1
|
Kang HJ, Lim JW, Im JM, Woo Y, Jung HG. Improvement of Valgus Deviation of the Lesser Toes of Moderate to Severe Hallux Valgus After Proximal Chevron Metatarsal Osteotomy and Akin Osteotomy. Foot Ankle Int 2024; 45:485-495. [PMID: 38348624 DOI: 10.1177/10711007241228273] [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: 05/12/2024]
Abstract
BACKGROUND This study examines the correction of lesser toe valgus deviation following proximal chevron metatarsal osteotomy (PCMO) and Akin osteotomy in moderate to severe hallux valgus patients, while identifying influencing factors. METHOD Among 89 patients (116 feet), those with moderate to severe hallux valgus underwent PCMO and Akin osteotomy. Radiologic assessments included preoperative metatarsus adductus angle (MAA), hallux valgus angle (HVA), intermetatarsal angle (IMA), valgus angles of the second to fourth metatarsophalangeal joints, and hallux valgus recurrence. Assessments included visual analog scale (VAS) pain scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores, and patient satisfaction over an average follow-up of 30.6 ± 21.2 (range, 12-99) months. RESULTS The mean preoperative HVA of 34.4 degrees decreased to 8.7 degrees at final follow-up. The valgus angles of the second, third, and fourth toes improved by 37.1%, 27%, and 44.5%, respectively. In metatarsus adductus patients, lesser toe valgus angles were significantly higher both preoperatively and at final follow-up. Hallux valgus recurrence patients had higher preoperative and final follow-up IMA and valgus angles in the second and third toes. Nonrecurrence patients showed greater decreases in these angles. A larger HVA correction corresponded to a greater decrease in lesser toe valgus deviation. VAS and AOFAS scores improved significantly at the last follow-up. CONCLUSION The study found a significant reduction in the valgus angle of the second, third, and fourth toes after PCMO and Akin osteotomy in moderate to severe hallux valgus cases, without additional surgeries on lesser toes. The lesser toe angular reductions were less pronounced in patients with metatarsus adductus or with hallux valgus recurrence. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
- Hwa Jun Kang
- Department of Orthopedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasung, Republic of Korea
| | - Jung-Won Lim
- Department of Orthopedic Surgery, Chung-Ang University Gwang-Myeong Hospital, Gwangmyeong, Republic of Korea
| | - Je-Min Im
- Department of Orthopedic Surgery, The Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Youngje Woo
- Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hong-Geun Jung
- Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
2
|
Unterfrauner I, Andronic O, Viehöfer AF, Wirth SH, Berli MC, Waibel FWA. Ulcer occurrence on adjacent toes and hallux valgus deformity after amputation of the second toe in diabetic patients. J Orthop Surg Res 2023; 18:99. [PMID: 36782206 PMCID: PMC9926725 DOI: 10.1186/s13018-023-03577-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/03/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Amputation of the second toe is associated with destabilization of the first toe. Possible consequences are hallux valgus deformity and subsequent pressure ulcers on the lateral side of the first or on the medial side of the third toe. The aim of this study was to investigate the incidence and possible influencing factors of interdigital ulcer development and hallux valgus deformity after second toe amputation. METHODS Twenty-four cases of amputation of the second toe between 2004 and 2020 (mean age 68 ± 12 years; 79% males) were included with a mean follow-up of 36 ± 15 months. Ulcer development on the first, third, or fourth toe after amputation, the body mass index (BMI) and the amputation level (toe exarticulation versus transmetatarsal amputation) were recorded. Pre- and postoperative foot radiographs were evaluated for the shape of the first metatarsal head (round, flat, chevron-type), the hallux valgus angle, the first-second intermetatarsal angle, the distal metatarsal articular angle and the hallux valgus interphalangeal angle by two orthopedic surgeons for interobserver reliability. RESULTS After amputation of the second toe, the interdigital ulcer rate on the adjacent toes was 50% and the postoperative hallux valgus rate was 71%. Neither the presence of hallux valgus deformity itself (r = .19, p = .37), nor the BMI (r = .09, p = .68), the shape of the first metatarsal head (r = - .09, p = .67), or the amputation level (r = .09, p = .69) was significantly correlated with ulcer development. The interobserver reliability of radiographic measurements was high, oscillating between 0.978 (p = .01) and 0.999 (p = .01). CONCLUSIONS The interdigital ulcer rate on the first or third toe after second toe amputation was 50% and hallux valgus development was high. To date, evidence on influencing factors is lacking and this study could not identify parameters such as the BMI, the shape of the first metatarsal head or the amputation level as risk factors for the development of either hallux valgus deformity or ulcer occurrence after second toe amputation. TRIAL REGISTRATION BASEC-Nr. 2019-01791.
