Interdigital vs Transarticular Lateral Release With Scarf Osteotomy

2021 ◽  
pp. 107110072110353
Author(s):  
Florian Hartenbach ◽  
Brigitta Höger ◽  
Karl-Heinz Kristen ◽  
Hans-Jörg Trnka
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Rating Scale ◽  
Lateral Release ◽  
Soft Tissue Release ◽  
Foot And Ankle ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Scarf Osteotomy ◽  
Radiographic Outcomes

Background: We compare the clinical and radiographic outcomes of the interdigital approach vs the medial transarticular approach for lateral release combined with scarf osteotomy. Methods: Seventy-seven feet with moderate to severe hallux valgus underwent scarf osteotomy and lateral soft tissue release, using an interdigital approach (n = 36) vs medial transarticular approach (n = 41). The clinical measurements (range of motion, American Orthopaedic Foot and Ankle Society [AOFAS] score) and radiographic data were evaluated preoperatively and at final follow-up (93-124 months postoperatively). Additionally, the numeric pain rating scale and Foot and Ankle Outcome score [FAOS] were assessed postoperatively. Results: The AOFAS score improved from 60 (q1 = 54, q3 = 70) to 93 (q1 = 85, q3 = 98) in the transarticular group, and from 59 (q1 = 50, q3 = 64) to 95 (q1 = 85, q3 = 100) in the interdigital group. The hallux valgus angle improved from 35.7±6.5 degrees to 15.5±7.6 degrees in the transarticular group, and from 36.0±6.8 degrees to 12.9±13.0 degrees in the interdigital group. The intermetatarsal angle improved from 16.5±2.5 degrees to 6.5±2.7 degrees within the transarticular group and from 17.2±2.5 degrees to 7.3±4.3 degrees in the interdigital group. None of the clinical or radiographic parameters showed any significant differences between the treatment groups. Conclusion: Comparison of outcomes between the interdigital approach and the transarticular approach for lateral soft-tissue release with scarf osteotomy are equally successful. The transarticular approach can thus be considered safe and effective, with the additional benefits of just one scar as opposed to 2. Level of Evidence: Level III, therapeutic.

Surgical Treatment of Mild to Severe Hallux Valgus Deformities With a Percutaneous Subcapital Osteotomy Combined With a Lateral Soft Tissue Procedure

2018 ◽  
Vol 12 (2) ◽  
pp. 138-145 ◽  
Author(s):  
Mauro Maniglio ◽  
Paolo Fornaciari ◽  
Henrik Bäcker ◽  
Emanuel Gautier ◽  
Marc Lottenbach
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Complication Rate ◽  
Lateral Release ◽  
Soft Tissue Release ◽  
Aofas Score ◽  
Radiological Parameters ◽  
Soft Tissue Procedure ◽  
Significant Correction

Distal metatarsal (MT) osteotomies have been used in mild or moderate cases of hallux valgus (HV) and proximal MT osteotomy has been considered the treatment of choice for severe deformities. A distal osteotomy could achieve a greater degree of correction by the addition of a distal soft-tissue procedure and be used to treat also severe deformity. Limited evidence about the use of the percutaneous subcapital osteotomy (SCOT); a type of MT osteotomy, in combination of a soft tissue procedure, is available. We evaluated this procedure routinely used in our clinic. A total of 30 consecutive patients treated in our hospital from September 2012 to April 2015 with SCOT combined with lateral soft tissue release were included in this retrospective review. Outcomes assessed included radiological parameters: HV angle (HVA) and intermetatarsal angle (IMA), clinical evaluation using the American Orthopaedic Foot and Ankle Society (AOFAS) score, and complication rate. In 12 of the 30 patients included, the pathology was bilateral, comprising a total of 42 cases. The overall correction of the angles was statistically significant (P < .001), changing from a HVA of 28.2° and IMA of 13.5° preoperatively to 8.0° and 6.0° postoperatively, respectively. The cases were divided into mild-moderate (34/42) and severe (8/42). Both groups showed a statistically significant correction in the angles, 3 months after surgery (P < .001). The AOFAS score showed a median of 49 points (n = 24) preoperatively and of 95 points (n = 40) at the end of follow-up. The complication rate at end of follow-up was 19% (8/42). After a minimum follow-up of 1 year, our technique for HV correction results in a clinically relevant improvement of the radiological parameters and AOFAS score in mild to severe deformities. Combination with lateral release could be a meaningful surgical alternative for the treatment of severe cases to help decrease the risk of recurrence. Levels of Evidence: Level IV

