Hallux Valgus in Men: Effect of the Distal Metatarsal Articular Angle on Hallux Valgus Correctiong

1997 ◽  
Vol 18 (8) ◽  
pp. 463-470 ◽  
Author(s):  
Michael J. Coughlin
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Valgus Deformity ◽  
Metatarsal Osteotomy ◽  
Hallux Valgus Angle ◽  
First Metatarsal ◽  
Soft Tissue Procedure ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
Mtp Joints

The results of hallux valgus correction were reviewed for 34 male patients (41 feet). The severity of the preoperative deformity determined the operative technique of correction. A distal soft tissue procedure with proximal first metatarsal osteotomy was performed in 30 patients (35 feet) with an average correction of the hallux valgus angle of 22°. A chevron procedure was performed in five cases and a McBride procedure in one other case, all with less severe deformities. Complications included one deep wound infection, one broken screw at the metatarsal osteotomy site, and three cases of hallux varus. No patients underwent reoperation. Undercorrection was noted in 10 of 35 cases (29%) where a distal soft tissue procedure with proximal first metatarsal osteotomy was performed. A nonsubluxated (congruent) metatarsophalangeal (MTP) joint associated with a hallux valgus deformity was present in 15 of 41 (37%) of all cases and 10 of 35 (29%) of cases that underwent a distal soft tissue procedure with proximal metatarsal osteotomy (DSTR with PMO). A subluxated (noncongruent) MTP joint associated with hallux valgus was present in 26 of 41 (63%) of all cases and 25 of 35 (71 %) of cases undergoing a DSTR with PMO. There was a highly significant difference in the average distal metatarsal articular angle (DMAA) as measured in the nonsubluxated (congruent) MTP joints (20.7°) and the subluxated (noncongruent) MTP joints with hallux valgus (10°) ( P = 0.0001). The average distal metatarsal articular angle for all cases undergoing DSTR with PMO was 13°. When the postoperative hallux valgus angle was compared with the DMAA, the average residual hallux valgus angle was 10.1°. With a subluxated (noncongruent) first MTP joint with hallux valgus (a low DMAA), the percent of hallux valgus correction (hallux valgus correction [in degrees])preoperative hallux valgus deformity [in degrees]) was 77%. In patients with a nonsubluxated (congruent) first MTP joint with hallux valgus (a high DMAA), the percent correction was 46%, an almost twofold difference in percent correction. There was a close correlation between the preoperative DMAA and the postoperative hallux valgus angle in both the subluxated and congruent subgroups ( P = 0.0003). With an intra-articular repair (a DSTP with PMO), the magnitude of correction of a hallux valgus deformity is limited at the MTP joint by the distal metatarsal articular angle.

scholarly journals Rotated Insertion Metatarsal Osteotomy with Distal Soft Tissue Procedure for Severe Hallux Valgus Deformity ―Novel Procedure of the 1st metatarsal osteotomy―

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Norihiro Samoto ◽  
Yasuhito Tanaka ◽  
Ryuhei Katsui ◽  
Kazuya Sugimoto
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Locking Plate ◽  
Valgus Deformity ◽  
Metatarsal Osteotomy ◽  
Rigid Fixation ◽  
Soft Tissue Procedure ◽  
Hallux Valgus Deformity ◽  
The Mean ◽  
Severe Hallux Valgus

