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Wang C, Wang Z, Zhao H, Zhang M. Radiologic and Clinical Outcomes of the Dovetailed Notch Scarf Osteotomy for Correcting the First Metatarsal Pronation in Moderate to Severe Hallux Valgus Deformity: A Comparative Study. Foot Ankle Int 2024; 45:728-736. [PMID: 38634422 DOI: 10.1177/10711007241238226] [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: 04/19/2024]
Abstract
BACKGROUND The traditional scarf osteotomy (TSO) has limited ability to correct the first metatarsal pronation. A novel modification that we refer to as a "dovetailed notch scarf osteotomy" (DNSO) has been developed to enhance the ability to correct coronal plane pronation. The study aimed to observe and compare TSO to DNSO in the treatment of moderate to severe hallux valgus deformity. METHODS This retrospective study included 78 feet that had a TSO and 105 feet that had a DNSO. Minimum follow-up was 24 months. Weightbearing computed tomography (WBCT) and weightbearing anterior-posterior (AP) radiographs were taken preoperatively and at the last follow-up. We measured the intermetatarsal angle (IMA), hallux valgus angle, distal metatarsal articular surface angle on AP radiographs and first metatarsal coronal pronation angle (α angle), tibial sesamoid coronal grading, and first metatarsal length on WBCT. Clinical assessment was done using visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, Foot and Ankle Ability Measure (FAAM), and the 36-Item Short Form Health Survey (SF-36). The occurrence of postoperative complications was also documented. RESULTS The DNSO group exhibited a significantly higher correction amount of α angle and IMA (14.3 ± 9.9 and 10.3 ± 4.6 degrees) than the TSO group (8.6 ± 5.9 and 5.4 ± 5.9 degrees) during the final follow-up assessment (P < .05).The DNSO group (10.1 [8.0-12.0] degrees and 4.8 [3.9-5.6] degrees) demonstrated significantly smaller α angle and IMA compared with the TSO group (4.8 [3.9-5.6] degrees and 9.5 [7.5-11.5] degrees) at 24 months postsurgery (P < .05). The postoperative FAAM activities of daily living and SF-36 physical functioning scores were significantly higher in the DNSO group (97.2 ± 3.3 and 95.7 ± 4.4 points) compared with the TSO group (92.3 ± 3.3 and 87.7 ± 8.7 points) (P < .05). Additionally, hallux varus occurred in 1 case in the DNSO group, whereas 4 cases were observed in the TSO group. CONCLUSION Two osteotomy methods can effectively correct moderate to severe hallux valgus deformity. Compared with the TSO, the DNSO has stronger correction ability. The most crucial aspect lies in its controllability when correcting first metatarsal pronation and addressing IMA. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Chao Wang
- Center of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhi Wang
- Center of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hongmou Zhao
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mingzhu Zhang
- Center of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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The Minimally Invasive SERI Osteotomy for Pediatric Hallux Valgus. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010094. [PMID: 36670645 PMCID: PMC9856383 DOI: 10.3390/children10010094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/23/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023]
Abstract
Hallux valgus (HV), one of the most common forefoot pediatric pathologies, is characterized by lateral deviation of the big toe and medial displacement of the first metatarsal bone. Different surgical techniques have been described to correct the deformity, but no consensus has been reached regarding the best surgical option. The aim of this retrospective study was to report the results of the SERI technique in 58 pediatric HV of 45 consecutive patients. Pre- and postoperative VAS, AOFAS score, HVA, IMA and DMAA were collected. Preoperatively 3 patients (5.2%) had a mild deformity, 52 patients (89.6%) had moderate deformity and 3 patients (5.2%) had severe deformity according to Coughlin et al. Mean VAS score decreased from 5.2 ± 2.2 preoperatively to 0.8 ± 0.4 postoperatively. Mean AOFAS score improved from 68.1 ± 6.8 (range 59−75) preoperatively to 96.3 ± 3.2 (range 88−100) postoperatively, mean HVA reduced from 28.4° preoperatively to 13.2° postoperatively, mean IMA decreased from 15.2° preoperatively to 9.5° postoperatively (p < 0.01); mean DMAA decreased from 13.7° preoperatively to 8.2° postoperatively (p < 0.01). SERI technique showed satisfactory results when treating mild to severe pediatric HV deformity. No major complications were reported.
