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PubMed2004

Results of bioabsorbable fixation of metatarsal osteotomies.

Biodegradable rods of self-reinforcing polylevolactic acid were used for fixation in 51 consecutive distal chevron osteotomies correcting for mild to moderate hallux valgus. Charts were retrospectively reviewed specifically for sterile sinus formation, wound complications, infection, and symptom recurrence. Radiographs obtained at most recent follow-up were evaluated for osteolysis and fixation failure. Hallux valgus angle, intermetatarsal angle, and distal metatarsal articular angle were measured preoperatively and postoperatively. Given the data presented here, we conclude that these implants can be used for fixation of distal chevron metatarsal osteotomies and that clinical results and patient satisfaction are excellent.

Adolescent↗
PubMed1981

Arthrodesis of the metatarsophalangeal joint of the great toe.

A review of the literature attests to a place for arthrodesis of the metatarsophalangeal joint of the great toe in the management of hallux valgus and rigidus. The predictability and consistency of the result of arthrodesis is noted with good results in approximately 90% of cases. The functional excellence and durability of such a result are impressive. The procedure is particularly indicated in patients with hallux rigidus and hallux valgus associated with metatarsalgia. There are a number of operative techniques, but the cone arthrodesis procedure described by Wilson is probably nearest to the ideal.

Arthrodesis↗
PubMed1997

Radiographic analysis of metatarsus primus varus. 45 feet followed 15 months after distal metatarsal osteotomy and lateral soft-tissue release.

We analyzed standardized radiographs of 45 feet in 41 patients with symptomatic hallux valgus and an intermetatarsal angle of 17 (15-23) degrees 15 (9-24) months after distal metatarsal osteotomy and lateral soft-tissue releases. A mean reduction in the II-intermetatarsal angle of 12 degrees and hallux valgus angle of 24 degrees was found. On average, the metatarsus primus varus angle improved by 4 degrees, the I-intermetatarsal angle by 3 degrees and the inclination angle of the first cuneiform by 4 degrees. We conclude that this operation corrects the metatarsus primus varus, without substantially altering the alignment of the long axis of the first metatarsal.

Adult↗
PubMed1998

Biplanar chevron osteotomy.

We retrospectively reviewed the results of using a biplanar chevron osteotomy performed on patients who presented with hallux valgus deformities with an increased distal metatarsal articular angle (DMAA). The study included 17 feet (14 patients) of 12 women and 2 men. The average follow-up was 33 months. The average American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Clinical Rating Score was 91. Ten of the 14 patients (13 of 17 feet) stated that they would choose to undergo the procedure again. The hallux valgus angle was improved from an average of 22 degrees to 18 degrees, the intermetatarsal angle from 11 degrees to 9 degrees, and the DMAA from 16 degrees to 9 degrees. We have demonstrated this procedure to be useful in the treatment of symptomatic bunion deformities with an increased DMAA.

Adult↗
PubMed1995

First metatarsophalangeal joint arthroplasties in the Commonwealth of Virginia.

This retrospective analysis of arthroplasty of the first metatarsophalangeal joint documents the incidence of surgery as well as the selection of the commercially available implants. During a 1-year period, 1994, arthroplasties were performed in 47 of the 1.7 million subscribers to Trigon Blue Cross Blue Shield of Virginia. Women received the majority of the arthroplasties (83%). Of the 47 cases, the silicone implant was predominantly used (83%). The most common indications for arthroplasty were hallux valgus (30%) and hallux rigidus (28%). Podiatrists performed 79% of the procedures, while orthopedic surgeons performed the remaining 21% of the cases. A prospective study is needed that will assess the long-term performance of the different implants.

Age Distribution↗
PubMed1994

Turf toe injury.

Long term morbidity secondary to previous first MP injury has been reported by Coker and associates and involved persistent pain with athletic activities and restricted range of motion. Clanton and coworkers noted hallux valgus and early hallux rigidus as specific long term sequelae. Clanton and Seifert have reviewed 20 athletes with prior turf toe injury with greater than 5 year follow-up noting a 50% incidence of persistent symptoms. Further study is needed regarding the long term effect of turf toe injury, but it is clearly a significant athletic injury that requires appropriate treatment tailored to the severity of the injury.

Athletic Injuries↗
PubMed1998

Fixation comparison for chevron osteotomies.

