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PubMed2002

[Short-term results of proximal oblique crescentic osteotomy in hallux valgus].

OBJECTIVES: We evaluated the short-term results of a combination of distal soft tissue procedure and a modification of proximal crescentic osteotomy, namely, proximal oblique crescentic osteotomy (POCO) in moderate to severe hallux valgus. METHODS: Twenty-five male patients (mean age 21 years; range 19 to 26 years) with moderate to severe hallux valgus and incongruent joint were treated by the distal soft tissue procedure and POCO. Objective evaluations included the hallux valgus angle, the intermetatarsal angle, shortening of the first metatarsal bone, and angulation at the osteotomy site on weight-bearing anteroposterior and lateral radiographs of the foot obtained before surgery and for final examinations. Subjective evaluation was made with the use of a patient questionnaire whose overall scores ranged from 6 (completely satisfied) to 18 (completely dissatisfied). The mean follow-up period was 44 weeks (range 28 to 52 weeks). RESULTS: The mean corrections in the hallux valgus angle and the intermetatarsal angle were 22.1 degrees and 10.8 degrees, respectively. Shortening of the first metatarsal bone (mean 3 mm) occurred in five patients and dorsiflexion deformity of the metatarsal head in one patient, which did not lead to transfer metatarsalgia. Nine patients expressed complete satisfaction (36%), followed by seven and six patients with scores of 7 and 8, respectively. The least satisfaction score was 12 in one patient. CONCLUSION: The results suggest that metatarsus primus varus, which is the main deformity in moderate to severe hallux valgus, can be corrected by POCO. This technique may be preferable in terms of ease and a low complication rate.

Adult↗
PubMed2004

Sensory dysfunction in the great toe in hallux valgus.

Injury to the dorsomedial cutaneous nerve in the foot may occur after operations for hallux valgus. Pressure neuropathy before operation is also described but remains largely unexplored. We have investigated the incidence of sensory deficit in the great toe before operating for hallux valgus and examined to what extent any deficit was related to the degree of angulation of the joint. Forty-three patients with a total of 61 great toes with hallux valgus presenting for consideration of surgical correction had their sensation tested in pre-designated zones using a five-filament set of Semmes-Weinstein monofilaments. These allowed good inter-observer reliability with an intra-class correlation coefficient of 0.84. Sensory symptoms were noted by only 21% of the patients, a measurable reduction in sensation by one monofilament grade or more was found in an additional 44%. No relationship was found between the degree of sensory loss and the degree of angulation. Patients with symptomatic hallux valgus may have sensory loss in the toe without being aware of it. Normal subjective sensation does not reliably predict normal sensory function. Given the potentially high rates of nerve damage following operations for hallux valgus, we recommend objective sensory testing as part of routine assessment before surgery.

Adult↗
PubMed2004

[Radiographic and functional results of the Lindgren-Turan operation in the treatment of hallux valgus].

OBJECTIVES: We evaluated the radiographic and functional results of the Lindgren-Turan operation in the treatment of hallux valgus. METHODS: Twenty-nine feet of 25 patients (15 women, 7 men; mean age 42 years; range 20 to 68 years) were treated by the Lindgren-Turan method. Of these, 24 feet with appropriate follow-up were included. Intermetatarsal and hallux valgus angles were measured on preoperative, postoperative, and follow-up anteroposterior radiographs. Pain was evaluated by a visual analog scale. The range of motion of the first metatarsophalangeal joint was measured at the end of follow-ups. The mean follow-up period was 26.5 months (range 6 to 54 months). RESULTS: Postoperatively, the mean corrections were 6.9 degrees and 5.1 degrees in the hallux valgus and intermetatarsal angles, respectively (p<0.05). At the end of the follow-up period, the mean loss of correction was 1.8 degrees for the hallux valgus angle, and 0.5 degrees for the intermetatarsal angle; the mean pain score decreased from preoperative 7.78 to 1.35 (p<0.05) and the mean range of motion of the first metatarsophalangeal joint was 56.8 degrees dorsiflexion and 14.9 degrees plantar flexion. The mean time to return to presurgery activity levels was 44.2 days (range 30 to 70 days). Of the patient group, 83.3% expressed satisfaction with the surgical outcome. Clinical and radiographic evaluations showed excellent results in 15 (62.5%), good in seven (29.2%), and unsuccessful in two patients (8.3%). CONCLUSION: The Lindgren-Turan osteotomy is a preferable method in the surgical treatment of patients with moderate hallux valgus.

