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

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.

scholarly journals Effect on Foot Width With Triplanar Tarsometatarsal Arthrodesis for Hallux Valgus

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142093480
Author(s):  
Justin Vaida ◽  
Justin J. Ray ◽  
Taylor L. Shackleford ◽  
William T. DeCarbo ◽  
Daniel J. Hatch ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Functional Outcome ◽  
Hallux Valgus ◽  
Metatarsal Head ◽  
Level Of Evidence ◽  
3 Dimensional ◽  
First Metatarsal ◽  
Institutional Review ◽  
Retrospective Comparative Study ◽  
Width Reduction

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

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

2016 ◽  
Vol 38 (1) ◽  
pp. 20-26 ◽  
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.

Clinical, Quantitative Assessment of First Tarsometatarsal Mobility in the Sagittal Plane and Its Relation to Hallux Valgus Deformity

1994 ◽  
Vol 15 (1) ◽  
pp. 9-13 ◽  
Author(s):  
Kaj Klaue ◽  
Sigvard T. Hansen ◽  
Alain C. Masquelet
Keyword(s):  
Hallux Valgus ◽  
Sagittal Plane ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Valgus Deformity ◽  
Main Concern ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
First Ray

Today, bunion surgery is still controversial. Considering that a bunion deformity in fact may be a result of multiple causes, the rationale of the currently applied techniques of surgical treatment has not been conclusively demonstrated. In view of the known hypermobility syndrome of the first ray that results in insufficient weightbearing beneath the first metatarsal head, the relationship between this syndrome and hallux valgus deformity has been investigated. The results suggest a direct relationship between painful hallux valgus deformity and hypermobility in extension of the first tarsometatarsal joint. A pathological mechanism of symptomatic hallux valgus is proposed that relates this pathology with primary weightbearing disturbances in the forefoot where angulation of the first metatarsophalangeal joint is one of the consequences. The alignment of the metatarsal heads within the sagittal plane seems to be a main concern in many hallux valgus deformities. As a consequence, treatment includes reestablishing stable sagittal alignment in addition to the horizontal reposition of the metatarsal over the sesamoid complex. As an example, first tarsometatarsal reorientation arthrodesis regulates the elasticity of the multiarticular first ray within the sagittal plane and may be the treatment of choice in many hallux valgus deformities.

Effect of Metatarsal Head Shape on the Development of Hallux Valgus Deformity: 10 Years of Natural Follow-up

2020 ◽  
Vol 110 (3) ◽  
Author(s):  
Ulunay Kanatli ◽  
Onur Unal ◽  
Muhammet Baybars Ataoglu ◽  
Tacettin Ayanoglu ◽  
Mustafa Ozer ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Plantar Pressure ◽  
Metatarsal Head ◽  
Valgus Deformity ◽  
Radiographic Evaluation ◽  
Hallux Valgus Angle ◽  
Head Shape ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Valgus Angle

Background We investigated the role of first metatarsal head shape in the etiology of hallux valgus. By pedobarographic analysis, we evaluated whether first metatarsal head shape causes an alteration in plantar pressure values that would result in metatarsalgia. Methods Referrals to our clinic for metatarsalgia, plantar fasciitis, and calcaneal spur were scanned retrospectively. Patients with severe hallux valgus, pes planus, gastrocnemius stiffness, generalized joint laxity, neuromuscular disease, or a history of lower-extremity orthopedic surgery were excluded. Sixty-two patients with plantar pressure assessment and radiographic evaluation were included. These patients were invited for reassessment after 10 years. Feet were divided into three groups by metatarsal head shape: round, square, and chevron. On anteroposterior radiographs, the hallux valgus and intermetatarsal angles, relative first metatarsal length, lateral sesamoid subluxation, and presence of bipartite sesamoid were noted. Plantar pressure was assessed with pedobarography. Results Feet with round-shaped first metatarsal heads had a statistically significantly greater progression in hallux valgus angle than the other shapes. Plantar pressures under the first, second and third, and fourth and fifth metatarsals increased with time. This can explain the mechanism of transfer metatarsalgia and painful callosities under the first metatarsal in hallux valgus. There was no correlation between hallux valgus angle, relative metatarsal length, and lateral sesamoid subluxation. Conclusions We found a strong relation between round-shaped first metatarsal head and hallux valgus angle progression. No patients had a risk factor responsible for hallux valgus. In other words, this study gives approximately 10-year natural history results in nearly normal feet.

