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PubMed2001

First ray dorsal mobility in relation to hallux valgus deformity and first intermetatarsal angle.

The hypermobile first ray has been implicated as contributing to the cause and progression of hallux valgus deformity. Deformity of the hallux is often accompanied by an enlarged first intermetatarsal (IM 1-2) angle. It has been hypothesized that subjects having an abnormally large IM 1-2 angle have laxity of the first ray. Objectives of this study were to compare dorsal mobility of the first ray in subjects with hallux valgus to asymptomatic controls, and to investigate the relationship between dorsal mobility and the IM 1-2 angle. Fourteen subjects (age 23-81) with hallux valgus were matched by gender and age to control subjects. The IM 1-2 angle was measured from radiographs. A load-cell device measured dorsal mobility of the first ray under a standard load of 55 N. Pearson's correlation coefficient identified a marginal correlation (r = .51) between IM 1-2 angle and dorsal mobility. An independent t-test showed a statistically (P < 0.01) larger amount of dorsal mobility in the group of subjects having hallux valgus. Mobility of the first ray was increased in subjects with hallux valgus and a large IM 1-2 angle may be an indicator of increased dorsal mobility.

Adult↗
PubMed2005

Correlation of hallux valgus surgical outcome with AOFAS forefoot score and radiological parameters.

BACKGROUND: The purpose of the study was to evaluate the effect of three different types of hallux valgus surgeries on patient function using validated questionnaires and to correlate the results with radiographic and physical examinations. This study presents the 2-year followup data of a previous prospective outcome study. METHODS: One hundred and ninety-six patients were enrolled in this study and completed a baseline AAOS Lower Limb Outcomes Data Collection Questionnaire. They completed the same form at 6, 12, and 24 months after having one of three types of hallux valgus surgeries (106 chevron osteotomies, 72 modified McBride procedures, and 18 modified Lapidus procedures). This questionnaire included the Short Form-36 Health Survey (SF-36) as well as questions relating to lower extremity function. Additionally, physicians were asked to complete preoperative and postoperative questionnaires on each patient that included radiographic and physical examination data and the type of surgery done. Completed outcome surveys and radiographic data were available on 196 patients, and physical examination scores were available to assign an AOFAS score in 111 patients at 24-month followup. A one-way comparison was done after stratifying the results for the type of surgery, preoperative hallux valgus angle and 1-2 intermetatarsal angle, postoperative hallux valgus angle and 1-2 intermetatarsal angle, and the change in the angles. RESULTS: Four of the 10 SF-36 scores (physical function, role-physical, bodily pain, and role-emotional) for the combined data improved by more than five points. For the AAOS lower extremity function scores, physical health and pain (68.5 to 81.6), satisfaction with symptoms (1.8 to 3.6), global foot and ankle (77.6 to 93.4), and shoe comfort (29.0 to 58.7) scores all increased significantly. The AOFAS score increased from 52.6 to 85.5 (p <0.001). Surprisingly, when comparing mild-to-moderate to severe deformities preoperatively and postoperatively using the absolute magnitude of the angular change in the hallux valgus or intermetatarsal angles, similar improvement was noted in AOFAS, SF-36, and AAOS lower extremity scores. The magnitude of preoperative deformity, postoperative residual deformity, and magnitude of correction also did not significantly change the amount of improvement in any of these scores. No significant differences were noted in the outcome scores among the three different surgeries. CONCLUSION: Patients who had hallux valgus surgery had significant improvements in four of their SF-36 scores, four of five of AAOS lower extremity scores, and AOFAS scores. The degree of deformity, amount of correction, or type of operation did not influence outcome.

Adolescent↗
PubMed2005

The modified Lapidus procedure for hallux valgus: a clinical and radiographic analysis.

