Juvenile hallux abducto valgus.
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Foot Deformities↗
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The Reverdin-Isham procedure for the correction of hallux abducto valgus. A distal metatarsal osteotomy procedure.
The Reverdin-Isham Procedure is a distal metatarsal osteotomy procedure that has stood the test of time and has revolutionized the correction of simple to severe hallux abducto valgus deformities. This procedure, a modification of the classic Reverdin bunionectomy, modifies the osteotomy cut of Reverdin by performing a medial wedge osteotomy through the head of the first metatarsal. In this modification, the osteotomy is performed at an oblique angle from dorsal distal to plantar proximal through the head of the first metatarsal, preserving the entire articular surface of the first metatarsal head. The result of this osteotomy places the articular surface of the first metatarsal into alignment with the shaft of the first metatarsal, thereby correcting the structural deformity of hallux abducto valgus at the first MPJ. This modification, using the advances of minimal incision surgery, is a procedure that is highly successful, permits immediate ambulation, causes minimal disability, allows early return to productive activities, and is cost effective.
Bandages↗
[Open osteotomy of the first cuneiform in the treatment of tarsometatarsal varus in children].
MATERIAL AND METHODS: Open wedge osteotomy of the first cuneiform was used for correction of metatarsus varus primus. The osteotomy interested the medial, dorsal and plantar face of the first cuneiform, but lateral cortex should be carefully left intact, it is used like a hinge for opening the osteotomy. This procedure is carried out when varus of the tarsometatarsal joint is superior to 20 degree, it is reduced to its normal value, between 5 and 10 degree. Osteotomy is stabilized with bone graft. In resistant metatarsus adductus, closed wedge osteotomy of the cuboid has been added to correct the varus deformity of the fore foot, it allowed lateral swing of the forefoot: the bone excised from cuboid is used to stabilized medial osteotomy. Twelve children, aged 5 to 15 years, underwent medial open wedge osteotomy of the first cuneiform for correction of 16 feet including 8 hallux valgus, 6 serpentine feet, defined as adductus of the forefoot and valgus of the hindfoot, and 2 clubfeet. In all hallux valgus it was associated with release of all contracted lateral structures and in three cases, shortening of the proximal phalanx. In serpentine feet and clubfeet closed wedge osteotomy of cuboid has been added. RESULTS: Results have been studied with follow up ranging between 18 months and 5 years. In 8 cases of hallux valgus, one case showed recurrence; failure was related to technical deficiency, because the lateral cortex of the first cuneiform was cut accidently leading to over lengthening of the first column. In 6 resistant metatarsus varus and 2 clubfeet, we didn't find any recurrence at term of our follow up. DISCUSSION: In all cases, growth of metatarsals hasn't been disturbed at term of our follow up and tarsometatarsal joint remained well corrected, because proximal epiphyseal plate of metatarsal was normally positioned and saved from damage.
Adolescent↗
Distal L osteotomy in treatment of hallux abducto valgus.
The distal L osteotomy is a useful and versatile procedure for the treatment of mild-to-moderate hallux abducto valgus. A review of common distal osteotomies was presented, along with the original indications and procedural disadvantages. The operative procedure of the distal L osteotomy, coupled with various modifications and complications was described. It is hoped that this brief paper will stimulate interest and use of this valuable osteotomy.
Bone Screws↗
Force, pressure, and motion measurements in the foot: current concepts.
