PREOPERATIVE ANALYSIS OF RADIOGRAPHIC FINDINGS IN 516 PATIENTS WITH HALLUX VALGUS DEFORMITY

ABSTRACT Objective: This is a descriptive study to report our method of operative correction for patients with hallux valgus deformities. Methods: From 2006 to 2012, 516 consecutive patients (601 feet) with hallux valgus deformities were treated surgically in our department after conservative treatments were exhausted. The hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and degree of osteoarthritis in the first metatarsophalangeal joint were measured on preoperative plain radiographs of the weight-bearing forefoot. Results: Young patients with severe intermetatarsal deviation received a combined proximal and distal osteotomy of the first metatarsal (n = 21). Patients with low intermetatarsal deviation received a distal metatarsal chevron osteotomy (n = 196), whereas patients with severe intermetatarsal deviation and less flexible deformities without osteoarthritis received a basal metatarsal osteotomy with a distal soft tissue procedure (n = 173). Elderly active patients with osteoarthritis in the first metatarsophalangeal joint received an arthrodesis (n = 100) or resection arthroplasty (n = 58). Conclusion: Determining a few simple angles on plain radiographs of the weight-bearing forefoot in combination with the age and level of activity of patients can help simplify the operative correction method by using the schema we developed. Level of evidence IV, case series.

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

Foot & Ankle Orthopaedics ◽

10.1177/24730114211008514 ◽

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.

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The Mayday Distal First Metatarsal Osteotomy for Hallux Valgus: A Review After the Introduction of a New Instrument

Foot & Ankle International ◽

10.1177/107110079701800102 ◽

1997 ◽

Vol 18 (1) ◽

pp. 3-7 ◽

Cited By ~ 4

Author(s):

G.D. Terzis ◽

F. Kashif ◽

M.A.S. Mowbray

Keyword(s):

Hallux Valgus ◽

Metatarsophalangeal Joint ◽

Metatarsal Osteotomy ◽

Distal Fragment ◽

Short Term ◽

First Metatarsophalangeal Joint ◽

First Metatarsal ◽

Satisfactory Outcome ◽

New Instrument

We present the short-term follow-up of 55 symptomatic hallux valgus deformities in 38 patients, treated operatively with a modification of the spike distal first metatarsal osteotomy, as described by Gibson and Piggott in 1962. The age range of the patients was 17 to 72 years at the time of surgery. The postoperative follow-up period was 12 to 55 months. Excellent and good clinical and radiographic results were recorded in 96.2% of our patients. Two of the patients (3.8%) were dissatisfied; one of them complained of metatarsalgia after the procedure, and the other had stiffness of the metatarsophalangeal joint and metatarsalgia that had been present before surgery. Three others (5.45%) required revision after early postoperative displacement but were asymptomatic subsequently. We concluded that our technique is an effective method of treating mild hallux valgus deformities with the advantages of simplicity, no shortening of the first metatarsal, and no risk of dorsal tilting of the distal fragment. Hallux valgus (lateral deviation of the great toe) is not a single disorder, as the name implies, but a complex deformity of the first ray that sometimes may involve the lesser toes. More than 130 procedures exist for the surgical correction of hallux valgus, which means that no treatment is unique. No single operation is effective for all bunions. 5 , 22 , 29 The objectives of surgical treatment are to reduce pain, to restore articular congruency, and to narrow the forefoot without impairing function, by transferring weight to the lesser metatarsals either by shortening or by dorsal tilting of the first metatarsal. 5 , 19 , 24 , 27 Patient selection is important for a satisfactory outcome after surgery of any kind, and our criteria were age, degree of deformity, presence of arthrosis, and subluxation of the first metatarsophalangeal joint. 1 , 5 , 13 , 19 – 21 , 24 , 29 In this study, we present a new method of treating hallux valgus that has been used at Mayday University Hospital since 1990. The technique was first described at the British Orthopaedic Foot Surgery Society, Liverpool, November 1990, 7 and we now present the short-term follow-up results. The procedure is essentially a modification of the spike osteotomy of the neck of the first metatarsal, as described by Gibson and Piggott. 9 It has the advantages of simplicity, no shortening of the first metatarsal, and no risk of dorsal displacement of the distal fragment.