Outcomes of Proximal Chevron Osteotomy for Moderate versus Severe Hallux Valgus Deformities

2012 ◽  
Vol 33 (8) ◽  
pp. 637-643 ◽  
Author(s):  
Jae-Young Moon ◽  
Keun-Bae Lee ◽  
Jong Keun Seon ◽  
Eun-Sun Moon ◽  
Sung-Taek Jung
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Soft Tissue Procedure ◽  
Chevron Osteotomy ◽  
Group A ◽  
Group B ◽  
Severe Hallux Valgus

Background: Proximal chevron osteotomy with a distal soft tissue procedure has been widely used to treat moderate to severe hallux valgus deformities. However, there have been no studies comparing the results of proximal chevron osteotomy between patients with moderate and severe hallux valgus. We compared the results of this procedure among these groups. Methods: A retrospective review of 95 patients (108 feet) that underwent proximal chevron osteotomy and distal soft tissue procedure for moderate and severe hallux valgus was conducted. The 108 feet were divided into two groups: moderate hallux valgus (Group A) and severe hallux valgus (Group B). Group A was composed of 57 feet (52 patients) and Group B of 51 feet (43 patients). Average followup was 45 months. Results: Mean American Orthopedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal scores were 54.1 points in Group A and 53.0 points in Group B preoperatively, and these improved to 90.8 and 92.6, respectively, at the last followup. Mean hallux valgus angles in Groups A and B reduced from 32.3 and 40.8 degrees, preoperatively to 10.7 and 13.2 degrees, postoperatively. Similarly, mean first intermetatarsal angles in Groups A and B reduced from 15.0 and 19.2 degrees, preoperatively to 9.0 and 9.2 degrees, postoperatively. Conclusion: The clinical and radiographic outcomes of proximal chevron osteotomy with a distal soft tissue procedure were found to be comparable for moderate and severe hallux valgus. Accordingly, our results suggest that this procedure provides an effective and reliable means of correcting hallux valgus regardless of severity of deformity. Level of Evidence: III, Retrospective Comparative Series

scholarly journals The Role of Lateral Soft Tissue Release for the Treatment of Hallux Valgus with Distal Chevron Osteotomy

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0051
Author(s):  
Zhijian Wang ◽  
Tao Zhong
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Metatarsal Head ◽  
Soft Tissue Release ◽  
Aofas Score ◽  
Chevron Osteotomy ◽  
Valgus Angle ◽  
Group A ◽  
Group B

Category: Bunion Introduction/Purpose: To define the effect of distal chevron osteotomy with and without lateral soft tissue release for the correction of mild and moderate hallux valgus. Methods: 24 consecutive patients were enrolled in this prospective study. In Group A, 12 patients underwent a chevron osteotomy only. In Group B, 12 patients underwent a chevron osteotomy with lateral soft tissue release. The hallux valgus angle (HVA) and intermetatarsalangle (IMA), and AOFAS score were measured preoperatively, and 6-month follow up postoperatively and complications were evaluated. Results and complications were evaluated. Results: The change in HVA, IMA and AOFAS score were insignificant (p > 0.05) between Group A and Group B. Complications of digital neuritis and cosmetically dissatisfied scarring of the dorsal web space were seen only in Group B. No cases had avascular necrosis of the metatarsal head, malunion or nonunion. Conclusion: Lateral soft tissue release may not be needed for mild or moderate hallux valgus deformities which may prevent neuritis of dorsal or plantar lateral digital nerve and cosmetic dissatisfaction of adorsal scar.

