The co-occurrence of calcaneal spur and hallux valgus: A radiological evaluation

2021 ◽  
pp. 1-6
Author(s):  
Mehmet Öncü ◽  
Erdinç Genç
Keyword(s):  
Hallux Valgus ◽  
Demographic Data ◽  
Female Gender ◽  
Older Age ◽  
Foot Deformities ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
Calcaneal Spur ◽  
Valgus Angle ◽  
Foot Biomechanics

BACKGROUND: Calcaneal spur and hallux valgus are common foot deformities and both conditions have been shown to disrupt foot biomechanics. OBJECTIVES: This study aimed to investigate the association between calcaneal spur and hallux valgus using radiographic and demographic data. METHODS: A total of 1375 patients (1083 women; mean age: 45.5 years) with standard ankle lateral and foot conventional anteroposterior radiographs were evaluated. The following data were obtained: age, gender, laterality, hallux valgus angle (HVA), intermetatarsal angle (IMA), and calcaneal spur. Patients with a HVA of 15∘ and above were considered to have hallux valgus. Patients with hallux valgus were classified into three different groups according to the HVA. RESULTS: The prevalence of calcaneal spur was higher in older age and women (45.8%, 30.2%; p< 0.01, p< 0.01, respectively). Subjects with and without calcaneal spurs had similarities in terms of their laterality, having a HVA of ⩾ 15∘ and an IMA of ⩾ 11∘ (p> 0.05). Hallux valgus severity was not associated with calcaneal spur (p> 0.05). In addition, the hallux valgus prevalence was higher in patients who were over 50 years old (58.2%, p= 0.046). CONCLUSIONS: The presence of calcaneal spurs does not affect the prevalence of hallux valgus. The severity of hallux valgus determined according to the HVA was similar in patients with and without calcaneal spurs. In addition, female gender and older age were identified as risk factors for calcaneal spurs, while only older age was a risk factor for hallux valgus.

Modified Austin Procedure for Correction of Hallux Valgus

1997 ◽  
Vol 18 (3) ◽  
pp. 119-127 ◽  
Author(s):  
Hans-Jörg Trnka ◽  
Alexander Zembsch ◽  
Hermann Wiesauer ◽  
Marc Hungerford ◽  
Martin Salzer ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Hallux Valgus Angle ◽  
First Metatarsophalangeal Joint ◽  
Intermetatarsal Angle ◽  
Soft Tissue Procedure ◽  
Valgus Angle

The Austin osteotomy is a widely accepted method for correction of mild and moderate hallux valgus. In view of publications by Kitaoka et al. in 1991 and by Mann and colleagues, a more radical lateral soft tissue procedure was added to the originally described procedure. From September 1992 to January 1994, 85 patients underwent an Austin osteotomy combined with a lateral soft tissue procedure to correct their hallux valgus deformities. Seventy-nine patients (94 feet) were available for follow-up. The average patient age at the time of the operation was 47.1 years, and the average follow-up was 16.2 months. The average preoperative intermetatarsal angle was 13.9°, and the average hallux valgus angle was 29.7°. After surgery, the feet were corrected to an average intermetatarsal angle of 5.8° and an average hallux valgus angle of 11.9°. Sesamoid position was corrected from 2.1 before surgery to 0.5 after surgery. The results were also graded according to the Hallux Metatarsophalangeal Interphalangeal Score, and the functional and cosmetic outcomes were graded by the patient. Dissection of the plantar transverse ligament and release of the lateral capsule repositioned the tibial sesamoid and restored the biomechanics around the first metatarsophalangeal joint. There was no increased incidence of avascular necrosis of the first metatarsal head compared with the original technique.

scholarly journals Radiographic Recurrence of Hallux Valgus Based on Osteotomy Location

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0021
Author(s):  
Andrew Federer ◽  
Travis Dekker ◽  
David Tainter ◽  
Jordan Liles ◽  
Mark Easley ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Surgical Correction ◽  
P Value ◽  
Single Individual ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
Valgus Angle ◽  
Significant Difference

