An evaluation of the DuVries modification of the McBride hallux abducto valgus correction. A preoperative, immediate postoperative, and longterm study.
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Evaluation Studies as Topic↗
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[Clinical aspects of arthrosis].
Symptoms, physical, laboratory, and x-ray findings in osteoarthrosis are reviewed, special emphasis is drawn to the different clinical forms as compensated, activated, decompensated osteoarthrosis. A sample of 2,494 patients with degenerative joint disease or functional disorders as e.g. myalgia were studied with respect to symptoms and physical findings. As previously described in other studies it turned out, that osteoarthrosis of the knee specially in women is correlated with high body weight; furthermore it could be shown that foot deformities--hallux valgus and pes planus in gonarthrosis, hallux valgus and hammer-toe in polyarthrosis of the finger joints--are significantly more frequent in some degenerative joint diseases.
Adolescent↗
Distal soft tissue release using direct and indirect approaches: an anatomic study.
Two surgical approaches for distal soft tissue release in the correction of hallux valgus, one using a dorsal first web space incision and the other a longitudinal medial capsulotomy incision (used also for medial eminence resection), were studied to compare and delineate the structures actually incised. Anatomic dissections were performed on six fresh-frozen amputation specimens using each of the approaches. The adequacy of release of the adductor hallucis, transverse and oblique heads, first metatarsophalangeal lateral capsule, and suspensory ligament was reviewed. Any inadvertent damage to the first metatarsal head cartilage, second metatarsophalangeal capsule, and lateral head of the flexor hallucis brevis tendon was also noted. Distal soft tissue release is thought to be an important part of hallux valgus surgery. Based on our anatomic dissections, the actual extent of the release may be inconsistent and unpredictable, and may have implications for the predictability of results after hallux valgus surgery.
Cadaver↗
Modified Reverdin technique for hallux abducto valgus (with increased proximal articular set angle of the first metatarsophalangeal joint).
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Cartilage, Articular↗
The radiographic morphology of foot deformities in patients with fibrodysplasia ossificans progressiva.
BACKGROUND: The most consistent deformities that allow early diagnosis of fibrodysplasia ossificans progressiva are the presence of bilateral short first rays and hallux valgus. The purpose of this study was to describe the radiographic features observed in the feet of patients with fibrodysplasia ossificans progressiva. METHODS: The radiographs of 26 feet (15 patients with fibrodysplasia ossificans progressiva) were reviewed to evaluate the radiographic changes that occur in the first ray. Variables analyzed were the hallux valgus (HV) angle, the distal metatarsal articular (DMA) angle, the proximal phalangeal articular (PPA) angle, the intermetatarsal (IM) angle, ratio of the lengths of the first and second metatarsal lengths (MT1:MT2), and the first and second ray length ratio. The length ratios were then subtracted from similar ratios in radiographs of age- and gender-matched normal patients previously reported. RESULTS: The proximal phalanx was consistently shortened but morphologically dissimilar from subject to subject. Asymmetry was noted in some patients with bilateral radiographs. The mean HV angle was 28 degrees, and the mean IM angle was 10 degrees. The mean DMA angle was 33 degrees, and the mean PPA angle was 14 degrees. The MT1:MT2 ratio was 0.89, and the mean first ray to second ray length ratio was 0.87. The mean of the differences in the MT1:MT2 and first and second ray length ratios in patients with fibrodysplasia ossificans progressiva compared to the normal controls were 0.05 and 0.01, respectively. Fusion occurred between the abnormal tibial epiphysis of the proximal phalanx and metatarsal head with advancing age, and 68% of the metatarsal heads were fused with the abnormal proximal phalangeal epiphysis. CONCLUSIONS: Foot pathology in patients with fibrodysplasia ossificans progressiva is variable but consistently involves an abnormality of the tibial aspect of the proximal phalangeal epiphysis of the hallux. This results in the clinical observation of hallux valgus in these patients. The first metatarsal is consistently shortened, and fusion between the epiphysis of the abnormal proximal phalanx and the shortened first metatarsal head occurs with advancing age.
Child↗
Biplanar chevron osteotomy.
