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PubMed2002

Relationship between proximal articular set angle and hallux abducto valgus.

A study of radiographs from 50 males and 50 females was undertaken to determine whether a relationship existed between the proximal articular set angle and the hallux abductus angle. Gender differences in the relationship were also investigated. The normal range for the proximal articular set angle was -2.6 degrees to 8.6 degrees, with a mean of 5 degrees. There was no significant difference in the mean values between males and females. A positive linear correlation between the proximal articular set angle and hallux abducto valgus deformity was found (R(2) = 0.52), suggesting that an increased lateral tilt of the metatarsal head is one of the factors that lead to hallux abducto valgus deformity. The relationship between proximal articular set angle and hallux abducto valgus deformity was similar in males and females and did not account for the increased hallux deformity seen in females.

Adolescent↗
PubMed2000

Arthrodesis procedures for salvage of the hallux metatarsophalangeal joint.

First metatarsophalangeal (MTP) fusion has been recommended as a means to salvage various great toe deformities. These deformities include failed hallux valgus procedures, failed silicon implants, previous infection, rheumatoid arthritis, post-traumatic conditions, hallux rigidus, severe hallux valgus deformities, and neuromuscular disorders. A variety of complications, such as hallux varus, first MTP joint instability, infection, recurrent hallux valgus, and avascular necrosis of the first metatarsal head can develop from hallux valgus deformity treatment procedures.

Adult↗
PubMed1993

Flexor tendon transfer for metatarsophalangeal instability of the second toe.

Flexor to extensor transfer was used to treat painful second metatarsophalangeal joint instability in thirteen feet in eleven patients. All patients had their pain reproduced with vertical stress motion of 50% to 100% at the metatarsophalangeal joint. Seven feet had concomitant hallux valgus correction, two feet had no hallux valgus, and four feet underwent no correction for asymptomatic hallux valgus. Results at an average of 33.4 months followup showed that all patients had substantial pain relief, with eight patients becoming pain-free, and five patients experiencing mild pain. All but one were satisfied with their result. Stiffness appeared to be the source of the mild residual pain. All toes, including six toes with preoperative medial crossover toe deformity, were corrected into valgus alignment with adjacent toes. All toes operated on for the first time were able to touch the ground with grasp postoperatively. Flexor to extensor transfer is successful in reducing the second toe and relieving pain caused by instability of the second metatarsophalangeal joint, but may require rapid postoperative mobilization to ensure passive dorsiflexion equal to that of the adjacent toes to reduce postoperative uncomfortable stiffness.

Adult↗
PubMed1976

Double osteotomies for structural correction of hallux abducto valgus.

The authors discuss their procedure for performing osteotomies for correction of hallux abducto valgus. Their technique involves the use of a paper template which aids in establishing normal values according to the functional position in which they desire to place the joint. They outline their procedure for performing the closing abductory wedges of the base of the first metatarsal and the closing medial wedges of the head of the first metatarsal. After the correction has been completed, they apply a below-the-knee cast.

Hallux Valgus↗
PubMed1996

Iatrogenic deformities of the first ray.

Surgical correction of a hallux valgus deformity is common among podiatric and orthopedic surgeons. Complications following hallux valgus surgery are not uncommon. Although many of these complications can be avoided by a comprehensive understanding of the pathomechanics of a hallux valgus deformity and continual honing o surgical skills, some are inevitable. This article provides a comprehensive overview and insight into the diagnosis and treatment of the more common complications encountered with hallux valgus surgery.

Foot Deformities, Acquired↗
PubMed1993

The Chevron bunionectomy: a trigonometric analysis to predict correction.

A trigonometric analysis was developed in an attempt to predict the postoperative hallux valgus angles and intermetatarsal angles after Chevron bunionectomy. This analysis was used in 20 feet to predict postoperative angles, and these predicted values were compared with actual measured roentgenographic values. The postoperative intermetatarsal angles were evaluated to determine their correction to postoperative hallux valgus angles of 20 degrees or less. Using the trigonometric analysis, the postoperative intermetatarsal angles were highly predictable, but the hallux valgus angle could not be reliably predicted for individual patients. The intermetatarsal angle obtained at surgery, however, was indicative of the final hallux valgus angle: 75% of feet with intermetatarsal angles of more than 11 degrees had postoperative hallux valgus angles of more than 20 degrees. Thus, when an intermetatarsal angle of 11 degrees or less can be obtained surgically, the hallux valgus angle can be corrected to 20 degrees or less in most patients.