Category: Bunion Introduction/Purpose: Hallux valgus (HV) is one of the most common deformities of the foot resulting in pain and lifestyle modification of the patient. Recurrence rates of 10-47% have been documented in single individual osteotomy series. Unfortunately, surgical correction and recurrence are often defined as changes related to normal radiographs and not actually as the magnitude of correction lost with follow-up. Currently there have not been studies evaluating the percentage of recurrence of intermetatarsal angle (IMA) and hallux valgus angle (HVA). As there is substantial difference in starting IMA and HVA, as well as amount of surgical correction, our goal was to evaluate the percentage loss of correction over time comparing preoperative, initial postoperative and minimum of 2-year follow up radiographs among three different surgical correction techniques. Methods: This is a retrospective chart review study that examines the weight-bearing radiographic measurements of patients undergoing hallux valgus corrective surgery at a single institution over 5 years. Fifty-three patients were divided into first tarsometatarsal arthrodesis (i.e. Lapidus), mid-diaphyseal osteotomies (i.e. scarf), and distal metatarsal osteotomies (i.e. chevron). The preoperative, initial postoperative, and final follow up weight-bearing radiographs were measured for intermetatarsal angle (IMA) and hallux valgus angle (HVA). Primary outcome was percentage of recurrence of IMA and HVA, with the difference in angles between preoperative and initial postoperative weight-bearing films being considered 100% correction. The percentage of recurrence between initial postoperative and most recent follow up was then calculated (Figure 1A). A one-way analysis of variance (ANOVA) test and post-hoc Tukey-Kramer tests were used to compare preoperative IMA and HVA and percentage recurrence of IMA and HVA at most recent follow up. Results: There was no significant difference between Lapidus (14.3deg) and mid-diaphyseal osteotomies (12.7deg) in preoperative IMA (p-value=0.26). There was a significant difference between Lapidus (-0.3deg) and mid-diaphyseal (2.8deg) osteotomies for degree of hallux valgus recurrence as measured by IMA between initial postoperative films and final 2-year follow up (p-value=0.009). Lapidus procedure showed a greater magnitude decrease in IMA degrees from preoperation to final follow up compared to distal osteotomy (p-value=0.037) and trended toward significance compared to mid-diaphyseal (p-value=0.056). Mid-diaphyseal osteotomies (30%) showed a statistically significant higher percentage of IMA recurrence compared to Lapidus (-11%) (p-value=0.0014) (Figure 1B). When comparing percentage recurrence of HVA, distal osteotomies had a significantly smaller rate of recurrence when compared to the diaphyseal osteotomies (p-value=0.030). Conclusion: Though Lapidus and mid-diaphyseal osteotomies were performed for patients with a similar preoperative IMA, mid-diaphyseal osteotomies had a significantly higher percentage of recurrence at 2-year follow up compared to Lapidus procedures. Moreover, Lapidus procedures trended toward greater overall of IMA correction compared to mid-diaphyseal osteotomies. When either a Lapidus or mid-diaphyseal osteotomy is indicated, a Lapidus procedure may result in decreased rate of radiographic recurrence of hallux valgus at 2 years.

scholarly journals Natural Progression of Radiographic Indices in Juvenile Hallux Valgus Deformity

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0031
Author(s):  
Seung Yeol Lee ◽  
Soon-Sun Kwon ◽  
Moon Seok Park ◽  
Kyoung Min Lee
Keyword(s):  
Hallux Valgus ◽  
Older Patients ◽  
Valgus Deformity ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
Younger Patients ◽  
Hallux Valgus Deformity ◽  
Metatarsal Angle ◽  
Valgus Angle ◽  
Metatarsus Adductus

Category: Bunion Introduction/Purpose: There is a lack of quantitative studies on the progression of juvenile hallux valgus deformity. Therefore, we performed this study to estimate an annual change of radiographic indices for juvenile hallux valgus. Methods: We reviewed medical records of consecutive patients under the age of 15 with juvenile hallux valgus who underwent weight-bearing foot radiographs more than twice, and were followed over a period of one year or more. A total of 133 feet from 69 patients were included. Hallux valgus angle, hallux interphalangeal angle, intermetatarsal angle, metatarsus adductus angle, distal metatarsal articular angle, anteroposterior talo-1st metatarsal angle, anteroposterior talo-2nd metatarsal angle, and lateral talo-1st metatarsal angle were measured and were used as a study criteria. The progression rate of hallux valgus angle was adjusted by multiple factors including the use of a linear mixed model with gender and radiographic measurements as the fixed effects and laterality and each subject as the random effect. Results: Our results demonstrate that the value of hallux valgus angle on the radiographs progressed as the patients grew older. The hallux valgus angle increased by 0.8° per year (p<0.001)(Figure). The distal metatarsal articular angle also increased by 0.8 per year (p=0.003). Conversely, hallux interphalangeal angle decreased by 0.2° per year (p=0.019). Progression of the intermetatarsal angle and metatarsus adductus angle with aging were not statistically significant. There was a difference in progression of radiographic indices between older patients (≥10 years) and younger patients (<10 years). The hallux valgus angle increased by 1.5° per year (p<0.001) in younger patients, progression of the hallux valgus angle in older patients was not statistically significant (p=0.869) as children grew up. Conclusion: These results suggest that the hallux valgus angle increased in patients with juvenile hallux valgus under 10 years old, unlike the patients aged 10 or older. We believed that our results can help surgeons to determine a treatment strategy that uses the growth potential to achieve correction of deformity such as lateral hemiepiphyseodesis of the 1st metatarsal to patients with juvenile hallux valgus.

