Adding Stability to the Crescentic Basilar First Metatarsal Osteotomy

2004 ◽  
Vol 94 (5) ◽  
pp. 502-504 ◽  
Author(s):  
Brian Carpenter ◽  
Travis Motley
Keyword(s):  
Hallux Valgus ◽  
Bone Healing ◽  
Sagittal Plane ◽  
Metatarsal Osteotomy ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Valgus Angle ◽  
Made In

Crescentic basilar osteotomies for metatarsus primus varus and hallux valgus allow for substantial correction of the first intermetatarsal angle and the hallux valgus angle. Crescentic osteotomies have two well-documented pitfalls: sagittal plane instability and difficulty in fixation. We describe the addition of a plantar shelf to crescentic basilar osteotomy that allows for easier fixation and less risk of elevation of the first metatarsal postoperatively. This plantar shelf is made in the metaphyseal portion of the first metatarsal, which provides the benefit of better bone healing. In 20 patients, we found an average reduction in the intermetatarsal angle of 9.3° and an average reduction in the hallux valgus angle of 21.8°. Eight weeks postoperatively, only one patient showed elevation of the first metatarsal. (J Am Podiatr Med Assoc 94(5): 502–504, 2004)

Hallux Valgus Correction with Proximal Metatarsal Osteotomy: Two-year Follow-up

Foot & Ankle ◽  
1992 ◽  
Vol 13 (6) ◽  
pp. 321-326 ◽  
Author(s):  
David B. Thordarson ◽  
Edward O. Leventen
Keyword(s):  
Hallux Valgus ◽  
Metatarsal Osteotomy ◽  
Hallux Valgus Angle ◽  
Foot Surgery ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Valgus Angle ◽  
Distal Metatarsal Osteotomy ◽  
Proximal Metatarsal Osteotomy

We evaluated the results of 33 feet in 23 patients who underwent a basilar crescentic osteotomy with a modified McBride procedure with a minimum 24-month follow-up. The average hallux valgus improved from 37.5° to 13.8° and the intermetatarsal 1–2 angle from 14.9° to 4.7°. The angle of declination of the first metatarsal was found to have dorsiflexed an average of 6.2°. Unfortunately, osteotomies secured with staples dorsiflexed to a greater degree. Bilateral foot surgery produced results similar to those with unilateral procedures. Four of our patients developed a hallux varus (range 2–8°); however, none were dissatisfied at the time of evaluation. Although this bunion procedure resulted in more prolonged swelling and pain than a distal osteotomy, it should be considered for more complex deformities to avoid the failure that a distal metatarsal osteotomy might produce given a high 1–2 intermetatarsal angle or a high hallux valgus angle.

scholarly journals Rotational Distal Chevron Osteotomy for Correction of Hallux Valgus Associated with Metatarsus Adductus and Large Distal Metatarsal Articular Angle

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0023
Author(s):  
Jae-Jung Jeong
Keyword(s):  
Hallux Valgus ◽  
Metatarsal Head ◽  
Metatarsal Osteotomy ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Chevron Osteotomy ◽  
Valgus Angle ◽  
Before And After ◽  
Metatarsus Adductus

Category: Bunion Introduction/Purpose: Hallux valgus treatment in the setting of associated metatarsus adductus is less common and not well described. The presence of metatarsus adductus reduces the gap between the first and second metatarsals. Consequently, it complicates the measurement of the first-second intermetatarsal angle and can limit the area available for transposition of the first metatarsal head. If distal metatarsal articular angle (DMAA) is also increased here, it is difficult to correct. We investigated the effects of rotational distal chevron metatarsal osteotomy (DCMO) on hallux valgus associated with metatarsus adductus and increased DMAA. Methods: Twelve patients, (12 female, 15 feet), of average age 59 (SD 23) with symptomatic hallux valgus associated with metatarsus adductus and increased DMAA underwent a rotation DCMO and were reviewed at an average of 12 months postoperatively. Clinically preoperative and postoperative AOFAS hallux MP-IP scale and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, the 1st intermetatarsal angle, DMAA before and after the operation was analyzed. Results: Distal Chevron osteotomy was done in 15 cases. After DCMO, The distal fragment was translated to laterally as far as possible and rotated to reduce DMAA. Clinically AOFAS scale was increased from 65.3 points preoperatively to 92.2 points postoperatively. Two patients were not satisfied with the results. Radiologically hallux valgus angle was decreased from 21.8° preoperatively to 8.5° postoperatively. The first intermetatarsal angle was decreased from 11.8° preoperatively to 6.7° postoperatively. DMAA was decreased from 15.8° preoperatively to 5.5° postoperatively. Conclusion: The rotational DCMO was an effective procedure for correcting hallux valgus associated with metatarsus adductus and increased DMAA. It allowed good realignment of the first MTP joint without the need for lesser metatarsal surgery to reduce the metatarsus adductus.

