scholarly journals TL 18196 - The lapidus procedure for severe hallux valgus deformity

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 108S
Author(s):  
Marcelo Pires Prado ◽  
Daniel Amodio ◽  
Leticia Devito ◽  
Alberto Abussamra Moreira Mendes ◽  
Guilherme Honda Saito
Keyword(s):  
Hallux Valgus ◽  
Surgical Techniques ◽  
Valgus Deformity ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
Medial Cuneiform ◽  
Group 2 ◽  
Severe Hallux Valgus ◽  
Group 1

Introduction: Surgical techniques for hallux valgus correction are constantly evolving. However, there is little data in the literature comparing the different techniques and methods of fixation. The aim of this study was to compare two variations of the Lapidus procedure with respect to the rate of complications, radiographic and functional outcomes. Methods: A retrospective review of 94 consecutive patients treated with a Lapidus fusion for hallux valgus correction between 2006 and 2017 was performed. In the first group, 33 patients underwent modeling arthrodesis between the first metatarsal base and the medial cuneiform, and between the base of the first and second metatarsals. In the second group, 61 patients underwent a fusion between the base of the first metatarsal and the medial cuneiform only. Results: In group 1, the rate of complications was 18% compared with 13% in group 2; of these, 10,5% required a revision procedure in group 1 versus 7,5% in group 2. The most common complications were nonhealing, partial recurrence of the deformity and loosened screws. In group 1, the first intermetatarsal angle and the hallux valgus angle were improved from an average of 18,3 degrees to 14 degrees and from 29 to 9,7 degrees, respectively. In group 2, the angles were improved from 16,1 to 9,1 degrees and from 31,1 to 9,1 degrees, respectively. The AOFAS score was improved from 44,5 to 94,9 in group 1 and from 35,8 to 91,32 in group 2. Conclusion: The Lapidus procedure with fusion of only the first metatarsal base and the medial cuneiform is safe, with a low rate of complications. In this modified procedure, the surgeon is required to optimize the congruency between the base of the first metatarsal and the medial cuneiform prior to fixation, which may conceivably explain the good results observed in this group.

Hallux Valgus: Demographics, Etiology, and Radiographic Assessment

2007 ◽  
Vol 28 (7) ◽  
pp. 759-777 ◽  
Author(s):  
Michael J. Coughlin ◽  
Caroll P. Jones
Keyword(s):  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
First Ray ◽  
The Mean ◽  
Severe Hallux Valgus

Background The purpose of the study was to preoperatively evaluate the demographics, etiology, and radiographic findings associated with moderate and severe hallux valgus deformities in adult patients (over 20 years of age) treated operatively over a 33-month period in a single surgeon's practice. Methods Patients treated for a hallux valgus deformity between September, 1999, and May, 2002, were identified. Patients who had mild deformities (hallux valgus angle < 20 degrees), concurrent degenerative arthritis of the first metatarsophalangeal joint, inflammatory arthritis, recurrent deformities, or congruent deformities were excluded. When enrolled, all patients filled out a standardized questionnaire and had a routine examination that included standard radiographs, range of motion testing, and first ray mobility measurement. A chart review and evaluation of preoperative radiographs were completed on all eligible patients. Results One-hundred and three of 108 (96%) patients (122 feet) with a diagnosis of moderate or severe hallux valgus (hallux valgus angle of 20 degrees or more) 70 qualified for the study. The onset of the hallux valgus deformity peaked during the third decade although the distribution of occurrence was almost equal from the second through fifth decades. Twenty-eight of 122 feet (23%) developed a deformity at an age of 20 years or younger. Eighty-six (83%) of patients had a positive family history for hallux valgus deformities and 87 (84%) patients had bilateral bunions. 15% of patients in the present series had moderate or severe pes planus based on a positive Harris mat study. Only 11% (14 feet) had evidence of an Achilles or gastrocnemius tendon contracture. Radiographic analysis found that 86 of 122 feet (71%) had an oval or curved metatarsophalangeal joint. Thirty-nine feet (32%) had moderate or severe metatarsus adductus. A long first metatarsal was common in patients with hallux valgus (110 of 122 feet; 71%); the mean increased length of the first metatarsal when compared to the second was 2.4 mm. While uncommon, the incidence of an os intermetatarsum was 7% and a proximal first metatarsal facet was 7%. The mean preoperative first ray mobility as measured with Klaue's device was 7.2 mm. 16 of 22 (13%) feet were observed to have increased first ray mobility before surgery. Conclusions The magnitude of the hallux valgus deformity was not associated with Achilles or gastrocnemius tendon tightness, increased first ray mobility, bilaterality or pes planus. Neither the magnitude of the preoperative angular deformity nor increasing age had any association with the magnitude of the first metatarsophalangeal joint range of motion. Constricting shoes and occupation were implicated by 35 (34%) patients as a cause of the bunions. A familial history of bunions, bilateral involvement, female gender, a long first metatarsal, and an oval or curved metatarsophalangeal joint articular surface were common findings. Increased first ray mobility and plantar gapping of the first metatarsocuneiform joint were more common in patients with hallux valgus than in the general population (when compared with historical controls).