BACKGROUND: Historically, the modified Lapidus procedure has been considered technically challenging, with high rates of complications, including nonunion and malunion. The purpose of this study was to review the clinical and radiographic results of this technique for the treatment of hallux valgus associated with first ray hypermobility, specifically examining patient satisfaction and the incidence of complications. METHODS: We retrospectively reviewed the results of the modified Lapidus procedure in 32 patients (38 feet). Evaluation included preoperative and postoperative questionnaires, physical examination, and radiographs. RESULTS: Complete clinical data was available for 29 patients (35 feet) and complete radiographic data for 29 patients (34 feet). Average age at surgery was 54 (range 27 to 84) years. Average followup was 42 months (range 29 to 93) months. Average preoperative visual analog pain score was 7.2 and postoperative 2.3 (p < 0.001). Average preoperative AOFAS Hallux MTP-IP Score was 44.8 and postoperative 87.3 (p < 0.001). Average preoperative intermetatarsal (IM) angle was 16 degrees, and the hallux valgus (HV) angle was 34 degrees. Postoperatively, the average IM angle was 6 degrees, the HV angle 11 degrees. There were no cases of nonunion or malunion. Complications included symptomatic hallux varus in two, recurrence of hallux valgus deformity in one, deep venous thrombosis in one, and failure of fixation in one patient. Twenty-four percent of patients (7 of 29) noted the subjective sensation of midfoot stiffness and 34% (10 of 29) noted forefoot stiffness. None of these patients thought that the stiffness was a disability. Ninety percent of patients (26 of 29) were satisfied with their foot function, and 86% (25 of 29) were satisfied with the cosmetic appearance of their foot. CONCLUSIONS: The modified Lapidus procedure results in a satisfactory clinical outcome in most patients. With meticulous operative technique, rigid internal fixation, and strict postoperative weightbearing restrictions, successful union can be achieved and complications can be minimized. Care should be taken to avoid hallux varus, and patients need to be counseled regarding a potentially long convalescent period and possible postoperative stiffness.

Adult↗
PubMed1997

Acquired hallux varus and clinical tolerability.

This retrospective study was undertaken to determine the long-term clinical problems, residual disability, and need for further surgery in patients with iatrogenic hallux varus. Between 1975 and 1985, in 16 (19 feet) of 83 patients who underwent foot surgery for hallux valgus or metatarsus primus varus, hallux varus deformity was noted at 1-year follow-up on dorsoplantar roentgenograms obtained with the patients bearing weight. Thirteen of those patients (16 feet) were reexamined at an average of 18.3 years (220 months) after surgery. The average hallux varus deformity in this group was 10.1 degrees. Eleven patients (12 feet) rated their results as excellent. The average hallux metatarsophalangeal interphalangeal score for all patients was 91.5 points. Only those with extreme hallux varus deformity were dissatisfied or required further surgery.

Adolescent↗
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↗
PubMed1999

[Selected anatomical features of the foot with hallux valgus].

Hallux valgus is still an open problem consists of many unexplained questions related to, not only its etiopathogenesis and biomechanics but also to treatment of this deformity. The purpose of investigation: 1) To find out hallux valgus predisposing factors; 2) To recognise anatomic features of the foot in hallux valgus patients, basing on orthopaedic physical examination as well as to find out the frequency of the occurrence of foot skeleton disorders in rentgenometric and plantoconturographic (foot prints) measurements. 335 feet in 173 patients (females) treated operatively due to hallux valgus in Orthopaedic Department of Wrocław Medical Academy in years 1980-1994 were examined. Those patients were operated on according to Keller, Dega and McBride method. All the patients underwent preoperative orthopaedic physical examination as well as rentgenographic and plantoconturographic one. Such factors as heredity and Egyptian shape of the foot as well as metatarsal index "plus" were recognised as hallux valgus predisposing factors. Most of the parameters evaluated in orthopaedic, rentgenographic and plantocontourographic examination presented pathologic values that indicated pathology within foot in hallux valgus patients.

Adolescent↗
PubMed2000

The chevron osteotomy for correction of hallux valgus. Comparison of findings after two and five years of follow-up.

