The impact of hindfoot deformities for the recurrence of hallux valgus after joint-preserving surgeries for rheumatoid forefoot deformities

Background Properly fitted shoes can support the development of growing feet and prevent problems and pathologies, not only in childhood, but also in adulthood. This points to the need to conduct research on the impact of shoe fitting on the structure of the foot in order to raise awareness and importance of this problem, to enable proper decisions regarding the purchase and use of shoes. The aim of this study was to analyze indoor footwear fit and its impact on foot structure in 7-year-old schoolchildren. Methods The CQ-ST podoscope and the Clevermess device were used for measurements. The analysis was carried out using the Mann Whitney U test, Wilcoxon signed-rank test, Chi-square test, regression analysis. Results About 40% of girls and boys had shoes that were incorrectly fitted in length, while as many as 74% of girls and 66% of boys wore shoes that were incorrectly fitted in width. Regression analysis demonstrated a statistically significant influence of the footwear length on longitudinal arch of the right and left foot and the transverse arch of the right foot. In boys, the length of the shoes shows associations with the right and left hallux valgus angle. Conclusion A significant percentage of the studied 7-year-olds, regardless of gender, wears inappropriately fitted shoes. In both sexes, the length of the footwear influenced the longitudinal arch of the right and left foot and the transverse arch of the right foot. Due to the deformity of the first metatarsophalangeal joint, the boys with hallux valgus require footwear which is wider and therefore their shoes need to be bigger in size.

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Effect of Severity of Deformity on Clinical Outcomes of Scarf Osteotomies

Foot & Ankle International ◽

10.1177/1071100720907387 ◽

2020 ◽

Vol 41 (6) ◽

pp. 705-713 ◽

Cited By ~ 1

Author(s):

Gin Way Law ◽

Kae Sian Tay ◽

Jeremy Wei Sern Lim ◽

Karen Ting Zhang ◽

Chusheng Seng ◽

...

Keyword(s):

Patient Satisfaction ◽

Clinical Outcomes ◽

Hallux Valgus ◽

Short Form ◽

Group Differences ◽

Level Of Evidence ◽

Severe Group ◽

American Orthopaedic ◽

The Impact ◽

Second Toe

Background: Literature is sparse on whether severity of hallux valgus affects outcomes of surgery. We thus aimed to evaluate the impact of hallux valgus severity on the clinical outcomes of surgery. Methods: 83 consecutive scarf osteotomies performed by a single surgeon for symptomatic hallux valgus between 2007 and 2011 were divided into 3 groups (mild, moderate, and severe) based on severity of their preoperative hallux valgus using the hallux valgus and intermetatarsal angles. Outcomes were assessed using the visual analog scale (VAS) for pain, 36-Item Short Form Health Survey physical functioning (SFPF) and mental health (SFMH) subscales, and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores. These were assessed preoperatively and at 6 months and 2 years postoperatively. Patient satisfaction was assessed at 6 months and 2 years postoperatively. Eleven (13.2%), 54 (65.1%), and 18 (21.7%) feet were in the mild, moderate, and severe groups, respectively. Results: There was no difference in preoperative VAS, SFPF, SFMH and AOFAS scores between the groups except for AOFAS scores for the second toe, which were poorer with increasing hallux valgus. Postoperatively, there was improvement across all outcome scores. VAS and AOFAS showed excellent scores, and patient satisfaction was high across all 3 groups (88.9%, 89.4%, and 86.7%). The severe group had slightly lower SFPF scores at 6 months (mild, 81.1; moderate, 84.0; severe, 74.3; P = .031) and 2 years postoperatively (mild, 93.4; moderate, 89.7; severe, 76.4; P = .005), and slightly poorer second toe scores for VAS (mild, 0.0; moderate, 0.1; severe, 1.2; P = .017) and AOFAS (mild, 94.7; moderate, 93.5; severe, 83.4; P = .043) at 2 years postoperatively. All other scores including patient satisfaction showed no between-group differences. Complication and revision rates between the groups were similar. Conclusion: Surgery for symptomatic hallux valgus lead to excellent outcomes and high patient satisfaction regardless of severity of deformity. Level of Evidence: Level III, comparative series.

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Does Hallux Rigidus produce worse functional disability than Hallux Valgus?

