Correction of Hallux Valgus Deformity in Association With Underlying Metatarsus Adductus Deformity

2017 ◽  
Vol 10 (6) ◽  
pp. 538-542 ◽  
Author(s):  
Naohiro Shibuya ◽  
Daniel C. Jupiter ◽  
Britton S. Plemmons ◽  
Lanster Martin ◽  
Jakob C. Thorud
Keyword(s):  
Cohort Study ◽  
Hallux Valgus ◽  
Retrospective Cohort ◽  
Regression Models ◽  
Common Factors ◽  
Valgus Deformity ◽  
Corrective Surgery ◽  
Logistic Regression Models ◽  
Hallux Valgus Deformity ◽  
Metatarsus Adductus

Presence of underlying metatarsus deformity is known to negatively affect the outcome of hallux valgus corrective surgery. Yet there are many other factors that also affect final outcomes. In order to address the potential relationships between variables, we attempted to evaluate the association of metatarsus adductus with surgical outcomes, independent of other common factors used in evaluation of hallux valgus deformity. We enrolled 154 patients who had undergone hallux valgus corrective surgery and recorded their pre- and postoperative intermetatarsal (IM12) and hallux valgus (HVA) angles, preoperative Engel’s angle, and type of hallux valgus procedure. Using linear and logistic regression models, we identified variables that were independently (1) associated with the final IM12 and HVA and those (2) independently associated with dichotomized postoperative IM12 and HVA. We found that the only factors that were independently associated were preoperative IM12 with postoperative IM12, and preoperative HVA with postoperative HVA. In the linear model, a discretized Engel’s angle of 21 to 25 was marginally negatively associated with the final IM12. There was no detectable relationship between underlying metatarsus adductus deformity and the final outcome of hallux valgus correction after adjusting for other covariates. Levels of Evidence: Level III: Retrospective, cohort study

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.

scholarly journals Recurrent Hallux Valgus

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
David Beck ◽  
Steven Raikin ◽  
Andrew Park
Keyword(s):  
Hallux Valgus ◽  
Revision Surgery ◽  
Valgus Deformity ◽  
Older Age ◽  
Consecutive Series ◽  
Corrective Surgery ◽  
Time To Recurrence ◽  
Surgery Patient ◽  
Hallux Valgus Deformity ◽  
Metatarsal Angle

Category: Bunion Introduction/Purpose: Recurrence of hallux valgus deformity can be a common complication after corrective surgery. The cause of recurrent hallux valgus is usually multifactorial, and includes patient-related factors such as preoperative anatomic predisposition, medical comorbidities, post-operative compliance, as well as surgical factors. This study examines a single surgeon’s consecutive series of corrective surgical cases for recurrent bunion deformity over a 15-year time span. The purpose of the study is to report on common characteristics of patients with symptomatic recurrent hallux valgus deformity, average time to recurrence defined as the time from index surgery to revision surgery, and identify potential associations or risk factors with respect to time to recurrence and revision surgery type. Methods: A single board certified foot and ankle orthopaedic surgeon’s clinical charts and operative findings were compiled in a database over 15 years spanning from 2001 to 2016. 300 patients with recurrent hallux valgus diagnoses were identified and 254 had complete data. Revision surgeries included corrective surgery on the first ray, midfoot, or the forefoot as a result of prior hallux valgus surgery. Patient factors analyzed included diabetes, gender, smoking status, rheumatoid disease, neuromuscular disease, age at index surgery, index surgery, and number of prior surgeries. Preoperative revision surgery radiographic parameters measured included hallux valgus angle (HVA), inter-metatarsal angle (IMA), and sesamoid station. Revision surgery type and number of revision procedures were also logged. Full linear regression models were generated. The first model predicts the time to recurrence in months, while the second produced models that reported odds ratios of revision surgery Results: Average age at index surgery was 43 years old with 90% female and average BMI of 27 in this cohort. Average time to recurrence after index surgery was 14 years. Average radiographic data at presentation for revision surgery were HVA = 28.6, IMA = 12. Index surgeries included 41% distal osteotomy, 32% simple bunionectomy, while revision/corrective procedures included 35% proximal osteotomy, 44% receiving a 1st MTP/midfoot fusion, and 60% forefoot procedures. 32% required 1st MTP fusion at revision. Diabetes and higher HVA were statistically significant and directly associated with longer time to recurrence. Greater number of surgeries, older age, and index proximal osteotomy were associated with a quicker time to recurrence. Index surgery type did not have a significant association with revision surgery type. Conclusion: To our knowledge this is the largest single surgeon series examining recurrent hallux valgus deformity. Most patients with recurrent symptomatic hallux valgus were women in their 6th decade with relatively normal BMI. Average time from index surgery to revision surgery was 14 years. Several factors including diabetes and greater HVA were associated with longer time to revision, while number of surgeries, older age, and proximal osteotomies were associated with earlier time to revision. 44% of patients required a MTP or midfoot fusion at revision. We did not see an association between type of index surgery and type of revision surgery.

