Effect on Foot Width With Triplanar Tarsometatarsal Arthrodesis for Hallux Valgus

Background: Foot width reduction is a desirable cosmetic and functional outcome for patients with hallux valgus. Triplanar first tarsometatarsal (TMT) arthrodesis could achieve this goal by 3-dimensional correction of the deformity. The aim of this study was to evaluate changes in bony and soft tissue width in patients undergoing triplanar first TMT arthrodesis. Methods: After receiving Institutional Review Board approval, charts were retrospectively reviewed for patients undergoing triplanar first TMT arthrodesis for hallux valgus at 4 institutions between 2016 and 2019. Patients who underwent concomitant first metatarsal head osteotomies (eg, Silver or Chevron) or fifth metatarsal osteotomies were excluded. Preoperative and postoperative anteroposterior weightbearing radiographs were compared to evaluate for changes in bony and soft tissue width. One hundred forty-eight feet from 144 patients (48.1 ± 15.7 years, 92.5% female) met inclusion criteria. Results: Preoperative osseous foot width was 96.2 mm, compared to 85.8 mm postoperatively ( P < .001). Preoperative soft tissue width was 106.6 mm, compared to 99.3 mm postoperatively ( P < .001). Postoperatively, patients had an average 10.4 ± 4.0 mm reduction (10.8% reduction) in osseous width and average 7.3 ± 4.0 mm reduction (6.8% reduction) in soft tissue width. Conclusions: Triplanar first TMT arthrodesis reduced both osseous and soft tissue foot width, providing a desirable cosmetic and functional outcome for patients with hallux valgus. Future studies are needed to determine if patient satisfaction and outcome measures correlate with reductions in foot width. Level of evidence: Level III, retrospective comparative study

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Reduction of Foot Width with Triplanar Tarsometatarsal Arthrodesis for Hallux Valgus Deformity: A Multicenter Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00474 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0047

Author(s):

Justin Vaida ◽

Justin J. Ray ◽

Taylor L. Shackleford ◽

William T. DeCarbo ◽

Daniel J. Hatch ◽

...

Keyword(s):

Soft Tissue ◽

Functional Outcome ◽

Hallux Valgus ◽

Three Dimensional ◽

Metatarsal Head ◽

Valgus Deformity ◽

Inclusion Criteria ◽

First Metatarsal ◽

Hallux Valgus Deformity ◽

Width Reduction

Category: Bunion; Hindfoot Introduction/Purpose: Foot width reduction is a desirable cosmetic and functional outcome for patients with hallux valgus. Triplanar tarsometatarsal (TMT) arthrodesis achieves this by three-dimensional correction of the deformity. The aim of this study was to evaluate changes in bony and soft tissue width in patients undergoing triplanar TMT arthrodesis. Methods: After receiving IRB approval, charts were retrospectively reviewed for patients undergoing triplanar TMT arthrodesis for hallux valgus deformity at four institutions between 2016 and 2019. Patients who underwent concomitant first metatarsal head osteotomies (e.g., Silver or Chevron) or fifth metatarsal osteotomies were excluded. Preoperative and postoperative anteroposterior weightbearing radiographs were compared to evaluate for changes in bony and soft tissue width. Bony width was defined as the distance from the most medial aspect of the first metatarsal head to the most lateral aspect of the fifth metatarsal head. Soft tissue width was defined as the distance from the most medial soft tissue overlying the first metatarsal head to the most lateral soft tissue overlying the fifth metatarsal head. Results: 148 feet from 144 patients (48.1 +- 15.7 years, 92.5% male) met inclusion criteria. Preoperative osseous foot width was 96.2 mm, compared to 85.8 mm postoperative (p < 0.001). Preoperative soft tissue width was 106.6 mm, compared to 99.3 mm postoperative (p < 0.001). Postoperatively, patients had an average 10.4 +- 0.33 mm reduction (10.8% reduction) in osseous width and average 7.3 +- 0.33 mm reduction (6.8% reduction) in soft tissue width. Conclusion: Triplanar TMT arthrodesis reduces both osseous and soft tissue foot width providing a desirable cosmetic and functional outcome for patients with hallux valgus. Future studies are needed to determine if patient satisfaction and outcome measures correlate with reductions in foot width.

