scholarly journals Tarsometatarsal bone remodelling after subtalar arthroereisis

2020 ◽  
Vol 14 (3) ◽  
pp. 221-229
Author(s):  
Matthias Braito ◽  
Maria Radlwimmer ◽  
Dietmar Dammerer ◽  
Philipp Hofer-Picout ◽  
Jürgen Wansch ◽  
...  
Keyword(s):  
Bone Remodelling ◽  
Deformity Correction ◽  
Lateral View ◽  
Bone Morphology ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Medial Cuneiform ◽  
Angular Measurements ◽  
Subtalar Arthroereisis

Purpose Subtalar arthroereisis has been described for the treatment of flexible juvenile flatfoot. However, the mechanism responsible for deformity correction has not yet been investigated adequately. The aim of this study was to document the effect of subtalar arthroereisis on the tarsometatarsal bone morphology. Methods We retrospectively reviewed the clinical and radiological data of 26 patients (45 feet) with juvenile flexible flatfoot deformity treated by subtalar arthroereisis at our department between 2000 and 2018. Radiological evaluation included angular measurements of tarsometatarsal bone morphology as well as hindfoot and midfoot alignment. Mean radiographic follow-up was 19.4 months (sd 8.8; 12 to 41). Results A significant change of angular measurements of tarsometatarsal bone morphology was found after subtalar arthroereisis (p < 0.001). While there was an increase of the distal medial cuneiform angle (DMCA) and the medial cuneo-first metatarsal angle on the anteroposterior view, a decrease of the naviculo-medial cuneiform angle and the medial cuneo-first metatarsal angle was seen on the lateral view. Furthermore, we found significant improvements of all hindfoot and midfoot alignment parameters except the lateral tibio-calcaneal angle and the calcaneal pitch angle (p < 0.001). Conclusion Our data support the theory of tarsometatarsal bone remodelling, which may contribute to the effect of subtalar arthroereisis for the treatment of flexible juvenile flatfoot. Level of evidence IV

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

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110085
Author(s):  
Christopher Traynor ◽  
James Jastifer
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Medial Cuneiform ◽  
Radiographic Alignment

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.

scholarly journals Structural Effect of Long-Term Use of Medial Arch Support Insole on Children with Pediatric Flexible Flatfoot

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0014
Author(s):  
Jun Young Choi ◽  
Min Jin Kim ◽  
Jin Soo Suh
Keyword(s):  
Structural Effect ◽  
Hindfoot Alignment ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Medial Cuneiform ◽  
Flexible Flatfoot ◽  
Arch Support ◽  
Group 2 ◽  
Physeal Closure ◽  
Group 1

Category: Midfoot/Forefoot Introduction/Purpose: This prospective study aimed to rule out the effect of the normal physiologic maturation in applying medial arch support insole for patients with pediatric flexible flatfoot (PFFF). Methods: From January 2005 to June 2015, 18 patients (34 feet) in group 1 (insole was continuously applied) and 16 patients (32 feet) in group 2 (untreated group) were enrolled. A medial arch support insole was applied from age 10-11 years until radiographic physeal closure. Results: In group 1, the talonavicular coverage angle, lateral talo-first metatarsal angle, calcaneal pitch angle, and medial cuneiform height were significantly changed at final follow-up, although all values were still within the abnormal range. Moreover, no significant differences were found in any of the increments of the radiographic parameters between groups 1 and 2. Conclusion: Radiographic improvements were found in both medial arch support insole-treated and untreated groups even if all radiographic values were still within the abnormal range. This means that PFFF could be somehow improved with heel stretching exercise until the physes were closed. Further, hindfoot alignment remained unchanged regardless of the medial arch support insole application.

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.

Pes Planus Deformity and Its Association With Hallux Valgus Recurrence Following Scarf Osteotomy

2020 ◽  
Vol 41 (10) ◽  
pp. 1212-1218
Author(s):  
Gavin John Heyes ◽  
Amir R. Vosoughi ◽  
Lizzy Weigelt ◽  
Lyndon Mason ◽  
Andrew Molloy
Keyword(s):  
Hallux Valgus ◽  
P Value ◽  
Level Of Evidence ◽  
Pes Planus ◽  
First Metatarsal ◽  
Scarf Osteotomy ◽  
Metatarsal Angle ◽  
Valgus Angle ◽  
Akin Osteotomy