Effect of Bipartite Hallucal Sesamoid on Hallux Valgus Surgery

2017 ◽  
Vol 38 (6) ◽  
pp. 634-640 ◽  
Author(s):  
Young Hwan Park ◽  
Chan Dong Jeong ◽  
Gi Won Choi ◽  
Hak Jun Kim
Keyword(s):  
Hallux Valgus ◽  
Study Cohort ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Chevron Osteotomy ◽  
Radiographic Measurements ◽  
Valgus Angle ◽  
Retrospective Comparative Study

Background: Bipartite hallucal sesamoids are often found in patients with hallux valgus. However, it is unknown whether bipartite hallucal sesamoids affect the results of hallux valgus surgery or not. The purpose of the present study was to evaluate the outcomes of chevron osteotomy for hallux valgus with and without bipartite hallucal sesamoid. Methods: A total of 152 patients (168 feet) treated with distal or proximal chevron osteotomy for hallux valgus constituted the study cohort. The 168 feet were divided into 2 groups: bipartite hallucal sesamoid (31 feet) and without bipartite hallucal sesamoid (137 feet). Hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), tibial sesamoid position, and first metatarsal length were measured for radiographic outcomes and the American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal (MTP-IP) score was measured for clinical outcomes. Results: All radiographic measurements and the AOFAS score showed significant ( P < .05) improvement at the time of final follow-up compared with preoperative measurements in both groups. No significant differences ( P > .05) were found between the 2 groups in terms of HVA, IMA, DMAA, tibial sesamoid position, metatarsal shortening, and AOFAS score on final follow-up. Conclusions: This study suggests that bipartite hallucal sesamoids do not affect the results of hallux valgus surgery. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Modified Scarf osteotomy for hallux valgus deformity in rheumatoid arthritis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0049
Author(s):  
Hideki Tsuboi ◽  
Makoto Hirao ◽  
Takaaki Noguchi ◽  
Jun Hashimoto
Keyword(s):  
Rheumatoid Arthritis ◽  
Hallux Valgus ◽  
Joint Destruction ◽  
Significant Negative Correlation ◽  
Foot And Ankle ◽  
Scarf Osteotomy ◽  
Radiographic Outcomes ◽  
Hallux Valgus Deformity ◽  
Scale Scores

Category: Midfoot/Forefoot Introduction/Purpose: For severe hallux valgus (HV) deformity in rheumatoid arthritis (RA) cases, arthrodesis of the 1st metatarsophalangeal (MTP) joint has been recommended. However, with the progress of medical treatment of RA, joint preservation surgery has recently been performed. This study aimed to investigate the clinical and radiographic outcomes of modified Scarf osteotomy with medial capsule interposition for RA cases, including severe 1st MTP joint destruction, and to evaluate risk factors for recurrence. Methods: A retrospective observational study of 76 cases (60 patients) [mean follow-up period: 35.3 months (24-56 months)] that underwent the modified Scarf osteotomy was performed. Japanese Society for Surgery of the Foot (JSSF) RA foot ankle scale scores, hallux scale scores, and a self-administered foot evaluation questionnaire (SAFE-Q) were evaluated, along with preoperative and postoperative radiographic parameters. Results: The mean JSSF RA foot and ankle and hallux score improved significantly (RA: preoperative: 52.2, final follow-up: 76.9, hallux: preoperative: 38.2, final follow-up: 74.5). Recurrence (hallux valgus angle (HVA) >20°) occurred in 12 feet (15.8%). Preoperative DAS28-CRP (Disease activity score evaluated on 28 joints-C-reactive protein), intermetatarsal angle between the first and second metatarsal bone (M1M2A), and M1M5A, as well as HVA, M1M2A, M1M5A, and Hardy grade at 3 months after surgery, were significantly greater in the recurrence group. There was a significant negative correlation between preoperative DAS28-CRP and JSSF RA foot and ankle scores at final follow-up (ß = -0.39: p=0.02), while there was a significantly positive correlation between preoperative DAS28-CRP and HVA at the final follow-up (ß = 0.44: p=0.001). Conclusion: The modified Scarf osteotomy with medial capsule interposition for HV deformity improved clinical and radiographic outcomes in RA cases with severe 1st MTP joint destruction. Increased preoperative M1M2A and M1M5A, incomplete reduction of the sesamoid bone, HVA, M1M2A, and M1M5A at 3 months after surgery should be kept in mind for recurrence. The preoperative DAS28-CRP score was associated with clinical and radiographic outcomes after surgery.