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Reconceptualizing the Juvenile Bunion. J Pediatr Orthop 2023; 43:e43-e47. [PMID: 36224093 DOI: 10.1097/bpo.0000000000002277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The operative management of the juvenile bunion has not enjoyed the same level of success as its adult counterpart leading to the concern that we do not fully understand what differentiates these 2 deformities. This study aims to (1) characterize the radiographic and pedobarographic features commonly encountered in the juvenile bunion and (2) determine which of these radiographic or pedobarographic parameters correlate with patient-reported outcome (PRO) scores at the time of presentation. METHODS An IRB-approved retrospective analysis of prospectively enrolled patients between 10 and 18 years of age with bunion deformities was performed at a single pediatric institution over a 4-year period. Standardized weight-bearing radiographs were used to determine hallux valgus angle (HVA), intermetatarsal angle, sesamoid position (SP), distal metatarsal articular angle (DMAA), and other radiographic parameters. Pedobarographic analysis was used to determine peak pressure, contact area, contact time, and pressure-time integral within 11 plantar regions. Foot-specific PRO measures were administered at the initial presentation. RESULTS Thirty-two patients (57 feet) met the inclusion criteria of which56/57 feet (98.2%) had an elevated DMAA (average 21.4degrees±8.9 degrees), and 51/57 (89.4%) had a congruent joint. The DMAA correlated positively with the HVA (r=0.734 P <0.001), intermetatarsal angle (r=0.439 P =0.001), and SP (r=0.627 P <0.001). Pedobarographic analysis (available in 15/32 patients) demonstrated that the HVA correlated with increased second metatarsal head peak pressure (r=0.667 P =0.011) and pressure-time integral (r=0.604 P =0.002), which in turn was strongly correlated with worse PROs. Conversely, increased first metatarsal head contact area correlated with improved PROs. Analysis of radiographic measurements demonstrated that HVA and lateralized SP correlated significantly with worse PRO scores. CONCLUSIONS Nearly all juvenile bunions have an elevated DMAA and a congruent joint. There is a clear correlation between the severity of radiographic and pedobarographic deformity and worse PRO scores at the time of presentation. We believe that the presence of elevated DMAA is the defining factor that differentiates the juvenile bunion from the deformity typically seen in adults. LEVEL OF EVIDENCE III.
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Caravelli S, Vocale E, Di Ponte M, Fuiano M, Massimi S, Zannoni F, Zaffagnini S, Mosca M. SERI Technique for Isolated Juvenile Hallux Valgus Patients: A Retrospective Evaluation With Mid-term to Long-term Follow-up. Foot Ankle Spec 2022:19386400221121409. [PMID: 36113025 DOI: 10.1177/19386400221121409] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Many different operative procedures have been described to treat hallux valgus, but many of them are inappropriate for active, skeletally immature patients. This retrospective evaluation aimed to show the efficacy of SERI (Simple, Effective, Rapid, Inexpensive) technique in young patients affected by mild to moderate hallux valgus deformity at a mid-term to long-term follow-up. METHODS All patients were clinically and radiographically evaluated, independently by 2 researchers, by American Orthopaedic Foot and Ankle Society (AOFAS) Hallux-Metatarsophalangeal-Interphalangeal score and radiographic examination. RESULTS Twenty-nine feet, undergone SERI procedure, have been reviewed at a mean follow-up of 5 years. The mean AOFAS score was significantly improved from 59.7 preoperatively to a mean value of 90.7 at last follow-up. Mean correction degrees have been recorded for both angles (hallux valgus angle [HVA] -13.7° and intermetatarsal angle [IMA] -6.7°). CONCLUSIONS The SERI technique represents a powerful surgical procedure for the treatment of painful, mild to moderate, juvenile hallux valgus. Recurrence and complication rate make this surgical approach effective, repeatable, and safe. LEVEL OF EVIDENCE Level IV, Retrospective case series.
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Affiliation(s)
- Silvio Caravelli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Emanuele Vocale
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Di Ponte
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mario Fuiano
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Simone Massimi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Zannoni
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano Mosca
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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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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AlFarii H, Marwan Y, Algarni N, Addar A, Hamdy R, Janelle C. Temporary Screw Lateral Hemiepiphysiodesis of the First Metatarsal for Juvenile Hallux Valgus Deformity: A Case Series of 23 Feet. J Foot Ankle Surg 2022; 61:88-92. [PMID: 34266723 DOI: 10.1053/j.jfas.2021.06.012] [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: 06/23/2019] [Revised: 03/13/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
Juvenile hallux valgus (JHV) can limit the quality of life of the affected children. This study aims to evaluate the outcomes of temporary screw lateral hemiepiphysiodesis of the base of the first metatarsal. A chart review of patients who underwent temporary screw lateral hemiepiphysiodesis of the first metatarsal at a tertiary care pediatric orthopedic center was done. A total of 23 feet of 14 patients were included. The mean age of the patients was 10.6 ± 1.8 years, while the bone age was 11.1 ± 1.8 years. The mean follow-up duration was 24.7 ± 13.4 months (range: 12-60 months). The hallux valgus angle (HVA) improved from a mean of 30.9° ± 6.7° to a mean of 27.6° ± 8.2° (p = .001), while the intermetatarsal angle (IMA) improved from a mean of 14.6° ± 2.3° to a mean of 12.5° ± 3.0° (p < .001). Revision surgery was done for 5 (21.7%) feet of 3 patients for symptomatic uncorrected deformity (4 feet) or screw migration due to bone growth (1 foot). The mean HVA correction was 5.00° ± 3.7° in patients with bone age of 12 years or less compared to 1.50° ± 4.6° in patients with bone age of more than 12 years (p = .060). The radiological outcomes of temporary screw lateral hemiepiphysiodesis of the first metatarsal for JHV deformity correction are promising, especially in children with lesser bone age. The procedure was technically simple to perform and had minor complications.