Background: Hallux valgus recurrence is an unsatisfactory complication, with many causes postulated. This study investigated the effect of pes planus on recurrence after scarf osteotomy. Methods: A total of 183 feet were retrospectively reviewed. All patients were treated with a scarf osteotomy and if required Akin osteotomy. We measured preoperative lateral talus first metatarsal angle (T1MA) to study pes planus; an angle of under −4 degrees was considered pes planus. We measured pre and postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), and sesamoid location. In total 164 feet were suitable for inclusion, with follow-up of at least 6 months (10 males and 154 females, mean age: 52 years). Results: Recurrence frequency (HVA greater than 15 degrees) was 27 feet (16%). Hallux valgus recurrence was not influenced by gender ( P value = .66) or preoperative IMA ( P value = .48). Preoperative HVA greater than 35 degrees was associated with increased frequency of recurrence ( P value = .004). Those with T1MA less than −10 degrees demonstrated progression in HVA and deterioration in sesamoid location up to 6 months postoperatively ( P value = .038). HVA did not progress beyond 6 months. The prevalence of recurrent hallux valgus with normal T1MA was 1%, in T1MA −4 to −10 degrees it was 29% and in T1MA less than −10 degrees it was 47% ( P value <.001). Breaks in T1MA less than −4 degrees were found at the naviculocuneiform joint in 68% of feet in this series. Conclusion: The prevalence of hallux valgus recurrence correlated with the severity of pes planus. Level of Evidence: Level III, retrospective cohort study.

scholarly journals Combined Subtalar and Naviculocuneiform Fusion for Treating Adult Acquired Flatfoot Deformity With Medial Arch Collapse at the Level of the Naviculocuneiform Joint

2018 ◽  
Vol 40 (1) ◽  
pp. 42-47 ◽  
Author(s):  
Caspar Samuel Steiner ◽  
Andrea Gilgen ◽  
Lukas Zwicky ◽  
Christine Schweizer ◽  
Roxa Ruiz ◽  
...  
Keyword(s):  
Case Series ◽  
Fusion Rate ◽  
Subsequent Treatment ◽  
Talonavicular Joint ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Ankle Replacement ◽  
Chopart Joint ◽  
Adult Acquired Flatfoot Deformity

Background: A challenge in treating acquired flatfoot deformities is the collapse of the medial arch at the level of the naviculocuneiform (NC) joint. Triple fusions, being a treatment option, may lead to problems such as increased foot stiffness. We thus established a method that combines subtalar (ST) fusion with NC fusion while preserving the Chopart joint. We analyzed the radiographic correction, fusion rate, and patient satisfaction with this procedure. Methods: 34 feet in 31 patients (female, 23; male, 8; age 67 [45-81] years) were treated with a ST and NC joint fusion. In 15 cases, a medial sliding-osteotomy was additionally necessary to fully correct hindfoot valgus. The following radiographic parameters were measured on weightbearing radiographs preoperatively and at 2 years: talo–first metatarsal angle, talocalcaneal angle, calcaneal pitch, talonavicular coverage angle and calcaneal offset. Fusion was radiologically confirmed. Results: All parameters, except the calcaneal pitch, showed a significant improvement. Fusion was observed after 1 year in all but 2 cases (94.1%). One nonunion each occurred at the ST and NC joint without needing any subsequent treatment. One patient developed avascular necrosis of the lateral talus with need for total ankle replacement after 1 year. All patients were satisfied with the obtained results. Conclusion: Our data suggest that a combined fusion of the ST and NC joint was effective and safe when treating adult acquired flatfoot with collapse of the medial arch at the level of the NC joint. Although the talonavicular joint was not fused, its subluxation was significantly reduced. Level of Evidence: Level IV, case series.

