Multicenter Early Radiographic Outcomes of Triplanar Modified Lapidus Arthrodesis with Immediate Weight-Bearing

Category: Bunion Introduction/Purpose: Hallux valgus is a complex positional deformity of the first ray. Traditional correction methods for hallux valgus prioritize correction in the transverse plane based on anteroposterior (AP) radiographs. However, only addressing the transverse plane component of hallux valgus is a potential factor resulting in poor outcomes and high long-term recurrence rates ranging from 8%-78%. Recent evidence suggests that hallux valgus is a multi-planar deformity with significant contributions from the sagittal and frontal planes. The triplanar tarsometatarsal arthrodesis (modified Lapidus, Figure 1) uses a multi-planar approach to evaluate and correct the deformity associated with hallux valgus in all three anatomical planes. The purpose of this study is to investigate early radiographic outcomes and complications of triplanar tarsometatarsal (TMT) arthrodesis with immediate weight-bearing. Methods: After receiving IRB approval, radiographs and charts were retrospectively reviewed for 101 patients (age 41.9 ± 17.9 years) undergoing triplanar tarsometatarsal arthrodesis (modified Lapidus) for hallux valgus deformity correction at four institutions between June 2016 and June 2017. Patients were allowed immediate weight-bearing as tolerated after the procedure. Radiographic imaging at 4 months and 12 months was reviewed and compared to pre-operative imaging. Radiographic measures included hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position (TSP), metatarsus adductus angle, evidence of metatarsal pronation, and radiographic first TMT union. Demographics included age, gender, body mass index, medical comorbidities, and smoking status. Time (days) to weight-bearing, wearing athletic shoes, and return to full activity were also noted. Any complications were recorded. For statistical analysis, t-tests were performed for continuous variables and chi-square tests were performed for categorical variables using JMP 11.0.0 (SAS Institute Inc., Cary, NC). Results: Radiographic results demonstrated significant improvements in IMA, HVA, and TSP at final follow-up. IMA was 5.9 ± 3.2 degrees at final follow-up compared to 15.0 ± 3.1 degrees pre-operatively (p < 0.001). At final follow-up, HVA was 8.3 ± 5.5 degrees compared to 23.7 ± 10.1 degrees pre-operatively (p < 0.001). TSP was also significantly improved at final follow-up (2.0 ± 0.9) compared to pre-operatively (5.1 ± 1.2; p < 0.001). Lateral round sign was present in 5 patients (4.9%) at final follow-up compared to 88 patients (87.1%) prior to corrective surgery. Four patients (4.0%) demonstrated evidence of radiographic non-union at final follow-up. Regarding complications, there were four cases (3.9%) of hardware removal for either soft-tissue irritation or hardware failure. Conclusion: In this study, early radiographic outcomes of triplanar tarsometatarsal arthrodesis (modified Lapidus) with immediate weight-bearing were promising with low complication rates. These results demonstrate that this procedure is able to reliably achieve anatomic correction in all three planes for hallux valgus deformity. The triplanar tarsometatarsal arthrodesis technique also demonstrated high union rates and low recurrence rates at final follow-up. Longer follow-up is necessary to determine the long-term survivorship, outcomes, and complications of this new technique to correct hallux valgus deformity.

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Early Clinical Outcomes of Triplanar Modified Lapidus Arthrodesis with Immediate Weight Bearing

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00397 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0039

Author(s):

Justin Ray ◽

Jennifer Koay ◽

Robert Santrock

Keyword(s):

