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Lucar-Lopez G, Apostu D, Paz-Ramirez G, Guevara-Noriega KA, Pereira AS, Ballester-Alomar M. Distal Rotational Metatarsal Osteotomy (DROMO) for the treatment of hallux valgus associated with first metatarsal pronation: Surgical technique and initial results. Foot (Edinb) 2024; 59:102086. [PMID: 38626576 DOI: 10.1016/j.foot.2024.102086] [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: 09/17/2022] [Accepted: 03/10/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Hallux valgus (HV) is a very common deformity worldwide. Most of the surgical techniques used in the treatment of HV only correct these deformities in two planes, that is sagittal and transverse planes. The importance of the first metatarsal pronation as an etiological factor of hallux valgus is validated by numerous authors and it is usually unaddressed. Few surgical techniques have focused on the correction of rotational deformity of the hallux valgus. We aim to first report a detailed technique and a case series using the Distal Rotational Metatarsal Osteotomy (DROMO) surgical technique, which is less invasive and can address the pronation deformation. METHODS The inclusion period was 6 months finishing in April 2021. The study analyzed the following x-ray parameters: preoperative and postoperative intermetatarsal angle (IMA), preoperative and postoperative hallux valgus angle (HVA), preoperative and postoperative coronal rotation of the first metatarsal according Hardy and Clapham's classification as described by Kim et al., preoperative and postoperative shape of the first metatarsal head as described by Ono et al. RESULTS: 33 patients matched our inclusion and exclusion criteria. Most patients underwent the surgery for the left foot (n = 18), compared to the right foot (n = 15). We found statistically significant differences between preoperative and postoperative IMA (p < 0.001), preoperative and postoperative HVA (p < 0.001). Preoperative and postoperative coronal rotation of the first metatarsal as classified by Hardy and Clapham was significantly different (p < 0.001), as well as preoperative and postoperative shape of the first metatarsal head (p < 0.01). CONCLUSIONS DROMO can correct the metatarsal rotation through minimal invasive surgery. From our perspective, DROMO technique should be another alternative for HV correction technique which in time can be associated as a local anesthetic technique, DROMO results are attractive for an ambulatory procedure.
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Affiliation(s)
| | - Dragos Apostu
- Department of Orthopaedics and Traumatology, University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
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Hatch DJ. Re: The Triplanar Hallux Abducto Valgus Classification System: Is it Valid? (Article in Press). J Foot Ankle Surg 2024; 63:432. [PMID: 38670780 DOI: 10.1053/j.jfas.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 04/28/2024]
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Padovano A, Tennant JN, Martin K, Santrock RD, Lalli T. The Triplanar Hallux Abducto Valgus Classification System: Is it Valid? J Foot Ankle Surg 2024; 63:324-326. [PMID: 38104889 DOI: 10.1053/j.jfas.2023.12.003] [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: 09/06/2022] [Revised: 10/20/2023] [Accepted: 12/10/2023] [Indexed: 12/19/2023]
Abstract
Historically, 2-dimensional radiographic study techniques have been used to classify deformity and guide treatment of hallux valgus deformities in the transverse plane. Recently, a triplanar hallux abducto valgus classification system was proposed. The key elements of this classification system are the pathologic alignments in 3 anatomic planes. The triplanar hallux abducto valgus classification system is intended to clarify the deformity and apply a triplanar anatomic algorithm for treatment. To our knowledge, this classification system has not been validated. Our objective was to assess reliability of the triplanar hallux valgus classification system. Patients with hallux abducto valgus were identified from a foot and ankle registry. Digital radiographs were assembled in a digital slide presentation. The eligibility criteria required complete radiographic studies and represented varying degrees of hallux abducto valgus. The reviewers included 3 board-certified, fellowship-trained orthopedic foot and ankle surgeons. Each reviewer independently classified the hallux abducto valgus deformity for a total of 75 observations. After an 8-week washout period, the order of the hallux abducto valgus cases was randomized in the digital slide presentation and redistributed to the reviewers. The average kappa value from 3 readers was 0.241 with 95% CI (0.093-0.374), indicating a fair agreement. The inter-reader agreement was 0.046 with 95% CI (-0.041 to 0.112), showing poor agreement between readers. Our results indicate the triplanar hallux abducto valgus is not a reliable classification system. While this is the first known triplanar hallux abducto valgus classification system, it lacks prognostic value and reliability.