Effect of Unilateral Accessory Navicular Bone on Radiologic Parameters of Foot

2020 ◽  
pp. 107110072096482
Author(s):  
Mustafa Kara ◽  
Serkan Bayram
Keyword(s):  
Navicular Bone ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Asymptomatic Patients ◽  
Accessory Navicular ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Background: This study aimed to compare the radiologic parameters of both feet in patients with unilateral accessory navicular bone (ANB) and evaluate the differences from one another. Methods: Forty-one patients with unilateral ANB volunteered to participate in this study from August 2019 to January 2020. Patient data, including age, sex, body mass index (BMI), type of ANB, and presence of symptoms were obtained. Group 1 comprised 23 patients with asymptomatic unilateral ANB, and group 2 comprised 18 patients with symptomatic unilateral ANB. Seven radiologic parameters were evaluated assessing hindfoot, midfoot, and forefoot alignment—calcaneal pitch angle, talocalcaneal angle, tibiocalcaneal angle, naviculocuboid overlap (NCO), talonavicular coverage angle (TNCA), anteroposterior talo–first metatarsal angle, and lateral talo–first metatarsal angle. Results: The mean age of patients was 40.1 years in group 1 and 42.6 years in group 2. Mean BMI was 25.2 in group 1 and 26.6 in group 2. No significant differences were noted in the radiologic parameters between the ANB and contralateral sides in all patients. The radiologic parameters of both feet in symptomatic and asymptomatic patients were not significantly different. No significant differences were noted between the affected sides of type 1 and 2 ANB and contralateral sides in terms of the radiologic parameters. BMI was significantly correlated with NCO and TNCA. Conclusion: This study demonstrated that the presence of an accessory navicular bone did not affect radiologic parameters of the foot. Radiologic parameters of both feet in symptomatic patients were not significantly different. Level of Evidence: Level III, diagnostic, comparative study.

Derotation of the Talus and Arthrodesis Treatment of Stages II-V Müller-Weiss Disease: Midterm Results of 36 Cases

2019 ◽  
Vol 40 (5) ◽  
pp. 506-514 ◽  
Author(s):  
Chengjie Yuan ◽  
Chen Wang ◽  
Chao Zhang ◽  
Jiazhang Huang ◽  
Xu Wang ◽  
...  
Keyword(s):  
Case Series ◽  
Deformity Correction ◽  
Stage Iv ◽  
Staging System ◽  
Functional Improvement ◽  
Midterm Results ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Metatarsal Angle

Background: Various operative procedures have been reported for the treatment of Müller-Weiss disease (MWD). This study reports the midterm operative treatment results for stages II to V MWD with derotation of the talus and arthrodesis. Methods: Thirty-four patients (36 feet) with MWD were treated by talonavicular (TN) or talonavicular-cuneiform (TNC) arthrodesis in our center from 2008 to 2015. The affected feet were staged according to the Maceira staging system (stage II: 9; stage III: 10; stage IV: 9; stage V: 8). The American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scale, the visual analog scale (VAS), and relative radiologic parameters were evaluated preoperatively and also during follow-up. The mean follow-up duration was 38.2 (range, 25-113 months). Results: The final follow-up showed satisfactory outcomes. Overall, the AOFAS scores improved from 41.5 (range, 20-56) to 85.3 (range, 68-100) points ( P <.001), and the VAS score decreased from 5.7 (range, 3-8) to 0.9 (range, 0-4) points ( P <.001). The Tomeno-Méary angle decreased from −6.7 (range, −26.4 to 17.7) to 0.7 (range, −5.3 to 7) degrees ( P=.001). The calcaneal pitch angle increased from 13.7 (range, 4.1-26.2) to 22.0 (range, 13.3-28.9) degrees ( P < .001). The anteroposterior (AP) talar–first metatarsal angle decreased from −15.8 (range, −30.1 to −13.7) to −7.0 (range, −25.9 to −8.9) degrees ( P < .001), and the AP talocalcaneal angle increased from 14.7 (range, 4.7-22.3) to 22.1 (range, 13.4-29.5) degrees ( P=.005). The AP talonavicular coverage angle decreased from −27.0 (range, −40.4 to −13.3) to −7.8 degrees (range, −20.7 to −1.8) degrees ( P < .001). Conclusion: The midterm results found that the TN or TNC joint fusion could achieve a favorable clinical and radiologic outcome for patients with MWD. Even for the patients with severe deformities (stages IV-V), this treatment strategy could also achieve satisfactory deformity correction and functional improvement. Intraoperative restoration of talus rotation was the key to normal alignment of the subtalar joint/TN joint. Level of Evidence: Level IV, retrospective case series.

