First-Tarsometatarsal Joint Alignment After First-Metatarsophalangeal Joint Arthrodesis for Hallux Valgus

Background: Instability of the first-tarsometatarsal (TMT) joint has been proposed as a cause of hallux valgus. Although there is literature demonstrating how first-TMT arthrodesis affects hallux valgus, there is little published on how correction of hallux valgus affects the first-TMT joint alignment. The purpose of this study was to determine if correction of hallux valgus impacts the first-TMT alignment and congruency. Improvement in alignment would provide evidence that hallux valgus contributes to first-TMT instability. Our hypothesis was that correcting hallux valgus angle (HVA) would have no effect on the first-TMT alignment and congruency. Methods: Radiographs of patients who underwent first-MTP joint arthrodesis for hallux valgus were retrospectively reviewed. The HVA, 1-2 intermetatarsal angle (IMA), first metatarsal–medial cuneiform angle (1MCA), medial cuneiform–first metatarsal angle (MC1A), relative cuneiform slope (RCS), and distal medial cuneiform angle (DMCA) were measured and recorded for all patients preoperatively and postoperatively. Results: Of the 76 feet that met inclusion criteria, radiographic improvements were noted in HVA (23.6 degrees, P < .0001), 1-2 IMA (6.2 degrees, P < .0001), 1MCA (6.4 degrees, P < .0001), MC1A (6.5 degrees, P < .0001), and RCS (3.3 degrees, P = .001) comparing preoperative and postoperative radiographs. There was no difference noted with DMCA measurements (0.5 degrees, P = .53). Conclusion: Our findings indicate that the radiographic alignment and subluxation of the first-TMT joint will reduce with isolated treatment of the first-MTP joint. Evidence suggests that change in the HVA can affect radiographic alignment and subluxation of the first-TMT joint. Level of Evidence: Level IV, retrospective case series.

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Radiographic Evaluation of First Metatarsal and Medial Cuneiform Morphology in Juvenile Hallux Valgus

Foot & Ankle International ◽

10.1177/1071100718789696 ◽

2018 ◽

Vol 39 (10) ◽

pp. 1223-1228 ◽

Cited By ~ 2

Author(s):

Philip Kaiser ◽

Kristin Livingston ◽

Patricia E. Miller ◽

Collin May ◽

Susan Mahan

Keyword(s):

Hallux Valgus ◽

Multivariable Analysis ◽

Metatarsophalangeal Joint ◽

Radiographic Evaluation ◽

High Recurrence Rate ◽

Level Of Evidence ◽

First Metatarsal ◽

Valgus Angle ◽

Medial Cuneiform ◽

Highly Correlated

Background: Operative treatment of juvenile hallux valgus (JHV) has a high recurrence rate. The aim of this study was to better understand the pattern of radiographic deformity. Methods: Standing radiographs of 93 feet in 57 patients with JHV, and 50 feet in 36 normal patients were measured. Measurements included: hallux valgus angle (HVA), first metatarsal physis status (open or closed), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), Meary’s angle, medial cuneiform angle (MCA), relative first to second metatarsal length ratio (1:2 MT ratio), cuneiform obliquity (CO), and congruency of the metatarsophalangeal joint (MTPJ). JHV groups were defined as normal (HVA 0-15 degrees), mild-moderate (HVA 15-35), or severe (HVA > 35) and were analyzed. Results: Seventy of 93 feet (75%) with JHV presented with mild-moderate JHV (average HVA of 26.2 ± 5.6 degrees), and 23 feet (25%, 23/93) presented with severe JHV (average HVA of 41.9 ± 5.3 degrees). Multivariable analysis determined that DMAA ( P < .001), MCA ( P = .04), and congruency ( P < .001) were independently associated with JHV and its severity (normal vs mild-moderate vs severe). Severe JHV cases had larger DMAA ( P = .01), larger IMA ( P = .01), larger 1:2 MT ratio ( P = .02), and were less frequently congruent ( P = .03) compared with mild-moderate JHV cases. Conclusion: Deformity in JHV was highly correlated with both the proximal and distal morphology of the first metatarsal and medial cuneiform. Severe JHV was associated with increased bony deformity and increased incongruity of the MTPJ. Treatment should be individualized, but JHV treatment algorithms can take this information into account. Level of Evidence: Level III, comparative study.