Clinical Outcomes ◽

Hallux Valgus ◽

Weight Bearing ◽

Valgus Deformity ◽

Recurrence Rates ◽

Full Activity ◽

Radiographic Outcomes ◽

Hallux Valgus Deformity ◽

Athletic Shoes

Category: Bunion Introduction/Purpose: There are numerous corrective procedures for hallux valgus deformity. The majority of procedures prioritize correction in the transverse plane based on anteroposterior (AP) radiographs. Long-term results demonstrate high recurrence rates ranging from 8-78% with various metatarsal osteotomy techniques. Recent evidence suggests that hallux valgus is a multi-planar deformity with significant contributions from the sagittal and frontal planes. Correction of hallux valgus at the first tarsometatarsal joint (modified Lapidus) offers a powerful method to restore anatomic alignment in all three planes and correct hallux valgus at the apex of the deformity. The purpose of this study is to investigate early clinical and radiographic outcomes and complications of triplanar tarsometatarsal (TMT) arthrodesis with immediate weight-bearing. Methods: After receiving IRB approval, charts and radiographs were retrospectively reviewed for 37 patients (30 female, age 54.8 years) undergoing triplanar tarsometatarsal (TMT) arthrodesis for hallux valgus deformity correction at our institution between June 2016 and June 2017. All patients were allowed immediate weight-bearing as tolerated in a boot walker. Radiographic imaging at 4 months and 12 months was compared to pre-operative imaging. Clinical outcomes were evaluated using the American Academy of Orthopaedic Surgeons Foot and Ankle questionnaire (AAOS FAQ), Quality of Life 12 (QOL-12), and the patient-reported outcomes measurement information system 10 (PROMIS 10). Demographics included age, gender, body mass index, and medical comorbidities. The time in days to weight-bearing, wearing athletic shoes, and return to full activity were noted. Any complications were recorded. For statistical analysis, t-tests were performed for continuous variables and chi-square tests were performed for categorical variables using JMP 11.0.0 (SAS Institute Inc., Cary, NC). Results: Although improvements were noted in the AAOS FAQ and PROMIS 10 at 3 and 6 months post-operative, these results were not significantly different compared to baseline scores (Table 1). From the time of procedure, average time to weight-bearing was 2.75 ± 7.2 days. Patients returned to wearing athletic shoes an average of 48.3 ± 12.1 days after the procedure. Return to full activity without restrictions was 130.9 ± 37.0 days from surgery. Radiographic results demonstrated significant improvement in IMA and HVA at final follow-up (p < 0.001). 35 patients (94.6%) demonstrated evidence of radiographic union by final follow-up. Regarding complications, one patient (2.7%) required hardware removal for soft-tissue irritation, and there were three cases (8.1%) of hardware failure that did not require re-operation. Conclusion: In this study, early clinical and radiographic outcomes of triplanar tarsometatarsal corrective arthrodesis (modified Lapidus) with immediate weight-bearing were promising with low complication rates. Patients were able to return to normal shoe wear approximately 7 weeks after the procedure and return to full activity a little more than 4 months after surgery. Radiographic results demonstrated high union rates, low recurrence rates, and significant improvements in HVA and IMA at final follow-up. Longer follow-up is necessary to determine the long-term radiographic and clinical outcomes of triplanar tarsometatarsal arthrodesis to correct hallux valgus deformity.

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Does the Presence of Pes Planus Deformity Increase Recurrence of Hallux Valgus Deformity Following Surgery?

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00211 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0021

Author(s):

Gavin Heyes ◽

Eric Swanton ◽

Lyndon Mason ◽

Andrew P. Molloy

Keyword(s):