Results of biplanar chevron osteotomy performed on patients with mild-to-moderate hallux valgus deformity with an increased distal metatarsal articular angle (DMAA) are shown. The study included clinical data of 32 patients (54 feet) who had completed a 2-year follow-up, and radiological data of these 32 and other 29 patients (50 feet) for a total of 61 patients (104 feet, 53 right and 51 left). There were 59 females and two males with ages varying from 11 to 66 years. According to the AOFAS Hallux Rating, the preoperative average score (50) improved to 90 (average score after the surgery). The hallux valgus angle was improved from an average of 25 degrees to 14 degrees, the first intermetatarsal angle from 12 degrees to 8 degrees and the DMAA from 15 degrees to 5 degrees. At the end of treatment, 94% of patients were classified as having grade 0 or 1 sesamoid lateral sub-luxation. Given improvement in angles and 90% of patients satisfied with an average AOFAS postoperative score of 90, the technique seems indicated for treatment of symptomatic hallux valgus deformity with increased DMAA.
Adolescent↗
Metatarsus primus elevatus in hallux rigidus: fact or fiction?
Two hundred seventy-five lateral weightbearing radiographs of isolated pathology were reviewed and stratified into hallux rigidus (n = 100), hallux valgus (n = 75), plantar fasciitis (n = 50), and Morton's neuroma (n = 50) groups. The patient population consisted of healthy individuals with no history of foot trauma or surgery. The first to second metatarsal head elevation, Seiberg index, first to second sagittal intermetatarsal angle, first to fifth metatarsal head distance, and hallux equinus angle were measured in each population. Statistically significant differences were found between the hallux valgus, plantar fasciitis, and Morton's neuroma populations and the hallux rigidus population, which showed greater elevation of the first metatarsal relative to the second for each radiographic measurement technique. In the hallux rigidus population, there was a statistically significant difference between grade II and grades I and III regarding the first to fifth metatarsal head distance (greater in grade II) and the hallux equinus angle (lower in grade II). A review of the literature and comparison with historical controls reveals that metatarsus primus elevatus exists in hallux rigidus and is greater than that found in hallux valgus, plantar fasciitis, and Morton's neuroma groups.
Adult↗
Small-dose clonidine prolongs postoperative analgesia after sciatic-femoral nerve block with 0.75% ropivacaine for foot surgery.
UNLABELLED: To evaluate the effects of adding small-dose clonidine to 0.75% ropivacaine during peripheral nerve blocks, 30 ASA physical status I and II patients undergoing hallux valgus repair under combined sciatic-femoral nerve block were randomly allocated in a double-blinded fashion to receive block placement with 30 mL of either 0.75% ropivacaine alone (group Ropivacaine, n = 15) or 0.75% ropivacaine plus 1 microg/kg clonidine (group Ropivacaine-Clonidine, n = 15). Hemodynamic variables, oxygen saturation, and levels of sedation, as well as the time required to achieve surgical block and time to first analgesic request, were recorded by a blinded observer. Time to surgical blockade required 10 min in both groups. Patients in the Ropivacaine-Clonidine group were more sedated than patients in the Ropivacaine group only 10 min after block placement. No differences in oxygen saturation and hemodynamic variables, degree of pain measured at first analgesic request, and consumption of postoperative analgesics were observed between the two groups. The mean time from block placement to first request for pain medication was shorter in group Ropivacaine (13.7 h; 25th-75th percentiles: 11. 8-14.5 h) than in group Ropivacaine-Clonidine (16.8 h; 25th-75th percentiles: 13.5-17.8 h) (P = 0.038). We conclude that adding 1 microg/kg clonidine to 0.75% ropivacaine provided a 3-h delay in first request for pain medication after hallux valgus repair, with no clinically relevant side effects. IMPLICATIONS: This prospective, randomized, double-blinded study demonstrated that, when providing combined sciatic-femoral nerve block for hallux valgus repair, the addition of 1 microg/kg clonidine to 0.75% ropivacaine prolongs the duration of postoperative analgesia by 3 h, with only a slight and short-lived increase in the degree of sedation and no hemodynamic adverse effects.
Adult↗
Surgical correction of hallux abducto valgus in a cerebral palsy patient. A 5-year follow-up.
This article reviews the causes of foot deformities in patients with cerebral palsy. The authors underscore the necessity for a total evaluation of such patients. It is believed that the patient described in this article showed a recurrence of the hallux deformity due to failure to control the causative factors of this condition. Postoperative management with braces or orthoses may well have prevented recurrence.
Adult↗
[Scarf osteotomy for the treatment of forefoot deformity].
