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Nair A, Bence M, Saleem J, Yousaf A, Al-Hilfi L, Kunasingam K. A Systematic Review of Open and Minimally Invasive Surgery for Treating Recurrent Hallux Valgus. Surg J (N Y) 2022; 8:e350-e356. [PMID: 36568477 PMCID: PMC9771687 DOI: 10.1055/s-0042-1759812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 11/10/2022] [Indexed: 12/24/2022] Open
Abstract
Background Despite advancements in primary correction of hallux valgus (HV), significant rates of reoperation remain across common techniques, with complications following primary correction up to 50% according to some studies. 1 This study explored different methods of surgery currently used in treating HV recurrence specifically (for which literature on the subject has been limited), evaluating open and adapted minimally invasive surgical (MIS) primary techniques used for revision. Methods In December 2020, literature search for both open and MIS surgical techniques in HV revision was conducted using PubMed, EMBASE, and MEDLINE library databases. Results and Conclusion Of initial 143 publications, 10 were finally included for data synthesis including 273 patients and 301 feet. Out of 301 feet, 80 (26.6%) underwent revision with MIS techniques (involving distal metatarsal osteotomies). Those undergoing grouped MIS revisions had an average improvement of 38.3 in their American Orthopaedic Foot and Ankle Society score, compared to 26.8 in those using open techniques. Revision approaches using grouped MIS techniques showed a postoperative reduction in intermetatarsal angle and HV angle of 5.6 and 18.4 degrees, respectively, compared to 15.5 and 4.4 degrees, respectively, for open techniques. There are, however, limitations in the current literature on MIS techniques in revision HV surgery specifically. MIS techniques grouped did not show worse outcomes or safety concerns compared to open techniques.
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Affiliation(s)
- Arun Nair
- Department of Trauma & Orthopaedics, Croydon University Hospital, Croydon, United Kingdom,Address for correspondence Arun Nair, MBCHB Department of Trauma & Orthopaedics, Croydon University Hospital530 London Road, Thornton Heath, Croydon, CR7 7YEUnited Kingdom
| | - Matthew Bence
- Department of Trauma & Orthopaedics, Croydon University Hospital, Croydon, United Kingdom
| | - Jawaad Saleem
- Department of Trauma & Orthopaedics, Croydon University Hospital, Croydon, United Kingdom
| | - Azka Yousaf
- Department of Trauma & Orthopaedics, Croydon University Hospital, Croydon, United Kingdom
| | - Lena Al-Hilfi
- Department of Trauma & Orthopaedics, Croydon University Hospital, Croydon, United Kingdom
| | - Kumar Kunasingam
- Department of Trauma & Orthopaedics, Croydon University Hospital, Croydon, United Kingdom
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Li Y, Wang Y, Tang K, Tao X. Modified scarf osteotomy for hallux valgus: From a finite element model to clinical results. J Orthop Surg (Hong Kong) 2022; 30:10225536221143816. [PMID: 36459594 DOI: 10.1177/10225536221143816] [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] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Finite element (FE) analysis and clinical follow-up were used to evaluate the efficacy of modified scarf osteotomy for moderate-to-severe hallux valgus (HV). METHOD We retrospectively evaluated 42 patients (44 feet) who underwent modified rotational scarf osteotomy for moderate-to-severe HV at our institution between January 2010 and January 2019. Radiological indicators and subjective scores were recorded at different time points. To compare the results and elemental characteristics, a FE model of the metatarsophalangeal (MTP) joint that included anatomically realistic geometrical and structural characteristics was built. The biomechanical features and correction differences in dynamic loads as well as the incidence of troughing were estimated. RESULTS Both the hallux valgus angle (HVA) and intermetatarsal angle (IMA) showed significant improvement 6 weeks postoperatively (p < 0.05); additionally, the HVA increased from 6 weeks postoperatively to the last follow-up, while the IMA showed no significant changes (p > 0.05). The subjective scores significantly improved from the preoperative period to the last follow-up. The percentages of troughing and recurrence were remarkably low in our pilot study because of the innate stability of the modified rotated fixation. CONCLUSION Our preliminary findings suggest that modified rotational scarf osteotomy offers sufficient stability, correct HV deformity effectively, and good clinical outcomes for moderate to severe HV.