Adult↗
PubMedDate not supplied

Axial wedge osteotomy of the first metatarsal head (an adjunctive procedure for correction of hallux abducto valgus).

The authors have introduced an adjunctive procedure for correction of the osseous axial eversion of the first ray with hallux abducto valgus deformity. They believe that recurrence of bunion deformity is reduced with correction of this osseous abnormality. Consecutive illustrations are presented with recognition of the individual surgeon's ability to modify the procedure to allow for correction of deformities associated with hallux abducto valgus.

Female↗
PubMed1990

Postsurgical rehabilitation exercises for hallux abducto valgus repair.

The authors describe postsurgical exercises designed to maximize first metatarsophalangeal joint range of motion following the surgical correction of hallux abducto valgus deformities. Concerns regarding the healing of skin, tendon, and bone are discussed, and the need to individualize the exercise program based on the surgical procedures performed is emphasized. Use of these exercises in the postoperative management of hallux abducto valgus surgical repair is encouraged.

Exercise Therapy↗
PubMed2004

The accessory extensor tendon of the first metatarsophalangeal joint.

The accessory extensor tendon of the first metatarsophalangeal joint (1st MTPJ) was evaluated in 32 cadaver feet. Eighty-one percent of feet possessed an accessory tendon to the 1st MTPJ. Of those feet possessing an accessory tendon to the 1st MTPJ, approximately 92% originated from the extensor hallucis longus muscle-tendon unit, while approximately 8% originated from the tibialis anterior muscle-tendon unit. All accessory tendons inserted onto the dorsal/dorsomedial capsule of the 1st MTPJ. Accessory tendons were found to be bilateral in the majority (87.5%) of specimens. Differences in sex distribution of the accessory tendon of the 1st MTPJ were not statistically significant. The difference in distribution of an accessory tendon to the 1st MTPJ in those feet that demonstrated clinical hallux valgus versus those that did not demonstrate hallux valgus was not statistically significant (p = 1.0000, respectively, Fisher's exact test). This tendon is unique to the human foot (lacking in primates) and is a fairly constant structure (80%). The data presented do not lend support for the accessory tendon of the 1st MTPJ to play a role in the development of hallux valgus. At the present time, the role of this accessory tendon on the biomechanics of the 1st MTPJ remains unknown.

Cadaver↗
PubMed2004

Role of first ray hypermobility in the outcome of the Hohmann and the Lapidus procedure. A prospective, randomized trial involving one hundred and one feet.

BACKGROUND: The role of hypermobility of the first tarsometatarsal joint in the etiology of hallux valgus deformity is controversial. Consequently, the need to include an arthrodesis of this joint in the surgical treatment of hallux valgus has been questioned. We designed a study to evaluate the role of arthrodesis of the first tarsometatarsal joint on the outcome of surgical treatment of hallux valgus. METHODS: A prospective, blinded, randomized study was performed to compare the results of a distal osteotomy of the first metatarsal (the Hohmann procedure) with those of an arthrodesis of the first tarsometatarsal joint combined with a soft-tissue procedure of the first metatarsophalangeal joint (the Lapidus procedure) for correction of a symptomatic hallux valgus deformity. One hundred and one feet of eighty-seven patients were included in the study. Fifty feet had a Hohmann procedure, and fifty-one had a Lapidus procedure. The mobility of the first tarsometatarsal joint was assessed in the preoperative clinical examination. On the basis of this examination, two subgroups were identified: sixty-eight feet with a hypermobile first tarsometatarsal joint and thirty-three feet with a nonhypermobile first tarsometatarsal joint. The patients were assessed clinically and radiographically at two years after the operation. RESULTS: There was a significant improvement in the score on the great toe metatarsophalangeal-interphalangeal scale of the American Orthopaedic Foot and Ankle Society and in the pain score following both procedures (p < 0.001). With the numbers available, no significant difference between the two procedures or between the subgroups of feet with a hypermobile first tarsometatarsal joint and those with a nonhypermobile joint could be identified. The patient satisfaction rating did not differ either between the two procedures or between the two subgroups. The radiographic results of the two methods were also similar, except for shortening of the first metatarsal, which was significantly greater (p < 0.001) in the Hohmann group, and plantar flexion of the first metatarsal, which was greater in the Lapidus group. CONCLUSIONS: These short-term results were satisfactory and were comparable with those in previous isolated reports on these two procedures. As no significant differences between the two procedures or between the two subgroups (feet with a hypermobile first tarsometatarsal joint and those with a nonhypermobile joint) were found on clinical assessment, the theory that patients with hallux valgus and a hypermobile first tarsometatarsal joint should be managed with a Lapidus procedure was not supported. LEVEL OF EVIDENCE: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2003

