scholarly journals Os Intermetatarseum May not Interfere with Metatarsus Primus Varus Deformity Correction: A Case Report

2018 ◽  
Vol 25 (1) ◽  
pp. 24-28
Author(s):  
Daniel Y. Wu
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Hallux Valgus ◽  
Deformity Correction ◽  
Varus Deformity ◽  
Valgus Deformity ◽  
Hallux Valgus Deformity ◽  
Os Intermetatarseum ◽  
First Time

It has been believed that the correction of metatarsus primus varus (MPV) deformity of hallux valgus foot using nonosteotomy procedures would be compromised by the presence of os intermetatarseum (OI). Therefore, no soft tissue procedure has ever been reported for the correction of MPV deformity of hallux valgus foot. This is a case report of a female patient with bilateral hallux valgus deformity and also a large OI of her left foot that was corrected, satisfactorily and simultaneously, with a soft tissue technique called syndesmosis procedure, without osteotomy or OI resection. Excellent feet function was observed for 2 years until her last follow-up examination without any symptoms or signs of problems relating to the OI in her left foot. This case report demonstrated for the first time that OI may not interfere with proper MPV deformity correction because it can be preexisting and X-ray can be misleading.

Percutaneous Chevron and Akin (PECA) Osteotomies for Severe Hallux Valgus Deformity With Mean 3-Year Follow-up

2021 ◽  
pp. 107110072110084
Author(s):  
Thomas L. Lewis ◽  
Robbie Ray ◽  
Peter Robinson ◽  
Paul M. C. Dearden ◽  
Thomas J. Goff ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Deformity Correction ◽  
Valgus Deformity ◽  
Percutaneous Surgery ◽  
Residual Deformity ◽  
Hallux Valgus Deformity ◽  
Patient Reported ◽  
The Mean ◽  
Severe Hallux Valgus

Background: Patients with severe hallux valgus deformity present technical and operative challenges with high rates of recurrence and residual deformity. The clinical and radiologic outcomes of percutaneous surgery for severe hallux valgus are not known. Methods: A retrospective review of consecutive patients with a hallux valgus angle (HVA) >40 degrees or intermetatarsal angle (IMA) >20 degrees who underwent third-generation percutaneous chevron and Akin osteotomy (PECA) for hallux valgus deformity correction. Results: Between December 2012 and August 2019, 59 feet in 50 patients underwent PECA. Preoperative and follow-up radiographic data were available for 53 feet (89.8%). Postoperative clinical patient-reported outcome measures and satisfaction results were available for 51 feet (86.4%). The mean clinical and radiographic follow-up was 3.1 years and the mean postoperative Manchester-Oxford Foot Questionnaire Index score was 15.1. There was a statistically significant improvement ( P < .001) in both IMA and HVA following surgery (IMA 17.5-5.1 degrees; HVA 44.1-11.5 degrees). All patients reported they were satisfied with their outcome, with 76.8% reporting they were highly satisfied. The hallux valgus recurrence rate was 7.5%. Conclusion: Percutaneous surgery for severe hallux valgus deformity can achieve a large deformity correction, patient satisfaction, and quality of life, with reasonable rates of residual deformity and low rates of recurrence. Level of Evidence: IV

Clinico-radiological Results of Distal Chevron Osteotomy without Lateral Soft Tissue Release in Mild to Moderate Hallux Valgus Deformity

2021 ◽  
Vol 23 (4) ◽  
pp. 287-293
Author(s):  
Mohd Rafeeq Wani ◽  
Mohd Iqbal Wani ◽  
Arshid Bashir ◽  
Manzoor Ahmad Halwai ◽  
Stanzin Sonum ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Valgus Deformity ◽  
Soft Tissue Release ◽  
Average Value ◽  
Radiological Results ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
A Prospective Study