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Affiliation(s)
- Alexander Padovano
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC.
| | - Joshua N Tennant
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC
| | - Kevin Martin
- Department of Orthopedics, Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Trapper Lalli
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC
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4
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Investigation on the site of coronal deformities in Hallux valgus. Sci Rep 2023; 13:1815. [PMID: 36725901 PMCID: PMC9892504 DOI: 10.1038/s41598-023-28469-4] [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: 12/10/2021] [Accepted: 01/18/2023] [Indexed: 02/03/2023] Open
Abstract
Hallux valgus (HV) is a common foot deformity that is more prevalent in females, characterised by abnormal adduction of the first metatarsal (MT) and valgus deviation of the phalanx on the transverse plane. Increasing evidence indicates that HV is more than a 2D deformity but a 3D one with rotational malalignment. Pronation deformity is seen during clinical examination for HV patients, but the exact origin of this rotational deformity is still unknown. Some attribute it to first tarsometatarsal (TMT) joint rotation, while others attribute it to intra-metatarsal bony torsion. In addition, the correlation between the rotational and transverse plane deformity is inconclusive. Identifying the origin of the rotational deformity will help surgeons choose the optimal surgical procedure while also enhancing our understanding of the pathophysiology of HV. This study aims to (1) develop an objective method for measuring the first MT torsion and first TMT joint rotation; (2) investigate the exact location of the coronal deformity in HV; (3) investigate the relationship between the severity of deformity on the transverse and coronal planes as well as the correlation between deformity severity and foot function/symptoms in HV. Age-matched females with and without HV were recruited at the Foot and Ankle Clinic of the Department of Orthopaedics and Traumatology. Computed tomography was conducted for all subjects with additional weight-bearing dorsal-plantar X-ray examination for HV subjects. Demographic information of all subjects was recorded, with symptoms and functions related to HV evaluated. The intra-class correlation was used to explore the relationship between deformities on different planes and the deformity severity and functional outcomes, respectively. An Independent t-test was used to compare joint rotation and bone torsion degrees. TMT joint rotation is significantly correlated with foot function. HV patients had more TMT joint rotation but not MT torsion compared to normal controls. No relationship was found between the coronal rotation and the 1,2-intermetatarsal angle (IMA) or Hallux valgus angle (HVA) on the transverse plane. Our results indicate that coronal deformities in HV may originate from TMT joint rotation. In addition, the severity of the TMT joint coronal rotation correlates with worse foot function; thus, multi-plane assessment and examination will be necessary for more precise surgical correction.
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Del Vecchio JJ, Dealbera ED, Brue J, Ghioldi ME, Chemes LN, Abdelatif NMN, Chan D. Intra‑ and Interobserver Reliability of Yamaguchi's Method for the Assessment of First Metatarsal Pronation in Hallux Valgus Deformity. J Foot Ankle Surg 2022; 62:432-436. [PMID: 36402635 DOI: 10.1053/j.jfas.2022.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 09/26/2022] [Accepted: 10/16/2022] [Indexed: 11/15/2022]
Abstract
Pronation of the first metatarsal is a risk factor for the formation and progression of the hallux valgus deformity. Recently, Yamaguchi et al published a study that showed how the round sign increases on digitally reconstructed radiography taken from a CT scan when pronation is applied. In this study, the shape of the lateral edge of the first metatarsal head was evaluated on weightbearing dorsoplantar radiographs. Yamaguchi's signs were presented to observers after the visual presentation of each foot as an image. The best-fit circle was drawn using the PACS drawing function. Ninety radiographs of adults presenting hallux valgus deformities were classified as mild-to-moderate, based on hallux valgus angle and intermetatarsal angle. The global average observations were 3.72 ± 3.92 (range 2.3°-4.6°). The interclass correlation (Fleiss Kappa index κ = 0.225) and the Spearman correlation (0.16 of Kappa) coefficients were poor for interobserver measurements and statistically significant. Using the linear model, there was no significant variability between the repetitions corresponding to each observer (t-value -1.527, p value .127). Our findings show that the Yamaguchi method can be very subjective and should not be the exclusive technique to assess the rotation of the first metatarsal or head roundness.
