Roentgenographs Study of Cavus Foot Deformity in Friedreich Ataxia Patients: Preliminary Report

SUMMARY:The preliminary results based on a three year retrospective study in cavus foot deformity of forty-four Friedreich ataxia patients regularly seen at the Neuromuscular Disease Clinic of Sainte-Justine Hospital have been presented. An accurate “weight-bearing” foot stereoradiographic technique has been recently developed by our group. Since the follow-up period with this device is not sufficient to provide statistical information, the conventional non-weight bearing technique has been utilized in this study to enable a possible comparison between the radiographs of ambulant and non-ambulant patients. Due to the present technique, the results of this study must be interpreted with caution.For 132 pairs of radiographs, 28 parameters have been analyzed. Four of these, namely the calcaneal inclination angle, the first metatarsal inclination angle, the inferior cortex of calcaneus-first metatarsal angle and the first-fifth metatarsals angle, were of particular interest. From these parameters, a preliminary quantitative description of cavus foot deformity in Friedreich’s ataxia has been attempted. Three stages of evolution have been tentatively identified for this type of neurological disorder.

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Radiographic Measurements Associated with the Natural Progression of the Hallux Valgus Deformity during at Least Two Years of Follow-up

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000255 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002 ◽

Cited By ~ 1

Author(s):

Kyoung Min Lee ◽

Seung Yeol Lee ◽

Sonya Ahmed ◽

Byung Chae Cho ◽

Moon Seok Park ◽

...

Keyword(s):

Hallux Valgus ◽

Weight Bearing ◽

Binary Logistic Regression ◽

Valgus Deformity ◽

Binary Logistic Regression Analysis ◽

First Metatarsal ◽

Hallux Valgus Deformity ◽

Metatarsal Angle ◽

Radiographic Measurements

Category: Bunion Introduction/Purpose: There have been few longitudinal studies regarding hallux valgus deformity. This retrospective study aimed to investigate the radiographic measurements associated with the progression of hallux valgus deformity during at least two years of follow-up. Methods: Seventy adult patients (mean age, 58.0 years; standard deviation [SD], 12.3 years; 13 males and 57 females) with hallux valgus who were followed-up for at least two years and underwent weight-bearing foot radiography were included. Radiographic measurements included the hallux valgus angle (HVA), hallux interphalangeal angle, intermetatarsal angle (IMA), metatarsus adductus angle, distal metatarsal articular angle (DMAA), tibial sesamoid position, anteroposterior (AP) talo-first metatarsal angle, and lateral talo-first metatarsal angle. Progression of hallux valgus deformity was defined as an increase of 5 degrees or more in the HVA during follow-up. Patients were divided into progressive and non-progressive groups. Binary logistic regression analysis was performed to identify factors that significantly affect the progression of hallux valgus deformity. The correlation between change in HVA and changes in other radiographic indices during follow-up was analyzed. Results: Eighteen out of 70 patients showed progression of 5 degrees or more in the HVA during the mean follow-up of 47.0 months (SD, 19.8 months). The DMAA (p=0.027) and AP talo-first metatarsal angle (p=0.034) at initial presentation were found to be significant factors affecting the progression of hallux valgus deformity. Change in the HVA during follow-up was significantly correlated with changes in the IMA (r=0.423; p=0.001) and DMAA (r=0.541; p<0.001). Conclusion: Special attention needs to be given to patients with pes planovalgus and increased DMAA during follow-up. Change in HVA was significantly correlated with changes in IMA and DMAA. Therefore, progression of hallux valgus deformity is considered to be closely related to the progressive instability of the first tarsometatarsal joint.

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Radiographic Evaluation of Adult Acquired Flatfoot Correction with Augmented Spring Ligament Repair

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00172 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0017

Author(s):

Jason Fogleman ◽

Christopher Kreulen ◽

Aida Sarcon ◽

Patrick Michelier ◽

Rachel Swafford ◽

...

