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

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.

Multicenter Early Radiographic Outcomes of Triplanar Tarsometatarsal Arthrodesis With Early Weightbearing

2019 ◽  
Vol 40 (8) ◽  
pp. 955-960 ◽  
Author(s):  
Justin J. Ray ◽  
Jennifer Koay ◽  
Paul D. Dayton ◽  
Daniel J. Hatch ◽  
Bret Smith ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Retrospective Case ◽  
Recurrence Rates ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Valgus Angle ◽  
First Ray ◽  
Akin Osteotomy

Background:Hallux valgus is a multiplanar deformity of the first ray. Traditional correction methods prioritize the transverse plane, a potential factor resulting in high recurrence rates. Triplanar first tarsometatarsal (TMT) arthrodesis uses a multiplanar approach to correct hallux valgus in all 3 anatomical planes at the apex of the deformity. The purpose of this study was to investigate early radiographic outcomes and complications of triplanar first TMT arthrodesis with early weightbearing.Methods:Radiographs and charts were retrospectively reviewed for 57 patients (62 feet) aged 39.7 ± 18.9 years undergoing triplanar first TMT arthrodesis at 4 institutions between 2015 and 2017. Patients were allowed early full weightbearing in a boot walker. Postoperative radiographs were compared with preoperative radiographs for hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position (TSP), and lateral round sign. Any complications were recorded.Results:Radiographic results demonstrated significant improvements in IMA (13.6 ± 2.7 degrees to 6.6 ± 1.9 degrees), HVA (24.2 ± 9.3 degrees to 9.7 ± 5.1 degrees), and TSP (5.0 ± 1.3 to 1.9 ± 0.9) from preoperative to final follow-up ( P < .001). Lateral round sign was present in 2 of 62 feet (3.2%) at final follow-up compared with 52 of 62 feet (83.9%) preoperatively. At final follow-up, recurrence was 3.2% (2/62 feet), and the symptomatic nonunion rate was 1.6% (1/62 feet). Two patients required hardware removal, and 2 patients required additional Akin osteotomy.Conclusion:Early radiographic outcomes of triplanar first TMT arthrodesis with early weightbearing were promising with low recurrence rates and maintenance of correction.Level of Evidence:Level IV, retrospective case series.

Effect of Akin Osteotomy on Hallux Valgus Correction After Scarf Osteotomy With Hallux Valgus Interphalangeus

2019 ◽  
Vol 40 (10) ◽  
pp. 1182-1188 ◽  
Author(s):  
Gerhard Kaufmann ◽  
Philipp Hofer ◽  
Matthias Braito ◽  
Reto Bale ◽  
David Putzer ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Level Of Evidence ◽  
Scarf Osteotomy ◽  
Loss Of Correction ◽  
Valgus Angle ◽  
Akin Osteotomy ◽  
Group A ◽  
Joint Congruity ◽  
Initial Correction

Background: Recurrence after hallux valgus correction is a relatively frequent occurrence. Little is known about the importance of initial correction on radiologic outcome. The objective of our study was to determine postoperative radiologic parameters correlating with loss of correction after scarf osteotomy and the combined scarf/akin osteotomy, respectively. Methods: Loss of correction was evaluated based on a group of 53 feet with isolated scarf osteotomy (S group) and a group of 17 feet with combined scarf and akin osteotomy (SA group) in a retrospective analysis. The intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), the proximal to distal phalangeal articular angle (PDPAA), the position of the sesamoids, and joint congruity were measured in weight-bearing radiographs preoperatively and postoperatively throughout a mean follow-up of 44.8 ± 23.6 months. Results: Loss of correction was comparable between the S and the SA group ( P > .05). In contrast, we found higher loss of HVA correction in the S subgroup with a preoperative PDPAA above 8 degrees ( P = .011), whereas loss of correction in the S subgroup below 8 degrees of PDPAA was comparable to the SA group. In the S group, loss of correction showed significant correlation with postoperative IMA ( P = .015) and PDPAA ( P = .008), whereas in the SA group a correlation could be detected for IMA only ( P = .045). Conclusion: In cases with a PDPAA above 8 degrees, we recommend a combined scarf/akin osteotomy to diminish the potential for loss of correction. Level of Evidence: Level III, therapeutic, retrospective comparative series.