Hallux Valgus Correction in a Patient with Metatarsus Adductus with Multiple Distal Oblique Osteotomies

2010 ◽  
Vol 100 (3) ◽  
pp. 204-208 ◽  
Author(s):  
Nicolò Martinelli ◽  
Andrea Marinozzi ◽  
Francesco Cancilleri ◽  
Vincenzo Denaro
Keyword(s):  
Surgical Treatment ◽  
Elderly Patients ◽  
Hallux Valgus ◽  
Extensor Digitorum Longus ◽  
Clinical Case ◽  
Valgus Deformity ◽  
Extensor Digitorum ◽  
Foot Deformity ◽  
Hallux Valgus Deformity ◽  
Metatarsus Adductus

Metatarsus adductus is a structural foot deformity that is rarely associated with hallux valgus deformity. Surgical treatment is challenging, and multiple osteotomies are often required to correct both deformities. However, surgical impact must be considered, especially in elderly patients. We present a clinical case of a 76-year-old woman affected by hallux valgus and metatarsus adductus deformity. Multiple distal oblique osteotomies were performed on the first, second, and third metatarsals, coupled with Z-lengthening of the extensor digitorum longus tendons. (J Am Podiatr Med Assoc 100(3): 204–208, 2010)

Modified Lapidus Versus Scarf Osteotomy Outcomes for Treatment of Hallux Valgus Deformity

2021 ◽  
pp. 107110072110137
Author(s):  
Megan E. Reilly ◽  
Matthew S. Conti ◽  
Jonathan Day ◽  
Aoife MacMahon ◽  
Bopha Chrea ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Retrospective Cohort ◽  
Patient Reported Outcome Measures ◽  
Valgus Deformity ◽  
Patient Reported Outcome ◽  
Measurement Information ◽  
Level Of Evidence ◽  
Scarf Osteotomy ◽  
Hallux Valgus Deformity ◽  
Patient Reported

Background: The Lapidus procedure and scarf osteotomy are indicated for the operative treatment of hallux valgus; however, no prior studies have compared outcomes between the procedures. The aim of this study was to compare clinical and radiographic outcomes between patients with symptomatic hallux valgus treated with the modified Lapidus procedure versus scarf osteotomy. Methods: This retrospective cohort study included patients treated by 1 of 7 fellowship-trained foot and ankle surgeons. Inclusion criteria were age older than 18 years, primary modified Lapidus procedure or scarf osteotomy for hallux valgus, minimum 1-year postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores, and minimum 3-month postoperative radiographs. Revision cases were excluded. Clinical outcomes were assessed using 6 PROMIS domains. Pre- and postoperative radiographic parameters were measured on anteroposterior (AP) and lateral weightbearing radiographs. Statistical analysis utilized targeted minimum-loss estimation (TMLE) to control for confounders. Results: A total of 136 patients (73 Lapidus, 63 scarf) with an average of 17.8 months of follow-up were included in this study. There was significant improvement in PROMIS physical function scores in the modified Lapidus (mean change, 5.25; P < .01) and scarf osteotomy (mean change, 5.50; P < .01) cohorts, with no significant differences between the 2 groups ( P = .85). After controlling for bunion severity, the probability of having a normal postoperative intermetatarsal angle (IMA; <9 degrees) was 25% lower ( P = .04) with the scarf osteotomy compared with the Lapidus procedure. Conclusion: Although the modified Lapidus procedure led to a higher probability of achieving a normal IMA, both procedures yielded similar improvements in 1-year patient-reported outcome measures. Level of Evidence: Level III, retrospective cohort.