Keyword(s):

Weight Bearing ◽

Radiographic Evaluation ◽

Ligament Repair ◽

First Metatarsal ◽

Spring Ligament ◽

Radiographic Parameters ◽

Metatarsal Angle ◽

Medial Cuneiform ◽

Suture Tape

Category: Flatfoot reconstruction Introduction/Purpose: Adult acquired flatfoot often results from posterior tibial tendon dysfunction followed by attenuation of the ligamentous support of the medial longitudinal arch of the foot. The spring ligament is the strongest ligamentous support for the talonavicular joint making it a viable target for flatfoot reconstruction procedures. There are concerns that direct repair of the spring ligament complex could result in failure as the already attenuated tissues of the ligament stretch out with mobilization and weight bearing. Suture tape augmentation of ligament repairs has shown greater loads to failure in biomechanical testing; however, there is a paucity of data surrounding clinical and radiographic outcomes of flatfoot reconstruction with augmented spring ligament repair. Methods: A retrospective review was performed of patients who underwent flatfoot reconstruction including spring ligament repair with suture tape augmentation between July 2014 and August 2017. Weight bearing radiographs were obtained for all patients both pre-operatively and at their last available follow-up. All radiographs were assessed by two surgeons for validated radiographic parameters including AP talocalcaneal angle, AP talo-first metatarsal angle, AP talar uncoverage, lateral talocalcaneal angle, lateral talo-first metatarsal (Meary) angle, lateral medial cuneiform-fifth metatarsal height, and lateral calcaneal pitch. Paired sample T-tests were used to compare pre-operative and post-operative radiographic measurements to assess for correction of these parameters. Results: 57 patients met inclusion criteria. The average time to final radiographic evaluation was 47 weeks (10 to 200 weeks). All radiographic parameters assessed showed significant correction when compared to pre-operative measurements. The average correction for each parameter included 6.02 degrees for AP talocalcaneal angle (p<0.001), 10.96 degrees for AP talo-first metatarsal angle (p<0.001), 12.65% for AP talar uncoverage percentage (p<0.001), 4.27 degrees for lateral talocalcaneal angle (p<0.001), 11.35 degrees for lateral talo-first metatarsal (Meary) angle (p<0.001), 8.31 mm for lateral medial cuneiform-fifth metatarsal height (p<0.001), and 2.91 degrees for lateral calcaneal pitch (p<0.001). Post-operative complications occurred in 5 patients. Conclusion: Reconstruction of adult acquired flatfoot with spring ligament repair using suture tape augmentation is a safe procedure that resulted in significant weight bearing radiographic correction at an average of 47 weeks follow-up.

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Short-Term Complications Following Early Protected Weight Bearing after Flatfoot Reconstruction when Utilizing a Fibertape Device for Spring Ligament Reefing Augmentation

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00295 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0029

Author(s):

Morgan S. Kim ◽

Emily Vannatta ◽

Chris M. Stauch ◽

Paul J. Juliano ◽

Michael C. Aynardi ◽

...

Keyword(s):

