scholarly journals The Influence of Patient Factors on the Outcome of Synthetic Cartilage Implant Hemiarthroplasty versus First Metatarsophalangeal Joint Arthrodesis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Andrew Goldberg ◽  
Mark Glazebrook ◽  
Timothy Daniels ◽  
Gwyneth de Vries ◽  
M. Elizabeth Pedersen ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Clinical Success ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Success Rates ◽  
Preoperative Pain ◽  
Duration Of Symptoms ◽  
First Metatarsophalangeal Joint ◽  
Valgus Angle ◽  
The Impact

Category: Midfoot/Forefoot Introduction/Purpose: Many studies have compared the outcomes of MTPJ1 hemiarthroplasty and arthrodesis, but there is a paucity of data on the influence of patient factors on clinical outcomes. A prior prospective, randomized, clinical trial compared the efficacy and safety of first metatarsophalangeal joint (MTPJ1) hemiarthroplasty with a synthetic polyvinyl alcohol hydrogel implant (Cartiva®) and MTPJ1 arthrodesis for moderate to severe hallux rigidus. The current study evaluated the data from this clinical trial to determine the impact of numerous patient variables, including osteoarthritis grade, hallux valgus angle, preoperative range of motion (ROM), gender, body mass index (BMI), preoperative duration of symptoms, and preoperative pain level, on the success or failure of MTPJ1 hemiarthroplasty and arthrodesis. Methods: Patients =18 years diagnosed with hallux rigidus grade 2, 3, or 4 were randomized and treated with synthetic cartilage implant MTPJ1 hemiarthroplasty (n=129) or arthrodesis (n=47). Outcome measures included a pain visual analogue scale (VAS), Foot and Ankle Ability Measure (FAAM) Sports and Activities of Daily Living (ADL) scores, and Short Form-36 Physical Functioning (SF-36 PF) subscore, obtained preoperatively and at 2, 6, 12, 24, 52 and 104 weeks postoperatively. Great toe active dorsiflexion motion, secondary procedures, radiographs and safety parameters were evaluated. A patient’s outcome was deemed successful if composite primary endpoint criteria for clinical success (pain, function and safety) were met at 24 months. Predictor variables included: osteoarthritis grade; hallux valgus angle; preoperative ROM; gender; body mass index (BMI); preoperative symptom duration; prior surgery; and preoperative pain level. Two-sided Fisher’s Exact test was used to assess the impact of these variables on success of surgery (p<0.05). Results: Standard patient demographics and baseline outcome measures were similar for both groups; both procedures demonstrated equivalent pain relief and functional outcomes.1 There was no significant difference (p>0.05) in success rates (i.e., VAS pain reduction ≥ 30%, maintenance/improvement in function, freedom from radiographic complications, and no secondary surgical intervention) between synthetic cartilage implant MTPJ1 hemiarthroplasty and arthrodesis when stratified by osteoarthritis grade, degree of preoperative hallux valgus, extent of preoperative ROM, gender, BMI, duration of symptoms, prior MTPJ1 surgery status, and preoperative pain VAS score (Table 1). Notably, patients with minimal ROM and mild hallux valgus had equivalent success rates for both procedures. Males tended to have greater clinical success with implant hemiarthroplasty versus arthrodesis, but this difference was not statistically significant. 1Baumhauer et al., FAI, 2016;37(5):457-69. Conclusion: Synthetic cartilage implant hemiarthroplasty is an appropriate treatment for patients with hallux rigidus of Coughlin grade 2, 3 or 4. Its results in those with associated mild hallux valgus (<20 degrees) and in those with a high degree of preoperative stiffness are equivalent to MTPJ1 fusion, irrespective of gender, BMI, osteoarthritis grade, or preoperative pain or duration of symptoms, in contrast to what might have been expected.

