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PubMed2004

Axial radiographic evaluation in hallux valgus: evaluation of the transverse arch in the forefoot.

To quantitatively evaluate the shape of the transverse arch in the forefoot with hallux valgus, a method for axial imaging and analysis of the forefoot has been developed. A foot was imaged at 30 degrees of flexion. A two-dimensional coordinate system was established by drawing a vertical line on the X-ray image through the lowest point of the head of the second metatarsal. The origin was set at the intersection between the plane of the base of the foot and this vertical line. A control group of 51 feet from 29 normal subjects and a test group of 59 feet from 34 subjects with hallux valgus were examined. Compared with the normal group, the heads of the first, second, and third metatarsal bones were lower in the hallux valgus group, and their sesamoids were shifted outward with a rotational deviation. There was a statistical correlation between the degree of outward dislocation of the fibular sesamoid bone and the hallux valgus angle. The position of the fibular sesamoid bone become higher than the head of the first metatarsal when the angle of the hallux valgus exceeded 25 degrees.

Adolescent↗
PubMed2001

Quantification of first tarsometatarsal joint stiffness in hallux valgus patients.

OBJECTIVE: Comparison of the clinical mobility test of the first tarsometatarsal joint with Doppler Imaging of Vibrations measurement of the stiffness of this joint in hallux valgus patients. DESIGN: Clinical testing of first tarsometatarsal joint mobility was related to independent Doppler Imaging of Vibrations measurement of first tarsometatarsal joint stiffness. BACKGROUND: Hypermobility of the first tarsometatarsal joint has consequences for the surgical treatment of hallux valgus deformity. However, the clinical test is subjective. Doppler Imaging of Vibrations could be helpful in quantification of the stiffness of this joint. METHODS: Clinical examination of the mobility of 32 first tarsometatarsal joints in 20 hallux valgus patients was compared with Doppler Imaging of Vibrations stiffness measurements performed by an independent observer. RESULTS: There was a statistically significant relation between the clinical test and the stiffness measurement by Doppler Imaging of Vibrations. CONCLUSION: Doppler Imaging of Vibrations proves to be a method to quantify first tarsometatarsal joint stiffness and could contribute to a rational policy for the surgical treatment of hallux valgus deformity. RELEVANCE: The clinical test to establish hypermobility of the first tarsometatarsal joint is subjective. Doppler Imaging of Vibrations offers objective criteria and quantification of first tarsometatarsal joint stiffness. This provides additional information for the choice of the surgical procedure to correct hallux valgus deformity.

Biomechanical Phenomena↗
PubMedDate not supplied

Predicting articular erosion in hallux valgus: clinical, radiographic, and intraoperative analysis.

The authors present a prospective intraoperative evaluation of the articular wear pattern of the first metatarsal, tibial and fibular sesamoids, and base of the proximal phalanx of 166 feet undergoing hallux valgus surgery. The collected data were compared with various clinical parameters and radiographic measurements to determine if any of these variables can predict the incidence and location of articular erosion. The incidence and predictability of the location of the articular erosion increased significantly as the patient's age ( P = .000), intermetatarsal angle 1-2 ( P = .004), hallux abductus angle ( P = .000), tibial sesamoid position ( P = .016), and proximal articular set angle ( P = .02) increased. The association of foot type (ie, digital length pattern), metatarsal protrusion distance, metatarsal head shape, and hallux abductus interphalangeus was not significant. Therefore, preoperative clinical parameters (ie, age) and radiographic measurements (ie, intermetatarsal angle 1-2, hallux abductus angle, tibial sesamoid position, and proximal articular set angle) can directly define the incidence and location of articular erosion and are helpful in the preoperative assessment of the hallux valgus deformity. In addition, nearly every first metatarsophalangeal joint evaluated had some degree of articular erosion and, in certain circumstances (ie, advanced age and increased proximal articular set angle), it was universal and extensive.