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Radiographic Assessment of Relative First Metatarsal Length Following Modified Lapidus Procedure

Foot & Ankle International ◽

10.1177/1071100720924016 ◽

2020 ◽

Vol 41 (8) ◽

pp. 972-977 ◽

Cited By ~ 1

Author(s):

Wessel Greeff ◽

Andrew Strydom ◽

Nikiforos Pandelis Saragas ◽

Paulo Norberto Faria Ferrao

Keyword(s):

Hallux Valgus ◽

Sagittal Plane ◽

Case Series ◽

Relative Length ◽

Long Term Results ◽

Retrospective Case ◽

Level Of Evidence ◽

First Metatarsal ◽

Patient Reported ◽

The Mean

Background: The modified Lapidus is a surgical procedure for managing moderate to severe hallux valgus, especially in the presence of first tarsometatarsal joint arthritis or hypermobility. It has good long-term results but reportedly can lead to transfer metatarsalgia due to inherent shortening of the first metatarsal. Methods: A retrospective analysis of all adult patients who underwent a modified Lapidus procedure during a 3-year period was performed. Clinical notes were evaluated to look for nonunion or any other complications related to the surgery. Pre- and postoperative standard weightbearing radiographs were used to establish the relative metatarsal length (RML), intermetatarsal angle (IMA), hallux valgus angle (HVA), and distal metatarsal articular angle (DMMA). A total of 69 modified Lapidus procedures were identified, with 32 included in the study. Results: The mean pre- and postoperative RMLs were −0.8 and −4.9 mm, respectively. The average RML shortening due to the procedure was −4.1 ( P < .0001). The mean pre- and postoperative IMAs were 15 and 5 degrees, respectively ( P < .0001). The mean pre- and postoperative HVAs were 33 and 9 degrees, respectively ( P < .0001). One patient reported transfer metatarsalgia, which was attributed to elevation of the first metatarsal. Conclusion: We found a statistically significant degree of shortening of the relative length of the first metatarsal without any clinically significant metatarsalgia. The low rate of transfer metatarsalgia following the modified Lapidus procedure could be attributed to the sagittal plane correction and stability obtained by performing a first tarsometatarsal fusion. Level of Evidence: Level IV, retrospective case series.

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Effectiveness of the Plantar Aponeurosis Release for Limitation of the First Metatarsophalangeal Joint Extension after Hallux Valgus Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000138 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Hongjoon Choi ◽

Daewook Kim ◽

Yeong Hun Kang ◽

Jong Ho Park

Keyword(s):

Hallux Valgus ◽

Metatarsophalangeal Joint ◽

Metatarsal Head ◽

Knee Extension ◽

First Metatarsophalangeal Joint ◽

Plantar Aponeurosis ◽

First Metatarsal ◽

Metatarsal Angle ◽

Additional Procedure ◽

The Mean

Category: Midfoot/Forefoot Introduction/Purpose: Even though stiffness of the first metatarsophalangeal joint (1MTP) is not a common complication, reduced dorsiflexion range of motion at the 1MTP after surgery for hallux valgus was reported as a complication. However, few clinical studies have investigated this issue and no clinical resolution has been reached thus far. We hypothesized that tightness of the gastrocnemius-plantar aponeurosis complex is one of the factors that limits the extension of 1MTP after hallux valgus surgery. Thus, an additional procedure of the plantar aponeurosis release during hallux valgus surgery may improve the range of extension at 1MTP. The purpose of this study was to test the efficacy of plantar aponeurosis release in improving the range of extension when a limitation is detected after hallux valgus surgery. Methods: Thirteen patients (17 feet) with limited 1MTP extension after hallux valgus surgery, underwent an additional procedure of plantar aponeurosis release. The inclusion criterion was limitation of 1MTP extension showed more than 15 degrees difference between knee extension and flexion position, measured after completing all procedures of the hallux valgus surgery. The passive range of 1MTP extension was evaluated by a goniometer while the first metatarsal head was supported with a palm, assuming a weightbearing position with knee extension and flexion, after completing all procedures of the hallux valgus surgery (Barouk test). A silfverskiold test was performed in all cases preoperatively. The weightbearing dorsoplantar and lateral radiographs of the foot were performed to measure the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and the talo-first metatarsal angle. Results: The mean range of 1MTP extension significantly improved from 2.53 degrees to 40.88 degrees in the knee extension position (p<0.0000). The mean range of the 1MTP extension also improved from 18.24 degrees to 43.24 degrees in the knee flexion position. The silfverskiold test was positive in 12 cases. In all patients, congruence of 1MTP was corrected. There were no surgery-related complications such as plantar aponeurosis rupture or nerve injury. Conclusion: Our study supports tightness of the gastrocnemius-plantar aponeurosis complex is one of the factors that limit the extension of 1MTP after hallux valgus surgery. Hence, plantar aponeurosis release can be considered as an effective additional procedure to improve the range of 1MTP extension when a limitation is presented after hallux valgus surgery.