Collapse
Affiliation(s)
- Ines Unterfrauner
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Octavian Andronic
- grid.7400.30000 0004 1937 0650Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Arnd F. Viehöfer
- grid.7400.30000 0004 1937 0650Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stephan H. Wirth
- grid.7400.30000 0004 1937 0650Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Martin C. Berli
- grid.7400.30000 0004 1937 0650Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Felix W. A. Waibel
- grid.7400.30000 0004 1937 0650Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| |
Collapse
|
3
|
Wong DWC, Cheung JCW, Zhao JG, Ni M, Yang ZY. Forefoot Function after Hallux Valgus Surgery: A Systematic Review and Meta-Analysis on Plantar Load Measurement. J Clin Med 2023; 12:jcm12041384. [PMID: 36835920 PMCID: PMC9965975 DOI: 10.3390/jcm12041384] [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: 12/14/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
While hallux valgus (HV) surgeries are useful for correcting skeletal alignment problems, their effects on plantar load, which reflects forefoot functions, are less understood. The objective of this study is to conduct a systematic review and meta-analysis on the plantar load change after HV surgeries. A systematic search of Web of Science, Scopus, PubMed, CENTRAL, EMBASE, and CINAHL was performed. Studies that assessed the pre- and post-operative plantar pressure of HV patients undergoing surgeries and reported load-related parameters over the hallux, medial metatarsal, and/or central metatarsal regions were included. Studies were appraised by using the modified NIH quality assessment tool for before-after study. Studies suitable for meta-analysis were pooled with the random-effects model, using the standardized mean difference of the before-after parameters as an effect measure. Twenty-six studies containing 857 HV patients and 973 feet were included for the systematic review. Meta-analysis was conducted on 20 of them, and most studies did not favor HV surgeries. Overall, HV surgeries reduced the plantar load over the hallux region (SMD -0.71, 95% CI, -1.15 to -0.26), indicating that forefoot function worsened after surgeries. For the other five outcomes, the overall estimates were not statistically significant, indicating that surgeries did not improve them either. There was substantial heterogeneity among the studies, which in most cases could not be resolved by pre-planned subgroup analyses by surgical classification, year of publication, median age of patients, and length of follow-up. Sensitivity analysis removing lower-quality studies showed that the load integrals (impulse) over the central metatarsal region significantly increased (SMD 0.27, 95% CI, 0 to 0.53), indicating that surgeries increased the risk of transfer metatarsalgia. There is no solid evidence that HV surgeries could improve forefoot functions from a biomechanical point perspective. Currently available evidence even suggests that surgeries might reduce the plantar load over the hallux and adversely affect push-off function. The reasons behind and the effectiveness of alternative surgical methods warrant further investigation.
