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PubMedDate not supplied

Arthrodesis of the first metatarsophalangeal joint for severe bunions and hallux rigidus.

Compression arthrodesis of the first metararsophalangeal joint using a modification of the technique of McKeever is described. This operation consistently produces the best results for hallux valgus and hallux rigidus of the great toe. The operation has been found to be applicable where there have been previous attempts at surgical correction. It also produces good results in patients having rheumatoid arthritis when there is minimal involvement of the interphalangeal joint.

Arthrodesis↗
PubMedDate not supplied

[The significance of inflammatory changes in the tarsometatarsal joints for development of rheumatic splayed foot: a radiologic follow-up].

The involvement of foot joints is a common finding in more than 90% of the patients with rheumatoid arthritis. The typical deformity of the forefoot is the splayfoot with hallux valgus or hallux rigidus and deformities of the lesser toes. 70 feet of 36 patients with rheumatoid arthritis were observed radiologically over a period between 5 years/1 month and 6 years/1 month. The x-rays were analyzed for arthritic changes of the various joints and changes of the foot statics. The question was whether the splay of the forefoot is caused by an arthritis of the metatarsophalangeal or tarsometatarsal joints with a consequent weakening of joint capsules and ligaments, or statistically by a flattening of the longitudinal arch owing to arthritic changes of the hindfoot. The statistic analysis showed that the splay of the forefoot appears between the first and second metatarsal bones. The arthritis of the tarsometatarsal joints II-IV could be identified as a statistically significant factor for the development of a splayfoot in rheumatoid arthritis. The influence of arthritic changes of the tarsometatarsal joints I and V was striking, but not statistically significant. The arthritis of the tarsometatarsal joints caused a flattening of the transverse arch already at an early stage. An arthritis of the metatarsophalangeal joints and the flattening of the longitudinal arch with arthritides of the rear foot had no statistically significant influence on the forefoot. From the results, we must draw the conclusions that orthopedic aids like shoe supports with retrocapital metatarsal bars should be recommended already at an early stage of the disease and that the support of the longitudinal arch is not sufficient to prevent a splayfoot.

Adult↗
PubMedDate not supplied

First metatarsophalangeal joint arthrodesis utilizing a mini-Hoffman External Fixator.

Arthrodesis was initially indicated for severe hallux valgus and hallux rigidus. Today, it is primarily a salvage procedure, which provides a painless first metatarsophalangeal joint. This manuscript reviews the various procedures for arthrodesis of the first metatarsophalangeal joint. A case report is presented utilizing arthrodesis as a salvage procedure for a painful first metatarsophalangeal joint, after previously failed procedures.

Adult↗
PubMedDate not supplied

Revisional hallux abducto valgus surgery using tricorrectional bunionectomy.

We present a radiographic analysis of 91 failed hallux abducto valgus surgeries. Patients were categorized by type of postoperative complication: hallux varus, hallux limitus, or recurrent hallux abducto valgus deformities. All deformities were radiographically evaluated preoperatively and after correction using tricorrectional bunionectomy. Analysis of the surgical revisions showed improvement in radiographic parameters, including the intermetatarsal angle, hallux abductus angle, proximal articular set angle, and tibial sesamoid position. We conclude that tricorrectional bunionectomy is a versatile procedure that can be used when addressing a residual deformity after failed hallux abducto valgus surgery.

Foot Deformities↗
PubMedDate not supplied

Metatarsus adductus and hallux abducto valgus: their correlation.

Metatarsus adductus has long been suspected to contribute to hallux abducto valgus. This paper gives statistical evidence on the relationship between metatarsus adductus and hallux abducto valgus in an attempt to support this long held belief.

Foot Deformities, Congenital↗
PubMedDate not supplied

First metatarsal head shape in juvenile hallux abducto valgus.

