Outcome of Second-Ray Pathologies Following Weil Osteotomy in Patients Treated for Hallux Valgus

2018 ◽  
Vol 12 (5) ◽  
pp. 452-457 ◽  
Author(s):  
Ki Won Young ◽  
Hong Seop Lee ◽  
Ki Chol Park
Keyword(s):  
Patient Satisfaction ◽  
Hallux Valgus ◽  
Case Series ◽  
Relative Length ◽  
Claw Toe ◽  
Satisfaction Rate ◽  
Surgery Outcome ◽  
Chevron Osteotomy ◽  
Second Metatarsal ◽  
Toe Deformity

Background: We hypothesized that the cause of second-ray pathology with hallux valgus is excessive relative length of the second metatarsal and performed Weil osteotomy to shorten it, with correction of hallux valgus. The purpose of this study is to evaluate the outcome of second-ray pathology after distal chevron osteotomy (DCO) with Weil osteotomy to correct metatarsal parabola. Methods: We performed concomitant Weil osteotomy of the second metatarsal with DCO of the first metatarsal as part of hallux valgus with second-ray pathology correction surgery in 45 feet (40 patients). Second-ray pathologies were claw toe deformity, painful plantar callosity, second metatarsophalangeal joint (MTPJ) dislocation, and osteoarthritis (OA) of the second MTPJ. We measured projection of the second metatarsal (PSM), metatarsal protrusion index (MPI), and metatarsal protrusion distance (MPD). The second-ray surgery outcome was assessed by patient satisfaction. Results: Patient satisfaction was good in claw toe deformity and OA (satisfaction rate: 60% [23 patients] and 71% [7 patients], respectively) and fair in painful plantar callosity and second MTP joint dislocation (satisfaction rate: 44% [9 patients] and 33% [6 patients], respectively). Total patient satisfaction rate was higher when the PSM, MPI, and MPD ranged between 7 and 12 mm, −5 and 0 mm, and 0 and 4 mm, respectively. Conclusions: We concluded that simultaneous performance of hallux valgus correction and Weil osteotomy in patients with second-ray pathologies associated with hallux valgus was safe as well as effective. Correcting the metatarsal parabola within the appropriate range after surgery is associated with second-ray pathology outcome. Levels of Evidence: Therapeutic studies, Level VI: Case series

A Clinicoradiological and Functional Evaluation of Lapidus Surgery for Moderate to Severe Bunion Deformity Shows Excellent Stable Correction and High Long-Term Patient Satisfaction

2019 ◽  
Vol 13 (6) ◽  
pp. 488-493 ◽  
Author(s):  
Vivek S. Jagadale ◽  
Ruth L. Thomas
Keyword(s):  
Patient Satisfaction ◽  
Hallux Valgus ◽  
Case Series ◽  
Relative Length ◽  
Valgus Deformity ◽  
Radiographic Evaluation ◽  
Functional Evaluation ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Severe Hallux Valgus

Background. Lapidus surgery involving arthrodesis of the first metatarsocuneiform (MTC) joint is an effective procedure for the correction of moderate to severe hallux valgus. The aim of this study was to collect and analyze radiographic data from our institution and determine the extent of first metatarsal shortening associated with the Lapidus procedure. Materials and Methods. A total of 53 patients (54 feet) who underwent arthrodesis of the first MTC joint combined with modified McBride bunionectomy for correction of moderate to severe hallux valgus deformity, between 2010 and 2015 were included in this study. Complete radiographic evaluation and AOFAS (American Orthopaedic Foot and Ankle Surgery) scoring was available for 54 feet. The average preoperative hallux valgus angulation (HVA) was 32° and the average intermetatarsal angle (IMA) was 16°. Results. Excluding 2 patients with postoperative hallux varus the average postoperative HVA correction at last follow-up was 14°. Average postoperative IMA was 9°. Although there was minimal bone resection during preparation of the MTC joint, no significant shortening of the first metatarsal was observed with this procedure. The relative length of the first metatarsal to the second metatarsal changed only 1.3%. Nonunion of the first MTC joint occurred in 10.3%, but only 1 foot was symptomatic requiring revision. The average postoperative hallux AOFAS score was 80.8. In sum, 63% of patients were very satisfied, 27% satisfied with reservations, and 10% were dissatisfied. Conclusion. The Lapidus bunion procedure offers excellent stable correction of moderate to severe hallux valgus deformity with minimal shortening of the first metatarsal and thereby higher patient satisfaction. Levels of Evidence: Level IV: Retrospective case series

