Weightbearing Computed Tomography and 3-Dimensional Analysis of Mobility Changes of the First Ray After Proximal Oblique Osteotomy for Hallux Valgus

2020 ◽  
pp. 107110072096247
Author(s):  
Tadashi Kimura ◽  
Makoto Kubota ◽  
Naoki Suzuki ◽  
Asaki Hattori ◽  
Mitsuru Saito
Keyword(s):  
Computed Tomography ◽  
Hallux Valgus ◽  
Metatarsal Osteotomy ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
Oblique Osteotomy ◽  
Valgus Angle ◽  
Significant Difference ◽  
Before And After ◽  
First Ray

Background: Hypermobility of the first ray has been evaluated using various methods and has conventionally been considered to be involved in the pathology of hallux valgus. We hypothesized that hypermobility of the first ray in hallux valgus could be decreased by simply correcting foot alignment without arthrodesis. This study sought to evaluate first-ray mobility using weightbearing computed tomography (CT) before and after proximal oblique osteotomy and also in healthy volunteer’s feet. Methods: Subjects were 11 feet of 11 patients with primary hallux valgus who underwent surgery with a plantarly applied anatomic precontoured locking plate and 22 feet of 11 matched healthy volunteers. We performed nonweightbearing and weightbearing (using a load equivalent to body weight) CT scans using an original loading device preoperatively and 1-1.5 years postoperatively. Three-dimensional displacement of the distal bone relative to the proximal bone was quantified for each joint of the first ray by comparing nonweightbearing and weightbearing CT images. Results: At baseline, there were significant differences in hallux valgus angle ( P < .001) and 1-2 intermetatarsal angle ( P < .001) between healthy volunteer’s feet and preoperative hallux valgus feet. Hallux valgus angle ( P < .001) and 1-2 intermetatarsal angle ( P < .001) differed significantly between before and after surgery. All first ray joint displacement under loading decreased postoperatively to within 2° of that in healthy volunteer’s feet and showed no significant difference between postoperatively hallux valgus feet and healthy volunteer’s feet ( P > .05). Conclusions: We found that first metatarsal osteotomy even without arthrodesis corrected deformity and decreased mobility of the first ray after hallux valgus surgery. Level of Evidence: Level III, case-control study.

scholarly journals Rotational Distal Chevron Osteotomy for Correction of Hallux Valgus Associated with Metatarsus Adductus and Large Distal Metatarsal Articular Angle

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0023
Author(s):  
Jae-Jung Jeong
Keyword(s):  
Hallux Valgus ◽  
Metatarsal Head ◽  
Metatarsal Osteotomy ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Chevron Osteotomy ◽  
Valgus Angle ◽  
Before And After ◽  
Metatarsus Adductus

Category: Bunion Introduction/Purpose: Hallux valgus treatment in the setting of associated metatarsus adductus is less common and not well described. The presence of metatarsus adductus reduces the gap between the first and second metatarsals. Consequently, it complicates the measurement of the first-second intermetatarsal angle and can limit the area available for transposition of the first metatarsal head. If distal metatarsal articular angle (DMAA) is also increased here, it is difficult to correct. We investigated the effects of rotational distal chevron metatarsal osteotomy (DCMO) on hallux valgus associated with metatarsus adductus and increased DMAA. Methods: Twelve patients, (12 female, 15 feet), of average age 59 (SD 23) with symptomatic hallux valgus associated with metatarsus adductus and increased DMAA underwent a rotation DCMO and were reviewed at an average of 12 months postoperatively. Clinically preoperative and postoperative AOFAS hallux MP-IP scale and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, the 1st intermetatarsal angle, DMAA before and after the operation was analyzed. Results: Distal Chevron osteotomy was done in 15 cases. After DCMO, The distal fragment was translated to laterally as far as possible and rotated to reduce DMAA. Clinically AOFAS scale was increased from 65.3 points preoperatively to 92.2 points postoperatively. Two patients were not satisfied with the results. Radiologically hallux valgus angle was decreased from 21.8° preoperatively to 8.5° postoperatively. The first intermetatarsal angle was decreased from 11.8° preoperatively to 6.7° postoperatively. DMAA was decreased from 15.8° preoperatively to 5.5° postoperatively. Conclusion: The rotational DCMO was an effective procedure for correcting hallux valgus associated with metatarsus adductus and increased DMAA. It allowed good realignment of the first MTP joint without the need for lesser metatarsal surgery to reduce the metatarsus adductus.