Background. The study was done to evaluate short term clinico-radiological results of distal chevron oste­otomy without lateral soft tissue release in mild to moderate hallux valgus. Materials and methods. This was a prospective study consisting of a total of 35 cases with mild to moderate hallux valgus deformity. All these patients were treated by distal chevron osteotomy without lateral soft tissue release. Results. In our study, the average value of hallux angle preoperatively was 32° (range, 24°-40°) and at final follow-up it was 14° (range, 8°-31°). The average reduction was 18°. The average intermetatarsal angle showed mean reduction of 5.3° at the final follow-up. Average range of motion of the first metatarsophalyngeal joint preoperatively and at final follow-up showed a small reduction of 5 degrees. The average preoperative AOFAS score was 49, which improved by 35 points to 84 at the final follow-up. 11.42% of the patients in the study group had a recurrence. Conclusions. 1. Based on our experience with distal chevron osteotomy without lateral soft tissue release, we found the procedure easy to perform with good procedural outcomes. 2. The possible complications of lateral soft tissue release are avoided.

scholarly journals Proximal Rotational Metatarsal Osteotomy for Hallux Valgus

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Pablo Wagner ◽  
Emilio Wagner ◽  
Diego Zanolli de Solminihac ◽  
Cristian Ortiz ◽  
Andres Keller Díaz ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Internal Rotation ◽  
Hallux Valgus ◽  
Recurrence Rate ◽  
Case Series ◽  
Deformity Correction ◽  
Varus Deformity ◽  
Metatarsal Osteotomy ◽  
Hallux Valgus Deformity

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Hallux valgus combines two deformities, the metatarsus varus and metatarsal internal rotation. The rotational deformity is seldom corrected during surgery, but is a known recurrence factor. Most techniques only correct the metatarsus varus (scarf, chevron, etc). We present a prospective case series using a novel metatarsal rotational osteotomy called PROMO (proximal rotational metatarsal osteotomy) which simultaneously corrects the metatarsal internal rotation and varus deformity by rotating the metatarsal through an oblique plane osteotomy. This is performed with no bone resection. Our objective was to report this new technique, preliminary results, its advantages and complications. Methods: 20 consecutive patients (17 women) with Hallux Valgus, average age 45 (25-55), were operated using this technique. The average preoperative intermetatarsal angle (IMA) was 15 degrees with an average Hallux internal malrotation of 30 degrees and a sesamoid malposition of grade V or more in all cases. Postoperatively, sesamoids position, Hallux rotation, IMA and metatarsal length were registered. They were followed for 1 year (8-14 months). The surgical technique is described, with its potential benefits and drawbacks. The radiological outcome, postoperative LEFS score, recurrence rate (IMA increase >5 degrees) and complications were registered. Results: Well positioned sesamoids (grade IV or less) were obtained in all patients postoperatively, with a complete Hallux rotational correction. Postoperative IMA was 5 degrees. achieving a complete metatarsal varus correction. No metatarsal shortening was observed whatsoever. No recurrence has been observed until final follow up. Preoperative and postoperative LEFS scores were 58 and 73 respectively. Conclusion: The PROMO has the advantage over other osteotomies that it can reliable correct, both metatarsal malrotation and varus deformities, achieving a complete deformity correction and hopefully decreasing recurrence rate. The surgical technique has been studied and refined extensively, in order to simplify it and make it reliable. Although more patients and follow-up are needed, the authors believe it is a promising surgical technique which addresses a previously not considered hallux valgus deformity component.

scholarly journals The metatarsaus adductus effect by the syndesmosis procedure for hallux valgus correction

2021 ◽  
Vol 2 (3) ◽  
pp. 174-180
Author(s):  
Daniel Yiang Wu ◽  
Eddy Kwok Fai Lam
Keyword(s):  
Hallux Valgus ◽  
Deformity Correction ◽  
Varus Deformity ◽  
Valgus Deformity ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Second Metatarsal ◽  
Metatarsus Adductus ◽  
American Orthopaedic ◽  
Clinical Records