Hallux Valgus ◽

Weight Bearing ◽

Valgus Deformity ◽

P Value ◽

X Rays ◽

Recurrence Rates ◽

Pes Planus ◽

Hallux Valgus Deformity ◽

Increased Risk

Category: Bunion Introduction/Purpose: Factors linked with increased risk of developing Hallux Valgus include; shod footwear, genetic factors, metatarsal morphology, ligamentous laxity and Pes Planus. With regards to Pes planus, it has been suggested that the loss of the medial longitudinal arch in Pes Planus increases Hallux plantar medial pressures and drives deformity during heel rise. There is little in the literature regarding whether Pes Planus is associated with increased recurrence rates. Given this is a potentially modifiable risk factor we believe the risk of recurrence should be studied. This paper reports the results of a retrospective study following up 183 consecutive Hallux valgus cases. The primary objective is to evaluate whether pes planus is associated with increased recurrence following treatment. Methods: Retrospective review of consecutively treated patients from 07/03/2008 to 05/12/2017. Patients were typically followed up for six to twelve months depending on any additional factors that require follow up. X-rays were performed routinely at six weeks, three months and many had x-rays at six and/or 12 months for additional pathology. We examined radiological markers including Sesamoid location (using the Hardy and Clapham Classification), Hallux Valgus Angle (HVA), Intermetatarsal Angle, Meary’s angle and Talonavicular uncovering. 183 cases were reviewed, 12 were excluded due to previously amputated second toes, Hallux Varus, revision surgery and only 6 weeks follow up. This left 171 cases of which 75 had Pes Planus (Meary’s angle < -4°). Results: Table 1 describes the preoperative HVAs we encountered and the correction achieved along with frequencies. Postoperative measurements were taken off weight bearing x-rays. The incidence of recurrent HVA > 15° was significantly higher in those with Meary’s angle < - 4° (Chi-Sq 22.6 P-value 0.000002). Those with a Meary’s angle -20° to -10° had a significantly higher rate of recurrence than ones measuring -10° to -4° (Chi-Sq 9.7 P-value 0.0018 There was no difference in progression of recurrent deformity between those initially corrected to HVA < 15° (Chi-Sq 0.26 P- value 0.61) and those not. Multiple regression analysis revealed there was no meaningful association with sesamoid location or pes planus with recurrence of Hallux Valgus deformity. Conclusion: Our results demonstrate a link between Preoperative Pes Planus deformity and increased recurrence rates of Hallux Valgus deformity following surgery. Consideration of correction of pes planus and appropriate consent of recurrence rates should therefore be undertaken in treatment of hallux valgus in the presence of pes planus

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Modified Chevron Osteotomy for Hallux Valgus

Foot & Ankle International ◽

10.1177/107110079401501202 ◽

1994 ◽

Vol 15 (12) ◽

pp. 642-645 ◽

Cited By ~ 64

Author(s):

Richard E. Donnelly ◽

Charles L. Saltzman ◽

Todd A. Kile ◽

Kenneth A. Johnson

Keyword(s):

Hallux Valgus ◽

Screw Fixation ◽

Valgus Deformity ◽

Chevron Osteotomy ◽

Hallux Valgus Deformity ◽

Long Term Follow Up ◽

Reliable Procedure ◽

Shoe Wear

The chevron osteotomy for hallux valgus was modified by addition of screw fixation and change of the osteotomy angle. Thirty-six patients underwent this modified osteotomy. All had mild to moderate symptomatic hallux valgus deformities. No other forefoot procedures were performed. Standing radiographs were taken before surgery, at 1 month after surgery, and, for the 15 patients who returned for long-term follow-up, at 1 year or more after surgery. Overall, 35/42 procedures were rated as satisfactory without reservations and 7 were rated as satisfactory with mild reservations. All patients stated that they had some improvement in their preoperative symptoms, which included pain, cosmetic concerns, and shoe wear difficulties. Radiographically, none of the capital fragments displaced and there were no malunions, nonunions, nor evidence of avascular necrosis. The average metatarsophalangeal-1 angle improved 8° and the average intermetatarsal 1–2 angle improved 4°. This modification is relatively simple, increases stability, and allows early weightbearing. In our experience, the modified chevron osteotomy has been a very reliable procedure for mild to moderate symptomatic hallux valgus deformity.

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Percutaneous Chevron Akin (Peca) Osteotomy for Treatment of Hallux Valgus Deformity: The Long- Term Results

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00074 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0007

Author(s):

Peter W. Robinson ◽

Robbie Ray ◽

Thomas A. Goff ◽

Paul M. Dearden ◽

Clare Watt ◽

...