Weight Bearing ◽

Radiographic Evaluation ◽

Bony Union ◽

Early Weight Bearing ◽

First Metatarsal ◽

Spring Ligament ◽

Metatarsal Angle ◽

Gastrocnemius Recession ◽

Adult Acquired Flatfoot Deformity

Category: Ankle Introduction/Purpose: In an estimated 70% of cases of Adult Acquired Flatfoot Deformity (AAFD) reconstruction, the spring ligament is elongated and/or damaged. Spring ligament reefing can be performed through several techniques including augmentation with Fibertape devices. In addition, biomechanical studies have demonstrated its safety and suggest early weight bearing may be performed. The purpose of this study is to evaluate the outcomes of early weight bearing following flatfoot reconstruction with use of InternalBrace augmentation for spring ligament reefing when performed in combination with medical displacing calcaneal osteotomy (MCO) and FDL tendon transfer. Methods: From 2016-2018, 45 patients underwent flatfoot reconstruction (MCO, FDL transfer, and gastrocnemius recession) with spring ligament reefing and augmentation with the InternalBrace device. All surgeries were performed by the senior orthopaedic surgeons (PJJ & MCA). Institutional early post-operative weight bearing protocol involves weight bearing as tolerated in a splint with crutches for two weeks, transitioning at 2 weeks to a Cam boot with 1 wedge WBAT. At 4 weeks, the patient is weaned off crutches and recommended to start therapy restricting excessive eversion and concentrating on calf strengthening, gait, and ROM. At weeks 6-8 they are weaned from the Cam boot into lace up ASO and shoe with arch support. Data were recorded at 2 weeks, 6 weeks, 12 weeks, 6 months and at yearly intervals. Outcomes and complications were documented. Results: Of the 45 cases there were no complications related to early weight bearing. Radiographic bony union rate of the MCO was 100% (45/45). Moreover, there was no loss of fixation of either the FDL transfer or spring ligament reefing with InternalBrace augmentation with early weight bearing. Lastly, radiographic evaluation noted no loss of Meary’s talo-first metatarsal angle when comparing initial postoperative radiographic to their final follow up. Additional complications in our cohort included the following: removal of painful hardware (1, 2.22%), sural neuritis (2, 4.44%), superficial cellulitis (1, 4.44%), and delayed lateral wound healing (1, 2.22%). Conclusion: Preliminary data shows that early protected weight bearing after flatfoot reconstruction and augmentation of the spring ligament with the InternalBrace device is safe and demonstrates few complications and no early loss of correction.

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Effect of Proximal Dome and Distal Chevron Osteotomies on Plantar Pressures and Radiographic and Functional Outcomes in Hallux Valgus Surgery: A Retrospective Analysis

Journal of the American Podiatric Medical Association ◽

10.7547/20-016 ◽

2021 ◽

Vol 111 (3) ◽

Author(s):

Kadir Ilker Yildiz ◽

Abdulhamit Misir ◽

Turan Bilge Kizkapan ◽

Mustafa Cukurlu ◽

Canan Gonen Aydin

Keyword(s):

Hallux Valgus ◽

Inclination Angle ◽

Plantar Pressure ◽

Functional Outcomes ◽

First Metatarsal ◽

Pressure Point ◽

Radiographic Outcomes ◽

Metatarsal Angle ◽

Dome Osteotomy ◽

Pressure Changes

Background No detailed comparative studies have been performed regarding plantar pressure changes between proximal dome and distal chevron osteotomies. This study aimed to compare radiographic and plantar pressure changes after distal chevron and proximal dome osteotomies and to investigate the effect of radiographic and plantar pressure changes on clinical outcomes. Methods This study included 26 and 22 patients who underwent distal chevron and proximal dome osteotomies, respectively. Visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) forefoot scores were used to evaluate pain and functional outcomes. Hallux valgus angle, intermetatarsal angle, talar–first metatarsal angle, and calcaneal inclination angle were measured in the evaluation of radiographic outcomes. Preoperative and postoperative plantar pressure changes were evaluated. Results There were no statistically significant differences between the two groups in age, body mass index, or AOFAS forefoot and VAS scores. In the proximal dome group, the pressure measurement showed significant lateralization of the maximal anterior pressure point in the forefoot (P < .001). In addition, the postoperative calcaneal inclination angle was significantly lower (P = .004) and the talar–first metatarsal angle was significantly higher (P < .001) in the proximal dome group. Postoperative transfer metatarsalgia was observed in one patient (3.8%) in the distal chevron group and five (22.7%) in the proximal dome group (P < .05). Conclusions Proximal dome osteotomy led to more lateralization of the maximum anterior pressure point, decreased calcaneal inclination angle and first metatarsal elevation, and related higher transfer metatarsalgia.