BACKGROUND: The chevron osteotomy, an accepted method for the correction of mild and moderate hallux valgus, is generally advocated for patients younger than the age of fifty years. The purposes of this prospective study were to compare the short-term (two-year) and intermediate-term (five-year) results of this operation with respect to patient satisfaction, flexion and extension of the metatarsophalangeal joint, maintenance of correction, and development of arthrosis and to determine whether the effectiveness of the procedure was limited by age. METHODS: Between April 1991 and September 1992, the chevron osteotomy was performed for the treatment of mild-to-moderate hallux valgus deformity in sixty-six consecutive feet. Forty-three patients (fifty-seven feet) were available for follow-up at both two and five years postoperatively. The two-year and five-year clinical assessments were based on the American Orthopaedic Foot and Ankle Society's hallux-metatarsophalangeal-interphalangeal scale. RESULTS: Between the two-year and five-year follow-up evaluations, there was only a minimal change in overall patient satisfaction, and the average score on the hallux-metatarsophalangeal-interphalangeal scale was unchanged. The passive range of motion of the first metatarsophalangeal joint decreased between the preoperative assessment and the two-year follow-up evaluation and was unchanged at the five-year follow-up evaluation. Radiographic evaluation showed no changes in the hallux valgus or intermetatarsal angle between the two-year and five-year evaluations, although the number of feet with arthrosis of the metatarsophalangeal joint increased slightly, from eight to eleven. Patients aged fifty years or older did as well as younger patients. CONCLUSIONS: At these two follow-up periods, the chevron osteotomy was found to be a reliable procedure for the correction of mild and moderate hallux valgus deformity, and outcome did not differ on the basis of age.

Case-Control Studies↗
PubMedDate not supplied

Correlation between hallux valgus angle and age.

A study was made of the relationship between the hallux valgus angle and age. Between January 1983 and June 1985, 464 hallux valgus operations were performed on 404 patients at the Department of Orthopedic Surgery at Huddinge Hospital. The mean age of the patients was 54 +/- 12 years (range 16 to 75). The patients were divided into six groups with regard to nature and extent of radiographic changes. Linear regression analysis was used for analysis of the correlation between age and hallux valgus angle. A significant correlation was found in group 1: hallux valgus grade 1, type I (great toe rotated, slight bunion) and group 6: hallux valgus grade 2, type III (great toe rotated, severe bunion and severe arthrosis). There was a large scatter around the lines, however, which means that age is poor predictor of the hallux valgus angle.

Adolescent↗
PubMedDate not supplied

Hallux varus--a study of thirty cases.

Although both congenital and acquired hallux varus have been described, the deformity has been considered uncommon. Contrary to this belief, we noted that it is fairly common in the unshod population. Analysis of 30 cases shows that congenital hallux varus is the most common type encountered and it is of three types, namely: primary, secondary, and teratogenic. The congenital primary and secondary varieties are apparently easy to treat in infancy, but if left untreated, they progress with age in unshod persons. The more severe grades of hallux varus are associated with medial deviation of the lateral toes. Hallux varus occasionally develops in unshod persons during the fourth, fifth, or sixth decades of life. This is referred to as the idiopathic hallux varus of middle age. The length of the first metatarsal, the first intermetatarsal angle, and the shape of the first metatarsal head appear to have no bearing on the causation of hallux varus. The progression of the deformity in congenital cases and the de novo development of the deformity in middle age appear to be related to the failure to use footwear.

Adolescent↗
PubMed1984

The primary deformity in hallux valgus and metatarsus primus varus.

Analysis of radiographs from patients with hallux valgus showed that following surgical correction there were statistically significant reductions in the hallux valgus, intermetatarsal, and metatarsus primus varus angles. Normal values for these angles were established from a control group of asymptomatic feet and from previously published reviews. If the metatarsus primus varus deformity returns to normal following correction of the hallux valgus by a procedure that does not directly realign the metatarsal, the deformity must be secondary to hallux valgus. This is of importance in planning surgical procedures for the correction of these deformities and confirms the relative popularity and success of distal metatarsal osteotomies. Any operation designed to correct both hallux valgus and metatarsus primus varus must aim to correct the primary hallux valgus lesion rather than the secondary metatarsal deviation.

Adolescent↗
PubMedDate not supplied

Preventing loss of the great toe with the hallux interphalangeal joint arthroplasty.