Keyword(s):

Hallux Valgus ◽

Weight Bearing ◽

Patient Reported Outcome Measures ◽

Long Term Results ◽

Consecutive Series ◽

Satisfaction Scale ◽

Hallux Valgus Deformity ◽

Patient Reported

Category: Bunion Introduction/Purpose: Little is known about the long-term results of percutaneous hallux valgus correction, particularly the recurrence rate and factors leading to recurrence. Methods: We retrospectively reviewed a single surgeon consecutive series of percutaneous chevron and akin osteotomies (PECA) performed between 2012-14 on 127 feet in 86 patients. Mean age was 52+-13 years at surgery and mean follow up (FU) was 69+-7 months. Patient reported outcome measures (PROMs) were completed by 65 patients (MOXFQ, VAS pain (0-100)) and Likert satisfaction scale by 86 patients. Pre-operative, 6 month and final follow up weight bearing radiographs were available for 68 feet. Radiological parameters measured were the hallux valgus angle (HVA) and 1-2 intermetatarsal angle (IMA). The data was normally distributed and presented as mean+-SD. Paired t-test was used to compare pre- and post-operative angles. Ordinal logistic regression was used to test for significant dependent variables on PROMs. Results: Mean MOXFQ was 10+-16 and mean VAS pain was 6+-13 out of 100 at a mean FU of 69+-7 months. 99% (85/86) patients were highly satisfied or satisfied. Mean HVA improved from 28.3+-8.1º to 8.4+-5.6º at final FU (p<0.001). No clinically relevant difference in HVA was seen between 6 months and final FU. Mean IMA improved from 12.7+-2.9º to 6.2+-2.7º at final FU (p<0.001). 2.9% (2/68) had an HVA >20º at final FU, these both started with a pre-operative HVA >40°. Pre-operative HVA >40º was significantly more likely to have an HVA >20º at final FU than those with pre-operative HVA <40º (22% vs 0%, p<0.001). There were 5 re-operations for removal of screws. 1 foot had hallux varus, but was still satisfied. Conclusion: The 5 year results for PECA hallux valgus correction show high levels of patient satisfaction, function and pain relief, with low complication and re-operation rates. Radiological correction is maintained at long term FU.

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Radiographic Measurements Associated with the Natural Progression of the Hallux Valgus Deformity during at Least Two Years of Follow-up

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000255 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002 ◽

Cited By ~ 1

Author(s):

Kyoung Min Lee ◽

Seung Yeol Lee ◽

Sonya Ahmed ◽

Byung Chae Cho ◽

Moon Seok Park ◽

...

Keyword(s):

Hallux Valgus ◽

Weight Bearing ◽

Binary Logistic Regression ◽

Valgus Deformity ◽

Binary Logistic Regression Analysis ◽

First Metatarsal ◽

Hallux Valgus Deformity ◽

Metatarsal Angle ◽

Radiographic Measurements

Category: Bunion Introduction/Purpose: There have been few longitudinal studies regarding hallux valgus deformity. This retrospective study aimed to investigate the radiographic measurements associated with the progression of hallux valgus deformity during at least two years of follow-up. Methods: Seventy adult patients (mean age, 58.0 years; standard deviation [SD], 12.3 years; 13 males and 57 females) with hallux valgus who were followed-up for at least two years and underwent weight-bearing foot radiography were included. Radiographic measurements included the hallux valgus angle (HVA), hallux interphalangeal angle, intermetatarsal angle (IMA), metatarsus adductus angle, distal metatarsal articular angle (DMAA), tibial sesamoid position, anteroposterior (AP) talo-first metatarsal angle, and lateral talo-first metatarsal angle. Progression of hallux valgus deformity was defined as an increase of 5 degrees or more in the HVA during follow-up. Patients were divided into progressive and non-progressive groups. Binary logistic regression analysis was performed to identify factors that significantly affect the progression of hallux valgus deformity. The correlation between change in HVA and changes in other radiographic indices during follow-up was analyzed. Results: Eighteen out of 70 patients showed progression of 5 degrees or more in the HVA during the mean follow-up of 47.0 months (SD, 19.8 months). The DMAA (p=0.027) and AP talo-first metatarsal angle (p=0.034) at initial presentation were found to be significant factors affecting the progression of hallux valgus deformity. Change in the HVA during follow-up was significantly correlated with changes in the IMA (r=0.423; p=0.001) and DMAA (r=0.541; p<0.001). Conclusion: Special attention needs to be given to patients with pes planovalgus and increased DMAA during follow-up. Change in HVA was significantly correlated with changes in IMA and DMAA. Therefore, progression of hallux valgus deformity is considered to be closely related to the progressive instability of the first tarsometatarsal joint.

