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Nishikawa DRC, Duarte FA, Saito GH, de Miranda BR, de Araújo LM, Fonseca FCP, Mendes AAM, Prado MP. A comparative analysis of clinical, functional and radiographic outcomes of patients with and without fusion between the first and second metatarsals after the lapidus procedure. Foot Ankle Surg 2023; 29:481-487. [PMID: 37407353 DOI: 10.1016/j.fas.2023.06.004] [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: 03/25/2023] [Revised: 05/11/2023] [Accepted: 06/12/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The aim of this study was to compare the clinical, functional and radiographic outcomes in patients who underwent the original Lapidus procedure (OLP) with fusion and undesired non-fusion between the first (M1) and second (M2) metatarsals. METHODS A retrospective and comparative analysis of 29 patients (38 feet) who underwent the OLP was performed. They were divided in two groups: (1) 23 feet in which fusion occurred and (2) 15 with undesired non-fusion. Clinical and functional data were assessed with the VAS for pain, AOFAS, LEFS and SF-12. SF-12 comprises physical and mental health scales (PCS-12 and MCS-12). Radiographic parameters assessed were bony and soft tissue forefoot widths (BSFW), intermetatarsal-angle (IMA) and HV-angle (HVA). RESULTS Separately, the groups presented significant improvements in all questionnaires (p < 0.001), except on MCS-12 (fusion p = 0.08 and non-fusion p = 0.27). When comparing both groups, patients with fusion had higher AOFAS scores (p < 0.05). Both groups presented the same improvements on BSFW, IMA and HVA (p = 0.09, p = 0.16, p = 0.52 and p = 0.63). CONCLUSION Excellent results were observed, even when without fusion between M1 and M2. Patients who evolved with fusion between the M1 and M2 showed greater improvements in the AOFAS score. LEVEL OF EVIDENCE III, retrospective comparative study.
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Affiliation(s)
- Danilo Ryuko Cândido Nishikawa
- Department of Orthopaedics, Hospital do Servidor Público Municipal de São Paulo (HSPM), 60, Castro Alves Street, Aclimação, CEP: 01532-000 São Paulo, SP, Brazil; Department of Orthopaedic Surgery, Clínica de Ortopedia e Traumatologia Ortocity, 526, Brigadeiro Gavião Peixoto Street, Lapa, CEP: 05078-000 São Paulo, SP, Brazil; Department of Orthopaedic Surgery, Hospital Alemão Oswaldo Cruz, 94, São Joaquim Street, Liberdade, CEP: 01508-000 São Paulo, SP, Brazil.
| | - Fernando Aires Duarte
- Department of Orthopaedic Surgery, Clínica de Ortopedia e Traumatologia Ortocity, 526, Brigadeiro Gavião Peixoto Street, Lapa, CEP: 05078-000 São Paulo, SP, Brazil
| | - Guilherme Honda Saito
- Department of Orthopaedic Surgery, Hospital Sírio-Libanês, 91, Dona Adma Jafet Street, Bela Vista, CEP: 01308-050 São Paulo, SP, Brazil
| | - Bruno Rodrigues de Miranda
- Department of Orthopaedics, Hospital do Servidor Público Municipal de São Paulo (HSPM), 60, Castro Alves Street, Aclimação, CEP: 01532-000 São Paulo, SP, Brazil
| | - Leonardo Mendes de Araújo
- Department of Orthopaedics, Hospital do Servidor Público Municipal de São Paulo (HSPM), 60, Castro Alves Street, Aclimação, CEP: 01532-000 São Paulo, SP, Brazil
| | - Fábio Correa Paiva Fonseca
- Department of Orthopaedics, Hospital do Servidor Público Municipal de São Paulo (HSPM), 60, Castro Alves Street, Aclimação, CEP: 01532-000 São Paulo, SP, Brazil
| | - Alberto Abussamra Moreira Mendes
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, CEP: 05652-900 São Paulo, SP, Brazil
| | - Marcelo Pires Prado
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, CEP: 05652-900 São Paulo, SP, Brazil
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Abstract
The interaction between hypermobility and hallux valgus remains both contemporary and incendiary. The difficulty in setting clinical and radiological parameters to diagnose and the complexity of questions that circumnutate the philosophy among etiology and denouement, fires up the debate regarding these conditions. Outcomes among procedures that address or neglect ray instability are still used as argument for any group of believers or nonbelievers. Through proving the true existence of hypermobility and its relationship with bunions, our colleges and professors have produced an incredible amount of excellent data that helped us better comprehend the hallux valgus syndrome in a general manner.
