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PubMed1994

Epiphysiodesis in juvenile hallux abducto valgus. A preliminary retrospective study.

Juvenile hallux abducto valgus manifested prior to physeal plate closure was treated by lateral epiphyseal stapling and modified McBride bunionectomy in nine children (15 feet) from 1984 to 1992. The prevalent preoperative symptoms were significantly reduced postoperatively. The intermetatarsal angle decreased an average of 6.6 degrees (initial decrease was 2.7 degrees with an additional 3.9 degrees occurring over time). The hallux abducto valgus angle decreased an average of 19.6 degrees (initial decrease was 10.7 degrees with an additional 8.9 degrees occurring over time).

Adolescent↗
PubMed1986

Kinematics of the first metatarsophalangeal joint.

The kinematics of both the first metatarsophalangeal joint and the articulation of the hallux sesamoid bones with the metatarsal head were investigated with fifteen fresh-frozen below-the-knee amputation specimens using a radiographic technique. Six feet were of normal structural anatomy, six displayed hallux valgus, and three had hallux rigidus. Normal specimens demonstrated an average total range of motion in the sagittal plane of 111 degrees, with about 76 degrees of dorsiflexion and 34 degrees of plantar flexion. The abnormal specimens revealed a decreased total arc of motion, with a limitation of plantar flexion in feet with hallux valgus and a loss of dorsiflexion in feet with hallux rigidus. Motion analysis of the normal metatarsophalangeal joints demonstrated minimum scattering of instant centers of rotation. This was in contrast to the diseased articulations, which displayed markedly displaced instant centers of rotation located eccentrically about the metatarsal head. Surface motion in the normal joints was characterized as tangential sliding from maximum plantar flexion to moderate dorsiflexion, with some compression at maximum dorsiflexion. The feet with hallux valgus and the feet with hallux rigidus displayed distinctive patterns of distraction and jamming throughout specific portions of the range of motion in the sagittal plane. Motion of the metatarsophalangeal joint in the transverse plane concomitant with motion in the sagittal plane, which has been hypothesized by other investigators, was confirmed and quantified in this study. The feet with hallux rigidus displayed a reduction in this motion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Tibialis posterior tendon associated with hallux abducto valgus. A preliminary study.

The etiology of hallux abducto valgus has been the topic of much study. The authors of this study have attempted to investigate an association of anomalous insertions of the tibialis posterior tendon and their relationship to hallux abducto valgus. The authors present evidence that such anomalous insertions are normal, but may contribute to the development of the deformity because of variations in those insertions. A biomechanical model for that contribution is proposed.

Foot↗
PubMedDate not supplied

[Intermediate results with Swanson's hallux implant].

Fifty Swanson single stemmed metatarsophalangeal silastic great toe prostheses in 38 patients inserted between 1974 and 1984 in the Orthopaedic University Clinic of Innsbruck were reviewed. The authors compare results of hallux valgus correction and of hallux rigidus correction by the Swanson prostheses and conclude, that implant arthroplasty should not be performed to correct hallux valgus, but is an excellent procedure in the treatment of hallux rigidus, if the hallux valgus angle is not higher than 18 degrees.

Adult↗
PubMed1980

The tear-drop capsulectomy and capsulorrhaphy: a new approach in aiding the soft tissue repair of hallux abducto valgus.

Capsular correction is an important part of the repair of hallux abducto valgus. In this paper, the authors discuss the tear-drop method of capsular repair--a method that can be used in all hallux valgus corrections, either alone or in conjunction with the dorsolinear capsulotomy and repair. They believe the tear-drop method has many advantages, among which is the fact that severe splinting and/or casting is not needed and the patient can walk in a surgical shoe almost immediately after surgery. Excellent results were obtained in a high percentage of their 288 cases.

Connective Tissue↗
PubMed1989

Preparing for hallux abducto valgus surgery.

This article reviews the criteria for hallux abducto valgus surgery. Clinical and radiographic examinations are reviewed in a stepwise approach to evaluate the deformity. A hallux abducto valgus surgical evaluation form is presented in order for the podiatrist to logically assess the patient's deformity.

Hallux Valgus↗
PubMed1989

Modified V-Y capsulorrhaphy in hallux abducto valgus surgery.

The two-stage capsular closure modification of the V-Y capsulorrhaphy in hallux abducto valgus surgery is a technique for restoring the soft tissue anatomical relationships of the first metatarsophalangeal joint in a bunion deformity. The first stage of the V-Y capsulorrhaphy corrects the plantar and lateral deviation of the abductor hallucis tendon. The second stage of the V-Y capsulorrhaphy closure allows for the correction of abductus and valgus rotation of the hallux. Inasmuch as each element of the soft tissue deformity in hallux abducto valgus deformity is corrected individually, greater precision can be applied to each constituent of the hallux abducto valgus deformity.