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00447 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0044

Author(s):

Malik Siddique ◽

Jayasree Ramaskandhan ◽

Sultan Qasim

Keyword(s):

Quality Of Life ◽

Health Status ◽

Hallux Valgus ◽

General Health ◽

Functional Disability ◽

Hallux Rigidus ◽

Foot And Ankle ◽

General Health Status ◽

The Impact

Category: Midfoot/Forefoot Introduction/Purpose: There is paucity of literature comparing foot and general health status including quality of life between patients presenting with Hallux Valgus and Hallux Rigidus. We aimed to compare foot specific patient reported disability and general health status including higher functional activities and quality of life reported between patients presenting with Hallux Valgus and Hallux Rigidus. Methods: All patients who presented at our hospital foot and ankle clinics (between June 2016 and December 2017) with a diagnosis of primary Hallux Valgus or Hallux Rigidus were included in this prospective study. Patients with associated foot problems, bilateral presentations, h/o previous reconstructive surgeries, and underlying neurological conditions were excluded. These patients were grouped based on diagnosis into Group A (Hallux Valgus) and Group B (Hallux Rigidus). In these patients, differences were studied between groups for scores of MOX-FQ Manchester-Oxford foot questionnaire (Domains: Pain, Walking/Standing, Social activities), EQ-5D EuroQol (UK) and Foot and Ankle outcomes scores (FAOS) (Domains: Pain, symptoms, ADL, Recreation, Quality of Life). Statistical tests between groups included tests for normality, student t’tests and chi square tabulation tests using SPSS software. Results: MOX-FQ differences: - Both groups reported similar level of pain (59.6 ± 22.6 vs. 58.2 ± 23.3); p=0.776; Difficulty with walking/ standing (61.6 vs. 61.4 ); p= 0.960; and restriction with social activity because of foot symptoms (61.6 vs. 59.7 ); p=0.683 EQ-5D: - For mobility, both groups reported no (21.7% vs. 26.8); slight (28.2% vs. 29.2%) or moderate (34.7% vs. 31.7%) problems; p=0.931. For self-care, pain/discomfort, anxiety/ depression levels, there was no differences between groups; p>0.05. Mean overall general health scores was (71.3 ± 22.8) and (69.5 ± 20.8); p=0.663 FAOS: - There was no difference in mean pain score (59.6 vs. 58.2; p=0.776), symptoms (70.3 vs. 63.8; p=0.104), ADL score (p=0.587), difficulty with sport/ recreation (p=0.907) or Quality of Life (p=0.662) between groups Conclusion: - There is no difference in foot related quality of life, general health status and higher functional disability levels between patients presenting with Hallux Valgus vs. Hallux Rigidus. - The impact of these conditions on disability levels remain the same, amidst the difference in pathology

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Management of the Arthritic Forefoot

Foot & Ankle ◽

10.1177/107110078200300104 ◽

1982 ◽

Vol 3 (1) ◽

pp. 17-23 ◽

Cited By ~ 22

Author(s):

Andrea Cracchiolo

Keyword(s):

Hallux Valgus ◽

Nonoperative Treatment ◽

Silicone Implant ◽

Operative Care ◽

Hindfoot Deformities ◽

Relationship Of ◽

The Relationship ◽

Severe Hallux Valgus ◽

Mtp Joints ◽

Rheumatoid Diseases

Rheumatoid diseases frequently involve the forefoot producing severe hallux valgus and dislocated metatarsophalangeal (MTP) joints. One must stress the importance of continual evaluation of the foot in these patients. The relationship of midfoot and hindfoot deformities, especially pronation deformities, to the forefoot is essential. Nonoperative treatment can be highly effective and consists of skin and nail care and proper shoes which enclose and support early deformities. Operative care now spans the gamut from excising all or part of the MTP joints, to silicone implant arthroplasty of the MTP joints.

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The impact of hallux valgus on foot kinematics: A cross-sectional, comparative study

Gait & Posture ◽

10.1016/j.gaitpost.2010.03.017 ◽

2010 ◽

Vol 32 (1) ◽

pp. 102-106 ◽

Cited By ~ 59

Author(s):

Kevin Deschamps ◽

Ivan Birch ◽

Kaat Desloovere ◽

Giovanni A. Matricali

Keyword(s):

Comparative Study ◽

Hallux Valgus ◽

Cross Sectional ◽

Foot Kinematics ◽

The Impact

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The short-term effectiveness of Kinesiology Taping on foot biomechanics in patients with hallux valgus

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-200231 ◽

2021 ◽

pp. 1-7

Author(s):

Tobiasz Żłobiński ◽

Anna Stolecka-Warzecha ◽

Magdalena Hartman-Petrycka ◽

Barbara Błońska-Fajfrowska

Keyword(s):