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Affiliation(s)
- Yan Li
- Department of Orthopaedics, Sports Medicine Center, 12525The First Affiliated Hospital of Army Military Medical University, Chongqing, China
| | - Yue Wang
- College of Physical Education and Health, 12524Chongqing Normal University, Chongqing, China
| | - Kanglai Tang
- Department of Orthopaedics, Sports Medicine Center, 12525The First Affiliated Hospital of Army Military Medical University, Chongqing, China
| | - Xu Tao
- Department of Orthopaedics, Sports Medicine Center, 12525The First Affiliated Hospital of Army Military Medical University, Chongqing, China
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Lee JY, Tay KS, Tan JHI, Abdul Kadir HB, Koo K, Yeo N. Hallux valgus with second metatarsalgia: Is second metatarsal Weil osteotomy necessary? Foot Ankle Surg 2022; 28:1433-1439. [PMID: 35995690 DOI: 10.1016/j.fas.2022.08.001] [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: 04/25/2022] [Revised: 07/20/2022] [Accepted: 08/02/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The role of concomitant Weil osteotomy to address second toe metatarsalgia during hallux valgus correction is unclear. We aimed to critically analyse outcomes of an additional Weil osteotomy versus isolated Scarf osteotomy.in the management of hallux valgus and second metatarsalgia. METHODS Patients with second toe metatarsalgia who underwent first metatarsal Scarf osteotomy for hallux valgus were enrolled retrospectively. Demographics, radiographic measurements and functional outcomes were assessed at baseline, 6-months and 2-years postoperatively. Between-group significance was established with Fisher exact test, Chi-square or Mann-Whitney U test. Within-group changes from baseline were assessed with paired t-test and Wilcoxon signed-rank test. RESULTS 48 feet (34 isolated Scarf, 14 concomitant Weil osteotomy) were included. Both cohorts demonstrated significant improvements across all measures of functional outcome. However, patients with additional Weil osteotomy reported poorer short-term outcomes. CONCLUSION Superiority of additional Weil osteotomy versus isolated Scarf osteotomy in addressing second toe metatarsalgia or improving functional outcomes was not demonstrated.
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Affiliation(s)
- Jia Ying Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Rd, 169608, Singapore
| | - Kae Sian Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Rd, 169608, Singapore.
| | - Joelle Hwee Inn Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore
| | | | - Kevin Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Rd, 169608, Singapore
| | - Nicholas Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Rd, 169608, Singapore; Consultant, Head of Foot and Ankle Service, Singapore
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Jiao X, Gan Y, Li Y, Xu C, Wang Z, Sun X, Shi D, Zhao J, Dai K. Outcomes of V-cut Osteotomy on the First Metatarsal Head Combined with Fixation in Mortise-shaped Bone Groove-Plasty and Akin Osteotomy on the First Toe for Hallux Valgus Correction. Orthop Surg 2022; 14:3070-3077. [PMID: 36178077 PMCID: PMC9627060 DOI: 10.1111/os.13528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/26/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Hallux valgus (HV) is a common foot deformity, and recurrence is one of the most serious complications after HV correction. As a result, the surgical technique with a lower recurrence rate is a dream. The purpose of the article should be to observe the correction effect of hallux valgus using a novel “V‐cut” osteotomy on the first metatarsal head combined with fixation in mortise‐shaped bone groove‐plasty technique. Methods Twenty‐three consecutive patients (40 feet) with HV were included from March 2019 to May 2020, who were all treated using single screw fixation with V‐cut osteotomy on the first metatarsal head combined with mortise‐shaped metatarsal bone groove‐plasty and Akin osteotomy on the first toe for hallux valgus correction. With a mean follow‐up time of 21.7 months, the visual analogue scale (VAS) score and American Orthopedic Foot and Ankle Society (AOFAS) forefoot score and the changes of the hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA) were evaluated during the clinical follow‐up. The paired t test was used for analytical statistics. Results The VAS score improved from 6.78 ± 1.74 to 1.87 ± 1.45 and the AOFAS score improved from 53.9 ± 12.3 preoperatively to 94.7 ± 6.8 in the latest follow‐up postoperatively (P < 0.01). Besides, the HVA improved from 30.0 ± 6.1° to 5.7 ± 2.8° (P < 0.01); the IMA changed from 13.1 ± 2.8° into 3.3 ± 1.6° (P < 0.01); and the DMAA ameliorated from 27.0 ± 8.4° to 5.9 ± 3.5° (P < 0.01). Only five toes had slight numbness and stiffness in early postoperative period, and these symptoms disappeared completely at 6 months after the surgery. Only one foot was corrected to excess. One screw stern protruding beneath the skin happened, which needed secondary screw removal under local anesthesia. Conclusions Single screw fixation with V‐cut osteotomy on the first metatarsal head combined with fixation in mortise‐shaped metatarsal bone groove‐plasty and Akin osteotomy on the first toe is an effective way with low recurrence rate for HV correction.