A comparison study of temporary K-wire fixation, permanent Herbert Whipple screw fixation, versus no osteotomy fixation was performed on distal chevron osteotomies for hallux valgus deformities. Nineteen chevron osteotomies were performed on 17 patients. Six patients received a Herbert Whipple screw for fixation, seven patients received temporary K-wire fixation, and six patients received no fixation for the chevron osteotomy. The average postoperative hallux valgus (HV) angle improved by 7.1 degrees with no fixation, 6.3 degrees with temporary K-wire fixation, and 9.5 degrees with Herbert Whipple screw fixation. Comparison of the three groups using the Student's t-test revealed no statistical difference between the three groups (P = 0.6). The increased anesthesia time and operative costs for Herbert Whipple screw fixation was found to be statistically significant in comparison with the use of no fixation (P = <0.001). Time and cost studies were not significantly different for the K-wire and no fixation groups. Follow-up averaged 3.3 years. All patients reported satisfaction with the procedure and an improvement of their preoperative complaints. No significant difference in patient satisfaction was found to exist between the groups receiving fixation and those who did not have fixation. The results of this study can find no long-term benefit when comparing costs and patient satisfaction with the use of any temporary or permanent fixation of osteotomy sites when performing chevron osteotomies.

Adult↗
PubMed2005

Alternative to the modified jones procedure: outcomes of the flexor hallucis longus (FHL) tendon transfer procedure for correction of clawed hallux.

BACKGROUND: The modified Jones procedure is the traditional operative procedure for correction of a clawed hallux, although the deformity may be caused by overpull of one of three different muscles. In this study we present the radiographic and functional outcomes of flexor hallucis longus (FHL) tendon transfer as treatment for clawed hallux. The transfer is performed by drawing two thirds of the FHL tendon up through a drill hole in the proximal phalanx and then suturing it medially back to the remaining third. METHODS: We retrospectively identified 19 patients (22 feet) who had FHL tendon transfer for correction of clawed hallux over a period of 5 years. Followup was an average of 51.0 (range 6 to 74; +/- 3.8) months after the procedure. Outcome and patient satisfaction were determined using the Long-Form Musculoskeletal Function Assessment (MFA) score. Patients were asked whether they were satisfied, somewhat satisfied, or dissatisfied with the overall outcome and were asked about shoewear limitations. Preoperative and postoperative radiographs were evaluated in 15 patients (17 feet). We measured the hallux valgus and interphalangeal (IP) angles on the anteroposterior (AP) radiographs. On the lateral view we measured the angle of the IP joint, the metatarsophalangeal (MTP) joint, and the talometatarsal angle. Statistical analysis was done using a repeated measures ANOVA (p < 0.05). RESULTS: On the lateral radiographs, the hallux IP joint angle (p < 0.0012; n = 15) and hallux MTP joint angle (p < 0.0265; n = 15) were significantly reduced postoperatively. On AP radiographs, the hallux valgus angle (p < 0.0334) was significantly reduced; however, the IP angle and the talometatarsal angle were not significantly different after surgery. Patients had an average MFA score of 14.6 (+/-3.8 standard error, range 1 to 35; n = 19). Thirteen patients were fully satisfied and six were somewhat satisfied with the overall result of the surgery. Four patients thought that their hallux limited the types of shoes they could wear, while 15 did not. CONCLUSION: It has been shown that clawed hallux can result from excessive motor function in one of three muscles: FHL tendon, peroneus longus (PL), and extensor hallucis longus (EHL). This study suggests that transfer of part of the tendon of the FHL is an effective alternative operative procedure for correction of clawed hallux.

Adolescent↗
PubMedDate not supplied

The Mitchell bunionectomy: a prospective study of 60 consecutive cases utilizing single K-wire fixation.

The authors prospectively evaluated 45 patients (60 feet) affected by hallux valgus and treated with a distal metatarsal osteotomy. The surgical procedure consisted of a modified Mitchell osteotomy, in which fixation was achieved with a Kirschner wire that was driven into the proximal osteotomy fragment and buttressed the distal one. Early weightbearing was allowed without a cast. Follow-up averaged 25 months. The mean American Orthopedic Foot and Ankle Society clinical hallux score increased from 44.6/100 preoperatively to 83.2/100. Radiographic evaluation showed that mean metatarsophalangeal and intermetatarsal angles decreased respectively from 31.7 degrees to 16.9 degrees, and from 15.4 degrees to 8.6 degrees. Short-term loss of correction occurred in three cases (4%). Six feet (10%) had unrelieved metatarsalgia that was related to excessive shortening of the first metatarsal and/or inappropriate orientation of the metatarsal head. Stabilization of the Mitchell osteotomy with a Kirschner wire proved safe and effective for the surgical correction of mild to moderate hallux valgus.