Adult↗
PubMed2005

[Sagittal mobility study on the first tarsometatarsal joint in hallux valgus patients and its clinical values].

OBJECTIVE: To study sagittal mobility about the FTJ (first tarsometatarsal joint) and its relationship with the pathophysiology and treatment of hallux valgus patients. METHODS: According to Lee's method, FTJ sagittal mobility of 300 normal feet and 200 hallux valgus was measured, and its correlative factors were statistically analysed. RESULTS: FTJ sagittal mobility of 300 normal feet was 8.4 degrees +/- 2.3 degrees , and that of 200 hallux valgus was 11.7 degrees +/- 3.2 degrees , the difference was significant. The normal range of FTJ sagittal mobility was less than 13 degrees . The sagittal overmotion of FTJ had relation to the anatomical configuration of FTJ (P < 0.05), intercuneiform splitting (P < 0.01), transferred pain under the second metatarsal head (P < 0.01), and FTJ osteoarthritis (P < 0.01) had no relation to HVA (hallux valgus angle), IMA (intermetatarsal angle), second metatarsus medial diaphyseal cortex hypertrophy (P > 0.05). CONCLUSION: Lee's method is convenient and accurate. Both HVA and IMA can not represent the sagittal mobility measurement of FTJ, which should be routinely evaluated, especially for hallux valgus patients with type I FTJ. Lapidus procedure should be considered for patients with larger FTJ in combination with transferred pain under the second metatarsal head, intercuneiform splitting, FTJ osteoarthritis.

Adolescent↗
PubMed2006

[The effect of micro-trauma technic with small incision on treating hallux valgus].

OBJECTIVE: To explore an effective micro-trauma technic with small incision for hallux valgus. METHODS: From August 2002 to June 2004, 136 cases (263 feet) with hallux valgus were treated with micro-trauma technic with small incision and postoperative external elastic fixation. Of all the cases, 7 were males and 129 were females. Their ages ranged from 19 to 84 years. According to Coughlin classification, there were 24 gentle cases, 63 medium cases, and 49 severe cases. All the feet were with some degree of pain and flatfoot. Symptom, sign and the results of X-ray were evaluated. RESULTS: Wound healed at stage I. All cases were followed up for 8 to 26 months, 19 months on average. Hallux valgus of the 263 feet were completely healed, feet pain disappeared, and no nonunion or osteonecrosis was observed. X-ray examination indicated that 105 feet's hallux valgus angle was less than 12 degrees, inter metatarsal angle less than 9 degrees, and remedy subluxation of the tibial sesamoid less than 50%. Evaluation on the result indicated that there were 84 cases of excellent result, 48 cases of good result, 3 cases of fair result, and 1 case of poor result. The rate of excellent and good was 97%. CONCLUSION: With less injury, less pain, complete restoration, and fewer possibility of relapse, micro-trauma technic with small incision is effective in treating hallux valgus.

Adult↗
PubMed1991

Hallux valgus repair. DuVries modified McBride procedure.

The DuVries modification of the McBride procedure was investigated in 72 feet in 47 patients with hallux valgus deformity. Overall, the patient satisfaction rate was 92%. The hallux valgus averaged 32 degrees preoperatively, and 16 degrees postoperatively. The intermetatarsal angle averaged 14 degrees preoperatively and 9 degrees postoperatively. Anatomic realignment of the remaining tibial sesamoid was achieved in 28% of the feet. As a result of realignment of the first metatarsophalangeal joint, the intractable plantar keratosis beneath the second metatarsal head was resolved in 19 of 20 feet. Six patients developed a hallux varus deformity that averaged 7.5 degrees. All cases of hallux varus had medial displacement of the tibial sesamoid. The number of patients who could withstand unrestricted shoe wear increased from ten patients preoperatively to 30 patients postoperatively. The patient activity level increased in two thirds of the cases. The distal soft-tissue procedure produces the most predictable correction in patients with a hallux valgus deformity measuring less than 30 degrees. In more severe deformities, a proximal metatarsal osteotomy should be added to the procedure.