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Affiliation(s)
- Xin Jiao
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yaokai Gan
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yiming Li
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Chen Xu
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Zengguang Wang
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xin Sun
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Dingwei Shi
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jie Zhao
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Kerong Dai
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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Chong XL, Drittenbass L, Dubois-Ferriere V, Assal M. Iatrogenic transfer metatarsalgia after hallux valgus surgery: a comprehensive treatment algorithm. EFORT Open Rev 2022; 7:618-627. [PMID: 36125013 PMCID: PMC9624479 DOI: 10.1530/eor-22-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Current literature has described many of the complications following hallux valgus surgery and their treatment options. Iatrogenic transfer metatarsalgia is a distinctive and challenging complication that has not been addressed in a comprehensive fashion yet. Iatrogenic transfer metatarsalgia may result from poor preoperative assessment, planning and/or surgical technique. We have classified the causes of iatrogenic transfer metatarsalgia based on a multiplanar assessment of the malalignment(s) and are recommending a comprehensive treatment algorithm to guide surgeons in addressing this complication. With this knowledge, surgeons may avoid potential pitfalls in the primary surgery that can result in iatrogenic transfer metatarsalgia and find the appropriate treatment option to correct them.
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Affiliation(s)
- Xue Ling Chong
- Centre Assal SA, Foot and Ankle Surgery Centre, La Colline, Geneva, Switzerland
| | - Lisca Drittenbass
- Centre Assal SA, Foot and Ankle Surgery Centre, La Colline, Geneva, Switzerland
| | | | - Mathieu Assal
- Centre Assal SA, Foot and Ankle Surgery Centre, La Colline, Geneva, Switzerland
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Rougereau G, Marty-Diloy T, Rougereau G, Boisrenoult P, Langlais T. Litigation after hallux valgus surgery in France between 2000 and 2020: A review of the two national legal research databases. Foot Ankle Surg 2022; 28:497-502. [PMID: 35063363 DOI: 10.1016/j.fas.2022.01.004] [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: 04/20/2021] [Revised: 06/18/2021] [Accepted: 01/10/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The objectives of this review were to: 1) describe reasons for lawsuits following primary hallux valgus surgery in France from 2000 to 2020; 2) to compare private and public practice. METHODS Civil (private practice) and administrative (public practice) court decisions in France between 2000 and 2020 were collected using the two leading legal data sources (Legifrance, Doctrine). RESULTS Seventy-two court decisions related to hallux valgus surgery were included. An appeal was filed in 93% of cases. Finally, 70.8% of the verdicts were in favor of the complainants. The average compensation awarded to a plaintiff was €55,333. The main reasons for complaint after hallux valgus surgery were: a failure to provide preoperative information (47.2%), post-operative pain/stiffness (38.9%), and infection (30.6%). A proven lack of information increased the risk of recognizing the occurrence of post-operative pain and stiffness as faulty from 13.3% to 61.5% (p = 0.01), and the average compensation from €25,330 to €76,716 (p = 0.04). The duration of the procedure was about 1.5 years longer in civil proceedings (p = 0.04). There was no significant difference between private and public activity litigation. CONCLUSION Clear and adapted patient information and its traceability could be a way to reduce the number of complaints and their consequences in case of disappointing results.
