First Metatarsophalangeal Joint Arthrodesis for Hallux Valgus in a Patient with Preaxial Polydactyly and Triphalangeal Hallux

Hallux valgus is characterized by the appearance and growth of a painful “lump” in the region of the first metatarsophalangeal joint, the development of forefoot corns, and inability to choose the right shoes, which leads to a significant decrease in the quality of life of these patients. Corrective osteotomies that preserve the metatarsophalangeal joint, for example Austin (Chevron) osteotomy, are usually used for hallux valgus deformity of the I, II degrees. Radiography with the study of the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA) is a research method that shows the true correlation between bone structures. The correlation between the radiological and functional indicators of osteotomy allows us to determine possible recommendations for indications for surgical treatment of Hallux valgus. Correlation shows that the largest correction of hallux valgus in older patients occurs due to a small adjustment of the angle of DMMA and HVA. IMA had the best correction after Austin osteotomy among patients of a younger age, then the HVA, and the DMMA had minimum correction according to the AOFAS rating scale (Kitaoka). The revealed correlations allow us to determine the correct tactics for the treatment of hallux valgus by identifying the benefits of Austin osteotomy.

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Temporary Kirschner wire fixation of the first metatarsophalangeal joint before osteotomy for hallux valgus

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2021.106104 ◽

2021 ◽

pp. 106104

Author(s):

Ichiro Tonogai ◽

Koichi Sairyo

Keyword(s):

Hallux Valgus ◽

Kirschner Wire ◽

Metatarsophalangeal Joint ◽

First Metatarsophalangeal Joint ◽

Kirschner Wire Fixation ◽

Wire Fixation

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Modified Austin Procedure for Correction of Hallux Valgus

Foot & Ankle International ◽

10.1177/107110079701800302 ◽

1997 ◽

Vol 18 (3) ◽

pp. 119-127 ◽

Cited By ~ 55

Author(s):

Hans-Jörg Trnka ◽

Alexander Zembsch ◽

Hermann Wiesauer ◽

Marc Hungerford ◽

Martin Salzer ◽

...

Keyword(s):

Soft Tissue ◽

Hallux Valgus ◽

Metatarsophalangeal Joint ◽

Metatarsal Head ◽

Hallux Valgus Angle ◽

First Metatarsophalangeal Joint ◽

Intermetatarsal Angle ◽

Soft Tissue Procedure ◽

Valgus Angle

The Austin osteotomy is a widely accepted method for correction of mild and moderate hallux valgus. In view of publications by Kitaoka et al. in 1991 and by Mann and colleagues, a more radical lateral soft tissue procedure was added to the originally described procedure. From September 1992 to January 1994, 85 patients underwent an Austin osteotomy combined with a lateral soft tissue procedure to correct their hallux valgus deformities. Seventy-nine patients (94 feet) were available for follow-up. The average patient age at the time of the operation was 47.1 years, and the average follow-up was 16.2 months. The average preoperative intermetatarsal angle was 13.9°, and the average hallux valgus angle was 29.7°. After surgery, the feet were corrected to an average intermetatarsal angle of 5.8° and an average hallux valgus angle of 11.9°. Sesamoid position was corrected from 2.1 before surgery to 0.5 after surgery. The results were also graded according to the Hallux Metatarsophalangeal Interphalangeal Score, and the functional and cosmetic outcomes were graded by the patient. Dissection of the plantar transverse ligament and release of the lateral capsule repositioned the tibial sesamoid and restored the biomechanics around the first metatarsophalangeal joint. There was no increased incidence of avascular necrosis of the first metatarsal head compared with the original technique.