Intraoperative Incidence of Hallux Valgus Interphalangeus following Basilar First Metatarsal Osteotomy and Distal Soft Tissue Realignment

2011 ◽  
Vol 32 (11) ◽  
pp. 1058-1062 ◽  
Author(s):  
Jae-Yong Park ◽  
Hong-Geun Jung ◽  
Tae-Hoon Kim ◽  
Min-Seok Kang
Keyword(s):  
Soft Tissue ◽  
Pain Score ◽  
Hallux Valgus ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Osteotomy ◽  
Aofas Score ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Akin Osteotomy

Background: The premise of this study was that after the correction of hallux-metatarsophalangeal pronation, the intraoperative interphalangeal angle (HIA) increases significantly, and that an additional Akin osteotomy (AO) is often needed. Therefore, the purpose of this study was to evaluate whether HIAs in hallux valgus (HV) feet were underestimated, and to assess the need for AO during HV correction. Method: This study was conducted on 54 feet with moderate to severe HV treated from June 2007 to December 2008. HIAs and medial sesamoid subluxations (MSS) were measured initially and intraoperatively after a distal soft tissue procedure (DSTP) and proximal chevron metatarsal osteotomy (PCMO). An intraoperative technique was used to evaluate the incongruency of the metatarsophalangeal joint (MTPJ) to determine the need for additional Akin osteotomy. Results: After performing DSTP and PCMO, HIAs significantly increased from an average of 9 to 13.3 degrees and MSS reduced from average grade 2.5 to 0.5 ( p < 0.05). Akin ostetomy was added in 44 (81%) feet. After an average followup of 13.2 months in Akin group, average VAS pain score decreased from 5.7 to 1.2 and average AOFAS score increased from 57.8 to 90.2 ( p < 0.05). Final hallux MTPJ dorsiflexion in the Akin group was significantly larger than in the without-Akin group ( p < 0.05). Conclusion: Average HIA significantly increased after DSTP and PCMO for moderate to severe HV necessitating additional Akin osteotomy, to achieve ideal HV correction and, to preserve MTPJ motion. Level of Evidence: IV, Case Series

scholarly journals Triple Osteotomy for Correction of Hallux Valgus with an Increased Distal Metatarsal Articular Angle

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0050
Author(s):  
Li Yi ◽  
Liang Xiaojun ◽  
Zhao Hong-Mou
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Soft Tissue Release ◽  
Aofas Score ◽  
First Metatarsophalangeal Joint ◽  
Surgical Methods ◽  
Wide Range ◽  
Triple Osteotomy

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: At present, there is a wide range of surgical methods for the treatment of hallux valgus with an increased distal metatarsal articular angle, there are not many reports on the effectiveness of this method that triple osteotomy and lateral soft tissue release. To study the clinical effect of triple osteotomy and lateral soft tissue release in treatment of hallux valgus with an increased distal metatarsal articular angle. Methods: A retrospective analysis of the clinical data of 23 patients (35 feet) with an increased distal metatarsal articular angle and undergoing triple osteotomy and lateral soft tissue release between January 2010 and December 2014 in Xi’an Hong Hui Hospital was conducted including 7 male (12 feet) and 16 female (23 feet). Their average age was (45.7+-15.2) years (range: 21˜66 years). The hallux valgus angle (HVA), the intermetatarsal angle (1-2 IMA) and the distal metatarsal articular angle (DMAA) in weightbearing dorsoplantar radiographs of the foot before operation and at final follow-up visit were compared. The preoperative and the final follow-up clinical functional outcomes were evaluated by the American Orthopaedic Foot & Ankle Society Hallux metatarsophalangeal-interphalangeal (AOFAS-MTP-IP) scale and a visual analogue scale (VAS). Results: The average follow-up time was (19.1+-7.3) months (range: 10˜32 months). There are no such severe complications as nonunion, avascular necrosis. The pain of first metatarsophalangeal joint was apparent release after operation 6 months. The incomplete range of motion in the first metatarsophalangeal joint occured at three patient (4 feet), but the symptoms disappeared after functional exercise. The HVA, IMA and DMAA were significantly improved from preoperative (47.6+-6.4)°, (18.6+-2.1)° and (34.7+-7.2)° to the latest follow-up (16.7+-4.3)°, (8.2+-2.2)°and (9.0+-4.5)°(P<0.01). The preoperative AOFAS score was 56.6+-3.9 points, which was significantly different from 89.2+-2.1 points (P<0.01). The postoperative VAS score has declined from 6.0+-0.8 points to 0.8+-0.7 points with statistically significant differences (P<0.01). According AOFAS score, 22 feet got an excellent result, 6 good and 5 fair. The function was good and excellent in 84.8%. Conclusion: Triple osteotomy and lateral soft tissue release in treatment of hallux valgus with an increased distal metatarsal articular angle which can gain good result in respect of functional and radiological outcomes. It is important to correct the distal metatarsal articular angle and functional training of the first metatarsophalangeal joint after operation.