Adult↗
PubMedDate not supplied

Phalangeal osteotomy versus first metatarsal decompression osteotomy for the surgical treatment of hallux rigidus: a prospective study of age-matched and condition-matched patients.

The surgical options for hallux rigidus in the presence of painful but moderate degenerative metatarsophalangeal joint disease are limited to either joint-destructive or joint-preserving procedures. The following study compared the effectiveness of 2 joint-preservation procedures. Forty-nine patients, with a mean age of 53 years, underwent phalangeal osteotomy and were reviewed at an average 29 months postoperatively. A subsequent group of 59 patients, with a mean age of 51 years, underwent first metatarsal decompression osteotomy and were reviewed at an average 15 months postoperatively. In the phalangeal osteotomy group, 65% of patients were completely satisfied, 24% were satisfied with reservation, and 11% were dissatisfied. Three patients suffered continued metatarsophalangeal joint pain, 3 developed hallux interphalangeal joint pain, and 4 patients developed transfer metatarsalgia. The postoperative decrease from 36 degrees to 35 degrees in mean peak hallux dorsiflexion on walking was not significant. In the first metatarsal decompression osteotomy group, 54% were completely satisfied, 13.5% were satisfied with reservations, and 32% were dissatisfied. Continued metatarsophalangeal joint pain occurred in 2 patients, 18 developed transfer metatarsalgia, and 6 of these patients required lesser metatarsal osteotomy. Peak hallux dorsiflexion during walking increased from 36 degrees to 42 degrees (P < .001). First metatarsal decompression osteotomy will increase joint range of motion but the risk of complication and patient dissatisfaction is less after phalangeal osteotomy. Neither procedure could be considered definitive for hallux rigidus.

Decompression, Surgical↗
PubMedDate not supplied

The spike osteotomy for hallux valgus: a clinical and radiological evaluation.

A distal metatarsal osteotomy with soft tissue correction is a frequently performed operation to correct mild to moderate hallux valgus deformity. This is a prospective study of 28 feet in 25 patients who underwent spike osteotomy of the first metatarsal with medial capsulorraphy for symptomatic hallux valgus. The osteotomy is a distal metatarsal osteotomy with a spike fashioned in the plantar and lateral quarter of the proximal fragment and impacted into the trough created in the center of the distal fragment, providing lateral and plantar shift of the distal fragment. The American Orthopaedic Foot and Ankle Society's rating scale was used for functional assessment, and a visual analog scale gauged pain. The average follow-up was 27 months. The rating scale score improved from a mean preoperative value of 39/100 to 84/100. Twenty-six feet had complete pain relief, whereas 2 feet had a lesser degree of persistent metatarsalgia. A review of preoperative and postoperative radiographs showed that the hallux valgus angle improved from a mean 36 degrees preoperatively to 18 degrees postoperatively. Likewise, the mean 1 to 2 intermetatarsal angle improved from 13 degrees to 7.3 degrees. There was no incidence of avascular necrosis. Fourteen patients (16 feet) rated the outcome as excellent, 10 (11 feet) as good, and 1 patient with asymptomatic mild hallux varus deformity rated the result as fair. These results demonstrate that the spike osteotomy is a suitable operation for treatment of mild to moderate hallux valgus.

Adult↗
PubMedDate not supplied

[Early outcome of correction of hallux valgus with the Scarf osteotomy].