PURPOSE OF THE STUDY: The outcome of surgical treatment in hallux valgus is sometimes unsatisfactory for both the patient and the surgeon. The valgus position of the big toe in the metatarsophalangeal joint is associated with a deviation to varus of the first metatarsal, resulting in the space between the first and second metatarsals called the intermetatarsal (IMT) angle. In most patients the angle is between 10 and 20 degrees. These patients were indicated for scarf osteotomy as this method has been reported to achieve good outcomes. The results are compared with the relevant literature data on foot osteotomy. MATERIAL: Our group involved 62 scarf osteotomies carried out on 49 patients who were followed up for an average of 18 months (range, 6-36 months). Three patients underwent surgery on both feet in one stage, five had bilateral surgery in two stages. The average pre-operative IMT angle was 16 degrees (range, 9-21 degrees) and the average hallux valgus angle was 37 degrees. METHODS: The patients were indicated for surgery on the basis of subjective complains and weight-bearing radiographs. Scarf osteotomy was performed by the Barouk technique. From a signle incision in the first intermetatarsal space, the lateral articular capsule was released, adductor tendon was dissected and sesamoid bones were reduced. The first metatarsal was exposed from an incision along its medial axis, the bunion was excised and Z-osteotomy of the metatarsal was performed. The distal fragment was shifted laterally, fixed with two 3.5 mm Poldi screws, and the capsule was closed under tension with transosseal suture. If necessary, an additional procedure on the big toe phalanges or osteotomy of the other metatarsals are carried out. From the second post-operative day the patients were allowed to walk on the heel, after removal of sutures they walked wearing a special sandal and, from the third week onwards, full weight-bearing was allowed. The average hospital stay lasted 4 days. The evaluation of post-operative results was based on radiograms, subjective feelings of the patients and clinical assessment of the range of big toe motion. RESULTS: Out of 62 operations carried out on 49 patients (average age, 41.5 years), 23 were performed on the right and 23 on the left foot; bilateral surgery was carried out in three patients in one stage and in five patients in two stages. Simultaneously, the Weil osteotomy was performed on six feet, Akin osteotomy of the big toe phalanges on five feet, Braggard surgery of the second toe on three feet, and scarf osteotomy of the fifth metatarsal on three feet. All feet were indicated for scarf osteotomy because of pain and, in 56 feet, also esthetic reasons were involved. The patients' subjective post-operative assessments were as follows: satisfaction with the outcome in 58 feet, pain associated with tight shoes in two feet, pain while walking in six feet, and dissatisfaction with the big toe shape in one patient.The average IMT angle of 16 degrees and hallux valgus angle of 37 degrees on the pre-operative radiograms showed improvements to 9 degrees and 18 degrees, respectively, on the post-operative X-ray. The sesamoid bones were reduced in all cases. After surgery the average range of motion was restricted as follows: plantar flexion by 7 degrees (to 23 degrees) and dorsal flexion by 6 degrees (to 54 degrees). The complications included one fracture of the head requiring osteosynthesis, one failure of fixation with repeat valgus osteotomy, three cases of insufficient correction of a valgus position that had to be treated by additional osteotomy of the first toe phalanges. DISCUSSION: Out of other types of osteotomy (Funk, Dega, spike osteotomy), outcomes similar to scarf osteotomy have been achieved only by the Austin procedure. However, in this, shifting of the distal fragment is limited and the results show that the Austin method should be preferred in deformities with an IMT angle of about 10 degrees. Scarf osteotomy in addition allows for early weight-bearing, does not produce shortening of the first metatarsal but permits its elongation and elevation by oblique osteotomy, if necessary. It can also be used for the fifth metatarsal. The drawbacks include a more complicated surgical technique and higher risk of complications; shifting of the distal fragment is also limited and, for this reason, scarf osteotomy is not effective in deformities with an IMT angle higher than 20 degrees. CONCLUSIONS: Scarf osteotomy is an effective procedure for a moderate valgus deformity of the big toe with an IMT angle between 10 and 20 degrees. It permits early weight-bearing of the treated extremity. It requires exact pre-operative planning and strict adherence to the operative technique.
Adult↗
Pathologic anatomy of hallux abducto valgus.