scholarly journals Improvement of Valgus Deviation of the Lesser Toes of Moderate to Severe Hallux Valgus After Proximal Chevron Metatarsal Osteotomy and Akin Osteotomy

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0027
Author(s):  
Hong-Geun Jung ◽  
Hwa Jun Kang ◽  
Juan Agustin Coruna
Keyword(s):  
Hallux Valgus ◽  
Metatarsal Osteotomy ◽  
Metatarsal Angle ◽  
Valgus Angle ◽  
Significant Difference ◽  
Akin Osteotomy ◽  
The Mean ◽  
Severe Hallux Valgus ◽  
Mtp Joints

Category: Lesser Toes Introduction/Purpose: The valgus deviation of lesser toes is often found in the hallux valgus patients. It has been known that valgus deviation of lesser toes remain unchanged even after correction of hallux valgus. The purpose of this study was to determine whether valgus deviation of lesser toes can be corrected after proximal chevron metatarsal osteotomy (PCMO) and Akin osteotomy for the hallux valgus patients, and to evaluate the factors affecting the degree of correction. Methods: The study is based on 116 feet (89 patients) of moderate to severe hallux valgus that underwent proximal chevron metatarsal osteotomy with Akin ostetomy. Hallux valgus angle (HVA), inter-metatarsal angle (IMA), valgus angle of 2nd, 3 rd, 4th metatarso-phalangeal joint were assessed preoperatively and postoperative 6 month, 1 year and yearly. VAS pain cores, American Orthopedic Foot and Ankle Society metatarsophalangeal-interphalangeal (AOFAS MTP-IP) scale and patient satisfaction were evaluated preoperatively and at subsequent follow-up. Results: The average follow-up was 30.6 months (range,12-99). The mean HVA and IMA reduced from 34.4° to 8.7° and 15.9° to 5.3° respectively at the final follow-up. Patients with more severe HVA showed higher degree of valgus deviation of lesser toes than those with lesser HVA. The valgus angle of 2nd,3 rd,4th MTP joints reduced from 8.9°, 6.7°, 2.4° preoperatively to 5.6°, 4.9°, 1.3° respectively at the final follow-up (p<0.05). The more HVA corrected, the more valgus deviation of lesser toe was found corrected. There was no significant difference in the degree of lesser toe correction angle according to follow up period after postoperative 1 year. The mean VAS and AOFAS scores significantly improved from 6.0, 60.9 to 1.2, 92.0 at the final follow-up, respectively (P<0.05). Conclusion: Unlike the previous reports, the current study showed significant reduction of the valgus angle of 2nd, 3 rd, 4th MTP joints after PCMO and Akin osteotomy for the moderate to severe HV without additional corrective lesser toe surgery.

Effectiveness of Percutaneous Proximal Closing Wedge Osteotomy With Akin Osteotomy to Correct Severe Hallux Valgus Determined by Radiographic Parameters

2016 ◽  
Vol 10 (2) ◽  
pp. 170-179 ◽  
Author(s):  
Toshinori Kurashige ◽  
Seiichi Suzuki
Keyword(s):  
Hallux Valgus ◽  
Wedge Osteotomy ◽  
Metatarsal Osteotomy ◽  
Closing Wedge Osteotomy ◽  
First Metatarsal ◽  
Closing Wedge ◽  
Valgus Angle ◽  
Akin Osteotomy ◽  
Severe Hallux Valgus