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Affiliation(s)
- Jorge Javier Del Vecchio
- Head Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro -Hospital Universitario, Buenos Aires, Argentina; Department of Kinesiology and Physiatry, Universidad Favaloro, Buenos Aires, Argentina; Minimally Invasive Foot and Ankle Society (GRECMIP-MIFAS), Merignac, France.
| | - Eric Daniel Dealbera
- Foot and Ankle Section, Orthopaedics Department, Hospital Universitario - Fundación Favaloro, Buenos Aires, Argentine
| | - Julieta Brue
- Ex-Foot and Ankle and Limb Salvage Surgery Fellowship, Fundación Favaloro - Hospital Universitario, Buenos Aires, Argentina
| | | | - Lucas Nicolás Chemes
- Foot and Ankle Section, Fundación Favaloro - Hospital Universitario, Buenos Aires, Argentina
| | - Nasef M N Abdelatif
- Professor, Private Practice, Orthopedic Surgery, Maadi, Cairo, Egypt; Professor, Private Practice, Orthopedic Surgery, Sayeda Zainab, Cairo, Egypt
| | - Debora Chan
- Statitian Department UTN FRBA, Buenos Aires Argentina; Data Science Department Universidad Austral, Buenos Aires Argentina
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6
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Blouin C, Genet F, Denormandie P, Graff W, Perrier A. Development of a preoperative questionnaire to improve satisfaction with hallux valgus repair: A Delphi study. PLoS One 2022; 17:e0276303. [PMID: 36279269 PMCID: PMC9591061 DOI: 10.1371/journal.pone.0276303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/05/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Satisfaction with hallux valgus repair is often poor, despite good surgical outcomes. Many tools have been developed to assess the outcome of the procedure; however none evaluate the association between the initial motive for repair and the reasons for post-surgical dissatisfaction. The aim of this study was to develop a new tool to analyse the subjective and objective expectations of individuals during a pre-operative consultation for hallux valgus repair in order to improve post-surgical satisfaction. METHODS We first collected the reasons for dissatisfaction with repair from the medical files of dissatisfied individuals. Then, a steering committee of 4 French experts in the management of hallux valgus designed a questionnaire based on the reasons for dissatisfaction. We then used the DELPHI method to validate the questionnaire: we submitted the questionnaire to a panel of 34 francophone experts in hallux valgus repair for rating in 4 rounds. RESULTS The medical files of 853 individuals were reviewed and a 52-item questionnaire relating to expectations from hallux valgus surgery was drafted. After the 4 rounds, a final 44 item questionnaire reached consensus. Thirteen items related to clinical and psychological profile, 5 to pain, 9 to physical activity, 4 to aesthetics and 13 to footwear. CONCLUSION This tool should facilitate gathering of individuals' expectations from hallux valgus repair to ensure realistic goals and reduce post-surgical dissatisfaction.