HAV is a joint deformity that has some very characteristic anatomic features but that may be developed from a variety of interactive causes, both anatomic and functional. In the normal condition, the first metatarsal bone and hallucal phalanges form an axial array of bones. At the first metatarsophalangeal joint this arrangement is stabilized by a set of muscles whose tendons surround the joint. The pathology is associated with the deviation of the bones from their axial position and the related destabilization of the muscle group around the joint, specifically: (1) The hallux deviates and rotates laterally, while the first metatarsal deviates medially and also rotates laterally to some degree. (2) Deviation of the two main segments of the joint causes tearing and weakening of the medial capsular fibers and pulls the sesamoid bones and metatarsal head away from their normal plantar articulation. (3) Abnormal articulation of the sesamoid bones under the crista and pressure of the medial capsular wall cause erosion of cartilage and subchondral bone on the metatarsal head. (4) Deviation of the hallux redistributes the tendon insertions in relation to the joint axes of motion such that they serve to aggravate the deviation. (5) The deviated position of the hallux and eccentric actions of the tendons create a reaction force on the metatarsal head that serves to further medially displace the first metatarsal bone.
Hallux Valgus↗
Complications of screw-fixated chevron osteotomies for the correction of hallux abducto valgus.
The surgical records of three podiatric physicians were reviewed to identify all chevron-type osteotomies performed during 2000-2001 for the correction of bunion deformity, and complications were reviewed for each. In the 95 cases identified, 15 complications occurred in 12 patients. Of these 15 complications, 4 were soft-tissue infections (4 patients), 4 were cases of painful hardware (3 patients), 4 were cases of second metatarsal head pain (2 patients), 2 were cases of cystic changes initially interpreted as osteomyelitis but later determined to be degenerative changes (2 patients), and 1 was a case of stiff toe (1 patient). There were no cases of avascular necrosis, hallux varus, or recurrence.
Adult↗
Application of distal metaphyseal osteotomy for treatment of high intermetatarsal angle bunion deformities.
This is a retrospective study of 10 patients (13 feet) with moderate to severe hallux valgus who underwent a chevron or modified chevron osteotomy with multiple adjunctive soft-tissue releases for surgical treatment. Radiographic and subjective results were evaluated with an average follow-up of 24 months (range, 10-41). Preoperative criteria included an intermetatarsal (IM) angle of greater than 16 degrees (average of 18.4 degrees) and painful hallux valgus deformity. Average preop hallux abductus was 35.4 degrees (range, 25 degrees-48 degrees). The average reduction in the actual IM angle was (-) 5.2 degrees with a relative IM correction of (-) 11.6 degrees. Average postoperative hallux abductus angle was 7.0 degrees (range, 0 degree-22 degrees). Subjectively, all patients were satisfied with their results and stated they would have the procedure again. No complications were noted in this patient population, including, infection, avascular necrosis, hallux varus, and recurrence of deformity. The chevron osteotomy was found to be successful in this population with high intermetatarsal angles when appropriate consideration was given to correction of soft-tissue-deforming forces and contractures.
Adult↗
Reliability of clinical tests of foot and ankle characteristics in older people.
Lower-extremity problems are common in older people; however, the reliability of clinical tools used to assess foot and ankle characteristics has not been rigorously evaluated. This study evaluated the test-retest reliability of a battery of simple clinical tests of foot and ankle characteristics (tactile sensitivity of the first metatarsophalangeal joint, navicular height, foot length and width, hallux valgus severity, an overall foot problem score, ankle flexibility, ankle dorsiflexion strength, and foot pain) in 31 individuals (13 men and 18 women) aged 76 to 87 years recruited from the community. Three examiners performed the tests on two occasions approximately 2 weeks apart. Intraclass correlation coefficients and coefficients of variation were calculated for continuously scored tests, and the kappa statistic (kappa) was used to determine the reliability of hallux valgus severity grading. All of the continuously scored tests had acceptable reliability (intraclass correlation coefficients of 0.64 to 0.98; coefficients of variation of 0.6% to 15.0%), as did hallux valgus severity grading (kappa = 0.77; absolute percentage agreement, 84%). These simple clinical tests can now be used with confidence in clinical and research settings to provide reliable and functionally important information regarding foot and ankle characteristics in older people.
Aged↗
MRI evaluation of Orthosorb pin insertion for surgical treatment of hallux abducto valgus.
This preliminary study considers the advantage of magnetic resonance imaging over plain film radiography in assessing pin resorption and bone marrow regeneration over a 6-month period. The Orthosorb pin was used to fixate an Austin osteotomy in a patient and was followed with serial magnetic resonance imaging at scheduled intervals. This study expands on the preceding study in this issue of the Journal, which was carried out in the rat model.