Some authors reported the results from percutaneous distal metatarsal osteotomy for hallux valgus recently. On the other hand, there are few reports of percutaneous proximal metatarsal osteotomy. The purpose of the present study was to evaluate the radiographic results of percutaneous proximal closing wedge osteotomy with Akin osteotomy for correction of severe hallux valgus and increasing longitudinal arch height. Consecutive 17 feet (mean age = 70.8 years) were investigated. The mean follow-up was 22 months. Excision of medial eminence, distal soft tissue release, and Akin osteotomy were all performed percutaneously and concurrently. Weight-bearing anteroposterior and lateral radiographs of the feet were acquired preoperatively and at final follow-up. On the anteroposterior radiographs, hallux valgus angle, intermetatarsal angle, and first metatarsal shortening were measured. On the lateral radiographs, talometatarsal angle, calcaneal pitch angle, and first metatarsal dorsiflexion were measured. The average improvements in hallux valgus angle and intermetatarsal angle were 27.6° and 9.9°, respectively. The average first metatarsal shortening was 2.7 mm. The first metatarsal dorsiflexion improved by 2.2°; however, other parameters did not improve significantly. In conclusion, percutaneous proximal closing wedge osteotomy with Akin osteotomy corrects severe hallux valgus; however, the procedure does not increase the medial longitudinal arch. Levels of Evidence: Therapeutic, Level IV: Case series

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

2018 ◽  
Vol 39 (4) ◽  
pp. 463-470 ◽  
Author(s):  
Seung Yeol Lee ◽  
Chin Youb Chung ◽  
Moon Seok Park ◽  
Ki Hyuk Sung ◽  
Sonya Ahmed ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Binary Logistic Regression ◽  
Valgus Deformity ◽  
Binary Logistic Regression Analysis ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Metatarsal Angle ◽  
Radiographic Measurements

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.

scholarly journals Percutaneous Chevron Osteotomy Combined with Adductor Tendon Release for Hallux Valgus Correction

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0013
Author(s):  
Sofia Carlucci ◽  
Nelly Carrasco ◽  
Maria Santini-Araujo ◽  
Ana Parise ◽  
Leonardo Conti ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Deformity Correction ◽  
Hallux Valgus Angle ◽  
Chevron Osteotomy ◽  
Metatarsal Angle ◽  
Valgus Angle ◽  
Akin Osteotomy ◽  
American Orthopaedic

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: The use of minimally invasive techniques for hallux valgus may provide complete deformity correction with minor soft tissue damage, which reduces morbidity and shortens recovery. In this way, some open osteotomies were adapted to percutaneous approaches, with good outcomes reported. The minimally invasive chevron-Akin (MICA) described by Vernois and Redfern in 2011, combines benefits of percutaneous approaches with a stable internal fixation. Since 2015 we have adapted this technique, by adding a percutaneous adductor tenotomy to dispense with the Akin osteotomy. The aim of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a minimally invasive chevron osteotomy and a percutaneous adductor tendon release. Methods: This was a prospective cohort study. A total of 38 feet with moderate hallux valgus underwent the procedure and were followed up for a minimum 12 months (SD 1.10). The median age was 58 years (IQR 52 - 65), 36 women and 2 men. Radiological parameters were compared at preoperatory and at the last follow-up and included: Hallux Valgus Angle (HVA), Inter- Metatarsal Angle (IMA), Distal Metatarsal Articular Angle (DMAA) and first metatarsal shortening. Time to consolidation was also assessed. For clinical evaluation the American Orthopaedic Foot & Ankle Society score (AOFAS) was evaluated. Complications during the follow up were reported. Patients in which another procedure in the hallux was performed, with previous surgeries or not completed 1 year follow-up were excluded. Results: Radiologic postoperative parameters demonstrated to achieved correction. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and distal metatarsal articular angle. Shortening of the first metatarsus was a mean 7.02 mm (IQR 1.24 - 10,27). The mean AOFAS score increased from 58.23 (SD 9.02) pre-operatively to 97.15 (SD 4.72) post-operatively (p< 0.001). Complications reported were 2 superficial infections, 1 broken screw, 1 screw extraction. Five patients referred metatarsalgia after surgery and 1 presented a fourth metatarsal stress fracture. Only one patient presented lost of correction in the first postoperative week and needed a second surgery. Conclusion: Our series of hallux valgus correction with a minimally invasive chevron osteotomy combined with the adductor tendon release shows good clinical and radiological outcomes, and results are comparable to series with the additional Akin osteotomy. Comparative studies are needed for major evidence.