Correlation analysis of the x-ray and functional parameters from the results of chevron (Austin) osteotomy for hallux valgus

2020 ◽  
pp. 54-63
Author(s):  
Ruslan Khairutdinov ◽  
Timur Minasov ◽  
Ekaterina Yakupova ◽  
Elvina Mukhametzyanova
Keyword(s):  
Hallux Valgus ◽  
Rating Scale ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
First Metatarsophalangeal Joint ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
The Right ◽  
Bone Structures

Hallux valgus is characterized by the appearance and growth of a painful “lump” in the region of the first metatarsophalangeal joint, the development of forefoot corns, and inability to choose the right shoes, which leads to a significant decrease in the quality of life of these patients. Corrective osteotomies that preserve the metatarsophalangeal joint, for example Austin (Chevron) osteotomy, are usually used for hallux valgus deformity of the I, II degrees. Radiography with the study of the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA) is a research method that shows the true correlation between bone structures. The correlation between the radiological and functional indicators of osteotomy allows us to determine possible recommendations for indications for surgical treatment of Hallux valgus. Correlation shows that the largest correction of hallux valgus in older patients occurs due to a small adjustment of the angle of DMMA and HVA. IMA had the best correction after Austin osteotomy among patients of a younger age, then the HVA, and the DMMA had minimum correction according to the AOFAS rating scale (Kitaoka). The revealed correlations allow us to determine the correct tactics for the treatment of hallux valgus by identifying the benefits of Austin osteotomy.

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 The impact of functional excess of footwear on the foot shape of 7-year-old girls and boys

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e11277
Author(s):  
Ewa Puszczalowska-Lizis ◽  
Aleksandra Lukasiewicz ◽  
Sabina Lizis ◽  
Jaroslaw Omorczyk
Keyword(s):  
Regression Analysis ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Rank Test ◽  
Chi Square ◽  
First Metatarsophalangeal Joint ◽  
Longitudinal Arch ◽  
Transverse Arch ◽  
The Right ◽  
The Impact

Background Properly fitted shoes can support the development of growing feet and prevent problems and pathologies, not only in childhood, but also in adulthood. This points to the need to conduct research on the impact of shoe fitting on the structure of the foot in order to raise awareness and importance of this problem, to enable proper decisions regarding the purchase and use of shoes. The aim of this study was to analyze indoor footwear fit and its impact on foot structure in 7-year-old schoolchildren. Methods The CQ-ST podoscope and the Clevermess device were used for measurements. The analysis was carried out using the Mann Whitney U test, Wilcoxon signed-rank test, Chi-square test, regression analysis. Results About 40% of girls and boys had shoes that were incorrectly fitted in length, while as many as 74% of girls and 66% of boys wore shoes that were incorrectly fitted in width. Regression analysis demonstrated a statistically significant influence of the footwear length on longitudinal arch of the right and left foot and the transverse arch of the right foot. In boys, the length of the shoes shows associations with the right and left hallux valgus angle. Conclusion A significant percentage of the studied 7-year-olds, regardless of gender, wears inappropriately fitted shoes. In both sexes, the length of the footwear influenced the longitudinal arch of the right and left foot and the transverse arch of the right foot. Due to the deformity of the first metatarsophalangeal joint, the boys with hallux valgus require footwear which is wider and therefore their shoes need to be bigger in size.

scholarly journals Sesamoid malalignment in hallux valgus: Radiographic and MRI measurements and their correlation with internal derangement findings of the first metatarsophalangeal joint

2019 ◽  
Vol 92 (1100) ◽  
pp. 20190038
Author(s):  
Justin Skweres ◽  
Avneesh Chhabra ◽  
Jed Hummel ◽  
Nathan Heineman ◽  
Riham Dessouky ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Rotation Angle ◽  
Metatarsophalangeal Joint ◽  
Preoperative Assessment ◽  
X Rays ◽  
First Metatarsophalangeal Joint ◽  
Valgus Angle ◽  
Internal Joint ◽  
Reader Reliability ◽  
Mri Measurements