Effects of insole with toe-separator and night splint on patients with painful hallux valgus: A comparative study

2008 ◽  
Vol 32 (1) ◽  
pp. 79-83 ◽  
Author(s):  
Ali Tehraninasr ◽  
Hassan Saeedi ◽  
Bijan Forogh ◽  
Mahmood Bahramizadeh ◽  
Mohammad Reza Keyhani
Keyword(s):  
Pain Intensity ◽  
Hallux Valgus ◽  
Valgus Deformity ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
Significant Difference ◽  
Before And After ◽  
Night Splint

The objective of this study was to compare the effects of wearing an insole with toe separator and night splint on hallux valgus and intermetatarsal angles and also on the intensity of pain in patients suffering from painful hallux valgus deformity. Subjects in this study consisted of 30 female patients aged 19 – 45 years (mean 27.83 ± 8.91) who were divided into two groups. The first group received the insole and toe separator and the second group received night splint. Hallux valgus angle and intermetatarsal angle were radiographically measured before and after a 3-month study period. Foot pain intensity was assessed by 10 cm Visual Analogue Scale before and after intervention. After statistical analysis the reduction of pain was significant in the first group ( p < 0.05) whereas in the second group no significant difference was obtained. The hallux valgus angle and intermetatarsal angle decreased in both groups; however, the reduction was not significant. According to the results of this study, using night splint seems to have no effect on painful hallux valgus deformity. On the other hand, although the insole with toe separator significantly decreased the pain intensity in these patients and was a good option for pain reduction, it was not effective in improvement of the great toe angles.

scholarly journals Radiographic Recurrence of Hallux Valgus Based on Osteotomy Location

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0021
Author(s):  
Andrew Federer ◽  
Travis Dekker ◽  
David Tainter ◽  
Jordan Liles ◽  
Mark Easley ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Surgical Correction ◽  
P Value ◽  
Single Individual ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
Valgus Angle ◽  
Significant Difference