Radiographic changes in forefoot geometry with weightbearing.

Quality assessment of forefoot surgery depends mainly on weightbearing radiographs. A prospective study has been performed to compare the influence of weightbearing on forefoot geometry. Dorsoplantar radiographs for weightbearing and non-weightbearing conditions were performed in 99 patients. Hallux valgus angle, the intermetatarsal angles between the first and second and first and fifth metatarsals and intermetatarsal distance were measured using an interactive digitizer connected to a computer. The intermetatarsal angles showed a statistically significant increase during weightbearing. Unrelated to the severity of hallux valgus deformity, hallux valgus angles demonstrated an inverse behavior showing larger values under non-weightbearing conditions. For that reason, radiological evaluation of forefoot geometry strictly requires similar weightbearing conditions and comparable positioning of the foot.

Adult↗
PubMed2006

Pedographic, clinical, and functional outcome after scarf osteotomy.

The aim of this study was to investigate whether a Scarf osteotomy for hallux valgus correction achieves a good functional restoration with pain reduction, improved mobility, and hallux loading. Therefore, we prospectively studied 32 patients who had a Scarf osteotomy for unilateral hallux valgus. We performed clinical, radiographic, and pedographic evaluations after a mean followup of 33 months to assess clinical and functional outcomes. The mean postoperative American Orthopaedic Foot and Ankle Society score was 89 points. The hallux valgus angle improved from 32.5 degrees to 6.2 degrees , and the intermetatarsal angle improved from 15.5 degrees to 6.6 degrees . The postoperative pedographic patterns showed that the maximum force and impulse decreased under the lateral forefoot and increased under the medial forefoot and hallux. The first ray became more important in the roll-over process. There was a moderate relationship between satisfaction and postoperative hallux valgus angle. The Scarf osteotomy improved the pain situation, the walking capacity, and led to an improved contribution of the hallux in the roll-over process. Therefore, this surgical procedure restores forefoot function and normalizes plantar pressure patterns.

Adult↗
PubMed1996

The podiatric treatment of hallux abducto valgus and its associated condition, bunion, with Tagetes patula.

To assess the effectiveness of marigold therapy using Tagetes patula preparations, a double-blind placebo-controlled trial was designed to be carried out over a period of eight weeks. Sixty patients were entered in the trial. Twenty patients with bilateral hallux abducto valgus and its associated condition, bunion, were randomly selected from 37 subjects for group A. For group B, 40 patients with unilateral hallux abducto valgus and bunion were randomly selected from 69 subjects and subdivided into groups Ba and Bb. Patients with ulcerated conditions, those on medication and those who had undergone surgery for the condition were excluded. The results obtained were highly significant (P < 0.001), suggesting that T. patula preparations, plus protective pad, were effective in reducing the width of the lesion and level of pain of hallux abducto valgus.

Hallux Valgus↗
PubMedDate not supplied

Retrospective statistical analysis of factors influencing the formation of long-term complications following hallux abducto valgus surgery.

A retrospective analysis was performed to determine the long-term results of hallux abducto valgus surgery done under the auspices of the Texas Health Science Center at San Antonio and its teaching hospitals. Two hundred eighty-five patients with a postoperative follow-up ranging from 3 to 10 years were studied. Attempts were made to study many of the patient demographic factors and perioperative procedures that acted to affect the development of a long-term complication. It was found that type of procedure, past medical history, age, medical control, and location of the surgical suite were all important variables to consider in this regard.

Adolescent↗
PubMed2006

[Capsuloperiosteal flap application for the stabilization of chevron osteotomy].