scholarly journals Earlier onset of proteinuria or hypertension is a predictor of progression from gestational hypertension or gestational proteinuria to preeclampsia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mamoru Morikawa ◽  
Michinori Mayama ◽  
Kiwamu Noshiro ◽  
Yoshihiro Saito ◽  
Kinuko Nakagawa-Akabane ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort ◽  
Regression Models ◽  
Gestational Hypertension ◽  
P Value ◽  
Hypertensive Disorders Of Pregnancy ◽  
Multivariate Logistic Regression ◽  
Logistic Regression Models ◽  
Hypertensive Disorders ◽  
New Onset

AbstractAlthough gestational hypertension (GH) is a well-known disorder, gestational proteinuria (GP) has been far less emphasized. According to international criteria, hypertensive disorders of pregnancy include GH but not GP. Previous studies have not revealed the predictors of progression from GP to preeclampsia or those of progression from GH to preeclampsia. We aimed to determine both sets of predictors. A retrospective cohort study was conducted with singleton pregnant women who delivered at 22 gestational weeks or later. Preeclampsia was divided into three types: new onset of hypertension/proteinuria at 20 gestational weeks or later and additional new onset of other symptoms at < 7 days or at ≥ 7 days later. Of 94 women with preeclampsia, 20 exhibited proteinuria before preeclampsia, 14 experienced hypertension before preeclampsia, and 60 exhibited simultaneous new onset of both hypertension and proteinuria before preeclampsia; the outcomes of all types were similar. Of 34 women with presumptive GP, 58.8% developed preeclampsia; this proportion was significantly higher than that of 89 women with presumptive GH who developed preeclampsia (15.7%). According to multivariate logistic regression models, earlier onset of hypertension/proteinuria (before or at 34.7/33.9 gestational weeks) was a predicator for progression from presumptive GH/GP to preeclampsia (odds ratios: 1.21/1.21, P value: 0.0044/0.0477, respectively).

scholarly journals Biopsy in emergency gastroscopy does not increase the risk of rebleeding in patients with Forrest I acute nonvariceal upper gastrointestinal bleeding combined with suspected malignant gastric ulcer: a multicenter retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Quchuan Zhao ◽  
Tianyu Chi
Keyword(s):  
Logistic Regression ◽  
Gastric Ulcer ◽  
Cohort Study ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Retrospective Cohort ◽  
Regression Models ◽  
Upper Gastrointestinal Bleeding ◽  
Logistic Regression Models ◽  
Upper Gastrointestinal

Abstract Background Few studies have reported whether a biopsy in emergency gastroscopy (EG) increased the risk of rebleeding in patients with Forrest I acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) combined with suspected malignant gastric ulcer (SMGU). This study aims to conduct a multicenter retrospective cohort study using propensity score matching to verify whether a biopsy in EG increases the risk of rebleeding in patients diagnosed with Forrest I ANVUGIB combined with SMGU. Methods Using the data for propensity-matched patients, logistic regression models were fitted using rebleeding as the dependent variable. Survival time was defined as the length of time the patient experienced from visiting the emergency department to rebleeding. We used the Kaplan–Meier (KM) method to analyze the 30-day survival of the patients with and without a biopsy after matching, and the log-rank test was performed to examine the differences in survival. Results With the use of propensity score matching, 308 patients who underwent a biopsy in EG were matched with 308 patients who did not. In the five logistic regression models, there were no significant group differences in the risk of rebleeding in patients with Forrest I ANVUGIB combined with SMGU between the biopsy and no-biopsy groups. The probability of survival was not significantly different between the no-biopsy and biopsy groups. Conclusions In this multicenter, retrospective propensity score matching cohort study, compared with patients without a biopsy, patients with a biopsy during EG had no increased risk of rebleeding, and there was no significant difference in the rate of rebleeding.

scholarly journals Management of Hallux Valgus Deformity in Patients with Metatarsus Adductus

2016 ◽  
Vol 1 (1) ◽  
pp. 2473011416S0005
Author(s):  
Amiethab Aiyer ◽  
Raheel Shariff ◽  
Joseph A. Tracey ◽  
Mark S. Myerson
Keyword(s):  
Hallux Valgus ◽  
Valgus Deformity ◽  
Hallux Valgus Deformity ◽  
Metatarsus Adductus

scholarly journals The metatarsaus adductus effect by the syndesmosis procedure for hallux valgus correction

2021 ◽  
Vol 2 (3) ◽  
pp. 174-180
Author(s):  
Daniel Yiang Wu ◽  
Eddy Kwok Fai Lam
Keyword(s):  
Hallux Valgus ◽  
Deformity Correction ◽  
Varus Deformity ◽  
Valgus Deformity ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Second Metatarsal ◽  
Metatarsus Adductus ◽  
American Orthopaedic ◽  
Clinical Records

