Management of Hallux Valgus Deformity in Patients with 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.

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

Foot & Ankle Specialist ◽

10.1177/1938640017690441 ◽

2017 ◽

Vol 10 (6) ◽

pp. 538-542 ◽

Cited By ~ 4

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

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Intrasubject Radiographic Progression of Hallux Valgus Deformity in Patients With and Without Metatarsus Adductus: Bilateral Asymmetric Hallux Valgus Deformity

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2020.05.025 ◽

2021 ◽

Author(s):

Sung Hee Chodr ◽

Chin Youb Chung ◽

Moon Seok Park ◽

Ki Hyuk Sung ◽

Ji Hye Choi ◽

...

Keyword(s):

Hallux Valgus ◽

Radiographic Progression ◽

Valgus Deformity ◽

Hallux Valgus Deformity ◽

Metatarsus Adductus

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

Journal of the American Podiatric Medical Association ◽

10.7547/1000204 ◽

2010 ◽

Vol 100 (3) ◽

pp. 204-208 ◽

Cited By ~ 6

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)

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

Bone & Joint Open ◽

10.1302/2633-1462.23.bjo-2020-0195.r1 ◽

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.

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Natural Progression of Radiographic Indices in Juvenile Hallux Valgus Deformity

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000033 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000

Author(s):

Sangho Chun ◽

Soon-Sun Kwon ◽

Kyoung min Lee ◽

Moon Seok Park ◽

Ki Hyuk Sung ◽

...

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, Midfoot/Forefoot 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.

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