Adult↗
PubMed1997

Prevalence of radiographic foot abnormalities in patients with diabetes.

Clinicians are increasingly aware that mechanical aspects of foot deformities, such as Charcot changes, clawtoes, bunion deformities, or cavus or planus foot deformities, might have an impact on the occurrence, potential healing, and recurrence of foot ulcers. We report the prevalence of plain radiographic changes and attempt to rate the severity of those deformities in the feet of 456 diabetic veteran medicine clinic enrollees. All 456 radiographs were reviewed by orthopaedic surgeons to specifically identify Charcot changes, presence of arterial calcification, dislocation of the lesser toe metatarsophalangeal joints, hallux interphalangeal joint dislocation, and radiographic evidence of previous surgery. Radiographs of 428 patients were taken while weight-bearing, and these were reviewed to quantify hallux valgus angles, intermetatarsal 1-2 angles, fifth metatarsal-proximal phalangeal angles, second metatarsal lengths, lateral talocalcaneal and talar-first metatarsal angles, and claw toe deformities. The prevalence of Charcot changes was 1.4% (six subjects), and all had radiographic evidence of midfoot Charcot changes. Other deformities, such as clawtoes, hallux valgus, lesser toe joint dislocations, and alterations in arch height, are more common in veterans with diabetes.

Adult↗
PubMed1981

Hallux disorder and metatarsal alignment.

The results of surgical procedures to correct hallux valgus have thus far been unpredictable. Hitherto the problem has been approached on the horizontal plane (i.e., from the dorsoplantar point of view), but the author has devised a new apparatus for measuring and recording the weight-bearing frontal alignment (WFA). Abnormal positions of the metatarsal heads, observed from the front, may cause pain in the forefoot, and hallux valgus may contribute to the problem. Analysis of the WFA before a surgical operation enables the surgeon to select the proper procedure for each foot and simultaneously to correct the defects in the horizontal and frontal planes. WFA analysis also enables the surgeon to avoid grave errors in choosing a surgical procedure. After hallux rigidus surgery, the forefoot tends to be more pronated than before and although painless, is predisposed to metatarsalgia. if the WFA is known, this can be avoided.

Biomechanical Phenomena↗
PubMed1995

[Long-term results with women's feet].

When ladies complain of painful feet, they usually have hallux valgus. They can hardly accept that their ailment has something to do with too narrow shoes; therefore, it is not easy to explain to them, that usually the problem could be solved with comfortable large foot-wear and that an operation is not always necessary. On the other hand, operations for hallux valgus must not be labelled simply as a luxury procedure. Many patients can be relieved of pain and given the opportunity to wear acceptable fashionable shoes, provided that the appropriate method is chosen for each patient individually. This choice depends not only on the deformity of the foot, but to a high degree on age, profession and the situation of the patient, and what is most important, on her ideas and wishes.

Female↗
PubMed2001

Single absorbable polydioxanone pin fixation for distal chevron bunion osteotomies.

The distal chevron osteotomy is a well-established technique for correction of symptomatic mild to moderate metatarsus primus varus with hallux valgus deformity. Fixation of the osteotomy ranges from none to bone pegs, Kirschner wires, screws, or absorbable pins. We evaluated one surgeon's (J.K.D.) results of distal chevron osteotomy fixation with a single, nonpredrilled, 1.3-mm poly-p-dioxanone pin and analyzed any differences in patients with unilateral or bilateral symptomatic metatarsus primus varus with hallux valgus deformities. All osteotomies healed without evidence of infection, osteolysis, nonunion, or necrosis. Equal correction was achieved in unilateral and bilateral procedures. The technique is quick and easy, and adequate fixation is achieved.

Adult↗
PubMedDate not supplied

Considerations for the Lapidus operation.