A round first metatarsal head has been implicated as a predisposing factor in hallux abducto valgus. The shape of one hundred first metatarsal heads was analyzed on 50 weightbearing dorsoplantar x-rays of 10-year-old children with a hallux abductus angle in excess of 15 degrees and osteophytic thickening of the first metatarsophalangeal joint. The metatarsals were subjectively described as either round or square. A measurement technique was then devised to quantify in millimeters the difference between the two types. Using chi-square analysis, a very strong statistical association (p less than 0.001) was found between the subjective assessment and the objective measurement. A weak relationship was found between the metatarsal head shape and the degree of hallux abducto valgus (HAV) (r = -0.294). While the trend of this correlation is consistent with accepted wisdom, that is, the squarer the metatarsal head the less the hallux abducto valgus, the association is not strong enough to scientifically confirm it. This finding along with the presence of so many square metatarsal heads in children with advanced HAV indicates that assessment of metatarsal head shape has little place in the scientific assessment of first metatarsophalangeal joint pathology.

Child↗
PubMed2004

The Lapidus procedure: a prospective cohort outcome study.

BACKGROUND: Multiple reports are found in the literature about the surgical treatment of hallux valgus deformities. Few, however, are prospective outcome studies. The purpose of this study was to prospectively look at the functional outcome of patients with moderate and severe hallux valgus deformities (intermetatarsal angle of more than 14 degrees and a hallux valgus angle of more than 30 degrees) after the Lapidus procedure. METHODS: Indication for surgery and inclusion into the study was failure of nonoperative management for metatarsus primus varus and painful hallux valgus deformities. Data was collected using the AOFAS Hallux Metatarsophalangeal Interphalangeal Scale, Visual Analog Pain Scale, clinical examination, weightbearing radiographs, and a patient satisfaction questionnaire. Data was collected preoperatively, 6 weeks after surgery, 6 months after surgery, and then yearly. One hundred and five feet in 91 patients were followed for an average of 3.7 years (range, 18 months to 6.2 years). Sixty-two patients were female and 29 were male. The average age at surgery was 41 years (range, 20 years to 71 years). RESULTS: The AOFAS Hallux Metatarsophalangeal Interphalangeal Scale scores increased from 52 preoperatively to 87 points at most recent follow-up (p <.001). The average intermetatarsal angle preoperatively was 18 degrees and 8.2 degrees at most recent follow-up. Between the 1-year and 3.7-year follow-up visits, only.3-degree increase of the intermetatarsal angle was noted. The average hallux valgus angle preoperatively was 37 degrees and 16 degrees at most recent follow-up. Less than 1-degree increase in the hallux valgus angle was noted between the 1-year to 3.7-year follow-up visits. Complications included tarsometatarsal nonunion in seven patients. Five patients lost correction and all seven patients had a revision procedure done for pain. Removal of hardware was necessary in eight patients, minor wound problems occurred in two patients, superficial neuroma in two patients, and transfer metatarsalgia in four. CONCLUSIONS: The Lapidus procedure obviously is not the answer to all bunion deformities, but with proper technique and attention to detail it is an excellent alternative treatment for moderate to severe metatarsus primus varus and hallux valgus deformities.

Adult↗
PubMed1994

Characteristics of adolescent hallux abducto valgus. A retrospective review.

The authors review 63 surgical cases of adolescent hallux abducto valgus in 54 patients from the Foot and Ankle Institute of the Pennsylvania College of Podiatric Medicine over a 7-year period. Twenty-five closing base wedge and capital osteotomies were evaluated for radiographic changes. Three quarters of a group of 65 patients with adolescent hallux abducto valgus were found to have an abnormally high metatarsus adductus angle. Patients who had a closing base wedge osteotomy had higher preoperative radiographic angles for the intermetatarsal, metatarsus adductus, hallux abductus, and proximal articular set angles as well as the tibial sesamoid position. Those patients had 4.49 degrees more intermetatarsal angle correction than the patients who had a capital osteotomy. Implications for evaluation and treatment are discussed.

Adolescent↗
PubMed1991

The Akin procedure: an analysis of results.