Percutaneous, intra-articular, chevron osteotomy (PeICO) for the treatment of mild-to-moderate hallux valgus: a case series

2021 ◽  
Author(s):  
Jorge Javier Del Vecchio ◽  
Mauricio Esteban Ghioldi ◽  
Lucas Nicolás Chemes ◽  
Eric Daniel Dealbera ◽  
Julieta Brue ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Chevron Osteotomy

Loss of Correction After Chevron Osteotomy for Hallux Valgus as a Function of Preoperative Deformity

2018 ◽  
Vol 40 (3) ◽  
pp. 287-296 ◽  
Author(s):  
Gerhard Kaufmann ◽  
Stefanie Sinz ◽  
Johannes M. Giesinger ◽  
Matthias Braito ◽  
Rainer Biedermann ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
X Rays ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Loss Of Correction ◽  
Chevron Osteotomy ◽  
Significant Correction ◽  
Preoperative Deformity

Background: Recurrence is relatively common after surgical correction of hallux valgus. Multiple factors are discussed that could have an influence in the loss of correction. The aim of this study was to determine preoperative radiological factors with an influence on loss of correction after distal chevron osteotomy for hallux valgus. Methods: Five hundred twenty-four patients who underwent the correction of a hallux valgus by means of distal chevron osteotomy at our institution between 2002 and 2012 were included. We assessed weightbearing x-rays at 4 time points: preoperatively, postoperatively, and after 6 weeks and 3 months. We investigated the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), joint congruity, and the position of the sesamoids. Results: At all points of the survey, significant correction of the IMA and HVA was detected. The IMA improved from 12.9 (± 2.8) to 4.5 (± 2.4) degrees and the HVA from 27.5 (± 6.9) to 9.1 (± 5.3) degrees. Loss of correction was found in both HVA and IMA during follow-up with a mean of 4.5 and 1.9 degrees, respectively. Loss of correction showed a linear correlation with preoperative IMA and HVA, and a correlation between preoperative DMAA and sesamoid position. Conclusion: The chevron osteotomy showed significant correction for HVA, IMA, and DMAA. Preoperative deformity, in terms of IMA, HVA, DMAA, and sesamoid position, correlated with the loss of correction and could be assessed preoperatively for HVA and IMA. Loss of correction at 3 months persisted during the follow-up period. Level of Evidence: Level IV, retrospective case series.

Keller Arthroplasty: A Prospective Review

Foot & Ankle ◽  
1987 ◽  
Vol 8 (1) ◽  
pp. 46-54 ◽  
Author(s):  
T. R. Love ◽  
A. S. Whynot ◽  
I. Farine ◽  
M. Lavoie ◽  
L. Hunt ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Prospective Study ◽  
Hallux Valgus ◽  
Joint Pain ◽  
Female Patients ◽  
Satisfaction Rate ◽  
Level Of Activity ◽  
A Prospective Study ◽  
Patient Satisfaction Rate

A prospective study of the Keller procedure for hallux valgus was carried out on 44 female patients (75 feet) with an average age of 66 years. The average follow-up was 31 months (range, 12–64 months). The operation was effective in improving symptoms (joint pain and bunion tenderness), cosmesis, function (footwear and level of activity) and in decreasing the deformity. The operation did not have an influence on metatarsal calluses. Cock-up deformity was common postoperatively but did not affect the results. The overall patient satisfaction rate was 77%.

scholarly journals Proximal Opening Wedge Osteotomy With Distal Chevron Osteotomy of the First Metatarsal for the Treatment of Moderate to Severe Hallux Valgus

2018 ◽  
Vol 40 (1) ◽  
pp. 89-97 ◽  
Author(s):  
Matthias Braito ◽  
Dietmar Dammerer ◽  
Philipp Hofer-Picout ◽  
Gerhard Kaufmann
Keyword(s):  
Wound Infection ◽  
Hallux Valgus ◽  
Case Series ◽  
Wedge Osteotomy ◽  
Metatarsal Osteotomy ◽  
Level Of Evidence ◽  
Opening Wedge ◽  
First Metatarsal ◽  
Chevron Osteotomy ◽  
Severe Hallux Valgus

