Influence of Hindfoot Malalignment on Hallux Valgus Operative Outcomes

The efficacy of shoes modification and orthotics in hallux valgus deformity: a comprehensive review of literature

Hallux valgus (HV) is a frequent forefoot deformity affecting about 23% of adults and 35.7% of people over 65. The exact etiology is not fully understood. The first ray plays a significant role in walking cause it bears the principal amount of weight and maintains the position of the medial arch. Several factors that deteriorate the integrality of the first ray, such as foot deformities, restrictive footwear, and pes planus, may be ascribed to the HV occurrence. Before any surgical correction, conservative treatment should always be initiated first. Currently, there is no consensus that conservative management by shoe modification and foot orthoses could correct the pathology or terminate the clinical worsening of the condition.From a careful analysis of the literature, proper footwear should be a shoe with an adequate length, wide toe box, cushioned sole, and a lowered heel to not increase the load on the metatarsal heads and cause pain. Personalized 3D printed customized toe spreaders may be applied in patients with HV, improving symptoms and bringing pain relief. Compensating the subtalar joint hyperpronation through foot orthoses plays a fundamental role in the HV development, preventing or at least controlling the condition's progress; this, along with weight reduction and regular physical activity.Data obtained suggest that dynamic foot orthoses prefer a biomechanical type with 3/4-length, which is less likely to negatively affect the dorsal or medial pressures, which instead were noted to increase with the sulcus- and full-length orthoses.Although some studies suggest that foot orthoses would favor the correction of HV deformity, results have been very variable and just in few studies appear to correct HV or reduce its progression, improving symptoms and bringing pain relief. In the case of HV surgical correction, orthoses seem to maintain the correct position acquired over time.

Foot structural factors and ground reaction force in hallux valgus grades

BACKGROUND

Little attention has been paid to foot structural factors and ground reaction force in hallux valgus. Investigating the structural factors in detail and determining their biomechanical effects can help to better manage hallux valgus.

METHODS

In this case-control study, 120 females, 90 hallux valgus and 30 healthy, were recruited. Hallux valgus grades (mild, moderate, severe), first metatarsal mobility, foot pronation, hallux rotation, and pain were assessed by clinical tests. Ground reaction forces were measured in barefoot and shod conditions for both feet and analyzed using mixed within-between MANOVA. The association between structural factors and pain with force was analyzed using Spearman correlation coefficient.

RESULTS

The frequency of foot structural factors and pain severity were reported in hallux valgus grades. A significant difference was seen in the force values between groups (P<0.001). Bonferroni post hoc test indicated that the mean of the first peak for the severe group was significantly higher than the mild group (P=0.013) and the mean of second peak for the moderate group was higher than that of the healthy group (P=0.009). The force values were affected by wearing shoe (P<0.001) but not by foot side (P=0.086). There was a medium, positive correlation between the hallux rotation and force in the moderate group (r=0.39, P=0.03) and also between the pronation and force in the severe group (r=0.36, P=0.04).

CONCLUSION

Foot structural factors, pain, and force were different in each hallux valgus grads. Similar force in both feet, and increased force by wearing shoe were seen. The relationship between the pronation and hallux rotation with force revealed the importance of these factors from the biomechanical viewpoint.

Management of Complications After Hallux Valgus Reconstruction

Complications following hallux valgus (HV) reconstruction will have an expected incidence of between 10% and 55% of cases. The more commonly reported complications include undercorrection/recurrence, overcorrection (hallux varus), transfer metatarsalgia, nonunion, malunion, avascular necrosis, arthritis, hardware removal, nerve injury, and ultimately patient dissatisfaction. The presence of arthritis will be an indication for fusion, whereas osteotomies will be the procedure of choice if the first metatarsophalangeal joint is healthy. Wide experience in primary HV surgery is advised before dealing with complex cases of failed HV surgery.

The impact of hindfoot deformities for the recurrence of hallux valgus after joint-preserving surgeries for rheumatoid forefoot deformities

BACKGROUND

Recurrence of hallux valgus (HV) is a common complication after forefoot surgery for rheumatoid forefoot deformities. The aim of this study is to evaluate the impact of hindfoot malalignment on recurrence.

METHODS

This was a retrospective observational study designed to analyze the radiographic outcomes of 87 feet in 64 patients with rheumatoid arthritis treated with a joint-preserving surgery for HV deformity. Differences in hindfoot alignment preoperatively between the recurrence and nonrecurrence groups was compared.

RESULTS

There were no significant differences in hindfoot alignment preoperatively between groups. To estimate the impact of technical problems, the HV and intermetatarsal angles measured from radiographs 3 months postoperatively were compared between groups. The HV angles in the recurrence group were significantly larger than those in the nonrecurrence group (p=0.02).

CONCLUSIONS

There were no significant differences between preoperative hindfoot malalignment and postoperative recurrence of HV in rheumatoid forefoot surgeries.