Cartilage, Articular↗
PubMedDate not supplied

Variation in practitioner-measured x-ray angles in hallux abducto valgus evaluation.

Angular measurements taken on preoperative hallux abducto valgus x-rays have been relied upon heavily by surgeons in helping to determine the nature and extent of the deformity, as well as a guide for selecting the most appropriate surgical procedure for correction. The reliability of measuring these angles among different physicians has never been tested, to these authors' knowledge. Therefore, this study is designed to measure the variation in values for the five basic angles among a group of podiatrists with varying capabilities, training, and experiences, and demonstrates that preoperative radiographic measurements may not be an accurate reflection of the general degree of pathology about the first metatarsophalangeal joint.

Calibration↗
PubMed1986

The relationship of abnormal foot pronation to hallux abducto valgus--a pilot study.

Abnormal foot mechanics is the most common cause of hallux abducto valgus. To date no quantitative data regarding the relationship between abnormal foot mechanics and the degree of hallux abducto valgus has been presented. An outline of the abnormal foot mechanics responsible for hallux abducto valgus is described along with a technique for measuring the extent of abnormal function. A common intrinsic abnormality responsible for hallux abducto valgus is described along with its diagnosis and orthotic treatment.

Adult↗
PubMedDate not supplied

The "Z" osteotomy versus the Kalish osteotomy for the correction of hallux abducto valgus deformities: a retrospective analysis.

A retrospective analysis of hallux abducto valgus surgery performed between 1990 and 1995 where the "Z" osteotomy and Kalish osteotomy were utilized was performed. Objective and subjective data were collected to determine the effectiveness of the Z osteotomy versus the Kalish osteotomy. Twenty cases of hallux abducto valgus where the Z osteotomy was utilized were evaluated on the basis of intermetatarsal angle correction and alleviation of preoperative symptoms. The same evaluation was performed on 21 cases where the Kalish osteotomy was utilized. There did not appear to be an appreciable difference in intermetatarsal angle correction between the two osteotomies; however, the Kalish osteotomy did alleviate preoperative symptoms to a greater degree compared with the Z osteotomy.

Adolescent↗
PubMedDate not supplied

Effect of sesamoid position on long-term results of hallux abducto valgus surgery.

Radiographic parameters for 70 patients that underwent hallux abducto valgus (HAV) surgery were evaluated with emphasis on the tibial sesamoid position. The preoperative and postoperative sesamoid positions were analyzed. Soft tissue bunionectomies, metatarsal head and base osteotomies, and first metatarsocuneiform arthrodesis are procedures that were included in this evaluation. The inadequate relocation of the sesamoids, along with other standard parameters, were then correlated with recurrence of hallux abducto valgus and metatarsus primus adductus. The surgical relocation of the sesamoid apparatus is discussed, including both an intracapsular and extracapsular release. Possible indications for fibular sesamoidectomy are suggested. Effects of sesamoid position on the long-term results of HAV surgery are presented.

Hallux Valgus↗
PubMedDate not supplied

Complications of distal first metatarsal osteotomies.

Many surgical procedures have been described for the correction of hallux valgus and hallux limitus deformities. Distal first metatarsal osteotomies have been advocated since the turn of the century, and have been modified and improved since that time. Various complications have been associated with distal osteotomies, but there is infrequent reference to the normal changes in joint function, foot biomechanics, and forefoot pressures after surgery. The following literature review addresses the postoperative effects of decreased first metatarsophalangeal joint motion, shortening of the first metatarsal, dorsal displacement of the capital fragment, and transfer metatarsalgia on foot function.

Biomechanical Phenomena↗
PubMed2001

Complications after surgery of the hallux.

The great toe is affected by many congenital and acquired conditions including arthritis, hallux valgus, and hallux rigidus and disease of the hallucal sesamoids. Many surgical procedures have been described for the treatment of these conditions. With the increased popularity of forefoot surgery comes the potential for complications even when the surgery is done meticulously by an experienced surgeon under well-planned conditions. When a complication occurs, it can present difficult and challenging problems. It is, therefore, important to recognize a complication early so it may be analyzed and treated successfully. When recognized, a plan should be developed to identify, quantify, control, and resolve the problem. The current review defines some common complications and treatment options. Several problems may exist at the same time. A solution addressing all aspects of the problem must be designed so as not to augment the presenting complications. Salvage operations and long-term treatment are included to provide a perspective on treatment of residual deformity. It is important to realize that there often are several solutions to a difficult problem. Many factors influence the surgeon's choice and implementation of a solution, but the ultimate outcome always depends on a well thought out plan.