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Quantifying Patient-Reported Disability and Health While Waiting for Bunion Surgery

Foot & Ankle International ◽

10.1177/1071100718772037 ◽

2018 ◽

Vol 39 (9) ◽

pp. 1047-1055 ◽

Cited By ~ 6

Author(s):

Jason M. Sutherland ◽

Kevin Wing ◽

Murray Penner ◽

Alastair Younger ◽

Guiping Liu ◽

...

Keyword(s):

Hallux Valgus ◽

Metatarsophalangeal Joint ◽

Wait Time ◽

Patient Reported Outcome ◽

Loss Of Function ◽

Level Of Evidence ◽

First Metatarsophalangeal Joint ◽

Operative Correction ◽

Patient Reported ◽

Foot Function

Background: Many patients with hallux valgus progress to experiencing pain and loss of function that requires corrective surgery when nonoperative treatments fail. The primary goal of this study was to measure changes in participants’ health while patients waited for their operative correction. Methods: Patients were prospectively recruited to complete a number of patient-reported outcome measures preoperatively. Baseline data collection was initiated in October 2014, and participants’ second surveys were returned by August 2017. The setting of the study was Vancouver, Canada. There were 80 participants in the study. The participation rate among eligible patients was 52.7%. Results: The average wait time for surgery exceeded 8 months, with a mean wait of 35.7 weeks. Baseline pain among participants was high. Only in the domain of foot- and ankle-related quality of life was the duration of wait time associated with participants’ change in health. The other 4 domains of foot function remained stable over the preoperative period. Conclusion: Preoperative health in this study was consistent with other research showing high pain and compromised foot function among patients failing nonoperative therapies for treatment of hallux valgus. This study found high pain and compromised foot function among patients waiting for hallux valgus surgery but only minor relationships between participants’ duration of wait time for operative correction of the first metatarsophalangeal joint and changes in patient-reported outcome scores. Level of Evidence: Level III, comparative study.

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Chevron (Austin) Distal Metatarsal Osteotomy for Hallux Valgus: Comparison of Pre- and Post-Surgical Characteristics

Foot & Ankle International ◽

10.1177/107110070202300606 ◽

2002 ◽

Vol 23 (6) ◽

pp. 503-508 ◽

Cited By ~ 46

Author(s):

Thomas W. Kernozek ◽

Steven A. Sterriker

Keyword(s):

Range Of Motion ◽

Hallux Valgus ◽

Metatarsophalangeal Joint ◽

Pain Scale ◽

Metatarsal Osteotomy ◽

Talocrural Joint ◽

First Metatarsophalangeal Joint ◽

Perceived Pain ◽

Distal Metatarsal Osteotomy ◽

Joint Range

The purpose of the study was to compare the range of motion, perceived pain and plantar loading characteristics of the Chevron (Austin) corrective procedures in treating hallux valgus (HV) 12 months postsurgically. Twenty-five female participants with the diagnosis of mild to moderate HV deformity were studied. All participants had a distal metatarsal osteotomy (Chevron (Austin)) to correct their deformity. First metatarsophalangeal and talocrural joint range of motion (ROM) and a 10-point analog pain scale were measured presurgically and 12 months post-surgically on each participant. Radiographic measures of hallux valgus and intermetatarsal (IM) angles were taken preoperatively and six weeks postoperatively for comparison. Five pressure distribution measurements were recorded of barefoot walking using the EMED-SF presurgically and 12 months postsurgically. Statistical analyses revealed that plantar loading is still altered 12 months postsurgically despite a decrease in perceived pain and adequate first metatarsophalangeal joint ROM. Greater loading occurred in the central forefoot (CFF) region with decreases in some of the loading parameters in the medial toe (MT) region postsurgically. Loading parameters in the lateral forefoot (LFF), heel (HL), midfoot (MF), and lateral toe (LT) were unchanged 12 months postsurgery compared to presurgery.