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Affiliation(s)
- Grégoire Rougereau
- Department of Orthopedics and Traumatology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
| | - Thibault Marty-Diloy
- Department of Orthopedic and Trauma Surgery, University Hospital Center, 2 Rue de la Milétrie, 86021 Poitiers, France
| | - Guillaume Rougereau
- Department of Orthopedic Surgery, Clinique du Trocadéro, 62 Rue de la Tour, 75116 Paris, France
| | - Philippe Boisrenoult
- Department of Orthopedic and Trauma Surgery, André Mignot Hospital, University Île-de-France Ouest, 177 Rue de Versailles, 78150 Le Chesnay, France
| | - Tristan Langlais
- Department of Orthopedics Pediatrics, Children Hospital Purpan, Toulouse University, Toulouse, France
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Rouveyrol M, Harrosch S, Curvale G, Rochwerger A, Mattei JC. Does screwless scarf osteotomy for hallux valgus increase the risk of transfer metatarsalgia? Orthop Traumatol Surg Res 2021; 107:102853. [PMID: 33578039 DOI: 10.1016/j.otsr.2021.102853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 06/08/2020] [Accepted: 07/01/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The scarf osteotomy is a reliable surgical technique for treating hallux valgus. The aim of our study was to analyze the occurrence of transfer metatarsalgia after surgery on the first ray using a screwless Scarf osteotomy technique that we have been using in our department since 1995, which consists of stabilization by axial impaction without internal fixation. We hypothesized that the alleged shortening of the first metatarsal produced by this technique may be at the origin of postoperative metatarsalgia. PATIENTS AND METHODS This was a case series of first ray metatarsal screwless Scarf osteotomies reviewed in the medium term. We did a clinical and radiological review of all patients operated using this technique between 2012 and 2017 who did not meet the following exclusion criteria: procedure on the other lateral metatarsals, concurrent hindfoot pathology, incomplete medical records. RESULTS Of 114 feet, 96 were included in the study and 18 were excluded. The mean follow-up was 1 year and 8 months [1-4years]. The mean AOFAS score was 90.3 and 96% of patients were either satisfied or very satisfied with the outcome. All the parameters improved significantly: shoe wearing, pain, function, alignment. Fourteen feet had transfer metatarsalgia, which appeared during the first year postoperative (AOFAS 75/100). Ten other complications occurred: two Morton's neuromas, three cases of complex regional pain syndrome, one superficial infection, one paresthesia, two recurrences with surgical revision, one nonunion. No general complications were found. Based on radiographs, the mean M1 shortening was 3.3mm (6.3mm in metatarsalgia group versus 3.0 mm in the non-metatarsalgia group, P=0.2) and the mean angular correction was 16.2° (±6°). DISCUSSION The overall results of screwless Scarf osteotomy are comparable and satisfactory, allowing large deformities to be corrected (28°±8° preoperatively in our cohort). M1 shortening and the transfer metatarsalgia rate appear to be higher than with other techniques. CONCLUSION Screwless scarf osteotomy of M1 yields good functional and radiological outcomes in the medium term. However, it appears to cause more shortening and transfer metatarsalgia. LEVEL OF EVIDENCE IV Retrospective, non-interventional in current practice (Recommendation grade C, low level of scientific proof).
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Affiliation(s)
| | - Sylvain Harrosch
- Assistance Publique des Hopitaux de Marseille, Marseille, France
| | - Georges Curvale
- Assistance Publique des Hopitaux de Marseille, Marseille, France
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Migliorini F, Eschweiler J, Tingart M, Maffulli N. Revision surgeries for failed hallux valgus correction: A systematic review. Surgeon 2021; 19:e497-e506. [PMID: 33423923 DOI: 10.1016/j.surge.2020.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/13/2020] [Accepted: 11/27/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Failure of hallux valgus (HV) correction is not uncommon, and its management can be challenging. The available literature is not exhaustive. Therefore, we conducted a systematic review to investigate the current evidence on the role of revision surgery for failed HV correction, including clinical presentation, indications, surgical strategies and outcomes. MATERIAL AND METHODS The present systematic review was performed according to the PRISMA guidelines. Pubmed, EMBASE, Google Scholar and Scopus online databases were accessed in November 2020. All the clinical studies on revision for failed HV correction were analysed, and only studies reporting quantitative data under the outcomes of interest were considered for inclusion. RESULTS Data from 20 studies (586 procedures) were retrieved. The HV angle, the intermetatarsal angle and the distal metatarsal articular angle were reduced of 17.8° (P < 0.001), 3.3° (P = 0.05) and 7.3° (P < 0.001) respectively. The American Orthopaedic Foot & Ankle Society score improved of 24.7% (P < 0.001). The visual analogue scale improved by 40.8% (P < 0.001). Dorsiflexion and plantar flexion of the first metatarso-phalangeal joint remained similar to their preoperative values (P = 0.2 and P = 0.4, respectively). After revision surgery the following complications were further detected: recurrences 5.1% (30 of 586 patients), non-unions 4.1% (24/586), additional surgical procedures 8.7% (51 of 586 patients). CONCLUSION Revision surgery for failed primary HV correction can yield satisfying results. Accurate preoperative planning is necessary to try and identify the causes of failure, and address them appropriately.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy; School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, UK; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, UK.