Correlation of Hallux Valgus Surgical Outcome With AOFAS Forefoot Score and Radiological Parameters

2005 ◽  
Vol 26 (2) ◽  
pp. 122-127 ◽  
Author(s):  
David Thordarson ◽  
Edward Ebramzadeh ◽  
Murali Moorthy ◽  
Jessica Lee ◽  
Sally Rudicel
Keyword(s):  
Lower Extremity ◽  
Physical Examination ◽  
Hallux Valgus ◽  
Hallux Valgus Angle ◽  
Lower Extremity Function ◽  
Aofas Score ◽  
Intermetatarsal Angle ◽  
Valgus Angle ◽  
Sf 36 ◽  
Type Of Surgery

Background: The purpose of the study was to evaluate the effect of three different types of hallux valgus surgeries on patient function using validated questionnaires and to correlate the results with radiographic and physical examinations. This study presents the 2-year followup data of a previous prospective outcome study. Methods: One hundred and ninety-six patients were enrolled in this study and completed a baseline AAOS Lower Limb Outcomes Data Collection Questionnaire. They completed the same form at 6, 12, and 24 months after having one of three types of hallux valgus surgeries (106 chevron osteotomies, 72 modified McBride procedures, and 18 modified Lapidus procedures). This questionnaire included the Short Form-36 Health Survey (SF-36) as well as questions relating to lower extremity function. Additionally, physicians were asked to complete preoperative and postoperative questionnaires on each patient that included radiographic and physical examination data and the type of surgery done. Completed outcome surveys and radiographic data were available on 196 patients, and physical examination scores were available to assign an AOFAS score in 111 patients at 24-month followup. A one-way comparison was done after stratifying the results for the type of surgery, preoperative hallux valgus angle and 1-2 intermetatarsal angle, postoperative hallux valgus angle and 1-2 intermetatarsal angle, and the change in the angles. Results: Four of the 10 SF-36 scores (physical function, role-physical, bodily pain, and role-emotional) for the combined data improved by more than five points. For the AAOS lower extremity function scores, physical health and pain (68.5 to 81.6), satisfaction with symptoms (1.8 to 3.6), global foot and ankle (77.6 to 93.4), and shoe comfort (29.0 to 58.7) scores all increased significantly. The AOFAS score increased from 52.6 to 85.5 ( p < 0.001). Surprisingly, when comparing mild-to-moderate to severe deformities preoperatively and postoperatively using the absolute magnitude of the angular change in the hallux valgus or intermetatarsal angles, similar improvement was noted in AOFAS, SF-36, and AAOS lower extremity scores. The magnitude of preoperative deformity, postoperative residual deformity, and magnitude of correction also did not significantly change the amount of improvement in any of these scores. No significant differences were noted in the outcome scores among the three different surgeries. Conclusion: Patients who had hallux valgus surgery had significant improvements in four of their SF-36 scores, four of five of AAOS lower extremity scores, and AOFAS scores. The degree of deformity, amount of correction, or type of operation did not influence outcome.

scholarly journals Hallux valgus correction using Scarf-Osteotomy leads to shortening of the first metatarsal

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0032
Author(s):  
Christopher Lenz ◽  
Paul Borbas
Keyword(s):  
Hallux Valgus ◽  
Consecutive Series ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Valgus Angle ◽  
Correction Technique ◽  
Second Metatarsal ◽  
First Ray ◽  
Akin Osteotomy