Juvenile Hallux Valgus: Etiology and Treatment

1995 ◽  
Vol 16 (11) ◽  
pp. 682-697 ◽  
Author(s):  
Michael J. Coughlin
Keyword(s):  
Hallux Valgus ◽  
Normal Population ◽  
Surgical Correction ◽  
Metatarsal Osteotomy ◽  
Hallux Valgus Angle ◽  
Pes Planus ◽  
First Metatarsal ◽  
Chevron Osteotomy ◽  
Valgus Angle ◽  
Metatarsus Adductus

In an 11-year retrospective study of 45 patients (60 feet) with juvenile hallux valgus, a multiprocedural approach was used to surgically correct the deformity. A Chevron osteotomy or McBride procedure was used for mild deformities, a distal soft tissue procedure with proximal first metatarsal osteotomy was used for moderate and severe deformities with MTP subluxation, and a double osteotomy (extra-articular correction) was used for moderate and severe deformities with an increased distal metatarsal articular angle (DMAA). The average hallux valgus correction was 17.2° and the average correction of the 1–2 intermetatarsal angle was 5.3°. Good and excellent results were obtained in 92% of cases using a multiprocedural approach. Eighty-eight percent of patients were female and 40% of deformities occurred at age 10 or younger. Early onset was characterized by increased deformity and an increased DMAA. Maternal transmission was noted in 72% of patients. An increased distal metatarsal articular angle was noted in 48% of cases. With subluxation of the first MTP joint, the average DMAA was 7.9°. With a congruent joint, the average DMAA was 15.3°. In patients where hallux valgus occurred at age 10 or younger, the DMAA was increased. First metatarsal length was compared with second metatarsal length. While the incidence of a long first metatarsal was similar to that in the normal population (30%), the DMAA was 15.8° for a long first metatarsal and 6.0° for a short first metatarsal. An increased DMAA may be the defining characteristic of juvenile hallux valgus. The success of surgical correction of a juvenile hallux valgus deformity is intimately associated with the magnitude of the DMAA. Moderate and severe pes planus occurred in 17% of cases, which was no different than the incidence in the normal population. No recurrences occurred in the presence of pes planus. Pes planus was not thought to have an affect on occurrence or recurrence of deformity. Moderate and severe metatarsus adductus was noted in 22% of cases, a rate much higher than that in the normal population. The presence of metatarsus adductus did not affect the preoperative hallux valgus angle or the average surgical correction of the hallux valgus angle. Constricting footwear was noted by only 24% of patients as playing a role in the development of juvenile hallux valgus. There were six recurrences of the deformities and eight complications (six cases of postoperative hallux varus, one case of wire breakage, and one case of undercorrection).

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.

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.

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.

scholarly journals The interobserver reliability of first metatarsal rotational component of axial sesamoid radiographs in hallux valgus

2020 ◽  
Vol 14 (3) ◽  
pp. 249-253
Author(s):  
Mariel García-Limón ◽  
Jaime Ortiz-Garza ◽  
Abraham Espinosa-Uribe ◽  
Eduardo Carranza-Cantú ◽  
Javier Meza-Flores ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Bone Structure ◽  
Interobserver Reliability ◽  
Weight Bearing ◽  
Case Series ◽  
Rotational Component ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Valgus Angle

Objective: Hallux valgus is a progressive triplanar deformity of the forefoot with an important rotational component (RC) in the first metatarsal, which has been associated with recurrence. There is controversy about using weight-bearing vs. non-weight-bearing radiographs in RC measurement. This study aims to assess interobserver reliability for RC of the first metatarsal using a non-weight-bearing sesamoid view, as well as to correlate the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle (DMAA) and sesamoid position regarding RC. Methods: An observational, cross-sectional and descriptive study was conducted with 81 feet from 48 patients (66.6% female). RC was evaluated regarding the first metatarsal proximal shaft in non-weight-bearing axial metatarsal radiographs and weight-bearing anteroposterior radiographs. Measurements were taken independently by two foot and ankle subspecialists and an orthopedic resident, all of whom were blinded. Results: Statistically significant intraclass correlations (p = 0.02) were obtained for first metatarsal RC assessment among the three observers (95%CI 0.01–0.65; Cronbach’s α =0.41) in non-weight-bearing axial metatarsal views. Significant correlations (Spearman ρ) were also found for hallux valgus angle (p = 0.04) and DMAA (p = 0.01), and non-significant correlations were found for intermetatarsal angle and sesamoid position (p > 0.05). Conclusion: The significant correlations between hallux valgus angle and DMAA for RC suggest that RC is isolated from the first metatarsal bone structure. This practical assessment method may isolate the first metatarsal head RC regarding the proximal metatarsal in the metaphyseal region and could be useful in centers where weight-bearing CT scans are not available. Level of Evidence IV; Therapeutic Studies; Case Series.