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Correlation of Different Methods of Measuring Pronation of the First Metatarsal on Weightbearing CT Scans

Foot & Ankle International ◽

10.1177/10711007211003090 ◽

2021 ◽

pp. 107110072110030

Author(s):

Matthew S. Conti ◽

Tamanna J. Patel ◽

Kristin C. Caolo ◽

Joseph M. Amadio ◽

Mark C. Miller ◽

...

Keyword(s):

Hallux Valgus ◽

Computer Aided Design ◽

Foot And Ankle ◽

Level Of Evidence ◽

3 Dimensional ◽

3D Cad ◽

First Metatarsal ◽

Hallux Valgus Deformity ◽

Second Metatarsal ◽

Α Angle

Background: There is no consensus in the foot and ankle literature regarding how to measure pronation of the first metatarsal in patients with hallux valgus. The primary purpose of this study was to compare 2 previously published methods for measuring pronation of the first metatarsal and a novel 3-dimensional measurement of pronation to determine if different measurements of pronation are associated with each other. Methods: Thirty patients who underwent a modified Lapidus procedure for their hallux valgus deformity were included in this study. Pronation of the first metatarsal was measured on weightbearing computed tomography (WBCT) scans using the α angle with reference to the floor, a 3-dimensional computer-aided design (3D CAD) calculation with reference to the second metatarsal, and a novel method, called the triplanar angle of pronation (TAP), that included references to both the floor (floor TAP) and base of the second metatarsal (second TAP). Pearson’s correlation coefficients were used to determine if the 3 calculated angles of pronation correlated to each other. Results: Preoperative and postoperative α angle and 3D CAD had no correlation with each other ( r = 0.094, P = .626 and r = 0.076, P = .694, respectively). Preoperative and postoperative second TAP and 3D CAD also had no correlation ( r = 0.095, P = .624 and r = 0.320, P = .09, respectively). However, preoperative and postoperative floor TAP and α angle were found to have moderate correlations ( r = 0.595, P = .001 and r = 0.501, P = .005, respectively). Conclusion: The calculation of first metatarsal pronation is affected by the reference and technique used, and further work is needed to establish a consistent measurement for the foot and ankle community. Level of Evidence: Level III, retrospective cohort study.

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Three-Dimensional Analysis of the First Metatarsal Bone in Minimally Invasive Distal Linear Metatarsal Osteotomy for Hallux Valgus

Foot & Ankle International ◽

10.1177/1071100719875222 ◽

2019 ◽

Vol 41 (1) ◽

pp. 84-93 ◽

Cited By ~ 1

Author(s):

Hiroyuki Seki ◽

Satoshi Oki ◽

Yasunori Suda ◽

Kenichiro Takeshima ◽

Tetsuro Kokubo ◽

...