Management of the Tarsometatarsal Joint in the Rotational Correction of Hallux Valgus by the Modified Lapidus Procedure: Intraoperative Technical Tips to Prevent Complications

2021 ◽  
pp. 193864002098668
Author(s):  
Danilo Ryuko Cândido Nishikawa ◽  
Guilherme Honda Saito ◽  
Alberto Abussamra Moreira Mendes ◽  
Marcelo Pires Prado
Keyword(s):  
Postoperative Complications ◽  
Hallux Valgus ◽  
Satisfactory Result ◽  
Valgus Deformity ◽  
First Metatarsal ◽  
Tarsometatarsal Joint ◽  
Hallux Valgus Deformity ◽  
Medial Cuneiform ◽  
A New Technique ◽  
Severe Hallux Valgus

The modified Lapidus procedure is considered a useful tool for correction of multiplanar deformities in the hallux valgus, including first metatarsal pronation. It offers a greater power of correction compared to most other osteotomies. However, postoperative complications can occur in up to 12% of cases. The aim of this study was to describe intraoperative technical tips in the management of the tarsometatarsal joint during multiplanar correction of severe hallux valgus deformity using the modified Lapidus procedure. It is not the authors’ intention to describe a new technique, but to draw attention to intraoperative details in order to prevent complications as nonunion, extension of the first metatarsal and undercorrection of the deformity. Rotational correction of the first metatarsal with adequate bone coaptation of the first metatarsal and the medial cuneiform are the cornerstone for a satisfactory result. Levels of Evidence: Level V, expert opinion

The Effect of Adductor Tendon Transposition in the Modified McBride Procedure

2008 ◽  
Vol 1 (5) ◽  
pp. 275-279 ◽  
Author(s):  
Alfonso Martínez-Nova ◽  
Raquel Sánchez-Rodríguez ◽  
Beatriz Gómez-Martín ◽  
Elena Escamilla Martínez ◽  
Antonio Expósito-Arcas ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
First Metatarsophalangeal Joint ◽  
Hallux Valgus Deformity ◽  
Radiographic Measurements ◽  
Group 2 ◽  
A Prospective Study ◽  
Adductor Hallucis ◽  
Group 1

The modified McBride technique is widely used in bunion surgery. The aim of this report is to analyze the influence that transferring the adductor hallucis tendon had on the first intermetatarsal angle (IMA), hallux abductus angle (HAA), and tibial sesamoid position (TSP) when used to correct the hallux valgus deformity. A prospective study was conducted of 31 hallux abducto valgus patients. A modified McBride procedure was performed to repair the deformity. In 16 patients (group 1), the adductor tendon was transferred, and in 15 (group 2), it was not. The tendon transfer was at random. The preoperative and postoperative variables IMA, HAA, and TSP were measured and analyzed by means of univariate and multivariate statistics. In group 1, the preoperative values of the first IMA and the HAA averaged 13.5° and 30°, respectively, decreasing postoperatively to 10.3° and 10.7°. In group 2, the corresponding preoperative angles were 12.9° and 25.6°, and the postoperative angles were 9.7° and 10°. There were no statistically significant differences between the 2 groups in the correction of the IMA, HAA, and TSP. As measured by the aforementioned radiographic measurements, there is no advantage in transferring the adductor hallucis tendon to the first metatarsophalangeal joint capsule in the correction of hallux valgus

Treatment of Hallux Valgus by Oblique Osteotomy of the First Metatarsal

Foot & Ankle ◽  
1992 ◽  
Vol 13 (8) ◽  
pp. 447-452 ◽  
Author(s):  
Kosaku Mizuno ◽  
Masataka Hashimura ◽  
Mayako Kimura ◽  
Kazushi Hirohata
Keyword(s):  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
X Rays ◽  
Great Toe ◽  
First Metatarsal ◽  
Oblique Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle

This paper describes a simple technique of oblique osteotomy of the first metatarsal for treatment of symptomatic hallux valgus deformity. The osteotomy is performed at a 30° angle from the long axis of the metatarsal shaft. The head of the metatarsal is then displaced laterally to provide correction of the hallux valgus. This is an uncomplicated procedure for the treatment of hallux valgus. From 1984 through 1989, 53 feet in 31 patients were treated with an oblique osteotomy of the first metatarsal. A total of 49 feet in 27 patients were followed up more than 2 years. The follow-up x-rays and clinical examinations revealed a good result in 43 feet. In six feet of three patients, all of whom had simultaneous oblique osteotomies of both the first and second metatarsals, a fair or poor result was obtained. It was learned that oblique osteotomy for hallux valgus greater than 40° provided insufficient correction of the valgus angle or limitation of motion at the metatarsophalangeal joint of the great toe.

scholarly journals A New Minimally Invasive Surgery of Hallux Valgus: Technique and Preliminary Outcomes

2020 ◽  
Author(s):  
Changjun Guo ◽  
Xingchen Li ◽  
Chunguang Li ◽  
Yang Xu ◽  
Ming Cai ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Hallux Valgus ◽  
Invasive Surgery ◽  
Valgus Deformity ◽  
Safe Procedure ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Valgus Angle

Abstract PurposeThis study aimed to present a new minimally invasive surgery (MIS) technique and evaluate the safety and efficacy for correction of hallux valgus deformity at a preliminary follow-up.Methods48 consecutive feet that underwent a new MIS of hallux valgus with a mean 17.6 months follow-up (range 9 to 28 months). This technique uses a new osteotomy of the first metatarsal with screw fixation and percutaneous Weil osteotomy of lesser metatarsal without fixation. All patients were clinically evaluated using the Manchester-Oxford Foot Questionnaire (MOXFQ), American Orthopedic Foot & Ankle Society Hallux Metatarsophalangeal-Interphalangeal score (AOFAS HMI) and visual analogue scale (VAS). Radiographic measures included hallux valgus angle (HVA), intermetatarsal angle (IMA) and the length of the first metatarsal. ResultsThere was significant improvement in the radiographic parameters(P<0.001). The IMA decreased from 13.3° to 9.8°, the HVA improved from 35.9° to 17.9° and the mean MT length decreased by 4 mm. There was significant improvement of VAS in the postoperative 2 weeks (P < .001). There were significant improvements in the MOXFQ scores and AOFAS HMI scores, respectively. The total rate of complication was 10.4%.ConclusionThe preliminary radiographic and clinical outcomes of this new minimally invasive surgery show that it is a safe procedure and had significantly less pain in the first 2 weeks following surgery.

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.

Scarf Osteotomy for Hallux Valgus Deformity

2010 ◽  
Vol 100 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Jeroen J. K. De Vil ◽  
Peter Van Seymortier ◽  
Willem Bongaerts ◽  
Pieter-Jan De Roo ◽  
Barbara Boone ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Prospective Studies ◽  
Valgus Deformity ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
Scarf Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
Severe Hallux Valgus

Background: Scarf midshaft metatarsal osteotomy has become increasingly popular as a treatment option for moderate-to-severe hallux valgus deformities because of its great versatility. Numerous studies on Scarf osteotomy have been published. However, no prospective studies were available until 2002. Since then, only short-term follow-up prospective studies have been published. We present the results of a prospective study of 21 patients treated by Scarf osteotomy for hallux valgus with follow-up of 8 years. Methods: Between August 1, 1999, and October 31, 1999, 23 patients (23 feet) with moderate-to-severe hallux valgus deformity were included. Clinical (American Orthopaedic Foot and Ankle Society score) and radiologic (hallux valgus angle, first intermetatarsal angle, and sesamoid position) evaluations were performed preoperatively and 1 and 8 years postoperatively. Results: Clinical evaluation showed a significant improvement in the mean forefoot score from 47 to 83 (of a possible 100) at 1 year (P &lt; .001). Radiographic evaluation showed significant improvement in the hallux valgus angle (mean improvement, 19°; P &lt; .001) and in the intermetatarsal angle (mean improvement, 6°; P &lt; .001). These clinical and radiographic results were maintained at the final evaluation 8 years postoperatively. Conclusions: Scarf osteotomy tends to provide predictable and sustainable correction of moderate-to-severe hallux valgus deformities. (J Am Podiatr Med Assoc 100(1): 35–40, 2010)

scholarly journals Comparison of Two Different Approaches to Treat a Hallux Valgus Deformity: Intramedullary Self-Locked Plates and Herbert Screws

