scholarly journals 753 Sesamoid Alignment After MIS Chevron Osteotomy and Its Role to Prevent Hallux Valgus Recurrence

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K A Edres ◽  
K Abdelghafour ◽  
A Felstead ◽  
C Adam ◽  
S Palmer
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Corrective Osteotomy ◽  
Valgus Deformity ◽  
P Value ◽  
First Metatarsal ◽  
Observer Reliability ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Risk Factor For Recurrence

Abstract Introduction Incomplete correction of the sesamoid position after corrective osteotomy is a risk factor for recurrence of the hallux valgus deformity. This study was done to report the results of sesamoid alignment after chevron osteotomy. Method 92 patients (111 feet) had minimally invasive (MIS) distal chevron osteotomy and release of fibular sesamoid ligaments done, sesamoid position was assessed in the weight-bearing views of the foot, tibial sesamoid position in relation to the mechanical axis of the first metatarsal was classified as grades 0-3 where the normal position was graded (0) and the most lateral sublaxation was graded (3). There were 2 groups; the reduced (grade 0-1) & the dislocated (grade 2,3) groups. Preoperative and post-operative radiographs were compared. Postoperative images were done 6-8 weeks post-operatively to ensure osteotomy healing. Results Sesamoids alignment was corrected following the MIS chevron osteotomy; 84 feet (75.7%) were from the dislocated group and 27 feet (24.3%) were from the reduced group pre-operatively improved to 102 feet (91.9%) reduced and only 9 feet (8.1%) dislocated following the procedure with P-value < 0.00001. To ensure inter-observer reliability, images were assessed by 2 observers with Cohen’s Kappa coefficient 0.477. Conclusions MIS chevron osteotomy can produce significant improvement of sesamoid position which is crucial to prevent recurrence of hallux valgus.

scholarly journals PO 18074 - Rotational biplanar Chevron osteotomy

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 9S
Author(s):  
Tiago Soares Baumfeld ◽  
Marcelo Pires Prado ◽  
Alberto Mendes ◽  
Caio Augusto De Souza Nery ◽  
Daniel Soares Baumfeld
Keyword(s):  
Internal Rotation ◽  
Hallux Valgus ◽  
Valgus Deformity ◽  
Metatarsal Bone ◽  
Distal Fragment ◽  
Rotational Deformity ◽  
First Metatarsal ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Rotation Component

Introduction: The Chevron osteotomy is a reliable and popular osteotomy for treating hallux valgus worldwide. Many modifications have been described, but none of them address the rotational deformity of the first metatarsal. The objective of this study is to describe a variation of biplanar Chevron osteotomy that can address first metatarsal rotation when necessary. Methods: The indications for the Rotational Biplanar Chevron Osteotomy (RBCO) are mild to moderate hallux valgus deformity associated with hallux pronation related to internal rotation of the first metatarsal bone. We describe a technique that uses a medial-based wedge parallel to the plantar limb of the osteotomy to free the distal fragment for correct rotation. Results: The more recent concern about hallux valgus surgery represents a very interesting concept that this deformity truly occurs in three different planes, and we may have mistreated the rotation component using current techniques. Many authors have revisited numerous common techniques to adapt them to correct metatarsal pronation. To the best of our knowledge, this is the first paper to describe a modification of the Chevron osteotomy to address rotation of the first metatarsal.  Conclusion: We can conclude that rotational biplanar Chevron osteotomy is an useful tool in the treatment of mild hallux valgus associated with metatarsal pronation.

scholarly journals Does the Presence of Pes Planus Deformity Increase Recurrence of Hallux Valgus Deformity Following Surgery?

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0021
Author(s):  
Gavin Heyes ◽  
Eric Swanton ◽  
Lyndon Mason ◽  
Andrew P. Molloy
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Valgus Deformity ◽  
P Value ◽  
X Rays ◽  
Recurrence Rates ◽  
Pes Planus ◽  
Hallux Valgus Deformity ◽  
Increased Risk