Background: The aim of this study was to assess radiographic and clinical outcomes after double osteotomy with proximal opening wedge first metatarsal osteotomy and first metatarsal distal chevron osteotomy in the treatment of moderate to severe hallux valgus. Methods: 33 patients (4 male, 29 female; 36 feet; average age 60.7 years) were included in the study. Radiographic and clinical outcome in terms of intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), and the American Orthopaedic Foot & Ankle Society metatarsophalangeal-interphalangeal hallux score (AOFAS MTP-IP hallux score) were investigated at 6 weeks, 6 months, and after an average of 28 (range, 7-123) months postoperatively. Results: Preoperative IMA, HVA, and DMMA showed statistically significant improvement ( P ≤ .05) from 19.1 ± 3.8 (8.9-27.3) degrees, 45.4 ± 8.7 (25.9-60.9) degrees, and 20.8 ± 8.9 (4.5-38.0) degrees to 6.0 ± 3.3 (0.4-12.2) degrees, 9.1 ± 8.9 (–6.7 to 39.0) degrees, and 6.4 ± 5.6 (–6.8 to 21.0) degrees at last follow-up, respectively. Postoperative AOFAS MTP-IP hallux score averaged 88.1 points. Overall, 10 complications were observed: hallux varus (3 feet), hallux valgus recurrence (3 feet), nonunion (1 foot), loss of fixation (1 foot), and wound infection (2 feet). Conclusion: Proximal opening wedge first metatarsal osteotomy with distal chevron osteotomy provided powerful correction of each component of moderate to severe hallux valgus but had a substantial rate of complications in terms of over- and undercorrection, nonunion, loss of fixation, and wound infection. Level of Evidence: Level IV, case series.

Medium-term Outcome of Chevron Osteotomy for hallux valgus correction in a Spanish population: radiological clinical parameters and patient satisfaction.

2020 ◽  
Author(s):  
MANUEL COHEÑA-JIMENEZ ◽  
Esther Chicharro-Luna ◽  
José Algaba Del-Castillo ◽  
Fernando Chacón-Giráldez ◽  
Amanda Paez-Tudela ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Hallux Valgus ◽  
Weight Bearing ◽  
Final Visit ◽  
Medium Term ◽  
Term Outcome ◽  
Average Value ◽  
Chevron Osteotomy ◽  
Informed Consent Form

BACKGROUND:Chevron osteotomy for the treatment of mild and moderate hallux valgus obtain good effects. The procedure is suitable for a variety of cases, thereby allowing for a significant degree of correction. This study aimed to investigate Chevron osteotomy procedures for the correction of hallux valgus in the medium-term (2010-2016) by podiatrists surgeons. It takes into account clinical and radiological findings as well as patient perspectives and level of satisfaction.METHODS: All patients were assessed preoperatively, postoperatively and at a final follow-up. Fifty feet (forty five patients). The mean age was 59.43 (range 32 to 80) years. All of the participants signed an informed consent form to take part in the study. The protocols include: chart review, clinical and radiological. Anterior-posterior weight-bearing radiographs were analyzed preoperatively and at final follow-up. All radiological data were assessed by two observers blinded. Clinical and functional measurements as well as evaluation of the satisfaction survey at the final visit were carried out by another researcher blinded to the study. All patients were analyzed with VAS and AOFAS score. It was applied to evaluate clinical effects.RESULTS:Inter and intra-observer reliability was evaluated (ICC- 95%). The average value of the hallux valge angle (HVA) decreased at final follow-up (25.30º {plus minus} 7.21 VS 17.98º{plus minus} 8.18; p=0.041). There was no significant reduction in the average value of the intermetatarsal angle (IMA) at final follow-up (13.13º {plus minus} 3.03 VS 11.3º {plus minus}3.18; p= 0.78). Final AOFAS scale was 83. This study show the relevance of magnet therapy, nail surgery and others additional procedures. No patient was dissatisfied with the aesthetic scarring.CONCLUSIONS: The results showed that radiological results at final follow-up weren´t compatible with relapse of the deformity. The definitive clinical results, and the degree of patient satisfaction achieved with this technique were favorable from the patients' point of view.

scholarly journals Distal Chevron Osteotomy Increases Anatomic Intermetatarsal Angle in Hallux Valgus

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0016
Author(s):  
Jeremy Y. Chan ◽  
Naudereh B. Noori ◽  
Stephanie Chen ◽  
Glenn B. Pfeffer ◽  
Timothy P. Charlton ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Metatarsal Head ◽  
Rank Test ◽  
Metatarsal Osteotomy ◽  
Recurrence Rates ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Chevron Osteotomy

