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Shima H, Togei K, Hirai Y, Tanaka K, Yasuda T, Neo M. Ultrasonography-Based Quantitative Evaluation of Second Metatarsophalangeal Joint Instability in Female Patients With Hallux Valgus. Foot Ankle Int 2024; 45:737-745. [PMID: 38563279 DOI: 10.1177/10711007241239335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Patients with moderate to severe hallux valgus (HV) sometimes exhibit second metatarsophalangeal (MTP) joint dislocation. Second MTP joint instability due to plantar plate (PP) injury has been suggested as one of the causes. However, there have been no reports that quantitatively evaluate this instability. This study aimed to evaluate second MTP joint instability in patients with HV without dislocation via ultrasonography and investigate its relationship with the presence of PP injury or foot form. METHODS Between May 2018 and July 2023, symptomatic female patients with HV without any lesser toe deformity were included in this study. Second MTP joint instability was defined as the dorsal displacement ratio (DDR) of the passively subluxated proximal phalangeal articular surface on the metatarsal head articular surface. The presence of PP injury was assessed using ultrasonography. Foot "form" was determined by measuring standard foot bony angles on weight-bearing foot-ankle radiographs. The relationship between DDR or PP injury and radiographic measurements was investigated. RESULTS Sixty-four patients (100 feet) were included. The average DDR of the second MTP joint in patients with HV without dislocation was 35.7%. There was an increase in the probability of PP injury, above a cutoff DDR value r of 35.4% (area under the curve = 0.712). The sensitivity, specificity, positive predictive value, and negative predictive value for the presence of PP injury based on this cutoff level were 63.9%, 74.4%, 79.6%, and 56.9%, respectively. Metatarsalgia was reported in 21 feet (21.0%), of which 15 feet (71.4%) showed PP injury. An increase in DDR was weakly associated with increased metatarsus adductus angle and decreased second metatarsal height. CONCLUSION In female patients with HV without second MTP dislocation, we found ultrasonographic evidence of second MTP plantar plate injury and joint instability to be a relatively common finding with a high prevalence in those with localized metatarsalgia. LEVEL OF EVIDENCE Level II, development of diagnostic criteria based on consecutive patients.
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Affiliation(s)
- Hiroaki Shima
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Kosho Togei
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yoshihiro Hirai
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Ken Tanaka
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Toshito Yasuda
- Faculty of Nursing, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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Okuda R, Tanaka K, Shima H. Proximal Supination Osteotomy for Hallux Valgus: Comparison of Clinical and Radiologic Outcomes for the Most Severe Deformities. Foot Ankle Int 2024; 45:141-149. [PMID: 38063154 DOI: 10.1177/10711007231210809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2024]
Abstract
BACKGROUND There is little available information regarding the difference in outcomes between severe hallux valgus (S-HV), defined as 40 degrees ≤ hallux valgus angle (HVA) < 50 degrees, and what we consider to be "super-severe HV" (SS-HV), defined as >50 degrees, following a proximal metatarsal osteotomy. We aimed to retrospectively compare the outcomes of a proximal metatarsal osteotomy in S- and SS-HV. METHODS The series consisted of 57 female patients (57 feet) treated with a proximal supination osteotomy for symptomatic S- and SS-HV (33 and 24 feet, respectively). The outcome measures included radiographic parameters and for 45 patients included the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) score, and a visual analog scale pain score (VAS-PS) preoperatively and at a minimum follow-up of 12 months with a median of 26 months. No significant differences were found in age, body mass index, and the duration of follow-up between patients with S-HV and SS-HV (P > .10 for all comparisons) with the numbers available. RESULTS Preoperative HVA in patients with S- and SS-HV was significantly improved at the final follow-up (P < .0001 for both comparisons). No significant differences in postoperative HVA and IMA were observed between patients with S- and SS-HV (P = .51 and .50, respectively). All 5 preoperative subscale scores of SAFE-Q in patients with S- and SS-HV significantly improved postoperatively (P < .01 for all comparisons). Preoperative VAS-PS in patients with S- and SS-HV significantly improved postoperatively (P < .0001 and <.009, respectively). There were no significant differences in preoperative and postoperative scores of all the SAFE-Q subscales and VAS-PS between patients with S-HV and SS-HV (P > .10 for all) with the numbers available. CONCLUSION We found for this patient group that a proximal supination osteotomy can achieve a large correction for SS-HV as well as S-HV and significantly improve radiologic and clinical outcomes in SS-HV. The outcomes between patients with S- and SS-HV were not different in this series. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Ryuzo Okuda
- Department of Orthopaedic Surgery, Rakusai-Shimizu Hospital, Kyoto, Japan
| | - Kei Tanaka
- Department of Orthopaedic Surgery, Rakusai-Shimizu Hospital, Kyoto, Japan
| | - Hiroaki Shima
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
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Watanabe K, Kubota M, Tanaka H, Nishiyama T, Hirao M, Fukushi JI, Kakihana M, Nozawa D, Okuda R. Japanese Orthopaedic Association (JOA) Clinical Practice Guidelines on the Management of Hallux Valgus - Secondary publication. J Orthop Sci 2024; 29:1-26. [PMID: 37451976 DOI: 10.1016/j.jos.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Kota Watanabe
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Japan.