Validation of the Talar–Second Metatarsal Angle as a Standard Measurement for Radiographic Evaluation

2011 ◽  
Vol 101 (6) ◽  
pp. 475-483 ◽  
Author(s):  
Michael E. Graham ◽  
Avanthi Chikka ◽  
Paul C. Jones
Keyword(s):  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Radiographic Evaluation ◽  
Foot Deformities ◽  
Accurate Information ◽  
Intraclass Correlation Coefficients ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Second Metatarsal ◽  
Angular Measurements

Background: Radiographs provide valuable information for assessing osseous foot deformities and aid in accurate diagnosis. The radiographic angular measurements can be used to establish a relationship between the forefoot and the hindfoot that will present valuable information about normal versus pathologic alignment of the foot. The talar–first metatarsal (T1M) angle is frequently used as one of these angles in this capacity; however, there are limitations to the anteroposterior T1M angle. We present a more consistent, reproducible, and accurate measurement for determining foot abnormalities in the transverse plane using the T2M angle instead of the T1M angle. Methods: Seventy feet in 35 participants (12 men and 23 women) were considered for this study. Individuals were selected on the basis of the established inclusion and exclusion criteria. Anteroposterior radiographs were taken in the angle and base of gait, the neutral calcaneal stance position (NCSP), and the resting calcaneal stance position (RCSP). Three observers measured these angles using three different methods. Results: The mean ± SD T2M angle was 2.95° ± 7.16° in NCSP and 18.61° ± 7.21° in RCSP. No significant differences were found among the measurements made by the three observers using slightly varying procedures in NCSP and RCSP (P &gt; .05). The intraclass correlation coefficients among the measurements were 0.905 in NCSP and 0.937 in RCSP. Bland-Altman plots showed very good agreement between the measurements made by the three observers. Conclusions: The anteroposterior T2M angle gives a consistent and reproducible measurement that provides accurate information about foot alignment. (J Am Podiatr Med Assoc 101(6): 475–483, 2011)

Incidence and Radiographic Predictors of Valgus Tibiotalar Tilt After Hindfoot Fusion

2017 ◽  
Vol 38 (5) ◽  
pp. 519-525 ◽  
Author(s):  
Sara Lyn Miniaci-Coxhead ◽  
Benjamin Weisenthal ◽  
John P. Ketz ◽  
A. Samuel Flemister
Keyword(s):  
Confidence Interval ◽  
Valgus Deformity ◽  
Hazard Ratio ◽  
Radiographic Measurement ◽  
Level Of Evidence ◽  
Common Procedure ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Hindfoot Fusion ◽  
Hindfoot Arthrodesis

Background: The development of valgus tibiotalar tilt following hindfoot arthrodesis is rarely discussed in the literature. The purpose of this study was to determine the incidence of valgus tibiotalar tilt and to evaluate if there were any radiographic predictors for the development of valgus tibiotalar tilt. Methods: Patients who underwent hindfoot fusion between January 1, 2004 and December 31, 2013 were identified. Charts were reviewed for demographic information and operative details. Preoperative and postoperative radiographs were reviewed for the development of tibiotalar tilt, and standardized measurements and angles were calculated. A total of 187 patients were included. There were 106 (56.7%) females and 81 (43.3%) males. The average age was 52 years (range, 11-82 years). The most common indication for surgery was adult-acquired flatfoot deformity (n = 92, 49.2%), followed by arthritis (n = 83, 44.4%). The most common procedure was triple arthrodesis (n = 101, 54%). Twenty-seven patients demonstrated tibiotalar tilt preoperatively. Results: A total of 51 patients (27.3%) developed valgus tibiotalar tilt postoperatively at an average of 3.6 months after surgery. We found that an increase in the preoperative Meary (lateral talar–first metatarsal) angle (hazard ratio, 1.039; 95% confidence interval, 1.002-1.077; P < .05) was associated with the development of tibiotalar tilt. An increase in the postoperative Meary angle (hazard ratio, 1.052; 95% confidence interval, 0.999-1.108; P = .0528) approached significance for the development of tibiotalar tilt. Conclusion: The development of valgus tibiotalar tilt following hindfoot fusion was a notable phenomenon, occurring in 27% of our patient population. The preoperative Meary angle was the only radiographic measurement that was significantly associated with the development of valgus tibiotalar tilt, although the postoperative Meary angle approached significance. These findings should encourage surgeons to be aware of patients with large deformities and of their propensity to develop a valgus deformity about the ankle. Level of Evidence: Level III, retrospective comparative series.

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

2018 ◽  
Vol 39 (10) ◽  
pp. 1223-1228 ◽  
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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