Objective: Sesamoid displacement (SD) and rotation are important components in the preoperative assessment of hallux valgus (HV). To date, Inter reader reliability (IRR) of SD on X-rays and MRI, correlations with hallux valgus angle (HVA), and qualitative changes of the hallux-sesamoid complex (HSC) on MRI have not been studied. The aim of this study was to correlate sesamoid malalignment with HV severity and findings of internal joint derangement. Methods: Two readers analyzed a series of 56 consecutive patients who had X-rays and MRI performed on the same foot within 3 months of each other. Multiple measures of SD on X-rays and MRI and the sesamoid rotation angle (SRA) on MRI were assessed and correlated with HVA and various qualitative features at the HSC including cartilage, plantar plate, and collateral ligament abnormalities. Results: We found excellent IRR (ICC = 0.79 – 0.99) for SRA on MR, but poor IRR for lateral sesamoid displacement (LDS) and tibial sesamoid position (TSP) scales on both modalities. Good IRR was also seen for morphologic abnormalities of HSC. The absolute value of the SRA on MR positively correlated with HVA ( p < 0.0001). LDS and TSP on both modalities lacked a significant correlation with HVA ( p > 0.05). No correlation was found between any measure of SD or rotation with HSC morphologic changes ( p > 0.05). Conclusion: Among different measures of sesamoid malalignment, sesamoid rotation angle measured on MRI can be used to judge the severity of HV; however, it does not correlate with qualitative morphologic abnormalities of the HSC. Advances in knowledge: The MRI measurement of SRA is a better indicator of sesamoid displacement relative to the HSC than standard AP radiographic measures of non-rotational sesamoid displacement; however, it should not be used to predict qualitative morphologic abnormalities of the HSC.

Silastic Ball Spacer Arthroplasty in the Management of Hallux Valgus and Hallux Rigidus

Foot & Ankle ◽  
1989 ◽  
Vol 10 (2) ◽  
pp. 61-64 ◽  
Author(s):  
N. S. Broughton ◽  
A. Doran ◽  
B. F. Meggitt
Keyword(s):  
Hallux Valgus ◽  
Young Patients ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
New Bone Formation ◽  
Great Toe ◽  
First Metatarsophalangeal Joint ◽  
Proximal Migration ◽  
Original Concept

Sixty-two feet in 39 patients who were treated by insertion of a silastic ball spacer prosthesis into the first metatarsophalangeal joint for hallux valgus or hallux rigidus have been reviewed with a follow-up time of between 2 and 6 years. Twenty-one results (34%) were excellent, 27 (43%) were fair, 13 (21%) were poor, and one was revised. Seventeen feet (27%) had some metatarsalgia at followup. Results were disappointing in the young patients; in 19 cases of hallux valgus under the age of 45, 8 were either poor or had been revised. The original concept of the silastic ball spacer was to maintain great toe length and prevent proximal migration of the sesamoids. However 60% of these feet showed settling of the prosthesis or new bone formation around the prosthesis and 54% had more than 2 mm proximal migration of the sesamoid bones. The symptomatic results in these patients were similar to those in whom great toe length had been successfully maintained. The silastic ball spacer infrequently achieves its aims, however maintenance of hallux length does not seem to be important in the symptomatic result.

scholarly journals Effect of Displacement Degree of Distal Chevron Osteotomy on Metatarsal Stress: A Finite Element Method

Biology ◽  
2022 ◽  
Vol 11 (1) ◽  
pp. 127
Author(s):  
Qiaolin Zhang ◽  
Yan Zhang ◽  
Jialu Huang ◽  
Ee Chon Teo ◽  
Yaodong Gu
Keyword(s):  
Finite Element ◽  
Soft Tissue ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Plantar Fascia ◽  
First Metatarsophalangeal Joint ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Chevron Osteotomy ◽  
Valgus Angle

