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At least 19 recordsLinked to original sources
PubMed1997

Hallux valgus in men: effect of the distal metatarsal articular angle on hallux valgus correction.

The results of hallux valgus correction were reviewed for 34 male patients (41 feet). The severity of the preoperative deformity determined the operative technique of correction. A distal soft tissue procedure with proximal first metatarsal osteotomy was performed in 30 patients (35 feet) with an average correction of the hallux valgus angle of 22 degrees. A chevron procedure was performed in five cases and a McBride procedure in one other case, all with less severe deformities. Complications included one deep wound infection, one broken screw at the metatarsal osteotomy site, and three cases of hallux varus. No patients underwent reoperation. Undercorrection was noted in 10 of 35 cases (29%) where a distal soft tissue procedure with proximal first metatarsal osteotomy was performed. A nonsubluxated (congruent) metatarsophalangeal (MTP) joint associated with a hallux valgus deformity was present in 15 of 41 (37%) of all cases and 10 of 35 (29%) of cases that underwent a distal soft tissue procedure with proximal metatarsal osteotomy (DSTR with PMO). A subluxated (noncongruent) MTP joint associated with hallux valgus was present in 26 of 41 (63%) of all cases and 25 of 35 (71%) of cases undergoing a DSTR with PMO. There was a highly significant difference in the average distal metatarsal articular angle (DMAA) as measured in the nonsubluxated (congruent) MTP joints (20.7 degrees) and the subluxated (noncongruent) MTP joints with hallux valgus (10 degrees) (P = 0.0001). The average distal metatarsal articular angle for all cases undergoing DSTR with PMO was 13 degrees. When the postoperative hallux valgus angle was compared with DMAA, the average residual hallux valgus angle was 10.1 degrees. With a subluxated (noncongruent) first MTP joint with hallux valgus (a low DMAA), the percent of hallux valgus correction (hallux valgus correction [in degrees]/preoperative hallux valgus deformity [in degrees]) was 77%. In patients with a nonsubluxated (congruent) first MTP joint with hallux valgus (a high DMAA), the percent correction was 46%, an almost twofold difference in percent correction. There was a close correlation between the preoperative DMAA and the postoperative hallux valgus angle in both the subluxated and congruent subgroups (P = 0.0003). With an intra-articular repair (a DSTP with PMO), the magnitude of correction of a hallux valgus deformity is limited at the MTP joint by the distal metatarsal articular angle.

Adult↗
PubMed1996

Hallux limitus and hallux rigidus. Clinical examination, radiographic findings, and natural history.

Numerous clinical features of hallux limitus/rigidus have been previously reported as isolated entities based on individual case review or myopic observations. Few attempts have been made to synthesize a comprehensive natural history which correlates the inter-relationship of these findings. Frequently unrecognized or overlooked subtle clinical findings, such as shoe-wear patterns, hyperkeratoses locations, and gait disturbances, precede significant radiographic changes or painful degenerative arthritis by months to years. Recognition of these subtle clinical features will aid in establishing an early and accurate diagnosis, and provide the physician with an opportunity to institute treatment prior to the need for surgical reconstruction. Several conclusions can be made regarding the natural history of hallux rigidus. 1. Predisposing factors (pes planovalgus, uncompensated varus) lead to spastic contracture of the hallux (hallux equinus). 2. A shift in the axis of movement occurs within the first metatarsophalangeal joint, from centrally within the metatarsal head to plantarly at the level of the sesamoidophalangeal ligament. 3. Dorsal articular impingement of the proximal phalangeal base on the metatarsal head leads to either a chronic erosion of the dorsal metatarsal head (chondritis dissecans), or fracture through the subchondral bone plate (osteochondritis dissecans). 4. Progressive degenerative arthritis within the first metatarsophalangeal joint appears as joint space narrowing, dorsal osteophyte proliferation, subchondral cyst formation and sclerosis, and articular flattening. 5. Synovial effusion produces periarticular pain, resulting in chronic splinting of the hallux. 6. Auto-fusion of the metatarsophalangeal joint represents the end-stage progression of hallux rigidus. In addition to degeneration of the metatarsophalangeal joint, sesamoid degeneration further compounds joint immobility. 1. Sesamoid immobility from chronic spasm leads to traction proliferation of the sesamoid bones (hypertrophy). 2. Disuse osteopenia of the sesamoids is an indication of sesamoid-metatarsal degeneration, and parallels degenerative changes of the first metatarsophalangeal joint. 3. Proximal sesamoid retraction reflects the degree of hallux equinus. Metatarsus primus elevatus is a co-existant feature of hallux limitus and hallux rigidus. 1. Primary metatarsus primus elevatus is encountered in patients with a more proximal level of uncompensated varus, with hallux equinus occurring secondarily in an attempt to provide medial column support. 2. Secondary metatarsus primus elevatus results from the retrograde effects of hallux equinus on the first metatarsal, and occurs in patients with pes planovalgus. 3. Flexor stabilization syndrome of the hallux occurs in patients with pes planovalgus, and is analogous to a flexor stabilization hammertoe of the lesser digits. 4. Differentiation between primary and secondary metatarsus primus elevatus is made by evaluation of weight-bearing radiographs, comparing the standard lateral radiograph to a lateral radiograph using a forefoot block test, in which the digits are suspended off of the weight-bearing surface.