Hallux Valgus in Men: Effect of the Distal Metatarsal Articular Angle on Hallux Valgus Correctiong

1997 ◽  
Vol 18 (8) ◽  
pp. 463-470 ◽  
Author(s):  
Michael J. Coughlin
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Valgus Deformity ◽  
Metatarsal Osteotomy ◽  
Hallux Valgus Angle ◽  
First Metatarsal ◽  
Soft Tissue Procedure ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
Mtp Joints

The results of hallux valgus correction were reviewed for 34 male patients (41 feet). The severity of the preoperative deformity determined the operative technique of correction. A distal soft tissue procedure with proximal first metatarsal osteotomy was performed in 30 patients (35 feet) with an average correction of the hallux valgus angle of 22°. A chevron procedure was performed in five cases and a McBride procedure in one other case, all with less severe deformities. Complications included one deep wound infection, one broken screw at the metatarsal osteotomy site, and three cases of hallux varus. No patients underwent reoperation. Undercorrection was noted in 10 of 35 cases (29%) where a distal soft tissue procedure with proximal first metatarsal osteotomy was performed. A nonsubluxated (congruent) metatarsophalangeal (MTP) joint associated with a hallux valgus deformity was present in 15 of 41 (37%) of all cases and 10 of 35 (29%) of cases that underwent a distal soft tissue procedure with proximal metatarsal osteotomy (DSTR with PMO). A subluxated (noncongruent) MTP joint associated with hallux valgus was present in 26 of 41 (63%) of all cases and 25 of 35 (71 %) of cases undergoing a DSTR with PMO. There was a highly significant difference in the average distal metatarsal articular angle (DMAA) as measured in the nonsubluxated (congruent) MTP joints (20.7°) and the subluxated (noncongruent) MTP joints with hallux valgus (10°) ( P = 0.0001). The average distal metatarsal articular angle for all cases undergoing DSTR with PMO was 13°. When the postoperative hallux valgus angle was compared with the DMAA, the average residual hallux valgus angle was 10.1°. With a subluxated (noncongruent) first MTP joint with hallux valgus (a low DMAA), the percent of hallux valgus correction (hallux valgus correction [in degrees])preoperative hallux valgus deformity [in degrees]) was 77%. In patients with a nonsubluxated (congruent) first MTP joint with hallux valgus (a high DMAA), the percent correction was 46%, an almost twofold difference in percent correction. There was a close correlation between the preoperative DMAA and the postoperative hallux valgus angle in both the subluxated and congruent subgroups ( P = 0.0003). With an intra-articular repair (a DSTP with PMO), the magnitude of correction of a hallux valgus deformity is limited at the MTP joint by the distal metatarsal articular angle.

An Imaged-Based Three-Dimensional Study of First Metatarsal Protrusion Distance in Women with and Without Hallux Valgus

2017 ◽  
Vol 107 (6) ◽  
pp. 531-537
Author(s):  
Michael W. Rodriguez ◽  
Kara E. Pioske ◽  
Ward M. Glasoe
Keyword(s):  
Hallux Valgus ◽  
Three Dimensional ◽  
Spatial Relationship ◽  
Valgus Deformity ◽  
Magnetic Resonance Images ◽  
Single Plane ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Foot Posture ◽  
First Ray