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Reliability and Relevance of Radiographic Measures of Metatarsus Primus Elevatus and Arch Alignment in Individuals with Midfoot Arthritis and Controls

Journal of the American Podiatric Medical Association ◽

10.7547/1030347 ◽

2013 ◽

Vol 103 (5) ◽

pp. 347-354 ◽

Cited By ~ 5

Author(s):

Smita Rao ◽

Katie Bell

Keyword(s):

Inclination Angle ◽

Intraclass Correlation ◽

Positive Association ◽

Group Differences ◽

Control Group ◽

Arch Height ◽

First Metatarsal ◽

Compressive Stresses ◽

Metatarsal Angle ◽

The Relationship

Background: Low arch alignment and metatarsus primus elevatus (MPE) have been postulated to increase dorsal compressive stresses in the joints of the medial column of the foot and to contribute to the development of degenerative changes. The primary purposes of this study were 1) to examine the relationship between radiographic measures of arch alignment and MPE and 2) to assess arch alignment and MPE in individuals with midfoot arthritis and in asymptomatic controls. The secondary aim was to examine the reliability of radiographic measures of arch alignment and MPE. Methods: Radiographic measures of arch height and MPE were quantified on 28 individuals with midfoot arthritis and 22 individuals in a control group. Reliability was assessed using the intraclass correlation coefficient (ICC). The Pearson product moment correlation (r) was used to assess the relationship between arch alignment and MPE. Between-group differences were assessed using a two-sample t test (α = 0.05). Results: Good to excellent reliability was noted for measures of arch height (ICC[2,3] = 0.919–0.994) as well as MPE (ICC[2,3] = 0.891–0.882). A modest positive association was noted between normalized cortical elevation and normalized navicular height (r = 0.274, P = .030) and calcaneal inclination angle (r = 0.263, P = .035). Individuals with midfoot arthritis demonstrated lower arch alignment, reflected in a significantly higher calcaneal–first metatarsal angle (P = .002), lower calcaneal inclination angle (P = .004), and lower normalized navicular height (P < .001) compared with controls. No evidence was found to support between-group differences in lateral intermetatarsal angle (P = .495) and normalized cortical elevation (P = .146). Conclusions: These findings provide objective data establishing the reliability of measures of MPE and arch alignment and their potential clinical significance. (J Am Podiatr Med Assoc 103(5): 347–354, 2013)

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Radiographic Outcomes after Fixation of Distal Metatarsal Osteotomy for Hallux Valgus Using a Tension Band Construct

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00428 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0042

Author(s):

Alexander Volpi ◽

Robert Zbeda ◽

Christopher Katchis ◽

Lon Weiner ◽

Stuart Katchis

Keyword(s):