Surgical Treatment ◽

Hallux Valgus ◽

Gait Cycle ◽

Metatarsal Head ◽

Dynamic Parameters ◽

Short Term ◽

First Metatarsal ◽

Foot Biomechanics ◽

Foot Loading ◽

The Impact

BACKGROUND: Hallux valgus, one of the most common foot disorders, contributes to the formation of pain and changes foot biomechanics. OBJECTIVE: To assess the impact of Kinesiology Taping (KT) on foot loading during gait in patients with hallux valgus. METHODS: Forty feet with hallux valgus were examined. Patients wore the KT for a month and the parameters of the foot during gait on a baropodometric platform were measured three times: before taping, immediately after application of taping and after one month’s use. RESULTS: The taping had a statistically significant effect on dynamic foot measurements. The maximum and mean foot load (p< 0.001), foot surface (p< 0.001), ratio of forefoot to hindfoot load (p< 0.01) and the proportions of the lateral and medial foot loading (p< 0.05) all changed. During gait cycle, taping significantly increased the load and surface at the first metatarsal head (p< 0.001) while there was a decrease around the second to fifth (p< 0.001) metatarsal heads. CONCLUSIONS: Using KT to correct a hallux valgus is a procedure that has an impact on the dynamic parameters of the foot during gait. The use of this method could become an alternative to surgical treatment for those patients, who have any contraindication for surgery.

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The Influence of Patient Factors on the Outcome of Synthetic Cartilage Implant Hemiarthroplasty versus First Metatarsophalangeal Joint Arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000045 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000

Author(s):

Andrew Goldberg ◽

Mark Glazebrook ◽

Timothy Daniels ◽

Gwyneth de Vries ◽

M. Elizabeth Pedersen ◽

...

Keyword(s):

Hallux Valgus ◽

Clinical Success ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

Success Rates ◽

Preoperative Pain ◽

Duration Of Symptoms ◽

First Metatarsophalangeal Joint ◽

Valgus Angle ◽

The Impact

Category: Midfoot/Forefoot Introduction/Purpose: Many studies have compared the outcomes of MTPJ1 hemiarthroplasty and arthrodesis, but there is a paucity of data on the influence of patient factors on clinical outcomes. A prior prospective, randomized, clinical trial compared the efficacy and safety of first metatarsophalangeal joint (MTPJ1) hemiarthroplasty with a synthetic polyvinyl alcohol hydrogel implant (Cartiva®) and MTPJ1 arthrodesis for moderate to severe hallux rigidus. The current study evaluated the data from this clinical trial to determine the impact of numerous patient variables, including osteoarthritis grade, hallux valgus angle, preoperative range of motion (ROM), gender, body mass index (BMI), preoperative duration of symptoms, and preoperative pain level, on the success or failure of MTPJ1 hemiarthroplasty and arthrodesis. Methods: Patients =18 years diagnosed with hallux rigidus grade 2, 3, or 4 were randomized and treated with synthetic cartilage implant MTPJ1 hemiarthroplasty (n=129) or arthrodesis (n=47). Outcome measures included a pain visual analogue scale (VAS), Foot and Ankle Ability Measure (FAAM) Sports and Activities of Daily Living (ADL) scores, and Short Form-36 Physical Functioning (SF-36 PF) subscore, obtained preoperatively and at 2, 6, 12, 24, 52 and 104 weeks postoperatively. Great toe active dorsiflexion motion, secondary procedures, radiographs and safety parameters were evaluated. A patient’s outcome was deemed successful if composite primary endpoint criteria for clinical success (pain, function and safety) were met at 24 months. Predictor variables included: osteoarthritis grade; hallux valgus angle; preoperative ROM; gender; body mass index (BMI); preoperative symptom duration; prior surgery; and preoperative pain level. Two-sided Fisher’s Exact test was used to assess the impact of these variables on success of surgery (p<0.05). Results: Standard patient demographics and baseline outcome measures were similar for both groups; both procedures demonstrated equivalent pain relief and functional outcomes.1 There was no significant difference (p>0.05) in success rates (i.e., VAS pain reduction ≥ 30%, maintenance/improvement in function, freedom from radiographic complications, and no secondary surgical intervention) between synthetic cartilage implant MTPJ1 hemiarthroplasty and arthrodesis when stratified by osteoarthritis grade, degree of preoperative hallux valgus, extent of preoperative ROM, gender, BMI, duration of symptoms, prior MTPJ1 surgery status, and preoperative pain VAS score (Table 1). Notably, patients with minimal ROM and mild hallux valgus had equivalent success rates for both procedures. Males tended to have greater clinical success with implant hemiarthroplasty versus arthrodesis, but this difference was not statistically significant. 1Baumhauer et al., FAI, 2016;37(5):457-69. Conclusion: Synthetic cartilage implant hemiarthroplasty is an appropriate treatment for patients with hallux rigidus of Coughlin grade 2, 3 or 4. Its results in those with associated mild hallux valgus (<20 degrees) and in those with a high degree of preoperative stiffness are equivalent to MTPJ1 fusion, irrespective of gender, BMI, osteoarthritis grade, or preoperative pain or duration of symptoms, in contrast to what might have been expected.