Category: Bunion Introduction/Purpose: Hallux valgus deformity is recently a common disease involved in the foot and ankle and many procedures are recommended globally. However it is controversial about the operative treatment for severe hallux valgus. Many authors have reported the technical difficulties and various complications. We performed rotated insertion metatarsal osteotomy with the distal soft tissue procedure for severe hallux valgus deformity since January 2008. The purpose of this study is to evaluate the medium-term outcome of this procedure. Methods: Two hundred thirty-two feet in 173 patients were enrolled in this study and followed them up for a mean of 44.5 months. The mean age at the operation was 64.5 years. Hallux valgus angle(HVA) and intermetatarsal angle(IMA) were measured. This procedure consists of the rotated insertion metatarsal osteotomy and the distal soft tissue procedure. This diaphysial longitudinal metatarsal oblique osteotomy was performed from proximally- medial site of the first metatarsal directed to distally- lateral site through the dorsal exposure. The tip of osteotomized proximal metatarsal was formed at the dorso-distal site to insert in the central intramedullary aspect of osteotomized distal metatarsal. The second triangular cut of one third of dorso-plantar thick was made about 10 to 15 mm length from the lateral tip of osteomized proximal metatarsal. The internal fixation was performed with locking plate with screws. As a result, osteotomized sites were locked each other such as a puzzle. Results: The mean preoperative HVA and IMA were 43.8 degrees and 20.1 degrees. The mean postoperative HVA and IMA were decreased to 9.0 degrees and 6.1 degrees. AOFAS scores improved from 49.3 to 89.7. All cases were obtained complete union. Postoperative displacement was in 12 feet (5.2%) and followed under-correction (or recurrence). Overcorrection (hallux varus) occurred in 10 feet (4.7%). Wound healing was delayed in 21 feet (9.1%). In general, we found no severe complication and unsatisfactory result. Conclusion: This procedure provided satisfactory result for severe hallux valgus deformity. Especially the rigid fixation at the site of metatarsal osteotomy was much stronger because of the insertion and locking plate. However the further more outcomes in detail are essential for longer term follow-up.

Effect of Metatarsal Head Shape on the Development of Hallux Valgus Deformity: 10 Years of Natural Follow-up

2020 ◽  
Vol 110 (3) ◽  
Author(s):  
Ulunay Kanatli ◽  
Onur Unal ◽  
Muhammet Baybars Ataoglu ◽  
Tacettin Ayanoglu ◽  
Mustafa Ozer ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Plantar Pressure ◽  
Metatarsal Head ◽  
Valgus Deformity ◽  
Radiographic Evaluation ◽  
Hallux Valgus Angle ◽  
Head Shape ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Valgus Angle

Background We investigated the role of first metatarsal head shape in the etiology of hallux valgus. By pedobarographic analysis, we evaluated whether first metatarsal head shape causes an alteration in plantar pressure values that would result in metatarsalgia. Methods Referrals to our clinic for metatarsalgia, plantar fasciitis, and calcaneal spur were scanned retrospectively. Patients with severe hallux valgus, pes planus, gastrocnemius stiffness, generalized joint laxity, neuromuscular disease, or a history of lower-extremity orthopedic surgery were excluded. Sixty-two patients with plantar pressure assessment and radiographic evaluation were included. These patients were invited for reassessment after 10 years. Feet were divided into three groups by metatarsal head shape: round, square, and chevron. On anteroposterior radiographs, the hallux valgus and intermetatarsal angles, relative first metatarsal length, lateral sesamoid subluxation, and presence of bipartite sesamoid were noted. Plantar pressure was assessed with pedobarography. Results Feet with round-shaped first metatarsal heads had a statistically significantly greater progression in hallux valgus angle than the other shapes. Plantar pressures under the first, second and third, and fourth and fifth metatarsals increased with time. This can explain the mechanism of transfer metatarsalgia and painful callosities under the first metatarsal in hallux valgus. There was no correlation between hallux valgus angle, relative metatarsal length, and lateral sesamoid subluxation. Conclusions We found a strong relation between round-shaped first metatarsal head and hallux valgus angle progression. No patients had a risk factor responsible for hallux valgus. In other words, this study gives approximately 10-year natural history results in nearly normal feet.

Radiographic Assessment of the Second Metatarsal: Measure of First Ray Hypermobility

1996 ◽  
Vol 17 (6) ◽  
pp. 331-333 ◽  
Author(s):  
David W. Prieskorn ◽  
Roger A. Mann ◽  
Germaine Fritz
Keyword(s):  
Hallux Valgus ◽  
Cortical Thickness ◽  
Valgus Deformity ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
Second Metatarsal

Hypermobility of the first metatarsal cuneiform joint has been implicated as a cause of the hallux valgus deformity. The objective definition of hypermobility at this joint, however, has not been clearly defined. We used a modified Coleman block test to accentuate motion at the first metatarsal cuneiform joint in order to measure physiologic limits of motion in vivo. This motion was compared with radiographic analysis of the feet, which included the hallux valgus angle, intermetatarsal angle, and medial cortical thickening at the midshaft of the second metatarsal. This assessment was performed on 100 feet (50 right feet and 50 left feet in 50 patients). The average intermetatarsal angle was 8.7° (range, 4–14°), the average hallux valgus angle was 11° (range, 4° of varus to 30° of valgus), and the average midshaft medial cortical thickness was 3.2 mm (range, 2.0–5.5 mm). Pearson's correlation coefficient was calculated to compare these factors. The relationship between variables was found to be small ( r ≤ 0.2). Motion was noted to occur in the normal foot at this joint and a range of normal values for medial cortical thickness was identified.