Modern foot-pressure measurement studies have successfully debunked the tripod theory; on the contrary, the highest peak loads under the forefoot occur as often as not under the third metatarsal head and not the first and fifth. This does not necessarily mean that the first metatarsophalangeal joint does not sustain the highest pressures; calculations based on the measured pressures under the metatarsals and digits show that it does. One must bear in mind that the hallux consistently bears significantly more pressure than any of the other toes. It is likely that the pressure borne by the first metatarsal head and hallux combined consistently exceed that for the other four metatarsal heads and their respective digits. In other words, the first ray probably has the consistently highest load in normal feet, even when the second or third metatarsal head achieves a greater peak pressure than the first metatarsal head. Three lines of evidence suggest the role that pressure plays in forefoot pathology. First, metatarsalgia is commonly associated with hallux valgus. It often arises following or is exacerbated by hallux valgus surgery (especially arthroplastic procedures). Patients with hallux valgus demonstrate increased peak pressure under the lateral metatarsal heads that actually increases following the Keller procedure. Second, the peak pressure under callosities are, on the average, higher than normal. Third, diabetic plantar ulcers occur at sites of high pressure. The correlations between peak loads on the lateral column and both age and weight merit some attention, since it is common experience that the prevalence of symptomatic foot lesions is higher in older populations. The correlation with body weight may be unexpected. One would expect that, on the average, body weight would correlate with the weight-bearing surface area of the foot and, therefore, the pressure would be relatively constant. The increased pressure under the medial column suggests a relative instability of the medial column with advancing age and weight. Pressure should not be construed as the only factor. The large overlap in peak pressures found under diabetic ulcers and intact skin in both normal and diabetic feet makes this apparent. However, while peak pressures have been extensively studied, there has been no attempt to measure the duration or frequency of loading on a day-to-day basis. According to Brand, it is not the absolute loads applied to a part but repetitive pressure that is responsible for tissue breakdown, especially when such repetitive loads are applied without any interim period for the tissues to recover.(ABSTRACT TRUNCATED AT 400 WORDS)
Biomechanical Phenomena↗
Surgical considerations in hallux abducto valgus with rheumatoid arthritis.
The rheumatoid arthritis patient often suffers with forefoot complaints. The most frequently seen pedal deformities are hallux abducto valgus and metatarsus primus adductus. Various surgical procedures have been developed to treat these disabling problems. Arthroplasty has been successfully utilized to relieve pain, but often leaves an unpleasant cosmetic result due to shortening and possible return of the deformity. Arthrodesis and implant arthroplasty are alternatives, but introduce other risks and complications for the patient and surgeon.
Arthritis, Rheumatoid↗
The first metatarsal bicorrectional head osteotomy (distal "L"/Reverdin-Laird procedure) for correction of hallux abducto valgus: a retrospective study.
A retrospective analysis of the distal "L" osteotomy with bunionectomy (Reverdin-Laird procedure) for correction of hallux abducto valgus was performed. Sixty-nine cases meeting strict eligibility and exclusion criteria underwent evaluation an average of 33.51 months after the procedure. The evaluation included radiographs, physical examination, patient survey, and medical record review. The average decreases in radiographic angles were as follows: Hallux abductus: 19.97 degrees, relative intermetatarsal angle: 7.49 degrees, proximal articular set angle: 13.9 degrees. Twenty-seven cases demonstrated a negative proximal articular set angle. Only five of these cases resulted in clinical hallux varus. There was an average of 4.23 mm. of first metatarsal shortening with this procedure. Average postoperative range of motion of the first metatarsophalangeal joint was 72.05 degrees. The appearance of the forefoot was judged good or excellent in 91.3% of the surgeries. Hallux position was in rectus or mild abductus in 86.9% of cases. Complication rates included hallux varus, metatarsalgia, lesion subsecond metatarsophalangeal joint, pain at the surgical site, long-term stiffness, pin tract infection, and numbness. There were no cases of osteomyelitis or avascular necrosis. Survey results revealed a high level of patient satisfaction with this procedure (94.2%). Patient satisfaction was dependent on elimination of pain and ability to wear the desired shoe gear comfortably, not on hallux position.
Adolescent↗
Tricorrectional bunionectomy for hallux abducto valgus. A comprehensive outcome study.