Category: Bunion Introduction/Purpose: Hallux valgus (HV) is one of the most common deformities of the foot resulting in pain and lifestyle modification of the patient. Recurrence rates of 10-47% have been documented in single individual osteotomy series. Unfortunately, surgical correction and recurrence are often defined as changes related to normal radiographs and not actually as the magnitude of correction lost with follow-up. Currently there have not been studies evaluating the percentage of recurrence of intermetatarsal angle (IMA) and hallux valgus angle (HVA). As there is substantial difference in starting IMA and HVA, as well as amount of surgical correction, our goal was to evaluate the percentage loss of correction over time comparing preoperative, initial postoperative and minimum of 2-year follow up radiographs among three different surgical correction techniques. Methods: This is a retrospective chart review study that examines the weight-bearing radiographic measurements of patients undergoing hallux valgus corrective surgery at a single institution over 5 years. Fifty-three patients were divided into first tarsometatarsal arthrodesis (i.e. Lapidus), mid-diaphyseal osteotomies (i.e. scarf), and distal metatarsal osteotomies (i.e. chevron). The preoperative, initial postoperative, and final follow up weight-bearing radiographs were measured for intermetatarsal angle (IMA) and hallux valgus angle (HVA). Primary outcome was percentage of recurrence of IMA and HVA, with the difference in angles between preoperative and initial postoperative weight-bearing films being considered 100% correction. The percentage of recurrence between initial postoperative and most recent follow up was then calculated (Figure 1A). A one-way analysis of variance (ANOVA) test and post-hoc Tukey-Kramer tests were used to compare preoperative IMA and HVA and percentage recurrence of IMA and HVA at most recent follow up. Results: There was no significant difference between Lapidus (14.3deg) and mid-diaphyseal osteotomies (12.7deg) in preoperative IMA (p-value=0.26). There was a significant difference between Lapidus (-0.3deg) and mid-diaphyseal (2.8deg) osteotomies for degree of hallux valgus recurrence as measured by IMA between initial postoperative films and final 2-year follow up (p-value=0.009). Lapidus procedure showed a greater magnitude decrease in IMA degrees from preoperation to final follow up compared to distal osteotomy (p-value=0.037) and trended toward significance compared to mid-diaphyseal (p-value=0.056). Mid-diaphyseal osteotomies (30%) showed a statistically significant higher percentage of IMA recurrence compared to Lapidus (-11%) (p-value=0.0014) (Figure 1B). When comparing percentage recurrence of HVA, distal osteotomies had a significantly smaller rate of recurrence when compared to the diaphyseal osteotomies (p-value=0.030). Conclusion: Though Lapidus and mid-diaphyseal osteotomies were performed for patients with a similar preoperative IMA, mid-diaphyseal osteotomies had a significantly higher percentage of recurrence at 2-year follow up compared to Lapidus procedures. Moreover, Lapidus procedures trended toward greater overall of IMA correction compared to mid-diaphyseal osteotomies. When either a Lapidus or mid-diaphyseal osteotomy is indicated, a Lapidus procedure may result in decreased rate of radiographic recurrence of hallux valgus at 2 years.

scholarly journals Hallux valgus correction using Scarf-Osteotomy leads to shortening of the first metatarsal

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0032
Author(s):  
Christopher Lenz ◽  
Paul Borbas
Keyword(s):  
Hallux Valgus ◽  
Consecutive Series ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Valgus Angle ◽  
Correction Technique ◽  
Second Metatarsal ◽  
First Ray ◽  
Akin Osteotomy

Category: Bunion Introduction/Purpose: In hallux valgus deformity less weight can be borne by the first ray which may lead to transfer metatarsalgia and lesser toe deformities. Depending on the exact configuration of the bone cuts during the scarf procedure, an iatrogenic shortening of the first metatarsal may occur which may diminish weightbearing ability of the first ray as well, causing transfer metatarsalgia. The aim of the present study was therefore to determine preoperative and postoperative changes in length of the first metatarsal by using different methods of measuring metatarsal length. Methods: A consecutive series of 118 feet in 106 patients (89% female, 11% male) was enrolled, who underwent correctional osteotomy (Scarf-with/without Akin-Osteotomy) from May 2015 to July 2017 at a single institution. Patients, who underwent additional shortening osteotomy of the metatarsals, were excluded. Average age at the time of surgery was 51 years (range, 14 to 83 years). Pre- and postoperative angle measurement of hallux valgus- and intermetatarsal angle was assessed at between six weeks and three months postoperatively on standardized weight-bearing radiographs in dorsoplantar plane. We also identified early complications in hallux valgus surgery. An assessment and comparison of different methods of measuring metatarsal length (length of first metatarsal, ratio first to second metatarsal, Coughlin method) postoperatively was performed to identify the amount of shortening with this technique. Results: Hallux valgus angle was statistically significant reduced by an average of 18.6° (28.3° preoperatively to 9.7° postoperatively, p < 0.001), intermetatarsal angle by 7.7° (12.8° to 5.1°, p < 0.001). Measuring the length of the first metatarsal, in all three methods a statistically significant reduction of the first metatarsal length could be detected. Mean absolute shortening of 1.8 mm was measured (p < 0.001). The ratio of the first metatarsal to the second metatarsal averaged -0.03 (p = 0.02). The mean relative lengthening of the second metatarsal, using the method described by Coughlin, was 0.42 mm (from 4.51 to 4.89 mm, p < 0.001) on average. Of those three methods, the Coughlin method showed the highest correlation. 6 minor complications were observed (5%). Conclusion: In the current study we could demonstrate a significant reduction of hallux valgus angle and intermetatarsal angle with hallux valgus correction using Scarf-/Akin-Osteotomy, with a low complication rate. However, statistically significant shortening of the first metatarsal could be detected as well. Further research is required to improve and establish a hallux valgus correction technique without shortening of the first metatarsal.