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Loss of correction in hallux valgus (HV) deformity following distal chevron metatarsal osteotomy (DCO) has been demonstrated in short-term follow-up with HV recurrence rates of up to 75% reported in the long-term. The purpose of this study was to evaluate the radiographic effect of the DCO on the anatomic and mechanical axes of the first metatarsal. Our hypothesis was that patients undergoing DCO would have improvement in the mechanical metatarsal axis but worsening of the anatomic axis. Methods: This was a retrospective single surgeon case series of all patients who underwent DCO for HV between 2017 and 2019. Patients were included if they had both preoperative and postoperative weightbearing foot radiographs. The primary outcomes were the change in anatomic first-second intermetatarsal angle (a1-2IMA, defined by the metatarsal diaphyseal axis) and the change in mechanical first-second intermetatarsal angle (m1-2IMA, defined by the axis from the center of the metatarsal head to the metatarsal base). Secondary outcomes included the change in hallux valgus angle (HVA) and medial sesamoid position (medial sesamoid in relation to the mechanical axis of the metatarsal). Change in second-third intermetatarsal angle (2-3IMA, defined by the metatarsal diaphyseal axis) was measured to control for any inconsistencies in radiographic technique. Given the relatively small patient cohort, the non-parametric Wilcoxon signed rank test and Mann Whitney U test were used for statistical analysis. Results: 41 feet were included for analysis with a mean follow-up of 20.4 weeks. The a1-2IMA increased significantly (mean, 4.0 degrees, p<0.001) while the m1-2IMA decreased significantly (mean, 4.6 degrees, p<0.001) following DCO. There was a significant improvement in HVA (mean, 13.2 degrees, p<0.001). No changes were noted in 2-3IMA (mean, 0.0 degrees, p=0.834). (Table 1) Medial sesamoid position was improved in 22 feet (53.7%). Patients with improved sesamoid position were noted to have a significantly larger decrease in m1-2IMA (mean, 5.3 versus 3.8 degrees, p=0.01) and a smaller increase in a1-2IMA (mean, 3.4 versus 4.7 degrees, p=0.02) compared to patients with no improvement in sesamoid position. Conclusion: Distal chevron osteotomy for HV is associated with an increase in the anatomic intermetatarsal angle despite improvements in the m1-2IMA, HVA and medial sesamoid position. Patients with improved sesamoid position were associated with greater correction of the mechanical first metatarsal axis. Our findings may suggest the presence of intermetatarsal instability, which could limit the power of DCO in HV correction for more severe deformities and provide a mechanism for HV recurrence. [Table: see text]

Radiographic Assessment of Relative First Metatarsal Length Following Modified Lapidus Procedure

2020 ◽  
Vol 41 (8) ◽  
pp. 972-977 ◽  
Author(s):  
Wessel Greeff ◽  
Andrew Strydom ◽  
Nikiforos Pandelis Saragas ◽  
Paulo Norberto Faria Ferrao
Keyword(s):  
Hallux Valgus ◽  
Sagittal Plane ◽  
Case Series ◽  
Relative Length ◽  
Long Term Results ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Patient Reported ◽  
The Mean

Background: The modified Lapidus is a surgical procedure for managing moderate to severe hallux valgus, especially in the presence of first tarsometatarsal joint arthritis or hypermobility. It has good long-term results but reportedly can lead to transfer metatarsalgia due to inherent shortening of the first metatarsal. Methods: A retrospective analysis of all adult patients who underwent a modified Lapidus procedure during a 3-year period was performed. Clinical notes were evaluated to look for nonunion or any other complications related to the surgery. Pre- and postoperative standard weightbearing radiographs were used to establish the relative metatarsal length (RML), intermetatarsal angle (IMA), hallux valgus angle (HVA), and distal metatarsal articular angle (DMMA). A total of 69 modified Lapidus procedures were identified, with 32 included in the study. Results: The mean pre- and postoperative RMLs were −0.8 and −4.9 mm, respectively. The average RML shortening due to the procedure was −4.1 ( P < .0001). The mean pre- and postoperative IMAs were 15 and 5 degrees, respectively ( P < .0001). The mean pre- and postoperative HVAs were 33 and 9 degrees, respectively ( P < .0001). One patient reported transfer metatarsalgia, which was attributed to elevation of the first metatarsal. Conclusion: We found a statistically significant degree of shortening of the relative length of the first metatarsal without any clinically significant metatarsalgia. The low rate of transfer metatarsalgia following the modified Lapidus procedure could be attributed to the sagittal plane correction and stability obtained by performing a first tarsometatarsal fusion. Level of Evidence: Level IV, retrospective case series.