Adolescent↗
PubMedDate not supplied

Forces under the hallux valgus foot before and after surgery.

Abnormalities in the hallux valgus foot and changes after surgery were investigated by measuring the distribuiion of load on the foot in walking. Hallux valgus was associated with reduced load imposed on the toes, and on the medial side of the forefoot, compared with a large sample of healthy feet. Abnormalities correlated with the degree of the deformity. Both Keller's operation and a wedge displacement osteotomy of the first metatarsal not only failed to restore normal loading but increased the abnormalities of loading seen preoperatively. A large decrease in the angle between first and second metatarsals as a result of surgery minimized this increase. A silastic arthroplasty did not carry high loads when used to treat hallux valgus, but near normal loads were imposed on it when used for hallux rigidus. Considerable variability was found in the loading distribution on the healthy feet. The distribution between first and second metatarsal heads was partially dependent upon their protrusions, relative to the direction of walking. The changes in the relationships between the loadings on the forefoot and skeletal shape in response to surgical operations are important for our understanding of treatment of the hallux valgus foot.

Adolescent↗
PubMed1981

[Between hallux rigidus arthrosis and gout is no causal relationship].

The following assertion - continuously being alleged - is examined: Hallux rigidus arthrosis is said to occur in patients suffering from gout more frequently than average, and it should be valued as a symptom of chronic gout. Results of our own findings are as follows: 1. Hallux rigidus arthrosis becomes manifest in general on the right side or bilaterally, respectively; on the left side, however, it occurs rarely in an isolated state. 2. In patients with hallux rigidus arthrosis hyperuricaemia, gout, and obesity are seen more frequently than in adults of the normal population - these three diseases often are combined with static mutations in the region of the lower extremities. 3. No criteria can be stated as to causal relationship between hyperuricaemia (or gout) and hallux rigidus arthrosis. Obesity has to be considered a connecting link between both of them, and it is accelerating their genesis. 4. Hallux rigidus arthrosis represents - same as the arthrosis of Heberden - the more frequent possibility for confusing it with gout.

Adult↗
PubMed1994

Hallux valgus: soft tissue procedure versus bony procedure.

Hallux valgus is one of the most common fore-foot problem in civilized populations. 49 feet of 33 cases, 8 males and 25 females with an average age of 50 years old, were treated surgically from 1987 to 1992 for hallux valgus and followed up for an average of 47.8 months, comprising 20 feet with McBride's soft tissue procedure and 29 feet of Mitchell metatarsal osteotomy. The clinical criteria for follow up included pain relief, cosmetic out look, shoe wearing comfort, metatarsophalangeal motion etc. 87.5% of the cases in the McBride's group and 95% of the cases in the Mitchell group were satisfied with the clinical results. The immediate post-operative metatarsophalangeal (MP) angle and intermetatarsal (IM) angle were both well corrected, but there was a significantly higher recurrence rate of hallux valgus in the group with the McBride's procedure (P < 0.05). One case in the McBride's group had the complication of hallux varus and one case from the Mitchell group had delayed union. The Mitchell bony procedure has a more stable result compared to the McBride's soft tissue procedure for the correction of moderate hallux valgus, and the modified Mitchell osteotomy is less invasive, easier to perform, easier to care for, and has more satisfactory long-term results.

Adolescent↗
PubMed1980

Hallux adductus as a surgical complication.

The authors correlate pertinent literature with their experience in discussing hallux adductus as a postoperative complication. Presented is the accurate terminology of hallux adductus to describe the transverse plane abnormality. Hallux adductovarus is utilized if there is an additional frontal plane rotation. In presenting 10 cases of hallux adductus, the authors found that 9 were sequelae of a McBride modification. Their incidence of slightly over 1% agrees with past reports. Detailed measurements of cases taken from pre- and postoperative radiographs are presented to attempt to gain better understanding of the factors involved with the deformity. Also introduced is the hallux adductus angle. A review of the treatments is discussed.