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Affiliation(s)
- Humaid AlFarii
- Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Yousef Marwan
- Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nizar Algarni
- Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University Health Centre, Montreal, Quebec, Canada
| | - Abdullah Addar
- Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University Health Centre, Montreal, Quebec, Canada
| | - ReggieC Hamdy
- Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University Health Centre, Montreal, Quebec, Canada
| | - Chantal Janelle
- Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University Health Centre, Montreal, Quebec, Canada
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Abstract
Treatment of juvenile hallux valgus can be challenging. Initial treatment with conservative measures is appropriate until exhausted. Surgical treatment should be delayed until after skeletal maturity when possible. Before any intervention, a thorough understanding of the whole patient and any underlying systemic contributors to their hallux valgus, in addition to the radiographic foot parameters, is imperative. Careful and individualized surgical planning should be done to optimize results and decrease the risk for recurrence.
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Affiliation(s)
- Susan T Mahan
- Department of Orthopaedics and Sports Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Emily O Cidambi
- Department of Orthopaedics, Rady Children's Hospital, UC San Diego Medical School, 3020 Children's Way, MC 5062, San Diego, CA 92123, USA
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8
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Bolzinger M, Thevenin-Lemoine C, Gallini A, Sales de Gauzy J. Abnormalities in distal first metatarsal joint surface orientation: Distal Metatarsal Articular Angle and Distal Metatarsal-2 Articular Angle. Orthop Traumatol Surg Res 2021; 107:102938. [PMID: 33895388 DOI: 10.1016/j.otsr.2021.102938] [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: 10/01/2019] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hallux valgus (HV) in adults is an acquired pathology related to 1st metatarsal (M1) abduction. In children, it is related to abnormal M1 joint surface orientation. HYPOTHESIS HV deformities in children and adults differ. OBJECTIVE Descriptive study of radiologic abnormalities in a pediatric population of symptomatic HV, with comparison to a population without symptomatic HV. MATERIALS AND METHODS Weight-bearing X-rays were studied in pediatric patients undergoing surgery for HV and in a control population. Measurements comprised M1P1, M1M2, DMAA, DM2AA, MPAA, and sesamoid subluxation index. RESULTS Twenty-five patients (42 feet) were included in the HV group, and 16 patients (29 feet) in the control group. Mean age was 13 years in both. Interobserver reproducibility was excellent for M1P1, and good for M1M2, DMAA and DM2AA. In HV, 71% of feet showed M1M2 angle>12° and 98% DMAA>10°; DM2AA was>0°, except in 1 foot. DISCUSSION Normal values are the same in children and adults: M1P1<15°, DMAA<10° and M1M2<12°. In the HV group, DMAA was systematically pathological, while M1M2 was pathological in only 71% of cases. Childhood HV is related to abnormal DMAA, sometimes associated with increased M1M2 angle, especially in severe forms. DM2AA assesses distal M1 joint surface orientation with respect to the M2 axis; in the HV group, it was systematically>0° (except in 1 foot). Thus, in case of concomitant DMAA and M1M2 abnormalities, DMAA is more severely abnormal than M1M2 (DM2AA=DMAA-M1M2). CONCLUSION Childhood HV is mainly due to abnormal M1 joint surface orientation, sometimes associated with increased 1st metatarsal abduction. DM2AA reflects the balance between 1st metatarsal abduction and M1 joint surface orientation abnormality. LEVEL OF EVIDENCE III.
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Kotlarsky P, Gannot G, Katsman A, Eidelman M. Treatment of Adolescent Hallux Valgus With Percutaneous Distal Metatarsal Osteotomy. Foot Ankle Spec 2021; 14:238-248. [PMID: 32228233 DOI: 10.1177/1938640020913182] [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: 11/17/2022]
Abstract
Background. Hallux valgus is a complex deformity of the first ray of the foot, and a significant number of adolescents develop this deformity. More than 130 surgical procedures have been described to treat hallux valgus, but there is no compelling evidence to prefer one method over another. Minimal invasive techniques have been proposed and reported to be successful and cost-effective. The objective of this study was to describe the clinical course of adolescent patients treated with percutaneous distal metatarsal osteotomy. Methods. A retrospective study included patients who had a percutaneous hallux valgus correction during the years 2008 to 2015. The following measurements were compared before surgery up to last follow-up: AOFAS Hallux-Metatarsophalangeal-Interphalangeal questionnaire and radiological measurements (HVA, IMA, DMAA). Any postoperative complications were extracted from the medical records. Results. The procedure was performed on 32 feet (27 patients). All patients were <18 years of age. There were 10 male patients (12 feet) and 17 female patients (20 feet). Average age at surgery was 15.8 years (range = 13-18 years). Average follow-up time was 43 months (range= 24-94 months). The average AOFAS score before surgery was 66, and after surgery, at last follow-up was 96. This difference was significant (P value <.0001). Most patients were pain free after the procedure and returned to appropriate age functioning. Significant improvement was noted in all radiological criteria. Conclusions. Percutaneous distal metatarsal osteotomy is safe, reliable, and effective for the correction of mild to moderate symptomatic hallux valgus in adolescents.Levels of Evidence: Level IV.
