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Results for “HALLUX VALGUS”

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PubMedDate not supplied

[Long-term results of basal wedge osteotomy in metatarsus primus varus in the young patient].

INTRODUCTION: Aim of this retrospective study was to analyse the long term results after basal closing wedge osteotomy for correction of metatarsus primus varus and hallux valgus in the younger patient. PATIENT AND METHODS: 49 patients (70 feet) were operated according to a basal closing wedge osteotomy from 1974 to 1985 at our institution. Age was under 40 years in all patients at the time of surgery. 34 patients (50 feet) were evaluated in respect to their clinical and 26 patients (37 feet) to their radiological outcome. The average age was 26 years (14-39 years). The follow-up was 12 to 22 years (Median: 18 years). Analysis was performed using the patient's record, weight-bearing X-rays, a standardized questionnaire and clinical investigation. RESULTS: 82% of the patients had very good and good subjective results. Cosmetics was rated very good and good in 78%, 88% of the patients were painfree. Radiological analysis at follow-up: Hallux valgus-angle 19,3 degrees, intermetatarsal I/II-angle 6 degrees, shortening of first metatarsale 5 mm, at average; dorsal elevation of first metatarsale 38%, degenerative arthritis of the metatarsocuneiforme joint 19%, congruency of first metatarsophalangeal joint 54%,sesamoid subluxation: 46% grade 0, 30% grade I, 14% grade II and 10% grade III. In 14 feet (28%) metatarsalgia was found. DISCUSSION: The basal closing wedge osteotomy is rather a technically demanding procedure conjuncted with a higher risk of failure. Satisfactory long term results can be obtained by an ideal operating technique. As undesirable side effects shortening of the first ray and dorsal malangulation of the first metatarsale may occur consecutively leading to metatarsalgia. Lower risk procedures like the crescentic osteotomy according to Mann or chevron osteotomy should be preferred.

Adolescent↗
PubMed2001

[Kramer's distal I metatarsal osteotomy in the treatment of halluces valgi].

The paper presents the surgical technique for Kramer's distal I metatarsal osteotomy and the results of halluces valgi treatment in 23 patients. The mean age of the patients was 48.6 years and mean follow-up time was 4 years and 5 months. Final clinical and radiological evaluation was performed according to Kramer's scale. Excellent and good results were found in 54% of the cases, fair in 32% and bad in 14%. This simple extraarticular osteotomy, without use of any external immobilization yielding three-dimensional correction is a useful method for treatment of hallux valgus.

Adult↗
PubMed1980

[Arthrosis of the first foot segment in aged patients (author's transl)].

Basing on x-ray and clinical examinations, the authors report on the incidence, distribution according to sex and age, and lateral localisation of arthrosis occurring in the first segment of the foot. The bilateral type of arthrosis mostly occurs as a result of hallux valgus and is seen in women. Furthermore, degnerative changes and structural modifications of the dislocated sesamoids are also frequent. Arthrosis associated with hallux rigidus is a degenerative process mainly found in men, which is exclusively unilateral. This degenerative process shows the classical clinical and x-ray signs pertaining to arthrosis

Age Factors↗
PubMedDate not supplied

A statistical analysis on the reliability of the proximal articular set angle.

The authors investigated the statistical relationship and significance between the transverse and sagittal plane proximal articular set angles both radiographically and intraoperatively. The analysis revealed a highly significant difference between the means of the respective measurements. Although the radiographic and intraoperative findings were found to be related for the transverse plane proximal articular set angle, the transverse plane PASA was approximately 7 degrees greater when measured intraoperatively. The concept of a sagittal plane PASA was also introduced. The significance of accurate measurements in the surgical correction of hallux valgus was also examined.

Hallux Valgus↗
PubMed2005

[The modified Lapidus arthrodesis].

For the correction of hallux valgus, as one of the most common deformities of the lower limbs, a modified Lapidus arthrodesis is applied at the base of the hallux. After using a lateral tissue technique with medial capsular reefing, a general arthrodesis of the tarsometatarsal 1 joint is carried out. An unstable hallux is the indication for a classic Lapidus arthrodesis. Before determination of the indication, an exact clinical x-ray examination should be made in the dorsoplanar position as well as laterally standing. Complications associated with the Lapidus arthrodesis are postoperative metatarsalgia and pseudoarthrosis. Advantages of this technique are, for example, a high correction potential and better healing, although the surgical technique and post-operative care are more time consuming than for other methods.

Arthrodesis↗
PubMedDate not supplied

The offset-v osteotomy with screw fixation: a retrospective evaluation of unilateral versus bilateral surgery.

Bilateral foot surgery is often performed; however, very little research is available to compare the outcomes of unilateral versus bilateral procedures. The concern that bilateral procedures could have an increased morbidity has often influenced the foot surgeon to choose unilateral staged procedures over bilateral procedures. Nineteen unilateral and 18 bilateral offset-V osteotomies with screw fixation were evaluated for a difference in the correction of the deformity, complications, disabilities, and patient satisfaction. There was no difference in correction of the deformity, a return to footwear, complications, or patient satisfaction between the two groups. The results of this study suggest that similar results can be obtained with unilateral and bilateral hallux valgus surgery using the V osteotomy.

