Radiographic Measurements Associated With the Natural Progression of the Hallux Valgus During at Least 2 Years of Follow-up

Background: This study aimed to investigate the radiographic measurements associated with the progression of hallux valgus during at least 2 years of follow-up. Methods: Seventy adult patients with hallux valgus who were followed for at least 2 years and underwent weightbearing 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. Patients were divided into progressive and nonprogressive groups. Binary logistic regression analysis was performed to identify factors that significantly affected the progression of hallux valgus deformity. The correlation between change in HVA and changes in other radiographic indices during follow-up was analyzed. Results: The DMAA ( P = .027) and AP talo–first metatarsal angle ( P = .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 = .001) and DMAA ( r = 0.541; P < .001). Conclusion: The change in the HVA was found to be significantly correlated with changes in the IMA and DMAA. A future study is required to elucidate whether this correlation can be explained by the progressive instability of the first tarsometatarsal joint. We believe special attention needs to be paid to patients with pes planus and increased DMAA. Level of Evidence: Level III, comparative study.

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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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Dynamic First Tarsometatarsal Instability During Gait Evaluated by Pedobarographic Examination in Patients with Hallux Valgus

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00304 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0030

Author(s):

Byung Jo Min ◽

Seungbum Koo ◽

Won-keun Park ◽

Ki-bum Kwon ◽

Kyoung Min Lee

Keyword(s):

Hallux Valgus ◽

Joint Instability ◽

Weight Bearing ◽

Binary Logistic Regression ◽

Valgus Deformity ◽

Binary Logistic Regression Analysis ◽

Tarsometatarsal Joint ◽

Hallux Valgus Deformity ◽

Metatarsal Angle ◽

Radiographic Measurements

Category: Midfoot/Forefoot Introduction/Purpose: This study aimed to investigate the pedobarographic characteristics of tarsometatarsal instability and to identify factors associated with pedobarographic first tarsometatarsal instability in patients with hallux valgus deformity. Methods: Fifty-seven patients (mean age, 59.7 years; standard deviation, 11.4 years; 6 men and 51 women) with a hallux valgus angle (HVA) greater than 15° were included. All patients underwent a pedobarographic examination along with weight-bearing anteroposterior (AP) and lateral foot radiography. Radiographic measurements were compared between the two groups with and without pedobarographic first tarsometatarsal instability. The association between the radiographic and pedobarographic parameters of the first tarsometatarsal instability was analyzed using the chi-square test. Binary logistic regression analysis was performed to identify significant factors affecting pedobarographic first tarsometatarsal instability. Results: HVA (p<0.001), the intermetatarsal angle (p=0.001), and AP talo-first metatarsal angle were significantly different between the pedobarographically stable and unstable tarsometatarsal groups. There was no significant association between radiographic and pedobarographic instabilities of the first tarsometatarsal joint (p=0.924). HVA was found to be the only significant factor affecting pedobarographic tarsometatarsal joint instability (p=0.001). Conclusion: The pedobarographic examination has possible clinical utility in evaluating first tarsometatarsal joint instability in patients with hallux valgus deformity. Patients with greater HVA need to be carefully monitored for the presence of first tarsometatarsal instability, and the necessity of the Lapidus procedure should be considered.

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Dynamic First Tarsometatarsal Instability During Gait Evaluated by Pedobarographic Examination in Patients With Hallux Valgus

Foot & Ankle International ◽

10.1177/1071100719850802 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1104-1109 ◽

Cited By ~ 3

Author(s):

Byung Cho Min ◽

Chin Youb Chung ◽

Moon Seok Park ◽

Young Choi ◽

Seungbum Koo ◽

...

Keyword(s):