Use of a Geometric Formula to Improve the Radiographic Correction Achieved by the Scarf Osteotomy

2012 ◽  
Vol 33 (8) ◽  
pp. 647-654 ◽  
Author(s):  
David E. O'Briain ◽  
Robert Flavin ◽  
Stephen R. Kearns
Keyword(s):  
Hallux Valgus ◽  
Prospective Trial ◽  
Deformity Correction ◽  
Recurrence Rates ◽  
Level Of Evidence ◽  
Scarf Osteotomy ◽  
Procedure Selection ◽  
Metatarsal Angle ◽  
Valgus Angle ◽  
Geometric Formula

Background: Many procedures for hallux valgus treatment have high recurrence rates, often related to operative considerations such as accuracy of deformity correction, soft tissue balancing and sesamoid alignment. Inadequate distal metatarsal-articular angle (DMAA) correction is common with uni- and bi-planar osteotomies which principally address the inter-metatarsal angle (IMA). The scarf osteotomy is a tri-planar osteotomy which corrects the DMAA and IMA, thereby achieving a more anatomical correction and potentially reducing the recurrence rate. Our hypothesis was that by controlling the length and relative proximal and distal translations of the scarf with a geometric formula, more accurate correction of the IMA and DMAA is possible. Methods: A formula was generated to determine the specific adjustments required to correct the deformity. A prospective trial was performed to assess the accuracy of this formula. Thirty-four adult patients were enrolled in the study. Seventeen patients underwent a standard scarf procedure; 17 were operated on using the corrections prescribed by the formula. Results: Hallux valgus angle (HVA), IMA and DMAA corrections improved with the formula ( p = 0.036, p = 0.049, and p = 0.006, respectively). Patient and procedure selection has changed in our unit as a result of this study, which identified some preoperative deformities as beyond the capabilities of the scarf procedure. Conclusion: The formula allows precise, reproducible, anatomical correction of IMA and DMAA deformities. The degree of correction attainable with the scarf is dependent on the first metatarsal width and the preoperative deformities. The formula highlighted the limitations of the scarf, thereby aiding in appropriate patient and procedure selection. Level of Evidence: II, Prospective Comparative Series

Results of Scarf Osteotomy Without Implant Fixation in the Treatment of Hallux Valgus

2018 ◽  
Vol 39 (11) ◽  
pp. 1320-1327 ◽  
Author(s):  
Henryk Liszka ◽  
Artur Gądek
Keyword(s):  
Hallux Valgus ◽  
Cost Effective ◽  
Implant Fixation ◽  
Level Of Evidence ◽  
Scarf Osteotomy ◽  
Valgus Angle ◽  
Duration Of Surgery ◽  
American Orthopaedic ◽  
Retrospective Comparative Study

Background: The main goal of the study was to evaluate the costs, clinical and radiologic results, and complications of hallux valgus surgery using scarf osteotomy, depending on the type of fixation (with or without screws). Methods: We evaluated 169 patients who underwent scarf osteotomy between January 2013 and August 2016. The patients were separated into 3 groups depending on the type of stabilization: A, 2 screws (50 patients); B, modified with 1 screw (55 patients); C, modified without implant (64 patients). We assessed duration of surgery, additional procedures, pre- and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA) on anteroposterior and lateral foot weightbearing radiographs, the American Orthopaedic Foot & Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale for the clinical assessment preoperatively and at the 12-month follow-up. We recorded all the complications and compared the costs between the groups. Results: Both the average HVA (A: from 33.7 to 12.6 degrees, B: 35.0 to 13.2 degrees, C: 34.7 to 12.4 degrees) and IMA (A: from 14.9 to 7.5 degrees, B: 15.2 to 6.9 degrees, C: 15.5 to 7.8 degrees) decreased in all groups without significant intergroup differences. The average AOFAS score improved in all the groups (A: from 40 to 88 points, B: 38 to 89 points, C: 42 to 91 points). A similar complication rate was observed (A: 9%, B: 10%, C: 11%). In group C, we noted a shorter time of surgery, and the procedure was the most cost-effective. Conclusion: Scarf osteotomy without implant stabilization was faster and cost-effective and gave comparable results. It was technically demanding and required patient compliance. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Percutaneous surgical treatment of hallux valgus