Adolescent↗
PubMed1956

Surgical treatment of bunions; distal metatarsal osteotomy.

The operation of Hawkins, Mitchell and Hedrick for the correction of metatarsus primus varus, bunion, and hallux valgus provides an eminently satisfactory solution both functionally and cosmetically. The procedure is applicable to any degree of deformity. Gratifying results were obtained in 43 operations on 25 patients.

Digestive System Abnormalities↗
PubMedDate not supplied

A new radiological technique for the forefoot.

Based on a study of 50 subjects seen at the University of Rochester Medical center, a new axial weightbearing radiological technique of the forefoot is described. The technique is simple, inexpensive, and easily reproducible. It has the advantage of not distorting the forefoot, relationships, unlike currently employed techniques. Since it is performed under weightbearing conditions, the results correlate closer to clinical situations. The subjects under this study, which excluded those with neuromuscular or malalignment problems, were found to fall into two categories: the pain-free and callous-free feet group, who have a well defined arch in the forefoot, and the group of subjects with pain and/or callous under the forefoot, who have a depressed arch. There is also a statistical significance between the relative heights of the tibial and fibular sesamoids. A new classification for hallux valgus based on observations of this technique is proposed.

Callosities↗
PubMedDate not supplied

[The elderly foot].

The aged foot suffers physiologic changes in form and structure to make it substantially more sensible for daily stress. Pathologic changes especially of the forefoot lead to stress-induced pain until final incapacity for stress. Special importance is due to a well-adapted clothing of the foot with a smooth-bedded sole of the foot. The operative treatment of forefoot diseases as there are hallux valgus, claw-toes and splayfoot leads to excellent functional results.

Aged↗
PubMedDate not supplied

The Austin bunionectomy: a follow-up study.

The Austin procedure, a distal metaphyseal "V" osteotomy for the management of hallux valgus was evaluated in several distinct patient groups. The results of the procedure were found to be both reproducible and predictable. Medial capsular reefing in an attempt to maintain the intermetatarsal angle reduction or hallux alignment does not appear to enhance the postoperative results.

Adolescent↗
PubMed1998

Hallux metatarsophalangeal arthritis.

Arthritis of the hallux metatarsophalangeal joint is a common disorder that affects shoewear, ambulation, and other activities of daily living. Etiologies include degenerative arthritis (hallux rigidus), crystal induced arthropathy (gout, pseudogout), rheumatoid arthritis, the seronegative spondyloathropathies, posttraumatic degeneration, and advanced hallux valgus. Accurate diagnosis and selection of the appropriate intervention depends on recognition of pertinent clinical and radiographic features. This study presents a synopsis of the senior author's (LCS) experience with 439 surgically treated patients with hallux metatarsophalangeal arthritis, focusing on origin and treatment.

Arthritis↗
PubMed1999

Mesenchymal cells and growth factors in bunions.

Bunion formation in adults is an example of bone growth that occurs after physis closure. Bone is laid down secondary to mechanical irritation caused by foot deformity. It is a mechanism of ectopic bone formation unrelated to physeal growth. In this article, bone formation is analyzed using immunohistochemical and cell culture techniques. Using markers specific for mesenchymal cells (collagen type IIa and fibroblast growth factor receptor 3), a cell population is defined in the soft tissues that overlie the bunion and is isolated from explant cultures. The cells do not produce bone matrix in culture, and they do not express osteoblast-related antigens. Stimulation of the cells by fibroblast growth factor (FGF) 2 leads to rapid cell proliferation and phenotype change. The cells start to form humps and at the same time express alkaline phosphatase and collagen type I. Expression of collagen type IIa and fibroblast growth factor receptor 3 ceases. These series of experiments indicate that a specific population of mesenchymal cells occurs in the soft tissues that overlie the bunion. This population is capable of bone formation when stimulated by FGF, a common mediator of inflammatory processes. Thus, FGF stimulation of mesenchymal cells in soft tissues that overlie the head of the first metatarsal is a potential link between the biomechanical forces that cause hallux valgus and bunion formation.

Adult↗
PubMedDate not supplied

Modifications of the Regnauld osteochondral autogenous graft for correction of hallux limitus/valgus: a 2-year review.

This study compares modifications of Regnauld's enclavement procedure, the in situ "hat-shaped" and in situ "inverted" osteochondral graft. A 2-year retrospective analysis consisted of patients' satisfaction, activity level, first metatarsophalangeal joint range of motion, and radiographic evaluations. The result of this study demonstrates that both the "hat" and "inverted" type grafts are highly successful and satisfactory procedures. However, the "inverted" technique is found to provide faster healing rates and a broader range of motion of the first metatarsophalangeal joint; it is more stable and technically easier to perform. Therefore, the "inverted" graft provides more consistent and predictable results for the treatment of hallux rigidus and hallux valgus.

Activities of Daily Living↗
PubMed2006

[Optoelectronic gait analysis after metatarsophalangeal arthrodesis of the hallux: fifteen cases].