Radiographic Assessment of the Second Metatarsal: Measure of First Ray Hypermobility

1996 ◽  
Vol 17 (6) ◽  
pp. 331-333 ◽  
Author(s):  
David W. Prieskorn ◽  
Roger A. Mann ◽  
Germaine Fritz
Keyword(s):  
Hallux Valgus ◽  
Cortical Thickness ◽  
Valgus Deformity ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
Second Metatarsal

Hypermobility of the first metatarsal cuneiform joint has been implicated as a cause of the hallux valgus deformity. The objective definition of hypermobility at this joint, however, has not been clearly defined. We used a modified Coleman block test to accentuate motion at the first metatarsal cuneiform joint in order to measure physiologic limits of motion in vivo. This motion was compared with radiographic analysis of the feet, which included the hallux valgus angle, intermetatarsal angle, and medial cortical thickening at the midshaft of the second metatarsal. This assessment was performed on 100 feet (50 right feet and 50 left feet in 50 patients). The average intermetatarsal angle was 8.7° (range, 4–14°), the average hallux valgus angle was 11° (range, 4° of varus to 30° of valgus), and the average midshaft medial cortical thickness was 3.2 mm (range, 2.0–5.5 mm). Pearson's correlation coefficient was calculated to compare these factors. The relationship between variables was found to be small ( r ≤ 0.2). Motion was noted to occur in the normal foot at this joint and a range of normal values for medial cortical thickness was identified.

Weightbearing Computed Tomography and 3-Dimensional Analysis of Mobility Changes of the First Ray After Proximal Oblique Osteotomy for Hallux Valgus

2020 ◽  
pp. 107110072096247
Author(s):  
Tadashi Kimura ◽  
Makoto Kubota ◽  
Naoki Suzuki ◽  
Asaki Hattori ◽  
Mitsuru Saito
Keyword(s):  
Computed Tomography ◽  
Hallux Valgus ◽  
Metatarsal Osteotomy ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
Oblique Osteotomy ◽  
Valgus Angle ◽  
Significant Difference ◽  
Before And After ◽  
First Ray

Background: Hypermobility of the first ray has been evaluated using various methods and has conventionally been considered to be involved in the pathology of hallux valgus. We hypothesized that hypermobility of the first ray in hallux valgus could be decreased by simply correcting foot alignment without arthrodesis. This study sought to evaluate first-ray mobility using weightbearing computed tomography (CT) before and after proximal oblique osteotomy and also in healthy volunteer’s feet. Methods: Subjects were 11 feet of 11 patients with primary hallux valgus who underwent surgery with a plantarly applied anatomic precontoured locking plate and 22 feet of 11 matched healthy volunteers. We performed nonweightbearing and weightbearing (using a load equivalent to body weight) CT scans using an original loading device preoperatively and 1-1.5 years postoperatively. Three-dimensional displacement of the distal bone relative to the proximal bone was quantified for each joint of the first ray by comparing nonweightbearing and weightbearing CT images. Results: At baseline, there were significant differences in hallux valgus angle ( P < .001) and 1-2 intermetatarsal angle ( P < .001) between healthy volunteer’s feet and preoperative hallux valgus feet. Hallux valgus angle ( P < .001) and 1-2 intermetatarsal angle ( P < .001) differed significantly between before and after surgery. All first ray joint displacement under loading decreased postoperatively to within 2° of that in healthy volunteer’s feet and showed no significant difference between postoperatively hallux valgus feet and healthy volunteer’s feet ( P > .05). Conclusions: We found that first metatarsal osteotomy even without arthrodesis corrected deformity and decreased mobility of the first ray after hallux valgus surgery. Level of Evidence: Level III, case-control study.

scholarly journals PO 18115 - Percutaneous hallux valgus correction using the Reverdin-Isham osteotomy

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 15S
Author(s):  
Fábio Lemos Rodrigues ◽  
Luiz Carlos Ribeiro Lara ◽  
Juan Antonio Grajales ◽  
Lucio Carlos Torres
Keyword(s):  
Hallux Valgus ◽  
Hallux Valgus Angle ◽  
Aofas Score ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Valgus Angle ◽  
Angle Correction ◽  
Age At Surgery ◽  
The Mean

Objective: To analyze the outcomes of percutaneous hallux valgus correction using the Reverdin-Isham osteotomy through clinical and radiographic studies. Methods: We retrospectively evaluated 43 feet in 38 patients with mild or moderate hallux valgus from June 2009 to July 2018. The mean age at surgery was 59 years; the mean postoperative follow-up time was 79 months. All patients treated with the Reverdin technique modified by Isham were evaluated in the pre- and postoperative periods using the American Association Orthopedic Foot and Ankle Society (AOFAS) score; we radiographically measured the hallux valgus angle (HVA), the intermetatarsal angle (IMA) and the first distal metatarsal articular angle (DMAA). Results: The AOFAS score increased by an average of 55 points. On average, the HVA decreased by 14°, the IMA by 3° and the DMAA by 9°. The mean reduction in the length of the first metatarsal bone was 0.3 cm. Conclusion: This surgical technique was effective for hallux valgus correction, demonstrating good angle correction and a marked increase in the AOFAS score.

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