Clinical and Radiographic Outcomes of Percutaneous Chevron-Akin Osteotomies for the Correction of Hallux Valgus Deformity

2021 ◽  
pp. 107110072110312
Author(s):  
Christopher M. Mikhail ◽  
Jonathan Markowitz ◽  
Luca Di Lenarda ◽  
Javier Guzman ◽  
Ettore Vulcano
Keyword(s):  
Hallux Valgus ◽  
Breakthrough Pain ◽  
Good Method ◽  
Valgus Deformity ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Hallux Valgus Deformity ◽  
Large Patient ◽  
Valgus Angle ◽  
The Mean

Background: Hallux valgus is a common cause of pain and dysfunction of the foot, sometimes requiring surgical correction when conservative measures fail. Although there are many methods of correction, one of the newer techniques is minimally invasive chevron-Akin (MICA). The aim of the current study is to evaluate clinical and radiographic effectiveness of MICA and narcotic use in a large patient cohort. Methods: All patients in this retrospective study were treated by a single fellowship-trained foot and ankle orthopedic surgeon. Patient demographics were collected for all cases. Preoperative and postoperative intermetatarsal angle (IMA) and hallux valgus angle (HVA) were measured in all patients on weightbearing 3-views radiographs. The Foot Function Index (FFI) was obtained pre- and postoperatively at each visit. All patients were prescribed regular use of ibuprofen for 3 days with acetaminophen and oxycodone reserved for breakthrough pain. Use of narcotic pain medication was recorded. Results: A total of 274 feet in 248 patients were included in the study. Overall, 87.9% were female and 12.1% were male. The mean preoperative IMA and HVA were 13.4 and 29.1 degrees, respectively. The postoperative IMA and HVA were 4.9 and 8.9 degrees, respectively. The mean FFI score part A was 92 preoperatively and 43 postoperatively. Patient satisfaction was 91.6%. The mean postoperative 5 mg oxycodone pill consumption was 2.2. Conclusion: MICA is good method to correct hallux valgus deformity with low postoperative narcotic use. Level of Evidence: Level III, this is a restrospective cohort study of a single surgeon practice.

scholarly journals Proximal Rotational Metatarsal Osteotomy for Hallux Valgus (PROMO)

2018 ◽  
Vol 3 (3) ◽  
pp. 247301141879007 ◽  
Author(s):  
Pablo Wagner ◽  
Emilio Wagner
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Valgus Deformity ◽  
Metatarsal Osteotomy ◽  
Level Of Evidence ◽  
Reliable Technique ◽  
Intermetatarsal Angle ◽  
Hallux Valgus Deformity ◽  
The Mean ◽  
Prospective Case Series

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

scholarly journals First Tarsometatarsal Joint Derotational Arthrodesis for Flexible Hallux Valgus: Results from Follow-Up of 3–8 Years

2017 ◽  
Vol 106 (4) ◽  
pp. 325-331 ◽  
Author(s):  
T. Klemola ◽  
O. Savola ◽  
P. Ohtonen ◽  
R. Ojala ◽  
J. Leppilahti
Keyword(s):  
Confidence Interval ◽  
Hallux Valgus ◽  
Valgus Deformity ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Tarsometatarsal Joint ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
The Mean

Purpose: We report 3- to 8-year follow-up results for the first tarsometatarsal joint derotational arthrodesis. Methods: A total of 70 patients (88 feet) with symptomatic flexible hallux valgus were operated between 2003 and 2009. In all, 66 patients (94.3%) with 84 (95.5%) feet were enrolled in retrospective analysis; of those, 58 (87.9%) patients with 76 (90.5%) feet were followed for a mean of 5.1 (range: 3.0–8.3) years. Preoperative, 6 week postoperative, and late follow-up weightbearing radiographs were evaluated along with clinical examination and questionnaires. Results: The mean hallux valgus angle improved 13.4° (95% confidence interval: 11.6–15.1, p < .001) at the latest follow-up, while the mean intermetatarsal angle correction was 4.5° (95% confidence interval: 3.7–5.2, p < .001). There were three (4.0%) nonunions, and seven (9.2%) feet needed reoperation during follow-up. Conclusion: First tarsometatarsal joint derotational arthrodesis is an effective procedure for correcting flexible hallux valgus deformity and provides a satisfactory long-term outcome.

