scholarly journals Influence of First Metatarsophalangeal Joint Degenerative Changes on Functional Outcomes Following Hallux Valgus Correction

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0017
Author(s):  
Daniel Corr ◽  
Ryan G. Rogero ◽  
Andrew Fisher ◽  
Joseph T. O’Neil ◽  
Daniel J. Fuchs ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Functional Outcomes ◽  
Proximal Phalanx ◽  
Metatarsal Head ◽  
Degenerative Changes ◽  
Foot And Ankle ◽  
First Metatarsophalangeal Joint ◽  
Pain Scores ◽  
Exposed Bone ◽  
Arthritic Changes

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Previous studies have documented the prevalence of 1st metatarsophalangeal (MTP) joint arthritis in the setting of hallux valgus, with the articulation between the metatarsal head and the sesamoids being particularly vulnerable. However, little is known as to whether such degenerative changes of the metatarsal head-sesamoid articulation have any influence on postoperative functional and pain scores following hallux valgus correction. The purpose of this study is to determine the influence of degenerative changes of the 1st metatarsal head on outcomes at 2 years postoperatively. Methods: Patients underwent correction of a hallux valgus deformity from 2016-2017 by a single fellowship trained foot and ankle surgeon. Degenerative changes were classified by dividing the articular surface of the metatarsal head into 6 zones: zones 1 through 4 represented the surface articulating with the base of the proximal phalanx, while zones 5 and 6 represented the plantar aspect. Cartilage loss in each zone was graded from 0-2, with 0 representing the absence of arthritis, 1 indicating fissures without exposed bone, and 2 representing degenerative changes with exposed bone. Scoring was performed via direct visualization during the procedure. At 2 years postoperatively, patients were contacted to complete the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales and Visual Analog Scale (VAS) for pain. Spearman’s correlations and one-way analysis of variance (ANOVA) were performed to determine if degree of arthritis had any influence on outcomes. Results: One hundred and forty-one patients (87.9% female) with both intraoperative arthritic grading and 2-year functional outcomes were included. At a mean of 25.4 (range, 23.0-34.8) months postoperatively, patients reported a mean (+- standard deviation) FAAM-ADL of 88.9 +- 17.3, FAAM-Sport of 77.3 +- 26.0, and VAS pain of 20.8 +- 27.1. Arthritis in zone 2 (r=0.20, p= 0.027) was found to be positively correlated with FAAM-Sport scores. ANOVA revealed those with a total arthritis grade of 0 or 2 or more in zones 1-4 had a significantly greater reduction in VAS pain scores (means of -35.1 and -37.7, respectively) than those with a grade of 1 (mean: -14.3) (p=0.008). Conclusion: Patients demonstrated a significant influence of arthritis on 2-year functional outcomes following HV correction, with higher levels of degenerative changes in zone 2 generally associated with better functional outcomes. Patients with more severe arthritic changes in zones 1-4 and those whose arthritic changes were localized solely to zones 5 and 6 demonstrated greater pain relief than those with mild degenerative changes. While these findings were unexpected, it demonstrates that those with more pronounced arthritis may benefit more from surgical correction of HV. Furthermore, surgeon intraoperative evaluation of arthritis may allow for improved counseling of patients regarding expected postoperative functional improvement.

scholarly journals Influence of First Metatarsophalangeal Joint Degenerative Changes on Functional Outcomes Following Hallux Valgus Correction

2020 ◽  
Vol 5 (2) ◽  
pp. 2473011420S0001
Author(s):  
Ryan G. Rogero ◽  
Andrew Fischer ◽  
Daniel Corr ◽  
Joseph T. O’Neil ◽  
Daniel J. Fuchs ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Functional Outcomes ◽  
Proximal Phalanx ◽  
Metatarsal Head ◽  
Degenerative Changes ◽  
Foot And Ankle ◽  
First Metatarsophalangeal Joint ◽  
Pain Scores ◽  
Plantar Aspect ◽  
Exposed Bone

