Correlation Analysis of Age, Functional and X-Ray Morphological Parameters of Osteotomies in Hallux Valgus

Hallux valgus (HV) violates the musculoskeletal function of the lower limb, and also affect the x-ray anatomical parameters of the foot. There is the study of the most important correlations between age, morphological and functional changes of the forefoot play a big role in the choice of treatment tactics for this pathology. The aim was to analyze the age, functional and radiological results of surgical treatment of Hallux valgus deformity of the first toe using the methods saving the metatarsophalangeal joint. 126 patients had Hallux valgus deformity of the first toe of I, II, III degree. They were examined before surgery, then 3, 6 and 12 months after operation. 126 patients were operated according to the method of Scarf, Austin, Bosch-Magnan osteotomy. X-ray results were assessed by the Hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMMA) before and after the operations. AOFAS rating scale (Kitaoka) and biomechanical (stabilometric) study were used for the functional assessment of the surgical treatment results. The IMA correction angle after operation increases with the patient's age. HVA becomes the most deformed angle in the pathology of Hallux valgus with increasing age before osteotomy. The best functional result according to the AOFAS scale was obtained with the greatest correction of the IMA angle after osteotomy. The functional index of the foot decreased with increasing age after osteotomies.

Outcomes of Scarf and Akin Osteotomy with Intra-Articular Stepwise Lateral Soft Tissue Release for Correcting Hallux Valgus Deformity in Rheumatoid Arthritis

Background. The effectiveness of scarf and Akin osteotomy with intra-articular lateral soft tissue release for the correction of hallux valgus (HV) in patients with rheumatoid arthritis (RA) has not been elucidated. Methods. A total of 36 feet in 28 patients with RA who had scarf and Akin osteotomy with intra-articular stepwise lateral soft tissue release between 2015 and 2020 at a single institute were investigated retrospectively, with a mean follow-up period of 32.0 ± 16.9 months. Radiographic evaluations including the HV angle, intermetatarsal angle, and sesamoid position were performed preoperatively and postoperatively. Clinical outcomes were assessed using the Japanese Society of Surgery of the Foot (JSSF) hallux scale and self-administered foot evaluation questionnaire (SAFE-Q). Results. The procedure resulted in significant HV correction, with a recurrence rate of 13.9%. The JSSF scale and all five SAFE-Q subscale scores significantly improved (p < 0.05), with no major complications. More than 90% of cases achieved adequate lateral soft tissue release without sacrificing the adductor tendon of the hallux. Conclusions. Intra-articular stepwise lateral soft tissue release in combination with scarf and Akin osteotomy provided satisfactory radiographic and patient-reported outcomes for the correction of HV in patients with RA with minimum lateral soft tissue release.

Combination of Modified Scarf Osteotomy and Metatarsal Shortening Offset Osteotomy for Rheumatoid Forefoot Deformity

With the progress of medical treatment for rheumatoid arthritis (RA), several joint-preserving forefoot surgical procedures have been established and performed. In this situation, we have been choosing the combined surgery: modified scarf osteotomy for the great toe and metatarsal shortening offset osteotomy for the lesser toes in RA cases. A retrospective observational study of 53 RA patients (mean follow-up period: 4.6 years) who underwent the surgery was completed. RA foot ankle scores were assessed, using the Japanese Society for Surgery of the Foot (JSSF) standard rating system, and a self-administered foot evaluation questionnaire (SAFE-Q) was also checked to evaluate clinical outcomes. For radiological evaluations, deformity parameters were measured using radiographs of the feet with weight-bearing. JSSF hallux and lesser toes scores and the SAFE-Q score showed significant improvement in all indices. HVA, M1-M2A, M1-M5A, M2-M5A, and sesamoid position were significantly improved after surgery. At the final follow-up, the hallux valgus deformity had recurred in 4 feet (7.5%), and hallux varus deformity had developed in 8 feet (15.1%). No case of recurrent hallux valgus deformity required revision surgery. Recurrence of dorsal dislocation/subluxation of the lesser toe MTP joint was seen in 6 feet (11.3%) after surgery. A combination of modified scarf osteotomy for the great toe and modified metatarsal shortening offset osteotomy for the lesser toes is one of the novel surgical procedures for rheumatoid forefoot deformity. Preoperative disease activity of RA negatively affected the clinical score of the hallux. The spread of M2-M5A was a risk factor for resubluxation of the lesser toe MTP joint.

Effect of Hallux Valgus Correction with Kinesiology Taping on Hindfoot Position. Pilot Study

Background. Hallux valgus is the most common deformity of the forefoot. It has a multifactorial aetiology, with hindfoot valgus considered one of its causes. The aim of this study was to evaluate hindfoot position and loading pattern after a treatment of Kinesiology Taping (KT) for the mechanical correction of hallux valgus. Material and methods. The study involved 25 feet with hallux valgus deformity and hindfoot valgus. The hallux valgus angle (HVA) and hindfoot angle were assessed with a 3D scanner. Hindfoot loading pattern was examined with a baropodometric platform while standing and during gait. Measurements were taken on the following three occasions: before and immediately after KT placement as well as after a month of taping. Results. The KT treatment had a significant influence on the hindfoot angle (p<0.001) and HVA (p<0.001) measured while standing and on lateral heel loading in dynamic conditions during gait (p<0.01). Conclusions. 1. KT decreased HVA and improved hindfoot position while standing in the pilot study participants. 2. KT exerted a corrective influence on the foot loading pattern in patients with hallux valgus and hindfoot pronation. 3. The foot position correction and normalisation of foot loading achieved in the pilot study provide a basis for further research on KT effectiveness in patients with hallux valgus and hindfoot pronation.

Clinico-radiological Results of Distal Chevron Osteotomy without Lateral Soft Tissue Release in Mild to Moderate Hallux Valgus Deformity

Background. The study was done to evaluate short term clinico-radiological results of distal chevron oste­otomy without lateral soft tissue release in mild to moderate hallux valgus. Materials and methods. This was a prospective study consisting of a total of 35 cases with mild to moderate hallux valgus deformity. All these patients were treated by distal chevron osteotomy without lateral soft tissue release. Results. In our study, the average value of hallux angle preoperatively was 32° (range, 24°-40°) and at final follow-up it was 14° (range, 8°-31°). The average reduction was 18°. The average intermetatarsal angle showed mean reduction of 5.3° at the final follow-up. Average range of motion of the first metatarsophalyngeal joint preoperatively and at final follow-up showed a small reduction of 5 degrees. The average preoperative AOFAS score was 49, which improved by 35 points to 84 at the final follow-up. 11.42% of the patients in the study group had a recurrence. Conclusions. 1. Based on our experience with distal chevron osteotomy without lateral soft tissue release, we found the procedure easy to perform with good procedural outcomes. 2. The possible complications of lateral soft tissue release are avoided.