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Affiliation(s)
- Pavel Kotlarsky
- Pediatric Orthopedics, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Gil Gannot
- Pediatric Orthopedics, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Alexander Katsman
- Pediatric Orthopedics, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Mark Eidelman
- Pediatric Orthopedics, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
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Martínez G. DEFORMIDADES DE LOS PIES EN NIÑOS. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Forefoot malformations, deformities and other congenital defects in children. Orthop Traumatol Surg Res 2020; 106:S115-S123. [PMID: 31648997 DOI: 10.1016/j.otsr.2019.03.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/28/2019] [Accepted: 03/12/2019] [Indexed: 02/02/2023]
Abstract
Congenital pathologies of the forefoot encompass two broad entities with vastly different treatments and prognosis: malformations, which occur during the embryonic period and cause anatomical defects, and deformations, which occur during the fetal period on a foot that is configured normally. These deformities are more easily cured when they occur later during the fetal period. When the anomaly is bilateral, a genetic origin must be considered. There are two main entities under the term "deformity": metatarsus adductus and skewfoot (aka "Z"-foot or serpentine foot). Within malformations are brachydactyly (transverse defects), longitudinal defects, syndactyly, polydactyly, clinodactyly and macrodactyly. Among other forefoot abnormalities are hallux valgus, which rarely presents in congenital form, and for which conservative treatment is sometimes sufficient. Also in this group are sequelae of amniotic band constriction, forefoot anomalies secondary to the treatment of congenital pathologies (talipes equinovarus and congenital vertical talus) and nail-related pathologies (ingrown toe nail and incorrect nail position).
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Wang XW, Wen Q, Li Y, Liu C, Zhao K, Zhao HM, Liang XJ. Scarf Osteotomy for Correction of Hallux Valgus Deformity in Adolescents. Orthop Surg 2019; 11:873-878. [PMID: 31663288 PMCID: PMC6819182 DOI: 10.1111/os.12539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 08/09/2019] [Accepted: 08/19/2019] [Indexed: 11/29/2022] Open
Abstract
Objective To report the radiological and clinical outcomes of the modified scarf osteotomy for the treatment of hallux valgus deformity in adolescents. Methods This retrospective study analyzed 21 patients (31 feet) who underwent a modified scarf osteotomy for correcting juvenile hallux valgus deformity between March 2015 and January 2017. There were 3 male (3 feet) and 18 female (28 feet) patients. The average age at the time of surgery was 28.6 years (range, 20–35). Patients were postoperatively followed up in the outpatient department for 12–18 months. Clinical and radiological assessments were performed preoperatively and postoperatively at 1 year. Moreover, postoperative complications were recorded. Statistical analyses for differences between preoperative and postoperative values were performed. Results All the 21 patients were postoperatively followed up for 12–18 months, with an average of 13.2 ± 2.5 months. Clinical assessment showed that the American Orthopaedic Foot and Ankle Society score was increased from preoperative 58.0 ± 5.8 to postoperative 94.2 ± 6.6 points, respectively, and the visual analog scale score was remarkably decreased from preoperative 6.0 ± 2.0 to postoperative 1.5 ± 2.0 points at 1 year follow‐up. Further radiological assessment showed that the hallux valgus angle was 37.5° ± 9.2°, 14.1° ± 6.5°, and 14.5° ± 6.5° before surgery, half a year after surgery, and 1 year after surgery, respectively; the intermetatarsal angle was 14.1° ± 4.4°, 4.8° ± 3.2°, and 5.5° ± 4.9°, respectively; and the distal metatarsal articular angle was 31.0° ± 3.5°, 7.2° ± 2.3°, and 7.5° ± 2.1°, respectively. They were significantly improved at half a year after surgery and 1 year after surgery compared to those before surgery. Complications occurred in two patients (9.5%) who had numbness on the skin of the edge of the medial incision, and the symptoms were relieved after 10 months. There was no clinical recurrence in all patients. One of the 31 feet had hallux varus, which was corrected in a second operation. Notably, a postoperative radiograph of a typical case whose both feet had hallux valgus deformity and underwent modified scarf osteotomy and additional Akin osteotomy showed adequate correction of the hallux valgus angle (HVA, 11°), intermetatarsal angle (IMA, 6°), and distal metatarsal articular angle (DMAA, 8°) on left foot compared to preoperative HVA (28°), IMA (13°), and DMAA (35°). Conclusion The modified scarf osteotomy can effectively correct the adolescent hallux valgus deformity, which is worth popularizing.