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First-Tarsometatarsal Joint Alignment After First-Metatarsophalangeal Joint Arthrodesis for Hallux Valgus

Foot & Ankle Orthopaedics ◽

10.1177/24730114211008514 ◽

2021 ◽

Vol 6 (2) ◽

pp. 247301142110085

Author(s):

Christopher Traynor ◽

James Jastifer

Keyword(s):

Hallux Valgus ◽

Case Series ◽

Metatarsophalangeal Joint ◽

Retrospective Case ◽

Level Of Evidence ◽

First Metatarsophalangeal Joint ◽

First Metatarsal ◽

Metatarsal Angle ◽

Medial Cuneiform ◽

Radiographic Alignment

Background: Instability of the first-tarsometatarsal (TMT) joint has been proposed as a cause of hallux valgus. Although there is literature demonstrating how first-TMT arthrodesis affects hallux valgus, there is little published on how correction of hallux valgus affects the first-TMT joint alignment. The purpose of this study was to determine if correction of hallux valgus impacts the first-TMT alignment and congruency. Improvement in alignment would provide evidence that hallux valgus contributes to first-TMT instability. Our hypothesis was that correcting hallux valgus angle (HVA) would have no effect on the first-TMT alignment and congruency. Methods: Radiographs of patients who underwent first-MTP joint arthrodesis for hallux valgus were retrospectively reviewed. The HVA, 1-2 intermetatarsal angle (IMA), first metatarsal–medial cuneiform angle (1MCA), medial cuneiform–first metatarsal angle (MC1A), relative cuneiform slope (RCS), and distal medial cuneiform angle (DMCA) were measured and recorded for all patients preoperatively and postoperatively. Results: Of the 76 feet that met inclusion criteria, radiographic improvements were noted in HVA (23.6 degrees, P < .0001), 1-2 IMA (6.2 degrees, P < .0001), 1MCA (6.4 degrees, P < .0001), MC1A (6.5 degrees, P < .0001), and RCS (3.3 degrees, P = .001) comparing preoperative and postoperative radiographs. There was no difference noted with DMCA measurements (0.5 degrees, P = .53). Conclusion: Our findings indicate that the radiographic alignment and subluxation of the first-TMT joint will reduce with isolated treatment of the first-MTP joint. Evidence suggests that change in the HVA can affect radiographic alignment and subluxation of the first-TMT joint. Level of Evidence: Level IV, retrospective case series.

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Hallux Valgus Recurrence After Simple Bunionectomy: Algorithm Treatment

10.21203/rs.3.rs-1121623/v1 ◽

2022 ◽

Author(s):

Josep Torrent ◽

Raúl Figa ◽

Iban Clares ◽

Eduard Rabat

Keyword(s):

Comparative Study ◽

Hallux Valgus ◽

Treatment Algorithm ◽

Metatarsophalangeal Joint ◽

Salvage Procedure ◽

Bone Stock ◽

Level Of Evidence ◽

First Metatarsophalangeal Joint ◽

Retrospective Comparative Study ◽

End Stage

Abstract Background: Recurrences of hallux valgus can be difficult to manage, especially after a prior simple bunionectomy. This study aimed to present a treatment algorithm for the correction of recurrences after a simple bunionectomy.Methods: This was a single-center, descriptive, and retrospective comparative study. Thirty-four consecutive patients were classified according to the bone stock and the presence or absence of end-stage arthritis of the first metatarsophalangeal joint (MTPJ). According to our algorithm, we only performed an osteotomy as the salvage procedure in cases with sufficient bone stock and absence of or mild arthritis. In the other cases, we performed an MTPJ fusion. Exceptionally, we chose a Keller-Brandes arthroplasty for patients with advanced age and comorbidities. Results: We performed 17 scarf osteotomies (50%), 15 MTPJ arthrodeses (44.1%), and 2 Keller-Brandes arthroplasties (5.9%). Following the algorithm, we achieved an improvement of the AOFAS score of >30 points without severe complications in all groups.Conclusions: The proposed operative algorithm successfully addresses the recurrences considering the lack of bone stock and the presence of MTPJ arthritis.Level of EvidenceLevel 3: retrospective comparative study

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The impact of functional excess of footwear on the foot shape of 7-year-old girls and boys

PeerJ ◽

10.7717/peerj.11277 ◽

2021 ◽

Vol 9 ◽

pp. e11277

Author(s):

Ewa Puszczalowska-Lizis ◽

Aleksandra Lukasiewicz ◽

Sabina Lizis ◽

Jaroslaw Omorczyk

Keyword(s):