Collapse
Affiliation(s)
- Duo Wai-Chi Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - James Chung-Wai Cheung
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Jia-Guo Zhao
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin 300211, China
| | - Ming Ni
- Department of Science Development, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai 200240, China
- Department of Orthopaedics, Pudong New Area People’s Hospital, Shanghai 201299, China
| | - Zu-Yao Yang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
- Correspondence: ; Tel.: +852-2252-8739
| |
Collapse
|
4
|
Menz HB, Lim PQ, Hurn SE, Mickle KJ, Buldt AK, Cotchett MP, Roddy E, Wluka AE, Erbas B, Munteanu SE. Footwear, foot orthoses and strengthening exercises for the non-surgical management of hallux valgus: protocol for a randomised pilot and feasibility trial. J Foot Ankle Res 2022; 15:45. [PMID: 35655233 PMCID: PMC9162879 DOI: 10.1186/s13047-022-00553-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background Hallux valgus is a common and disabling condition. This randomised pilot and feasibility trial aims to determine the feasibility of conducting a fully-powered parallel group randomised trial to evaluate the effectiveness of a multifaceted non-surgical intervention for reducing pain associated with hallux valgus. Methods Twenty-eight community-dwelling women with painful hallux valgus will be randomised to receive either a multifaceted, non-surgical intervention (footwear, foot orthoses, foot exercises, advice, and self-management) or advice and self-management alone. Outcome measures will be obtained at baseline, 4, 8 and 12 weeks. The primary outcome is feasibility, which will be evaluated according to demand, acceptability, adherence, adverse events, and retention rate. Limited efficacy testing will be conducted on secondary outcome measures including foot pain (the Manchester-Oxford Foot Questionnaire), foot muscle strength (hand-held dynamometry), general health-related quality of life (the Short Form-12), use of cointerventions, and participants’ perception of overall treatment effect. Biomechanical testing will be conducted at baseline to evaluate the immediate effects of the footwear/orthotic intervention on pressure beneath the foot and on the medial aspect of the first metatarsophalangeal joint and hallux. Discussion This study will determine the feasibility of conducting a fully-powered randomised trial of footwear, foot orthoses, foot exercises, advice and self-management for relieving pain associated with hallux valgus and provide insights into potential mechanisms of effectiveness. Trial registration Australian and New Zealand Clinical Trial Registry (ACTRN12621000645853). Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00553-4.
Collapse
Affiliation(s)
- Hylton B Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Polly Q Lim
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia
| | - Karen J Mickle
- School of Environment and Life Sciences, College of Engineering, Science and Environment, University of Newcastle, Ourimbah, NSW, 2258, Australia
| | - Andrew K Buldt
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Matthew P Cotchett
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, ST5 5BG, Staffordshire, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Burslem, ST6 7AG, Staffordshire, UK
| | - Anita E Wluka
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Shannon E Munteanu
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| |
Collapse
|
5
|
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
| |
Collapse
|
6
|
Tan CC, Sayampanathan AA, Kwan YH, Yeo W, Singh Rikhraj I, Yeo NEM. Validity and Reliability of the American Orthopaedic Foot and Ankle Society Score for the English-Literate Singapore Population With Hallux Valgus. Foot Ankle Spec 2022:19386400221079490. [PMID: 35189715 DOI: 10.1177/19386400221079490] [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: 12/25/2022]
Abstract
BACKGROUND This study aimed to evaluate the reliability and validity of the American Orthopaedic Foot and Ankle Society Metatarsophalangeal-Interphalangeal (AOFAS MTP-IP) score in patients with hallux valgus in Singapore. METHOD A total of 121 English-literate patients with hallux valgus identified between October 2017 and May 2020 were analyzed. Reliability was assessed via Cronbach α. Construct validity was evaluated through 20 a priori hypotheses by correlating the AOFAS MTP-IP score for hallux and lesser toes with other patient-reported outcome measures (PROMs). Standardized response means (SRMs) were calculated to evaluate responsiveness at 6 months postoperative. Structural validity was evaluated via confirmatory factor analysis (CFA) whereby a good fit was indicated when comparative fit index (CFI) is >0.95, Tucker-Lewis index (TLI) is >0.95 and standardized root mean residual (SRMR) is <0.08. RESULTS The AOFAS MTP-IP score demonstrated reliability with a Cronbach α of 0.837. Convergent construct validity was confirmed when all a priori hypotheses were fulfilled. Structural validity was established with our AOFAS MTP-IP score model that displayed good fit for a 1-factor structure (CFI = 0.988, TLI = 0.960, SRMR = 0.034). Responsiveness of the AOFAS MTP-IP score for hallux was demonstrated by an SRM score of 1.28. CONCLUSION The AOFAS MTP-IP score displayed adequate reliability and validity among English-literate patients in Singapore with an operatively managed hallux valgus. LEVEL OF EVIDENCE Level III: Retrospective cohort study.