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Affiliation(s)
- Cédric Blouin
- UFR Simone Veil-Santé, UR2020 Erphan, Université Versailles Saint-Quentin-en-Yvelines (UVSQ), Montigny-le-Bretonneux, France
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Saint-Simon, Groupe Hospitalier Diaconesses–Croix-Saint-Simon, Paris, France
- ISPC Synergies, Paris, France
- * E-mail:
| | - François Genet
- ISPC Synergies, Paris, France
- Département PARASPORT-SANTE, Unité Péri Opératoire du Handicap, (UPOH-Perioperative Disability Unit), Service de Médecine Physique et de Réadaptation, Hôpital Raymond-Poincaré, Groupe Hospitalo-Universitaire APHP-Université PARIS SACLAY, Garches, France
- UFR Simone Veil-Santé, END: ICAP, Inserm U1179, Université Versailles Saint-Quentin-en-Yvelines (UVSQ), Montigny-le-Bretonneux, France
| | - Philippe Denormandie
- Service de Chirurgie Orthopédique, Hôpital Raymond Poincaré, APHP, Garches, France
- Groupe Mutuelle Nationale des Hospitaliers (MNH), Paris, France
| | - Wilfrid Graff
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Saint-Simon, Groupe Hospitalier Diaconesses–Croix-Saint-Simon, Paris, France
| | - Antoine Perrier
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Saint-Simon, Groupe Hospitalier Diaconesses–Croix-Saint-Simon, Paris, France
- Laboratoire de Recherche Translationnelle et D’Innovation en Médecine et Complexité TIMC, CNRS, Grenoble, France
- Service de Diabétologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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Dujela MD, Langan T, Cottom JM, DeCarbo WT, McAlister JE, Hyer CF. Lapidus Arthrodesis. Clin Podiatr Med Surg 2022; 39:187-206. [PMID: 35365323 DOI: 10.1016/j.cpm.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
There has been significant enhancement in surgical management of hallux valgus deformity. Recognition of the role of medial column hypermobility has resulted in better functional outcomes with decreased risk of recurrence. Modern techniques have evolved to include enhanced fixation in a move toward minimal postoperative downtime. Evolution to include true triplane correction, including frontal plane derotation of the first ray, has resulted in optimal functional outcomes. The addition of anatomic triplane restoration, enhanced internal fixation, and early return to weight-bearing activities are combined resulting in lifelong correction with excellent functional outcomes and a high degree of patient satisfaction.
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Affiliation(s)
- Michael D Dujela
- Washington Orthopaedic Center, 1900 Cooks Hill Road, Centralia, WA 98532, USA.
| | - Travis Langan
- Carle Clinic Orthopedics and Sports Medicine, 2300 S 1st Street, Champaign, IL, USA
| | - James M Cottom
- Florida Orthopedic Foot and Ankle Center, 1630 S Tuttle Avenue, Suite A, Sarasota, FL 34239, USA
| | - William T DeCarbo
- Foot and Ankle Division, St. Clair Medical Group, 3928 Washington Road. Ste 270, Pittsburgh, PA 15317, USA
| | - Jeffrey E McAlister
- Phoenix Foot and Ankle Institute, 7301 E 2nd Street, Suite. 206, Scottsdale, AZ 85085, USA
| | - Christopher F Hyer
- Orthopedic Foot and Ankle Center, 350 W Wilson Bridge Road Suite 200, Worthington, OH 43085, USA
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8
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Lalevée M, Barbachan Mansur NS, Lee HY, Maly CJ, Iehl CJ, Nery C, Lintz F, de Cesar Netto C. Distal Metatarsal Articular Angle in Hallux Valgus Deformity. Fact or Fiction? A 3-Dimensional Weightbearing CT Assessment. Foot Ankle Int 2022; 43:495-503. [PMID: 34779306 DOI: 10.1177/10711007211051642] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Distal Metatarsal Articular Angle (DMAA) was previously described as an increase in valgus deformity of the distal articular surface of the first metatarsal (M1) in hallux valgus (HV). Several studies have reported poor reliability of this measurement. Some authors have even called into question its existence and consider it to be the consequence of M1 pronation resulting in projection of the round-shaped lateral edge of M1 head.Our study aimed to compare the DMAA in HV and control populations, before and after computer correction of M1 pronation and plantarflexion with a dedicated weightbearing CT (WBCT) software. We hypothesized that after computerized correction, DMAA will not be increased in HV compared to controls. METHODS We performed a retrospective case-control study including 36 HV and 20 control feet. In both groups, DMAA was measured as initially described on conventional radiographs (XR-DMAA) and WBCT by measuring the angle between the distal articular surface and the longitudinal axis of M1. Then, the DMAA was measured after computerized correction of M1 plantarflexion and coronal plane rotation using the α angle (3d-DMAA). RESULTS The XR-DMAA and the 3d-DMAA showed higher significant mean values in HV group compared to controls (respectively 25.9 ± 7.3 vs 7.6 ± 4.2 degrees, P < .001, and 11.9 ± 4.9 vs 3.3 ± 2.9 degrees, P < .001).Comparing a small subset of precorrected juvenile HV (n=8) and nonjuvenile HV (n=28) demonstrated no significant difference in the measure DMAA values. On the other hand, the α angle was significantly higher in the juvenile HV group (21.6 ± 9.9 and 11.4 ± 3.7 degrees; P = .0046). CONCLUSION Although the valgus deformity of M1 distal articular surface in HV is overestimated on conventional radiographs, comparing to controls showed that an 8.6 degrees increase remained after confounding factors' correction. CLINICAL RELEVANCE After pronation computerized correction, an increase in valgus of M1 distal articular surface was still present in HV compared to controls. LEVEL OF EVIDENCE Level III, retrospective case-control study.