Chronic ulcerations of the hallux may result in amputation if infection becomes uncontrolled. Salvage of the hallux often requires surgical intervention when conservative measures fail. Many authors have described various procedures to prevent recurrent ulceration and the potential for loss of the great toe. The authors have reviewed their experience with the hallux interphalangeal joint arthroplasty for chronic neuropathic ulcers of the great toe. Between August 1988 and July 1991, the authors performed 46 hallux interphalangeal joint arthroplasties on 40 patients (22 males, 18 females). Of the 40 original patients, one patient was lost to follow-up in the immediate postoperative period, leaving 45 procedures on 39 patients. Thirty-six feet were noted to heal both the procedure and ulceration uneventfully (80%). There were five minor complications (11%). Four cases were deemed failures (9%). Overall, 41 feet (91%) healed and had no evidence of recurrence in the follow-up period. Follow-up was an average of 23.6 months (range 4-44 months). The hallux interphalangeal joint arthroplasty has been a valuable procedure for chronic ulcerations of the hallux. By allowing these ulcers to heal, loss of the great toe has been avoided. Function and structure of the foot has been maintained.

Adult↗
PubMedDate not supplied

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↗
PubMed2000

Result of arthrodesis of the hallux metatarsophalangeal joint using bone graft for restoration of length.

We treated 24 patients (18 women, six men; average age, 46.4 years; (range, 28 to 66 years) with fusion of the hallux metatarsophalangeal (MTP) joint using bone graft for the restoration of the length of the first ray. This procedure was performed after bone loss subsequent to previous surgeries for the correction of hallux valgus and hallux rigidus with: silastic arthroplasty (11), bunionectomy and distal metatarsal osteotomy (six), Keller resection arthroplasty (five), and total joint replacement (two). The indication for performing the arthrodesis with bone graft was a short first metatarsal, and associated metatarsalgia of the lesser metatarsals in addition to a painful MTP joint with or without deformity. This bone loss was associated with avascular necrosis of the first metatarsal (nine patients) and with osteomyelitis (seven patients). Of the 24 patients, 14 underwent additional concurrent surgery for correction of hammer toes (10), excision of a Morton's neuroma (two), and lesser metatarsal osteotomy (two). All patients were examined clinically and radiographically at a mean interval of 62.7 months after surgery (range, 26 to 108 months). The patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux and MTP 100-point outcome scale. Arthrodesis occurred in 19/24 patients (79.1%) at a mean of 13.3 weeks (range, 11 to 16 weeks), and the first ray was lengthened by a mean of 13 mm (range, 0 to 29 mm). Of the five nonunions, two were asymptomatic, and three were subsequently revised successfully, with arthrodesis occurring at a mean of 10.7 weeks. Complications included one deep infection requiring intravenous antibiotics for treatment of osteomyelitis and two minor superficial wound infections. The mean AOFAS score improved from 39 points (range, 22 to 60 points) to 79 points (range, 64 to 90 points). All patients were satisfied with the final outcome of treatment and stated that they would undergo the surgical procedure again. We concluded that arthrodesis of the hallux MTP joint with bone graft to restore bone loss and length of the first ray may be a worthwhile procedure despite the technical difficulty and the high rate of nonunion.

Adult↗
PubMedDate not supplied

[Hallux varus congenitus].

INTRODUCTION: The congenital hallux varus is a rare hereditary deformity of the big toe, which often is combined either with polydactylia or with systemic deformities of the skeleton. The congenital hallux varus can be easily diagnosed clinically. The X-ray shows the ossified bony elements and provides information about the shape and number of the digits as well as their axial deviation. An operative treatment is required. So far a standardized surgical technique has not been accepted for all types of hallux varus. METHODS: The correction of the bony structures and soft tissues is planned by means of preoperative scetches. The amount of correction depends on the degree of the deformity. As consequence of the reorientation of the first ray a soft tissue flap has to be planned and prepared for wound closure which otherwise would need larger grafts. RESULTS: Based on this series the clinical and radiological appearance of the congenital hallux varus are discussed. The operative treatment is explained step by step illustrated by photographs as well as planing scetches. Our procedures are compared to other operative methods reported in the literature. CONCLUSIONS: There are no diagnostic problems with the hallux varus deformity. For therapy surgery is mandatory and recommended between 9 and 24 months of age. For microsurgical preparation and correction of the deformity planning of all surgical steps and alternatives is advocated, this allows for good functional and cosmetic results.