A longitudinal outcome study of the tricorrectional bunionectomy with AO screw fixation for the correction of hallux abducto valgus was undertaken involving 84 consecutive patients (121 feet) with a mean age of 48.4 years who underwent the procedure over a 6-month period. Preoperative and postoperative measurements of forefoot angles were calculated, with the following mean results obtained: intermetatarsal angle of 14.46 degrees corrected to 5.72 degrees, hallux abductus angle of 26.38 degrees corrected to 11.65 degrees, proximal articular set angle of 19.85 degrees corrected to 6.06 degrees, and tibial sesamoid position of 4.75 corrected to 1.87. The average time to return to athletic shoes was 12.63 days. Postoperative complications were minor, with no delayed unions, malunions, hematomas, bone infections, or hallux varus. Long-term follow-up (mean, 21.33 months) using the American Orthopaedic Foot and Ankle Society's objective Hallux Metatarsophalangeal-Interphalangeal Scale revealed an overall mean score of 88.94 points out of a possible 100. An excellent mean result of 95 points out of a possible 100 on the subjective patient rating scale was also reported.
Adolescent↗
The role of the akin osteotomy in the surgical management of hallux abducto valgus.
The Akin osteotomy has gained widespread popularity in foot surgery. This article reviews the proper indications, technique, modifications, and complications of the procedure. It also identifies the true role in the surgical management of the hallux abducto valgus deformity.
Hallux↗
Kinematics of the first metatarsophalangeal joint in intact and surgically altered cadavers.
The kinematics of the first metatarsophalangeal joint were investigated in five embalmed cadaver feet (three normal, one hallux valgus, one hallux rigidus). Sagittal displacements of the first metatarsal relative to the proximal phalanx were measured during first metatarsophalangeal joint dorsiplantarflexion; first in intact cadavers, then with an intact capsule sans extracapsular soft tissues (hallux amputated at the first metatarsal cuneiform joint), and finally with a double-stem silicone prosthesis inserted. In the intact cadaver, the base of the metatarsal is raised by FMTP dorsiflexion in a manner similar to a cam. However, this effect ceased when the extracapsular soft tissues were removed. Silicone arthroplasty did not restore cam function.
Biomechanical Phenomena↗
[A misdiagnosed disorder: syndrome of the musculocutaneous nerve of the foot].
The syndrome of the pedal dorsal cutaneous nerve (described by one of us in 1979) is caused by irritation of the nerve in its course at the dorsum pedis. This is a rather frequent syndrome, often overlooked. It is manifested by a distinct association of atypical pain at the dorsum pedis and in the foot. After a review of 10 cases and a literature survey, the authors describe the characteristic signs of this syndrome. There are many factors at the origin of this pathology: static deformities (pes cavus anterior, valgus calcaneus, hallux valgus), local trauma or repeated microtrauma (ill sitting shoe). The diagnosis is essentially clinical, based on a positive Tinel sign along the course of the nerve and on the result of a trial infiltration of the region. The treatment is initially conservative with correction of deformities, adaptation of shoes, and local infiltration with corticosteroids. The neurolysis (performed in 4 cases because of persistent pain), showed dystrophic fibrosis. Such histologic lesions are an argument for considering entrapment as a potential cause of the syndrome.
Adult↗
Physical deformities in Nigerian schools: the Port Harcourt Cohort study.
A total of 3,144 Nigerian school children, adolescents and adults were clinically screened for physical deformities in order to identify and classify the various forms of physical deformities found in Nigerian schools; ascertain cause; determine the health, educational and rehabilitation needs of the subjects and offer suggestions as to ways of meeting these needs. Nine hundred and seventy-two (30.9%) of the subjects were identified with various physical deformities including Non-rachitic Primary Knee Deformities; Pes Planus; Talipes Equinus Varus; Scoliosis; Limb Length Discrepancy; Cubitus Valgus and Hallux Valgus. Statistically significant differences were found in the proportion of male and female subjects who had Genu Valgum (p less than 0.005); Genu Recurvatum (p less than 0.001) and Cubitus Valgus (p less than 0.001). Subjects with Limb Length Discrepancies had a significant mean limb Length Difference between the right and left lower extremities (p less than 0.001). A majority of the physical deformities (92.1%) were attributed to congenital factors. Considering reports from numerous countries, the prevalence of scoliosis in this cohort may be said to be low. In general, it may be concluded that physical deformities in Nigerian schools are mild to moderate in nature; with a few cases requiring correction by physiotherapy or orthopaedic surgery.