The Lapidus operation for correction of severe hallux valgus with metatarsus primus varus has never been well accepted by foot surgeons. The main reason for this has been the poor results obtained from its misuse. Lapidus strongly advocated the operation as a virtual panacea for correction of all degrees of severity of these deformities in both young and old patients. The technique, however, is appropriate for severe metatarsus primus varus with hallux valgus, in the foot with marked first ray hypermobility and collapsed distal-medial arch. The purpose and proper indications for the Lapidus operation are discussed, and the technique is illustrated.

Abnormalities, Multiple↗
PubMedDate not supplied

Forefoot problems in cerebral palsy-diagnosis and management.

Forefoot deformities in cerebral palsy include cavus, metatarsus adductus, hallux valgus and bunion, dorsal bunion, and toe flexion contractures. Both prevention and correction of these deformities are surgical. Some can be prevented by lengthening or tenotomy of the spastic muscle that causes the dynamic deformity which eventually becomes the fixed skeletal deformity. Fixed deformities need osteotomies and arthrodesis of the bones in addition to removing the force of the deforming muscle. Some forefoot problems are related to the mid and hind foot, e.g., hallux valgus due to spastic pes valgus. Severe cavus can develop after overzealous Achilles tendon lengthening and failure to separate forefoot from hindfoot equinus.

Arthrodesis↗
PubMed1998

Assessing sesamoid subluxation: how good is the AP radiograph?

Subluxation of the metatarsosesamoid joints frequently occurs with the development of hallux valgus deformity, and the restoration of a normal metatarsosesamoid articulation has been proposed as essential for achieving a biomechanically sound operative result. The position of the sesamoid bones on the AP radiograph is used often to assess the pre- and postoperative relationship between the hallucal sesamoids and the metatarsal sulci. We evaluated the validity of this approach. Thirty subjects with hallux valgus and 30 control subjects participated in this study by undergoing both AP and tangential weightbearing radiographs. The sesamoid station on the AP radiographs was compared with the position of the sesamoids on tangential radiographs, using a new continuous measure to estimate subluxation. In approximately half of the cases, we found a difference between the apparent sesamoid station on the AP radiograph and the true position on the tangential one. Increased metatarsal rotation was associated with misclassification of the sesamoid station on the AP radiograph. We conclude that the standard method for measuring the sesamoid station on the AP radiograph is not valid. Surgeons wishing to evaluate the metatarsosesamoid joint should obtain weightbearing tangential radiographs.

Evaluation Studies as Topic↗
PubMed1985

Treatment of the juvenile bunion by Mitchell osteotomy.

Twelve patients who had a total of 18 Mitchell bunionectomies were reviewed to assess the long-term results of the procedure. Although metatarsus varus correction was maintained in all cases, hallux valgus recurred in 11 of the 18 cases. Sixty-seven percent reported complete relief or improvement of preoperative pain. Although lateral metatarsalgia did occur, the most common area of persistent pain remained the first metatarsal. Six of 18 procedures had marked loss of active joint motion, associated with pain and an unsatisfactory result. Of 18 procedures, 11 (61%) were satisfied with the results of their osteotomy. Although the Mitchell osteotomy corrected the metatarsus primus varus in each case, the current series shows a discouraging incidence of later recurrence of hallux valgus and restriction of metatarsophalangeal motion causing the abandonment of this procedure for the management of juvenile bunion.

Adolescent↗
PubMed1998

Surgical treatment for bunions in adolescents.

The results of three different surgical procedures for the correction of bunions on 25 adolescent feet (distal soft-tissue procedure, proximal closing-wedge osteotomy of the first metatarsal with distal soft-tissue procedure, and proximal phalangeal osteotomy) are reviewed. The results with an average follow-up of 3.5 years were excellent or good in 21 cases, and fair or poor in 4. The average correction of the metatarsophalangeal angle, the intermetatarsal angle, and the hallux valgus interphalangeus angle was, respectively, 9.88, 3.11, and 0.0 degrees for the first procedure, 21.0, 6.87, and 0.0 degrees for the second, and 11.0 0.9, and 22.5 degrees for the third. We conclude that distal soft-tissue reconstruction allows only mild to moderate correction of the metatarsophalangeal and intermetatarsal angles, and the association of a proximal osteotomy of the first metatarsal produces an statistically significant better correction (p < 0.05). Hallux valgus interphalangeus deformities are corrected only by proximal phalanx osteotomies. The selection of a particular procedure should therefore be based on an appropriate preoperative planification.

Adolescent↗