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Long-term clinical outcomes of scarf osteotomy in regional hospital Hong Kong

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/2210491719881768 ◽

2019 ◽

Vol 27 (1) ◽

pp. 28-32

Author(s):

Ng Weng-Io ◽

Chan Kwok-Bill ◽

Yeung Yuk-Nam

Keyword(s):

Hong Kong ◽

Clinical Outcomes ◽

Hallux Valgus ◽

Recurrence Rate ◽

Weight Bearing ◽

Symptom Control ◽

Scarf Osteotomy ◽

Hallux Valgus Deformity

Background: Lack of local data concerning the long-term clinical outcomes of scarf osteotomy in Hong Kong. Methods: This is a retrospective review of 75 patients (88 feet) who underwent scarf osteotomy with a mean follow-up of 94.20 months (60–144 months). Clinical ratings were based on visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) scale. Weight-bearing radiographs were used to perform angular measurements: (i) hallux valgus angle (HVA), (ii) intermetatarsal angle, (iii) distal metatarsal articular angle, and (iv) tibial sesamoid position before operation and at the time of latest follow-up. Results: The mean overall AOFAS scales improved from 29.66 (5–49) points preoperatively to 86.83 (39–100) points at the time of final follow-up. The VAS improved from 6.61 (5 to 9) to 0.66 (0 to 4). The average HVA correction was 25.42 (8–46). The 8- to10-year recurrence rate (HVA > 20) was 31.80%. A higher degree of preoperative HVA predicts higher recurrence rate. Conclusion: Scarf osteotomy is an effective procedure for symptom control and improvement in radiological parameters for hallux valgus deformity. However, recurrence rate is relatively high.

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Combination of Modified Scarf Osteotomy and Metatarsal Shortening Offset Osteotomy for Rheumatoid Forefoot Deformity

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph181910473 ◽

2021 ◽

Vol 18 (19) ◽

pp. 10473

Author(s):

Yuki Etani ◽

Makoto Hirao ◽

Kosuke Ebina ◽

Takaaki Noguchi ◽

Gensuke Okamura ◽

...

Keyword(s):

Hallux Valgus ◽

Surgical Procedures ◽

Weight Bearing ◽

Varus Deformity ◽

Valgus Deformity ◽

Great Toe ◽

Forefoot Deformity ◽

Scarf Osteotomy ◽

Hallux Valgus Deformity

With the progress of medical treatment for rheumatoid arthritis (RA), several joint-preserving forefoot surgical procedures have been established and performed. In this situation, we have been choosing the combined surgery: modified scarf osteotomy for the great toe and metatarsal shortening offset osteotomy for the lesser toes in RA cases. A retrospective observational study of 53 RA patients (mean follow-up period: 4.6 years) who underwent the surgery was completed. RA foot ankle scores were assessed, using the Japanese Society for Surgery of the Foot (JSSF) standard rating system, and a self-administered foot evaluation questionnaire (SAFE-Q) was also checked to evaluate clinical outcomes. For radiological evaluations, deformity parameters were measured using radiographs of the feet with weight-bearing. JSSF hallux and lesser toes scores and the SAFE-Q score showed significant improvement in all indices. HVA, M1-M2A, M1-M5A, M2-M5A, and sesamoid position were significantly improved after surgery. At the final follow-up, the hallux valgus deformity had recurred in 4 feet (7.5%), and hallux varus deformity had developed in 8 feet (15.1%). No case of recurrent hallux valgus deformity required revision surgery. Recurrence of dorsal dislocation/subluxation of the lesser toe MTP joint was seen in 6 feet (11.3%) after surgery. A combination of modified scarf osteotomy for the great toe and modified metatarsal shortening offset osteotomy for the lesser toes is one of the novel surgical procedures for rheumatoid forefoot deformity. Preoperative disease activity of RA negatively affected the clinical score of the hallux. The spread of M2-M5A was a risk factor for resubluxation of the lesser toe MTP joint.

