Effect of Proximal Dome and Distal Chevron Osteotomies on Plantar Pressures and Radiographic and Functional Outcomes in Hallux Valgus Surgery: A Retrospective Analysis

2021 ◽  
Vol 111 (3) ◽  
Author(s):  
Kadir Ilker Yildiz ◽  
Abdulhamit Misir ◽  
Turan Bilge Kizkapan ◽  
Mustafa Cukurlu ◽  
Canan Gonen Aydin
Keyword(s):  
Hallux Valgus ◽  
Inclination Angle ◽  
Plantar Pressure ◽  
Functional Outcomes ◽  
First Metatarsal ◽  
Pressure Point ◽  
Radiographic Outcomes ◽  
Metatarsal Angle ◽  
Dome Osteotomy ◽  
Pressure Changes

Background No detailed comparative studies have been performed regarding plantar pressure changes between proximal dome and distal chevron osteotomies. This study aimed to compare radiographic and plantar pressure changes after distal chevron and proximal dome osteotomies and to investigate the effect of radiographic and plantar pressure changes on clinical outcomes. Methods This study included 26 and 22 patients who underwent distal chevron and proximal dome osteotomies, respectively. Visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) forefoot scores were used to evaluate pain and functional outcomes. Hallux valgus angle, intermetatarsal angle, talar–first metatarsal angle, and calcaneal inclination angle were measured in the evaluation of radiographic outcomes. Preoperative and postoperative plantar pressure changes were evaluated. Results There were no statistically significant differences between the two groups in age, body mass index, or AOFAS forefoot and VAS scores. In the proximal dome group, the pressure measurement showed significant lateralization of the maximal anterior pressure point in the forefoot (P < .001). In addition, the postoperative calcaneal inclination angle was significantly lower (P = .004) and the talar–first metatarsal angle was significantly higher (P < .001) in the proximal dome group. Postoperative transfer metatarsalgia was observed in one patient (3.8%) in the distal chevron group and five (22.7%) in the proximal dome group (P < .05). Conclusions Proximal dome osteotomy led to more lateralization of the maximum anterior pressure point, decreased calcaneal inclination angle and first metatarsal elevation, and related higher transfer metatarsalgia.

scholarly journals Radiographic Outcomes, Union Rates, and Complications Associated With Plantar Implant Positioning for Midfoot Arthrodesis

2021 ◽  
Vol 6 (3) ◽  
pp. 247301142110271
Author(s):  
Tyler W. Fraser ◽  
Daniel T. Miles ◽  
Neal Huang ◽  
Franklin B. Davis ◽  
Burton D. Dunlap ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Skin Irritation ◽  
Case Series ◽  
Deformity Correction ◽  
Valgus Deformity ◽  
Union Rate ◽  
Radiographic Outcomes ◽  
Hallux Valgus Deformity ◽  
Metatarsal Angle ◽  
Radiographic Union