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Impact of Preoperative Metatarsus Adductus on Surgical Correction after Triplanar Tarsometatarsal Arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00401 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0040

Author(s):

Joshua M. Reside ◽

Justin J. Ray ◽

Taylor L. Shackleford ◽

Jennifer Koay ◽

Paul Dayton ◽

...

Keyword(s):

Hallux Valgus ◽

Surgical Correction ◽

Preoperative Imaging ◽

Recurrence Rates ◽

Chi Square ◽

Non Union ◽

Radiographic Outcomes ◽

Valgus Angle ◽

Metatarsus Adductus ◽

The Impact

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Early radiographic outcomes of hallux valgus correction focusing on multiplanar deformity have shown promising results. Surgical correction for patients with preexisting metatarsus adductus is considered more challenging and results in higher recurrence rates following hallux valgus surgery. The purpose of this study was to evaluate the impact of preoperative metatarsus adductus on surgical correction following triplanar first tarsometatarsal (TMT) arthrodesis with early weightbearing for hallux valgus. Methods: A retrospective review was performed of 57 patients (62 feet) aged 39.7 +- 18.9 years who underwent triplanar first TMT arthrodesis between 2015 and 2017 at four institutions. After the operation, patients were allowed early full weightbearing in a walking boot. Patients were grouped based on preoperative metatarsus adductus angles for comparison. Preoperative imaging was reviewed and compared to radiographic imaging at 12 months postoperative. Hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position (TSP), lateral round sign, and sesamoid subluxation (axial) were evaluated. For statistical analysis, one-way analysis of variance (ANOVA) and chi-square tests were performed using JMP 11.0.0 (SAS Institute Inc., Cary, NC). Results: Patients with a preoperative metatarsus adductus angle greater than 20 degrees had significantly higher HVA at 12 months (p = 0.0165). There were no differences in IMA or TSP at 12 months based on preoperative metatarsus adductus (p = 0.7687 and p = 0.8703, respectively). Overall recurrence rate for hallux valgus was 3.2% (2/62 patients), and both of these patients had a preoperative metatarsus adductus greater than 20 degrees. There was significantly more sesamoid axial subluxation at 12 months for patients with preoperative metatarsus adductus greater than 20 degrees (p = 0.0092). Overall, the symptomatic non- union rate was 1.7% (1/62 patients). Conclusion: Preoperative metatarsus adductus greater than 20 degrees resulted in higher HVA and recurrence rates at 12 months after triplanar tarsometatarsal arthrodesis. For patients with preexisting metatarsus adductus, additional consideration should be given to ensure the sesamoids are properly reduced under the crista. Future studies should compare the long-term impact of metatarsus adductus on surgical correction, recurrence, and complications after triplanar tarsometatarsal arthrodesis.

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Results of Hallux Valgus Surgery in Diabetic Patients With Good Glycemic Control

Foot & Ankle International ◽

10.1177/1071100720930011 ◽

2020 ◽

Vol 41 (8) ◽

pp. 945-953

Author(s):

Gin Way Law ◽

Kae Sian Tay ◽

Akshay Padki ◽

Khai Cheong Wong ◽

Karen Ting Zhang ◽

...