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 595
Author(s):  
Zekeriya Okan Karaduman ◽  
Ozan Turhal ◽  
Yalçın Turhan ◽  
Mehmet Arıcan ◽  
Cemal Güler ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Valgus Deformity ◽  
Test Results ◽  
First Metatarsophalangeal Joint ◽  
Hallux Valgus Deformity ◽  
Surgical Methods ◽  
Vas Scores ◽  
Group 2 ◽  
Post Hoc ◽  
Group 1

Background and objectives: Hallux valgus is a complex deformity of the first metatarsophalangeal joint characterized by varus deformity of the first metatarsal bone, valgus deformity of the big toe, and lateral deviation of the extensor tendons and sesamoid bones. Several surgical methods have been described for correction of the deformity. Different materials have been used for the fixation of osteotomy. We compared the functional, radiological, and pain results of intramedullary self-locked plates and Herbert screws for the treatment of a hallux valgus deformity. Materials and Methods: Distal metatarsals were treated with self-locking intramedullary plate–screw systems in 18 feet from 12 patients (Group 1) and with Herbert screws in 18 feet from 12 patients (Group 2). The hallux valgus angle (HVA) and intermetatarsal angle (IMA) in patients of Group 1 and 2 were examined radiologically during the pre- and postoperative periods. We also determined the American Orthopedic Foot and Ankle Society (AOFAS), EQ-5D General Life Quality Scale, and Visual Analogue Scale (VAS) scores during the pre- and postoperative periods and compared the scores between groups. Results: Post hoc test results of HVA and IMA angles measured after the operation were significantly higher in Group 2 than in Group 1. In each group, the AOFAS scores during the preoperation period were significantly lower than those during the postoperation period (p < 0.001). According to the post hoc test results, the VAS scores after the operation were significantly higher in Group 2 than in Group 1 (p < 0.001). Conclusions: For the surgical treatment of hallux valgus, operations using self-locked plates compared to a single screw are superior in terms of providing rigid stability and for functional, radiological, and pain scores.

A Clinicoradiological and Functional Evaluation of Lapidus Surgery for Moderate to Severe Bunion Deformity Shows Excellent Stable Correction and High Long-Term Patient Satisfaction

2019 ◽  
Vol 13 (6) ◽  
pp. 488-493 ◽  
Author(s):  
Vivek S. Jagadale ◽  
Ruth L. Thomas
Keyword(s):  
Patient Satisfaction ◽  
Hallux Valgus ◽  
Case Series ◽  
Relative Length ◽  
Valgus Deformity ◽  
Radiographic Evaluation ◽  
Functional Evaluation ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Severe Hallux Valgus

Background. Lapidus surgery involving arthrodesis of the first metatarsocuneiform (MTC) joint is an effective procedure for the correction of moderate to severe hallux valgus. The aim of this study was to collect and analyze radiographic data from our institution and determine the extent of first metatarsal shortening associated with the Lapidus procedure. Materials and Methods. A total of 53 patients (54 feet) who underwent arthrodesis of the first MTC joint combined with modified McBride bunionectomy for correction of moderate to severe hallux valgus deformity, between 2010 and 2015 were included in this study. Complete radiographic evaluation and AOFAS (American Orthopaedic Foot and Ankle Surgery) scoring was available for 54 feet. The average preoperative hallux valgus angulation (HVA) was 32° and the average intermetatarsal angle (IMA) was 16°. Results. Excluding 2 patients with postoperative hallux varus the average postoperative HVA correction at last follow-up was 14°. Average postoperative IMA was 9°. Although there was minimal bone resection during preparation of the MTC joint, no significant shortening of the first metatarsal was observed with this procedure. The relative length of the first metatarsal to the second metatarsal changed only 1.3%. Nonunion of the first MTC joint occurred in 10.3%, but only 1 foot was symptomatic requiring revision. The average postoperative hallux AOFAS score was 80.8. In sum, 63% of patients were very satisfied, 27% satisfied with reservations, and 10% were dissatisfied. Conclusion. The Lapidus bunion procedure offers excellent stable correction of moderate to severe hallux valgus deformity with minimal shortening of the first metatarsal and thereby higher patient satisfaction. Levels of Evidence: Level IV: Retrospective case series

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.

Sign in / Sign up

Export Citation Format

Share Document