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Radiologic Recurrence of Hallux Valgus Deformity after Scarf and Akin Osteotomy in Patients with High Distal Metatarsal Articular Angle

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00415 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0041

Author(s):

Jae Wan Suh ◽

Seung-Gwan Park ◽

Sung Hyun Kim ◽

Hyun-Woo Park

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Hallux Valgus ◽

Weight Bearing ◽

Valgus Deformity ◽

Fisher Exact Test ◽

Hallux Valgus Deformity ◽

Akin Osteotomy ◽

Risk Factors For Recurrence

Category: Bunion Introduction/Purpose: The most frequent complication after hallux valgus corrective surgery is recurrence of deformity. Many factors have been identified previously as risk factors for recurrence. Especially, inadequate correction of the distal metatarsal articular angle (DMAA) has been reported one of the surgical risk factors for recurrence. This study aimed to investigate the recurrence rate after hallux valgus correction using Scarf and Akin osteotomy and to identify the significance of postoperative DMAA as a risk factor of recurrence. Methods: We reviewed 87 hallux valgus patients (122 feet) who received Scarf and Akin osteotomy from January 2007 to August 2015. Clinical outcomes were evaluated using VAS and the AOFAS score. Radiological outcome measures included hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA) in serial weight bearing radiograph. Recurrence was defined as more than 20 degrees of HVA in final follow-up radiograph. Radiological factors associated with recurrence including high DMAA were evaluated and analyzed. Results: Mean follow-up duration was 20.6 months (range, 12.0-46.5 months) and mean age was 44 years (13-80 years). The VAS and AOFAS scores were significantly improved at the final follow-up (7.0 to 2.0, p<0.001, 78.0 to 92.0, p<0.001). Significant corrections in the HVA, IMA and DMAA were obtained(p<0.001). Eleven (9.0%, 11/122) cases recurred hallux valgus deformity. Postoperative IMA, DMAA and HVA showed significant moderate to strong correlation with HVA at final follow-up (rho: Spearman correlation coefficient, 0.42, 0.71, 0.87, p<0.001). There was no recurrence in cases of postoperative DMAA less than 11.3 degree (fisher exact test, p<0.001). Conclusion: High DMAA is one of numerous risk factor for hallux valgus recurrence after scarf and akin osteotomy. To avoid recurrence, we suggest that surgical correctional goal of DMAA should be considered less than 11.3 degrees.

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A Novel Technique for Moderate Hallux Valgus Correction: The BC Osteotomy

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00397 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0039

Author(s):

Gaston Slullitel ◽

Juan Pablo Calvi ◽

Victoria Alvarez ◽

Laura Gaitan ◽

Valeria Lopez

Keyword(s):