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Silastic Ball Spacer Arthroplasty in the Management of Hallux Valgus and Hallux Rigidus

Foot & Ankle ◽

10.1177/107110078901000203 ◽

1989 ◽

Vol 10 (2) ◽

pp. 61-64 ◽

Cited By ~ 17

Author(s):

N. S. Broughton ◽

A. Doran ◽

B. F. Meggitt

Keyword(s):

Hallux Valgus ◽

Young Patients ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

New Bone Formation ◽

Great Toe ◽

First Metatarsophalangeal Joint ◽

Proximal Migration ◽

Original Concept

Sixty-two feet in 39 patients who were treated by insertion of a silastic ball spacer prosthesis into the first metatarsophalangeal joint for hallux valgus or hallux rigidus have been reviewed with a follow-up time of between 2 and 6 years. Twenty-one results (34%) were excellent, 27 (43%) were fair, 13 (21%) were poor, and one was revised. Seventeen feet (27%) had some metatarsalgia at followup. Results were disappointing in the young patients; in 19 cases of hallux valgus under the age of 45, 8 were either poor or had been revised. The original concept of the silastic ball spacer was to maintain great toe length and prevent proximal migration of the sesamoids. However 60% of these feet showed settling of the prosthesis or new bone formation around the prosthesis and 54% had more than 2 mm proximal migration of the sesamoid bones. The symptomatic results in these patients were similar to those in whom great toe length had been successfully maintained. The silastic ball spacer infrequently achieves its aims, however maintenance of hallux length does not seem to be important in the symptomatic result.

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Development and Reliability of a Measurement Device for Flexion Force of the First Metatarsophalangeal Joint

Journal of Applied Biomechanics ◽

10.1123/jab.19.3.271 ◽

2003 ◽

Vol 19 (3) ◽

pp. 271-278 ◽

Cited By ~ 1

Author(s):

Jaap Swanenburg ◽

Karel H. Stappaerts ◽

Bart Tirez ◽

Daniel Uebelhart ◽

Geert Aufdemkampe

Keyword(s):

Hallux Valgus ◽

Weight Bearing ◽

Metatarsophalangeal Joint ◽

Measurement Device ◽

Good Reliability ◽

First Metatarsophalangeal Joint ◽

Healthy Female ◽

The Right ◽

Leg Dominance ◽

Flexion Force

The purpose of this study was to present a method for repeated measurement of flexion force of the hallux in the metatarsophalangeal joint. The reliability of this measurement device was also examined. This device is suitable for situations where weight-bearing is contraindicated or when it is not possible for patients to bear load on their toes, such as hallux valgus patients. Since most such patients are female, the participants in this study were 24 healthy female volunteers. Age, weight, height, and leg dominance were determined for each. Muscle strength was measured using a device with a built-in MicroFET dynamometer. The result for the left hallux was ICC(3,1).89 (95% CI .77–.95). The result for the right hallux was ICC(3,1).94 (95% CI .87–.97). In the Bland and Altman plots, the reliability again appeared to be sufficient. The Pearson product-moment correlations gave poor results for the association between body weight, height, age, and mean force of the four trails. The test results indicate good reliability of the measurement device as used in this study. The advantage of this testing device is that it makes it easier to standardize measurements as opposed to the MicroFET used as a hand-held dynamometer. Also, patients can be tested in a nonload situation, which makes it possible to test hallux valgus at any time, and therefore it is possible to monitor variations in progression (or regression).