| | - Makoto Kubota
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirofumi Tanaka
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Hyakutake Orthopedic Surgery and Sports Clinic, Saga, Japan
| | - Takayuki Nishiyama
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Makoto Hirao
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Jun-Ichi Fukushi
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Masataka Kakihana
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Japan
| | - Daisuke Nozawa
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryuzo Okuda
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Rakusai-Shimizu Hospital, Kyoto, Japan
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Shima H, Togei K, Hirai Y, Yasuda T, Okuda R, Neo M. Operative outcomes of hallux valgus with painful osteoarthritis of the lesser tarsometatarsal joints. J Orthop Sci 2024; 29:230-235. [PMID: 36564235 DOI: 10.1016/j.jos.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/03/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hallux valgus is sometimes accompanied by osteoarthritis of the lesser tarsometatarsal joint. However, information on the operative procedures and outcomes for the treatment of hallux valgus with osteoarthritis of the lesser tarsometatarsal joint simultaneously is limited. We aimed to describe this operative procedure and evaluate the outcomes of the treatment of hallux valgus with osteoarthritis of the lesser tarsometatarsal joint. METHODS Fifteen patients (17 feet; average age, 66.9 years; average follow-up, 59.4 months; and minimum follow-up, 24 months) with symptomatic hallux valgus accompanied by painful osteoarthritis of the lesser tarsometatarsal joint were enrolled. All feet showed osteoarthritis of the second and/or third tarsometatarsal joint on dorsoplantar weight-bearing radiograph. The operative procedure included a proximal osteotomy of the first metatarsal and arthrodesis of the lesser tarsometatarsal joint with an autologous bone graft. RESULTS The mean Japanese Society for Surgery of the Foot hallux metatarsophalangeal-interphalangeal score significantly improved from 54.8 points preoperatively to 91.7 points postoperatively (P <0.001). The mean postoperative visual analog score (15 feet) was 1.0 (0-3.9). Preoperative midtarsal pain disappeared in 14 feet and decreased in one foot postoperatively. Preoperative metatarsalgia was found in five feet, of which, it disappeared in two feet, decreased in two feet, and transferred to another region in one foot at the latest follow-up. The mean hallux valgus and intermetatarsal angles were 42.4° and 18.4° preoperatively, which decreased significantly to 12.5° and 6.9° postoperatively, respectively (P <0.001, all). Recurrence of hallux valgus (hallux valgus angle ≥20°) was observed in two feet (11.8%). Nonunion of the third tarsometatarsal joint was observed in one foot (3.1% among 32 joints). CONCLUSIONS The clinical and radiographic results indicated that operative treatment for hallux valgus with painful osteoarthritis of the lesser tarsometatarsal joint significantly improves forefoot and midfoot pain and function and has low complication rates. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Hiroaki Shima
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
| | - Kosho Togei
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yoshihiro Hirai
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Toshito Yasuda
- Faculty of Nursing, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Ryuzo Okuda
- Depatment of Orthopaedic Surgery, Rakusai-Shimizu Hospital, Kyoto, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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Hirai Y, Shima H, Togei K, Yasuda T, Neo M. Plantar Pressure Distribution Before and After Surgery for Lesser Metatarsophalangeal Joint Dislocation With Hallux Valgus. J Foot Ankle Surg 2023; 62:825-831. [PMID: 37160201 DOI: 10.1053/j.jfas.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/07/2023] [Accepted: 04/29/2023] [Indexed: 05/11/2023]
Abstract