Stress at the Second Metatarsal Bone After Correction of Hammertoe and Claw Toe Deformity

2013 ◽  
Vol 103 (4) ◽  
pp. 260-273 ◽  
Author(s):  
Javier Bayod ◽  
Ricardo Becerro de Bengoa Vallejo ◽  
Marta Elena Losa Iglesias ◽  
Manuel Doblaré
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Tendon Transfer ◽  
Metatarsal Bone ◽  
Element Analysis ◽  
Claw Toe ◽  
Compressive Stresses ◽  
Second Metatarsal ◽  
Flexor Digitorum ◽  
Toe Deformity

Background: We used finite element analysis to evaluate three techniques for the correction of hammertoe and claw toe deformities: flexor digitorum longus tendon transfer (FDLT), flexor digitorum brevis tendon transfer (FDBT), and proximal interphalangeal joint arthrodesis (PIPJA). Methods: We performed a finite element analysis of FDLT and FDBT compared with PIPJA of the second toe using multislice computed tomography and 93 tomographic images of the foot obtained in a healthy 36-year-old man. Results: The PIPJA showed a significantly higher increase in traction and compressive stresses and strain at the medial aspect of the shaft of the second metatarsal bone compared with FDLT or FDBT (P &lt; .01). Mean ± SD compressive stresses increased to −4.35 ± 7.05 MPa compared with the nonsurgical foot (−3.10 ± 4.90 MPa). It can, therefore, be hypothesized that if PIPJA is used to correct the hammertoe and claw toe deformities, it could also increase traction and compressive stresses and strain in the metatarsals during running and other vigorous activities. Conclusions: There is a biomechanical advantage to performing FDLT or FDBT instead of PIPJA to surgically treat a hammertoe or claw toe deformity. In addition, tensile strain at the dorsal aspect of the second metatarsal bone when performing PIPJA increases the risk of metatarsalgia or stress fracture in patients at risk. (J Am Podiatr Med Assoc 103(4): 260–273, 2013)

scholarly journals Effects of wearing shoes on the feet

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Jin Soo Suh ◽  
Jun Young Choi
Keyword(s):  
Hallux Valgus ◽  
Valgus Deformity ◽  
Middle Aged ◽  
Hindfoot Alignment ◽  
Claw Toe ◽  
Foot Length ◽  
Hallux Valgus Deformity ◽  
Metatarsal Angle ◽  
Walking Velocity ◽  
Toe Deformity

Category: Midfoot/Forefoot Introduction/Purpose: Maasai tribe members either walk barefoot or wearing traditional shoes made from recycled car tires. Despite walking long distances (up to 60 km) daily, they do not generally experience foot ailments. We compared parameters associated with the feet, ankles, and gait of middle-aged partially and regularly shod Maasai women and Koreans. Methods: Foot length, calf circumference, hindfoot alignment, step length, cadence, and walking velocity were compared among 20 middle-aged bush-living partially shod (PS) Maasai women, urban-living regularly shod (RS) Maasai women and Korean. Static and dynamic Harris mat footprints were taken to determine forefoot pressure distribution during walking. We also compared standing foot and ankle radiographic parameters. Results: The mean ratios of foot length to the width were not significantly different among three groups. Claw toe deformity was showed highly in PS (80%) and RS (95%) Maasai women. There were no significant differences in walking velocity and Harris mat findings among the three groups. On comparing PS and RS Maasai groups radiographically, talonavicular coverage angle, talo-first metatarsal angle and naviculo-cuboidal overlap were significantly greater in the PS Maasai group, whereas hallux valgus angle, the first and second intermetatarsal angle Meary angle and the medial cuneiform height were greater in the RS Maasai group. Conclusion: Regularly wearing shoes can protect the feet from fallen medial longitudinal arches with everted hindfeet and abducted midfeet. It could also cause hallux valgus deformity. Claw toe deformity was seen frequently in the Maasai tribe regardless of shoe wearing habits.

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