Category: Bunion Introduction/Purpose: In hallux valgus deformity less weight can be borne by the first ray which may lead to transfer metatarsalgia and lesser toe deformities. Depending on the exact configuration of the bone cuts during the scarf procedure, an iatrogenic shortening of the first metatarsal may occur which may diminish weightbearing ability of the first ray as well, causing transfer metatarsalgia. The aim of the present study was therefore to determine preoperative and postoperative changes in length of the first metatarsal by using different methods of measuring metatarsal length. Methods: A consecutive series of 118 feet in 106 patients (89% female, 11% male) was enrolled, who underwent correctional osteotomy (Scarf-with/without Akin-Osteotomy) from May 2015 to July 2017 at a single institution. Patients, who underwent additional shortening osteotomy of the metatarsals, were excluded. Average age at the time of surgery was 51 years (range, 14 to 83 years). Pre- and postoperative angle measurement of hallux valgus- and intermetatarsal angle was assessed at between six weeks and three months postoperatively on standardized weight-bearing radiographs in dorsoplantar plane. We also identified early complications in hallux valgus surgery. An assessment and comparison of different methods of measuring metatarsal length (length of first metatarsal, ratio first to second metatarsal, Coughlin method) postoperatively was performed to identify the amount of shortening with this technique. Results: Hallux valgus angle was statistically significant reduced by an average of 18.6° (28.3° preoperatively to 9.7° postoperatively, p < 0.001), intermetatarsal angle by 7.7° (12.8° to 5.1°, p < 0.001). Measuring the length of the first metatarsal, in all three methods a statistically significant reduction of the first metatarsal length could be detected. Mean absolute shortening of 1.8 mm was measured (p < 0.001). The ratio of the first metatarsal to the second metatarsal averaged -0.03 (p = 0.02). The mean relative lengthening of the second metatarsal, using the method described by Coughlin, was 0.42 mm (from 4.51 to 4.89 mm, p < 0.001) on average. Of those three methods, the Coughlin method showed the highest correlation. 6 minor complications were observed (5%). Conclusion: In the current study we could demonstrate a significant reduction of hallux valgus angle and intermetatarsal angle with hallux valgus correction using Scarf-/Akin-Osteotomy, with a low complication rate. However, statistically significant shortening of the first metatarsal could be detected as well. Further research is required to improve and establish a hallux valgus correction technique without shortening of the first metatarsal.

Influence of Metatarsal Head Displacement on Metatarsal Pressure Distribution after Hallux Valgus Surgery

Foot & Ankle ◽  
1993 ◽  
Vol 14 (2) ◽  
pp. 85-89 ◽  
Author(s):  
Axel Wanivenhaus ◽  
Wolfgang Brettschneider
Keyword(s):  
Pressure Distribution ◽  
Hallux Valgus ◽  
Load Distribution ◽  
Force Plate ◽  
Metatarsal Head ◽  
Hallux Valgus Angle ◽  
Lateral Direction ◽  
Intermetatarsal Angle ◽  
Head Displacement ◽  
Valgus Angle

We reviewed 63 feet after plain subcapital osteotomy for simultaneous correction of hallux valgus and metatarsus primus varus. Results were evaluated clinically and by radiographs and force plate measurements. Eighty-three percent of the patients were satisfied with their surgery. The hallux valgus angle was improved by 9.3° and the intermetatarsal angle by 6°. The osteotomy resulted in a displacement of the metatarsal head in the lateral direction(10 mm) and in the plantar direction (11.3 mm). Nor malization of the load distribution on the metatarsal head was achieved in the group with 11 to 15 mm of plantar displacement. Basedon our results, we recommend plain subcapital osteotomy for hallux valgus deformities with moderate metatarsus primus varus. After correction of the intermetatarsal angle and sufficient plantar displacement a physiological distribution of load on the metatarsal head can be expected.

scholarly journals Correlative Study Between the Sesamoid Bones under the Head of the First Metatarsal and the Development of Hallux Valgus Determined with Radiographs

2021 ◽  
Author(s):  
Xiaozhong Li ◽  
Dongxue Liu ◽  
Xufang Wang
Keyword(s):  
Hallux Valgus ◽  
Metatarsal Head ◽  
Sesamoid Bone ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Valgus Angle ◽  
Second Metatarsal ◽  
Sesamoid Bones ◽  
The Absolute