Category: Bunion Introduction/Purpose: Factors linked with increased risk of developing Hallux Valgus include; shod footwear, genetic factors, metatarsal morphology, ligamentous laxity and Pes Planus. With regards to Pes planus, it has been suggested that the loss of the medial longitudinal arch in Pes Planus increases Hallux plantar medial pressures and drives deformity during heel rise. There is little in the literature regarding whether Pes Planus is associated with increased recurrence rates. Given this is a potentially modifiable risk factor we believe the risk of recurrence should be studied. This paper reports the results of a retrospective study following up 183 consecutive Hallux valgus cases. The primary objective is to evaluate whether pes planus is associated with increased recurrence following treatment. Methods: Retrospective review of consecutively treated patients from 07/03/2008 to 05/12/2017. Patients were typically followed up for six to twelve months depending on any additional factors that require follow up. X-rays were performed routinely at six weeks, three months and many had x-rays at six and/or 12 months for additional pathology. We examined radiological markers including Sesamoid location (using the Hardy and Clapham Classification), Hallux Valgus Angle (HVA), Intermetatarsal Angle, Meary’s angle and Talonavicular uncovering. 183 cases were reviewed, 12 were excluded due to previously amputated second toes, Hallux Varus, revision surgery and only 6 weeks follow up. This left 171 cases of which 75 had Pes Planus (Meary’s angle < -4°). Results: Table 1 describes the preoperative HVAs we encountered and the correction achieved along with frequencies. Postoperative measurements were taken off weight bearing x-rays. The incidence of recurrent HVA > 15° was significantly higher in those with Meary’s angle < - 4° (Chi-Sq 22.6 P-value 0.000002). Those with a Meary’s angle -20° to -10° had a significantly higher rate of recurrence than ones measuring -10° to -4° (Chi-Sq 9.7 P-value 0.0018 There was no difference in progression of recurrent deformity between those initially corrected to HVA < 15° (Chi-Sq 0.26 P- value 0.61) and those not. Multiple regression analysis revealed there was no meaningful association with sesamoid location or pes planus with recurrence of Hallux Valgus deformity. Conclusion: Our results demonstrate a link between Preoperative Pes Planus deformity and increased recurrence rates of Hallux Valgus deformity following surgery. Consideration of correction of pes planus and appropriate consent of recurrence rates should therefore be undertaken in treatment of hallux valgus in the presence of pes planus

scholarly journals The corrective ability of the double chevron and Akin osteotomies on medial sesamoid position in Hallux Valgus deformity

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Jie Chen ◽  
Eugene Stautberg ◽  
David Spak ◽  
Gregory Schneider ◽  
Vinod Panchbhavi
Keyword(s):  
Hallux Valgus ◽  
Recurrence Rate ◽  
Lateral Displacement ◽  
Weight Bearing ◽  
Valgus Deformity ◽  
Observer Agreement ◽  
P Value ◽  
Great Toe ◽  
Hallux Valgus Deformity ◽  
Akin Osteotomy

Category: Bunion Introduction/Purpose: Recurrence of hallux valgus deformity is a common post-operative complication with rates in the literature ranging from 2.7 – 30%. Lateral displacement of the great toe medial sesamoid is correlated with a high recurrence rate, and failure to reduce sesamoid position has been implicated as a risk factor for recurrence due to an uncorrected deforming force. Sesamoid position has been studied in relation with Scarf osteotomy, but not other corrective osteotomies. The goal of this study is to determine the efficacy of the double chevron and Akin osteotomy in reducing the great toe medial sesamoid. Methods: We retrospectively reviewed all patients in the last five years undergoing hallux valgus correction via the double chevron and Akin osteotomy method with pre-operative and post-operative weight bearing radiographs. We measured sesamoid position pre and post-operatively using the Hardy-Clapham (HC) scale of I-VII with V or greater representing a laterally displaced medial sesamoid. We also measured hallux valgus and inter-metatarsal angles. Measurements were made by three authors in orthopedics and one in radiology. We used intra-class correlation coefficient (ICC) to determine inter-observer agreement and establish reliability. With adequate ICC, we could consider the lead author’s measurements as representative of the group. We examined the percent of hallux valgus cases with displaced sesamoids pre-operatively. Next, we determined how many of those cases did we reduce the sesamoids to grade IV or less. Finally, we performed subgroup analysis for pre-operative HC grades V, VI, and VII to determine correction percentage by severity. Results: There were 49 patients with 53 feet treated with the double chevron and Akin osteotomies for hallux valgus correction. Of these, 39 (73.6%) had significant preoperative lateral displacement of the medial sesamoid characterized by HC grade of V or greater. We corrected 30/39 (77.0%) to a reduced position of HC grade IV or less (p-value 0.048). In sub-analysis, we achieved reduction of the medial sesamoid position in 14/14 feet (100%) with HC grade V, 6/9 feet (66.7%) with HC grade VI, and 10/16 feet (62.5%) with HC grade VII (p-value 0.037). The ICC was 0.91 for pre-operative HC scores and 0.79 for post-operative HC scores. Average pre and post-operative HVA was 29.4° and 8.7°, respectively. Average pre and post-operative IMA was 13° and 5.2° respectively. Conclusion: Our study validates the double chevron and Akin osteotomies as effective in correcting sesamoid position. We achieved correction in 30/39 (77%) cases with initial sesamoid displacement. For mild cases of displacement with HC grade V, sesamoid correction was always achieved, and we were likely to achieve correction in the more severe cases of sesamoid displacement with HC grade VI or VII as well. The technique is also effective at reducing HVA and IMA. We had acceptable inter- observer agreement which supports the reliability of our methods. Future studies should examine recurrence rate following the double chevron and Akin osteotomies prospectively.