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Affiliation(s)
- Matthieu Lalevée
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.,Department of Orthopedic Surgery, Rouen University Hospital, Rouen, France
| | - Nacime Salomao Barbachan Mansur
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.,Department of Orthopedics and Traumatology, Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Hee Young Lee
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Connor J Maly
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Caleb J Iehl
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Caio Nery
- Department of Orthopedics and Traumatology, Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - François Lintz
- Ramsay Santé Clinique De L'union, Centre de Chirurgie de la Cheville et du Pied, Saint-Jean, France
| | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Meyr AJ, Doyle MD, King CM, Kwaadu KY, Nasser EM, Ramdass R, Theodoulou MH, Zarick CS. The American College of Foot and Ankle Surgeons® Clinical Consensus Statement: Hallux Valgus. J Foot Ankle Surg 2022; 61:369-383. [PMID: 34706857 DOI: 10.1053/j.jfas.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Andrew J Meyr
- Clinical Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
| | - Matthew D Doyle
- Silicon Valley Reconstructive Foot and Ankle Fellowship - Palo Alto Medical Foundation, Mountain View, CA
| | - Christy M King
- Residency Director, Kaiser San Francisco Bay Area Foot & Ankle Residency Program and Attending Surgeon, Kaiser Foundation Hospital, Oakland, CA
| | - Kwasi Y Kwaadu
- Clinical Associate Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA
| | | | - Roland Ramdass
- Residency Training Committee, INOVA Fairfax Medical Campus, Fairfax, VA
| | - Michael H Theodoulou
- Chief Division of Podiatric Surgery, Cambridge Health Alliance, and Instructor of Surgery, Harvard Medical School, Boston, MA
| | - Caitlin S Zarick
- Assistant Professor, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
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10
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Ezzatvar Y, López-Bueno L, Fuentes-Aparicio L, Dueñas L. Prevalence and Predisposing Factors for Recurrence after Hallux Valgus Surgery: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10245753. [PMID: 34945049 PMCID: PMC8708542 DOI: 10.3390/jcm10245753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/25/2021] [Accepted: 12/07/2021] [Indexed: 01/21/2023] Open
Abstract
Recurrence is a frequent and undesirable outcome after hallux valgus (HV) surgery. However, the prevalence of HV recurrence and the pre- and postoperatory factors associated with it have not been adequately studied. This study aimed to quantify the prevalence rate of HV recurrence and to analyze its predisposing factors. MEDLINE and EMBASE databases were systematically searched for observational studies including individuals undergoing HV surgical correction. The random-effects restricted maximum likelihood model was used to estimate the pooled effect size (correlation coefficient (r)). Twenty-three studies were included, yielding a total of 2914 individuals. Pooled prevalence of HV recurrence was 24.86% (95% confidence interval (CI), 19.15 to 30.57, I2 = 91.92%, p = 0.00). Preoperative HV angle (HVA) (r = 0.29; 95% CI, 0.14 to 0.43) and preoperative intermetatarsal angle (IMA) (r = 0.13; 95% CI, 0.00 to 0.27) showed a moderate positive relationship with recurrence. Postoperative HVA (r = 0.57; 95% CI, 0.21 to 0.94) and sesamoid position (r = 0.46; 95% CI, 0.31 to 0.60) showed strong relationships with recurrence. In conclusion, preoperative HVA, IMA, and postoperative HVA and sesamoid position are significant risk factors for HV recurrence, and the association of these factors with recurrence is affected by age.