INTRODUCTION: Aim of this study is to analyze complications as well as clinical and radiological results of the scarf osteotomy for the correction of hallux valgus. PATIENTS AND METHODS: Between 1994 and 1998 we performed a scarf osteotomy for the correction of hallux valgus in 45 cases. Indication was a symptomatic hallux valgus with an increased first intermetatarsal angle (IMA). Fixation of the osteotomy was performed with two 2.3 mm mini screws made of titaneum. Mobilisation was allowed with full weight bearing with a fore foot relief orthesis. Clinical results were valued with the fore foot scoring system (ffss). The determination of the IMA and hallux valgus angles (HVA) was performed with weight bearing d.p. radiographs. RESULTS: All osteotomies healed within the first 6 postoperative weeks. Removal of the screws was not necessary in any case. The preoperative ffss was 16.2 points. At the last follow up (16 month after surgery) the average value of the ffss was 59.1 points. Three patients reached a value below 35 points, two of them suffered from a rheumatic disease. Twenty patients assessed the cosmetic result as excellent, 16 as good, 4 as satisfactory and one as poor. The average IMA could be reduced significantly from 20.2 to 10.3 degrees. The HVA could be lowered from 37.5 to 20.9 degrees. In patients with an IMA of more than 20 degrees the HVA could be reduced to 23.1 degrees in contrast to 18.3 in patients with an IMA of less than 20 degrees. DISCUSSION: The scarf osteotomiy is a surgical procedure for the correction of hallux valgus due to increased IMA which is appropriate in patients younger than 50 years and older than 50 years. In cases of IMA more than 20 degrees correction of IMA and HVA was unsatisfactory.

Adolescent↗
PubMedDate not supplied

[Intermediate results with Swanson's hallux implant].

Fifty Swanson single stemmed metatarsophalangeal silastic great toe prostheses in 38 patients inserted between 1974 and 1984 in the Orthopaedic University Clinic of Innsbruck were reviewed. The authors compare results of hallux valgus correction and of hallux rigidus correction by the Swanson prostheses and conclude, that implant arthroplasty should not be performed to correct hallux valgus, but is an excellent procedure in the treatment of hallux rigidus, if the hallux valgus angle is not higher than 18 degrees.

Adult↗
PubMed1998

Role of medical capsule and transverse metatarsal ligament in hallux valgus deformity.

The role of the medial capsule and transverse metatarsal ligament in hallux valgus deformity including stability of the first metatarsophalangeal and adjacent joints was investigated in vitro. The three-dimensional positions of the proximal phalanx, first metatarsal, and second metatarsal before and after sectioning the medial capsule and metatarsal ligament were measured using a magnetic tracking system. Valgus deformity of the hallux increased with medial capsule sectioning an average of 22.3 degrees +/- 6 degrees. Valgus deformity of the hallux increased with medial capsule and metatarsal ligament sectioning an average of 27.4 degrees +/- 9.1 degrees. Valgus deformity of the hallux did not change significantly after sectioning the metatarsal ligament only. No significant changes were found in varus and eversion of the first metatarsal, in valgus of the second metatarsal, in the distance between first and second metatarsal heads after sectioning the medial capsule, or in the metatarsal ligament. This study shows the importance of the medial capsule in hallux valgus deformity. The transverse ligament did not contribute substantially to cause the deformity.

Aged↗
PubMed2002

Adult hallux valgus with metatarsus adductus: a case report.

It is difficult to surgically treat a hallux valgus deformity with significant metatarsus adductus, because the space between the first and second metatarsals is too narrow to correct the metatarsus primus varus with a first metatarsal osteotomy. A 55-year-old woman had severe hallux valgus with significant adduction of the second and third metatarsals. A distal soft tissue procedure and a proximal crescent-shaped osteotomy of the first metatarsal combined with corrective osteotomies of the second and third metatarsals were done. The patient's symptoms disappeared, and hallux valgus and adduction of the second and third metatarsals were corrected. To the authors' knowledge, there is no previous description of surgical treatment including correction of metatarsus adductus and hallux valgus for adult hallux valgus with metatarsus adductus.

Female↗
PubMed2004

Relationship between stress fractures of the proximal phalanx of the great toe and hallux valgus.

PURPOSE: To clarify the relationship between stress fractures of the great toe and hallux valgus. METHODS: Ten cases of this fracture were analyzed for their alignment of the great toe. RESULTS: Nine of them had hallux valgus. DISCUSSION: The continuous bowstring effect of the extensor hallux longus and shearing stress on the hallux valgus that occur during specific exercises such as sprinting, jumping, and standing on tiptoe, could cause these stress fractures. CONCLUSION: The hallux valgus could play a role in the cause of stress fractures of the proximal phalanx of the great toe.