This paper reports the initial and long-term results of 45 Akin procedures done at the Hospital for Joint Diseases/Orthopaedic Institute from 1966 to 1985. Indications for 36 of the 45 operated feet were for an essentially asymptomatic great toe valgus deformity which caused symptoms to develop in the second toe and in 9 of 45 feet for residual hallux valgus after previous hallux valgus surgery. Excellent and good results were reported in 89% of the patients. The most common technical problem reported in 22% of the patients was plantar angulation at the osteotomy site. The only technical problem that was associated with long-term complications was bone apposition of less than 50% which may have lead to a nonunion in one case and recurrence of deformity in another. Shortening of the hallux was observed in all cases secondary to the closing wedge osteotomy. Shortening can be limited if a minimum of bone is removed from the proximal phalanx. A mathematical analysis is presented in this paper which can be used to provide guidelines to osteotomy size so that a minimum of bone necessary for correction can be removed. The Akin procedure should be performed within certain guidelines. Rarely is an Akin procedure alone indicated for the correction of a hallux valgus deformity. In most patients the proximal phalangeal osteotomy needs to be performed in combination with some other procedure to correct all components of the hallux valgus deformity. Furthermore the procedure can be used with success in those patients who present with an essentially asymptomatic great toe valgus deformity at the metatarsophalangeal joint or the interphalangeal joint which causes symptoms and/or deformity to develop in the second toe.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Silicone implant arthroplasty of the great toe. A review of single stem and flexible hinge implants.

One hundred sixty-five feet were reconstructed with the single stem silicone implant, including patients with hallux regidus, hallux valgus due to degenerative and osteoarthritic joint changes, hallux valgus secondary to rheumatoid arthritis and patients with previous unsuccessful "bunion" procedures. Preoperative pain and intolerance to shoe wear were relieved in the great majority of patients. The amount of correction of the hallux valgus angle was directly related to the preoperative deformity. Infection occurred in 2 patients, and inflammatory reaction to the implant occurred in one patient. One hundred five feet were reconstructed with a flexible hinge implant; 94 of the feet had joints destroyed by rheumatoid arthritis. Dramatic improvement in the hallux valgus angle resulted in these feet which had relatively severe preoperative deformities. No implant fractures were recorded. The present survey of our cases, and experiences reported by others, encourage the use of these implants by surgeons who follow the suggested indications, surgical technique, and follow up care.

Adolescent↗
PubMedDate not supplied

Size and shape differences between male and female foot bones: is the female foot predisposed to hallux abducto valgus deformity?

This study introduces a new technique to measure bone size and shape. A three-dimensional laser scan was taken of the talus, navicular, medial cuneiform, and first metatarsal from 107 skeletons of known age and sex. The bones were analyzed for differences in bone morphology between the sexes and the ability of each bone to contribute to the adducted position of the first metatarsal. Linear measurements showed that male bones were larger than female bones. Measurements of articular surfaces suggested that female bones had the potential for more movement to occur in the direction of adduction, possibly resulting in the female first metatarsal being more adducted than that in the male skeleton. Such differences may underlie the predisposition of the female foot to develop hallux valgus deformity.

Adolescent↗
PubMedDate not supplied

Follow-up of the isolated medial approach to hallux abducto valgus correction without interspace release.

A retrospective radiographic review was performed of 29 patients (37 feet) who underwent an isolated medial approach for correction of hallux abducto valgus deformity from March 1993 to November 1998. Only those patients who had a traditional Austin-type osteotomy with a reducible first metatarsophalangeal joint and flexible first ray were included in the study. The average follow-up period for the entire study group was 18.4 months, with 13 patients (44.83%; 17 feet) having a follow-up period of longer than 2 years. The average decrease in the intermetatarsal angle was 9.89 degrees, and the average decrease in the hallux abductus angle was 14.0 degrees, results that correlated well with those of other studies on correction of hallux abducto valgus. No clinical or radiographic recurrence of hallux abducto valgus was noted throughout the follow-up period. The authors believe that an isolated medial approach to hallux abducto valgus correction without a lateral interspace release yields predictable results when performed in appropriately selected patients.