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Distal Chevron Osteotomy Increases Anatomic Intermetatarsal Angle in Hallux Valgus

Foot & Ankle Orthopaedics ◽

10.1177/2473011420960710 ◽

2020 ◽

Vol 5 (4) ◽

pp. 247301142096071

Author(s):

Jeremy Y. Chan ◽

Naudereh Noori ◽

Stephanie Chen ◽

Glenn B. Pfeffer ◽

Timothy P. Charlton ◽

...

Keyword(s):

Hallux Valgus ◽

Case Series ◽

Metatarsal Osteotomy ◽

Retrospective Case ◽

Level Of Evidence ◽

Intermetatarsal Angle ◽

First Metatarsal ◽

Retrospective Case Series ◽

Chevron Osteotomy ◽

Anatomic Axis

Background: Distal chevron metatarsal osteotomy (DCO) is a common technique to address hallux valgus (HV), which involves coronal translation of the capital fragment resulting in a nonanatomic first metatarsal. The purpose of this study was to evaluate the radiographic effect of the DCO on the anatomic vs the mechanical axis of the first metatarsal. Our hypothesis was that patients undergoing DCO would have improvement in the mechanical metatarsal axis but worsening of the anatomic axis. Methods: This was a retrospective case series of consecutive patients who underwent DCO for HV. The primary outcomes were the change in anatomic first–second intermetatarsal angle (a1-2IMA) vs mechanical first–second intermetatarsal angle (m1-2IMA). Secondary outcomes included the change in hallux valgus angle (HVA) and medial sesamoid position. Results: 40 feet were analyzed with a mean follow-up of 21.2 weeks. The a1-2IMA increased significantly (mean, 4.1 degrees) whereas the m1-2IMA decreased significantly (mean, 4.6 degrees) following DCO. There was a significant improvement in HVA (mean, 12.5 degrees). Medial sesamoid position was improved in 21 feet (52.5%). Patients with no improvement in sesamoid position were found to have a larger increase in a1-2IMA (mean, 4.7 vs 3.5 degrees, P = .03) and less improvement in m1-2IMA (mean, 3.8 vs 5.2 degrees, P = .02) compared to patients with improvement in sesamoid position. Conclusion: Distal chevron osteotomy for HV was associated with worsening of the anatomic axis of the first metatarsal despite improvements in the mechanical metatarsal axis, HVA, and medial sesamoid position. Greater worsening of the anatomic axis was associated with less improvement of sesamoid position. Our findings may suggest the presence of intermetatarsal instability, which could limit the power of DCO in HV correction for more severe deformities and provide a mechanism for HV recurrence. Level of Evidence: Level IV, retrospective case series.