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Affiliation(s)
- Xin-Wen Wang
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Qian Wen
- Department of Prevention and Health Care, Ninth Hospital of Xi'an, Xi'an, China
| | - Yi Li
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Cheng Liu
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Kai Zhao
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Hong-Mou Zhao
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xiao-Jun Liang
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
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Xiong Y, Shen B, Hao C, Xiao K, Wang J, Fang Z. Transfer of abductor hallucis tendon combined with scarf osteotomy versus single scarf osteotomy in moderate to severe hallux valgus deformity: a comparative retrospective cohort study. BMC Musculoskelet Disord 2019; 20:455. [PMID: 31630676 PMCID: PMC6802301 DOI: 10.1186/s12891-019-2860-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/01/2019] [Indexed: 11/21/2022] Open
Abstract
Background Scarf osteotomy (SO) was broadly applied in moderate to severe hallux valgus (MSHV), and the results were satisfactory. However, due to the complicated pathologic changes in hallux valgus, the ideal surgical treatment is still controversial. Transfer of the abductor hallucis tendon combined with Scarf osteotomy (TAHTCSO) was an innovative alternative technique. This retrospective cohort study aimed to define if TAHTCSO mode resulted in improved outcomes as compared with the single SO in MSHV. Methods Of 73 patients (92 ft) with MSHV, 36 (45 ft) were treated through TAHTCSO and 37 ones (47 ft) through SO. The patients were assessed clinically and radiographically with a 24-month follow-up. They were assessed pre-operatively and post-operatively with intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), first metatarsophalangeal joint range of motion (1#MTP ROM), as well as American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores and postoperative complications of surgery. Results Both cohorts had the same baseline feathures. All patients were followed up from 24 to 40 months, with a mean of 28.3 months. Patients in the TAHTCSO cohort had significantly decreased HVA at 6 months (p < 0.0001), 12 months (p < 0.0001), and 24 months (p < 0.0001) after surgery. 1#MTP had been increased slightly with non-statistic sense (p>0.05). IMA, DMAA and AOFAS also had not significantly difference at all followed time after surgery as compared with the SO cohort. The healing of osteotomies was observed within 8 weeks in the two cohorts. Two cases of hallus varus had been found in SO cohort and there were no cases of delayed healing and bone non-union in both cohorts. Conclusion In this retrospective cohort study, TAHTCSO had sufficient maintenance of the correction and improved functional performance thereby was a good alternative for MSHV, though it did not display a better result for MSHV compared to SO.
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Affiliation(s)
- Yuan Xiong
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 43033, China
| | - Bo Shen
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 43033, China
| | - Cheng Hao
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 43033, China
| | - Kai Xiao
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 43033, China
| | - Junwen Wang
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 43033, China
| | - Zhenhua Fang
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 43033, China.
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Kaufmann G, Hofer P, Braito M, Bale R, Putzer D, Dammerer D. Effect of Akin Osteotomy on Hallux Valgus Correction After Scarf Osteotomy With Hallux Valgus Interphalangeus. Foot Ankle Int 2019; 40:1182-1188. [PMID: 31200616 DOI: 10.1177/1071100719855043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recurrence after hallux valgus correction is a relatively frequent occurrence. Little is known about the importance of initial correction on radiologic outcome. The objective of our study was to determine postoperative radiologic parameters correlating with loss of correction after scarf osteotomy and the combined scarf/akin osteotomy, respectively. METHODS Loss of correction was evaluated based on a group of 53 feet with isolated scarf osteotomy (S group) and a group of 17 feet with combined scarf and akin osteotomy (SA group) in a retrospective analysis. The intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), the proximal to distal phalangeal articular angle (PDPAA), the position of the sesamoids, and joint congruity were measured in weight-bearing radiographs preoperatively and postoperatively throughout a mean follow-up of 44.8 ± 23.6 months. RESULTS Loss of correction was comparable between the S and the SA group (P > .05). In contrast, we found higher loss of HVA correction in the S subgroup with a preoperative PDPAA above 8 degrees (P = .011), whereas loss of correction in the S subgroup below 8 degrees of PDPAA was comparable to the SA group. In the S group, loss of correction showed significant correlation with postoperative IMA (P = .015) and PDPAA (P = .008), whereas in the SA group a correlation could be detected for IMA only (P = .045). CONCLUSION In cases with a PDPAA above 8 degrees, we recommend a combined scarf/akin osteotomy to diminish the potential for loss of correction. LEVEL OF EVIDENCE Level III, therapeutic, retrospective comparative series.