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Morphological Changes ◽

Case Series ◽

Metatarsal Bone ◽

Ct Scans ◽

Metatarsal Osteotomy ◽

Level Of Evidence ◽

3 Dimensional ◽

First Metatarsal

Background: Modified Bösch osteotomy (distal linear metatarsal osteotomy [DLMO]) is one of the minimally invasive correctional surgeries for hallux valgus. The 3-dimensional correctional angles and distances of the first metatarsal bone in DLMO have not been clarified. The purpose of this study was to analyze the 3-dimensional postoperative morphological changes of the first metatarsal bone in DLMO. Methods: Twenty patients (30 feet) who underwent DLMO were enrolled. Preoperative plain radiographs and computed tomography (CT) scans of the feet were examined. Postoperative radiographs and CT scans were also obtained after bone union. The surface data of the pre- and postoperative first metatarsals were reconstructed from the CT data. The positions of the distal ends of the first metatarsals described with respect to the proximal ends were calculated using CT surface-matching technique. Results: The distal end of the first metatarsal after DLMO was significantly supinated (10.2 ± 6.0 degrees, P < .001), adducted (6.0 ± 11.8 degrees, P = .004), dorsiflexed (11.1 ± 10.9, P < .001), shortened (7.4 ± 2.5 mm, P < .001), elevated (2.3 ± 3.1 mm, P = .001), and laterally shifted (8.2 ± 3.0 mm, P < .001) compared to the preoperative metatarsal distal end. Supination correction demonstrated a significant correlation with adduction correction ( r = 0.659, P < .001) on correlation analyses between these parameters. Conclusion: The 3-dimensional corrections of the first metatarsal bone after DLMO were evaluated. Pronation and abduction were successfully corrected. Furthermore, adduction correction might be an important factor affecting correction of pronation. Level of Evidence: Level IV, retrospective case series.

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Comparison of Postoperative Height Changes of the Second Metatarsal Among 3 Osteotomy Methods for Hallux Valgus Deformity Correction

Foot & Ankle International ◽

10.1177/1071100716666566 ◽

2016 ◽

Vol 38 (1) ◽

pp. 20-26 ◽

Cited By ~ 5

Author(s):

Jun Young Choi ◽

Yu Min Suh ◽

Ji Woong Yeom ◽

Jin Soo Suh

Keyword(s):

Hallux Valgus ◽

Deformity Correction ◽

Metatarsal Head ◽

Valgus Deformity ◽

Metatarsal Osteotomy ◽

Level Of Evidence ◽

First Metatarsal ◽

Scarf Osteotomy ◽

Hallux Valgus Deformity ◽

Second Metatarsal

Background: We aimed to compare the postoperative height of the second metatarsal head relative to the first metatarsal head using axial radiographs among 3 different commonly used osteotomy techniques: proximal chevron metatarsal osteotomy (PCMO), scarf osteotomy, and distal chevron metatarsal osteotomy (DCMO). Methods: We retrospectively reviewed the radiographs and clinical findings of the patients with painful callosities under the second metatarsal head, complicated by hallux valgus, who underwent isolated PCMO, scarf osteotomy, or DCMO from February 2005 to January 2015. Each osteotomy was performed with 20 degrees of plantar ward obliquity. Along with lateral translation and rotation of the distal fragment to correct the deformity, lowering of the first metatarsal head was made by virtue of the oblique metatarsal osteotomy. Results: Significant postoperative change in the second metatarsal height was observed on axial radiographs in all groups; this value was greatest in the PCMO group (vs scarf: P = .013; vs DCMO: P = .008) but did not significantly differ between the scarf and DCMO groups ( P = .785). The power for second metatarsal height correction was significantly greater in the PCMO group (vs scarf: P = .0005; vs DCMO: P = .0005) but did not significantly differ between the scarf and DCMO groups ( P = .832). Conclusions: Among the 3 osteotomy techniques commonly used to correct hallux valgus deformity, we observed that PCMO yielded the most effective height change of the second metatarsal head. Level of Evidence: Level III, retrospective comparative series.

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Effect of the Modified Lapidus Procedure on Pronation of the First Ray in Hallux Valgus

Foot & Ankle International ◽

10.1177/1071100719883325 ◽

2019 ◽

Vol 41 (2) ◽

pp. 125-132 ◽

Cited By ~ 4

Author(s):

Matthew S. Conti ◽

Joseph F. Willett ◽

Jonathan H. Garfinkel ◽

Mark C. Miller ◽

Stephen V. Costigliola ◽

...