Collapse
Affiliation(s)
- Chin Chuen Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - William Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | | |
Collapse
|
7
|
Fujitaka K, Tanaka Y, Taniguchi A, Ogawa M, Isomoto S, Otuki S, Okubo M. Pathoanatomy of the Jones Fracture in Male University Soccer Players. Am J Sports Med 2020; 48:424-431. [PMID: 31887064 DOI: 10.1177/0363546519893365] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Jones fractures are relatively common in soccer players and require an extended recovery period because this type of fracture has a high incidence of delayed union, nonunion, and refracture. There has been some previous research on risk factors for Jones fracture, but no study has yet investigated the effect of the length of the fifth metatarsal bone and the positional relationship of the articular surface of the fifth metatarsal bones and the tarsal bones. Clarification of the characteristics of the foot structure that predispose soccer players to Jones fracture may aid in the prevention of this injury. PURPOSE To investigate the association between Jones fracture and foot structure as assessed with a mapping system on weightbearing dorsoplantar and lateral foot radiographs. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS We used a mapping system to evaluate the radiographs of 60 feet from 30 university soccer players with Jones fractures and a control group of 60 feet from 60 male university soccer players without Jones fracture. The groups were compared regarding the length of the fifth metatarsal and the positions of the metatarsal and tarsal bones. RESULTS Analysis of weightbearing dorsoplantar foot radiographs showed that the fifth metatarsal was significantly longer and that its proximal tip was positioned more proximally in the Jones fracture group as compared with the control group. Analysis of weightbearing lateral foot radiographs showed that the reference points for the medial arch were significantly higher in the Jones fracture group than in the control group. CONCLUSION This study indicated that the proximally longer fifth metatarsal may cause greater stress at the base of the fifth metatarsal bone because the lever arm becomes long. In addition, high medial longitudinal arch may contribute to increased load on the lateral side of the foot. Thus, these anatomic features may be useful to identify soccer players at high risk of Jones fracture at medical checkup.
Collapse
Affiliation(s)
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Akira Taniguchi
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Munehiro Ogawa
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Shinji Isomoto
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Shingo Otuki
- Department of Sport and Health Science, Osaka Sangyo University, Osaka, Japan
| | - Mamoru Okubo
- Department of Orthopaedic Surgery, Kishima Honin Hospital, Osaka, Japan
| |
Collapse
|
8
|
Cronin S, Conti M, Williams N, Ellis SJ. Relationship Between Demographic and Radiographic Characteristics and Second Ray Pathology in Hallux Valgus Patients. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420909088. [PMID: 35097369 PMCID: PMC8697280 DOI: 10.1177/2473011420909088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Hallux valgus can alter load bearing in the foot leading to abnormal forces on the second toe. The purpose of this study was to determine demographic and radiographic factors associated with second ray hammertoes in hallux valgus using 3-dimensional weightbearing CT scans. METHODS Seventy-one patients who underwent a modified Lapidus procedure for hallux valgus with preoperative weightbearing CT scans were separated into 2 groups: (1) hallux valgus only (47 feet) and (2) hallux valgus with second ray hammertoe (29 feet). Preoperative age, body mass index (BMI), sex, hallux valgus angle (HVA), intermetatarsal angle (IMA), absolute and effective metatarsal (MT) lengths, ratios between metatarsal lengths, Meary angle, metatarsus adductus angle (MAA), and pronation were measured. Mean values of continuous variables were compared and both simple and multivariable logistic regression models were used to evaluate associations between variables and hammertoe occurrence. RESULTS Patients in the hammertoe group were found to be significantly older and have higher BMIs, HVAs, effective second MT lengths, IMAs, and more apex plantar Meary angles (all P < .05). The multivariable analysis demonstrated that a higher IMA and a more apex plantar Meary angle were the only significant predictors of second ray hammertoe risk (P = .03 and P = .01, respectively) once corrected for age and BMI. CONCLUSION Significant associations were found between older age, higher BMI, and more severe deformity and the occurrence of hammertoe in hallux valgus patients. These results may help clinicians counsel hallux valgus patients about the risk of developing an advanced hammertoe deformity. LEVEL OF EVIDENCE Level III, retrospective comparative series.