Foot↗
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↗
PubMed2002

New radiographic analysis of sesamoid rotation in hallux valgus: comparison with conventional evaluation methods.

The position of the hallucal sesamoids needs to be included in evaluation of hallux valgus. In order to quantify the rotational position of the hallucal sesamoids, a new weightbearing tangential radiograph was established by means of a specially designed tangential positioning device. This device has a depression, and a tangential radiograph is taken with the metatarsophalangeal joint at 45 degrees dorsiflexion. A lead marker plate is placed on the depression to show the horizontal plane, and the sesamoid rotation angle (SRA) is measured. The SRA is the angle between the tangential line of the most inferior aspect of the medial-lateral sesamoids and the lead marker line. The SRA was compared with values of the four-grade scale and seven-position scale which were measured from the antero-posterior view, with respect to the hallux valgus angle (HVA), by means of conventional methods. Measurements were made of 58 feet in 29 patients with hallux valgus and 64 feet in 32 normal subjects. The SRA showed the highest correlation among the three parameters (r=0.817). Some cases had a disparity regarding the position of the sesamoids between the tangential view and the AP view due to misclassification on the AP view. We conclude that the scale of position of the sesamoid on the AP view is not valid in some cases, whereas the SRA is useful for assessing quantitatively the rotational position of the hallucal sesamoids in cases of hallux valgus.

Adolescent↗
PubMed1994

A metallic hemiarthroplasty resurfacing prosthesis for the hallux metatarsophalangeal joint.

Two-hundred seventy-nine arthritic hallux metatarsophalangeal joints treated surgically with a metallic resurfacing hemiarthroplasty over a 40-year period were reviewed. The implant, which is made available in three evenly graded sizes, is designed to replace only the articular surface of the proximal phalanx, with minimal resection of bone stock. The pathologic indications for surgery included classical hallux rigidus, rheumatoid arthritis, and degenerative changes associated with hallux valgus and bunion deformity. Follow-up at 8 months to 33 years after surgery revealed good or excellent clinical results in 95%. The time to follow-up was in excess of 5 years in 101 (36%) of the procedures, beyond 10 years in 62 (22%), and longer than 20 years in 23 (8%). Unlike other available surgical options for this debilitating condition, biomechanics of the hallux metatarsophalangeal joint remained unaffected and problems associated with prosthetic wear or mechanical failure were not encountered.

Adult↗
PubMedDate not supplied

Hallux varus: a step-wise approach for correction.

Iatrogenic hallux varus can be an unfortunate complication of hallux abducto valgus surgery. The correction of hallux varus must be performed in a well planned, step-wise method. The authors present both soft tissue and osseous corrections for hallux varus, with two case reports.

Clinical Protocols↗
PubMed1984

The prevalence of hallux valgus in South African males.

The prevalence of hallux valgus and its relationship to the metatarsal angles have been assessed in South African males from two Black communities and one White community. After the age of 11 years there is a small increase in the metatarsal angle of White males, but this remains within the normal range. In comparison with White females, who seem to be predisposed to the disorder of hallux valgus, neither White nor Black males show a significant increase in hallux angles after adolescence. Males of all ages and race groups seldom develop clinical hallux valgus, and this apparent resistance to the deformity is associated with a minimal increase in the metatarsal angle, and therefore in the width of the foot.

Adolescent↗
PubMed1998

Arthrodesis versus resection arthroplasty for failed hallux valgus operations.

The results for 18 patients (20 feet) in whom a hallux valgus procedure had failed were reviewed. Ten patients (11 feet), with a mean age of 63 years, had correction with Keller resection arthroplasty and were observed for an average of 10 years (range, 3-15 years). The hallux valgus angle improved an average of 11 degrees +/- 3 degrees, and the intermetatarsal angle improved an average of 2 degrees +/- 1.7 degrees. Results were good in six feet, fair in four, and poor in one. Eight patients (nine feet), with a mean age of 63 years, had correction with arthrodesis and were observed for an average of 5 years (range, 2-8 years). The hallux valgus angle improved an average of 23 degrees +/- 6.9 degrees, and the intermetatarsal angle improved an average of 2 degrees +/- 3 degrees. Results were good in six feet, fair in two, and poor in one. There were differences between the two operations in terms of patient satisfaction, pain relief, appearance, and footwear. The incidence of metatarsalgia was similar for the two groups. Complications, particularly malalignment, were more common in the resection group. None of the patients required additional revision operation. Resection arthroplasty is a simple procedure and does not require cast immobilization. Resection arthroplasty and arthrodesis are reasonable options for salvage treatment of failed hallux valgus operations in older patients because good results were achieved in six of nine (67%) feet after arthrodesis and in six of 11 (54%) feet after resection.