Keyword(s):

Hallux Valgus ◽

Computer Aided Design ◽

Case Series ◽

Ct Scans ◽

Level Of Evidence ◽

3 Dimensional ◽

Computed Tomographic ◽

First Metatarsal ◽

Signed Rank ◽

First Ray

Background: Hallux valgus (HV) is a triplanar deformity of the first ray including pronation of the first metatarsal with subluxation of the sesamoids. The purpose of this study was to investigate if a first tarsometatarsal fusion (modified Lapidus technique), without preoperative knowledge of pronation measured on weightbearing computed tomographic (CT) scans, changed pronation of the first metatarsal and determine if reduction of the sesamoids was correlated with changes in first metatarsal pronation. Methods: Thirty-one feet in 31 patients with HV who underwent a modified Lapidus procedure had preoperative and at least 5-month postoperative weightbearing CT scans and radiographs. Differences in preoperative and postoperative pronation of the first metatarsal using a 3-dimensional computer-aided design, HV angle, and intermetatarsal angle (IMA) were calculated using Wilcoxon signed-rank tests. After dividing patients into groups based on sesamoid station, Kruskal-Wallis H tests were used to compare first metatarsal pronation between the groups. Results: The mean preoperative and postoperative pronation of the first metatarsal was 29.0 degrees (range 15.8-51.1, SD 8.7) and 20.2 degrees (range 10.4-32.6, SD 5.4), respectively, which was a mean change in pronation of the first ray of −8.8 degrees ( P < .001). There was no difference in pronation of the first ray when stratified by postoperative sesamoid position ( P > .250). The average preoperative and postoperative IMA was 16.7 degrees (SD 3.2) and 8.8 degrees (SD 2.8), which demonstrated a significant change ( P < .001). Conclusions: The modified Lapidus procedure was an effective tool to change pronation of the first ray. Reduction of the sesamoids was not associated with postoperative first metatarsal pronation. Level of Evidence: Level IV, case series.

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Radiological Evaluation of a Preoperative First Metatarsal Realignment Test for Metatarsus Primus Varus and Hallux Valgus Correction by the Syndesmosis Procedure

Foot & Ankle International ◽

10.1177/1071100719893339 ◽

2019 ◽

Vol 41 (3) ◽

pp. 342-349

Author(s):

Daniel Yiang Wu ◽

Eddy Kwok Fai Lam

Keyword(s):

Soft Tissue ◽

Hallux Valgus ◽

Rank Correlation ◽

Level Of Evidence ◽

Radiographic Images ◽

Intermetatarsal Angle ◽

First Metatarsal ◽

Spearman’S Rank Correlation ◽

Surgical Methods ◽

Wrapping Technique

Background: Metatarsus primus varus correction is one of the primary surgical objectives for hallux valgus correction. Some soft tissue procedures have shown that the first metatarsal can be adequately realigned without osteotomy. The hypothesis of this study was that this correctability should also be demonstrable preoperatively. The purpose of this study was to assess whether a simple forefoot taping technique could do so and whether it could also be correlated with operative results after the syndesmosis procedure. Methods: Between May 2014 and December 2015, 147 feet with hallux valgus from 85 patients with an average age of 46.2 years underwent the syndesmosis procedure. All were followed prospectively with standing radiographic assessment of their first intermetatarsal angle, metatarsophalangeal angle, and medial sesamoid position preoperatively without and with a forefoot wrapping technique and postoperatively at 10 days, 6 months, and 1 year. Results: Their average preoperative intermetatarsal angle was reduced from 14.4 to 8.4 degrees by the wrapping technique, and their average metatarsophalangeal angle was spontaneously reduced from 31.8 to 21.8 degrees. After a minimum 1-year follow-up, they stabilized at 7.4 and 18.6 degrees, respectively. There was significant correlation between hallux valgus and metatarsus primus varus corrections by both forefoot wrapping and surgical methods with Spearman’s rank correlation of metatarsophalangeal angle and intermetatarsal angle corrections ( r = 0.6077, P < .0001 due to the wrapping method; r = 0.7157, P < .0001 due to the syndesmosis procedure). All raw working radiographic images for this study can be viewed in the Supplemental Material section. Conclusion: This study found that a simple forefoot tape-wrapping technique could be used preoperatively to verify first metatarsal mobility for metatarsus primus varus correction by the soft tissue syndesmosis procedure without osteotomies. Level of Evidence: Level II, prospective comparative study.