Collapse
Affiliation(s)
| | | | - Nicholas Williams
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | | |
Collapse
|
9
|
Li HT, Bao BX, Zhang JZ. Effects of Single-Foot Centered and Double-Foot Centered X-ray Projection on Hallux Valgus Measurement. Orthop Surg 2019; 12:94-99. [PMID: 31840344 PMCID: PMC7031610 DOI: 10.1111/os.12588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 11/13/2019] [Accepted: 11/17/2019] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate whether use of single‐foot centered and double‐foot centered weight‐bearing X‐rays has an impact on the relevant indicators of hallux valgus. Methods A total of 55 female patients from the Department of Ankle Surgery of Beijing Tongren Hospital with hallux valgus (110 feet) were collected from September to December 2015. The age of these patients ranged from 18 to 43 years, with an average age of 47.9 ± 8.5 years. All selected patients fit the diagnostic criteria of hallux valgus and had weight‐bearing single foot centered and double foot centered radiographs taken. During the projection, all patients were instructed to stand on the X‐ray box, with the knee joint straightened and legs perpendicular to the floor. The projection center of the single foot was directed at the lateral part of the scaphoid bone of the foot, while the projection center was directed at the position between the scaphoid bones of both feet for the double‐foot shooting. The hallux valgus angle (HAV), the intermetatarsal angle between the first and second metatarsals (IMA), the intermetatarsal angle between the first and fifth metatarsals (IM1‐5), and the metatarsal adduction angle (MAA) were measured and examined. The difference between these two shooting conditions was compared and analyzed. Results The differences in X‐ray measurement results (IMA, HAV, IM1‐5, and MMA) between different measures for the same patient were not statistically significant. The values of HAV, IMA, IM1‐5, and MAA are common indexes for evaluating hallux valgus. The average IMA was 15.9° for single‐foot centered and 14.1° for double‐foot centered X‐rays. The average HAV was 30.2° for single‐foot centered and 29.7° for double‐foot centered X‐rays. The average IM1‐5 was 31.1° for single‐foot centered and 29.7° for double‐foot centered X‐rays. The average of metatarsal adduction angle was 13.8° for single‐foot centered and 14.1° for double‐foot centered X‐rays. The differences between single‐foot centered and double‐foot centered X‐rays were statistically significant in terms of the measurement index (P < 0.05). In addition, compared with double‐foot centered weight‐bearing X‐rays, the focus of single‐foot centered X‐rays was located on the lateral part of the scaphoid bone of the foot, and the ray was closer to the vertical foot in the single‐foot centered weight‐bearing X‐ray. Conclusion When the weight‐bearing position and projection distance are the same, the single‐foot centered weight‐bearing X‐ray is more effective in evaluating the severity of hallux valgus compared with the double‐foot centered weight‐bearing X‐ray.