Adolescent↗
PubMed2026

Contemporary surgical decision-making for hallux valgus and hallux rigidus in Switzerland: A national cross-sectional survey using standardized clinical scenarios.

BACKGROUND: Surgical management of hallux valgus and hallux rigidus is influenced by deformity severity, surgeon training, and evolving techniques. Previous surveys in Australia (2012), Switzerland (2015), and Israel (2023) using identical hypothetical cases demonstrated marked regional differences and a recent rise in minimally invasive Chevron-Akin (MICA). Whether these advances have altered contemporary Swiss practice remains unclear. METHODS: An electronic survey replicating the original questionnaire was distributed to members of the Swiss Foot and Ankle Society. Three standardized clinical cases were presented: mild hallux valgus, severe hallux valgus, and hallux valgus et rigidus. Respondents selected nonoperative versus operative management and specified procedures and fixation methods. Demographics, subspecialty training, and surgical volume were recorded. Current results were compared with prior Swiss data to assess temporal change. RESULTS: Eighty surgeons completed the survey (94% foot and ankle specialists). For mild hallux valgus, 87.7% recommended surgery; Scarf osteotomy remained most common (49.4%), followed by Chevron (21.0%) and Minimally Invasive Hallux Valgus correction (14.8%). Minimally Invasive adopters were predominantly mid-career (83% aged 41-50), high-volume surgeons. For severe hallux valgus, 95.1% favoured surgery; MTPJ arthrodesis was preferred (50.6% isolated; 11.1% with Lapidus), while Minimally Invasive Hallux Valgus correction was rarely chosen (2.5%). In hallux valgus et rigidus, 96% selected MTPJ fusion, most commonly plate-and-screw fixation (45.1%). Compared with 2015, fixation strategies evolved, yet procedure selection remained largely unchanged. CONCLUSION: Despite global expansion of minimally invasive bunion surgery, Swiss surgeons continue to favour established open techniques, particularly Scarf osteotomy and fusion-based strategies. Adoption of MIS remains limited and concentrated among high-volume, mid-career specialists, indicating a cautious national diffusion pattern. LEVEL OF EVIDENCE: IV, survey study.

Hallux Valgus↗
PubMedDate not supplied

A comparison of radiographic measurements in normal, hallux valgus, and hallux limitus feet.

This study investigated the differences in weightbearing, foot radiographs among normal subjects, those with hallux valgus, and those with hallux limitus. An intrarater reliability study of various x-ray measurements was conducted, utilizing seven dorsoplantar and six lateral measurements. The results showed that metatarsus primus adductus, increased metatarsal width, and a positive first metatarsal protrusion distance were associated with hallux valgus, whereas increased hallux interphalangeal angle was associated with hallux limitus.

Foot↗
PubMed1984

Hallux sesamoid bones. Anatomical observations with special reference to osteoarthritis and hallux valgus.