Female↗
PubMedDate not supplied

The effect of hallux abducto valgus surgery on the sesamoid apparatus position.

A new parameter, the tibial sesamoid-second metatarsal distance, was established to determine whether the sesamoids move in relation to the foot in hallux abducto valgus surgery. The reliability of the tibial sesamoid-second metatarsal distance was assessed and shown to be excellent. Seventy-five feet underwent surgical correction of hallux abducto valgus. Four radiographic parameters--the intermetatarsal angle, the hallux abductus angle, the tibial sesamoid position, and the tibial sesamoid-second metatarsal distance--were measured before and after surgery. The hallux abductus angle, intermetatarsal angle, and tibial sesamoid position were all significantly reduced following surgery. The tibial sesamoid-second metatarsal distance was not affected by hallux abducto valgus correction. Thus the correction in sesamoid position gained with hallux abducto valgus correction is a direct result of lateral translocation of the metatarsal head, with no contribution from change in position of the sesamoid apparatus relative to the foot.

Adolescent↗
PubMed1977

Criteria for fibular sesamoidectomy in hallux abducto valgus correction.

Fibular sesamoidectomy is necessary in certain instances to achieve permanent correction of hallux abducto valgus deformities. The decision to remove the fibular sesamoid is usually based on the position of the tibial sesamoid (which is determined by clinical and radiographic examination). If the fibular sesamoid is in positions 4 to 7, it is difficult, if not impossible, to maintain the correction of the hallux abducto valgus; if the position is 1 through 3, the sesamoids can be moved medially and maintained by the crista which is still intact.

Hallux↗
PubMed2002

[Reconstruction-arthrodesis of the first metatarsophalangeal joint iatrogenic bone defects].

PURPOSE OF THE STUDY: Arthrodesis-reconstruction for metatarsophanlangeal bone defects of the great toe after hallux valgus or hallux rigidus is rarely performed and only a few series are found in the literature. In these series, retarded bone fusion, skin rupture, and interphalangeal intolerance (both clinically and radiologically) have been frequent. The purpose of this work was to determine what parameters contribute to minimizing these postoperative risks. MATERIAL AND METHODS: Thirteen patients, mean age 60 years, were reviewed at a mean follow-up of 7 years. Mean delay from initial surgery to revision surgery was greater than 6 years. Preoperative complaints included metatarsophalangeal pain and especially transfer metatarsalgia. The procedure used corticocancellous bone grafting associated with osteosynthesis and unloading of the forefoot for three months. RESULTS: Eleven of the 13 patients achieved full relief of their metatarsophalangeal pain and metatarsalgia. Twelve of the 13 patients had a satisfactory great toe axis, including 2 who had a secondary osteotomy for correction. Bone fusion was achieved in all 13 patients; one at 8 months. Mean lengthening was 5.1 mm; reconstruction with the corticocancellous graft reconstruction generally filled the bone defect resulting from ablation of the joint prosthesis in 7 cases. The interphalangeal joint was pain free at last follow-up in all cases despite radiological evidence of suffering in one (similar to the situation before the revision surgery). DISCUSSION AND CONCLUSION: Correct position of the arthrodesis is essential to alleviate transfer metatarsalgia. A moderate lengthening of the great toe can minimize the risk of skin rupture. In order to preserve the interphalangeal joint, the position of the arthrodesis must be precise both in the sagittal and horizontal plane, leaving sufficient valgus and avoiding the need for temporary interphalangeal pinning.

Adult↗
PubMed1976

Procedures to correct hallux abducto valgus and metatarsus primus adductus.

Four procedures are presented to correct hallux abducto valgus and metatarsus primus adductus in the child between the ages of 3 and 7 years. A new procedure is introduced: a subtalar extra-articular lateral arthroereisis, and an erasure procedure of the epiphysis is discussed. An important new concept in pediatric podiatry is introduced: it is often possible to prevent major surgery in the adult by performing a minor procedure in the young child. Finally, a Reverdin's procedure to correct the articular set angle in adults is presented.

Adolescent↗