Background: Midfoot arthrodesis has long been successfully included in the treatment paradigm for a variety of pathologic foot conditions. A concern with midfoot arthrodesis is the rate of nonunion, which historically has been reported between 5% and 10%. Plantar plating has also been noted to be more biomechanically stable when compared to traditional dorsal plating in previous studies. Practical advantages of plantar plating include less dorsal skin irritation and the ability to correct flatfoot deformity from the same medial incision. The purpose of this study is to report the arthrodesis rate, the success of deformity correction, and the complications associated with plantar-based implant placement for arthrodesis of the medial column. Methods: A retrospective review was undertaken of all consecutive patients between 2012 and 2019 that underwent midfoot arthrodesis with plantar-positioned implants. Radiographic outcomes and complications are reported on 62 patients who underwent midfoot arthrodesis as part of a correction for hallux valgus deformity, flatfoot deformity, degenerative arthritis, Lisfranc injury, or Charcot neuroarthropathy correction. Results: Statistically significant improvement was seen in the lateral talus–first metatarsal angle (Meary angle) and medial arch sag angle for patients treated for flatfoot deformity correction. In patients treated for hallux valgus deformity, there was a reduction in the intermetatarsal angle from 15.4 to 6.8 degrees. The overall nonunion rate was 6.45% in all patients. The rate of nonunion was higher at the NC joint compared to the TMT joint and with compression claw plates. One symptomatic nonunion required revision surgery (1.7%). There were no nonunions when excluding neuroarthropathy patients and smokers. The odds ratio (OR) for nonunion in patients with neuroarthropathy was 6.05 ( P < .05), and in active smokers the OR was 2.33 ( P < .05). Conclusion: Plates placed on the plantar bone surface for midfoot arthrodesis achieved and maintained deformity correction with rare instances of symptomatic hardware for a variety of orthopedic conditions. An overall clinical and radiographic union rate of 94% was achieved. The radiographic union rate improved to 100% when excluding both neuroarthropathy patients and smokers. The incidence of nonunion was higher in smokers, neuroarthropathy patients, naviculocuneiform joint fusions, use of compression claw plates, and when attempting to fuse multiple joints. Incisional healing complications were rarely seen other than in active smokers. Level of Evidence: Level IV, case series.

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

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

Background: Instability of the first-tarsometatarsal (TMT) joint has been proposed as a cause of hallux valgus. Although there is literature demonstrating how first-TMT arthrodesis affects hallux valgus, there is little published on how correction of hallux valgus affects the first-TMT joint alignment. The purpose of this study was to determine if correction of hallux valgus impacts the first-TMT alignment and congruency. Improvement in alignment would provide evidence that hallux valgus contributes to first-TMT instability. Our hypothesis was that correcting hallux valgus angle (HVA) would have no effect on the first-TMT alignment and congruency. Methods: Radiographs of patients who underwent first-MTP joint arthrodesis for hallux valgus were retrospectively reviewed. The HVA, 1-2 intermetatarsal angle (IMA), first metatarsal–medial cuneiform angle (1MCA), medial cuneiform–first metatarsal angle (MC1A), relative cuneiform slope (RCS), and distal medial cuneiform angle (DMCA) were measured and recorded for all patients preoperatively and postoperatively. Results: Of the 76 feet that met inclusion criteria, radiographic improvements were noted in HVA (23.6 degrees, P < .0001), 1-2 IMA (6.2 degrees, P < .0001), 1MCA (6.4 degrees, P < .0001), MC1A (6.5 degrees, P < .0001), and RCS (3.3 degrees, P = .001) comparing preoperative and postoperative radiographs. There was no difference noted with DMCA measurements (0.5 degrees, P = .53). Conclusion: Our findings indicate that the radiographic alignment and subluxation of the first-TMT joint will reduce with isolated treatment of the first-MTP joint. Evidence suggests that change in the HVA can affect radiographic alignment and subluxation of the first-TMT joint. Level of Evidence: Level IV, retrospective case series.

Reliability and Relevance of Radiographic Measures of Metatarsus Primus Elevatus and Arch Alignment in Individuals with Midfoot Arthritis and Controls

2013 ◽  
Vol 103 (5) ◽  
pp. 347-354 ◽  
Author(s):  
Smita Rao ◽  
Katie Bell
Keyword(s):  
Inclination Angle ◽  
Intraclass Correlation ◽  
Positive Association ◽  
Group Differences ◽  
Control Group ◽  
Arch Height ◽  
First Metatarsal ◽  
Compressive Stresses ◽  
Metatarsal Angle ◽  
The Relationship