Category: Bunion; Other Introduction/Purpose: Previous studies have documented the prevalence of 1st metatarsophalangeal (MTP) joint arthritis in the setting of hallux valgus, with the articulation between the metatarsal head and the sesamoids being particularly vulnerable. However, little is known as to whether such degenerative changes of the metatarsal head-sesamoid articulation have any influence on postoperative functional and pain scores following hallux valgus correction. The purpose of this study is to determine the influence of degenerative changes of the 1st metatarsal head on outcomes at 2 years postoperatively. Methods: Patients who underwent correction of a hallux valgus deformity from 2016 to 2017 with 1 of 4 foot and ankle fellowship-trained orthopaedic surgeons were included in this study. Degenerative changes were classified using a novel grading system dividing the articular surface of the metatarsal head into 6 zones, with zones 1 through 4 representing the surface which articulates with the base of the proximal phalanx and zones 5 and 6 representing the plantar aspect of the metatarsal head. Cartilage loss in each zone was graded from 0-2, with a score of 0 representing the absence of arthritis, a score of 1 indicating fissures without exposed bone, and a score of 2 representing degenerative changes with exposed bone, for a maximum score of 12. Scoring was performed by the operating surgeon at the time of the index procedure by direct visualization. Photographic documentation of the metatarsal head was obtained in every case for secondary confirmation. At 2 years postoperatively, patients with intraoperative grading were contacted to complete the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales and Visual Analog Scale (VAS) for pain. Spearman’s correlations and one-way ANOVA were performed to determine if the degree of arthritis had any influence on outcomes. Results: Seventy-six patients (92.1% female) with both intraoperative arthritic grading and 2-year functional outcomes were included. At a mean of 24.6 (range, 23-28) months postoperatively, patients reported a mean (+- standard deviation) FAAM-ADL of 93.0 +- 11.9/100, FAAM-Sport of 84.8 +- 21.4/100, and VAS pain of 16.8 +- 22.2/100. Arthritis in zone 1 (r=0.345, p= 0.005) and zone 4 (r=0.249, p=0.044) was found to be positively correlated with FAAM-Sport scores. ANOVA analysis revealed those with a total arthritis grade of 0 or 2 or more in zones 1-4 had a significantly greater reduction in VAS pain scores (means of -36.5 and -48.1, respectively) than those with a grade of 1 (mean: +5.0) (p=0.005). Conclusion: We have demonstrated a significant influence of arthritis on 2-year functional outcomes following HV correction, with higher levels of degenerative changes in zones 1 and 4 generally associated with better functional outcomes. While this finding was unexpected, it demonstrates that those with arthritis may benefit more from surgical correction of HV. Furthermore, surgeon intraoperative evaluation of arthritis may allow for improved counseling of patients regarding expected postoperative functional improvement.

scholarly journals High Prevalence of Degenerative Changes at the Metatarsal Head Sesamoid Articulation Found During Hallux Valgus Correction Surgery

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0007
Author(s):  
Justin Tsai ◽  
Joseph N. Daniel ◽  
Elizabeth McDonald ◽  
Ryan Rogero ◽  
Kristen Nicholson ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Articular Surface ◽  
Metatarsal Head ◽  
Degenerative Changes ◽  
Suboptimal Outcome ◽  
High Prevalence ◽  
Exposed Bone ◽  
Correction Surgery ◽  
Preoperative Deformity ◽  
Arthritic Changes

Category: Bunion Introduction/Purpose: Despite absence of complications and a restoration of normal hallux alignment, some patients have suboptimal outcomes from hallux valgus correction surgery. One risk factor for persistent pain may be the presence of arthritic changes at the metatarsal head articulation with the sesamoids, an area not easily assessed with standard preoperative radiographs. In this study, we prospectively evaluated the metatarsal head for degenerative changes during hallux valgus correction surgery and identified preoperative risk factors associated with these changes. Methods: We prospectively evaluated 200 feet in 196 patients who underwent hallux valgus surgery intraoperatively for the pattern and severity of arthritic changes at the metatarsal head. Intraoperatively, the first metatarsophalangeal and sesamoid metatarsal joint were assessed for arthritic changes. The articular surface of the metatarsal head was divided into zones 1-6 (Figure 1). Cartilage loss in each zone was graded from 0-2 based on a novel grading system, with a score of 0 representing the absence of arthritis. A score of 1 indicated fissures without exposed bone, and a score of 2 represented degenerative changes to the level of exposed bone. Mann-Whitney U testing was implemented to compare differences in arthritic scores between preoperative deformity groups. Spearman’s correlation test was used to determine the association between age and preoperative deformity with the severity of degenerative changes. Results: One-hundred two out of 200 feet (51%) assessed had severe arthritic changes at the plantar medial aspect of the metatarsal head, and 40% (80/200) at the plantar lateral aspect. The mean preoperative hallux valgus and intermetatarsal angles were 29.6 ± 8.5 (range, 9.8-55.3) and 14.2 ± 3.3 (range, 6.6-25.9), respectively. Those presenting with an intermetatarsal angle (IMA) >/= 14 degrees had a significantly higher level of arthritis when compared to those presenting with an IMA < 14 degrees (p < 0.001). No difference in arthritis scores was found for HVA. Age was found to have a strong and significant (p < 0.001) correlation with zone 5, zone 6, total plantar zone, and total arthritis scores. Conclusion: The high prevalence of arthritic changes at the metatarsal head articulation with the sesamoids may be partially responsible for suboptimal outcome following hallux valgus correction surgery. Since these changes were associated with greater age and preoperative deformity, operating earlier in the pathology of hallux valgus may be of benefit.