Hallux Valgus Correction with Proximal Metatarsal Osteotomy: Two-year Follow-up

Foot & Ankle ◽  
1992 ◽  
Vol 13 (6) ◽  
pp. 321-326 ◽  
Author(s):  
David B. Thordarson ◽  
Edward O. Leventen
Keyword(s):  
Hallux Valgus ◽  
Metatarsal Osteotomy ◽  
Hallux Valgus Angle ◽  
Foot Surgery ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Valgus Angle ◽  
Distal Metatarsal Osteotomy ◽  
Proximal Metatarsal Osteotomy

We evaluated the results of 33 feet in 23 patients who underwent a basilar crescentic osteotomy with a modified McBride procedure with a minimum 24-month follow-up. The average hallux valgus improved from 37.5° to 13.8° and the intermetatarsal 1–2 angle from 14.9° to 4.7°. The angle of declination of the first metatarsal was found to have dorsiflexed an average of 6.2°. Unfortunately, osteotomies secured with staples dorsiflexed to a greater degree. Bilateral foot surgery produced results similar to those with unilateral procedures. Four of our patients developed a hallux varus (range 2–8°); however, none were dissatisfied at the time of evaluation. Although this bunion procedure resulted in more prolonged swelling and pain than a distal osteotomy, it should be considered for more complex deformities to avoid the failure that a distal metatarsal osteotomy might produce given a high 1–2 intermetatarsal angle or a high hallux valgus angle.

Modified Lapidus Procedure for Hallux Valgus

Foot & Ankle ◽  
1989 ◽  
Vol 9 (6) ◽  
pp. 262-266 ◽  
Author(s):  
Bruce J. Sangeorzan ◽  
Sigvard T. Hansen
Keyword(s):  
Bone Graft ◽  
Hallux Valgus ◽  
Medical Center ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Valgus Angle ◽  
First Ray ◽  
Without Bone Graft

A modified Lapidus procedure was introduced at Harborview Medical Center in 1979 for the treatment of symptomatic hallux valgus with hypermobile first ray. The results of the procedures were reviewed retrospectively in 32 patients with 40 feet that were operated on between 1979 and 1984. Preoperative diagnosis was symptomatic hallux valgus complex with hypermobile first ray in 33 and failed bunion surgery in 7. Follow-up ranged from 30 months to 6 1/2 years. Union of the arthrodesis site occurred in 36 (90%). The average preoperative intrametatarsal angle was 14° (range 7.5 to 20°) and the hallux valgus angle was 26° (range 0 to 50°). At healing, the angles were as follows: intermetatarsal angle 6° (range 0 to 18°) and hallux valgus angle 11° (range −3 to 30°). The average change in the length of the first metatarsal was −5 mm for those without bone graft and +4 mm for those with bone graft. Of 33 feet operated on as a primary procedure, successful results were reported in 75% by our rating system. Of 7 feet operated on for failed previous surgery, all were improved. Best results were obtained in those with multiple screw fixation, use of bone graft, and attention to plantarflexion of the first metatarsal.