PURPOSE OF THE STUDY: Degeneration of the metatarsophalangeal joint of the hallux is a frequent secondary lesion of the first ray subsequent to hallux valgus. Different surgical techniques have been proposed for cure, including metatarsophalangeal arthrodesis. Joint fusion relieves pain but sacrifices joint motion. The purpose of this work was to assess changes observed in gait after metatarsophalangeal arthrodesis of the hallux using a three-dimensional optoelectronic system. MATERIAL AND METHODS: Gait analysis was performed with a Vicon 3D system with five cameras and two AMTI force platforms in twelve patients who had undergone metatarsophalangeal arthrodesis more than six months earlier. The kinetic and kinematic curves and ground reaction forces were analyzed. Changes in the gait cycle and any compensations observed in the talocrural and interphalangeal joints were noted in the three dimensions. Wilcoxon test for paired series was applied for the statistical analysis. RESULTS: The general gait parameters and kinetic and kinematic values were not modified (excepting a non-significant decline in maximal dorsiflexion of the ankle joint). There was a significant decrease in propulsion force in the anteroposterior and vertical planes, with significantly later heal lift-off and systematic displacement of ground reaction forces anterior to the metatarsophalangeal joint on the arthrodesis side. Reflectors positioned on the distal extremity of the hallux demonstrated that the essential part of compensation occurred at the level of the interphalangeal joint. DISCUSSION: Gait analysis after tibiotalar arthrodesis has been widely reported in the literature. The consequence of joint fusion on the rear foot and/or the torsion couple have also been studied. However, to our knowledge, there has been only one report using a different methodology devoted to metatarsophalaneal arthrodesis of the hallux. In this study, only step length and interphalangeal moment as well as ankle force were found to be decreased. Function of the interphalangeal joint was not assessed. The Vicon system enabled an adapted study of gait after metatarsophalangeal arthrodesis. This method offers several perspectives: study of the effect of the position of the arthrodesis in the sagittal plane on gait, changes over time in interphalangeal joint motion, or consequences of fusion on walking up and down stairs. CONCLUSION: Metatarsophalangeal arthrodesis of the hallux does not modify general gait parameters nor the kinetic and kinematic values. Compensation is achieved via the interphalangeal joint.

Aged↗
PubMed1991

Simple bunionectomy with medial capsulorrhaphy.

Bunionectomy with medial capsulorrhaphy was performed on 54 feet (37 patients) and follow-up was obtained on 49 feet (33 patients) at a mean of 4.8 years postoperatively. Results were excellent in 17 feet, good in 16, fair in 7, and poor in 9. Mean motion of the first metatarsophalangeal joint was 81 degrees. The primary reason for failure was recurrent deformity. Patients were dissatisfied with the results in 41% of the feet. Mean intermetatarsal 1-2 angle increased 1.7 degrees and mean metatarsophalangeal-1 angle increased 4.8 degrees. The operation was significantly more successful in patients who underwent it for painful medial eminence. Bunionectomy with medial capsulorrhaphy is recommended for elderly patients with symptoms primarily due to prominent medial eminence, and its application for the young patient with significant hallux valgus deformity is limited.

Adolescent↗
PubMed1976

Weight-bearing deficiency of the 1st metatarsal ray.

The authors have analysed a special disturbance of the statics and dynamics of the forefoot - deficient weight-bearing on the first metatarsal ray whilst walking. From the clinical point of view, the condition resulted in the development of a dorsal bunion and metatarsalgia. Forty-nine cases were treated and seven causative factors were discovered: Club foot, Paralysis, Congenital deformity, Fracture-dislocation of Lisfranc's joint, Sequelae of surgery for hallux valgus, Sequelae of subtaler arthrodesis, "Functional" abnormality.

Adolescent↗
PubMed1980

Resection arthroplasty of the metatarsophalangeal joints in rheumatoid arthritis. A follow-up study of 100 patients.

The follow-up results 1 to 11 years (mean 5 years) after resection arthroplasty of the forefoot or arthrodesis of the first metatarsophalangeal (MTP) joint performed on 100 patients (179 feet) with classical or definite rheumatoid arthritis are presented and analysed. The main indication for surgery was pain in the damaged and more or less luxated MTP joint. Resection arthroplasty of MTP joints II-V was performed from the plantar approach in 167 feet. The Keller or Mayo operation was performed on the first MTP joint in 129 feet. Arthrodesis of the first MTP joint was done in 17 feet. The proximal joint of the hallux was not treated in 33 feet. According to the subjective assessment, results after surgery were considered good by 49 patients (91 feet, 51%), fair by 44 (76 feet, 42%), and poor by 7 (12 feet, 7%). These 7 patients complained of persistent pain or a disabling deformity of the toes, or both. Although these results were generally satisfactory, the objective results were not good. At follow-up more than 50% of the patients had recidivistic callosities, a hallux valgus deformity, a dorsal dislocation and lateral deviation of the lesser toes, or radiologically observable bony proliferations of the distal ends of the metatarsals--or a combination of these. All patients in whom a proximal or interphalangeal joint of the hallux was surgically or spontaneously fused were satisfied: the stiff joint was painless on walking. When destruction of the first MTP joint is severe and painful, arthrodesis is recommended.

Adult↗