Background: First metatarsal protrusion distance (MPD) has been commonly studied as a characteristic of hallux valgus deformity. To date, the majority of investigations have used radiographic methods, with most reporting first metatarsal (ray) protrusion to be associated with deformity. As an alternative, this study used a three-dimensional (3-D) image acquisition and data analysis method to quantify MPD. Methods: Magnetic resonance images were acquired in weightbearing on 29 women (19 with hallux valgus; 10 controls). After the 3-D images were reconstructed into virtual bone models, two examiners measured MPD in relation to the navicular. In addition to a reliability analysis, a t test assessed for group differences in demographics, foot posture (hallux valgus, intermetatarsal angles), and MPD. Results: Group demographics were not different, while measures of hallux valgus and intermetatarsal angles were different (P &lt; 0.01) between groups. The measurement of MPD was highly reliable (ICC 0.99; SEM 0.78 mm). Metatarsal protrusion averaged approximately –2.0 mm in both groups. There was no statistical group difference (P = 0.89) in MPD. Conclusions: The reconstructed image datasets captured the 3-D spatial relationship of the anatomy. Measurements of MPD were reliable. The first ray measured 2 mm shorter than the second ray in both the hallux valgus and control groups. Though unexpected, this result may prompt future study of the pathokinematics associated with hallux valgus that include the quantification of metatarsal protrusion with 3-D methods, instead of relying solely on single-plane radiograph reports.

Prospective, Randomized Comparison of Proximal Crescentic and Proximal Chevron Osteotomies for Correction of Hallux Valgus Deformity

1996 ◽  
Vol 17 (6) ◽  
pp. 307-316 ◽  
Author(s):  
Mark E. Easley ◽  
Gary M. Kiebzak ◽  
W. Hodges Davis ◽  
Robert B. Anderson
Keyword(s):  
Functional Outcome ◽  
Hallux Valgus ◽  
Valgus Deformity ◽  
Healing Time ◽  
First Metatarsal ◽  
Persistent Symptoms ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Severe Hallux Valgus

In this study, intermetatarsal angle (IMA) correction, functional outcome, and healing time for the proximal crescentic and proximal chevron osteotomies in moderate to severe hallux valgus deformity were prospectively compared. Seventy-five patients (97 feet) were prospectively randomized to either a proximal crescentic or proximal chevron osteotomy for the correction of moderate to severe hallux valgus deformity with associated metatarsus primus varus. Criteria for study entry included age (adult patients), IMA greater than or equal to 13°, persistent symptoms despite nonoperative treatment, and minimum follow-up of 12 months. Twenty-nine patients (41 feet) in the crescentic group and 37 patients (43 feet) in the chevron group returned for follow-up at an average of 24 and 20 months, respectively. Good results were achieved with both procedures. No statistically significant differences were found with respect to correction of the IMA or to functional outcome between the two groups. Results held true irrespective of patient age, severity of disease, or bilateral involvement. A statistically significant shorter healing time of the first metatarsal was found after proximal chevron osteotomy. Other potential benefits of the chevron procedure included avoidance of dorsiflexion of the first metatarsal, tendency toward less shortening of the first metatarsal, and more medial distribution of tibial sesamoids following surgery, all of which may reduce the potential for development or persistence of transfer lesions.

First Metatarsal Rotation in Hallux Valgus Deformity

2021 ◽  
Vol 42 (4) ◽  
pp. 510-522
Author(s):  
Jesse Steadman ◽  
Alexej Barg ◽  
Charles L. Saltzman
Keyword(s):  
Hallux Valgus ◽  
Potential Role ◽  
Axial Rotation ◽  
Valgus Deformity ◽  
Measurement Methods ◽  
Advanced Imaging ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Biplanar Radiographs

Rotation of the first metatarsal (M1) as a potential etiological factor of hallux valgus (HV) deformity was described relatively early in the description of HV pathoanatomy. However, because biplanar radiographs have been the standard method for imaging HV, clinicians primarily developed measurement methods and corrective operations confined to 2 dimensions, medial-lateral and inferior-superior. Recently, as our understanding of HV pathoanatomy has further developed, aided in part by advanced imaging technology, M1 rotation about its axis (“axial rotation”) and its implications for HV deformity and treatment has reemerged. The goal of this review is to summarize M1 rotation in HV from a historical perspective, to present the current understanding of its potential role in the etiology/pathogenesis of HV, and to summarize relevant imaging and operative considerations with respect to M1 rotation. Level of Evidence: Level III, systematic review.

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