The normal characteristics of the hallux sesamoid bones were studied in 200 toes (100 dissections and 100 radiographs from patients with hallux valgus), and pathological changes were recorded. Normally each sesamoid articulated with a separate groove on the plantar surface of the first metatarsal head. A bony ridge on the head separated these grooves. Bipartite sesamoids were found in 4% of the toes. Osteoarthritic changes manifested by deformity, irregularity, lipping, cysts in the sesamoids and in the heads of the first metatarsal, and erosions in the articular surfaces were present in 32% of the dissected toes. Fusion of the sesamoids was found in 6%. Ankylosis between the sesamoids and the head of the metatarsal was observed in 4%. In the toes affected by hallux valgus the sesamoids, together with the plantar pad and the tendon of the flexor hallucis brevis, were displaced laterally to a variable degree. In severe deformities the lateral sesamoid was dislocated lateral to the first metatarsal head and the medial sesamoid occupied the groove originally corresponding to the lateral sesamoid, while the metatarsal ridge separating the two sesamoids tended to disappear. Osteoarthritis of the metatarsophalangeal joint frequently accompanied hallux valgus.

Hallux↗
PubMedDate not supplied

Sliding oblique osteotomy for the treatment of hallux abducto valgus associated with functional hallux limitus.

This is a retrospective study of 27 patients (35 feet) with hallux abducto valgus associated with hallux limitus who underwent a sliding oblique osteotomy for surgical treatment between August 1997 and June 1998. Radiographic analysis and range-of-motion measurements were evaluated with an average follow-up of 65 days (range, 26-100). Preoperative criteria included < 45 degrees of dorsiflexion of the first metatarsophalangeal joint with weightbearing, no evidence of degenerative joint disease at the first metatarsocuneiform joint, and no previous surgical procedures on the first ray. The average preoperative intermetatarsal angle was 9 degrees, hallux abductus angle 17 degrees, and first metatarsal declination angle 15 degrees. The average postoperative intermetatarsal angle was 6.6 degrees, hallux abductus angle 10.3 degrees, and first metatarsal declination angle 21.7 degrees. Eighteen patients (22 feet) had a follow-up of over 6 weeks, and the first metatarsophalangeal joint was evaluated. The average gain in postoperative range of motion with weightbearing was 22.3 degrees.

Adult↗
PubMedDate not supplied

[Morphology of the adductor hallux muscle and its significance for the surgical treatment of hallux valgus].

The Mc Bride procedure for surgical treatment of the hallux valgus varies according to the different morphological features of the M. adductor hallucis. One hundred specimens of human adult feet-some with a hallux valgus deformity- were preserved in formaldehyde and examined under this aspect. The tendon of the M. adductor hallucis shows two heads-a caput transversum and a caput obliquum- and inserts at the basis as well as at the lateral sesamoid bone of the great toe. Morphological differences in type and place of confluence of both tendon heads give us a classification into 8 different types. In most cases the caput transversum inserted into the caput obliquum from the side and in the middle at the level of the lateral sesamoid bone of the great toe. In most cases, specimens with this muscle type showed a hallux valgus. In surgery of the hallux valgus deformity the tendon of the M. adductor hallucis should be detached from it insertion points in order to reduce the tension on the sesamoid bone and to prevent luxation. The insertion of the caput laterale of the M. flexor hallucis brevis at the lateral sesamoid bone should be left as it is.

Hallux Valgus↗
PubMed1989

Silastic ball spacer arthroplasty in the management of hallux valgus and hallux rigidus.

Sixty-two feet in 39 patients who were treated by insertion of a silastic ball spacer prosthesis into the first metatarsophalangeal joint for hallux valgus or hallux rigidus have been reviewed with a follow-up time of between 2 and 6 years. Twenty-one results (34%) were excellent, 27 (43%) were fair, 13 (21%) were poor, and one was revised. Seventeen feet (27%) had some metatarsalgia at followup. Results were disappointing in the young patients; in 19 cases of hallux valgus under the age of 45, 8 were either poor or had been revised. The original concept of the silastic ball spacer was to maintain great toe length and prevent proximal migration of the sesamoids. However 60% of these feet showed settling of the prosthesis or new bone formation around the prosthesis and 54% had more than 2 mm proximal migration of the sesamoid bones. The symptomatic results in these patients were similar to those in whom great toe length had been successfully maintained. The silastic ball spacer infrequently achieves its aims, however maintenance of hallux length does not seem to be important in the symptomatic result.

