, and 3) metatarsus primus adductus as a result of hyperobliquity of the first metatarsocuneiform joint (Lynch, F. R. Applications of the opening wedge cuneiform osteotomy in the surgical repair of juvenile hallux abducto valgus. Podiatry Tracts 5:173-187, 1987). Biplane cuneiform osteotomy, in conjunction with bicorrectional first metatarsal head osteotomy, was carried out a total of 48 times, in 44 patients, over a 5-year period of time. Patients averaged in age from 11 to 16 years old, with an average age of 13.2 years old. There were 44 females and no males, and the procedure was performed 18 times on the left foot, and 30 times on the right. Postoperative observations include decrease in the first intermetatarsal angle and hyperobliquity of the first metatarsocuneiform joint, decrease in medial column adductus, and stabilization of the anteromedial imbalance associated with the flexible flatfoot. Accordingly, the use of the biplane cuneiform osteotomy addresses the deformity at its apex and eliminates the primary contributory and etiologic factors responsible for its occurrence. It is thus invaluable in the surgical repair of juvenile hallux abducto valgus.

Adolescent↗
PubMedDate not supplied

Sliding oblique osteotomy for the treatment of hallux abducto valgus associated with functional hallux limitus.

This is a retrospective study of 27 patients (35 feet) with hallux abducto valgus associated with hallux limitus who underwent a sliding oblique osteotomy for surgical treatment between August 1997 and June 1998. Radiographic analysis and range-of-motion measurements were evaluated with an average follow-up of 65 days (range, 26-100). Preoperative criteria included < 45 degrees of dorsiflexion of the first metatarsophalangeal joint with weightbearing, no evidence of degenerative joint disease at the first metatarsocuneiform joint, and no previous surgical procedures on the first ray. The average preoperative intermetatarsal angle was 9 degrees, hallux abductus angle 17 degrees, and first metatarsal declination angle 15 degrees. The average postoperative intermetatarsal angle was 6.6 degrees, hallux abductus angle 10.3 degrees, and first metatarsal declination angle 21.7 degrees. Eighteen patients (22 feet) had a follow-up of over 6 weeks, and the first metatarsophalangeal joint was evaluated. The average gain in postoperative range of motion with weightbearing was 22.3 degrees.

Adult↗
PubMedDate not supplied

Osteotomies of the great toe.

Patients are operated on for forefoot problems at an increasingly younger age, according to the author's experience. This has resulted in extra articular osteotomies of the first phalanx of the great toe, usually associated with other forefoot procedures. There exist several indications for these osteotomies. Among them are hallux valgus, hallux rigidus, and other forefoot disorders, such as rheumatoid diseases. Since 1984, the author has performed 2850 great toe osteotomies, allowing him to specify indications, to elaborate osteotomy procedures (varisation, derotation, shortening) and to devise appropriate implants, including specific staples and compression screws. A great toe osteotomy system has resulted in facilitating the execution of this very useful procedure.

Adolescent↗
PubMed1985

Ambulatory correction of hallux abducto valgus. Angulational, transpositional, derotation, and hallux set procedure.

The importance of correction of the high proximal articular set angle with a subluxed joint in hallux abducto valgus for long-term correction is cited. I have shown that if the laterally deviated facet is not corrected, pronatory forces continue to act on the first ray. When force is applied to a still laterally tilted first metatarsophalangeal joint, further side-slipping of the joint will occur even though modification of the Silver, McBride, or osteotomy procedures of the first metatarsal have been performed successfully. A review of the standard procedures for the correction of a high proximal set angle alone usually did not correct the high intermetatarsal angle usually associated with this problem. Combination procedures sometimes created complications. These include dorsal dislocation of the distal fragment in correction of the sagittal plane deformity causing metatarsalgia, limited dorsal range of motion, and damage to the sesamoids or sesamoid grooves on the plantar aspect of the first metatarsal. Angulational transpositional derotation and hallux set (ATDH) is offered to correct four deformities using one or two 1-cm incisions together with "stab" incisions. This method overcomes the many disadvantages of previous procedures and can be used in the presence of biomechanical pronatory forces to reduce the proximal articular set and intermetatarsal angles; to derotate the hallux; to neutralize the forces that pull the proximal phalanx off the first metatarsal head; and if necessary, to correct the sagittal plane deformity of the first metatarsal so that weight bearing is not disturbed.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Surgical Procedures↗
PubMed1978

Total replacement of the first metatarsophalangeal joint.

Various prostheses for total replacement of the first metatarsophalangeal joint for painful hallux valgus and hallux rigidus are briefly discussed. Altogether, the results of eighty-six replacements in sixty-nine patients have been recorded after an average interval of two years. In seventy-eight operations a Silastic* prosthesis as designed by Swanson for the replacement of metacarpophalangeal joints was used, with no case of fracture or deep infection up to date. Overall, the assessment of pain showed that 98 per cent of operations gave either complete or considerable relief. For hallux valgus, the objective assessment showed excellent or good results in 79 per cent, fair in 16 per cent and poor in 5 per cent. For hallux rigidus the corresponding figures were 86, 14 and 0. The technique of replacement described promises to be most satisfactory, especially for hallux rigidus. In selected cases of hallux valgus, a basal osteotomy of the first metatarsal should be added.

Adult↗
PubMed1995

Disorders of the First Metatarsophalangeal Joint.