Hallux Valgus ◽

Weight Bearing ◽

Metatarsophalangeal Joint ◽

Valgus Deformity ◽

Invasive Technique ◽

First Metatarsophalangeal Joint ◽

Hallux Valgus Deformity ◽

Surgical Methods ◽

The Mean

Category: Bunion Introduction/Purpose: Surgical correction of hallux valgus rebalances the first ray, correcting the various features of the deformity. While several surgical methods are available, consensus regarding the best management has yet to be established. In the last decades, there was an increasing interest in mini-invasive procedures. In this scenario the Bosch technique appears to be a reproducible DMO to achieve proper correction. Theoretically, it allows for fast and safe correction of the deformity, however it was criticized for its unstable nature. We describe a new distal metatarsal osteotomy (DMO) that it is a combination of the (traditional) chevron and the (mini-invasive) Bosch-SERI techniques. The purpose of this investigation is to describe the surgical technique and report the results of this modified procedure at a minimum 2-year follow-up. Methods: Between January 2016 and June 2018, 63 consecutive patients, with mild to moderate hallux valgus deformity underwent corrective surgery using the BC technique. Preoperatively, each patient’s data was recorded and all patients underwent an assessment of functional limitation and pain level as well as a physical examination that included measurement of the passive range of motion of the first metatarsophalangeal joint. At final follow up, the patients were assessed using the American Orthopaedic Foot & Ankle Society’s (AOFAS) hallux- metatarsophalangeal and interphalangeal scale. Additionally, patients were asked to rate their satisfaction with regard to the overall result of the operation according to the Coughlin overall satisfaction scale. Anteroposterior and lateral weight-bearing radiographs were made preoperatively as well as at the short-term and intermediate-term follow-up evaluations. The HVA, the first IMA, and the congruency of the first metatarsophalangeal joint were measured with the technique recommended by the AOFAS. Results: BC osteotomy was performed in 62 patients, including 33 right feet and 29 left feet, with no bilateral procedures. The patient population consisted of 50 females (79%), with an average age of 50.4 years (range 19 to 75) years. The mean follow-up time was 36.5 months (range 23 to 59). The mean AOFAS score improved from 69.3 preoperatively to 88 postoperatively (p<0.001). IMA and HVA pre and postoperative improved from a median of 30.7 degrees to 11.1 degrees for HVA and 13.9 degrees to 6.5 degrees for the IMA (p<0.001). 82.5% of patients were very satisfied / satisfied with the procedure. There were no cases of infection, however we observed two cases of complex regional pain syndrome and two screws that required removal. Conclusion: We believe this osteotomy has a number of advantages: (1) one mini-invasive approach is used; (2) a large correction can be obtained in all directions including the frontal and sagittal planes; (3) blood supply to the metatarsal head is preserved; and (4) intrinsically stable OT, allowing immediate full weight bearing. The merge, of percutaneous techniques and classic stable fixed approach may seems to offer a stable, effective and reproducible correction of hallux valgus deformity with the advantages of a minimally-invasive technique

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Outcomes after Rotation Scarf with Akin Osteotomy for Severe Hallux Valgus

10.21203/rs.3.rs-733306/v1 ◽

2021 ◽

Author(s):

Wenyong Xie ◽

Hao Lu ◽

Guicheng Li ◽

Yusong Yuan ◽

Yijun Liu ◽

...

Keyword(s):

Hallux Valgus ◽

Valgus Deformity ◽

Optimal Choice ◽

Foot Deformities ◽

Hallux Valgus Deformity ◽

Valgus Angle ◽

Akin Osteotomy ◽

Severe Hallux Valgus

Abstract Background: Hallux valgus is one of the most common foot deformities. Surgical treatment is the optimal choice for moderate to severe hallux valgus deformity. Rotation scarf with Akin osteotomy has become increasingly popular. The purpose of our study is to evaluate the long-term outcomes of rotation scarf with Akin osteotomy on severe hallux valgus. Methods: We conducted a retrospective study of patients with hallux valgus who underwent surgery using rotation scarf with Akin osteotomy in our hospital between June 2014 and January 2020. Anteroposterior and lateral weightbearing X-ray were performed before and after the operation. The parameters evaluated include (1) the hallux valgus angle (HVA), (2) intermetatarsal angle (IMA), (3) distal metatarsal articular angle (DMAA) and (4) tibial sesamoid position (TSP). A visual analog scale (VAS) was used to evaluate the pain level before and at the last follow-up after the operation. American Orthopaedic Foot & Ankle Society (AOFAS) Forefoot Score were assessed before and at the last follow-up after the operation. Patient satisfaction assessment was also conducted at the time. Results: A total of 42 patients with 50 feet met our inclusion criteria. Average age at the time of surgery was 61 ± 9 years. Follow-up data were obtained in all 42 patients. The average follow-up time was 47.4 ± 20 months. All radiological parameteres including HVA, IMA, DMAA and TSP had statistically significant improvement (p < 0.001). The VAS score and AOFAS score was also statistically significant before operation and at the last follow-up after the operation (p < 0.001). There are 41 (82%) feet in patients were very satisfied or satisfied. Conclusion: Rotation scarf with Akin osteotomy is demonstrated to be safe, effective, and feasible for correcting severe hallux valgus. It can obtain good long-term correction with a low incidence of recurrence and metatarsalgia. Postoperative satisfaction and functional recovery of patients are significantly improved.

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