Correlation analysis of functional and X-ray morphological parameters from the results of Scarf osteotomy of the first metatarsal

2020 ◽  
pp. 44-53
Author(s):  
Ruslan Khairutdinov ◽  
Timur Minasov ◽  
Ekaterina Yakupova ◽  
Elvina Mukhametzyanova
Keyword(s):  
Hallux Valgus ◽  
Pain Syndrome ◽  
Functional Results ◽  
Valgus Deformity ◽  
Hallux Valgus Angle ◽  
First Metatarsal ◽  
Scarf Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle

Hallux valgus (deformity at the base of the big toe) is manifested by a sharp pain syndrome, difficulty in movement, a cosmetic defect on the medial surface of the big toe. This pathology reduces the quality of life of patients, and is also socially significant, since it often occurs in young and middle-aged women who belong to the able-bodied population. In this regard, metaphyseal and diaphyseal osteotomy for the treatment of Hallux valgus of varying degrees, such as surgery according to the Scarf method, is of great importance. Advantages of this surgery are associated with the ability to share the load across the entire osteotomy area, great stability and reliable compression in the fracture zone, which allows early postoperative loading. With increasing age of a patient, a greater correction of the HVA (Hallux Valgus Angle) after osteotomy is achieved. A clearly traced correlation between age and good functional results after Scarf osteotomy allows us to recommend Scarf surgery for elderly patients.

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.

Juvenile Hallux Valgus: Etiology and Treatment

1995 ◽  
Vol 16 (11) ◽  
pp. 682-697 ◽  
Author(s):  
Michael J. Coughlin
Keyword(s):  
Hallux Valgus ◽  
Normal Population ◽  
Surgical Correction ◽  
Metatarsal Osteotomy ◽  
Hallux Valgus Angle ◽  
Pes Planus ◽  
First Metatarsal ◽  
Chevron Osteotomy ◽  
Valgus Angle ◽  
Metatarsus Adductus

In an 11-year retrospective study of 45 patients (60 feet) with juvenile hallux valgus, a multiprocedural approach was used to surgically correct the deformity. A Chevron osteotomy or McBride procedure was used for mild deformities, a distal soft tissue procedure with proximal first metatarsal osteotomy was used for moderate and severe deformities with MTP subluxation, and a double osteotomy (extra-articular correction) was used for moderate and severe deformities with an increased distal metatarsal articular angle (DMAA). The average hallux valgus correction was 17.2° and the average correction of the 1–2 intermetatarsal angle was 5.3°. Good and excellent results were obtained in 92% of cases using a multiprocedural approach. Eighty-eight percent of patients were female and 40% of deformities occurred at age 10 or younger. Early onset was characterized by increased deformity and an increased DMAA. Maternal transmission was noted in 72% of patients. An increased distal metatarsal articular angle was noted in 48% of cases. With subluxation of the first MTP joint, the average DMAA was 7.9°. With a congruent joint, the average DMAA was 15.3°. In patients where hallux valgus occurred at age 10 or younger, the DMAA was increased. First metatarsal length was compared with second metatarsal length. While the incidence of a long first metatarsal was similar to that in the normal population (30%), the DMAA was 15.8° for a long first metatarsal and 6.0° for a short first metatarsal. An increased DMAA may be the defining characteristic of juvenile hallux valgus. The success of surgical correction of a juvenile hallux valgus deformity is intimately associated with the magnitude of the DMAA. Moderate and severe pes planus occurred in 17% of cases, which was no different than the incidence in the normal population. No recurrences occurred in the presence of pes planus. Pes planus was not thought to have an affect on occurrence or recurrence of deformity. Moderate and severe metatarsus adductus was noted in 22% of cases, a rate much higher than that in the normal population. The presence of metatarsus adductus did not affect the preoperative hallux valgus angle or the average surgical correction of the hallux valgus angle. Constricting footwear was noted by only 24% of patients as playing a role in the development of juvenile hallux valgus. There were six recurrences of the deformities and eight complications (six cases of postoperative hallux varus, one case of wire breakage, and one case of undercorrection).