Accidents↗
Juvenile hallux abducto valgus association with metatarsus adductus.
The authors evaluated the radiographs of 40 patients (72 feet) under 21 years of age who underwent surgery for symptomatic hallux abducto valgus deformity at Northlake Regional Medical Center. Forty-eight of 72 feet had metatarsus adductus angles greater than 15 degrees. A statistically significant correlation was found between an increasing metatarsus adductus angle and an increasing hallux abductus angle.
Adolescent↗
The Austin procedure for surgical correction of hallux abducto valgus deformity.
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Hallux Valgus↗
Bipartite tibial sesamoid and hallux abducto valgus deformity: a previously unreported correlation.
A retrospective radiographic study was undertaken to determine the incidence of a bipartite tibial sesamoid and its relationship in hallux abducto valgus (HAV) deformity. It was found that the incidence of a bipartite tibial sesamoid associated with HAV deformity was twice as frequent than a bipartite tibial sesamoid in a general foot population. The authors conclude that the tibial sesamoid plays an important role in the development of HAV deformity.
Adolescent↗
Cross screw compression fixation technique in proximal osteotomies of the first metatarsal for correction of hallux abducto valgus.
The author presents an excellent method of internal rigid compression fixation utilizing a cross screw technique for base wedge osteotomies of the first metatarsal in conjunction with hallux abducto valgus correction. Critical principles of AO technique that are satisfied with this particular procedure are discussed. Forty-eight cases are reviewed, summarizing the results and discussing the complications.
Adolescent↗
Rigid compression screw fixation of first proximal phalanx osteotomy for hallux abducto valgus.
Various external and internal immobilization techniques have been employed when performing a medial closing wedge osteotomy at the first proximal phalangeal base for the correction of hallux abducto valgus. Internally, the techniques used such materials as absorbable and nonabsorbable suture, monofilament stainless steel wire, osteoclasps, ministaples, and Kirschner wires. In this study, we have employed the A.O.3 technique of rigid compression screw fixation across the osteotomy site. Three different types of screws were utilized; 3.5-mm. and 4-mm. Bechtol screws and 2.7-mm. cortical bone screw, all of which were 3 cm. in length. Eight procedures were performed for six patients. The authors found the benefits afforded by rigid fixation according to the A.O. technique with respect to the production of postoperative callus at the osteotomy site to be superior in comparison to other modalities of fixation.
Adult↗
Follow-up results 17 years after resection arthroplasty of the great toe.
Resection arthroplasty of the first metatarsophalangeal joint is a well-known operation. The follow-up results more than 17 years after arthroplasty for hallux valgus are reported and discussed. Between 1971 and 1980, 335 resection arthroplasties were performed on 205 patients. The sole indication for resection arthroplasty of the great toe in this study was hallux valgus. The technique involved removal of the proximal one-third of the phalanx with interposition of a capsular flap, occasionally including temporary Kirschner wire fixation. After 17.6 years on average, 102 patients were re-examined clinically and radiographically. Questionnaire assessment revealed a significantly prolonged walking distance, and 70% of the patients were pain-free at follow-up investigation, whereas 67% suffered from severe pain before the operation. Clinical evaluation showed diminished weight-bearing of the great toe during walking and a reduced range of motion of the resected first metatarsophalangeal joint. Radiographic shortening of the proximal phalanx was 37%. The average hallux valgus angle was 23 degrees at follow-up and 34 degrees prior to surgery. The unacceptably high rate of hallux valgus relapse, especially due to a high intermetatarsal angle, emphasizes the unsatisfactory long-term results of the resection arthroplasty. We now recommend this operation for older patients only, and a differentiated approach using reconstructive procedures according to the clinical and radiographical situation for younger patients.
Adolescent↗