Background: The stress of foot bone can effectively evaluate the functional damage caused by foot deformity and the results of operation. In this study, the finite element method was used to investigate the degree of displacement of distal chevron osteotomy on metatarsal stress and metatarsophalangeal joint load; Methods: Four finite element models of displacement were established by using the CT images of a patient with moderate hallux valgus (hallux valgus angle and intermetatarsal angle were 26.74° and 14.09°, respectively), and the validity of the model was verified. Each finite element model consisted of bones and various cartilage structures, ligaments, and plantar fascia, as well as encapsulated soft tissue. Except for soft tissue, the material properties of other parts were isotropic linear elastic material, and the encapsulated soft tissue was set as nonlinear hyperelastic material. The mesh was tetrahedral mesh. Link elements were used in ligament and plantar fascia. A ground reaction force with a half-body weight was applied at the bottom of the floor to simulate the ground reaction when standing. The upper surfaces of the encapsulated soft tissue, distal tibia, and distal fibula were fixed. The stress distribution of metatarsals and the stress of cartilage of the first metatarsophalangeal joint were compared and analyzed; Results: Compared with the hallux valgus without osteotomy, the stress of the first metatarsals and second metatarsals of 2–4 mm decreased, and the stress of the interarticular cartilage of the first metatarsophalangeal joint with 4 mm was reduced. In the case of 6 mm, the stress value between the first metatarsal and the first metatarsophalangeal joint increased, and 4 mm was the most suitable distance; Conclusions: Compared with the hallux valgus without osteotomy, the stress of the first metatarsals and second metatarsals of 2–4 mm decreased, and the stress of the interarticular cartilage of the first metatarsophalangeal joint with 4 mm was reduced. In the case of 6 mm, the stress value between the first metatarsal and the first metatarsophalangeal joint increased, and 4 mm was the most suitable distance. For the degree of displacement of the distal chevron osteotomy, the postoperative stability and the stress distribution of metatarsal bone should be considered. Factors such as hallux valgus angle, intermetatarsal angle, patient’s age, body weight, and metatarsal width should be considered comprehensively. The factors affecting osteotomy need to be further explored. The degree of displacement of osteotomy can be evaluated by FE method before the operation, and the most suitable distance can be obtained.

Do Postoperative Hallux Angles Correlate With Outcome in MP1 Fusion? Our Experience With 71 Cases

2018 ◽  
Vol 11 (6) ◽  
pp. 500-506 ◽  
Author(s):  
Xavier Paredes-Carnero ◽  
Antonio María Fernández-Cebrián ◽  
Silvia Villardefrancos-Gil
Keyword(s):  
Clinical Outcomes ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Good Alternative ◽  
Hallux Rigidus ◽  
Hallux Valgus Angle ◽  
Aofas Score ◽  
Score Improvement ◽  
Valgus Angle ◽  
American Orthopaedic

Purpose: To determine if the postoperative alignment of the hallux influences the final clinical outcome of hallux metatarsophalangeal joint (first MTPJ) arthrodesis. Methods: A total of 71 consecutive cases (hallux rigidus) were studied in stages 3 and 4. They were operated through arthrodesis between 2008 and 2014. The follow-up mean was 7.3 years. The AOFAS (American Orthopaedic Foot and Ankle Society) test was performed preintervention and per annum. In radiology, both the hallux valgus angle and the dorsiflexion angle of the first MTPJ were studied. Furthermore, clinical outcomes were evaluated according to the type of implant used. Results: Preoperative AOFAS score was 27.5, rising to 91.3 after the intervention ( P < .01). The improvement test average was 63.6. There were 17 local complications (23%), 7 of them were considered to be major complications (9%), 6 of which needed reoperation (8.5%). The dorsiflexion angle postoperative mean was 21.7°. The hallux valgus angle postoperative mean was 10.9°. No correlations between both angles, and improved AOFAS score or complications ( P > .4 and P > .5, respectively), were found. Patients who had a dorsiflexion angle higher than 20° had greater improvement in the AOFAS score compared with those who had angles lower than 20° (64.5 vs 59.6 points). Nevertheless, this result was not statistically significant ( P = .059). No differences in AOFAS score improvement regarding arthrodesis plate ( P > .1) were found. Conclusion: First MTPJ arthrodesis is a good alternative for patients in advanced hallux rigidus stages when conservative treatment fails. We could not confirm if a better postoperative alignment may influence in clinical outcomes. However, better results are obtained with dorsiflexion angle greater than 20° than with those with less than 20°. Likewise, any differences between the 2 arthrodesis plates have been able to confirm. Levels of Evidence: Level III: Retrospective cohort study

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