Child, Preschool↗
PubMed2002

Medial eminence thickness with and without hallux valgus.

The purpose of this study was to determine if hypertrophy of the medial eminence occurs in patients with hallux valgus. Thirty-three patients (50 consecutive feet) who underwent surgical correction for hallux valgus were evaluated. They had preoperative and postoperative radiographs. The hallux valgus angle, intermetatarsal angle and size of the medial eminence were recorded. The same measurements were then obtained from the radiographs of 50 randomly selected, age-matched controls with a hallux valgus angle less than 15 degrees and intermetatarsal less than 9 degrees. The average width of the medial eminence was 4.4 mm in the hallux valgus group and 4.1 mm in the control group. In most patients, hypertrophy of the medial eminence is not a component of the pathology.

Case-Control Studies↗
PubMedDate not supplied

Reverse Austin osteotomy for correction of acquired static hallux adductus.

Hallux adductus, a horizontal plane deformity, often has an iatrogenic etiology especially as a complication of hallux abducto valgus surgery. A case at Sheridan Park Hospital is described in which the patient developed a steadily worsening static hallux adductus following foot surgery. She underwent further corrective procedures for the hallux adductus 11/2 years later. The authors conclude that if a mild static hallux adductus is observed in conjunction with bunionectomy or other surgery, it should be corrected at that time rather than some years later.

Adult↗
PubMed2000

Moderate to severe hallux valgus deformity: correction with proximal crescentic osteotomy and distal soft-tissue release.

Between 1991 and 1995, 96 patients (114 feet) were treated with a proximal crescentic metatarsal osteotomy and distal soft-tissue procedure for moderate to severe hallux valgus deformity [intermetatarsal (IM) angle > 15 degrees, or hallux valgus (HV) angle > 30 degrees]. At an average follow-up of 26 months, 8 men and 62 women (86 feet) with a mean age of 53.2 years were retrospectively reviewed. The HV angle averaged 41.1 degrees preoperatively and 14.6 degrees postoperatively. The respective values for the IM angle were 17.8 degrees and 7.8 degrees. Neither the average metatarsal shortening of 3 mm nor the dorsal angulation at the osteotomy site seen in 9% of cases evidenced any clinical significance at follow-up. Patient satisfaction was excellent or good in 91%, and the mean Mayo Clinic Forefoot Score (total 75 points) improved from 37.2 to 61.1 points. Complications included 8 cases of hallux varus and 5 cases of hardware failure. Based on this first study exclusively focusing on moderate to severe hallux valgus deformity, we conclude that proximal first metatarsal osteotomy in combination with a lateral soft-tissue procedure is effective in correcting moderate to severe symptomatic hallux valgus deformity with metatarsus primus varus (IM angle > 15 degrees or HV angle > 30 degrees).

Adolescent↗
PubMed2003

Degenerative osteoarthrosis of tarsometatarsal joints in hallux valgus: a radiographic study.

To clarify the pathogenesis of degenerative osteoarthrosis of the tarsometatarsal joints in hallux valgus, we evaluated dorsoplantar and lateral radiographs during weight-bearing in 16 patients (25 feet) with hallux valgus accompanied by degenerative osteoarthrosis of the tarsometatarsal joints and 25 controls (25 feet) with hallux valgus alone. The proximal second metatarsal articular angle (a parameter we devised), the hallux valgus angle, intermetatarsal angle, metatarsal length, sesamoid displacement, calcaneal pitch, and foot length were measured and then evaluation using a mapping system was performed. There were no significant differences in the hallux valgus angle, intermetatarsal angle, sesamoid displacement, calcaneal pitch, or foot length. In the presence of degenerative osteoarthrosis of the tarsometatarsal joints, the second, third, and fourth metatarsals were long, and a large inclination of the proximal articular surface of the second metatarsal and adduction of the first to fourth metatarsals were observed. These findings appeared to be involved in the development of this disorder.

Aged↗