OBJECTIVES: We retrospectively analyzed the results of capsuloperiosteal flap application to stabilize modified distal chevron osteotomy in patients with mild to moderate intermetatarsal and hallux valgus angles. METHODS: Modified chevron osteotomy was performed in 27 feet of 25 patients (14 females, 11 males; mean age 30.4 years; range 19 to 43 years) with hallux valgus. The study group was comprised of patients unresponsive to conservative treatment for painful deformity, at ages 18 to 50 years, and having an intermetatarsal angle less than 17 degrees, hallux valgus angle less than 40 degrees, and no osteoarthritic changes in the metatarsophalangeal joint. The patients were evaluated clinically and radiographically preoperatively and in the early postoperative period, in the sixth week, and once in every six weeks. Clinical assessments were made using the subjective and objective evaluation systems of Bonney and Macnab. The mean follow-up was 22 months (range 8 to 67 months). RESULTS: The mean preoperative hallux valgus angle, which was 31.4 degrees (range 23 degrees to 40 degrees), decreased to 12.8 degrees (4 degrees-22 degrees) postoperatively, with a corresponding decrease in the intermetatarsal angle from 14.2 degrees (11 degrees-17 degrees) to 9.6 degrees (7 degrees-14 degrees). Conformity of the first metatarsophalangeal joint was complete in all the cases. According to the Bonney and Macnab subjective scores, the results were excellent in seven feet (25.9%), good in 17 feet (63%), and moderate in three feet (11.1%). On objective evaluations, the results were excellent in 14 feet (51.9%), good in 11 feet (40.7%), moderate in one foot (3.7%), and poor in one foot. CONCLUSION: Our results suggest that modified chevron procedure whose stability is improved by the use of a capsuloperiosteal flap without using any internal fixation material is an effective alternative for the treatment of patients with moderate degrees of hallux valgus without metatarsophalangeal joint degeneration.

Adolescent↗
PubMed2000

Hypermobility of the first ray.

Hypermobility of the first ray is one of the causative components in common foot problems (such as hallux valgus) with a large intermetatarsal angle and metatarsus primus varus. Although not always associated with hallux valgus, hypermobility is a predisposing factor for this deformity, especially in conjunction with extrinsic factors, such as disruption of the plantar first metatarsal cuneiform ligament and tendon-muscle imbalance. Hypermobility is also frequently found in adolescents with hallux valgus, especially when associated with a large intermetatarsal angle. Motion at the first metatarsocuneiform joint occurs in the sagittal and transverse planes. Most studies agree that greater than 4 degrees and greater than 8 degrees, respectively, constitutes excessive motion. Clinically, hypermobility is evaluated by determining sagittal motion (the grasping test) and transverse motion (the clinical squeeze test) and by identifying signs such as the presence of a dorsal bunion, intractable plantar keratosis beneath the second metatarsal head, and arthritis of the first and second metatarsocuneiform joint. Radiographically, hypermobility is evaluated by measurements from the modified Coleman block test (for sagittal motion) and the radiographic squeeze test (for transverse motion) and by the identification of signs, such as cortical hypertrophy along the medial border of the second metatarsal shaft, a cuneiform split, the presence of os intermetatarseum, and the round shape and increased medial slope of the first metatarsocuneiform joint. Usually, treatment for hypermobility of the first ray is operative, but surgery is contraindicated for patients less than 20 years of age (especially when the epiphysis is not closed) and for patients with generalized ligamentous laxity, short first metatarsal, and arthritis of the hallux MTP joint. The authors' surgical treatment of choice is arthrodesis of the tarsometatarsal joint (as part of the hallux valgus correction), exostectomy, capsulorraphy, and distal soft tissue release to correct and stabilize the first metatarsal at the apex of the deformity. The authors have found it unnecessary to include the base of the second metatarsal. The main complications associated with the Lapidus procedure and its modifications are nonunion, malunion, and dorsal elevation of the first metatarsal. Although radiographic nonunion is the most frequent complication, only 25% of the patients with this condition have associated clinical findings; the results have been defined as good or excellent in two series. These results closely equal those in rheumatoid or sedentary patients managed with newer, modified, less traumatic techniques that stabilize the first metatarsocuneiform joint with screws rather than with arthrodesis.

Arthrodesis↗