Arthrodesis↗
PubMed2000

Result of arthrodesis of the hallux metatarsophalangeal joint using bone graft for restoration of length.

We treated 24 patients (18 women, six men; average age, 46.4 years; (range, 28 to 66 years) with fusion of the hallux metatarsophalangeal (MTP) joint using bone graft for the restoration of the length of the first ray. This procedure was performed after bone loss subsequent to previous surgeries for the correction of hallux valgus and hallux rigidus with: silastic arthroplasty (11), bunionectomy and distal metatarsal osteotomy (six), Keller resection arthroplasty (five), and total joint replacement (two). The indication for performing the arthrodesis with bone graft was a short first metatarsal, and associated metatarsalgia of the lesser metatarsals in addition to a painful MTP joint with or without deformity. This bone loss was associated with avascular necrosis of the first metatarsal (nine patients) and with osteomyelitis (seven patients). Of the 24 patients, 14 underwent additional concurrent surgery for correction of hammer toes (10), excision of a Morton's neuroma (two), and lesser metatarsal osteotomy (two). All patients were examined clinically and radiographically at a mean interval of 62.7 months after surgery (range, 26 to 108 months). The patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux and MTP 100-point outcome scale. Arthrodesis occurred in 19/24 patients (79.1%) at a mean of 13.3 weeks (range, 11 to 16 weeks), and the first ray was lengthened by a mean of 13 mm (range, 0 to 29 mm). Of the five nonunions, two were asymptomatic, and three were subsequently revised successfully, with arthrodesis occurring at a mean of 10.7 weeks. Complications included one deep infection requiring intravenous antibiotics for treatment of osteomyelitis and two minor superficial wound infections. The mean AOFAS score improved from 39 points (range, 22 to 60 points) to 79 points (range, 64 to 90 points). All patients were satisfied with the final outcome of treatment and stated that they would undergo the surgical procedure again. We concluded that arthrodesis of the hallux MTP joint with bone graft to restore bone loss and length of the first ray may be a worthwhile procedure despite the technical difficulty and the high rate of nonunion.

Adult↗
PubMed1984

Keller's arthroplasty: is distraction useful? A prospective trial.

There are many operations for hallux valgus and hallux rigidus, but Keller's operation remains one of the most popular, particularly for the older patient. A prospective trial was carried out to compare the results of Keller's operation modified by Kirschner-wire distraction with those of the standard operation. The results suggest that there is no advantage in using temporary Kirschner-wire distraction; indeed, degenerative changes in the interphalangeal joint and a subjectively worse result may result from its use.

Adult↗
PubMed1990

The management of the painful first metatarsophalangeal joint in the older patient. Arthrodesis or Keller's arthroplasty?

We report a prospective randomised trial comparing Keller's arthroplasty and arthrodesis of the first metatarsophalangeal joint for the management of symptomatic hallux valgus and hallux rigidus in the older patient. In 81 patients (110 feet), with a minimum of two years follow-up, both procedures gave a similar degree of patient satisfaction and symptom relief. The incidence of metatarsalgia was also similar. As there were no obvious advantages to arthrodesis, and since six out of 50 arthrodesed toes required revision, we suggest that Keller's arthroplasty is the better operation in these patients.

Aged↗
PubMed1991

Hinged silastic implants of the great toe.

Since 1982, hinged silastic implants have been used in the treatment of hallux valgus and hallux rigidus in preference to excision arthroplasty or metatarsophalangeal joint fusion. The results of this treatment in 106 feet in 89 patients are satisfactory to subjective and objective assessment over an average follow-up period of 27.7 months (range, 12-60 months). Hinged prosthesis overcomes the problems associated with resection arthroplasty.

Adult↗
PubMedDate not supplied

Implant arthroplasty of the first metatarsophalangeal joint: a 12-year retrospective study.

A study was conducted of the long-term results on Silastic implant arthroplasties of the first metatarsophalangeal joint in 88 feet. Silastic implants were evaluated on the basis of patient satisfaction, function, and radiographic findings. The period of follow-up ranged from 6 months to 12 years, with an average follow-up of 6.3 years for hemi-joint implants and 2.1 years for total joint implants. The results showed that a majority of patients with hallux valgus and hallux limitus had good results with either hemi-implant or total implant. The most common complication found was hallux extensus.

Adult↗