Adult↗
PubMed2003

Hallux valgus in men. Part II: First ray mobility after bunionectomy and factors associated with hallux valgus deformity.

PURPOSE: To determine the 1st ray mobility following a distal soft-tissue procedure with proximal osteotomy (DSTP-PMO) and any associated factors. METHODS: A retrospective study of 30 men (35 feet) was performed. First ray mobility, ankle dorsiflexion, pes planus, and metatarsus adductus were evaluated at the final follow-up. All internal fixation was routinely removed at six to eight weeks postoperatively. Standard radiographs were evaluated and angular measurements were calculated on all feet. RESULTS: The mean follow-up was 78 months. No cases of degenerative arthritis of the 1st MTC joint were noted on follow-up radiographs. DSTP-PMO resulted in a mean postoperative 1st ray mobility of 4.9 mm (range, 2.5 to 8). In those feet evaluated following bunion correction, there was no correlation with pes planus, limited ankle dorsiflexion or metatarsus adductus. The preoperative hallux valgus angle and 1-2 intermetatarsal angle correlated with toe pronation and a positive family history. Twenty-two patients had an AOFAS score of 90-100, seven of 80-89 and one less than 69. CONCLUSION: Hallux valgus in this group of male patients was not associated with limited ankle dorsiflexion or pes planus. Men with toe pronation and a positive family history had a greater hallux valgus deformity than those without after a distal soft tissue repair with proximal first metatarsal osteotomy. There was no evidence of first ray hypermobility after a DSTP-PMO.

Achilles Tendon↗
PubMed1985

Ambulatory correction of hallux abducto valgus. Angulational, transpositional, derotation, and hallux set procedure.

The importance of correction of the high proximal articular set angle with a subluxed joint in hallux abducto valgus for long-term correction is cited. I have shown that if the laterally deviated facet is not corrected, pronatory forces continue to act on the first ray. When force is applied to a still laterally tilted first metatarsophalangeal joint, further side-slipping of the joint will occur even though modification of the Silver, McBride, or osteotomy procedures of the first metatarsal have been performed successfully. A review of the standard procedures for the correction of a high proximal set angle alone usually did not correct the high intermetatarsal angle usually associated with this problem. Combination procedures sometimes created complications. These include dorsal dislocation of the distal fragment in correction of the sagittal plane deformity causing metatarsalgia, limited dorsal range of motion, and damage to the sesamoids or sesamoid grooves on the plantar aspect of the first metatarsal. Angulational transpositional derotation and hallux set (ATDH) is offered to correct four deformities using one or two 1-cm incisions together with "stab" incisions. This method overcomes the many disadvantages of previous procedures and can be used in the presence of biomechanical pronatory forces to reduce the proximal articular set and intermetatarsal angles; to derotate the hallux; to neutralize the forces that pull the proximal phalanx off the first metatarsal head; and if necessary, to correct the sagittal plane deformity of the first metatarsal so that weight bearing is not disturbed.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Surgical Procedures↗
PubMed1981

Hallux valgus and hallux flexus associated with cerebral palsy: analysis and treatment.

Hallux valgus and hallux flexus associated with cerebral palsy foot deformity may be due to equinovalgus and/or metatarsus primus adductus or combinations of these. Occasionally the condition occurs in equinovarus feet. Hallux flexus or "dorsal bunion" is usually due to a weak extensor hallucis longus, overpull of the anterior tibial muscle on the first metatarsal and spasticity or contracture of the flexor hallucis longus or brevis. A weak peroneus longus muscle has not caused this deformity. The condition is usually predictable in the growing child if all factors related to gait, collagen stability and foot alignment are observed. Treatment includes soft-tissue and bone realignment. Release of the adductor hallucis, lateral collateral ligaments of the metatarsophalangeal joint, plication of the medial capsule and of the abductor hallucis and centralization of the extensor hallucis longus will realign the first ray. The flexor hallucis longus is transferred to athe extensor hallucis longus proximal to the metatarsophalangeal joint and the anterior tibial tendon is transferred to the second metatarsal. An osteotomy at the base of the first metatarsal and at the base of the proximal phalanx will realign the skeleton. Twenty-six great toes in 16 patients have been observed for two to 20 years. The correction has been maintained without arthrodesis of the metatarsophalangeal joint except where chondromalacia occurred. Once the pattern of deformity is evident, progression is unrelenting and treatment is indicated in order to prevent chondromalacia of the articular cartilage.