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Barik S, Farr S. Brachymetacarpia and brachymetatarsia: do we need to operate? EFORT Open Rev 2021; 6:15-23. [PMID: 33532083 PMCID: PMC7845563 DOI: 10.1302/2058-5241.6.200087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Brachymetacarpia and brachymetatarsia are rare congenital presentations denoted by shortening of metacarpals and metatarsals respectively, in which the deformity usually presents around childhood/early adolescence. The aetiology is usually congenital besides several other syndromic or endocrinologic associations. Cosmetic issues such as absence of a normal-looking knuckle while making a fist or disruption of finger-tip curvature besides functional issues are the main indications for surgical intervention in brachymetacarpia. In the foot, apart from cosmetic issues, pain due to transfer metatarsalgia as well as callosities along with toe deformities which lead to difficulty of using footwear are the main indications for intervention. Lengthening of the affected bone, either acute with grafting or gradual, is the mainstay of treatment. Gradual lengthening can be either single-stage as in callotasis, or two-stage where the primary procedure is followed by bone grafting after the length has been achieved. Adolescence, specifically between 12 and 15 years, is the preferred period for surgical intervention in these cases.
Cite this article: EFORT Open Rev 2021;6:15-23. DOI: 10.1302/2058-5241.6.200087
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Affiliation(s)
- Sitanshu Barik
- Pediatric Orthopedic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sebastian Farr
- Orthopedic Hospital Speising, Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Vienna, Austria
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Abstract
Complications following hallux valgus (HV) reconstruction will have an expected incidence of between 10% and 55% of cases. The more commonly reported complications include undercorrection/recurrence, overcorrection (hallux varus), transfer metatarsalgia, nonunion, malunion, avascular necrosis, arthritis, hardware removal, nerve injury, and ultimately patient dissatisfaction. The presence of arthritis will be an indication for fusion, whereas osteotomies will be the procedure of choice if the first metatarsophalangeal joint is healthy. Wide experience in primary HV surgery is advised before dealing with complex cases of failed HV surgery.
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Affiliation(s)
- Manuel Monteagudo
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quironsalud Madrid, Calle Diego de Velázquez 1, Madrid 28223, Spain; Faculty of Medicine, UEM Madrid, Madrid, Spain.
| | - Pilar Martínez-de-Albornoz
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quironsalud Madrid, Calle Diego de Velázquez 1, Madrid 28223, Spain; Faculty of Medicine, UEM Madrid, Madrid, Spain
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Magnan B, Negri S, Maluta T, Dall'Oca C, Samaila E. Minimally invasive distal first metatarsal osteotomy can be an option for recurrent hallux valgus. Foot Ankle Surg 2019; 25:332-339. [PMID: 29409172 DOI: 10.1016/j.fas.2017.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/29/2017] [Accepted: 12/29/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recurrence rate of surgical treatment of hallux valgus ranges in the literature from 2.7% to 16%, regardless of used procedure. In this study, long-term results of a minimally invasive distal osteotomy of the first metatarsal bone for treatment of recurrent hallux valgus are described. METHODS 32 consecutive percutaneous distal osteotomies of the first metatarsal were performed in 26 patients for treatment of recurrent hallux valgus. Primary surgery had been soft tissue procedures in 8 cases (25%), first metatarsal or phalangeal osteotomies in 19 cases (59.4%) and Keller procedures in 5 cases (15.6%). RESULTS Patients were assessed with a mean follow-up of 9.8±4.3 years. All patients reported the disappearance or reduction of the pain. The mean overall AOFAS score improved from 46.9±17.8 points to 85.2±14.9 at final follow-up. The mean hallux valgus angle decreased from 26.1±9.1 to 9.7±5.4°, the intermetatarsal angle decreased from 11.5±4.5 to 6.7±4.0°. No major complications were recorded with a re-recurrence rate of 3.1% (1 case). CONCLUSIONS Percutaneous distal osteotomy of the first metatarsal can be a reliable and safe surgical option in the recurrent hallux valgus with low complication rate and the advantages of a minimally invasive surgery. LEVELS OF EVIDENCE IV, Retrospective Case Series.