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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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The Modified Subcapital Metatarsal Osteotomy in the Treatment of Hallux Valgus Recurrence

Foot & Ankle Specialist ◽

10.1177/1938640019875322 ◽

2019 ◽

Vol 13 (5) ◽

pp. 404-414

Author(s):

Andrea Scala ◽

Massimo Cipolla ◽

Silvana Giannini ◽

Giulio Oliva

Keyword(s):

Hallux Valgus ◽

Metatarsophalangeal Joint ◽

Metatarsal Osteotomy ◽

Reliable Technique ◽

First Metatarsophalangeal Joint ◽

Scale Parameters ◽

Male Patients ◽

The Mean ◽

American Orthopaedic

The purpose of the present study is to illustrate the use of a modified subcapital metatarsal osteotomy (MSMO) in the treatment of hallux valgus (HV) recurrence. The article reports the clinical and radiological outcomes of a cohort of 52 consecutive patients presenting with recurrent HV, treated with MSMO. A total of 52 patients (54 feet) underwent operations between May 2010 and November 2015. The mean time of follow-up was 2.5 years (range 5.5-1.0 years), and the mean age was 49 years (range 22-76 years). The patient cohort comprised 46 female and 6 male patients. The results of this research show that MSMO is a reliable technique for the correction of HV recurrence. The postoperative radiographic assessments show a statistically significant postoperative improvement of the HV angle (P < .05) and the intermetatarsal angle (P < .05). The postoperative position of the tibial sesamoid was significantly improved (P < .1). The distal metatarsal articular angle was improved (P < .001), though assessment may be affected by the previous operations performed on the first metatarsophalangeal joint. The statistical analysis shows that the postoperative American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale parameters were significantly improved (P < 0.001). Results of this study indicate that the minimally invasive MSMO is effective in restoring anatomical alignment and improving patient outcomes in recurrent cases of HV. Levels of Evidence: Level III: Case-control study

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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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Retrospective analysis of 5 years results of first metatarsophalangeal joint arthroplasty, Single surgeon series

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000297 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Khalid Merghani Saleh Mohammed ◽

Yasser Aljabi ◽

Ara Francis ◽

Robert Flavin

Keyword(s):

Retrospective Analysis ◽

Weight Bearing ◽

Case Series ◽

Metatarsophalangeal Joint ◽

Metatarsal Head ◽

Joint Arthroplasty ◽

Joint Surface ◽

X Rays ◽

Medium Term ◽

First Metatarsophalangeal Joint

Category: Bunion Introduction/Purpose: First Metatarsophalangeal joint (MTPJ) osteoarthritis is a common forefoot disease. It leads to joint surface destruction and erosions limiting function and causing pain. The disease can be classified to mobile and non mobile or traumatic and atraumatic disease. The gold standard for treatment of stage III and IV remains MTPJ arthrodesis. In this case series we demonstrate MTPJ arthroplasty in mobile MTPJ with stable first interphalangeal joint (IPJ) can achieve short and medium-term results that are comparable to arthrodesis with high satisfaction rate. Methods: Retrospective analysis of 48 MTPJ arthroplasties performed by single surgeon in the period between 2011 to 2016. Patient were included if they had mobile first MTPJ osteoarthritis in the absence of IPJ hypermobility. The Surgical procedure included resurfacing the 1st metatarsal head using Arthrosurface® Hemicap implant and Extensor Digitorum Brevis (EDB) graft on the phalangeal surface of the joint. Radiological parameters collected using weight bearing x-rays prior to surgery, immediate radiological correction after surgery, 6 month and 2 years radiological analysis following the index surgery. Physiotherapy data were collected by senior physiotherapist prospectively during the time of postoperative rehabilitations and it included AOFAS and VAS scores. Results: 48 patients underwent 1st MTP joint arthroplasty using Arthrosurface® Hemicap implant for the metatarsal head with EDB graft on the phalangeal aspect. 44 patients had primary OA of the 1st MTP joint, 4 were conversion of MTPJ arthrodesis to arthroplasty and 3 were treated for non-union of MTP joint arthrodesis. Average postoperative ROM in the sagittal plane was 30 degrees and no valgus deformity in the coronal plane. 3 Patients (0.68%) had residual pain following the surgery due to soft tissue impingement and required further surgical intervention. 1 patient remained dissatisfied after the revision surgery. Conclusion: In short to medium-term follow up, the first MTP joint arthroplasty with Arthrosurface® implant and EDB graft provides an excellent functional outcome in the management of moderate to severe OA. In some selected cases this can be an option for treatment of patient with failed arthrodesis or patients requiring the reversal of the arthrodesis due to other issues.

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