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Affiliation(s)
| | - Philipp Hofer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Matthias Braito
- Orthopedic Department, Medical University of Innsbruck, Innsbruck, Austria
| | - Reto Bale
- Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - David Putzer
- Department of Experimental Orthopedics, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Dammerer
- Orthopedic Department, Medical University of Innsbruck, Innsbruck, Austria
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15
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Kaufmann G, Hofmann M, Ulmer H, Putzer D, Hofer P, Dammerer D. Outcomes after scarf osteotomy with and without Akin osteotomy a retrospective comparative study. J Orthop Surg Res 2019; 14:193. [PMID: 31242910 PMCID: PMC6595682 DOI: 10.1186/s13018-019-1241-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/16/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The scarf osteotomy is a well-established surgical method for correcting a hallux valgus deformity. It is often combined with an Akin osteotomy. However, clear guidelines defining indication criteria are missing. The purpose of this study was to analyze the radiological outcome after scarf osteotomy in dependence of additional Akin osteotomy. METHODS This study included 184 patients in whom a hallux valgus deformity was corrected with a scarf osteotomy (group S), and 63 patients in whom an additional Akin osteotomy was performed (group SA). Weight-bearing radiographs were evaluated preoperatively, postoperatively, after 6 weeks, after 3 months and at a follow-up with a mean of 45.4 months. Analysis was made for the following radiological parameters: the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), the proximal to distal phalangeal articular angle (PDPAA), and the position of the sesamoids as well as the joint congruity. RESULTS Radiographic recurrence (HVA > 20°) was detected in 1 patient (1.6% of recurrence) in the SA group, and in 27 patients in the S group (14.7% of recurrence) at follow-up. Outcome between the two groups differed significantly showing reduced loss of HVA correction in the SA group (p < 0.001). The subgroup with a preoperative PDPAA above eight degrees showed significant inferiority of outcome for the S group compared to the SA group. CONCLUSION Radiological outcome after scarf osteotomy is superior with concomitant Akin osteotomy. A preoperative PDPAA above eight degrees makes additional Akin osteotomy recommendable. LEVEL OF EVIDENCE Therapeutic, Level III, retrospective comparative series.
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Affiliation(s)
| | - Maximilian Hofmann
- Orthopedic Department, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - David Putzer
- Department of Experimental Orthopedics, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Philipp Hofer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Dietmar Dammerer
- Orthopedic Department, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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16
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Hatch DJ, Santrock RD, Smith B, Dayton P, Weil L. Triplane Hallux Abducto Valgus Classification. J Foot Ankle Surg 2019; 57:972-981. [PMID: 29784530 DOI: 10.1053/j.jfas.2018.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 02/03/2023]
Abstract
One of the most common procedures performed in the foot and ankle is correction of hallux abducto valgus deformity or "bunion surgery." Most foot and ankle surgeons recognize the challenges associated with defining each patient's individual deformity and selecting the optimal procedure for the best long-term results. Using current 2-dimensional algorithms that focus on the severity of the transverse plane deformity, surgical outcomes have varied. In the past 10 years, high recurrence and complication rates for popular procedures have been reported. In the same period, the reported data have elucidated an evolving anatomic understanding of the bunion deformity, with an expansion to 3 dimensions, including the frontal/coronal plane. We present a new classification and approach for the evaluation and procedure selection for bunion surgery. We hope this conceptual treatise on hallux abducto valgus based on clinical consensus and current data will stimulate academic discussion and further research. This anatomic classification is based on the 3-dimensional anatomy of the first ray.
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Affiliation(s)
- Daniel J Hatch
- Surgical Director, Northern Colorado Podiatric Medicine & Surgery Residency, Greeley, CO; Clinical Instructor, Dr William M Scholl College of Podiatric Medicine, North Chicago, IL.