Regression Analysis ◽

Hallux Valgus ◽

Metatarsophalangeal Joint ◽

Rank Test ◽

Chi Square ◽

First Metatarsophalangeal Joint ◽

Longitudinal Arch ◽

Transverse Arch ◽

The Right ◽

The Impact

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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First Metatarsophalangeal Joint Motion After Hallux Valgus Correction: A Cadaver Study

Foot & Ankle International ◽

10.1177/107110070502600807 ◽

2005 ◽

Vol 26 (8) ◽

pp. 614-619 ◽

Cited By ~ 23

Author(s):

Carroll P. Jones ◽

Michael J. Coughlin ◽

Brett R. Grebing ◽

Michael P. Kennedy ◽

Paul S. Shurnas ◽

...

Keyword(s):

Hallux Valgus ◽

Metatarsophalangeal Joint ◽

Cadaver Study ◽

Joint Motion ◽

First Metatarsophalangeal Joint

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Sesamoid malalignment in hallux valgus: Radiographic and MRI measurements and their correlation with internal derangement findings of the first metatarsophalangeal joint

British Journal of Radiology ◽

10.1259/bjr.20190038 ◽

2019 ◽

Vol 92 (1100) ◽

pp. 20190038

Author(s):

Justin Skweres ◽

Avneesh Chhabra ◽

Jed Hummel ◽

Nathan Heineman ◽

Riham Dessouky ◽

...

Keyword(s):

Hallux Valgus ◽

Rotation Angle ◽

Metatarsophalangeal Joint ◽

Preoperative Assessment ◽

X Rays ◽

First Metatarsophalangeal Joint ◽

Valgus Angle ◽

Internal Joint ◽

Reader Reliability ◽

Mri Measurements

Objective: Sesamoid displacement (SD) and rotation are important components in the preoperative assessment of hallux valgus (HV). To date, Inter reader reliability (IRR) of SD on X-rays and MRI, correlations with hallux valgus angle (HVA), and qualitative changes of the hallux-sesamoid complex (HSC) on MRI have not been studied. The aim of this study was to correlate sesamoid malalignment with HV severity and findings of internal joint derangement. Methods: Two readers analyzed a series of 56 consecutive patients who had X-rays and MRI performed on the same foot within 3 months of each other. Multiple measures of SD on X-rays and MRI and the sesamoid rotation angle (SRA) on MRI were assessed and correlated with HVA and various qualitative features at the HSC including cartilage, plantar plate, and collateral ligament abnormalities. Results: We found excellent IRR (ICC = 0.79 – 0.99) for SRA on MR, but poor IRR for lateral sesamoid displacement (LDS) and tibial sesamoid position (TSP) scales on both modalities. Good IRR was also seen for morphologic abnormalities of HSC. The absolute value of the SRA on MR positively correlated with HVA ( p < 0.0001). LDS and TSP on both modalities lacked a significant correlation with HVA ( p > 0.05). No correlation was found between any measure of SD or rotation with HSC morphologic changes ( p > 0.05). Conclusion: Among different measures of sesamoid malalignment, sesamoid rotation angle measured on MRI can be used to judge the severity of HV; however, it does not correlate with qualitative morphologic abnormalities of the HSC. Advances in knowledge: The MRI measurement of SRA is a better indicator of sesamoid displacement relative to the HSC than standard AP radiographic measures of non-rotational sesamoid displacement; however, it should not be used to predict qualitative morphologic abnormalities of the HSC.

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Classification of Hallucal Sesamoid Bone Correlated with Hallux Valgus Severity

BioMed Research International ◽

10.1155/2020/9658916 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Lei Zhang ◽

Junqiu Wang ◽

Jiaju Liu ◽

Jiangqin Luo

Keyword(s):