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Intraoperative Incidence of Hallux Valgus Interphalangeus following Basilar First Metatarsal Osteotomy and Distal Soft Tissue Realignment

Foot & Ankle International ◽

10.3113/fai.2011.1058 ◽

2011 ◽

Vol 32 (11) ◽

pp. 1058-1062 ◽

Cited By ~ 14

Author(s):

Jae-Yong Park ◽

Hong-Geun Jung ◽

Tae-Hoon Kim ◽

Min-Seok Kang

Keyword(s):

Soft Tissue ◽

Pain Score ◽

Hallux Valgus ◽

Case Series ◽

Metatarsophalangeal Joint ◽

Metatarsal Osteotomy ◽

Aofas Score ◽

Level Of Evidence ◽

First Metatarsal ◽

Akin Osteotomy

Background: The premise of this study was that after the correction of hallux-metatarsophalangeal pronation, the intraoperative interphalangeal angle (HIA) increases significantly, and that an additional Akin osteotomy (AO) is often needed. Therefore, the purpose of this study was to evaluate whether HIAs in hallux valgus (HV) feet were underestimated, and to assess the need for AO during HV correction. Method: This study was conducted on 54 feet with moderate to severe HV treated from June 2007 to December 2008. HIAs and medial sesamoid subluxations (MSS) were measured initially and intraoperatively after a distal soft tissue procedure (DSTP) and proximal chevron metatarsal osteotomy (PCMO). An intraoperative technique was used to evaluate the incongruency of the metatarsophalangeal joint (MTPJ) to determine the need for additional Akin osteotomy. Results: After performing DSTP and PCMO, HIAs significantly increased from an average of 9 to 13.3 degrees and MSS reduced from average grade 2.5 to 0.5 ( p < 0.05). Akin ostetomy was added in 44 (81%) feet. After an average followup of 13.2 months in Akin group, average VAS pain score decreased from 5.7 to 1.2 and average AOFAS score increased from 57.8 to 90.2 ( p < 0.05). Final hallux MTPJ dorsiflexion in the Akin group was significantly larger than in the without-Akin group ( p < 0.05). Conclusion: Average HIA significantly increased after DSTP and PCMO for moderate to severe HV necessitating additional Akin osteotomy, to achieve ideal HV correction and, to preserve MTPJ motion. Level of Evidence: IV, Case Series

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Hallux interphalangeal involvement after metatarsophalangeal joint arthrodesis. Treatment and Results

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2020.v14.1172 ◽

2020 ◽

Vol 14 (2) ◽

pp. 132-137

Author(s):

Enzo Sperone ◽

Martín Rofrano ◽

Andrés Bigatti ◽

Matías Iglesias ◽

Iván Torterola ◽

...

Keyword(s):

Hallux Valgus ◽

Simple Procedure ◽

Case Series ◽

Metatarsophalangeal Joint ◽

Resection Arthroplasty ◽

Therapeutic Modality ◽

Level Of Evidence ◽

First Metatarsophalangeal Joint ◽

Severe Hallux Valgus

Objective: To assess the involvement of the hallux interphalangeal (IP) joint after first metatarsophalangeal joint (MTPJ) arthrodesis and propose a treatment consisting of MTPJ resection arthroplasty associated with phalangeal osteotomy or IP joint arthrodesis. Methods: We retrospectively analyzed 9 patients treated with MTPJ resection arthroplasty associated with phalangeal osteotomy or hallux IP joint arthrodesis from November 2006 to January 2017. Results: The main causes of MTPJ arthrodesis that subsequently evolved to IP involvement were severe hallux valgus and sequelae or complications of previous hallux valgus operations. Additionally, the reasons leading to rescue surgery were pain, deformity, and/or discomfort. Conclusion: This therapeutic modality is able to relieve symptoms by a simple procedure, with acceptable functional and estheticresults. Level of Evidence IV; Therapeutic Studies; Case Series.

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Maintenance of Correction of the Modified Lapidus Procedure With a First Metatarsal to Intermediate Cuneiform Cross-Screw Technique

Foot & Ankle International ◽

10.1177/1071100719895268 ◽

2019 ◽

Vol 41 (4) ◽

pp. 428-436 ◽

Cited By ~ 2

Author(s):

Travis M. Langan ◽

Joseph M. Greschner ◽

Roberto A. Brandão ◽

David A. Goss ◽

Clair N. Smith ◽

...