Aged↗
PubMed2001

Surgery vs orthosis vs watchful waiting for hallux valgus: a randomized controlled trial.

CONTEXT: Hallux valgus is a common foot deformation in adults, but evidence for effectiveness of surgical and conservative treatments for this condition is limited. OBJECTIVE: To compare the effectiveness of surgical and orthotic treatment with no treatment in patients with hallux valgus. DESIGN AND SETTING: Randomized controlled trial conducted in 4 general community hospitals in Finland in 1997-1998, with a follow-up period of 12 months. PARTICIPANTS: Two hundred nine consecutive patients (mean age, 48 years; 93% women) with a painful bunion and a hallux valgus angle 35 degrees or less. INTERVENTIONS: Patients were randomly assigned to surgery (distal chevron osteotomy; n = 71), orthosis (n = 69), or a 1-year waiting list (control group, n = 69). MAIN OUTCOME MEASURES: Pain intensity during walking on a visual analog scale (0-100), patient assessment of global improvement, number of painful days, cosmetic disturbance, footwear problems, functional status, and treatment satisfaction, compared among treatment groups. RESULTS: Follow-up rates at 6 and 12 months were 99% and 98%, respectively. At 6 months, pain intensity decreased more in the surgical group than in the control group (adjusted mean differences, -20 [95% confidence interval (CI), -28 to -12]) and more in orthosis than in the control groups (adjusted mean difference, -14 [95% CI, -22 to -6. At 1 year, pain intensity decreased more in the surgical than in the control groups (adjusted mean difference, -19 [95% CI, -28 to -10]) and more than in the surgical and orthosis groups (adjusted mean difference, -14 [95% CI, -22 to -5]). At 1 year, 83%, 46%, and 24% in the surgery, orthosis, and control groups, respectively, thought they had improved compared with baseline (number needed to treat), 1.7 between surgical and control groups). Number of painful days, cosmetic disturbance, and footwear problems were least and functional status and satisfaction with treatment were best in the surgical group. CONCLUSIONS: Surgical osteotomy is an effective treatment for painful hallux valgus. Orthoses provide short-term symptomatic relief.

Female↗
PubMed1999

Insertion of the abductor hallucis muscle in feet with and without hallux valgus.

Textbooks of human anatomy present different opinions on the insertion of the abductor hallucis muscle which is concerned in etiology as well as in therapy of hallux valgus. In plastic and reconstructive surgery the muscle is taken as a graft for flap-surgery. In this study 109 feet (58 right, 51 left) were examined, 18 of these with clinical hallux valgus. The tendon of the muscle may attach to the tendon of the medial head of the short flexor hallucis muscle where a subtendineous bursa can be found. At the head of the first metatarsal bone the joint capsule is reinforced by fibres arising from the medial sesamoid bone which may be called "medial sesamoidal ligament." The tendon passes the first metatarsophalangeal joint plantarily to its transverse axis. Three types of insertion could be distinguished: type A, insertion at the proximal phalanx (N = 42); type B, insertion at the medial sesamoid ligament and at the medial sesamoid bone (N = 65); type C, insertion at the medial sesamoid bone (N = 2). In all types superficial fibres of the tendon extended to the medial and plantar sides of the base of the proximal phalanx, running in a plantar to dorsal direction. Statistical analysis exposed neither significant differences between both sides nor significant difference between normal feet and feet with hallux valgus. Therefore, a specific pattern of insertion of the abductor hallucis muscle in hallux valgus cannot be stated.

Foot↗