2020 ◽  
Vol 14 (3) ◽  
pp. 278-284
Author(s):  
Luiz Lara ◽  
Lúcio Torres Filho ◽  
Gabriel Cervone ◽  
Rafael Viana ◽  
Glaucia Bordignon ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Metatarsal Bone ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Valgus Angle ◽  
Angle Correction ◽  
Age At Surgery ◽  
American Orthopaedic

Objective: To analyze outcomes of hallux valgus surgical correction using the Reverdin-Isham technique by means of clinical and radiographic studies. Methods: We retrospectively assessed 43 feet (38 patients) with moderate to severe hallux valgus treated from June 2009 to July 2014. Mean age at surgery was 59 years; mean postoperative follow-up time was 79 months. Patients were assessed at pre- and postoperative periods both functionally, by the American Orthopaedic Foot and Ankle Society (AOFAS) score, and radiographically, by the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), and shortening of 1st metatarsal bone. Results: AOFAS scores had a mean increase of 55 points. Mean HVA decreased 14.5°, whereas IMA and DMAA exhibited a mean decrease of 3.8° and 9.7°, respectively. Mean shortening of the first metatarsal bone was 3mm. Conclusion: The presented surgical technique showed to be effective to correct mild to moderate hallux valgus, resulting in appropriate angle correction angular and significant increase in AOFAS scores. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals First-Tarsometatarsal Joint Alignment After First-Metatarsophalangeal Joint Arthrodesis for Hallux Valgus

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110085
Author(s):  
Christopher Traynor ◽  
James Jastifer
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Medial Cuneiform ◽  
Radiographic Alignment

Background: Instability of the first-tarsometatarsal (TMT) joint has been proposed as a cause of hallux valgus. Although there is literature demonstrating how first-TMT arthrodesis affects hallux valgus, there is little published on how correction of hallux valgus affects the first-TMT joint alignment. The purpose of this study was to determine if correction of hallux valgus impacts the first-TMT alignment and congruency. Improvement in alignment would provide evidence that hallux valgus contributes to first-TMT instability. Our hypothesis was that correcting hallux valgus angle (HVA) would have no effect on the first-TMT alignment and congruency. Methods: Radiographs of patients who underwent first-MTP joint arthrodesis for hallux valgus were retrospectively reviewed. The HVA, 1-2 intermetatarsal angle (IMA), first metatarsal–medial cuneiform angle (1MCA), medial cuneiform–first metatarsal angle (MC1A), relative cuneiform slope (RCS), and distal medial cuneiform angle (DMCA) were measured and recorded for all patients preoperatively and postoperatively. Results: Of the 76 feet that met inclusion criteria, radiographic improvements were noted in HVA (23.6 degrees, P < .0001), 1-2 IMA (6.2 degrees, P < .0001), 1MCA (6.4 degrees, P < .0001), MC1A (6.5 degrees, P < .0001), and RCS (3.3 degrees, P = .001) comparing preoperative and postoperative radiographs. There was no difference noted with DMCA measurements (0.5 degrees, P = .53). Conclusion: Our findings indicate that the radiographic alignment and subluxation of the first-TMT joint will reduce with isolated treatment of the first-MTP joint. Evidence suggests that change in the HVA can affect radiographic alignment and subluxation of the first-TMT joint. Level of Evidence: Level IV, retrospective case series.

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