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Affiliation(s)
- Yasmin Ezzatvar
- Department of Nursing, University of Valencia, 46010 Valencia, Spain;
| | - Laura López-Bueno
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Correspondence:
| | - Laura Fuentes-Aparicio
- Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (L.F.-A.); (L.D.)
| | - Lirios Dueñas
- Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (L.F.-A.); (L.D.)
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11
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McAleer JP, Dayton P, DeCarbo WT, Hatch DJ, Smith WB, Ray JJ, Santrock RD. A Systematic Approach to the Surgical Correction of Combined Hallux Valgus and Metatarsus Adductus Deformities. J Foot Ankle Surg 2021; 60:1048-1053. [PMID: 34167887 DOI: 10.1053/j.jfas.2020.11.010] [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: 07/20/2020] [Accepted: 11/18/2020] [Indexed: 02/03/2023]
Abstract
The presence of metatarsus adductus (MTA) adds complexity to the diagnosis and treatment of hallux valgus (HV). Identification and careful analysis of these combined deformities is of paramount importance. The inability to completely correct HV and an increased incidence of recurrence has been established when MTA deformity is present. We present an option for correction of the combined deformities with multiplanar angular correction arthrodesis of the first, second, and third tarsometatarsal (TMT) joints.
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Affiliation(s)
- Jody P McAleer
- Department of Podiatry, Jefferson City Medical Group, Jefferson City, MO.
| | - Paul Dayton
- Foot & Ankle Center of Iowa, Midwest Bunion Center, Ankeny, IA
| | | | | | - W Bret Smith
- Mercy Orthopedic Associates, Mercy Regional Medical Center, Durango, CO
| | - Justin J Ray
- Department of Orthopaedics, West Virginia University, Morgantown, WV
| | - Robert D Santrock
- Department of Orthopaedics, West Virginia University, Morgantown, WV
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12
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Manchanda K, Chang A, Wallace B, Ahn J, Xi Y, Liu GT, Raspovic K, Van Pelt M, Chhabra A, Wukich D, Lalli T. Short Term Radiographic and Patient Outcomes of a Biplanar Plating System for Triplanar Hallux Valgus Correction. J Foot Ankle Surg 2021; 60:461-465. [PMID: 33558095 DOI: 10.1053/j.jfas.2020.06.026] [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] [Received: 03/18/2020] [Revised: 05/27/2020] [Accepted: 06/03/2020] [Indexed: 02/03/2023]
Abstract
Hallux valgus is a complex deformity with a variety of techniques described for correction. A biplanar plating system for triplanar correction system has been developed to address both the translation and rotational component of the hallux valgus deformity and allow an accelerated weightbearing protocol. The purpose of this study was to determine the correction and complications using radiographic parameters and patient reported outcomes. We sought to determine prognostic factors for successful correction, including age, gender, and preoperative deformity. From the medical records, we collected preoperative data. Patient-reported outcomes were obtained using AOFAS Hallux Metatarsophalangeal-Interphalangeal score, FAAM, and SF-12 scores preoperatively and postoperatively. Imaging was reviewed at preoperative and postoperative visits to determine hallux valgus angle, intermetatarsal angle, and tibial sesamoid position. Fifty-seven procedures, in 55 patients, were performed. There were 7 complications and mean follow-up time was 45.7 weeks (+ 28.3 weeks). Age over 62.5 years were associated with an increased risk of complications (p = .018). Males had an increased rate of complications (71%) compared with females. Radiographic parameters were significantly improved from preoperative values at alltime points (p < .05). Only the AOFAS Hallux Metatarsophalangeal-Interphalangeal score was statistically significant at 3, 6 and 12 months. We sought to determine the effectiveness of biplanar plating and triplanar correction procedure with early weightbearing. Over a 12 month follow-up period, our results showed significant improvement in deformity and maintained correction. AOFAS Hallux Metatarsophalangeal-Interphalangeal scores significantly improved from the preoperative to the postoperative state. Our results show a nonunion rate of 5.2%, which is comparable to prior studies.