Adult↗
A mechanical comparison of first metatarsal diaphyseal osteotomies for the correction of hallux abducto valgus.
The purpose of this study was to perform a mechanical comparison of four commonly performed diaphyseal first metatarsal osteotomies. Fifty first metatarsal-first cuneiform sawbone models were divided equally into five groups: control, offset V, inverted Z, Mau, and Ludloff osteotomy groups. All osteotomies were fixated with two 2.7-mm Synthes cortical screws. Each specimen was then stressed through a computer-controlled hydraulic tensile testing machine while recording the maximum load, energy, stiffness, and fracture pattern. The offset V was superior in terms of maximum load (137.8 N) and energy (0.86 J), as compared to the inverted Z (maximum load 74.7 N and energy 0.24 J), the Mau (maximum load 74.3 N and energy 0.15 J), and the Ludloff (maximum load 67.0 N and energy 0.32 J). The offset V (16.6 N/mm) demonstrated no significant difference in stiffness with the Mau (19.7 N/mm), and was stiffer to the inverted Z (14.4 N/mm) and the Ludloff (9.4 N/mm). We conclude that one could expect a safer and immediate return to weightbearing postoperatively with the offset V osteotomy as compared to the inverted Z, Mau, and Ludloff osteotomies.
Analysis of Variance↗
Revision of failed foot surgery: a critical analysis.
The purpose of this study was to consider the causes of patient dissatisfaction following foot surgery and review whether poor outcomes are more commonly associated with particular techniques. Two hundred forty-four patients who had previously undergone foot surgery were referred to a podiatric surgery service because of continued pain, disability, footwear-fitting problems, and cosmetic concerns. The majority of cases had previously undergone first ray surgery to correct hallux valgus. The most common reason for referral was transfer metatarsalgia followed by recurrence of hallux valgus and lesser digit deformity. Thirty-two patients were treated with conservative measures, including orthoses and cortisone injections. Eight patients (25%) were completely satisfied with conservative treatment, 20 patients (63%) were satisfied with reservations, and four patients (12.5%) were dissatisfied. One hundred seventy-six patients underwent revision surgery. High patient satisfaction was achieved with surgical revision with 123 patients (69%) completely satisfied at an average 5.6-month follow-up, 43 patients (24%) were satisfied with reservations, while 10 patients (6%) were dissatisfied. Complications occurred in 23 patients (13%) with nine cases developing a superficial postoperative infection. In reviewing this series of patients, it is apparent that poor surgical outcomes and the need for revision surgery could in many cases be prevented with selection of surgical techniques that avoid joint destruction, excessive shortening of single metatarsals, and digital amputation.
Adolescent↗
Long-term results of the modified Hoffman procedure in the rheumatoid forefoot.
BACKGROUND: Rheumatoid arthritis commonly affects the forefoot, causing metatarsalgia, hallux valgus, and deformities of the lesser toes. Various types of surgical correction have been described, including resection of the lesser-toe metatarsal heads coupled with arthrodesis of the great toe, resection arthroplasty of the proximal phalanx or metatarsal head, and metatarsal osteotomy. We report the results at an average of five and a half years following thirty-seven consecutive forefoot arthroplasties performed in twenty patients by one surgeon using a technique involving resection of all five metatarsal heads. METHODS: All patients were treated with the same technique of resection of all five metatarsal heads through three dorsal incisions. All surviving patients were asked to return for follow-up, which included subjective assessment (with use of visual analogue pain scores, AOFAS [American Orthopaedic Foot and Ankle Society] foot scores, and SF-12 [Short Form-12] mental and physical disability scores), physical examination, and radiographic evaluation. RESULTS: All results were satisfactory to excellent in the short term (six weeks postoperatively), and no patient sought additional surgical treatment for the feet. A superficial infection subsequently developed in two feet, and two feet had delayed wound-healing. At an average of 64.9 months postoperatively, the average AOFAS forefoot score was 64.5 points and the average hallux valgus angle was 22.3 degrees . There were no reoperations. CONCLUSIONS: Resection of all five metatarsal heads in patients with metatarsalgia and hallux valgus associated with rheumatoid arthritis can be a safe procedure that provides reasonable, if rarely complete, relief of symptoms.
Adult↗