scholarly journals Understanding the Rotational Positioning of the Bones in the Medial Column of the Foot: A Weightbearing CT Analysis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0044
Author(s):  
Thiago A. Silva ◽  
Daniel Baumfeld ◽  
Shuyuan Li ◽  
Nacime S. Mansur ◽  
Francois Lintz ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Proximal Phalanx ◽  
Foot And Ankle ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Rotational Position ◽  
Medial Cuneiform ◽  
Bone Segment ◽  
Essential Components ◽  
Weightbearing Ct

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Rotational deformities of the first ray have been described as essential components of hallux valgus (HV) deformity, influencing its severity and progression. The exact deformity location along the medial column, as well as the typical rotational pattern of each bone, is yet to be fully understood. The objective of this study was to evaluate the rotational position of the navicular, medial cuneiform, first metatarsal and proximal phalanx using three-dimensional weightbearing CT (WBCT) images of a diversity of patients with foot pathologies. Our goal was to describe the rotational profile of medial column bones, serving as a reference for future studies. Methods: A retrospective review of patients that underwent WBCT assessment of multiple foot and ankle pathologies was conducted in a single Institution. A blinded and independent Fellowship-Trained Foot and Ankle Orthopedic Surgeon performed measurements in Multiplanar Reconstruction (MPR) WBCT images assessing the rotational profile of each bone of the medial column (navicular, medial cuneiform, first metatarsal and proximal phalanx of the great toe), as demonstrated in the attached figure. The first metatarsal, representing a long bone, was evaluated on its proximal and distal ends. A total of 110 patients were included. As standard, we considered pronation as positive values and supination as negative values. Comparisons were performed using independent t-tests or Wilcoxon tests. P-values of <0.05 were considered significant. Results: The mean values and 95% Confidence Interval for the rotational profile of the medial column bones were found to be respectively: Navicular, pronated 43.2o (41.1 to 45.2); Medial Cuneiform, supinated -2.5o (-4.3 to -0.7); Proximal First Metatarsal, supinated -28.1o (-32 to -24.1); Distal Metatarsal, pronated 18.5o (16.3 to 20.7); First Toe Proximal Phalanx, pronated of 21.6o (18.7 to 24.5). Significant differences were found in the rotational position of each bone/segment (p<0.0001), with the exception of the distal metatarsal/proximal phalanx (p=0.11), that demonstrated similar amounts of pronation. When considering each segment/joint in isolation, the highest rotational deformity was found to exist within the first metatarsal (pronated 46.6o), naviculo-cuneiform joint (supinated 45.7o), first tarsometatarsal joint (supinated 25.5o) and first metatarsophalangeal joint (pronated 3.1 o). Conclusion: Our study described the rotational profile of the medial column bones using WBCT images, in a population of patients with diverse foot and ankle pathologies. We found significant differences in the rotational position of most of the bones along the medial column. The greatest amount of rotation was found to happen within the first metatarsal, which undergoes an average of 46o of pronation from proximal to distal, probably compensating a considerable amount of supination of the naviculo- cuneiform and first tarsometatarsal joints. Further studies comparing hallux valgus patients and controls are needed.