Adolescent↗
PubMed2000

Precise anatomic configuration changes in the first ray of the hallux valgus foot.

To detect precise anatomical configuration of the first ray in feet with hallux valgus, a two-dimensional coordinate system was devised for evaluation of a weight-bearing dorsoplantar radiograph. The radiographs, taken from 229 feet of 114 patients with symptomatic hallux valgus and 94 normal feet, were investigated. A comparative study showed the first metatarsal head of a foot with hallux valgus was located on the medial side of that of the normal foot and the base of the proximal phalanx of the hallux valgus foot was located on the same point of that of the normal foot. Lateral translation of the base of the proximal phalanx occurred only in cases with overlap toes. Our study shows that subluxation of the metatarsophalangeal joint in hallux valgus is primarily caused by metatarsus primus varus. This study indicated that first metatarsal osteotomies should be given the first priority in consideration for bunion surgery, because these procedures could move the first metatarsal heads laterally in a more normal position.

Adolescent↗
PubMed2001

Roger A. Mann Award . The reliability of angular measurements in hallux valgus deformities. .

The purpose of this study was to determine the intraobserver and inter-observer reliability of physicians on a repetitive basis in making angular measurements of hallux valgus deformities. The hallux valgus angle, the 1-2 intermetatarsal angle, and the distal metatarsal articular angle and the assessment of congruency/subluxation of the first MTP joint were evaluated on a repetitive basis. Physicians were provided with a series of black and white photographs of radiographs with a hallux valgus deformity. Three different sets of photographs randomly ordered were sent at a minimum interval of six weeks to the participants. Participating physicians were extremely reliable in the measurement of the 1-2 metatarsal angle. 96.7% of the photographs were repeatedly measured within a range of 5 degrees or less. The angular measurements to determine the hallux valgus angle were slightly less reliable, but 86.2% of photos were repeatedly measured within a range of 5 degrees or less. In the measurement of the distal metatarsal articular angle, 58.9% of photographs were repeatedly measured within a range of 5 degrees or less. There was a wide range within physician evaluators who recognized very few congruent joints (2 of 21) and those who recognized several congruent joints (11 of 21). Most physicians appeared to be internally consistent in the assessment of MTP congruency; however, some photographs were much more difficult to assess than others. This study validates the reliability of the measurement of the hallux valgus and the 1-2 metatarsal angle. The interobserver reliability in the measurement of the distal metatarsal articular angle is questioned.

Adult↗
PubMed2002

The SCARF osteotomy for the correction of hallux valgus deformities.

The authors report their experience with a modified SCARF osteotomy with three years follow-up. Correction of moderate to severe hallux valgus deformities was achieved using a Z step osteotomy cut to realign the first metatarsal bone. A retrospective analysis was undertaken in 89 consecutive patients (111 feet). Results were analyzed by clinical examination, a questionnaire including the AOFAS forefoot score, and plain roentgenograms. Hallux valgus and intermetatarsal angle improved at mean 19.1 degrees and 6.6 degrees, respectively. Mean forefoot score improved from 50.1 to 91 points out of 100 possible points. Satisfactory healing time was expressed by an average return back to work of 5.8 weeks and back to sport of 8.3 weeks. Persistence or recurrence of hallux valgus was seen in seven patients (6%). The complication rate was 5.4% including superficial wound infection, traumatic dislocation of the distal fragment, and hallux limitus. The presented technique provides predictable correction of moderate to severe hallux valgus deformities.

Adult↗
PubMed2003

Soft-tissue arthroplasty for hallux rigidus.