Hallux Valgus ◽

Postoperative Period ◽

Weight Bearing ◽

Line Tension ◽

Tension Band ◽

Metatarsal Osteotomy ◽

First Metatarsal ◽

Distal Metatarsal Osteotomy ◽

The Mean

Category: Bunion Introduction/Purpose: Hallux valgus is a common deformity of the forefoot. There are over 130 procedures described to correct hallux valgus. Classically, the treatment of mild to moderate hallux valgus is with a distal metatarsal osteotomy. A variety of fixation techniques have been described for use with this osteotomy most of which require partial or non-weight bearing until the osteotomy is healed. Tension Band fixation is a well-known principle in orthopedic surgery. The goal of the present study is to radiographically assess the maintenance of distal first metatarsal osteotomy fixation using a novel tension band device (Re+Line tension band bunion plate system, Nextremity Solutions) with immediate post-operative weight-bearing. Methods: The patient database for one surgeon was retrospectively reviewed for patients that underwent hallux valgus correction with the Re+Line tension band device between 2014 and 2017. Postoperative protocol included a soft dressing, firm surgical shoe, and weight-bearing as tolerated with a cane. Patients were excluded if fixation was achieved with something other than a tension band construct. Radiographs were obtained and reviewed retrospectively by 3 authors. Pre and postoperative hallux valgus (HVA) and intermetatarsal angles (IMA) were measured as described previously in the literature, and the changes in correction compared. Maintenance of correction and hardware integrity were assessed at final follow-up after weight bearing as tolerated in a surgical shoe in the postoperative period. Statistical analysis was performed using a Wilcoxon signed-rank test for the changes in HVA and IMA. Results: There was a total of 72 patients and 76 toes that underwent hallux valgus correction with a tension band construct, at a mean follow-up of 4.36 months. 68 of 72 patients were female. The average age was 60.8 years old. The mean preoperative HVA was 27.1 degrees. The mean postoperative HVA was 6.14 degrees, with a mean correction of 20.22 degrees (p<0.001). The mean preoperative IMA was 14.14 degrees. The mean postoperative IMA was 6.10 degrees, with a mean correction of 7.98 degrees (p<0.001). There was loss of reduction found in 6 of 76 toes (7.89%).There were zero cases of hardware failure. All osteotomies healed at final follow-up. Conclusion: This study shows successful radiographic outcome after hallux valgus correction using a tension band construct and allowing immediate full weight-bearing in a surgical shoe in the postoperative period. Significant deformity correction was achieved and maintained and all osteotomies healed. The Re+Line tension band bunion correction system can be safely used as a successful option to fix distal first metatarsal osteotomies, while allowing patients to fully weight bear in a surgical shoe postoperatively and potentially return to activities faster than when using traditional fixation methods. Future studies are needed to assess functional outcomes and patient satisfaction with this novel technique.

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Suture anchor stabilization of symptomatic accessory navicular in adolescents: Clinical and radiographic outcomes

Journal of Orthopaedic Surgery ◽

10.1177/2309499020918949 ◽

2020 ◽

Vol 28 (2) ◽

pp. 230949902091894

Author(s):

Masataka Kakihana ◽

Yuki Tochigi ◽

Takayuki Yamazaki ◽

Masanori Ohashi ◽

Satoru Ozeki

Keyword(s):

Tilt Angle ◽

Suture Anchor ◽

Weight Bearing ◽

Bone Union ◽

First Metatarsal ◽

Radiographic Outcomes ◽

Metatarsal Angle ◽

Radiographic Measurements ◽

Accessory Navicular ◽

Stabilization Technique

Background: Screw fixation used in modified Kidner procedures to treat persistent symptomatic accessory navicular in adult cases is often challenging in adolescent cases with a small accessory fragment. The present study aimed to document the clinical effect of a suture anchor stabilization technique applicable to such cases where osteosynthesis is considered an ideal outcome. Methods: Consecutive clinical cases who received this surgical treatment from 2009 to 2016 were retrospectively reviewed. The focus of interest included radiographic union of the accessory bone, changes in symptoms evaluated using a validated clinical outcome scale introduced by the Japanese Society for Surgery of the Foot, and changes in the medial arch bony alignment measured in lateral weight-bearing plain radiographs. Results: Twenty-two feet in 15 individuals (11 females and 4 males, age at surgery 10–16 years) were identified. In 14 feet (64%), radiographic bone union was confirmed within 8 weeks postoperatively. At the final follow-up ranging 12–51 months postoperation, the clinical scores have significantly improved ( p < 0.001) to 96 ± 5.71 (mean ± standard deviation, range 87–100), from 54 preoperatively. Radiographic measurements revealed significant postoperative increase of the sagittal talar tilt angle ( p < 0.001, increment 4 ± 3°, range 0–11) and the talo-first metatarsal angle ( p < 0.001, increment 5 ± 4°, range 0–12). No significant changes were identified in the calcaneal pitch angle, first metatarsal tilt angle, calcaneo-navicular angle, and the navicular height. Conclusion: Despite the modest bone union rate, the clinical outcomes suggest distinct symptom-relieving effect, at least in the short- to midterm, while the radiographic measurements suggest positive biomechanical effects. The present suture-anchor stabilization concept appears to be a promising treatment option for persistent symptomatic accessory navicular in adolescent cases.