Collapse
Affiliation(s)
- Hai-Tao Li
- Department of Orthopaedics, Tongren Hospital of China Capital Medical University, Beijing, China
| | - Bei-Xi Bao
- Department of Orthopaedics, Tongren Hospital of China Capital Medical University, Beijing, China
| | - Jian-Zhong Zhang
- Department of Orthopaedics, Tongren Hospital of China Capital Medical University, Beijing, China
| |
Collapse
|
10
|
Ohara K, Tanaka Y, Taniguchi A, Kurokawa H, Kumai T, Yamada H. Is metatarsus primus elevatus truly observed in hallux rigidus? Radiographic study using mapping methods. J Orthop Sci 2019; 24:312-319. [PMID: 30279135 DOI: 10.1016/j.jos.2018.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/27/2018] [Accepted: 09/02/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hallux rigidus and metatarsus primus elevatus (MPE) are associated, but their causal relationship remains unknown. Several surgical approaches for treating hallux rigidus are available. We evaluated morphological characteristics of hallux rigidus with different grades to determine the optimal surgical approach. The amount of degenerative change in the metatarsophalangeal joint on the preoperative roentgenograms was graded on a scale of 1-3. We analyzed the morphology of hallux rigidus using X-ray image mapping developed by our team. METHODS This study involved weight-bearing, dorsoplantar, and lateral foot X-rays of 36 feet from 26 patients underwent surgery for hallux rigidus (Group R) at our institution, and 26 normal feet (Group N). A two-dimensional coordinate system was used to analyze the sharps of these feet by converting each dot on the radiographs into X and Y coordinates. Diagrams of the feet from each group were drawn for comparison. Feet with grades 2 (Group R2) and 3 (Group R3) hallux rigidus and normal feet were compared by Kruskal-Wallis test. RESULTS Mapping revealed that the tip of distal phalanges of the second, and third toes in Group R medially shifted (P < 0.05) in dorsoplantar image of the feet, and that the medial point, a part of the talus, navicular, cuneiform, and first metatarsal bone in Group R, shifted lower (P < 0.05) in lateral feet images of the feet. Multiple comparisons revealed a significant navicular bone depression in grade 3 hallux rigidus compared with normal feet. A significant difference was observed between Group N and R3 but not between Group R2 and N or R3. CONCLUSIONS X-ray morphological analysis of the foot revealed MPE in Group R. Elevation gradually increased as hallux rigidus grade worsened. Therefore, osteotomy combined with cheilectomy, whereby the first metatarsal bone can be tilted toward the plantar side, are useful for treating a higher-grade hallux rigidus. LEVEL OF EVIDENCE Level III, comparative study.
Collapse
Affiliation(s)
- Kuniji Ohara
- Takagi Hospital, Department of Orthopaedic Surgery, Nagoya, Aichi, 4670806, Japan; Nara Medical University, Department of Orthopaedic Surgery, Kashihara, Nara, 6348522, Japan.