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Affiliation(s)
- Kshitij Manchanda
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Alice Chang
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Blake Wallace
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Junho Ahn
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Yin Xi
- Assistant Professor, Department of Radiology, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - George T Liu
- Associate Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Katherine Raspovic
- Assistant Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Van Pelt
- Associate Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Avneesh Chhabra
- Associate Professor, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dane Wukich
- Professor and Chair, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Trapper Lalli
- Assistant Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
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13
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Peng J, Wang Q, Jha AJ, Pitts C, Li Q, Brahmbhatt A, Shah AB. The Rotational Effect of Scarf Osteotomy With Transarticular Lateral Release on Hallux Valgus Correction. J Foot Ankle Surg 2021; 60:328-332. [PMID: 33423891 DOI: 10.1053/j.jfas.2020.11.001] [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: 02/10/2020] [Revised: 09/07/2020] [Accepted: 11/09/2020] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to explore the rotational effect of scarf osteotomy with transarticular lateral release (TALR) on hallux valgus correction. From January 2016 to January 2018, 28 consecutive patients (30 feet) were included in this study. The first intermetatarsal angle (IMA), hallux valgus angle (HVA), and round-shaped lateral edge of the first metatarsal head (R sign), and sesamoid rotation angle (SRA) were recorded prior to and 3 months after the surgery. The rotation of the capital fragment of the first metatarsal was termed the capital rotation angle (CRA) and was measured intraoperatively after the completion of scarf osteotomy. The IMA, HVA, and SRA were significantly reduced from 13.9 ± 4.9°, 34.6 ± 7.4°, and 28.7 ± 9.8° to 2.4 ± 2.3°, 7.3 ± 4.7°, and 13.4 ± 8.8°, respectively (p < .01 for all). The mean CRA was 7.0 ± 3.4° and was not significantly correlated with the reduction of IMA and SRA (p > .05 for all); nor was it significantly correlated with IMA preoperatively and postoperatively (p > .05 for all) or the reduction of SRA and IMA (p > .05). The R sign was positive in 40% (12/30) of the feet preoperatively compared to 13.3% (4/30) postoperatively (p < .001). Scarf osteotomy produced a supination effect on the capital fragment of the first metatarsal and supinated the sesamoids via lateral translation of the first metatarsal head. These changes may contribute to the correction of the pronation component of hallux valgus deformity.
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Affiliation(s)
- Jianguang Peng
- Associate Professor, Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qiang Wang
- Associate Professor, Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Aaradhana J Jha
- Trauma Fellow, Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Charles Pitts
- Resident Physician, Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Qi Li
- Associate Professor, Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ashish Brahmbhatt
- Foot and Ankle Fellow, Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Ashish B Shah
- Associate Profressor, Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL.