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Radiographic Union of Evans Osteotomy Without Fixation

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00358 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0035

Author(s):

Megan R. Miles ◽

Brian P. Gallagher ◽

Katherine L. Mistretta ◽

Nigel N. Hsu ◽

Haijun Wang ◽

...

Keyword(s):

Allogenic Bone ◽

Lateral Column ◽

First Metatarsal ◽

Calcaneocuboid Joint ◽

Calcaneal Osteotomy ◽

Metatarsal Angle ◽

Flexible Flatfoot ◽

Lateral Column Lengthening ◽

Allogenic Bone Graft

Category: Hindfoot; Other Introduction/Purpose: The Evans osteotomy is a lateral column lengthening procedure of the calcaneus that is commonly used to correct flexible flatfoot deformities. There is no consensus on whether fixation is needed to avoid nonunion and calcaneocuboid subluxation when performing this osteotomy. We assessed the nonunion rate and correlated extent of subluxation with graft size in an unfixed Evans osteotomy with an allograft wedge and no pinning of the calcaneocuboid joint at any point in the largest series of the procedure to date. Surgeries were performed in patients undergoing flexible flatfoot reconstruction. Methods: We retrospectively reviewed 120 consecutive patients who had undergone 145 unfixed Evans osteotomies by a single surgeon with allogenic bone graft for flatfoot reconstruction between January 2013 and October 2017, with a mean follow-up of 62.5 (range 9.4-266.7) weeks. The calcaneocuboid joint was not pinned during the procedure. Data were collected using clinical and radiographical examination during regular follow-up. Results: A total of 137 feet (94.5%) underwent a double calcaneal osteotomy with an associated medial displacement calcaneal osteotomy (MDCO). There was one nonunion (0.69%). The mean time to union was 10.8 (range, 6.7-17.9) weeks. There was significant improvement in all radiographic parameters postoperatively, including calcaneal pitch, talonavicular uncoverage, anteroposterior and lateral talo-first metatarsal angle, lateral column length, and naviculocuboid overlap (p<0.05). Minor postoperative calcaneocuboid joint subluxation (1.51 +- 2.3 mm) occurred in 72 of 118 feet (61.0%) and had no correlation with wedge size (r=0.06; 95% CI, -0.13, 0.24; p=0.6). Conclusion: An unfixed Evans osteotomy for symptomatic flatfoot deformity resulted in a significant improvement in the radiographic alignment of the foot with an exceptionally rare nonunion rate. Detectable calcaneocuboid subluxation was common but minimal in extent and was not correlated with wedge size in this series in which wedges were less than 12 mm in the maximum dimension. This report represents the largest series of the Evans procedure to date.

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Correction of Severe Flexible Pes Planovalgus Deformity Using Trabecular Metallic Wedges

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000287 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Elizabeth McDonald ◽

Justin Tsai ◽

Steven Raikin ◽

Ryan Sutton

Keyword(s):