Seven patients (seven feet) were evaluated at an average follow-up of 42 months following soft-tissue interposition arthroplasty of the hallux metatarsophalangeal (MTP) joint for severe hallux rigidus. The technique involved reaming of the base of the proximal phalanx and metatarsal head to decompress the first MTP joint and placement of a soft-tissue tendon bundle as a biologic spacer. Six of seven patients had bilateral disease, and a positive family history of hallux rigidus. At final follow-up, all seven patients rated their result as good or excellent, the level of pain was substantially reduced, and the mean AOFAS score substantially improved from 46 to 86 points. Mild metatarsalgia was noted by four patients and characterized by mild plantar callosities in these cases. The mean MTP dorsiflexion improved from 9 degrees to 34 degrees and patients demonstrated good to excellent plantarflexion strength on manual muscle testing and with toe rise. Physical examination of the involved feet demonstrated no evidence of pes planus, metatarsus primus elevatus, Achilles tendon contracture, or metatarsocuneiform joint hypermobility in any of the seven. The technique of soft-tissue interposition arthroplasty as described gave excellent pain relief and reliable function of the hallux, and is an alternative treatment to MTP arthrodesis in select cases of severe hallux rigidus.

Arthroplasty↗
PubMed2004

Clinical results with the Ludloff osteotomy for correction of adult hallux valgus.

BACKGROUND: Biomechanically, the Ludloff osteotomy fixed with lag screw compression has been shown to be more rigid than proximal crescentic and other proximal first metatarsal osteotomies for correction of symptomatic hallux valgus with a moderate to severe increase in the first intermetatarsal angle. The Ludloff osteotomy may, therefore, have a lower incidence of dorsal malunion and transfer metatarsalgia than other proximal first metatarsal osteotomies, such as the crescentic or chevron. METHODS: We reviewed the results of 82 consecutive cases of moderate to severe hallux valgus deformities corrected with the Ludloff oblique metaphyseal-diaphyseal osteotomy of the first metatarsal combined with a distal soft-tissue procedure and medial eminence resection. RESULTS: Follow-up was possible in 70 cases (85%) at an average of 30 months (range, 18 to 42 months). Preoperatively, the mean hallux valgus and first intermetatarsal angles were 31 degrees and 16 degrees, respectively. Postoperatively, these values improved to an average of 11 degrees and 7 degrees. In the sagittal plane, the first metatarsal was plantarflexed by an average of 1 mm, and there were no symptomatic transfer lesions of the second metatarsal. The mean AOFAS hindfoot score improved from 54 to 91 points. Complications included prominent hardware requiring removal (5), hallux varus (4), delayed union (3), superficial infection (3), and neuralgia (3). CONCLUSIONS: The use of the Ludloff oblique first metatarsal osteotomy resulted in excellent correction of the first intermetatarsal angle in patients with moderate to severe hallux valgus. With the plane of the osteotomy and rigidity of fixation, immediate ambulation was possible with minimal risk of dorsiflexion malunion of the first metatarsal.

Adult↗
PubMed2005

Foot pressure measurement differences between boys and girls with reference to hallux valgus deformity and hypermobility.

BACKGROUND: Previous studies that compared foot pressures in boys and girls found that girls had greater peak pressures under the hallux than did boys. Only one of these studies considered plantar pressure measurements in children. The purpose of the study was to investigate the effect of gender on foot pressure measurements in children. METHODS: This is a comparative study using the F-Scan pressure platform (F-Mat; Texscan Boston, MA) on a sample of children attending a podiatric clinic. Pressure measurements and temporal parameters were measured in 61 children between the ages of 5 and 16 years. Associations between joint hypermobility and hallux valgus angle also were investigated. RESULTS: Girls were found to have significantly greater peak pressure under the hallux, faster timing of heel contact to first metatarsal head loading, and a more medially placed center of pressure trajectory. No associations were found between these significant variables and hypermobility scores or hallux valgus angle. CONCLUSION: The results indicate that there are differences in pressure measurements between boys and girls, but the reasons for these remain unclear. Differences in pressure measurements in the feet of boys and girls may be useful in establishing the cause of foot pathologies for which a prevalence has been shown in boys or girls, such as hallux valgus deformity, which is known to be more frequent in females of all ages.

Adolescent↗
PubMed2005

Arthrodesis of the first metatarsophalangeal joint for idiopathic hallux valgus: intermediate results.