Hallux Valgus ◽

Joint Instability ◽

Binary Logistic Regression ◽

Binary Logistic Regression Analysis ◽

Chi Square ◽

Level Of Evidence ◽

Factors Affecting ◽

Tarsometatarsal Joint ◽

Metatarsal Angle ◽

Radiographic Measurements

Background:This study aimed to investigate the pedobarographic characteristics of tarsometatarsal instability and to identify factors associated with pedobarographic first tarsometatarsal instability in patients with hallux valgus.Methods:Fifty-seven patients (mean age, 59.7 years; standard deviation, 11.4 years; 6 men and 51 women) with a hallux valgus angle (HVA) greater than 15 degrees were included. All patients underwent a pedobarographic examination along with weightbearing anteroposterior (AP) and lateral foot radiography. Radiographic measurements were compared between the 2 groups with and without pedobarographic first tarsometatarsal instability. The association between the radiographic and pedobarographic parameters of the first tarsometatarsal instability was analyzed using the chi-square test. Binary logistic regression analysis was performed to identify significant factors affecting pedobarographic first tarsometatarsal instability.Results:The HVA ( P < .001), intermetatarsal angle ( P = .001), and AP talo-first metatarsal angle were significantly different between the pedobarographically stable and unstable tarsometatarsal groups. There was no significant association between radiographic and pedobarographic instability of the first tarsometatarsal joint ( P = .924). The HVA was found to be the only significant factor affecting pedobarographic tarsometatarsal joint instability ( P = .001).Conclusion:The pedobarographic examination has possible clinical utility in evaluating first tarsometatarsal joint instability in patients with hallux valgus. Patients with a greater HVA should be assessed for the presence of first tarsometatarsal instability, and the necessity of the Lapidus procedure should be considered.Level of Evidence:Level III, comparative study.

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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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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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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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Extended Distal Chevron Osteotomy

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000229 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002 ◽

Cited By ~ 1

Author(s):

Chan Kang ◽

Jaehwang Song ◽

Donghun Kang ◽

Chang-Kyun Noh ◽

Ahn Ki Jun

Keyword(s):

Hallux Valgus ◽

Valgus Deformity ◽

Plantar Surface ◽

Chevron Osteotomy ◽

Hallux Valgus Deformity ◽

Radiographic Measurements ◽

Valgus Angle ◽

Group A ◽

Group B

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Numerous corrective osteotomies have been performed for surgical treatment of hallux valgus(HV). One of these procedures is distal chevron osteotomy, traditionally indicated for correction of mild to moderate HV. We proposed a new modification of the chevron osteotomy, extended distal chevron osteotomy, to provide even greater stability by extend the contact surface, as well as more effective and accurate correction of the angulation and rotational profile than conventional osteotomy. Methods: Between July 2013 and June 2014, the extended distal chevron osteotomy (DCO) was performed for the treatment of mild-to-moderate hallux valgus deformity in 63 feet (Group A) by the same surgeon. For the extended chevron, the first osteotomy was performed to cut 5-10 mm from the head of metatarsal to the proximal upper 1/3 of the neck. The second osteotomy was performed to cut 2.5~3.0 cm from the upper 1/3 of the neck toward horizontal plane of the plantar surface with an angle of 45~50 degree. Standard foot radiographic measurements, hallux valgus angle(HVA) and intermetatarsal angle(IMA), were recorded to compare with the values of 37 patients (Group B) who were treated by the traditional DCO technique. Results: Mean patient age was 45.3 (range 15–78) years, and 54 patients were available for follow-up at both one and two years postoperatively. Mean follow-up duration was 13.7 (range 4–26) months. In group A, mean HVA decreased from 32.3° preoperatively to 8.4° at final follow-up, while the angle of group B decreased from 32.4° to 11.4°. Mean IMA decreased from 15.1° preoperatively to 7.3° at final follow-up in group A, while the IMA decreased from 15.1° to 8.9° in group B. That way we could verify that the extended chevron osteotomy is more effective for stability and correcting of the angulation and rotational profile than traditional DCO. Conclusion: The extended chevron osteotomy achieved even greater stability and accurate correction of the deformity. Furthermore, it was more effective than traditional chevron osteotomy in terms of correction of the angulation and rotational profile.

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Treatment of Hallux Valgus by Oblique Osteotomy of the First Metatarsal

Foot & Ankle ◽

10.1177/107110079201300803 ◽

1992 ◽

Vol 13 (8) ◽

pp. 447-452 ◽

Cited By ~ 8

Author(s):

Kosaku Mizuno ◽

Masataka Hashimura ◽

Mayako Kimura ◽

Kazushi Hirohata

Keyword(s):