Adult↗
PubMed2000

The use of osteotomies in the treatment of hallux limitus and hallux rigidus.

Though osteotomies for relief of hallux limitus and rigidus have been around since the earliest surgical corrections, no sound clinical studies have been performed to warrant their use over the standard accepted techniques of cheilectomy and arthrodesis. These operations are surely more technically demanding than such standard procedures, and involve significant increased risk and postoperative immobilization than cheilectomy alone. Sound theories such as metatarsus primus elevatus and excessive metatarsal length contributing to hallux rigidus have never been proven, and no accurate way to diagnose these structural deformities has been proposed. These operations are intriguing and some make clinical sense. It remains to be seen whether the orthopedic community will adopt them based on their merits.

Adolescent↗
PubMedDate not supplied

Hallux valgus and hallux rigidus: MRI findings.

The purpose of this article is to describe the MR findings of Hallux Valgus (HV) and Hallux Rigidus (HR). Twenty-four patients (11 with HV, 4 with HR, and 9 with both HV and HR) were studied at 1.5 Tesla MRI. Two separate observers evaluated the first ray blindly for the following signs: sesamoid position, sesamoid proliferation, hypertrophy of the median eminence, presence of a lateral facet, presence of an adventitial bursa, shape of the first metatarsal head, relative length of the first metatarsal, joint space loss, osteophytes (dorsalor lateral), marrow edema, geodes, subchondral sclerosis, intra-articular ossicle, and pes planus. The most common findings observed in HV were a hypertrophic medial eminence (95%), sesamoid proliferation (90%) and adventitial bursitis (70%). The most common findings observed in HR were osteophytes (77% and 69%), geodes, and marrow edema. We conclude that traditional routine radiograph signs of HV and HR may be applied to MR images.

Adult↗
PubMed1992

Measurement of extensor hallucis longus power in patients with hallux valgus. Is the Dandy sign reliable in cases of hallux valgus?

The authors took manual and dynamometric measurements of the power of the extensor hallucis longus (EHL) muscle in 100 patients with juvenile hallux valgus and 141 normal patients. Three degrees of valgus deformation were recognized: mild (15-25 degrees), moderate (26-35 degrees), and severe (> 35 degrees). Neither the manual nor the dynamometric measurements showed any difference in EHL power between the normal patients and those with mild valgus deformity. In the patients with moderate valgus deformity, the manual measurement usually showed the EHL force to be the same as that of the normal patients, while the dynamometric measurement gave a lower value. The patients with severe valgus deformation were shown to have a slight to moderate loss of power on manual measurement and a greater loss of power on dynamometric evaluation. Both methods of measurement are equally reliable. When the valgus deformation is mild to moderate, any loss of EHL power must be attributed to another cause; when the valgus deformation is severe, however, it by itself provokes a significant loss of EHL power. The Dandy maneuver is unreliable only in cases of severe hallux valgus.

Adult↗
PubMed1981

A new osteotomy for hallux valgus: a horizontally directed "V" displacement osteotomy of the metatarsal head for hallux valgus and primus varus.

A new operation for hallux valgus consists of a horizontally directed "V" displacement osteotomy done in the head of the first metatarsal. This procedure corrects most of the primus varus, the valgus tilt of the articular surface of the first metatarsal and, if present, the axial rotation of the great toe. The osteotomy is combined with a release and balancing of soft-tissue structures on both sides of the joint. No casting and usually no internal fixation is necessary. Ambulation is generally recommended on the third postoperative day. The operative techniques, indications for surgery, clinical material, and postoperative care are discussed. The operation, when done correctly, does not result in recurrence of the deformity. Significant complications are rare.

Biomechanical Phenomena↗