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14
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Hatch DJ, Dayton P, DeCarbo W, McAleer JP, Ray JJ, Santrock RD, Smith WB. Analysis of Shortening and Elevation of the First Ray With Instrumented Triplane First Tarsometatarsal Arthrodesis. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420960678. [PMID: 35097411 PMCID: PMC8702970 DOI: 10.1177/2473011420960678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Lapidus procedure using planar saw resection has often been criticized for complications related to excessive shortening and elevation of the first ray. The goal of this study was to assess the amount of shortening that occurs when using a cutting guide for controlled saw resection of the first tarsometatarsal (TMT) joint surfaces, along with assessment of deformity correction in all 3 anatomic planes. METHODS A prospective multicenter study with IRB approval included 35 hallux valgus subjects evaluated at baseline and 6 months following instrumented triplane first TMT arthrodesis without lesser metatarsal osteotomies. RESULTS The average first ray bone segment length loss was 3.1 mm (95% confidence interval [CI] 2.4-3.7) in the anteroposterior (AP) radiographic assessment and 2.4 mm (95% CI 1.7-3.1) in the sagittal plane. The mean preoperative radiographic measurements were 1.7 degrees (dorsiflexion) for sagittal plane angle, 13.8 degrees for intermetatarsal angle (IMA), and 5.1 for tibial sesamoid position (TSP). Improvements were seen postoperatively for all measures with a mean difference of -0.2 degrees (95% CI -1.0 to 0.6) for sagittal plane angle, -9.2 degrees (95% CI -10.1 to -8.3 degrees) for IMA, and -3.5 (95% CI -4.0 to -3.1) for TSP. Five of the patients reported lesser metatarsal pain preoperatively, and no patients complained of lesser metatarsalgia at 6-month follow-up. CONCLUSIONS Minimal length loss of the first ray can be expected following instrumented triplane TMT arthrodesis while achieving full 3-dimensional deformity correction and reducing the risk of lesser metatarsalgia. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Daniel J. Hatch
- Foot and Ankle Center of Northern Colorado, Greeley, CO, USA
| | - Paul Dayton
- Foot & Ankle Center of Iowa, Midwest Bunion Center, Ankeny, IA, USA
| | | | - Jody P. McAleer
- Jefferson City Medical Group, Department of Podiatry, Jefferson City, MO, USA
| | - Justin J. Ray
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - Robert D. Santrock
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - W. Bret Smith
- Mercy Orthopedic Associates, Mercy Regional Medical Center, Durango, CO, USA
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15
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Ono Y, Yamaguchi S, Sadamasu A, Kimura S, Watanabe S, Akagi R, Sasho T, Ohtori S. The shape of the first metatarsal head and its association with the presence of sesamoid-metatarsal joint osteoarthritis and the pronation angle. J Orthop Sci 2020; 25:658-663. [PMID: 31326222 DOI: 10.1016/j.jos.2019.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/15/2019] [Accepted: 06/20/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the associations of the shape of the first metatarsal head with (1) the presence of osteoarthritis in the sesamoid-metatarsal joint and (2) the pronation angle of the first metatarsal head on foot radiographs. METHODS A total of 121 patients, with the mean age of 61 years, underwent weight-bearing dorsoplantar, lateral, and first metatarsal axial radiographs. The shape of the first metatarsal head's lateral edge was classified as either rounded, intermediate, or angular in shape in the dorsoplantar view. The presence of osteoarthritis in the sesamoid-metatarsal joint and the pronation angle of the first metatarsal head were assessed in the first metatarsal axial view. Other variables that could affect the first metatarsal shape, including the lateral first metatarsal inclination angle, were also assessed. Univariate and multivariate analyses were performed to determine the associations. RESULTS The prevalence of sesamoid-metatarsal osteoarthritis was significantly higher (77%, 27%, and 29% for rounded, intermediate, and angular, respectively, P < .001), and the metatarsal pronation angle was significantly larger (14°, 8°, and 4° for rounded, intermediate, and angular, respectively, P < .001) in feet with a rounded metatarsal head. These associations were also significant in the multiple regression analysis. CONCLUSION A rounded metatarsal head was associated with a higher prevalence of osteoarthritis within the sesamoid-metatarsal joint, as well as a larger first metatarsal head pronation angle. A negative round sign can be used as a simple indicator of an effective correction to the first metatarsal pronation angle during hallux valgus surgery. However, in feet with sesamoid-metatarsal osteoarthritis, surgeons will need to be cautious as overcorrection may occur.
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Affiliation(s)
- Yoshimasa Ono
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Satoshi Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan; Collage of Liberal Arts and Sciences, Chiba University, Chiba, Japan.
| | - Aya Sadamasu
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Seiji Kimura
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Shotaro Watanabe
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Ryuichiro Akagi
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Takahisa Sasho
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan; Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
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