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

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002 ◽  
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.

scholarly journals Mucous Cyst at the Interphalangeal Joint of the First Toe Caused by Contact Pressure With the Second Toe due to Hallux Valgus

2018 ◽  
Vol 3 (3) ◽  
pp. 247301141877510
Author(s):  
Ichiro Tonogai ◽  
Yuhei Yamasaki ◽  
Toshihiko Nishisho ◽  
Koichi Sairyo
Keyword(s):  
Hallux Valgus ◽  
Contact Pressure ◽  
Weight Bearing ◽  
Valgus Deformity ◽  
Interphalangeal Joint ◽  
Lateral Aspect ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Mucous Cyst ◽  
Second Toe

A 77-year-old woman presented with a mucous cyst on the lateral aspect of the interphalangeal joint of the first toe caused by contact pressure with the second toe from hallux valgus. She complained of discomfort and discharge from the left first toe for approximately 4 months. Physical examination showed the second toe pressing strongly against the first toe due to hallux valgus and discharge from the skin on the lateral aspect of the interphalangeal joint of the first toe. Magnetic resonance imaging showed a cystic lesion at the same level. The patient underwent a modified scarf osteotomy of the first metatarsal for hallux valgus to resolve the contact pressure between the toes— considered the cause of the mucous cyst—and resection of mucous cyst. Forefoot weight bearing was allowed 6 weeks after surgery. As of 1 year after surgery, she has had no recurrence of the cyst. The score on the Japanese Society for Surgery of the Foot hallux metatarsophalangeal-interphalangeal scale improved from 59/100 points to 92/100. This outcome suggests that hallux valgus correction should be considered when a mucous cyst is associated with contact pressure due to a hallux valgus deformity. To the best of our knowledge, there are no previous reports of a mucous cyst caused by contact pressure between the first toe and second toe due to hallux valgus.

scholarly journals Radiographic Outcomes, Union Rates, and Complications Associated with Implants Positioned on the Plantar Bone Surface for Midfoot Arthrodesis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0021
Author(s):  
Tyler W. Fraser ◽  
Daniel Miles ◽  
Franklin B. Davis ◽  
Jesse F. Doty
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Deformity Correction ◽  
Valgus Deformity ◽  
Diabetic Patients ◽  
Bone Surface ◽  
Charcot Neuroarthropathy ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Metatarsal Angle