| | - Robert D Santrock
- Assistant Professor and Chief of Foot & Ankle Surgery, Department of Orthopaedics, West Virginia University School of Medicine, Morgantown, WV
| | - Bret Smith
- Director, Foot & Ankle Division, Palmetto Health-USC Orthopedic Center, Columbia, SC; Assistant Professor, Orthopedics, University of South Carolina, Columbia, SC
| | - Paul Dayton
- Attending Staff, UnityPoint Clinic, Fort Dodge, IA; Assistant Professor, College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, IA
| | - Lowell Weil
- President and Fellowship Director, Weil Foot and Ankle Institute, Des Plaines, IL
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17
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Cai J, Qu F, Liu P, Zhao H, Wang J, Li Y, Zeng Q, Ji W, Liang X. [Effectiveness comparison between Scarf osteotomy combined with Akin osteotomy fixed by absorbable screws and fixed by metal screws for the treatment of moderate to severe hallux valgus]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1386-1391. [PMID: 30417612 DOI: 10.7507/1002-1892.201805116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the effectiveness of Scarf osteotomy combined with Akin osteotomy in the treatment of moderate to severe hallux valgus with absorbable screws or metal screws fixation by clinical and radiological data. Methods Between March 2014 and May 2016, the Scarf osteotomy combined with Akin osteotomy was used to treat 62 patients (83 feet) with moderate to severe hallux valgus. Twenty-five patients (35 feet) were fixed by absorbable screws (group A) and 37 patients (48 feet) were fixed by metal screws (group B). The difference in gender, age, affected side, etiology, severity, disease duration, preoperative hallux valgus angle (HVA) and first-second intermetatarsal angle (1-2IMA) measured in weight-bearing anteroposterior X-ray film, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and visual analogue scale (VAS) scores between 2 groups ( P>0.05). The complications and healing time of 2 groups were recorded and compared. At last follow-up, the AOFAS and VAS scores, and HVA, 1-2IMA measured by weight-bearing anteroposterior X-ray film were used to evaluate the effectiveness. Results All incisions healed by first intention and no incision-related complication occurred in the two groups after operation. Both groups were followed up, the follow-up time in group A was 12-36 months (mean, 24.4 months) and in group B was 14-38 months (mean, 25.7 months). In group A, 1 foot was complicated with hallux varus, 2 feet had mild stiffness, 1 foot appeared metastatic metatarsal pain, and in group B was 2, 3, 2 feet, respectively. There was no recurrence of hallux valgus in both groups. The difference in the incidence of complications between the two groups after the first operation was not significant ( χ 2=0.275, P=0.843). The removal rate of internal fixator in group B was 89.2% (33 cases) during the second operation, among which 3 cases had screw slip and 1 case had screw fracture. And 10.8% (4 cases) refused the second removal operation due to their age. Postoperative X-ray films showed that both groups had good healing at the osteotomy site, and there was no significant difference in healing time between the two groups ( t=1.633, P=0.285). At last follow-up, the AOFAS score, VAS score, HVA, and 1-2IMA were significantly improved in the two groups when compared with preoperative ones ( P<0.05); but no significant difference was found between the two groups ( P>0.05). Conclusion The effectiveness of Scarf osteotomy combined with Akin osteotomy in the treatment of moderate to severe hallux valgus is significant, with few complications. Compared with being fixed by metal screws, being fixed by absorbable screws has the same effectiveness, but can avoid the risk of second operation to remove the internal fixator.
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Affiliation(s)
- Jie Cai
- Xi'an Medical University, Xi'an Shaanxi, 710068, P.R.China
| | - Fufeng Qu
- Xi'an Medical University, Xi'an Shaanxi, 710068, P.R.China
| | - Peilong Liu
- Xi'an Medical University, Xi'an Shaanxi, 710068, P.R.China
| | - Hongmou Zhao
- Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Junhu Wang
- Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Yi Li
- Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Qiu Zeng
- Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Weina Ji
- Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Xiaojun Liang
- Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an Shaanxi, 710054,
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18
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Kaiser P, Livingston K, Miller PE, May C, Mahan S. Radiographic Evaluation of First Metatarsal and Medial Cuneiform Morphology in Juvenile Hallux Valgus. Foot Ankle Int 2018; 39:1223-1228. [PMID: 30070585 DOI: 10.1177/1071100718789696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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 of juvenile hallux valgus (JHV) has a high recurrence rate. The aim of this study was to better understand the pattern of radiographic deformity. METHODS Standing radiographs of 93 feet in 57 patients with JHV, and 50 feet in 36 normal patients were measured. Measurements included: hallux valgus angle (HVA), first metatarsal physis status (open or closed), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), Meary's angle, medial cuneiform angle (MCA), relative first to second metatarsal length ratio (1:2 MT ratio), cuneiform obliquity (CO), and congruency of the metatarsophalangeal joint (MTPJ). JHV groups were defined as normal (HVA 0-15 degrees), mild-moderate (HVA 15-35), or severe (HVA > 35) and were analyzed. RESULTS Seventy of 93 feet (75%) with JHV presented with mild-moderate JHV (average HVA of 26.2 ± 5.6 degrees), and 23 feet (25%, 23/93) presented with severe JHV (average HVA of 41.9 ± 5.3 degrees). Multivariable analysis determined that DMAA ( P < .001), MCA ( P = .04), and congruency ( P < .001) were independently associated with JHV and its severity (normal vs mild-moderate vs severe). Severe JHV cases had larger DMAA ( P = .01), larger IMA ( P = .01), larger 1:2 MT ratio ( P = .02), and were less frequently congruent ( P = .03) compared with mild-moderate JHV cases. CONCLUSION Deformity in JHV was highly correlated with both the proximal and distal morphology of the first metatarsal and medial cuneiform. Severe JHV was associated with increased bony deformity and increased incongruity of the MTPJ. Treatment should be individualized, but JHV treatment algorithms can take this information into account. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Philip Kaiser
- 1 Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kristin Livingston
- 2 Department of Orthopaedic Surgery, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Patricia E Miller
- 3 Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Collin May
- 3 Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Susan Mahan
- 3 Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
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19
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Wagner P, Wagner E. Is the Rotational Deformity Important in Our Decision-Making Process for Correction of Hallux Valgus Deformity? Foot Ankle Clin 2018; 23:205-217. [PMID: 29729795 DOI: 10.1016/j.fcl.2018.01.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Rotational deformity in hallux valgus is a recognized component and a demonstrated recurrence factor in patients who have undergone surgery. More than 20 years ago, publications started reporting metatarsal pronation as part of the hallux valgus pathology. Identifying metatarsal pronation should be part of the preoperative angular measurements. The proximal metatarsal rotational osteotomy and Lapidus fusion are some of the few techniques that reliably correct metatarsal pronation. They have good results, with more nonunions reported for the Lapidus. The authors present their hallux valgus treatment algorithm that includes metatarsus varus severity, tarsometatarsal instability, and rotational deformity among its variables.