Correlation of Different Methods of Measuring Pronation of the First Metatarsal on Weightbearing CT Scans

2021 ◽  
pp. 107110072110030
Author(s):  
Matthew S. Conti ◽  
Tamanna J. Patel ◽  
Kristin C. Caolo ◽  
Joseph M. Amadio ◽  
Mark C. Miller ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Computer Aided Design ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
3 Dimensional ◽  
3D Cad ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Second Metatarsal ◽  
Α Angle

Background: There is no consensus in the foot and ankle literature regarding how to measure pronation of the first metatarsal in patients with hallux valgus. The primary purpose of this study was to compare 2 previously published methods for measuring pronation of the first metatarsal and a novel 3-dimensional measurement of pronation to determine if different measurements of pronation are associated with each other. Methods: Thirty patients who underwent a modified Lapidus procedure for their hallux valgus deformity were included in this study. Pronation of the first metatarsal was measured on weightbearing computed tomography (WBCT) scans using the α angle with reference to the floor, a 3-dimensional computer-aided design (3D CAD) calculation with reference to the second metatarsal, and a novel method, called the triplanar angle of pronation (TAP), that included references to both the floor (floor TAP) and base of the second metatarsal (second TAP). Pearson’s correlation coefficients were used to determine if the 3 calculated angles of pronation correlated to each other. Results: Preoperative and postoperative α angle and 3D CAD had no correlation with each other ( r = 0.094, P = .626 and r = 0.076, P = .694, respectively). Preoperative and postoperative second TAP and 3D CAD also had no correlation ( r = 0.095, P = .624 and r = 0.320, P = .09, respectively). However, preoperative and postoperative floor TAP and α angle were found to have moderate correlations ( r = 0.595, P = .001 and r = 0.501, P = .005, respectively). Conclusion: The calculation of first metatarsal pronation is affected by the reference and technique used, and further work is needed to establish a consistent measurement for the foot and ankle community. Level of Evidence: Level III, retrospective cohort study.

scholarly journals Redefining Knee Balance in a Medially Stabilized Prosthesis: An In-Vitro Study

2017 ◽  
Vol 11 (1) ◽  
pp. 1165-1172
Author(s):  
Philippe Van Overschelde ◽  
Vera Pinskerova ◽  
Peter P. Koch ◽  
Christophe Fornasieri ◽  
Sandro Fucentese
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
In Vitro Study ◽  
Lateral Release ◽  
Soft Tissue Release ◽  
Iliotibial Band ◽  
Soft Tissue Envelope ◽  
Medial Side ◽  
Fresh Frozen

Background: To date, there is still no consensus on what soft tissues must be preserved and what structures can be safely released during total knee arthroplasty (TKA) with a medially stabilized implant. Objective: The aim of this study was to analyze the effect of a progressive selective release of the medial and lateral soft tissues in a knee implanted with a medially stabilized prosthesis. Method: Six cadaveric fresh-frozen full leg specimens were tested. In each case, kinematic pattern and mediolateral laxity were measured in three stages: firstly, prior to implantation; secondly, after the implantation of the trial components, but before any soft tissue release; and thirdly, progressively as soft tissue was released with the trial implant in place. The incremental impact of each selective release on knee balance was then analyzed. Results: In all cases sagittal stability was not affected by the progressive release of the lateral soft tissue envelope. It was possible to perform progressive lateral release provided the anterior one-third of the iliotibial band (ITB) remained intact. Progressive medial release could be performed on the medial side provided the anterior fibers of the superficial medial collateral ligament (sMCL) remained intact. Conclusion: The medially conforming implant remains stable provided the anterior fibers of sMCL and the anterior fibers of the ITB remain intact. The implant’s sagittal stability is mainly dependent on its medial ball-in-socket design.

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