Hallux valgus surgery and open reduction of the lesser metatarsophalangeal joints with metatarsal shortening osteotomy help treat severe hallux valgus concomitant with the lesser metatarsophalangeal joint dislocation; however, pre- and postoperative plantar pressure distribution and its effect on the foot remain unclear. The pre- and postoperative groups comprised 16 patients with moderate-to-severe symptomatic hallux valgus with lesser metatarsophalangeal joint dislocation. All feet underwent open reduction and collateral ligament reconstruction of the second metatarsophalangeal joint and proximal metatarsal shortening osteotomy under the second metatarsal with proximal osteotomy of the first metatarsal. Twenty healthy participants (20 feet) were included in the control group. The plantar pressure distribution was determined by measuring the peak pressure, maximum force, contact area, and force-time integral for 12 regions. Under the second toe, all measurements in the preoperative group were significantly lower than those of the control group. The peak pressure, maximum force, and contact area of the postoperative group were significantly greater than those of the preoperative group. However, no differences were observed between the postoperative and control groups. Under the second metatarsal head, the peak pressure of the preoperative group was significantly higher than that of the control group. The peak pressure of the postoperative group was significantly lower than that of the preoperative group and showed no differences from the control group. Open reduction and collateral ligament reconstruction of the lesser metatarsophalangeal joints and proximal metatarsal shortening osteotomy with proximal osteotomy of the first metatarsal in hallux valgus with lesser metatarsophalangeal joints dislocation cases may improve operative outcomes, including favorable foot function.
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Affiliation(s)
- Yoshihiro Hirai
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan.
| | - Hiroaki Shima
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Kosho Togei
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Toshito Yasuda
- Department of Faculty of Nursing, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
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Okuda R, Yoshimura Y, Shima H. Prevalence and radiological characteristics of the dislocation of the second metatarsophalangeal joint in patients undergoing hallux valgus surgery; a matched control study. J Orthop Sci 2022:S0949-2658(22)00168-3. [PMID: 35803857 DOI: 10.1016/j.jos.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/19/2022] [Accepted: 06/14/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Hallux valgus (HV) is occasionally associated with chronic subluxation or dislocation (CS/D) of the second metatarsophalangeal joint (2MTPj). The present study aimed to radiographically investigate the prevalence and characteristics of HV with CS/D of the 2MTPj compared with matched controls. METHODS Dorsoplantar and lateral weight-bearing radiographs of 79 female patients (79 feet) who had HV with an age of 50 years or more were reviewed. All feet were treated with a proximal supination osteotomy for correction of HV. CS/D of the 2MTPj was evaluated on preoperative dorsoplantar and lateral radiographs. HV and intermetatarsal (IM) angles were measured. Seventy-nine feet were divided into two groups: Group CD (16 feet) had HV with CS/D of the 2MTPj, and Group non-CD had HV without the CS/D of the 2MTPj (63 feet). The severity of HV was divided into two grades according to the HV angle: moderate deformity (Group M, 36 feet, HV angle of less than 40°) and severe deformity (Group S, 43 feet, HV angle of 40° or greater). Group CD and non-CD, and Group M and S were matched by age, gender, and BMI. RESULTS The prevalence of CS/D of the 2MTPj was 20.3%. Group CD had a significantly higher HV angle (p = 0.0001) and a significantly higher IM angle (p = 0.042) than Group non-CD. The prevalence of CS/D of the 2MTPj in Group S (34.9%) were significantly higher than that in Group M (2.8%) (p < 0.001). CONCLUSIONS CS/D of the 2MTPj was significantly associated with greater HV and IM angles compared with matched controls. The prevalence of CS/D of the 2MTPj (34.9%) in Group S was significantly higher than that in Group M. Severe HV can be at higher risk of acquiring CS/D of the 2MTPj in middle-aged and older females.