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Affiliation(s)
- Pablo Wagner
- Universidad de los Andes - Hospital Militar de Santiago, Universidad del desarrollo - Clinica Alemana de Santiago, Av. Vitacura 5951, Vitacura, Santiago, Chile.
| | - Emilio Wagner
- Universidad del desarrollo - Clinica Alemana de Santiago, Av. Vitacura 5951, Vitacura, Santiago, Chile
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20
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Smith WB, Dayton P, Santrock RD, Hatch DJ. Understanding Frontal Plane Correction in Hallux Valgus Repair. Clin Podiatr Med Surg 2018; 35:27-36. [PMID: 29156165 DOI: 10.1016/j.cpm.2017.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hallux-abducto-valgus or "bunion" surgery is one of the most common surgical procedures for the foot and ankle specialist. As our understanding of the hallux-abducto-valgus deformity has grown, it is becoming clear that the anatomic CORA of the deformity may lie at the tarsometatarsal joint. There is also the component of the 3-dimensional nature of the deformity that may be best addressed at this CORA. With these issues in mind, it was necessary to address the shortcomings of the traditional Lapidus procedure and progress toward more consistent, instrumented steps that could address the 3-dimensional nature of the deformity.
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Affiliation(s)
- W Bret Smith
- Orthopedics, University of South Carolina, Palmetto Health-USC Orthopedic Center, 104 Saluda Pointe Drive, Lexington, SC 29072, USA.
| | - Paul Dayton
- Department of Podiatric Medicine and Surgery, College of Podiatric Medicine and Surgery, Des Moines University, UnityPoint Clinic, Trinity Regional Medical Center, 3200 Grand Avenue, Des Moines, IA 50312, USA
| | - Robert D Santrock
- Department of Orthopaedics, West Virginia University, 1 Medical Center Drive, PO Box 9100, Morgantown, WV 26506-9600, USA
| | - Daniel J Hatch
- Department of Podiatric Medicine and Surgery, North Colorado PMS Residency, 1600 23rd Avenue, Greeley, CO 80634, USA
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21
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Shibuya N, Thorud JC, Martin LR, Plemmons BS, Jupiter DC. Evaluation of Hallux Valgus Correction With Versus Without Akin Proximal Phalanx Osteotomy. J Foot Ankle Surg 2016; 55:910-4. [PMID: 27289220 DOI: 10.1053/j.jfas.2016.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Indexed: 02/03/2023]
Abstract
Although the efficacy of Akin proximal phalanx closing wedge osteotomy as a sole procedure for correction of hallux valgus deformity is questionable, when used in combination with other osseous corrective procedures, the procedure has been believed to be efficacious. However, a limited number of comparative studies have confirmed the value of this additional procedure. We identified patients who had undergone osseous hallux valgus correction with first metatarsal osteotomy or first tarsometatarsal joint arthrodesis with (n = 73) and without (n = 81) Akin osteotomy and evaluated their radiographic measurements at 3 points (preoperatively, within 3 months after surgery, and ≥6 months after surgery). We found that those people who had undergone the Akin procedure tended to have a larger hallux abduction angle and a more laterally deviated tibial sesamoid position preoperatively. Although the radiographic correction of the deformity was promising immediately after corrective surgery with the Akin osteotomy, maintenance of the correction was questionable in our cohort. The value of additional Akin osteotomy for correction of hallux valgus deformity is uncertain.
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Affiliation(s)
- Naohiro Shibuya
- Associate Professor, Department of Surgery, Texas A&M Health Science Center, College of Medicine, Temple, TX; Chief, Section of Podiatry, Central Texas Veterans Health Care System, Temple, TX; and Staff, Baylor Scott and White Health Care System, Temple, TX.
| | - Jakob C Thorud
- Staff, Section of Podiatry, Surgical Services, Central Texas Veterans Health Care System, Temple, TX; and Staff, Baylor Scott and White Health Care System, Temple, TX
| | - Lanster R Martin
- Podiatric Medicine and Surgery Resident, Scott and White Health Care System and Texas A&M Health Science Center, Temple, TX
| | - Britton S Plemmons
- Podiatric Medicine and Surgery Resident, Scott and White Health Care System and Texas A&M Health Science Center, Temple, TX
| | - Daniel C Jupiter
- Assistant Professor, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
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