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Radiographic and Clinical Results of Minimally Invasive Chevron Akin Osteotomy for Moderate to Severe Hallux Valgus Deformities

Foot & Ankle Specialist ◽

10.1177/19386400211045911 ◽

2021 ◽

pp. 193864002110459

Author(s):

Toshinori Kurashige

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Inclination Angle ◽

Case Series ◽

Metatarsal Head ◽

Clinical Results ◽

Level Of Evidence ◽

First Metatarsal ◽

Akin Osteotomy ◽

Severe Hallux Valgus

Background: Few studies have reported results of minimally invasive chevron Akin osteotomy (MICA) for moderate to severe hallux valgus correction. This study aims to evaluate MICA for moderate to severe hallux valgus radiographically and clinically. Methods: Forty feet were prospectively reviewed. Twenty-eight feet (70%) had a severe deformity (hallux valgus angle (HVA) ≥40° and/or first intermetatarsal angle (IMA) ≥18°). We measured HVA, IMA, lateral shape of the metatarsal head (round sign), tibial sesamoid position, first metatarsal shortening on anteroposterior weightbearing radiographs, and inclination angle of first metatarsal on lateral weightbearing radiographs. We evaluated the Japanese Society for Surgery of the Foot hallux scale and Self-Administered Foot Evaluation Questionnaire responses preoperatively and at the most recent follow-up. Results: All measurements except shortening and inclination angle improved significantly. Both clinical scale and all subscores significantly improved. Conclusions: MICA improved moderate to severe hallux valgus both radiographically and clinically. Level of Evidence: Level IV: case series

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Association of First Metatarsal Pronation Correction With Patient-Reported Outcomes and Recurrence Rates in Hallux Valgus

Foot & Ankle International ◽

10.1177/10711007211046938 ◽

2021 ◽

pp. 107110072110469

Author(s):

Matthew S. Conti ◽

Tamanna J. Patel ◽

Jiaqi Zhu ◽

Andrew J. Elliott ◽

Stephen F. Conti ◽

...

Keyword(s):

Physical Function ◽

Hallux Valgus ◽

Patient Reported Outcomes ◽

Measurement Information ◽

Recurrence Rates ◽

Level Of Evidence ◽

3 Dimensional ◽

First Metatarsal ◽

Patient Reported ◽

Multivariable Regression

Background: The purpose of this study was to determine if a postoperative decrease in first metatarsal pronation on 3-dimensional imaging was associated with changes in patient-reported outcomes as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) physical function, pain interference, and pain intensity domains or recurrence rates in patients with hallux valgus (HV) who undergo a first tarsometatarsal fusion (modified Lapidus procedure). Methods: Thirty-nine consecutive HV patients who met the inclusion criteria and underwent a modified Lapidus procedure had preoperative and ≥2-year postoperative PROMIS scores and had first metatarsal pronation measured on preoperative and at least 5-month postoperative weightbearing CT scans were included. Multivariable regression analyses were used to investigate differences in the change in PROMIS domains preoperatively and 2 years postoperatively between patients with “no change/increased first metatarsal pronation” and “decreased first metatarsal pronation.” A log-binomial regression analysis was performed to identify if a decrease in first metatarsal pronation was associated with recurrence of the HV deformity. Results: The decreased first metatarsal pronation group had a significantly greater improvement in the PROMIS physical function scale by 7.2 points ( P = .007) compared with the no change/increased first metatarsal pronation group. Recurrence rates were significantly lower in the decreased first metatarsal pronation group when compared to the no change/increased first metatarsal pronation group (risk ratio 0.25, P = .025). Conclusion: Detailed review of this limited cohort of patients who underwent a modified Lapidus procedure suggests that the rotational component of the HV deformity may play an important role in outcomes and recurrence rates following the modified Lapidus procedure. Level of Evidence: Level III, retrospective cohort study.