Keyword(s):

Hallux Valgus ◽

Case Series ◽

Bony Union ◽

Hallux Valgus Angle ◽

Retrospective Case ◽

Level Of Evidence ◽

Intermetatarsal Angle ◽

First Metatarsal ◽

Tarsometatarsal Joint ◽

Valgus Angle

Background: Recurrence of deformity remains a concern when fusing the first tarsometatarsal joint for correction of hallux valgus (HV). A recently described construct adds an additional point of fixation from the plantar medial first metatarsal to the intermediate cuneiform. The purpose of this study was to determine the maintenance of correction of the first and second intermetatarsal angle, hallux valgus angle, and tibial sesamoid position after undergoing a first tarsometatarsal joint arthrodesis using the proposed construct. Methods: A radiographic review was performed of patients with HV treated with a first tarsometatarsal joint arthrodesis with the addition of a cross-screw intermediate cuneiform construct. Three observers reviewed radiographic data, including preoperative weightbearing, first weightbearing, and final weightbearing plain-film radiographs. Initial improvement and maintenance of intermetatarsal angle, hallux valgus angle (HVA), and tibial sesamoid position were evaluated radiographically. A total of 62 patients met inclusion criteria and were included in the study. Mean follow-up time was 9.3 months (SD 6.7). Results: Bony union was achieved in 60 of 62 patients (96.7%). Two of 62 patients required revision surgery as a result of recurrence (3.3%). Final mean improvement of the intermetatarsal angle (IMA) was 6.8 degrees (±2.9 degrees), HVA was 14.8 degrees (±7.5 degrees), and tibial sesamoid position was 2.4 (±1.4) positions. Mean loss of IMA correction was 1.5 degrees (±1.6), HVA was 2.9 degrees (±4.8 degrees), and tibial sesamoid position was 0.8 (±0.8). Conclusion: This study showed that the cross-screw intermediate cuneiform construct for first tarsometatarsal joint arthrodesis had a good union rate, a low complication rate, and maintained radiographic correction. Level of Evidence: Level IV, retrospective case series.

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Loss of Correction After Chevron Osteotomy for Hallux Valgus as a Function of Preoperative Deformity

Foot & Ankle International ◽

10.1177/1071100718807699 ◽

2018 ◽

Vol 40 (3) ◽

pp. 287-296 ◽

Cited By ~ 8

Author(s):

Gerhard Kaufmann ◽

Stefanie Sinz ◽

Johannes M. Giesinger ◽

Matthias Braito ◽

Rainer Biedermann ◽

...

Keyword(s):

Hallux Valgus ◽

Case Series ◽

X Rays ◽

Retrospective Case ◽

Level Of Evidence ◽

Loss Of Correction ◽

Chevron Osteotomy ◽

Significant Correction ◽

Preoperative Deformity

Background: Recurrence is relatively common after surgical correction of hallux valgus. Multiple factors are discussed that could have an influence in the loss of correction. The aim of this study was to determine preoperative radiological factors with an influence on loss of correction after distal chevron osteotomy for hallux valgus. Methods: Five hundred twenty-four patients who underwent the correction of a hallux valgus by means of distal chevron osteotomy at our institution between 2002 and 2012 were included. We assessed weightbearing x-rays at 4 time points: preoperatively, postoperatively, and after 6 weeks and 3 months. We investigated the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), joint congruity, and the position of the sesamoids. Results: At all points of the survey, significant correction of the IMA and HVA was detected. The IMA improved from 12.9 (± 2.8) to 4.5 (± 2.4) degrees and the HVA from 27.5 (± 6.9) to 9.1 (± 5.3) degrees. Loss of correction was found in both HVA and IMA during follow-up with a mean of 4.5 and 1.9 degrees, respectively. Loss of correction showed a linear correlation with preoperative IMA and HVA, and a correlation between preoperative DMAA and sesamoid position. Conclusion: The chevron osteotomy showed significant correction for HVA, IMA, and DMAA. Preoperative deformity, in terms of IMA, HVA, DMAA, and sesamoid position, correlated with the loss of correction and could be assessed preoperatively for HVA and IMA. Loss of correction at 3 months persisted during the follow-up period. Level of Evidence: Level IV, retrospective case series.