Weight Bearing ◽

Attractive Alternative ◽

Complication Rates ◽

Pes Planovalgus ◽

Lateral Column ◽

Radiographic Parameters ◽

Metatarsal Angle ◽

Radiographic Measurements ◽

Picture Archiving And Communication

Category: Hindfoot, Midfoot/Forefoot Introduction/Purpose: Lateral column lengthening and a medial cuneiform plantarflexion (Cotton) osteotomy are procedures commonly used in the treatment of symptomatic flexible pes planovalgus. Traditionally, structural autograft or allograft have been used for both osteotomies. While union rates for both types of graft have been shown to be comparably high, the use of allograft or autograft each come with their own set of inherent risks and/or potential complications. A trabecular titanium wedge implant provides an attractive alternative that avoids the concerns associated with autograft and allograft use, and has previously been shown in the literature to demonstrate similar union rates. The purpose of this study was to retrospectively review the radiographic outcomes of corrective osteotomies utilizing trabecular metal wedges to address severe flexible pes planovalgus deformity. Methods: 115 feet in 109 patients who were treated with corrective osteotomies using a trabecular titanium wedges performed by one surgeon were retrospectively reviewed. All patients had symptomatic flexible pes planovalgus, mostly secondary to stage IIB posterior tibialis tendon dysfunction. Other diagnoses included pes planovalgus secondary to the adolescent idiopathic flexible subtype, traumatic posterior tibialis tendon rupture, coalition, or an accessory navicular. Preoperative radiographic parameters assessing severity of deformity were recorded and compared to the postoperative measurements taken at the time of most recent follow up visit to assess for correction. The radiographic measurements included the (1) AP talo-1st metatarsal angle (2) Lateral talo-1st metatarsal angle (3) Calcaneal pitch (4) Lateral talo-calcaneal angle and (5) Talonavicular uncoverage angle. All angles were measured off standard weight-bearing radiographs by one author using our institution’s picture archiving and communication system (PACS) software. All complications were also recorded. Results: At an average follow up time of 40 weeks, there were statistically significant corrective changes in the AP-talo-1st metatarsal angle (-12.56), lateral talo-1st metatarsal angle (+14.15), calcaneal pitch (+5.23), lateral talo-calcaneal angle (-3.87) and talonavicular uncoverage angle (-17.76). There were 3 nonunions (2.6%) confirmed by CT, 2 of which were eventually revised. There were a total of 9 complications (7.8%). Other than the nonunion revisions, none of these complications required a return to the operating room. There were no cases of collapse or loss of correction at the time of followup, as compared to the initial post-operative radiographs. Conclusion: In our study population corrective osteotomies using a trabecular titanium wedge was effective in improving radiographic parameters associated with flexible pes planovalgus deformity. The nonunion and overall complication rates using a trabecular titanium wedge were shown to be comparable or superior to what has previously been reported in the literature using allograft or autograft.

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Pes Planus Deformity and Its Association With Hallux Valgus Recurrence Following Scarf Osteotomy

Foot & Ankle International ◽

10.1177/1071100720937645 ◽

2020 ◽

Vol 41 (10) ◽

pp. 1212-1218

Author(s):

Gavin John Heyes ◽

Amir R. Vosoughi ◽

Lizzy Weigelt ◽

Lyndon Mason ◽

Andrew Molloy

Keyword(s):

Hallux Valgus ◽

P Value ◽

Level Of Evidence ◽

Pes Planus ◽

First Metatarsal ◽

Scarf Osteotomy ◽

Metatarsal Angle ◽

Valgus Angle ◽

Akin Osteotomy

Background: Hallux valgus recurrence is an unsatisfactory complication, with many causes postulated. This study investigated the effect of pes planus on recurrence after scarf osteotomy. Methods: A total of 183 feet were retrospectively reviewed. All patients were treated with a scarf osteotomy and if required Akin osteotomy. We measured preoperative lateral talus first metatarsal angle (T1MA) to study pes planus; an angle of under −4 degrees was considered pes planus. We measured pre and postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), and sesamoid location. In total 164 feet were suitable for inclusion, with follow-up of at least 6 months (10 males and 154 females, mean age: 52 years). Results: Recurrence frequency (HVA greater than 15 degrees) was 27 feet (16%). Hallux valgus recurrence was not influenced by gender ( P value = .66) or preoperative IMA ( P value = .48). Preoperative HVA greater than 35 degrees was associated with increased frequency of recurrence ( P value = .004). Those with T1MA less than −10 degrees demonstrated progression in HVA and deterioration in sesamoid location up to 6 months postoperatively ( P value = .038). HVA did not progress beyond 6 months. The prevalence of recurrent hallux valgus with normal T1MA was 1%, in T1MA −4 to −10 degrees it was 29% and in T1MA less than −10 degrees it was 47% ( P value <.001). Breaks in T1MA less than −4 degrees were found at the naviculocuneiform joint in 68% of feet in this series. Conclusion: The prevalence of hallux valgus recurrence correlated with the severity of pes planus. Level of Evidence: Level III, retrospective cohort study.

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