Hallux Valgus ◽

Statistical Difference ◽

Three Dimensional ◽

Morphological Characteristics ◽

Metatarsophalangeal Joint ◽

Metatarsal Head ◽

Type I ◽

Sesamoid Bone ◽

First Metatarsophalangeal Joint

The hallucal sesamoid bones (HSBs), having an important role in reducing load per unit area on the first metatarsal head, can be injured commonly which also affected the first metatarsophalangeal joint and the surrounding structure. Meanwhile, differences among each HSB type may be a major factor affecting the occurrence and development of HV. So far, many researchers had learned that there are three different conditions in hallucal sesamoid bone affecting the choice of clinical surgery corresponding to different solutions in clinic. Thus, it is necessary to study the anatomical morphological characteristics of the HSB which can be helpful in clinical diagnosis and treatment, especially hallux valgus (HV). 150 X-ray and three-dimensional (3D) computed tomographic (CT) images consist of 72 left and 78 right metatarsals were applied in this anatomic study between two variables and showed by a simple scatter plot. The first metatarsophalangeal joint is divided into four different types: type I (no HSB, 1.3%), type II (with one HSB, 0.07%), type IIIa (with two HSBs when THB is bigger, 28%), type IIIb (with two HSBs when FHB is bigger, 65.3%), and type IV (with three HSBs, 4.7%). There was no statistical difference between the left and right sides, except HVA, Meary, and pitch (P<0.05); all a, b, c, d, and i have statistical difference between male and female (P<0.05). Meanwhile, HVA and IMA and HVA and type group have a significant correlation. In summary, HVA and IMA and HVA and classification of HSBs have significant correlations. The classification and location of HSBs can be an important basis to choose operation methods and postoperation evaluation.

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The Mayday Distal First Metatarsal Osteotomy for Hallux Valgus: A Review After the Introduction of a New Instrument

Foot & Ankle International ◽

10.1177/107110079701800102 ◽

1997 ◽

Vol 18 (1) ◽

pp. 3-7 ◽

Cited By ~ 4

Author(s):

G.D. Terzis ◽

F. Kashif ◽

M.A.S. Mowbray

Keyword(s):

Hallux Valgus ◽

Metatarsophalangeal Joint ◽

Metatarsal Osteotomy ◽

Distal Fragment ◽

Short Term ◽

First Metatarsophalangeal Joint ◽

First Metatarsal ◽

Satisfactory Outcome ◽

New Instrument

We present the short-term follow-up of 55 symptomatic hallux valgus deformities in 38 patients, treated operatively with a modification of the spike distal first metatarsal osteotomy, as described by Gibson and Piggott in 1962. The age range of the patients was 17 to 72 years at the time of surgery. The postoperative follow-up period was 12 to 55 months. Excellent and good clinical and radiographic results were recorded in 96.2% of our patients. Two of the patients (3.8%) were dissatisfied; one of them complained of metatarsalgia after the procedure, and the other had stiffness of the metatarsophalangeal joint and metatarsalgia that had been present before surgery. Three others (5.45%) required revision after early postoperative displacement but were asymptomatic subsequently. We concluded that our technique is an effective method of treating mild hallux valgus deformities with the advantages of simplicity, no shortening of the first metatarsal, and no risk of dorsal tilting of the distal fragment. Hallux valgus (lateral deviation of the great toe) is not a single disorder, as the name implies, but a complex deformity of the first ray that sometimes may involve the lesser toes. More than 130 procedures exist for the surgical correction of hallux valgus, which means that no treatment is unique. No single operation is effective for all bunions. 5 , 22 , 29 The objectives of surgical treatment are to reduce pain, to restore articular congruency, and to narrow the forefoot without impairing function, by transferring weight to the lesser metatarsals either by shortening or by dorsal tilting of the first metatarsal. 5 , 19 , 24 , 27 Patient selection is important for a satisfactory outcome after surgery of any kind, and our criteria were age, degree of deformity, presence of arthrosis, and subluxation of the first metatarsophalangeal joint. 1 , 5 , 13 , 19 – 21 , 24 , 29 In this study, we present a new method of treating hallux valgus that has been used at Mayday University Hospital since 1990. The technique was first described at the British Orthopaedic Foot Surgery Society, Liverpool, November 1990, 7 and we now present the short-term follow-up results. The procedure is essentially a modification of the spike osteotomy of the neck of the first metatarsal, as described by Gibson and Piggott. 9 It has the advantages of simplicity, no shortening of the first metatarsal, and no risk of dorsal displacement of the distal fragment.

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