| | - Yasuhito Tanaka
- Nara Medical University, Department of Orthopaedic Surgery, Kashihara, Nara, 6348522, Japan
| | - Akira Taniguchi
- Nara Medical University, Department of Orthopaedic Surgery, Kashihara, Nara, 6348522, Japan
| | - Hiroaki Kurokawa
- Nara Medical University, Department of Orthopaedic Surgery, Kashihara, Nara, 6348522, Japan
| | - Tsukasa Kumai
- Nara Medical University, Department of Orthopaedic Surgery, Kashihara, Nara, 6348522, Japan
| | - Harumoto Yamada
- Fujita Health University, Department of Orthopaedic Surgery, Toyoake, Aichi, 4701192, Japan
| |
Collapse
|
11
|
Kokubo T, Hashimoto T, Suda Y, Waseda A, Ikezawa H. Radiographic Shape of Foot With Second Metatarsophalangeal Joint Dislocation Associated With Hallux Valgus. Foot Ankle Int 2017; 38:1374-1379. [PMID: 28934874 DOI: 10.1177/1071100717728579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Second metatarsophalangeal (MTP) joint dislocation is associated with hallux valgus, and the treatment of complete dislocation can be difficult. The purpose of this study was to radiographically clarify the characteristic foot shape in the presence of second MTP joint dislocation. METHODS Weight-bearing foot radiographs of the 268 patients (358 feet) with hallux valgus were examined. They were divided into 2 groups: those with second MTP joint dislocation (study group = 179 feet) and those without dislocation (control group = 179 feet). Parameters measured included the hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), second MTP joint angle, hallux interphalangeal angle (IPA), second metatarsal protrusion distance (MPD), metatarsus adductus angle (MAA), and the second metatarsal declination angle (2MDA). Furthermore, the dislocation group was divided into 3 subgroups according to second toe deviation direction: group M (medial type), group N (neutral type), and group L (lateral type). RESULTS The IPA and the 2MDA were significantly greater in the study group than in the control group. By multiple comparison analysis, the IMA was greatest in group M and smallest in group L. The IPA was smaller and 2MDA greater in group N than in group L. The HVA and MAA in group L were greatest, and MPD in group L was smallest. CONCLUSIONS The patients with second MTP joint dislocation associated with hallux valgus had greater hallux interphalangeal joint varus and a second metatarsal more inclined than with hallux valgus alone. The second toe deviated in a different direction according to the foot shape. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Tetsuro Kokubo
- 1 Department of Orthopedics Surgery, Kyosai Tachikawa Hospital, Tachikawa City, Tokyo, Japan
| | - Takeshi Hashimoto
- 2 Sports Medicine Research Center, Keio University, Yokohama City, Kanagawa, Japan
| | - Yasunori Suda
- 3 Department of Orthopedics Surgery, International University of Health and Welfare, Shioya Hospital, Yaita City, Tochigi, Japan
| | - Akeo Waseda
- 4 Department of Orthopedics Surgery, Ogikubo Hospital, Suginami-ku, Tokyo, Japan
| | - Hiroko Ikezawa
- 5 Department of Orthopedics Surgery, Eiju Hospital, Taito-ku, Tokyo, Japan
| |
Collapse
|
12
|
Palomo-López P, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Rodríguez-Sanz D, Calvo-Lobo C, López-López D. Impact of Hallux Valgus related of quality of life in Women. Int Wound J 2016; 14:782-785. [PMID: 27928895 DOI: 10.1111/iwj.12695] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 10/26/2016] [Accepted: 11/06/2016] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study is to analyse and compare the impact of hallux valgus (HV) in a sample of adult women with varying degrees of HV scores obtained with regard to foot health and health in general. A total 100 female patients of mean age 43·04 ± 16·84 years who attended a podiatric clinic were asked to answer a questionnaire. The degree of deformity, HV, was determined on both feet of the patients using the Manchester Scale tool and the scores from the Foot Health Status Questionnaire were compared. Participants with varying degrees of HV recorded lower scores in Section 1 for the footwear and general foot health and higher scores for foot pain and foot function. In Section 2, they obtained lower scores in physical activity and social capacity and higher scores in vigour and general health. Differences between the four groups were evaluated by means of a t-test for independent samples, showing statistical significance (P < 0·001). This study has detected measurable differences of association between varying degrees of HV with impaired quality of life related to foot health in women.