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Midfoot fusions have long been used to treat a variety of procedures in the foot. Indications may include hallux valgus correction, first ray instability, midfoot arthritis, pes planovalgus, trauma, and Charcot reconstruction. One of the drawbacks of this procedure is nonunion, which has been consistently reported between 5-10%. Placing implants and obtaining fixation along the plantar surface of the bone may create a tension band implant construct during physiologic loading that helps to compress the arthrodesis site and thereby may further optimize the healing potential. This study reports on the radiographic and clinical outcomes of plantar plating and arthrodesis of midfoot joints for a variety of procedures. Methods: A retrospective review was undertaken of consecutive patients between 2012-2019 that underwent a midfoot fusion with plantar positioned implants by a fellowship-trained foot and ankle orthopedic surgeon at a single institution. 62 patients underwent arthrodesis of the midfoot as part of a correction for hallux valgus, flatfoot deformity, midfoot arthritis, Lisfranc injury, Charcot correction or a combination these diagnoses. Average follow-up was 36.2 months (range, 16-66 months). For those treated for a flatfoot deformity, the lateral talus-first metatarsal (Meary’s) angle and medial arch sag angle (MASA) were compared on preoperative and postoperative imaging to obtain the magnitude of radiographic correction achieved. For those treated for hallux valgus deformity, the inter-metatarsal angle (IMA) was utilized to establish the magnitude of deformity correction. Serial weight-bearing radiographs were independently evaluated for malunion, nonunion, or hardware migration to be logged as complications at the arthrodesis site. Results: The 1st TMT joint was fused in 43 patients, and the NC joint was fused in 23 patients. Five patients had simultaneous fusion of the 1st TMT and NC joints. Two patients underwent arthrodesis of the talonavicular (TN) joint with one patient having simultaneous arthrodesis of the TN and NC joints. We found statistically significant improvement in the lateral talus-first metatarsal-angle (Meary’s) and medial arch sag angle (MASA) for those treated for flatfoot corrections. For those treated for hallux valgus, there was significant reduction in the Intermetatarsal angle (IMA) from 15.4 to 6.8 degrees. The overall nonunion rate was 6.45% in all patients. The nonunion rate was reduced to 3.3%when excluding the Charcot neuroarthropathy patients. There was one symptomatic nonunion requiring revision surgery (1.7%). Conclusion: Deformity correction was successfully maintained in those treated for hallux valgus and flatfoot deformities. There were significant improvements in the IMA, the MASA, and Meary’s angle Plates implanted on the plantar bone surface for midfoot arthrodesis provided and maintained deformity correction without hardware irritation for a variety of orthopedic conditions. A clinical and radiographic union rate of94% (97% when excluding Charcot neuroarthropathy patients) was achieved. The risk of nonunion appeared to be higher in diabetic patients, in smokers, with the utilization of claw plates, and when fusion constructs included the NC joint. [Table: see text]

Prospective, Randomized Comparison of Proximal Crescentic and Proximal Chevron Osteotomies for Correction of Hallux Valgus Deformity

1996 ◽  
Vol 17 (6) ◽  
pp. 307-316 ◽  
Author(s):  
Mark E. Easley ◽  
Gary M. Kiebzak ◽  
W. Hodges Davis ◽  
Robert B. Anderson
Keyword(s):  
Functional Outcome ◽  
Hallux Valgus ◽  
Valgus Deformity ◽  
Healing Time ◽  
First Metatarsal ◽  
Persistent Symptoms ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Severe Hallux Valgus

In this study, intermetatarsal angle (IMA) correction, functional outcome, and healing time for the proximal crescentic and proximal chevron osteotomies in moderate to severe hallux valgus deformity were prospectively compared. Seventy-five patients (97 feet) were prospectively randomized to either a proximal crescentic or proximal chevron osteotomy for the correction of moderate to severe hallux valgus deformity with associated metatarsus primus varus. Criteria for study entry included age (adult patients), IMA greater than or equal to 13°, persistent symptoms despite nonoperative treatment, and minimum follow-up of 12 months. Twenty-nine patients (41 feet) in the crescentic group and 37 patients (43 feet) in the chevron group returned for follow-up at an average of 24 and 20 months, respectively. Good results were achieved with both procedures. No statistically significant differences were found with respect to correction of the IMA or to functional outcome between the two groups. Results held true irrespective of patient age, severity of disease, or bilateral involvement. A statistically significant shorter healing time of the first metatarsal was found after proximal chevron osteotomy. Other potential benefits of the chevron procedure included avoidance of dorsiflexion of the first metatarsal, tendency toward less shortening of the first metatarsal, and more medial distribution of tibial sesamoids following surgery, all of which may reduce the potential for development or persistence of transfer lesions.

Correlation analysis of the x-ray and functional parameters from the results of chevron (Austin) osteotomy for hallux valgus

2020 ◽  
pp. 54-63
Author(s):  
Ruslan Khairutdinov ◽  
Timur Minasov ◽  
Ekaterina Yakupova ◽  
Elvina Mukhametzyanova
Keyword(s):  
Hallux Valgus ◽  
Rating Scale ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
First Metatarsophalangeal Joint ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
The Right ◽  
Bone Structures

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.

First Metatarsal Rotation in Hallux Valgus Deformity

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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