BACKGROUND: Followup studies documenting the outcome of primary metatarsophalangeal (MTP) joint arthrodesis for treatment of hallux valgus deformities are rare. The purpose of this report was to evaluate the results of first MTP joint arthrodesis as treatment for moderate and severe hallux valgus deformities over a 22-year period in a single surgeon's practice. METHODS: All living patients treated between 1979 and 2001, for moderate and severe idiopathic hallux valgus deformities with first MTP joint arthrodesis were contacted and asked to return for a followup examination. Outcomes were assessed by comparing preoperative and postoperative pain, function, and radiographic appearance. First ray mobility and ligamentous laxity also were assessed postoperatively. RESULTS: Eighteen of 21 of the first MTP joints had successfully fused with the primary procedure at an average followup of 8.2 years (range 24 to 271 months). The time to union averaged 10 (range 7 to 15) weeks. Two of the three nonunions, both in the same patient, were asymptomatic and were not revised. One required a revision to achieve fusion. The average corrections in the hallux valgus angle and 1-2 intermetatarsal (IM) angle were 21 degrees and 6 degrees, respectively, and the average postoperative dorsiflexion angle was 22 degrees. Subjective satisfaction was rated as excellent in seventeen of 21 cases (80%) and good in the remaining four (20%). There was significant reduction in postoperative pain (p < 0.001), complete resolution of lateral metatarsalgia, and the postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores averaged 84 (range 72 to 90) at final followup. Major activity restrictions after surgery were uncommon, and all patients were able to wear conventional or comfort shoes. Interphalangeal (IP) joint arthritis progressed in seven of 21 feet (33%), but all of these changes were mild. CONCLUSIONS: In the present study, arthrodesis of the first MTP joint for idiopathic hallux valgus resulted in a high percentage of successful results at an average followup of over 8 years.

Aged↗
PubMed2005

Evaluation of hallux alignment and functional outcome after isolated tibial sesamoidectomy.

BACKGROUND: Functional loss and clinical evidence of hallux malalignment have been reported to follow isolated tibial sesamoidectomy. METHODS: Thirty-two patients with isolated tibial sesamoidectomies were identified. Patients with a diagnosis of peripheral neuropathy, diabetes mellitus, inflammatory arthropathy or previous foot surgery were excluded as were patients who had concomitant joint realignment procedures. Twenty patients were available for followup with the Short Form-36 (SF-36), Foot Function Index (FFI) disability scale, visual analog scale (VAS), and questionnaire at an average of 62 (range 10 to 157) months after surgery. Fourteen patients returned for physical examination, radiographs, and pedographic and isokinetic examination. RESULTS: Physical examination of the 14 patients did not reveal any significant change in clinical alignment, range of motion or tenderness. Preoperative and postoperative comparison radiographs did not reveal significant differences in the intermetatarsal (IM) angle, hallux valgus (HV) angle distal metatarsal articular angle (DMAA), or sesamoid alignment (sesamoid station). Postoperative outcome measurements (VAS, SF36, and FFI) for 20 patients found significant relief of pain and improved functional outcome. Computerized dynamic pedographic measurements (Performance Orthotic) for 12 patients did not reveal any altered plantar pressures in the region of the hallux metatarsophalangeal joint. Isokinetic measurements of ankle plantar flexion push-off strength in eight patients did not reveal significant differences in side-to-side measurements. Eighteen of 20 (90%) patients indicated that they were able to resume all preoperative activities; six (30%) had extreme difficulty or an inability to stand on tip toe, but this did not impact their activities of daily living or their athletic endeavors. Two patients (14.3%) developed transfer metatarsalgia, but only one was symptomatic. CONCLUSION: Isolated tibial sesamoidectomy is a safe and effective treatment for recalcitrant tibial sesamoiditis. Hallux malalignment and deformity resulting in functional loss and change in hallux alignment can be avoided by meticulous surgical technique with repair of the soft tissues.

Adolescent↗