Collapse
Affiliation(s)
| | | | | | - David Rodríguez-Sanz
- Department, Faculty of Health, Exercise and Sport, European University of Madrid, Madrid, Spain
| | - César Calvo-Lobo
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Universidad Autónoma de Madrid, Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
| |
Collapse
|
13
|
Roll C, Forray M, Kinner B. [Amputation and exarticulation of the lesser toes]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2016; 28:345-51. [PMID: 27259483 DOI: 10.1007/s00064-016-0451-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/10/2016] [Accepted: 03/11/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Amputations and exarticulations of the toes may be necessary due to several reasons. The goal is to remove necrosis or infection prior to its spread to the midfoot region. From a functional or cosmetic point of view, amputation/exarticulation of a single toe plays no major role. However, this can be different with exarticulation of several toes. INDICATIONS Necrosis, trauma, infection, tumor, deformity. CONTRAINDICATIONS Conditions where amputation/exarticulation of a toe is insufficient, e. g., in progressing peripheral arterial disease. SURGICAL TECHNIQUE The toe can either be amputated through the distal phalanx or exarticulated in the metatarsophalangeal joint. POSTOPERATIVE MANAGEMENT Orthopedic shoes or orthotic devices are rarely necessary when a single toe is amputated/exarticulated. However, concomitant deformities of the foot have to be thoroughly addressed. If more than one toe is amputated, silicone spacers may be necessary to prevent the remaining toes from deviating. RESULTS Amputations and exarticulations of the toes are frequent and the procedure is technically simple. However, the complication rate is high due to typical indications making amputation necessary.
Collapse
Affiliation(s)
- C Roll
- Zentrum für Ambulante Rehabilitation, Regensburg, Deutschland
| | - M Forray
- Abteilung für Orthopädie und Unfallchirurgie, Robert-Bosch-Krankenhaus, Auerbachstr. 110, Stuttgart, Deutschland
| | - B Kinner
- Abteilung für Orthopädie und Unfallchirurgie, Robert-Bosch-Krankenhaus, Auerbachstr. 110, Stuttgart, Deutschland.
| |
Collapse
|
14
|
Shimobayashi M, Tanaka Y, Taniguchi A, Kurokawa H, Tomiwa K, Higashiyama I. Radiographic Morphologic Characteristics of Bunionette Deformity. Foot Ankle Int 2016; 37:320-6. [PMID: 26578480 DOI: 10.1177/1071100715614923] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Bunionette deformity is characterized as head hypertrophy, lateral bowing, or splaying of the fifth metatarsal, or a combination of these deformities. Most previous studies have focused on the fourth and fifth metatarsals; few have analyzed the radiographic morphologic characteristics of the entire foot. The morphologic characteristics of the entire foot in cases of symptomatic bunionette deformity were analyzed with a radiographic image-mapping system. METHODS The system was used for the morphologic analysis of 112 feet with symptomatic deformity and 123 asymptomatic control feet. The mapping system includes 2-dimensional coordinates. We compared morphologies of both groups on the basis of simple models prepared from x and y coordinates of each reference point, calculated by using the mapping system and various angle measurements. We set cutoff values and categorized cases according to Fallat's system. We evaluated the characteristics of each type and a new deformity type (type V) wherein no measurement exceeded the cutoff values. RESULTS The heads of the third, fourth, and fifth metatarsals were more laterally displaced, and the angles between the metatarsal axes were larger in the deformity group. Comparison of deformity types showed that the morphology of the fifth metatarsal might be only one cause of deformity. The intermetatarsal angles between the second and third metatarsals and between the third and fourth metatarsals were larger in deformity type II and type V feet than in control feet. Additionally, the intermetatarsal angles between the third and fourth metatarsals and between the fourth and fifth metatarsals were larger in deformity type III and type IV feet than in control feet. CONCLUSION We believe it is necessary to not only focus on the fourth and fifth metatarsals, but also assess the morphologic characteristics of the entire foot in patients with a bunionette, including splaying of all the metatarsals and the forefoot width, when planning surgery. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Mikio Shimobayashi
- Department of Orthopaedic Surgery, Yoshino Hospital, Yoshino gun Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara city Nara, Japan
| | - Akira Taniguchi
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara city Nara, Japan
| | - Hiroaki Kurokawa
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara city Nara, Japan
| | - Kiyonori Tomiwa
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara city Nara, Japan
| | - Ichiro Higashiyama
- Department of Orthopaedic Surgery, Matsukura Hospital, Nara city Nara, Japan
| |
Collapse
|