High Prevalence of Degenerative Changes at the Metatarsal Head Sesamoid Articulation Found During Hallux Valgus Correction Surgery

2020 ◽  
pp. 193864002091213
Author(s):  
Justin Tsai ◽  
Joseph N. Daniel ◽  
Elizabeth L. McDonald ◽  
David I. Pedowitz ◽  
Ryan G. Rogero ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Metatarsal Head ◽  
Positive Influence ◽  
Degenerative Changes ◽  
High Prevalence ◽  
Correction Surgery ◽  
Standard Radiographs ◽  
Preoperative Deformity ◽  
Arthritic Changes

Background. Despite the absence of complications and a restoration of normal hallux alignment, some patients have suboptimal outcomes from hallux valgus correction surgery. One risk factor for persistent pain may be the presence of arthritic changes at the metatarsal head articulation with the sesamoids, an area not easily assessed with standard radiographs unless dedicated sesamoid views are obtained. In this study, we prospectively evaluated the metatarsal head for degenerative changes during hallux valgus correction surgery and identified preoperative risk factors associated with these changes. Methods. We prospectively evaluated 200 feet in 196 patients who underwent hallux valgus surgery intraoperatively for the pattern and severity of arthritic changes at the metatarsal head. Mann-Whitney U testing was implemented to compare differences in arthritic scores between preoperative deformity groups. The Spearman correlation test was used to determine the association between age and preoperative deformity with the severity of degenerative changes. Results. More than half of all feet assessed had severe arthritic changes at the plantar medial aspect of the metatarsal head and 40% of feet at the plantar lateral aspect. Age and intermetatarsal angle were found to be positively correlated with arthritis in this area. Conclusion. Our prospective study has demonstrated the high prevalence of arthritic changes at the metatarsal head sesamoid articulation and the positive influence of age and severity of deformity on metatarsal head arthritic changes seen during hallux valgus correction surgery. Furthermore, these arthritic changes were found to have no significant influence on preoperative functional and pain levels. Levels of Evidence: Level IV: Case series

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.

Measuring Visualized Joint Surface in Hallux Metatarsophalangeal Arthroscopy

2018 ◽  
Vol 39 (8) ◽  
pp. 978-983
Author(s):  
Michael Hull ◽  
John T. Campbell ◽  
Clifford L. Jeng ◽  
R. Frank Henn ◽  
Rebecca A. Cerrato
Keyword(s):  
Clinical Practice ◽  
Clinical Relevance ◽  
Articular Surface ◽  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Lateral View ◽  
Joint Surface ◽  
Foot And Ankle ◽  
Kirschner Wires

Background: Arthroscopy has been increasingly used to evaluate small joints in the foot and ankle. In the hallux metatarsophalangeal (MTP) joint, little data exist evaluating the efficacy of arthroscopy to visualize the articular surface. The goal of this cadaveric study was to determine how much articular surface of the MTP joint could be visualized during joint arthroscopy. Methods: Ten fresh cadaveric foot specimens were evaluated using standard arthroscopy techniques. The edges of the visualized joint surface were marked with curettes and Kirschner wires; the joints were then surgically exposed and imaged. The visualized surface area was measured using ImageJ® software. Results: On the distal 2-dimensional projection of the joint surface, an average 57.5% (range, 49.6%-65.3%) of the metatarsal head and 100% (range, 100%-100%) of the proximal phalanx base were visualized. From a lateral view of the metatarsal head, an average 72 degrees (range, 65-80 degrees) was visualized out of an average total articular arc of 199 degrees (range, 192-206 degrees), for an average 36.5% (range, 32.2%-40.8%) of the articular arc. Conclusion: Complete visualization of the proximal phalanx base was obtained. Incomplete metatarsal head visualization was obtained, but this is limited by technique limitations that may not reflect clinical practice. Clinical Relevance: This information helps to validate the utility of arthrosocpy at the hallux metatarsophalangeal joint.

scholarly journals Classification of Hallucal Sesamoid Bone Correlated with Hallux Valgus Severity

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Lei Zhang ◽  
Junqiu Wang ◽  
Jiaju Liu ◽  
Jiangqin Luo
Keyword(s):  
Hallux Valgus ◽  
Statistical Difference ◽  
Three Dimensional ◽  
Morphological Characteristics ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Type I ◽  
Sesamoid Bone ◽  
First Metatarsophalangeal Joint