Aims The purpose of this study is to examine the adductus impact on the second metatarsal by the nonosteotomy nonarthrodesis syndesmosis procedure for the hallux valgus deformity correction, and how it would affect the mechanical function of the forefoot in walking. For correcting the metatarsus primus varus deformity of hallux valgus feet, the syndesmosis procedure binds first metatarsal to the second metatarsal with intermetatarsal cerclage sutures. Methods We reviewed clinical records of a single surgical practice from its entire 2014 calendar year. In total, 71 patients (121 surgical feet) qualified for the study with a mean follow-up of 20.3 months (SD 6.2). We measured their metatarsus adductus angle with the Sgarlato’s method (SMAA), and the intermetatarsal angle (IMA) and metatarsophalangeal angle (MPA) with Hardy’s mid axial method. We also assessed their American Orthopaedic Foot & Ankle Society (AOFAS) clinical scale score, and photographic and pedobarographic images for clinical function results. Results SMAA increased from preoperative 15.9° (SD 4.9°) to 17.2° (5.0°) (p < 0.001). IMA and MPA corrected from 14.6° (SD 3.3°) and 31.9° (SD 8.0°) to 7.2° (SD 2.2°) and 18.8° (SD 6.4°) (p < 0.001), respectively. AOFAS score improved from 66.8 (SD 12.0) to 96.1 (SD 8.0) points (p < 0.001). Overall, 98% (119/121) of feet with preoperative plantar calluses had them disappeared or noticeably subsided, and 93% (113/121) of feet demonstrated pedobarographic medialization of forefoot force in walking. We reported all complications. Conclusion This study, for the first time, reported the previously unknown metatarsus adductus side-effect of the syndesmosis procedure. However, it did not compromise function restoration of the forefoot by evidence of our patients' plantar callus and pedobarographic findings. Level of Clinical Evidence: III Cite this article: Bone Jt Open 2021;2(3):174–180.

scholarly journals Combination of Modified Scarf Osteotomy and Metatarsal Shortening Offset Osteotomy for Rheumatoid Forefoot Deformity

2021 ◽  
Vol 18 (19) ◽  
pp. 10473
Author(s):  
Yuki Etani ◽  
Makoto Hirao ◽  
Kosuke Ebina ◽  
Takaaki Noguchi ◽  
Gensuke Okamura ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Surgical Procedures ◽  
Weight Bearing ◽  
Varus Deformity ◽  
Valgus Deformity ◽  
Great Toe ◽  
Forefoot Deformity ◽  
Scarf Osteotomy ◽  
Hallux Valgus Deformity

With the progress of medical treatment for rheumatoid arthritis (RA), several joint-preserving forefoot surgical procedures have been established and performed. In this situation, we have been choosing the combined surgery: modified scarf osteotomy for the great toe and metatarsal shortening offset osteotomy for the lesser toes in RA cases. A retrospective observational study of 53 RA patients (mean follow-up period: 4.6 years) who underwent the surgery was completed. RA foot ankle scores were assessed, using the Japanese Society for Surgery of the Foot (JSSF) standard rating system, and a self-administered foot evaluation questionnaire (SAFE-Q) was also checked to evaluate clinical outcomes. For radiological evaluations, deformity parameters were measured using radiographs of the feet with weight-bearing. JSSF hallux and lesser toes scores and the SAFE-Q score showed significant improvement in all indices. HVA, M1-M2A, M1-M5A, M2-M5A, and sesamoid position were significantly improved after surgery. At the final follow-up, the hallux valgus deformity had recurred in 4 feet (7.5%), and hallux varus deformity had developed in 8 feet (15.1%). No case of recurrent hallux valgus deformity required revision surgery. Recurrence of dorsal dislocation/subluxation of the lesser toe MTP joint was seen in 6 feet (11.3%) after surgery. A combination of modified scarf osteotomy for the great toe and modified metatarsal shortening offset osteotomy for the lesser toes is one of the novel surgical procedures for rheumatoid forefoot deformity. Preoperative disease activity of RA negatively affected the clinical score of the hallux. The spread of M2-M5A was a risk factor for resubluxation of the lesser toe MTP joint.

scholarly journals Outcomes of Scarf and Akin Osteotomy with Intra-Articular Stepwise Lateral Soft Tissue Release for Correcting Hallux Valgus Deformity in Rheumatoid Arthritis

2021 ◽  
Vol 18 (20) ◽  
pp. 10667
Author(s):  
Takumi Matsumoto ◽  
Yuji Maenohara ◽  
Song Ho Chang ◽  
Kumiko Ono ◽  
Yasunori Omata ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Soft Tissue ◽  
Hallux Valgus ◽  
Valgus Deformity ◽  
Soft Tissue Release ◽  
Intermetatarsal Angle ◽  
Hallux Valgus Deformity ◽  
Patient Reported ◽  
Akin Osteotomy