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Affiliation(s)
- Bruno Magnan
- Department of Orthopaedics and Trauma Surgery, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Italy.
| | - Stefano Negri
- Department of Orthopaedics and Trauma Surgery, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Italy
| | - Tommaso Maluta
- Department of Orthopaedics and Trauma Surgery, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Italy
| | - Carlo Dall'Oca
- Department of Orthopaedics and Trauma Surgery, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Italy
| | - Elena Samaila
- Department of Orthopaedics and Trauma Surgery, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Italy
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Malatray M, Fessy MH, Besse JL. Comparison of screw versus locked plate fixation for Scarf osteotomy treatment of hallux valgus. Orthop Traumatol Surg Res 2018; 104:725-731. [PMID: 29933121 DOI: 10.1016/j.otsr.2018.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/28/2018] [Accepted: 04/05/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Scarf osteotomy is a commonly used surgical procedure for treating hallux valgus in Europe. Screw fixation is standard practice, although some surgeons now go without internal fixation. Plate fixation is still being studied. The aim of this study was to compare the radiological outcomes of these fixation methods, which has not been performed up to now. HYPOTHESIS Relative to screw fixation, plate fixation of a Scarf osteotomy of the first metatarsal (M1) prevents secondary impaction, without increasing the complication rate or recurrence rate. MATERIALS AND METHODS A retrospective study was performed of two internal fixation methods for Scarf osteotomy (screw vs. plate), by analyzing the secondary impaction of the first metatarsal, recurrence of the hallux valgus (angle M1P1>20) on X-rays, incidence of complications and potential discomfort related to the hardware. The osteotomy procedure was the same in both groups: 50patients were included consecutively in each fixation group between February 2014 and November 2015. RESULTS The mean follow-up was 13.0±2.7months in the screw group and 12.3±1.1 months in the plate group. There were no severe complications, although four cases of delayed wound healing occurred (3in plate group, 1in screw group). In the screw group, there was one case of secondary impaction, two cases of recurrence (4%) and one case of discomfort. In the plate group, there were no cases of impaction, three recurrences (6%) and five cases of discomfort, leading to plate removal in three of these cases. DISCUSSION There was no significant difference between groups in the M1 secondary impaction rate or recurrence rate: screw fixation did not lead to a higher recurrence rate. Systematic fixation with a locked plate for Scarf osteotomy had no advantages over screw fixation in our study. LEVEL OF EVIDENCE II, Comparative study with continuous cohorts.
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Affiliation(s)
- Matthieu Malatray
- Service de chirurgie orthopédique et traumatologique, hospices civils de Lyon, centre hospitalier Lyon-Sud, 69495 Pierre-Bénite, France.
| | - Michel Henri Fessy
- Service de chirurgie orthopédique et traumatologique, hospices civils de Lyon, centre hospitalier Lyon-Sud, 69495 Pierre-Bénite, France; Laboratoire de biomécanique et mécanique des chocs, université Lyon 1, Ifsttar, Lbmc UMR T9406, 69675 Bron, France
| | - Jean-Luc Besse
- Service de chirurgie orthopédique et traumatologique, hospices civils de Lyon, centre hospitalier Lyon-Sud, 69495 Pierre-Bénite, France; Laboratoire de biomécanique et mécanique des chocs, université Lyon 1, Ifsttar, Lbmc UMR T9406, 69675 Bron, France
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Chowdhary A, Drittenbass L, Stern R, Assal M. Technique tip: Simultaneous first metatarsal lengthening and metatarsophalangeal joint fusion for failed hallux valgus surgery with transfer metatarsalgia. Foot Ankle Surg 2017; 23:e8-e11. [PMID: 28159053 DOI: 10.1016/j.fas.2015.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/20/2015] [Accepted: 12/16/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Failed hallux valgus surgery may result in residual or recurrent hallux valgus, and as well transfer metatarsalgia. The present technical tip concerns the combination of fusion of the first metatarsophalangeal (MTP) joint and lengthening of the first metatarsal (MT) through a scarf osteotomy. MATERIALS AND METHODS Six patients underwent the presented technique, all for the indication of failed hallux valgus surgery with shortening of the first MT and degenerative changes in the 1st MTP joint. RESULTS Follow-up at six months revealed all patients had complete healing of the osteotomy and arthrodesis sites. They were all asymptomatic and fully active, completely satisfied with the outcome. CONCLUSIONS Combined fusion of the first MTP joint and lengthening of the first MT through a scarf osteotomy results in an excellent outcome in patients with failed hallux valgus surgery with shortening of the first MT and degenerative changes in the 1st MTP joint.