Background: Low arch alignment and metatarsus primus elevatus (MPE) have been postulated to increase dorsal compressive stresses in the joints of the medial column of the foot and to contribute to the development of degenerative changes. The primary purposes of this study were 1) to examine the relationship between radiographic measures of arch alignment and MPE and 2) to assess arch alignment and MPE in individuals with midfoot arthritis and in asymptomatic controls. The secondary aim was to examine the reliability of radiographic measures of arch alignment and MPE. Methods: Radiographic measures of arch height and MPE were quantified on 28 individuals with midfoot arthritis and 22 individuals in a control group. Reliability was assessed using the intraclass correlation coefficient (ICC). The Pearson product moment correlation (r) was used to assess the relationship between arch alignment and MPE. Between-group differences were assessed using a two-sample t test (α = 0.05). Results: Good to excellent reliability was noted for measures of arch height (ICC[2,3] = 0.919–0.994) as well as MPE (ICC[2,3] = 0.891–0.882). A modest positive association was noted between normalized cortical elevation and normalized navicular height (r = 0.274, P = .030) and calcaneal inclination angle (r = 0.263, P = .035). Individuals with midfoot arthritis demonstrated lower arch alignment, reflected in a significantly higher calcaneal–first metatarsal angle (P = .002), lower calcaneal inclination angle (P = .004), and lower normalized navicular height (P &lt; .001) compared with controls. No evidence was found to support between-group differences in lateral intermetatarsal angle (P = .495) and normalized cortical elevation (P = .146). Conclusions: These findings provide objective data establishing the reliability of measures of MPE and arch alignment and their potential clinical significance. (J Am Podiatr Med Assoc 103(5): 347–354, 2013)

scholarly journals Suture anchor stabilization of symptomatic accessory navicular in adolescents: Clinical and radiographic outcomes

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902091894
Author(s):  
Masataka Kakihana ◽  
Yuki Tochigi ◽  
Takayuki Yamazaki ◽  
Masanori Ohashi ◽  
Satoru Ozeki
Keyword(s):  
Tilt Angle ◽  
Suture Anchor ◽  
Weight Bearing ◽  
Bone Union ◽  
First Metatarsal ◽  
Radiographic Outcomes ◽  
Metatarsal Angle ◽  
Radiographic Measurements ◽  
Accessory Navicular ◽  
Stabilization Technique

Background: Screw fixation used in modified Kidner procedures to treat persistent symptomatic accessory navicular in adult cases is often challenging in adolescent cases with a small accessory fragment. The present study aimed to document the clinical effect of a suture anchor stabilization technique applicable to such cases where osteosynthesis is considered an ideal outcome. Methods: Consecutive clinical cases who received this surgical treatment from 2009 to 2016 were retrospectively reviewed. The focus of interest included radiographic union of the accessory bone, changes in symptoms evaluated using a validated clinical outcome scale introduced by the Japanese Society for Surgery of the Foot, and changes in the medial arch bony alignment measured in lateral weight-bearing plain radiographs. Results: Twenty-two feet in 15 individuals (11 females and 4 males, age at surgery 10–16 years) were identified. In 14 feet (64%), radiographic bone union was confirmed within 8 weeks postoperatively. At the final follow-up ranging 12–51 months postoperation, the clinical scores have significantly improved ( p < 0.001) to 96 ± 5.71 (mean ± standard deviation, range 87–100), from 54 preoperatively. Radiographic measurements revealed significant postoperative increase of the sagittal talar tilt angle ( p < 0.001, increment 4 ± 3°, range 0–11) and the talo-first metatarsal angle ( p < 0.001, increment 5 ± 4°, range 0–12). No significant changes were identified in the calcaneal pitch angle, first metatarsal tilt angle, calcaneo-navicular angle, and the navicular height. Conclusion: Despite the modest bone union rate, the clinical outcomes suggest distinct symptom-relieving effect, at least in the short- to midterm, while the radiographic measurements suggest positive biomechanical effects. The present suture-anchor stabilization concept appears to be a promising treatment option for persistent symptomatic accessory navicular in adolescent cases.

scholarly journals Roentgenographs Study of Cavus Foot Deformity in Friedreich Ataxia Patients: Preliminary Report

1982 ◽  
Vol 9 (2) ◽  
pp. 113-117 ◽  
Author(s):  
P. Allard ◽  
J.P. Sirois ◽  
P.S. Thiry ◽  
G. Geoffroy ◽  
M. Duhaime
Keyword(s):  
Inclination Angle ◽  
Weight Bearing ◽  
Friedreich Ataxia ◽  
Quantitative Description ◽  
Foot Deformity ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Cavus Foot ◽  
Three Stages