Adding Stability to the Crescentic Basilar First Metatarsal Osteotomy

2004 ◽  
Vol 94 (5) ◽  
pp. 502-504 ◽  
Author(s):  
Brian Carpenter ◽  
Travis Motley
Keyword(s):  
Hallux Valgus ◽  
Bone Healing ◽  
Sagittal Plane ◽  
Metatarsal Osteotomy ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Valgus Angle ◽  
Made In

Crescentic basilar osteotomies for metatarsus primus varus and hallux valgus allow for substantial correction of the first intermetatarsal angle and the hallux valgus angle. Crescentic osteotomies have two well-documented pitfalls: sagittal plane instability and difficulty in fixation. We describe the addition of a plantar shelf to crescentic basilar osteotomy that allows for easier fixation and less risk of elevation of the first metatarsal postoperatively. This plantar shelf is made in the metaphyseal portion of the first metatarsal, which provides the benefit of better bone healing. In 20 patients, we found an average reduction in the intermetatarsal angle of 9.3° and an average reduction in the hallux valgus angle of 21.8°. Eight weeks postoperatively, only one patient showed elevation of the first metatarsal. (J Am Podiatr Med Assoc 94(5): 502–504, 2004)

Comparison of Intercuneiform 1-2 Joint Mobility Between Hallux Valgus and Normal Feet Using Weightbearing Computed Tomography and 3-Dimensional Analysis

2017 ◽  
Vol 39 (3) ◽  
pp. 355-360 ◽  
Author(s):  
Tadashi Kimura ◽  
Makoto Kubota ◽  
Naoki Suzuki ◽  
Asaki Hattori ◽  
Keishi Marumo
Keyword(s):  
Computed Tomography ◽  
Hallux Valgus ◽  
Lower Limbs ◽  
3D Analysis ◽  
Hallux Valgus Angle ◽  
Level Of Evidence ◽  
Intermetatarsal Angle ◽  
3 Dimensional ◽  
Valgus Angle ◽  
Medial Cuneiform

Background: An association has been reported between hallux valgus and hypermobility of the first ray, but subluxation of the intercuneiform 1-2 joint was also suspected in some cases. However, dynamics of the intercuneiform 1-2 joint has seldom been investigated. This study used weightbearing computed tomography (CT) and a 3-dimensional (3D) analysis system to evaluate displacement of the intercuneiform 1-2 joint, intercuneiform 2-3 joint, and second cuneonavicular joint due to weightbearing in hallux valgus and normal feet. Methods: Patients were 11 women with hallux valgus (mean age, 56 years; mean hallux valgus angle, 43 degrees; mean first-second intermetatarsal angle, 22 degrees) and 11 women with normal feet (mean age, 57 years; mean hallux valgus angle, 14 degrees; mean first-second intermetatarsal angle, 9 degrees). Each patient was placed supine with the lower limbs extended, and CT was performed under nonweightbearing and weightbearing conditions (load equivalent to body weight). 3D models reconstructed from CT images were used to compare displacement of the intermediate cuneiform relative to the medial cuneiform under nonweightbearing and weightbearing conditions. Results: Relative to the medial cuneiform, the middle cuneiform was displaced by 0.1 and 0.8 degrees due to dorsiflexion, 0.2 and 1.0 degrees due to inversion, and 0.7 and 0.7 degrees due to abduction in normal feet and feet with hallux valgus, respectively, with the latter having significantly greater dorsiflexion ( P = .0067) and inversion ( P = .0019). There was no significant intergroup difference at the intercuneiform 2-3 joint and second cuneonavicular joint. Conclusion: This study clarified the detailed load-induced displacement of the cuneiform 3-dimensionally. Compared with normal feet, hallux valgus feet had significantly greater mobility of the intercuneiform 1-2 joint, suggesting hypermobility of this joint. Level of Evidence: Level III, case-control study.