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Hallux Valgus Recurrence After Simple Bunionectomy: Algorithm Treatment

10.21203/rs.3.rs-1121623/v1 ◽

2022 ◽

Author(s):

Josep Torrent ◽

Raúl Figa ◽

Iban Clares ◽

Eduard Rabat

Keyword(s):

Comparative Study ◽

Hallux Valgus ◽

Treatment Algorithm ◽

Metatarsophalangeal Joint ◽

Salvage Procedure ◽

Bone Stock ◽

Level Of Evidence ◽

First Metatarsophalangeal Joint ◽

Retrospective Comparative Study ◽

End Stage

Abstract Background: Recurrences of hallux valgus can be difficult to manage, especially after a prior simple bunionectomy. This study aimed to present a treatment algorithm for the correction of recurrences after a simple bunionectomy.Methods: This was a single-center, descriptive, and retrospective comparative study. Thirty-four consecutive patients were classified according to the bone stock and the presence or absence of end-stage arthritis of the first metatarsophalangeal joint (MTPJ). According to our algorithm, we only performed an osteotomy as the salvage procedure in cases with sufficient bone stock and absence of or mild arthritis. In the other cases, we performed an MTPJ fusion. Exceptionally, we chose a Keller-Brandes arthroplasty for patients with advanced age and comorbidities. Results: We performed 17 scarf osteotomies (50%), 15 MTPJ arthrodeses (44.1%), and 2 Keller-Brandes arthroplasties (5.9%). Following the algorithm, we achieved an improvement of the AOFAS score of >30 points without severe complications in all groups.Conclusions: The proposed operative algorithm successfully addresses the recurrences considering the lack of bone stock and the presence of MTPJ arthritis.Level of EvidenceLevel 3: retrospective comparative study

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Multicenter Early Radiographic Outcomes of Triplanar Tarsometatarsal Arthrodesis With Early Weightbearing

Foot & Ankle International ◽

10.1177/1071100719847700 ◽

2019 ◽

Vol 40 (8) ◽

pp. 955-960 ◽

Cited By ~ 9

Author(s):

Justin J. Ray ◽

Jennifer Koay ◽

Paul D. Dayton ◽

Daniel J. Hatch ◽

Bret Smith ◽

...

Keyword(s):

Hallux Valgus ◽

Case Series ◽

Retrospective Case ◽

Recurrence Rates ◽

Level Of Evidence ◽

Radiographic Outcomes ◽

Valgus Angle ◽

First Ray ◽

Akin Osteotomy

Background:Hallux valgus is a multiplanar deformity of the first ray. Traditional correction methods prioritize the transverse plane, a potential factor resulting in high recurrence rates. Triplanar first tarsometatarsal (TMT) arthrodesis uses a multiplanar approach to correct hallux valgus in all 3 anatomical planes at the apex of the deformity. The purpose of this study was to investigate early radiographic outcomes and complications of triplanar first TMT arthrodesis with early weightbearing.Methods:Radiographs and charts were retrospectively reviewed for 57 patients (62 feet) aged 39.7 ± 18.9 years undergoing triplanar first TMT arthrodesis at 4 institutions between 2015 and 2017. Patients were allowed early full weightbearing in a boot walker. Postoperative radiographs were compared with preoperative radiographs for hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position (TSP), and lateral round sign. Any complications were recorded.Results:Radiographic results demonstrated significant improvements in IMA (13.6 ± 2.7 degrees to 6.6 ± 1.9 degrees), HVA (24.2 ± 9.3 degrees to 9.7 ± 5.1 degrees), and TSP (5.0 ± 1.3 to 1.9 ± 0.9) from preoperative to final follow-up ( P < .001). Lateral round sign was present in 2 of 62 feet (3.2%) at final follow-up compared with 52 of 62 feet (83.9%) preoperatively. At final follow-up, recurrence was 3.2% (2/62 feet), and the symptomatic nonunion rate was 1.6% (1/62 feet). Two patients required hardware removal, and 2 patients required additional Akin osteotomy.Conclusion:Early radiographic outcomes of triplanar first TMT arthrodesis with early weightbearing were promising with low recurrence rates and maintenance of correction.Level of Evidence:Level IV, retrospective case series.

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