Keyword(s):

Body Mass Index ◽

Glycemic Control ◽

Hallux Valgus ◽

Body Mass ◽

Deformity Correction ◽

Diabetic Patients ◽

Complication Rates ◽

Patient Reported ◽

The Impact ◽

Reoperation Rates

Background: Literature is sparse on whether diabetes affects outcomes of hallux valgus surgery. With the rising global prevalence of diabetes and diabetes being an independent predictor of poorer outcomes, particularly in foot and ankle surgery, we aimed to investigate the impact of diabetes on the outcomes of hallux valgus surgery. Methods: We conducted a retrospective comparative cohort study of prospectively collected registry data of 951 feet in 721 patients who underwent surgery for symptomatic hallux valgus between 2007 and 2015 at our institution. All patients with diabetes were identified and matched with patients without diabetes for age, sex, and body mass index in a 1:2 ratio to construct the matched cohorts for analysis. Glycemic control in the diabetic cohort was assessed using preoperative HbA1c. The primary outcome measure was complication rates. Secondary outcomes were (1) deformity correction using the hallux valgus and intermetatarsal angles; (2) patient-reported outcomes using visual analog scale (VAS) for pain, Short Form–36 (SF-36) Physical and Mental Health subscales, and American Orthopaedic Foot & Ankle Society (AOFAS) scores; (3) patient satisfaction; and (4) reoperation rates up to 2 years postoperatively. Forty diabetic patients were identified and matched to 80 nondiabetic patients. Although matching was only performed for age, sex, and body mass index, the diabetic and the nondiabetic cohorts were also similar in hallux valgus severity, preoperative scores, and types of procedures performed. Results: The mean preoperative HbA1c in our diabetic cohort was 7.1%. Both the diabetic and nondiabetic cohorts showed excellent AOFAS and VAS scores with no differences in degree of deformity correction, complication profiles, reoperation rates, outcome scores, and satisfaction at both 6 months and 2 years postoperatively. Conclusion: We believe stringent patient selection was key to reduced complication rates and good outcomes in diabetic patients. Well-selected diabetic patients remain suitable candidates for hallux valgus surgery. Level of Evidence: Level III, retrospective comparative study.

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Foot Width Changes Following Hallux Valgus Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00481 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0048

Author(s):

Shay Tenenbaum ◽

Jason Bariteau ◽

Amir Herman ◽

Oded Coifman

Keyword(s):

Soft Tissue ◽

Hallux Valgus ◽

Metatarsal Head ◽

Soft Tissue Release ◽

X Rays ◽

Maximal Distance ◽

Bone Width ◽

Radiographic Measurements ◽

Valgus Angle ◽

The Impact

Category: Midfoot/Forefoot Introduction/Purpose: Hallux valgus is one of the most common deformities of the adult foot, and can adversely affect quality of life, with common complaints including pain, footwear restrictions and cosmesis. Every clinician is familiar with the patients’ concerns regarding the postoperative foot appearance and footwear anticipations. Surprisingly, although patients are concerned with postoperative foot width, there are only scarce reports on this issue. This study was undertaken to evaluate the impact of hallux valgus surgical treatment on foot width. Methods: Study included 71 consecutive cases with moderate to severe hallux valgus treated with Scarf osteotomy, distal soft tissue release and Akin osteotomy as needed. Patients were included only if pre- and postoperative weightbearing X-rays at minimum 6 months followup were available. The average age was 55.7 years (range, 20 to 76), with average follow-up of 20.7 months (range, 6 to 96). Patients’ medical records were reviewed for clinical data, surgical technique and radiographic measurements. The radiographic measurements included hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), and foot width. Foot width was assessed by measuring both the bony width (BW: maximal distance between the medial cortex of 1st metatarsal head and lateral cortex of the 5th metatarsal head) and the soft tissue width (STW: maximal distance between most medial soft tissue outline and the most lateral soft tissue outline at the level of metatarsal heads). Results: Preoperative HV deformity (mean HVA 35.8, IMA 14.1 and DMAA 15.2) was successfully corrected (postoperative mean HVA 13.7, IMA 6.9 and DMAA 7.7). Overall bony foot width was reduced by 5% and soft tissue foot width by 2% postoperatively. Further analysis showed there were 13 feet (18.3%) with increased (>5%) bone width, 26 feet (36.6%) with no change (±5%) and 32 feet (45.1%) for which width decreased in more than 5% postoperatively. Patients with the widest foot before surgery, had a decrease in foot width following surgery whereas, patients with the narrowest foot width, had an increase in foot width. Magnitude of preoperative deformity (as assessed by HVA, IMA and DMMA measurements) or amount of correction had low correlation (<0.2) with postoperative foot width. Conclusion: While the ability of surgery to correct HV deformity is well established and reported in the literature, its effect on foot width is less understood or predictable. Overall, the postoperative reduction of foot with was modest. Furthermore, while postoperative foot width (both bony and soft tissue) decreases or does not change in 4 out of 5 patients, there are cases in which foot width actually increases.

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