The hallucal sesamoid bones (HSBs), having an important role in reducing load per unit area on the first metatarsal head, can be injured commonly which also affected the first metatarsophalangeal joint and the surrounding structure. Meanwhile, differences among each HSB type may be a major factor affecting the occurrence and development of HV. So far, many researchers had learned that there are three different conditions in hallucal sesamoid bone affecting the choice of clinical surgery corresponding to different solutions in clinic. Thus, it is necessary to study the anatomical morphological characteristics of the HSB which can be helpful in clinical diagnosis and treatment, especially hallux valgus (HV). 150 X-ray and three-dimensional (3D) computed tomographic (CT) images consist of 72 left and 78 right metatarsals were applied in this anatomic study between two variables and showed by a simple scatter plot. The first metatarsophalangeal joint is divided into four different types: type I (no HSB, 1.3%), type II (with one HSB, 0.07%), type IIIa (with two HSBs when THB is bigger, 28%), type IIIb (with two HSBs when FHB is bigger, 65.3%), and type IV (with three HSBs, 4.7%). There was no statistical difference between the left and right sides, except HVA, Meary, and pitch (P<0.05); all a, b, c, d, and i have statistical difference between male and female (P<0.05). Meanwhile, HVA and IMA and HVA and type group have a significant correlation. In summary, HVA and IMA and HVA and classification of HSBs have significant correlations. The classification and location of HSBs can be an important basis to choose operation methods and postoperation evaluation.

scholarly journals Basilar Thumb Arthritis: The Utility of Suture-Button Suspensionplasty

Hand ◽  
2018 ◽  
Vol 14 (1) ◽  
pp. 66-72 ◽  
Author(s):  
Brent R. DeGeorge ◽  
Sagar S. Chawla ◽  
Bassem T. Elhassan ◽  
Sanjeev Kakar
Keyword(s):  
Functional Outcomes ◽  
Tendon Transfer ◽  
Proximal Phalanx ◽  
Pain Syndrome ◽  
Pinch Strength ◽  
Suture Button ◽  
Radiographic Outcomes ◽  
Pain Scores ◽  
Joint Arthritis

Background: We sought to compare the functional outcomes, radiographic outcomes, and complications of trapeziectomy and flexor carpi radialis (FCR) to abductor pollicis longus (APL) side-to-side tendon transfer with or without suture-button suspensionplasty for thumb basilar joint arthritis. Methods: Patients treated with and without suture-button suspensionplasty were compared over a 6-year period. Data were reviewed for complications and functional outcomes, including grip and pinch strength, range of motion, and visual analog scale (VAS) pain scores. Plain radiographs were independently reviewed at initial presentation and at final follow-up, including proximal phalanx length, trapezial space height, and trapezial height ratio. Results: Seventy thumb arthroplasties were performed in 70 patients. Trapeziectomy with FCR-APL side-to-side tendon transfer was performed in 39 patients, and trapeziectomy with FCR-APL side-to-side tendon transfer with suture-button suspensionplasty was performed in 31 patients. Mean length of follow-up was 28.4 ± 3.9 and 23.8 ± 2.6 months, respectively. Postoperative grip, oppositional and appositional pinch strength, and VAS pain scores improved compared with preoperative values, but were not significantly different based on suture-button suspensionplasty. Percentage decline in trapezial space ratio was significantly different between groups at 36.7% and 20.4% for procedures with and without suture-button suspensionplasty, respectively indicating that the trapezial space was better maintained within the suture suspension cohort. The incidence of postoperative complications, including surgical site infection, paresthesias, reoperation, complex regional pain syndrome, and symptomatic subsidence, was not significantly different between groups. Conclusions: Trapeziectomy with FCR to APL side-to-side tendon transfer with and without suture-button suspensionplasty results in comparable improvement in pain, grip strength, and functional parameters. Suture-button suspensionplasty results in significantly greater preservation of trapezial space.

scholarly journals Treatment of Moderate Hallux Valgus by Percutaneous, Extra-articular Reverse-l Chevron (PERC) Osteotomy