Background. The effectiveness of scarf and Akin osteotomy with intra-articular lateral soft tissue release for the correction of hallux valgus (HV) in patients with rheumatoid arthritis (RA) has not been elucidated. Methods. A total of 36 feet in 28 patients with RA who had scarf and Akin osteotomy with intra-articular stepwise lateral soft tissue release between 2015 and 2020 at a single institute were investigated retrospectively, with a mean follow-up period of 32.0 ± 16.9 months. Radiographic evaluations including the HV angle, intermetatarsal angle, and sesamoid position were performed preoperatively and postoperatively. Clinical outcomes were assessed using the Japanese Society of Surgery of the Foot (JSSF) hallux scale and self-administered foot evaluation questionnaire (SAFE-Q). Results. The procedure resulted in significant HV correction, with a recurrence rate of 13.9%. The JSSF scale and all five SAFE-Q subscale scores significantly improved (p < 0.05), with no major complications. More than 90% of cases achieved adequate lateral soft tissue release without sacrificing the adductor tendon of the hallux. Conclusions. Intra-articular stepwise lateral soft tissue release in combination with scarf and Akin osteotomy provided satisfactory radiographic and patient-reported outcomes for the correction of HV in patients with RA with minimum lateral soft tissue release.

scholarly journals Radiographic Outcomes, Union Rates, and Complications Associated With Plantar Implant Positioning for Midfoot Arthrodesis

2021 ◽  
Vol 6 (3) ◽  
pp. 247301142110271
Author(s):  
Tyler W. Fraser ◽  
Daniel T. Miles ◽  
Neal Huang ◽  
Franklin B. Davis ◽  
Burton D. Dunlap ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Skin Irritation ◽  
Case Series ◽  
Deformity Correction ◽  
Valgus Deformity ◽  
Union Rate ◽  
Radiographic Outcomes ◽  
Hallux Valgus Deformity ◽  
Metatarsal Angle ◽  
Radiographic Union

Background: Midfoot arthrodesis has long been successfully included in the treatment paradigm for a variety of pathologic foot conditions. A concern with midfoot arthrodesis is the rate of nonunion, which historically has been reported between 5% and 10%. Plantar plating has also been noted to be more biomechanically stable when compared to traditional dorsal plating in previous studies. Practical advantages of plantar plating include less dorsal skin irritation and the ability to correct flatfoot deformity from the same medial incision. The purpose of this study is to report the arthrodesis rate, the success of deformity correction, and the complications associated with plantar-based implant placement for arthrodesis of the medial column. Methods: A retrospective review was undertaken of all consecutive patients between 2012 and 2019 that underwent midfoot arthrodesis with plantar-positioned implants. Radiographic outcomes and complications are reported on 62 patients who underwent midfoot arthrodesis as part of a correction for hallux valgus deformity, flatfoot deformity, degenerative arthritis, Lisfranc injury, or Charcot neuroarthropathy correction. Results: Statistically significant improvement was seen in the lateral talus–first metatarsal angle (Meary angle) and medial arch sag angle for patients treated for flatfoot deformity correction. In patients treated for hallux valgus deformity, there was a reduction in the intermetatarsal angle from 15.4 to 6.8 degrees. The overall nonunion rate was 6.45% in all patients. The rate of nonunion was higher at the NC joint compared to the TMT joint and with compression claw plates. One symptomatic nonunion required revision surgery (1.7%). There were no nonunions when excluding neuroarthropathy patients and smokers. The odds ratio (OR) for nonunion in patients with neuroarthropathy was 6.05 ( P < .05), and in active smokers the OR was 2.33 ( P < .05). Conclusion: Plates placed on the plantar bone surface for midfoot arthrodesis achieved and maintained deformity correction with rare instances of symptomatic hardware for a variety of orthopedic conditions. An overall clinical and radiographic union rate of 94% was achieved. The radiographic union rate improved to 100% when excluding both neuroarthropathy patients and smokers. The incidence of nonunion was higher in smokers, neuroarthropathy patients, naviculocuneiform joint fusions, use of compression claw plates, and when attempting to fuse multiple joints. Incisional healing complications were rarely seen other than in active smokers. Level of Evidence: Level IV, case series.

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