Comparison of Postoperative Height Changes of the Second Metatarsal Among 3 Osteotomy Methods for Hallux Valgus Deformity Correction

2016 ◽  
Vol 38 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Jun Young Choi ◽  
Yu Min Suh ◽  
Ji Woong Yeom ◽  
Jin Soo Suh
Keyword(s):  
Hallux Valgus ◽  
Deformity Correction ◽  
Metatarsal Head ◽  
Valgus Deformity ◽  
Metatarsal Osteotomy ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Scarf Osteotomy ◽  
Hallux Valgus Deformity ◽  
Second Metatarsal

Background: We aimed to compare the postoperative height of the second metatarsal head relative to the first metatarsal head using axial radiographs among 3 different commonly used osteotomy techniques: proximal chevron metatarsal osteotomy (PCMO), scarf osteotomy, and distal chevron metatarsal osteotomy (DCMO). Methods: We retrospectively reviewed the radiographs and clinical findings of the patients with painful callosities under the second metatarsal head, complicated by hallux valgus, who underwent isolated PCMO, scarf osteotomy, or DCMO from February 2005 to January 2015. Each osteotomy was performed with 20 degrees of plantar ward obliquity. Along with lateral translation and rotation of the distal fragment to correct the deformity, lowering of the first metatarsal head was made by virtue of the oblique metatarsal osteotomy. Results: Significant postoperative change in the second metatarsal height was observed on axial radiographs in all groups; this value was greatest in the PCMO group (vs scarf: P = .013; vs DCMO: P = .008) but did not significantly differ between the scarf and DCMO groups ( P = .785). The power for second metatarsal height correction was significantly greater in the PCMO group (vs scarf: P = .0005; vs DCMO: P = .0005) but did not significantly differ between the scarf and DCMO groups ( P = .832). Conclusions: Among the 3 osteotomy techniques commonly used to correct hallux valgus deformity, we observed that PCMO yielded the most effective height change of the second metatarsal head. Level of Evidence: Level III, retrospective comparative series.

The Reliability of Angular Measurements in Hallux Valgus Deformities

2001 ◽  
Vol 22 (5) ◽  
pp. 369-379 ◽  
Author(s):  
Michael J. Coughlin ◽  
Elisha Freund
Keyword(s):  
Hallux Valgus ◽  
Valgus Deformity ◽  
Hallux Valgus Angle ◽  
Observer Reliability ◽  
Hallux Valgus Deformity ◽  
Metatarsal Angle ◽  
Valgus Angle ◽  
Wide Range ◽  
Angular Measurements ◽  
Minimum Interval

The purpose of this study was to determine the intra-observer and inter-observer reliability of physicians on a repetitive basis in making angular measurements of hallux valgus deformities. The hallux valgus angle, the 1–2 intermetatarsal angle, and the distal metatarsal articular angle and the assessment of congruency/subluxation of the first MTP joint were evaluated on a repetitive basis. Physicians were provided with a series of black and white photographs of radiographs with a hallux valgus deformity. Three different sets of photographs randomly ordered were sent at a minimum interval of six weeks to the participants. Participating physicians were extremely reliable in the measurement of the 1–2 metatarsal angle. 96.7% of the photographs were repeatedly measured within a range of 5 degrees or less. The angular measurements to determine the hallux valgus angle were slightly less reliable, but 86.2% of photos were repeatedly measured within a range of 5 degrees or less. In the measurement of the distal metatarsal articular angle, 58.9% of photographs were repeatedly measured within a range of 5 degrees or less. There was a wide range within physician evaluators who recognized very few congruent joints (2 of 21) and those who recognized several congruent joints (11 of 21). Most physicians appeared to be internally consistent in the assessment of MTP congruency; however, some photographs were much more difficult to assess than others. This study validates the reliability of the measurement of the hallux valgus and the 1–2 metatarsal angle. The inter-observer reliability in the measurement of the distal metatarsal articular angle is questioned.

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