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Affiliation(s)
- Ryuzo Okuda
- Department of Orthopaedic Surgery, Rakusai-Shimizu Hospital, 13-107 Oe Kutsukake-cho, Nishikyo-ku, Kyoto, 610-1106, Japan.
| | - Yukiko Yoshimura
- Department of Orthopaedic Surgery, Rakusai-Shimizu Hospital, 13-107 Oe Kutsukake-cho, Nishikyo-ku, Kyoto, 610-1106, Japan.
| | - Hiroaki Shima
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-0801, Japan.
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Ito E, Shima H, Togei K, Hirai Y, Tsujinaka S, Yasuda T, Neo M. Dislocations of the second and third metatarsophalangeal joints after local steroid injection in patients with refractory metatarsalgia: A case report. SAGE Open Med Case Rep 2021; 9:2050313X211046744. [PMID: 34552753 PMCID: PMC8450979 DOI: 10.1177/2050313x211046744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022] Open
Abstract
Local steroid injections are frequently administered to patients with refractory metatarsalgia. No reports have described dislocation of the second and third metatarsophalangeal joints after local steroid injections. A 46-year-old woman had suffered from metatarsalgia and received multiple local steroid injections for over 2 years. The second and third metatarsophalangeal joints revealed dorsal dislocations on the lateral radiograph. Therefore, collateral ligament reconstruction of the metatarsophalangeal joints was performed. Intraoperative findings suggested that the rupture of the plantar plate may have caused dorsal dislocation of both joints. Thus, unnecessary multiple steroid injections around the lesser metatarsophalangeal joint should be avoided.
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Affiliation(s)
- Eichi Ito
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Hiroaki Shima
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Kosho Togei
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yoshihiro Hirai
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Seiya Tsujinaka
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Toshito Yasuda
- Department of Nursing, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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Togei K, Shima H, Yasuda T, Tsujinaka S, Nakamura G, Neo M. Plantar pressure distribution in hallux valgus feet after a first metatarsal proximal crescentic osteotomy with a lesser metatarsal proximal shortening osteotomy. Foot Ankle Surg 2021; 27:665-672. [PMID: 32917524 DOI: 10.1016/j.fas.2020.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/12/2020] [Accepted: 08/26/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Plantar pressure distribution after the first metatarsal proximal crescentic osteotomy (FMPCO) with lesser metatarsal proximal shortening osteotomy (LMPSO) for hallux valgus with metatarsalgia has not been previously described. METHODS The pre- (Pre) and postoperative (Post) groups comprised of 18 patients who underwent unilateral FMPCO with LMPSO; fifteen healthy volunteers constituted the control (C) group. For each of the 10 regions, peak pressure (Peak-P), maximum force (Max-F), contact time (Con-T), contact area (Con-A), and force-time integral (FTI) were measured. RESULTS The mean Peak-P of the second metatarsal head was significantly lower in the Post group than the Pre group. The mean Peak-P, Max-F, Con-T, and FTI were not significantly different between the Post and C groups. The mean Con-A was significantly lower in the Post group than the C group. CONCLUSION FMPCO with LMPSO may improve the plantar pressure of the central forefoot comparable to healthy subjects.
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Affiliation(s)
- Kosho Togei
- Department of Orthopedic Surgery, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Hiroaki Shima
- Department of Orthopedic Surgery, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Toshito Yasuda
- Department of Orthopedic Surgery, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Seiya Tsujinaka
- Department of Orthopedic Surgery, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Gen Nakamura
- Department of Orthopedic Surgery, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
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Yang TC, Tzeng YH, Wang CS, Chang MC, Chiang CC. Distal Metatarsal Segmental Shortening for the Treatment of Chronic Metatarsophalangeal Dislocation of Lesser Toes. Foot Ankle Int 2021; 42:183-191. [PMID: 33138646 DOI: 10.1177/1071100720961086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This retrospective study aimed to describe the techniques and results of distal metatarsal segmental shortening (DMSS) for the treatment of chronic irreducible metatarsophalangeal (MTP) dislocation of lesser toes. METHODS We retrospectively reviewed patients who underwent DMSS for chronic dislocation of MTP joints of lesser toes between January 2010 and December 2017 with follow-up of at least 24 months. Demographic data, radiographic measurements, functional outcomes, and complications were analyzed. Furthermore, the results of patients with short segment of shortening (group I, <10 mm) were compared to those with long segment of shortening (group II, ≥10 mm). A total of 43 MTP joints of 30 patients with an average age of 70.4 years were included. RESULTS Union was observed in 42 metatarsals (97.7%). Mean American Orthopaedic Foot & Ankle Society scale scores improved significantly from 42.2 (range, 15-65) preoperatively to 79.1 (range, 52-90) (P < .001). Mean visual analog scale pain score improved significantly from 5.0 (range, 1-9) preoperatively to 1.8 (range, 0-6) (P < .001). Complications included 1 nonunion, 1 osteonecrosis, 3 metatarsal angulation, 4 recurrent instability, 4 symptomatic osteoarthritis, 3 transfer metatarsalgia, and 1 floating toe. Group I included 23 MTP joints and group II included 20 MTP joints. There was no significant difference in clinical outcomes and complications between the 2 groups. CONCLUSION DMSS was a reliable procedure for the treatment of chronic irreducible dislocated MTP joint of lesser toes. It provided satisfactory surgical outcomes and a low rate of postoperative complications, regardless of length of metatarsal shortening. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Tzu-Cheng Yang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei,Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei,Taiwan
| | - Yun-Hsuan Tzeng
- Division of Medical Imaging for Health Management, Cheng-Hsin General Hospital, Taipei,Taiwan.,Department of Radiology, School of Medicine, National Yang-Ming University, Taipei,Taiwan
| | - Chien-Shun Wang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei,Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei,Taiwan
| | - Ming-Chau Chang
- Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei,Taiwan.,Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei,Taiwan
| | - Chao-Ching Chiang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei,Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei,Taiwan
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Shima H, Okuda R, Yasuda T, Mori K, Kizawa M, Tsujinaka S, Neo M. Operative Treatment for Hallux Valgus With Moderate to Severe Metatarsus Adductus. Foot Ankle Int 2019; 40:641-647. [PMID: 30845841 DOI: 10.1177/1071100719835520] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Operative treatment is indicated for patients who have symptomatic hallux valgus (HV) with moderate to severe metatarsus adductus (MA). However, there is limited information available on the operative procedures and outcomes for the treatment of HV with MA. We aimed to investigate the average 10-year follow-up clinical and radiologic outcomes. METHODS Seventeen patients (21 feet, average age: 60.1 years) with symptomatic HV with moderate to severe MA were operatively treated. Mean postoperative follow-up duration was 114.4 (24-246) months. All feet had metatarsus adductus angle ≥20 degrees on dorsoplantar weight-bearing radiograph. The procedure included a proximal crescentic osteotomy of the first metatarsal and abduction osteotomy of the proximal third of the second and third metatarsals. RESULTS The mean American Orthopaedic Foot & Ankle Society scale score improved significantly postoperatively ( P < .001). The mean postoperative visual analog scale score (17 feet) was 2.0 (0-6). Preoperative metatarsalgia was severe in 2 feet, moderate in 17, and mild in 2. At the most recent follow-up evaluation, 11 feet had no pain, 9 had mild pain, and 1 had moderate pain. The mean hallux valgus angle, intermetatarsal angle, and metatarsus adductus angle significantly decreased postoperatively ( P < .001 for all). Recurrence of HV (HV angle ≥ 20 degrees) was observed in 4 feet. CONCLUSION The clinical and radiologic results indicated that our novel operative treatment for HV with moderate to severe MA can achieve significant correction of HV with MA deformities and significant improvement in pain and function. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Hiroaki Shima
- 1 Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Ryuzo Okuda
- 2 Department of Orthopaedic Surgery, Shimizu Hospital, Nishikyo-ku, Kyoto, Japan
| | - Toshito Yasuda
- 1 Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Katsunori Mori
- 1 Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Momoko Kizawa
- 1 Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Seiya Tsujinaka
- 1 Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Masashi Neo
- 1 Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
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Abstract
The anatomy of the lesser toes is highly complicated and not yet well understood. The high propensity of the metatarsophalangeal joint to develop hyperextension deformity should be recognized. Surgeons should provide each patient with a realistic expectation for lesser toe reconstructive procedures. A successful surgical result requires a well-planned procedure, accurate execution using proper techniques, and meticulous postoperative care. When complications occur, surgeons should identify culprits so that proper treatment strategies can be successfully executed. This article discusses a wide array of tactics to manage common complications in lesser toe surgery.
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