Hallux Valgus: Demographics, Etiology, and Radiographic Assessment

2007 ◽  
Vol 28 (7) ◽  
pp. 759-777 ◽  
Author(s):  
Michael J. Coughlin ◽  
Caroll P. Jones
Keyword(s):  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
First Ray ◽  
The Mean ◽  
Severe Hallux Valgus

Background The purpose of the study was to preoperatively evaluate the demographics, etiology, and radiographic findings associated with moderate and severe hallux valgus deformities in adult patients (over 20 years of age) treated operatively over a 33-month period in a single surgeon's practice. Methods Patients treated for a hallux valgus deformity between September, 1999, and May, 2002, were identified. Patients who had mild deformities (hallux valgus angle < 20 degrees), concurrent degenerative arthritis of the first metatarsophalangeal joint, inflammatory arthritis, recurrent deformities, or congruent deformities were excluded. When enrolled, all patients filled out a standardized questionnaire and had a routine examination that included standard radiographs, range of motion testing, and first ray mobility measurement. A chart review and evaluation of preoperative radiographs were completed on all eligible patients. Results One-hundred and three of 108 (96%) patients (122 feet) with a diagnosis of moderate or severe hallux valgus (hallux valgus angle of 20 degrees or more) 70 qualified for the study. The onset of the hallux valgus deformity peaked during the third decade although the distribution of occurrence was almost equal from the second through fifth decades. Twenty-eight of 122 feet (23%) developed a deformity at an age of 20 years or younger. Eighty-six (83%) of patients had a positive family history for hallux valgus deformities and 87 (84%) patients had bilateral bunions. 15% of patients in the present series had moderate or severe pes planus based on a positive Harris mat study. Only 11% (14 feet) had evidence of an Achilles or gastrocnemius tendon contracture. Radiographic analysis found that 86 of 122 feet (71%) had an oval or curved metatarsophalangeal joint. Thirty-nine feet (32%) had moderate or severe metatarsus adductus. A long first metatarsal was common in patients with hallux valgus (110 of 122 feet; 71%); the mean increased length of the first metatarsal when compared to the second was 2.4 mm. While uncommon, the incidence of an os intermetatarsum was 7% and a proximal first metatarsal facet was 7%. The mean preoperative first ray mobility as measured with Klaue's device was 7.2 mm. 16 of 22 (13%) feet were observed to have increased first ray mobility before surgery. Conclusions The magnitude of the hallux valgus deformity was not associated with Achilles or gastrocnemius tendon tightness, increased first ray mobility, bilaterality or pes planus. Neither the magnitude of the preoperative angular deformity nor increasing age had any association with the magnitude of the first metatarsophalangeal joint range of motion. Constricting shoes and occupation were implicated by 35 (34%) patients as a cause of the bunions. A familial history of bunions, bilateral involvement, female gender, a long first metatarsal, and an oval or curved metatarsophalangeal joint articular surface were common findings. Increased first ray mobility and plantar gapping of the first metatarsocuneiform joint were more common in patients with hallux valgus than in the general population (when compared with historical controls).

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.

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

2021 ◽  
Vol 6 (3) ◽  
pp. 247301142110271
Author(s):  
Tyler W. Fraser ◽  
Daniel T. Miles ◽  
Neal Huang ◽  
Franklin B. Davis ◽  
Burton D. Dunlap ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Skin Irritation ◽  
Case Series ◽  
Deformity Correction ◽  
Valgus Deformity ◽  
Union Rate ◽  
Radiographic Outcomes ◽  
Hallux Valgus Deformity ◽  
Metatarsal Angle ◽  
Radiographic Union