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Julien Lucas ◽  
Olivier Laffenetre
Keyword(s):  
Hallux Valgus ◽  
Proximal Phalanx ◽  
Subjective Rating ◽  
Outpatient Basis ◽  
Range Of Movement ◽  
Aofas Score ◽  
First Metatarsophalangeal Joint ◽  
Chevron Osteotomy ◽  
The Mean

Category: Midfoot/Forefoot Introduction/Purpose: The purpose of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a Percutaneous Extra-articular Reverse-L Chevron (PERC) osteotomy. Methods: A total of 38 patients underwent 45 PERC procedures. A medial approach is used just proximal to the flare of the metatarsal head. The osteotomy is performed using a burr, the thickness of which is selected according to the planned correction and shortening. A second dorsolateral approach is then performed and the osteotomy is fixed using a self-drilling, self-tapping 3 mm diameter cannulated and headless compression screw. There were 35 women and three men. The mean age of the patients was 48 years (17 to 69). An additional percutaneous Akin osteotomy was performed in 37 feet and percutaneous lateral capsular release was performed in 22 feet. Clinical and radiological assessments included the type of forefoot, range of movement, the American Orthopedic Foot and Ankle (AOFAS) score, a subjective rating and radiological parameters. The mean follow-up was 59.1 months (45.9 to 75.2). No patients were lost to follow-up. Results: The mean AOFAS score increased from 62.5 (30 to 80) pre-operatively to 97.1 (75 to 100) post-operatively. A total of 37 patients (97%) were satisfied. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and the proximal articular set angle. The range of movement of the first metatarsophalangeal joint improved significantly. There was more improvement in the range of movement in patients who had fixation of the osteotomy of the proximal phalanx. Conclusion: Preliminary results of this percutaneous approach are promising. This technique is reliable and reproducible. The PERC osteotomy procedure is an effective approach for surgical management of moderate hallux valgus which combines the benefits of percutaneous surgery with the versatility of the chevron osteotomy. Its main asset is that it maintains an excellent range of movement; other advantages relate to the procedure being performed on an outpatient basis and the absence of tourniquet use.

The Effects of Cheilectomy on Dorsiflexion of the First Metatarsophalangeal Joint

1997 ◽  
Vol 18 (12) ◽  
pp. 803-808 ◽  
Author(s):  
William A. Heller ◽  
Michael E. Brage
Keyword(s):  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Hallux Rigidus ◽  
Surface Velocity ◽  
First Metatarsophalangeal Joint ◽  
Motion Patterns ◽  
Custom Made ◽  
Fresh Frozen ◽  
End Stage

Our purpose in this study was to determine the effects of cheilectomy on the mechanics of dorsiflexion of the first metatarsophalangeal (MTP) joint. Ten fresh-frozen cadaver feet were utilized, of which two demonstrated radiographic evidence of hallux rigidus. Each specimen was rigidly mounted on a custom-made slide tray that was articulated with a hinge mechanism designed to dorsiflex the first MTP joint. Range-of-motion measurements were made on the first MTP joint. Cheilectomy of 30% of the metatarsal head diameter was performed. Lateral radiographs with the beam centered on the MTP joint were taken with the joint at neutral, 20°, 40°, and at the limits of dorsiflexion. This process was repeated after a 50% cheilectomy was performed. The radiographs were examined for changes in joint congruence and in patterns of surface motion as the hallux moved from neutral to full dorsiflexion. Instant centers of rotation were determined by a method first described by Rouleaux. We constructed surface velocity vectors to describe patterns of motion of the first MTP joint. The mean dorsiflexion of the first MTP joint was 67.9° and increased to 78.3° after 30% cheilectomy. The increase in dorsiflexion was significantly greater in the two specimens with hallux rigidus (33%) than in the other specimens (12.1%). After both levels of cheilectomy, the proximal phalanx demonstrated pivoting at the resection site on the metatarsal head. This pivoting resulted in abnormal motion patterns across the MTP joint. Normal sliding motion predominated in early dorsiflexion, with compression peaking at the end stage of dorsiflexion, producing jamming of the articular surfaces. Cheilectomy significantly increased dorsiflexion of the MTP joint, but resulted in abnormal motion patterns. The increase in dorsiflexion resulted from pivoting of the proximal phalanx on the metatarsal head, resulting in anomalous velocity vectors and compression across the MTP joint.

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