Modified Austin Procedure for Correction of Hallux Valgus

1997 ◽  
Vol 18 (3) ◽  
pp. 119-127 ◽  
Author(s):  
Hans-Jörg Trnka ◽  
Alexander Zembsch ◽  
Hermann Wiesauer ◽  
Marc Hungerford ◽  
Martin Salzer ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Hallux Valgus Angle ◽  
First Metatarsophalangeal Joint ◽  
Intermetatarsal Angle ◽  
Soft Tissue Procedure ◽  
Valgus Angle

The Austin osteotomy is a widely accepted method for correction of mild and moderate hallux valgus. In view of publications by Kitaoka et al. in 1991 and by Mann and colleagues, a more radical lateral soft tissue procedure was added to the originally described procedure. From September 1992 to January 1994, 85 patients underwent an Austin osteotomy combined with a lateral soft tissue procedure to correct their hallux valgus deformities. Seventy-nine patients (94 feet) were available for follow-up. The average patient age at the time of the operation was 47.1 years, and the average follow-up was 16.2 months. The average preoperative intermetatarsal angle was 13.9°, and the average hallux valgus angle was 29.7°. After surgery, the feet were corrected to an average intermetatarsal angle of 5.8° and an average hallux valgus angle of 11.9°. Sesamoid position was corrected from 2.1 before surgery to 0.5 after surgery. The results were also graded according to the Hallux Metatarsophalangeal Interphalangeal Score, and the functional and cosmetic outcomes were graded by the patient. Dissection of the plantar transverse ligament and release of the lateral capsule repositioned the tibial sesamoid and restored the biomechanics around the first metatarsophalangeal joint. There was no increased incidence of avascular necrosis of the first metatarsal head compared with the original technique.

scholarly journals Natural Progression of Radiographic Indices in Juvenile Hallux Valgus Deformity

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0031
Author(s):  
Seung Yeol Lee ◽  
Soon-Sun Kwon ◽  
Moon Seok Park ◽  
Kyoung Min Lee
Keyword(s):  
Hallux Valgus ◽  
Older Patients ◽  
Valgus Deformity ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
Younger Patients ◽  
Hallux Valgus Deformity ◽  
Metatarsal Angle ◽  
Valgus Angle ◽  
Metatarsus Adductus

Category: Bunion Introduction/Purpose: There is a lack of quantitative studies on the progression of juvenile hallux valgus deformity. Therefore, we performed this study to estimate an annual change of radiographic indices for juvenile hallux valgus. Methods: We reviewed medical records of consecutive patients under the age of 15 with juvenile hallux valgus who underwent weight-bearing foot radiographs more than twice, and were followed over a period of one year or more. A total of 133 feet from 69 patients were included. Hallux valgus angle, hallux interphalangeal angle, intermetatarsal angle, metatarsus adductus angle, distal metatarsal articular angle, anteroposterior talo-1st metatarsal angle, anteroposterior talo-2nd metatarsal angle, and lateral talo-1st metatarsal angle were measured and were used as a study criteria. The progression rate of hallux valgus angle was adjusted by multiple factors including the use of a linear mixed model with gender and radiographic measurements as the fixed effects and laterality and each subject as the random effect. Results: Our results demonstrate that the value of hallux valgus angle on the radiographs progressed as the patients grew older. The hallux valgus angle increased by 0.8° per year (p<0.001)(Figure). The distal metatarsal articular angle also increased by 0.8 per year (p=0.003). Conversely, hallux interphalangeal angle decreased by 0.2° per year (p=0.019). Progression of the intermetatarsal angle and metatarsus adductus angle with aging were not statistically significant. There was a difference in progression of radiographic indices between older patients (≥10 years) and younger patients (<10 years). The hallux valgus angle increased by 1.5° per year (p<0.001) in younger patients, progression of the hallux valgus angle in older patients was not statistically significant (p=0.869) as children grew up. Conclusion: These results suggest that the hallux valgus angle increased in patients with juvenile hallux valgus under 10 years old, unlike the patients aged 10 or older. We believed that our results can help surgeons to determine a treatment strategy that uses the growth potential to achieve correction of deformity such as lateral hemiepiphyseodesis of the 1st metatarsal to patients with juvenile hallux valgus.

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