SUMMARY:The preliminary results based on a three year retrospective study in cavus foot deformity of forty-four Friedreich ataxia patients regularly seen at the Neuromuscular Disease Clinic of Sainte-Justine Hospital have been presented. An accurate “weight-bearing” foot stereoradiographic technique has been recently developed by our group. Since the follow-up period with this device is not sufficient to provide statistical information, the conventional non-weight bearing technique has been utilized in this study to enable a possible comparison between the radiographs of ambulant and non-ambulant patients. Due to the present technique, the results of this study must be interpreted with caution.For 132 pairs of radiographs, 28 parameters have been analyzed. Four of these, namely the calcaneal inclination angle, the first metatarsal inclination angle, the inferior cortex of calcaneus-first metatarsal angle and the first-fifth metatarsals angle, were of particular interest. From these parameters, a preliminary quantitative description of cavus foot deformity in Friedreich’s ataxia has been attempted. Three stages of evolution have been tentatively identified for this type of neurological disorder.

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

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

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

scholarly journals Validity of Two-Dimensional Static Footprint in Medial Longitudinal Arch Evaluation and the Characteristics of Athletes’ Footprints

2020 ◽  
Author(s):  
Lingli Zhang ◽  
Dali Yu ◽  
Le Lei ◽  
Yuanwu Gao ◽  
Junjie Dong ◽  
...  
Keyword(s):  
College Students ◽  
Inclination Angle ◽  
Medial Longitudinal Arch ◽  
Two Dimensional ◽  
Important Indicator ◽  
First Metatarsal ◽  
Longitudinal Arch ◽  
Metatarsal Angle ◽  
The Right ◽  
High Level

AbstractBackgroundWe aimed to explore the validity of two-dimensional static footprint analysis in medial longitudinal arch evaluation as well as the characteristics of athletes’ footprints to provide a basis for the evaluation and selection of athletes.MethodsExperiment One: Twenty-nine high level athletes (runners and jumpers) and forty normal college students were selected. Based on the X-ray photos taken of the medial foot, we measured the calcaneal inclination angle, the calcaneal–first metatarsal angle and the ratio of height to length of the medial longitudinal arch. We collected indicators of two-dimensional static footprints. Experiment Two: 106 high level athletes (runners and jumpers) and 104 normal college students were selected. We also collected indicators of two-dimensional static footprints.ResultsThe average measuring the Interclass Correlation Efficient (ICC) of calcaneal inclination angle, calcaneal–first metatarsal angle, the ratio of height to length of the medial longitudinal arch, the width of ball, arch and heel, the length of footprint and each toe, Chippaux-Smirak Index (CSI) and Staheli Index (SAI) were higher than 0.800. Regardless of athletes or college students, male or female, the correlation between CSI, SAI and calcaneal inclination angle, calcaneal–first metatarsal angle, the ratio of height to length of the medial longitudinal arch was statistically significant (P<0.05). College students’ CSI of the right foot is significantly higher than that of the left foot regardless of gender (P<0.05).ConclusionsWe prove the qualification of CSI and SAI in medial longitudinal arch evaluation and explain that the relative height of medial longitudinal arch is an important indicator in track and field.

Radiographic and Clinical Results of Minimally Invasive Chevron Akin Osteotomy for Moderate to Severe Hallux Valgus Deformities

2021 ◽  
pp. 193864002110459
Author(s):  
Toshinori Kurashige
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Inclination Angle ◽  
Case Series ◽  
Metatarsal Head ◽  
Clinical Results ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Akin Osteotomy ◽  
Severe Hallux Valgus