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Affiliation(s)
- Nacime Salomão Barbachan Mansur
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Sao Paulo Federal University, 715 Napoleao de Barros Street-1st Floor, Vila Clementino, São Paulo, São Paulo 04038002, Brazil.
| | - Caio Augusto de Souza Nery
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Sao Paulo Federal University, 715 Napoleao de Barros Street-1st Floor, Vila Clementino, São Paulo, São Paulo 04038002, Brazil
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Wagner E, Ortiz C, Torres K, Contesse I, Vela O, Zanolli D. Cost effectiveness of different techniques in hallux valgus surgery. Foot Ankle Surg 2016; 22:259-264. [PMID: 27810025 DOI: 10.1016/j.fas.2015.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/12/2015] [Accepted: 11/07/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Different surgical techniques are available to correct each type of Hallux Valgus (HV) deformity, and all present similar good results. No information is available relative to the cost of each technique compared to their individual success. OBJECTIVE To determine the cost-effectiveness-ratio (CER) of five different techniques for HV. METHODS We included 245HV surgeries performed in 179 patients. The severity was defined according to radiological parameters. For mild to moderate HV we included the Chevron, Modified-Scarf and Ludloff techniques; for severe HV: either Poscow-osteotomy or Lapidus-arthrodesis fixed with plates or screws. Weighted costs were estimated. CER was expressed in $US dollars per AOFAS-point. RESULTS The lowest weighted cost was observed for the Chevron-group, and the highest weighted cost was observed in the Poscow-osteotomy and Lapidus-arthrodesis fixed with plate groups. The AOFAS-score improvement was higher in the Chevron and Modified-Scarf groups. The CER found for Chevron and Modified-Scarf techniques were significantly less than for Poscow and Lapidus-techniques. CONCLUSION Cost-Effectiveness-Ratio was lower, and therefore better, in the groups with mild to moderate deformities operated with Chevron or Modified-Scarf techniques. In severe HV, the three techniques investigated presented similar CER. CER analysis is an additional factor that can be included in the decision making analysis in hallux valgus surgery. Level of Evidence Level IV, Retrospective Study.
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Affiliation(s)
- Emilio Wagner
- Clínica Alemana-Universidad del Desarrollo, Foot and Ankle Surgeon, Chile
| | - Cristian Ortiz
- Clínica Alemana-Universidad del Desarrollo, Foot and Ankle Surgeon, Chile
| | | | | | - Omar Vela
- Traumatology and Orthopedic Surgeon, Chile
| | - Diego Zanolli
- Clínica Alemana-Universidad del Desarrollo, Foot and Ankle Surgeon, Chile.
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Espinosa N, Maurer MA. Stage I and II Posterior Tibial Tendon Dysfunction: Return to Running? Clin Sports Med 2015; 34:761-8. [PMID: 26409594 DOI: 10.1016/j.csm.2015.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Posterior tibial tendon dysfunction can be a difficult entity to treat in the athletic population. Understanding the deformity components allows the physician to maximize nonoperative intervention with orthotics and physical therapy. Not all patients improve with nonoperative treatment, and surgical intervention can be successful in minimizing symptoms. Although return to full athletic activity is not universally possible, an active lifestyle is possible for many after surgical reconstruction.
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Affiliation(s)
- Norman Espinosa
- Institute for Foot and Ankle Reconstruction Zurich, Kappelistrasse 7, Zurich 8002, Switzerland.
| | - Marc A Maurer
- Institute for Foot and Ankle Reconstruction Zurich, Kappelistrasse 7, Zurich 8002, Switzerland
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