Temporary screw lateral hemiepiphysiodesis of the first metatarsal for juvenile hallux valgus deformity: A case series of 23 feet.

Background. Lapidus surgery involving arthrodesis of the first metatarsocuneiform (MTC) joint is an effective procedure for the correction of moderate to severe hallux valgus. The aim of this study was to collect and analyze radiographic data from our institution and determine the extent of first metatarsal shortening associated with the Lapidus procedure. Materials and Methods. A total of 53 patients (54 feet) who underwent arthrodesis of the first MTC joint combined with modified McBride bunionectomy for correction of moderate to severe hallux valgus deformity, between 2010 and 2015 were included in this study. Complete radiographic evaluation and AOFAS (American Orthopaedic Foot and Ankle Surgery) scoring was available for 54 feet. The average preoperative hallux valgus angulation (HVA) was 32° and the average intermetatarsal angle (IMA) was 16°. Results. Excluding 2 patients with postoperative hallux varus the average postoperative HVA correction at last follow-up was 14°. Average postoperative IMA was 9°. Although there was minimal bone resection during preparation of the MTC joint, no significant shortening of the first metatarsal was observed with this procedure. The relative length of the first metatarsal to the second metatarsal changed only 1.3%. Nonunion of the first MTC joint occurred in 10.3%, but only 1 foot was symptomatic requiring revision. The average postoperative hallux AOFAS score was 80.8. In sum, 63% of patients were very satisfied, 27% satisfied with reservations, and 10% were dissatisfied. Conclusion. The Lapidus bunion procedure offers excellent stable correction of moderate to severe hallux valgus deformity with minimal shortening of the first metatarsal and thereby higher patient satisfaction. Levels of Evidence: Level IV: Retrospective case series

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First Metatarsal Rotation in Hallux Valgus Deformity

Foot & Ankle International ◽

10.1177/1071100721997149 ◽

2021 ◽

Vol 42 (4) ◽

pp. 510-522

Author(s):

Jesse Steadman ◽

Alexej Barg ◽

Charles L. Saltzman

Keyword(s):

Hallux Valgus ◽

Potential Role ◽

Axial Rotation ◽

Valgus Deformity ◽

Measurement Methods ◽

Advanced Imaging ◽

Level Of Evidence ◽

First Metatarsal ◽

Hallux Valgus Deformity ◽

Biplanar Radiographs

Rotation of the first metatarsal (M1) as a potential etiological factor of hallux valgus (HV) deformity was described relatively early in the description of HV pathoanatomy. However, because biplanar radiographs have been the standard method for imaging HV, clinicians primarily developed measurement methods and corrective operations confined to 2 dimensions, medial-lateral and inferior-superior. Recently, as our understanding of HV pathoanatomy has further developed, aided in part by advanced imaging technology, M1 rotation about its axis (“axial rotation”) and its implications for HV deformity and treatment has reemerged. The goal of this review is to summarize M1 rotation in HV from a historical perspective, to present the current understanding of its potential role in the etiology/pathogenesis of HV, and to summarize relevant imaging and operative considerations with respect to M1 rotation. Level of Evidence: Level III, systematic review.

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

Foot & Ankle Orthopaedics ◽

10.1177/24730114211027115 ◽

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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Preservation of the Length of the First Metatarsal after Modified Mitchell?s Osteotomy for Hallux Valgus Deformity. Overview, Technique and Preliminary Results

Clinical Research on Foot & Ankle ◽

10.4172/2329-910x.1000164 ◽

2015 ◽

Vol 03 (01) ◽

Author(s):

Vlamis John Karampinas K

Keyword(s):

Hallux Valgus ◽

Valgus Deformity ◽

Preliminary Results ◽

First Metatarsal ◽

Hallux Valgus Deformity

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Proximal Rotational Metatarsal Osteotomy for Hallux Valgus (PROMO)

Foot & Ankle Orthopaedics ◽

10.1177/2473011418790071 ◽

2018 ◽

Vol 3 (3) ◽

pp. 247301141879007 ◽

Cited By ~ 1

Author(s):

Pablo Wagner ◽

Emilio Wagner

Keyword(s):

Hallux Valgus ◽

Case Series ◽

Valgus Deformity ◽

Metatarsal Osteotomy ◽

Level Of Evidence ◽

Reliable Technique ◽

Intermetatarsal Angle ◽

Hallux Valgus Deformity ◽

The Mean ◽

Prospective Case Series

Background: Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique. Methods: Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded. Results: The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found. Conclusions: PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies. Level of evidence: IV, prospective case series.

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Minimally Invasive Retrocapital Osteotomy of the First Metatarsal in Hallux Valgus Deformity

Operative Orthopädie und Traumatologie ◽

10.1007/s00064-008-1231-0 ◽

2008 ◽

Vol 20 (1) ◽

pp. 89-96 ◽

Cited By ~ 30

Author(s):

Bruno Magnan ◽

Elena Samaila ◽

Gino Viola ◽

Pietro Bartolozzi

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Valgus Deformity ◽

First Metatarsal ◽

Hallux Valgus Deformity

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Comparison of Postoperative Height Changes of the Second Metatarsal Among 3 Osteotomy Methods for Hallux Valgus Deformity Correction

Foot & Ankle International ◽

10.1177/1071100716666566 ◽

2016 ◽

Vol 38 (1) ◽

pp. 20-26 ◽

Cited By ~ 5

Author(s):

Jun Young Choi ◽

Yu Min Suh ◽

Ji Woong Yeom ◽

Jin Soo Suh

Keyword(s):

Hallux Valgus ◽

Deformity Correction ◽

Metatarsal Head ◽

Valgus Deformity ◽

Metatarsal Osteotomy ◽

Level Of Evidence ◽

First Metatarsal ◽

Scarf Osteotomy ◽

Hallux Valgus Deformity ◽

Second Metatarsal

Background: We aimed to compare the postoperative height of the second metatarsal head relative to the first metatarsal head using axial radiographs among 3 different commonly used osteotomy techniques: proximal chevron metatarsal osteotomy (PCMO), scarf osteotomy, and distal chevron metatarsal osteotomy (DCMO). Methods: We retrospectively reviewed the radiographs and clinical findings of the patients with painful callosities under the second metatarsal head, complicated by hallux valgus, who underwent isolated PCMO, scarf osteotomy, or DCMO from February 2005 to January 2015. Each osteotomy was performed with 20 degrees of plantar ward obliquity. Along with lateral translation and rotation of the distal fragment to correct the deformity, lowering of the first metatarsal head was made by virtue of the oblique metatarsal osteotomy. Results: Significant postoperative change in the second metatarsal height was observed on axial radiographs in all groups; this value was greatest in the PCMO group (vs scarf: P = .013; vs DCMO: P = .008) but did not significantly differ between the scarf and DCMO groups ( P = .785). The power for second metatarsal height correction was significantly greater in the PCMO group (vs scarf: P = .0005; vs DCMO: P = .0005) but did not significantly differ between the scarf and DCMO groups ( P = .832). Conclusions: Among the 3 osteotomy techniques commonly used to correct hallux valgus deformity, we observed that PCMO yielded the most effective height change of the second metatarsal head. Level of Evidence: Level III, retrospective comparative series.

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