Aims The purpose of this study is to examine the adductus impact on the second metatarsal by the nonosteotomy nonarthrodesis syndesmosis procedure for the hallux valgus deformity correction, and how it would affect the mechanical function of the forefoot in walking. For correcting the metatarsus primus varus deformity of hallux valgus feet, the syndesmosis procedure binds first metatarsal to the second metatarsal with intermetatarsal cerclage sutures. Methods We reviewed clinical records of a single surgical practice from its entire 2014 calendar year. In total, 71 patients (121 surgical feet) qualified for the study with a mean follow-up of 20.3 months (SD 6.2). We measured their metatarsus adductus angle with the Sgarlato’s method (SMAA), and the intermetatarsal angle (IMA) and metatarsophalangeal angle (MPA) with Hardy’s mid axial method. We also assessed their American Orthopaedic Foot & Ankle Society (AOFAS) clinical scale score, and photographic and pedobarographic images for clinical function results. Results SMAA increased from preoperative 15.9° (SD 4.9°) to 17.2° (5.0°) (p < 0.001). IMA and MPA corrected from 14.6° (SD 3.3°) and 31.9° (SD 8.0°) to 7.2° (SD 2.2°) and 18.8° (SD 6.4°) (p < 0.001), respectively. AOFAS score improved from 66.8 (SD 12.0) to 96.1 (SD 8.0) points (p < 0.001). Overall, 98% (119/121) of feet with preoperative plantar calluses had them disappeared or noticeably subsided, and 93% (113/121) of feet demonstrated pedobarographic medialization of forefoot force in walking. We reported all complications. Conclusion This study, for the first time, reported the previously unknown metatarsus adductus side-effect of the syndesmosis procedure. However, it did not compromise function restoration of the forefoot by evidence of our patients' plantar callus and pedobarographic findings. Level of Clinical Evidence: III Cite this article: Bone Jt Open 2021;2(3):174–180.

scholarly journals Transfer of abductor hallucis tendon combined with scarf osteotomy versus single scarf osteotomy in moderate to severe hallux valgus deformity: a comparative retrospective cohort study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Yuan Xiong ◽  
Bo Shen ◽  
Cheng Hao ◽  
Kai Xiao ◽  
Junwen Wang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hallux Valgus ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Abductor Hallucis ◽  
First Metatarsophalangeal Joint ◽  
Non Union ◽  
Scarf Osteotomy ◽  
Hallux Valgus Deformity ◽  
Severe Hallux Valgus

Abstract Background Scarf osteotomy (SO) was broadly applied in moderate to severe hallux valgus (MSHV), and the results were satisfactory. However, due to the complicated pathologic changes in hallux valgus, the ideal surgical treatment is still controversial. Transfer of the abductor hallucis tendon combined with Scarf osteotomy (TAHTCSO) was an innovative alternative technique. This retrospective cohort study aimed to define if TAHTCSO mode resulted in improved outcomes as compared with the single SO in MSHV. Methods Of 73 patients (92 ft) with MSHV, 36 (45 ft) were treated through TAHTCSO and 37 ones (47 ft) through SO. The patients were assessed clinically and radiographically with a 24-month follow-up. They were assessed pre-operatively and post-operatively with intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), first metatarsophalangeal joint range of motion (1#MTP ROM), as well as American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores and postoperative complications of surgery. Results Both cohorts had the same baseline feathures. All patients were followed up from 24 to 40 months, with a mean of 28.3 months. Patients in the TAHTCSO cohort had significantly decreased HVA at 6 months (p < 0.0001), 12 months (p < 0.0001), and 24 months (p < 0.0001) after surgery. 1#MTP had been increased slightly with non-statistic sense (p>0.05). IMA, DMAA and AOFAS also had not significantly difference at all followed time after surgery as compared with the SO cohort. The healing of osteotomies was observed within 8 weeks in the two cohorts. Two cases of hallus varus had been found in SO cohort and there were no cases of delayed healing and bone non-union in both cohorts. Conclusion In this retrospective cohort study, TAHTCSO had sufficient maintenance of the correction and improved functional performance thereby was a good alternative for MSHV, though it did not display a better result for MSHV compared to SO.

Sign in / Sign up

Export Citation Format

Share Document