The two most common disorders of the first metatarsophalangeal (MTP) joint are hallux valgus and hallux rigidus. The hallux valgus deformity has been the subject of numerous clinical studies in the past decade. This information has enabled the creation of an algorithm to assist the clinician in evaluating the patient with hallux valgus and selecting the appropriate surgical procedure. The technical aspects of various operative procedures and the most common complications are reviewed. The other major disorder of the first MTP joint is arthrosis, which results in hallux rigidus. As the arthrosis progresses, there is often proliferation of bone on the dorsal aspect of the metatarsal head, which results in impingement of the proximal phalanx during dorsiflexion. The impingement causes jamming, instead of gliding, of the proximal phalanx on the metatarsal head, which results in pain. The treatment for this condition consists of debridement of the MTP joint to relieve the dorsal impingement and, in most cases, the pain. If the arthrosis is advanced in an active individual, arthrodesis is indicated.

Journal Article↗
PubMedDate not supplied

Modified lapidus arthrodesis for adolescent hallux abducto valgus.

The Lapidus arthrodesis was originally described for the surgical correction of hallux valgus associated with metatasus primus adductus. It was popularized on the adult patient with moderate to severe hallux valgus deformity. However, the authors present a retrospective review of 23 adolescents between the ages of 13 and 20 who underwent the procedures. Characteristics of adolescent hallux valgus include a smaller dorsal medial eminence, less valgus rotation of the hallux, and certain mechanical influences. These influences may include a generalized increase in motion at the first metatarsocuneiform joint. The modified Lapidus arthrodesis eliminates motion at the first metatarsocuneiform joint and therefore directly addresses an etiology of the deformity. Both preoperative and postoperative radiographs were evaluated for reduction in the 1-2 intermetatarsal angle. Patients were evaluated through either chart review or telephone interview for present activity level, comfortable footgear, and overall satisfaction of the procedure. Twenty-seven out of 30 feet (90%) had either a good or excellent result with only three complications and two recurrences over a mean follow-up of 61 months.

Adolescent↗
PubMed1979

Arthrodesis of the metatarsophalangeal joint of the great toe.

Since 1975 the usual treatment of hallux valgus and hallux rigidus at the Medical High School, Lübeck, has been arthrodesis of the metatarophalangeal joint of the great toe. We report 48 operations performed between 1975 and 1977 on 35 patients with a follow-up of 3-32 months. The operative technique, using the "dynamic compression plate" is described in detail. The patient's assessment and the clinical and radiological situations were recorded. There were only three poor results. Thus, arthrodesis of the metatarsophalangeal joint is considered to be a reliable therapeutic method in hallux valgus, with minimal post-operative complications. It compares well with other operations, including Keller's arthroplasty.

Aged↗
PubMed1990

Replacement of the first metatarsophalangeal joint with a silicone elastomer ball-shaped spacer.

We report the use of a silicone elastomer ball-shaped spacer for the treatment of hallux valgus and hallux rigidus. One hundred and eleven operations were performed in 77 patients over a 5-year period. The best results were obtained in patients with hallux rigidus. Good results were obtained in hallux valgus, but it was found that in patients with severe preoperative deformity the correction obtained was inadequate, and an additional procedure would be required for full correction. There were no cases of silicone synovitis.

Adult↗
PubMedDate not supplied

The effect of first metatarsophalangeal arthrodesis on transverse plane deviation of the second toe: a retrospective radiographic study.

The purpose of this retrospective, radiographic study was to examine the effect of first metatarsophalangeal arthrodesis on the transverse plane deviation of the second metatarsophalangeal joint. Sixty-nine patients (76 feet) were separated into 3 groups based on preoperative diagnosis: group 1, hallux valgus; group 2, hallux rigidus; and group 3, rheumatoid forefoot deformity with concomitant lesser metatarsal head resection. Intermetatarsal, hallux abduction, and second metatarsophalangeal angles were measured on preoperative and follow-up anteroposterior radiographs. Multivariate analysis found a significant postoperative change (P < .001) in both the intermetatarsal and hallux abduction angles for all groups, but no significant change in the second metatarsophalangeal angle for any group. There was also no significant difference in the number of patients with medial versus lateral second toe deviation in each group. The addition of a second ray procedure, such as a digital arthrodesis or second metatarsal decompression osteotomy, in groups 1 and 2 did not correlate to the amount of change in second metatarsophalangeal deviation. However, there was a significant correlation (r = .330; P = .004) between the amount of change in the hallux abduction angle and the amount of change in the second metatarsophalangeal angle. A lack of change in the second metatarsophalangeal angle in patients with hallux valgus and hallux rigidus suggests that the creation of a stable medial buttress may protect the lesser digits. However, in patients with rheumatoid, this lack of change denotes a postoperative recurrence of lateral deviation of the second toe despite lesser metatarsal head resection and stabilization of the hallux.

Adult↗
PubMed1993

Silicone granulomatous reactions after first metatarsophalangeal hemiarthroplasty.

We reviewed 55 patients (78 feet) who had undergone silicone hemiarthroplasty of the first metatarsophalangeal joint for hallux valgus (40) or hallux rigidus (38). At a mean period of 4.5 years (1 to 11), 56 feet had radiological evidence suggestive of silicone granulomatous disease. The frequency and severity of the changes increased with time from the operation. Histological material from three revisions confirmed the presence of silicone granulomata. We recommend that the operation of silicone hemiarthroplasty for hallux valgus and hallux rigidus be abandoned.

Female↗