Background: Midfoot arthrodesis has long been successfully included in the treatment paradigm for a variety of pathologic foot conditions. A concern with midfoot arthrodesis is the rate of nonunion, which historically has been reported between 5% and 10%. Plantar plating has also been noted to be more biomechanically stable when compared to traditional dorsal plating in previous studies. Practical advantages of plantar plating include less dorsal skin irritation and the ability to correct flatfoot deformity from the same medial incision. The purpose of this study is to report the arthrodesis rate, the success of deformity correction, and the complications associated with plantar-based implant placement for arthrodesis of the medial column. Methods: A retrospective review was undertaken of all consecutive patients between 2012 and 2019 that underwent midfoot arthrodesis with plantar-positioned implants. Radiographic outcomes and complications are reported on 62 patients who underwent midfoot arthrodesis as part of a correction for hallux valgus deformity, flatfoot deformity, degenerative arthritis, Lisfranc injury, or Charcot neuroarthropathy correction. Results: Statistically significant improvement was seen in the lateral talus–first metatarsal angle (Meary angle) and medial arch sag angle for patients treated for flatfoot deformity correction. In patients treated for hallux valgus deformity, there was a reduction in the intermetatarsal angle from 15.4 to 6.8 degrees. The overall nonunion rate was 6.45% in all patients. The rate of nonunion was higher at the NC joint compared to the TMT joint and with compression claw plates. One symptomatic nonunion required revision surgery (1.7%). There were no nonunions when excluding neuroarthropathy patients and smokers. The odds ratio (OR) for nonunion in patients with neuroarthropathy was 6.05 ( P < .05), and in active smokers the OR was 2.33 ( P < .05). Conclusion: Plates placed on the plantar bone surface for midfoot arthrodesis achieved and maintained deformity correction with rare instances of symptomatic hardware for a variety of orthopedic conditions. An overall clinical and radiographic union rate of 94% was achieved. The radiographic union rate improved to 100% when excluding both neuroarthropathy patients and smokers. The incidence of nonunion was higher in smokers, neuroarthropathy patients, naviculocuneiform joint fusions, use of compression claw plates, and when attempting to fuse multiple joints. Incisional healing complications were rarely seen other than in active smokers. Level of Evidence: Level IV, case series.

Effect of Hallux Valgus Correction with Kinesiology Taping on Hindfoot Position. Pilot Study

2021 ◽  
Vol 23 (4) ◽  
pp. 295-303
Author(s):  
Tobiasz Żłobiński ◽  
Anna Stolecka-Warzecha ◽  
Magdalena Hartman-Petrycka ◽  
Barbara Błońska-Fajfrowska
Keyword(s):  
Pilot Study ◽  
Hallux Valgus ◽  
Valgus Deformity ◽  
Loading Pattern ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
Position Correction ◽  
Foot Loading ◽  
Study Participants ◽  
Foot Position

Background. Hallux valgus is the most common deformity of the forefoot. It has a multifactorial aetiology, with hindfoot valgus considered one of its causes. The aim of this study was to evaluate hindfoot position and loading pattern after a treatment of Kinesiology Taping (KT) for the mechanical correction of hallux valgus. Material and methods. The study involved 25 feet with hallux valgus deformity and hindfoot valgus. The hallux valgus angle (HVA) and hindfoot angle were assessed with a 3D scanner. Hindfoot loading pattern was examined with a baropodometric platform while standing and during gait. Measurements were taken on the following three occasions: before and immediately after KT placement as well as after a month of taping. Results. The KT treatment had a significant influence on the hindfoot angle (p<0.001) and HVA (p<0.001) measured while standing and on lateral heel loading in dynamic conditions during gait (p<0.01). Conclusions. 1. KT decreased HVA and improved hindfoot position while standing in the pilot study participants. 2. KT exerted a corrective influence on the foot loading pattern in patients with hallux valgus and hindfoot pronation. 3. The foot position correction and normalisation of foot loading achieved in the pilot study provide a basis for further research on KT effectiveness in patients with hallux valgus and hindfoot pronation.

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.

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.

Biplanar Chevron Osteotomy

2002 ◽  
Vol 23 (9) ◽  
pp. 792-798 ◽  
Author(s):  
Caio Nery ◽  
Rui Barroco ◽  
Cibele Réssio
Keyword(s):  
Hallux Valgus ◽  
Valgus Deformity ◽  
Average Score ◽  
Intermetatarsal Angle ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
Radiological Data ◽  
End Of Treatment

Results of biplanar chevron osteotomy performed on patients with mild-to-moderate hallux valgus deformity with an increased distal metatarsal articular angle (DMAA) are shown. The study included clinical data of 32 patients (54 feet) who had completed a 2-year follow-up, and radiological data of these 32 and other 29 patients (50 feet) for a total of 61 patients (104 feet, 53 right and 51 left). There were 59 females and two males with ages varying from 11 to 66 years. According to the AOFAS Hallux Rating, the preoperative average score (50) improved to 90 (average score after the surgery). The hallux valgus angle was improved from an average of 25° to 14°, the first intermetatarsal angle from 12° to 8° and the DMAA from 15° to 5°. At the end of treatment, 94% of patients were classified as having grade 0 or I sesamoid lateral sub-luxation. Given improvement in angles and 90% of patients satisfied with an average AOFAS postoperative score of 90, the technique seems indicated for treatment of symptomatic hallux valgus deformity with increased DMAA.

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