Background: Few studies have reported results of minimally invasive chevron Akin osteotomy (MICA) for moderate to severe hallux valgus correction. This study aims to evaluate MICA for moderate to severe hallux valgus radiographically and clinically. Methods: Forty feet were prospectively reviewed. Twenty-eight feet (70%) had a severe deformity (hallux valgus angle (HVA) ≥40° and/or first intermetatarsal angle (IMA) ≥18°). We measured HVA, IMA, lateral shape of the metatarsal head (round sign), tibial sesamoid position, first metatarsal shortening on anteroposterior weightbearing radiographs, and inclination angle of first metatarsal on lateral weightbearing radiographs. We evaluated the Japanese Society for Surgery of the Foot hallux scale and Self-Administered Foot Evaluation Questionnaire responses preoperatively and at the most recent follow-up. Results: All measurements except shortening and inclination angle improved significantly. Both clinical scale and all subscores significantly improved. Conclusions: MICA improved moderate to severe hallux valgus both radiographically and clinically. Level of Evidence: Level IV: case series

Plantar pressure improvement in moderate hallux valgus with modified chevron osteotomy: Clinical and radiographic outcomes

2020 ◽  
Vol 26 (2) ◽  
pp. 205-208 ◽  
Author(s):  
Carmen Verdu-Roman ◽  
Javier Sanz-Reig ◽  
Enrique Martinez-Gimenez ◽  
Concepcion Carratala-Munuera ◽  
Adriana Lopez-Pineda ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Plantar Pressure ◽  
Radiographic Outcomes ◽  
Chevron Osteotomy

scholarly journals Effectiveness of the Plantar Aponeurosis Release for Limitation of the First Metatarsophalangeal Joint Extension after Hallux Valgus Surgery

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Hongjoon Choi ◽  
Daewook Kim ◽  
Yeong Hun Kang ◽  
Jong Ho Park
Keyword(s):  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Knee Extension ◽  
First Metatarsophalangeal Joint ◽  
Plantar Aponeurosis ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Additional Procedure ◽  
The Mean

Category: Midfoot/Forefoot Introduction/Purpose: Even though stiffness of the first metatarsophalangeal joint (1MTP) is not a common complication, reduced dorsiflexion range of motion at the 1MTP after surgery for hallux valgus was reported as a complication. However, few clinical studies have investigated this issue and no clinical resolution has been reached thus far. We hypothesized that tightness of the gastrocnemius-plantar aponeurosis complex is one of the factors that limits the extension of 1MTP after hallux valgus surgery. Thus, an additional procedure of the plantar aponeurosis release during hallux valgus surgery may improve the range of extension at 1MTP. The purpose of this study was to test the efficacy of plantar aponeurosis release in improving the range of extension when a limitation is detected after hallux valgus surgery. Methods: Thirteen patients (17 feet) with limited 1MTP extension after hallux valgus surgery, underwent an additional procedure of plantar aponeurosis release. The inclusion criterion was limitation of 1MTP extension showed more than 15 degrees difference between knee extension and flexion position, measured after completing all procedures of the hallux valgus surgery. The passive range of 1MTP extension was evaluated by a goniometer while the first metatarsal head was supported with a palm, assuming a weightbearing position with knee extension and flexion, after completing all procedures of the hallux valgus surgery (Barouk test). A silfverskiold test was performed in all cases preoperatively. The weightbearing dorsoplantar and lateral radiographs of the foot were performed to measure the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and the talo-first metatarsal angle. Results: The mean range of 1MTP extension significantly improved from 2.53 degrees to 40.88 degrees in the knee extension position (p<0.0000). The mean range of the 1MTP extension also improved from 18.24 degrees to 43.24 degrees in the knee flexion position. The silfverskiold test was positive in 12 cases. In all patients, congruence of 1MTP was corrected. There were no surgery-related complications such as plantar aponeurosis rupture or nerve injury. Conclusion: Our study supports tightness of the gastrocnemius-plantar aponeurosis complex is one of the factors that limit the extension of 1MTP after hallux valgus surgery. Hence, plantar aponeurosis release can be considered as an effective additional procedure to improve the range of 1MTP extension when a limitation is presented after hallux valgus surgery.

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