Hallux Valgus ◽

Metatarsophalangeal Joint ◽

Valgus Deformity ◽

X Rays ◽

Great Toe ◽

First Metatarsal ◽

Oblique Osteotomy ◽

Hallux Valgus Deformity ◽

Valgus Angle

This paper describes a simple technique of oblique osteotomy of the first metatarsal for treatment of symptomatic hallux valgus deformity. The osteotomy is performed at a 30° angle from the long axis of the metatarsal shaft. The head of the metatarsal is then displaced laterally to provide correction of the hallux valgus. This is an uncomplicated procedure for the treatment of hallux valgus. From 1984 through 1989, 53 feet in 31 patients were treated with an oblique osteotomy of the first metatarsal. A total of 49 feet in 27 patients were followed up more than 2 years. The follow-up x-rays and clinical examinations revealed a good result in 43 feet. In six feet of three patients, all of whom had simultaneous oblique osteotomies of both the first and second metatarsals, a fair or poor result was obtained. It was learned that oblique osteotomy for hallux valgus greater than 40° provided insufficient correction of the valgus angle or limitation of motion at the metatarsophalangeal joint of the great toe.

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A New Minimally Invasive Surgery of Hallux Valgus: Technique and Preliminary Outcomes

10.21203/rs.3.rs-54804/v1 ◽

2020 ◽

Author(s):

Changjun Guo ◽

Xingchen Li ◽

Chunguang Li ◽

Yang Xu ◽

Ming Cai ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Hallux Valgus ◽

Invasive Surgery ◽

Valgus Deformity ◽

Safe Procedure ◽

First Metatarsal ◽

Hallux Valgus Deformity ◽

Valgus Angle

Abstract PurposeThis study aimed to present a new minimally invasive surgery (MIS) technique and evaluate the safety and efficacy for correction of hallux valgus deformity at a preliminary follow-up.Methods48 consecutive feet that underwent a new MIS of hallux valgus with a mean 17.6 months follow-up (range 9 to 28 months). This technique uses a new osteotomy of the first metatarsal with screw fixation and percutaneous Weil osteotomy of lesser metatarsal without fixation. All patients were clinically evaluated using the Manchester-Oxford Foot Questionnaire (MOXFQ), American Orthopedic Foot & Ankle Society Hallux Metatarsophalangeal-Interphalangeal score (AOFAS HMI) and visual analogue scale (VAS). Radiographic measures included hallux valgus angle (HVA), intermetatarsal angle (IMA) and the length of the first metatarsal. ResultsThere was significant improvement in the radiographic parameters(P<0.001). The IMA decreased from 13.3° to 9.8°, the HVA improved from 35.9° to 17.9° and the mean MT length decreased by 4 mm. There was significant improvement of VAS in the postoperative 2 weeks (P < .001). There were significant improvements in the MOXFQ scores and AOFAS HMI scores, respectively. The total rate of complication was 10.4%.ConclusionThe preliminary radiographic and clinical outcomes of this new minimally invasive surgery show that it is a safe procedure and had significantly less pain in the first 2 weeks following surgery.

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Factors influencing medial sesamoid arthritis in patients with hallux valgus deformity

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00192 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0019

Author(s):

Jun Young Choi ◽

Jin Soo Suh ◽

Dong Joo Lee

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Hallux Valgus ◽

Logistic Regression Analysis ◽

Binary Logistic Regression ◽

Valgus Deformity ◽

Binary Logistic Regression Analysis ◽

Sesamoid Bone ◽

Hallux Valgus Deformity ◽

Arthritic Changes

Category: Midfoot/Forefoot Introduction/Purpose: The importance of preoperative evaluation of the position and degree of arthritic changes of the medial sesamoid bone before hallux valgus correction is emerging. This is an observational study to evaluate the magnetic resonance imaging (MRI) findings of hallux valgus deformity, and assess the severity of and identify the factors that influence the arthritic changes in medial sesamoid-metatarsal (mSM) joints. Methods: We reviewed weight-bearing anteroposterior radiographs, forefoot axial radiographs and MR images of 514 feet of 405 patients who underwent hallux valgus correction. On MRI, the degrees of the arthritic changes in the first metatarsophalangeal (MTP) and mSM joints were categorized into 5 classes. Binary logistic regression analysis was performed to identify the factors affecting the arthritic changes. Results: The binary logistic regression analysis showed that advanced age, more lateralized position of medial sesamoid bone on forefoot axial radiograph, and higher MRI grade of arthritic change of the 1st MTP joint were significant factors contributing to medial sesamoid arthritis (P <0.001, 0.001. 0.006, respectively). Conclusion: Medial sesamoid arthritis can be assessed using MRI. The position of medial sesamoid bone on forefoot axial radiographs can strongly help predict the possibility of mSM joint arthritis.

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