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Driving After Hallux Valgus Surgery

Foot & Ankle International ◽

10.1177/1071100717711926 ◽

2017 ◽

Vol 38 (9) ◽

pp. 982-986 ◽

Cited By ~ 10

Author(s):

Elizabeth McDonald ◽

Rachel Shakked ◽

Joseph Daniel ◽

David I. Pedowitz ◽

Brian S. Winters ◽

...

Keyword(s):

Reaction Time ◽

Hallux Valgus ◽

Control Group ◽

Metatarsal Osteotomy ◽

Level Of Evidence ◽

First Metatarsal ◽

Institutional Review ◽

Level Ii ◽

Survey Results ◽

Correction Surgery

Background: The purpose of the study was to determine when patients can safely return to driving after first metatarsal osteotomy for hallux valgus correction. Methods: After institutional review board approval, 60 patients undergoing right first metatarsal osteotomy for hallux valgus correction surgery were recruited prospectively. Patients’ brake reaction time (BRT) was tested at 6 weeks and repeated until patients achieved a passing BRT. A control group of twenty healthy patients was used to establish as passing BRT. Patients were given a novel driver readiness survey to complete. Results: At 6 weeks, 51 of the 60 patients (85%) had BRT less than 0.85 seconds and were considered safe to drive. At 6 weeks, the passing group average was 0.64 seconds. At the 8 weeks, 59 patients (100%) of those who completed the study achieved a passing BRT. Patients that failed at 6 weeks had statistically greater visual analog scale (VAS) pain score and diminished first metatarsophalangeal (MTP) range of motion (ROM). On the novel driver readiness survey, 8 of the 9 patients (89%) who did not pass disagreed or strongly disagreed with the statement, “Based on what I think my braking reaction time is, I think that I am ready to drive.” Conclusion: Most patients may be informed that they can safely return to driving 8 weeks after right metatarsal osteotomy for hallux valgus correction. Some patients may be eligible to return to driving sooner depending on their VAS, first MTP ROM, and driver readiness survey results. Level of Evidence: Level II, comparative study

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Distal Soft Tissue Release Using Direct and Indirect Approaches: An Anatomic Study

Foot & Ankle International ◽

10.1177/107110079601700804 ◽

1996 ◽

Vol 17 (8) ◽

pp. 458-463 ◽

Cited By ~ 39

Author(s):

Ian Lin ◽

Susan K. Bonar ◽

Robert B. Anderson ◽

W. Hodges Davis

Keyword(s):

Soft Tissue ◽

Hallux Valgus ◽

Metatarsal Head ◽

Soft Tissue Release ◽

Surgical Approaches ◽

Suspensory Ligament ◽

First Metatarsal ◽

Medial Eminence ◽

Fresh Frozen ◽

Adductor Hallucis

Two surgical approaches for distal soft tissue release in the correction of hallux valgus, one using a dorsal first web space incision and the other a longitudinal medial capsulotomy incision (used also for medial eminence resection), were studied to compare and delineate the structures actually incised. Anatomic dissections were performed on six fresh-frozen amputation specimens using each of the approaches. The adequacy of release of the adductor hallucis, transverse and oblique heads, first metatarsophalangeal lateral capsule, and suspensory ligament was reviewed. Any inadvertent damage to the first metatarsal head cartilage, second metatarsophalangeal capsule, and lateral head of the flexor hallucis brevis tendon was also noted. Distal soft tissue release is thought to be an important part of hallux valgus surgery. Based on our anatomic dissections, the actual extent of the release may be inconsistent and unpredictable, and may have implications for the predictability of results after hallux valgus surgery.

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