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Affiliation(s)
- Ashwin Chowdhary
- Center for Surgery of the Foot & Ankle, Clinique La Colline, Av. de Beau-Séjour 6, Geneva 1206, Switzerland.
| | - Lisca Drittenbass
- Center for Surgery of the Foot & Ankle, Clinique La Colline, Av. de Beau-Séjour 6, Geneva 1206, Switzerland
| | - Richard Stern
- Center for Surgery of the Foot & Ankle, Clinique La Colline, Av. de Beau-Séjour 6, Geneva 1206, Switzerland
| | - Mathieu Assal
- Center for Surgery of the Foot & Ankle, Clinique La Colline, Av. de Beau-Séjour 6, Geneva 1206, Switzerland; Faculté de Médecine, University of Geneva Medical Center, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland
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Wester JU, Hamborg-Petersen E, Herold N, Hansen PB, Froekjaer J. Open wedge metatarsal osteotomy versus crescentic osteotomy to correct severe hallux valgus deformity - A prospective comparative study. Foot Ankle Surg 2016; 22:26-31. [PMID: 26869496 DOI: 10.1016/j.fas.2015.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 03/16/2015] [Accepted: 04/19/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Different techniques of proximal osteotomies have been introduced to correct severe hallux valgus. The open wedge osteotomy is a newly introduced method for proximal osteotomy. The aim of this prospective randomized study was to compare the radiological and clinical results after operation for severe hallux valgus, comparing the open wedge osteotomy to the crescentic osteotomy which is our traditional treatment. METHODS Forty-five patients with severe hallux valgus (hallux valgus angle >35̊, and intermetatarsal angle >15̊) were included in this study. The treatment was proximal open wedge osteotomy and fixation with plate (Hemax), group 1, or operation with proximal crescentic osteotomy and fixation with a 3mm cannulated screw, group 2. The mean age was 52 years (19-71). Forty-one females and four males were included. Clinical and radiological follow-ups were performed 4 and 12 months after the operation. RESULTS In group 1 the hallux valgus angle decreased from 39.0̊ to 24.1̊ after 4 months and 27.9̊ after 12 months. In group 2 the angle decreased from 38.3̊ to 21.4̊ after 4 months and 27.0̊ after 12 months. The intermetatarsal angle in group 1 was 19.0̊ preoperatively, 11.6̊ after 4 months and 12.6̊ after 12 months. In group 2 the mean intermetatarsal angle was 18.9̊ preoperatively, 12.0̊ after 4 months and 12.6̊ after 12 months. The AOFAS score improved from 59.3 to 81.5 in group 1 and from 61.8 to 84.8 in group 2 respectively measured 12 months postoperatively. The relative length of the 1 metatarsal compared to 2 metatarsal bone was 0.88 and 0.87 preoperatively and 0.88 and 0.86 for group 1 and 2 respectively measured after 12 months. CONCLUSION Crescentic osteotomy and open wedge osteotomy improve AOFAS score and VAS scores on patients operated with severe hallux valgus. No significant difference was found in the two groups looking at the postoperative improvement of HVA and IMA measured 4 and 12 months postoperatively. The postoperative VAS score and AOFAS score were comparable for the two groups with no significant difference. An expected tendency to gain better length of the first metatarsal using the open wedge osteotomy compared to the crescentic osteotomy was not found. Even though the IMA and HVA reduction was only suboptimal the improvement in AOFAS score was comparable to other similar clinical trials.
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Affiliation(s)
- Jens Ulrik Wester
- Foot and Ankle Section, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Soendre Boulevard 29, 5000 Odense C, Denmark.
| | - Ellen Hamborg-Petersen
- Foot and Ankle Section, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Soendre Boulevard 29, 5000 Odense C, Denmark
| | - Niels Herold
- Foot and Ankle Section, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Soendre Boulevard 29, 5000 Odense C, Denmark
| | - Palle Bo Hansen
- Foot and Ankle Section, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Soendre Boulevard 29, 5000 Odense C, Denmark
| | - Johnny Froekjaer
- Foot and Ankle Section, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Soendre Boulevard 29, 5000 Odense C, Denmark
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