Abstract Objective. To study the correlative between the sesamoid bones under the head of the first metatarsal and the development of hallux valgus determined with radiographs.Methods.The measurements were performed on the X-ray of 300 normal feet and 300 cases of hallux valgus. The following parameters were measured: hallux valgus angle(HVA); the first-second intermetatarsal angle(IMA) between the axes of the first and second metatarsal;the length of the second metatarsal（CD）;the position of tibial sesamoid(TSP ) measured the percent formed between the tibial sesamoid and the centreline of the first metatarsal;the position of fibular sesamoid(FSP) measured tangent value between fibular sesamoid bone and lateral cortex of first metatarsal bone ; the absolute distances (AB) from the centre of the tibial sesamoid to the long axis of the second metatarsal, the absolute distances (EF) from the centre of the fibular sesamoid to the long axis of the second metatarsal and the absolute distance (GH) from the centre of the tibial sesamoid to the centre of the fibular sesamoid. Then calculate the ratio of AB to CD (K1), EF to CD (K2) and GH to CD (K3). Results.HVA moderately positively correlates with TSP and moderately negatively correlates with FSP in subjects with HVA ≥ 20°. HVA and FSP are strongly negatively correlated in the hallux valgus group. Conclusion.The dislocation of sesamoid bone under the first metatarsal head is an important pathological factor leading to valgus. HVA is positively correlated with TSP and negatively correlated with FSP.

Metatarsal Horizontal Angle Variety Information of Female with Different Hallux Valgus

2014 ◽  
Vol 21 ◽  
pp. 93-99
Author(s):  
Feng Ling Li ◽  
Yan Zhang ◽  
Min Jun Liang ◽  
Jian She Li ◽  
Yao Dong Gu
Keyword(s):  
Ct Scan ◽  
Hallux Valgus ◽  
Motion Analysis System ◽  
Foot Deformity ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
Factors Associated ◽  
Horizontal Angle ◽  
Valgus Angle ◽  
Analysis System

Hallux valgus is a common foot deformity with a multifactorial etiology. Factors associated with the development of hallux valgus (HV) are multifactorial and the etiology of hallux valgus remains unclear. The purpose of this study was to measure the biomechanical relationship between Hallux Valgus Angle (HVA), intermetatarsal Angle (IMA), Interphalangeal Angle (IPA), and metatarsal horizontal angle, in order to reveal the tendency of metatarsal horizontal angle along with hallux valgus angle increasing. Foot models of nine subjects are built through CT scan and editing software and calculated metatarsal horizontal angles using motion analysis system. It showed that with the increased of HVA, the metatarsal horizontal angle of the first to fifth was decreased. This method and results maybe have a new sight to reveal the characters of HV patients. Keywords: Hallux valgus; Metatarsal horizontal angle; Foot Models

Distal Chevron Osteotomy with Lateral Release for Treatment of Hallux Valgus Deformity

1994 ◽  
Vol 15 (9) ◽  
pp. 457-461 ◽  
Author(s):  
David J. Pochatko ◽  
Frank J. Schlehr ◽  
Mark D. Murphey ◽  
James J. Hamilton
Keyword(s):  
Hallux Valgus ◽  
Avascular Necrosis ◽  
Mayo Clinic ◽  
Scoring System ◽  
Lateral Release ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
Chevron Osteotomy ◽  
Valgus Angle

From 1986 to 1990, 42 feet in 30 patients had a combined chevron osteotomy and lateral release to correct their painful bunion deformity. Seventeen patients, 23 feet, were available for follow-up. The purpose of this study was to evaluate the outcome of this procedure and to determine the incidence of avascular necrosis. The patients were examined by an independent examiner, radiographs obtained, and questionnaires filled out. Avascular necrosis was determined using plain films read by a musculoskeletal radiologist who did not know the outcomes. The average age was 45 years at the time of the procedure. Average follow-up was 50 months. The preoperative intermetatarsal angle averaged 13° and the hallux valgus angle averaged 31°. At study follow-up, the intermetatarsal angle averaged 8° and the hallux valgus angle averaged 17.5°. The results were graded by the Mayo Clinic Forefoot Scoring System (75-point scale) and a subjective scoring system. Average postoperative Mayo Clinic score was 67. Fifteen feet were subjectively rated as excellent, six as good, and two as fair. Complications occurred in four feet. Hallux varus occurred in two feet, extension contracture in one foot, and an infection in one foot. None of the feet developed definite radiographic evidence of avascular necrosis. Distal chevron osteotomy combined with a lateral release for corrective bunion surgery has come under scrutiny, because of the risk of avascular necrosis of the first metatarsal head. However, our study showed no evidence of avascular necrosis on radiographs. In addition, 91% of patients had good to excellent results at an average 50-month follow-up.

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