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Hosokawa T, Ikoma K, Maki M, Kido M, Hara Y, Sotozono Y, Takahashi K. Relationship between arthritis of the second and third tarsometatarsal joints and incongruity of the first tarsometatarsal joint in patients with hallux valgus. Mod Rheumatol 2024; 34:410-413. [PMID: 36688576 DOI: 10.1093/mr/road009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/12/2022] [Accepted: 01/04/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Hallux valgus is associated with tarsometatarsal arthritis; its pathophysiology remains unknown. Therefore, we aimed to elucidate the relationship between arthritis of the second and third tarsometatarsal joints and incongruity of the first tarsometatarsal joint in the sagittal plane. METHODS Forty-three patients (64 feet) with hallux valgus who underwent surgery at University Hospital Kyoto Prefectural University of Medicine were included and divided into two groups: control (without second and third tarsometatarsal joint degeneration) and osteoarthritis (with second and third tarsometatarsal joint degeneration). Intergroup comparisons of the incongruity of the first tarsometatarsal joint in the sagittal plane, age, body mass index, hallux valgus angle, first-second intermetatarsal angle, metatarsus adductus angle, Meary's angle, and calcaneal pitch angle were performed. RESULTS The proportion of patients with incongruity of the first tarsometatarsal joint was significantly higher in the osteoarthritis group than in the control group. Logistic regression analysis identified incongruity of the first tarsometatarsal joint and metatarsus adductus angle as significant related factors for arthritis of the second and third tarsometatarsal joints. CONCLUSIONS Incongruity of the first tarsometatarsal joint in the sagittal plane was involved in the development of arthritis of the second and third tarsometatarsal joints in patients with hallux valgus.
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Affiliation(s)
- Toshihiro Hosokawa
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuya Ikoma
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Maki
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masamitsu Kido
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yusuke Hara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasutaka Sotozono
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Watanabe K, Kubota M, Tanaka H, Nishiyama T, Hirao M, Fukushi JI, Kakihana M, Nozawa D, Okuda R. Japanese Orthopaedic Association (JOA) Clinical Practice Guidelines on the Management of Hallux Valgus - Secondary publication. J Orthop Sci 2024; 29:1-26. [PMID: 37451976 DOI: 10.1016/j.jos.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Kota Watanabe
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Japan.
| | - Makoto Kubota
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirofumi Tanaka
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Hyakutake Orthopedic Surgery and Sports Clinic, Saga, Japan
| | - Takayuki Nishiyama
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Makoto Hirao
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Jun-Ichi Fukushi
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Masataka Kakihana
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Japan
| | - Daisuke Nozawa
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryuzo Okuda
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Rakusai-Shimizu Hospital, Kyoto, Japan
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Shima H, Togei K, Hirai Y, Yasuda T, Okuda R, Neo M. Operative outcomes of hallux valgus with painful osteoarthritis of the lesser tarsometatarsal joints. J Orthop Sci 2024; 29:230-235. [PMID: 36564235 DOI: 10.1016/j.jos.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/03/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hallux valgus is sometimes accompanied by osteoarthritis of the lesser tarsometatarsal joint. However, information on the operative procedures and outcomes for the treatment of hallux valgus with osteoarthritis of the lesser tarsometatarsal joint simultaneously is limited. We aimed to describe this operative procedure and evaluate the outcomes of the treatment of hallux valgus with osteoarthritis of the lesser tarsometatarsal joint. METHODS Fifteen patients (17 feet; average age, 66.9 years; average follow-up, 59.4 months; and minimum follow-up, 24 months) with symptomatic hallux valgus accompanied by painful osteoarthritis of the lesser tarsometatarsal joint were enrolled. All feet showed osteoarthritis of the second and/or third tarsometatarsal joint on dorsoplantar weight-bearing radiograph. The operative procedure included a proximal osteotomy of the first metatarsal and arthrodesis of the lesser tarsometatarsal joint with an autologous bone graft. RESULTS The mean Japanese Society for Surgery of the Foot hallux metatarsophalangeal-interphalangeal score significantly improved from 54.8 points preoperatively to 91.7 points postoperatively (P <0.001). The mean postoperative visual analog score (15 feet) was 1.0 (0-3.9). Preoperative midtarsal pain disappeared in 14 feet and decreased in one foot postoperatively. Preoperative metatarsalgia was found in five feet, of which, it disappeared in two feet, decreased in two feet, and transferred to another region in one foot at the latest follow-up. The mean hallux valgus and intermetatarsal angles were 42.4° and 18.4° preoperatively, which decreased significantly to 12.5° and 6.9° postoperatively, respectively (P <0.001, all). Recurrence of hallux valgus (hallux valgus angle ≥20°) was observed in two feet (11.8%). Nonunion of the third tarsometatarsal joint was observed in one foot (3.1% among 32 joints). CONCLUSIONS The clinical and radiographic results indicated that operative treatment for hallux valgus with painful osteoarthritis of the lesser tarsometatarsal joint significantly improves forefoot and midfoot pain and function and has low complication rates. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Hiroaki Shima
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
| | - Kosho Togei
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yoshihiro Hirai
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Toshito Yasuda
- Faculty of Nursing, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Ryuzo Okuda
- Depatment of Orthopaedic Surgery, Rakusai-Shimizu Hospital, Kyoto, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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Rajan L, Kim J, An T, Fuller R, Zhu J, Pinney SJ, Ellis SJ. The influence of concomitant hammertoe correction on postoperative outcomes in patients undergoing hallux valgus correction. Foot Ankle Surg 2022; 28:1100-1105. [PMID: 35346594 DOI: 10.1016/j.fas.2022.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/13/2022] [Accepted: 03/15/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients with hallux valgus often develop secondary hammertoe deformities of the lesser toes. Operative management of bunions with hammertoe can be more extensive; however, it is unclear whether this affects patient-reported outcomes. The aim of this study was to compare postoperative patient-reported outcome measures and radiographic outcomes between patients who underwent isolated bunion correction and patients who underwent simultaneous bunion and hammertoe correction. METHODS Preoperative, postoperative, and change in Patient-Reported Outcomes Measurement Information System (PROMIS) scores were compared between patients who underwent isolated hallux valgus correction and those who underwent concomitant hammertoe correction. Radiographic measures including hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal-articular angle (DMAA), and Meary's angle were also compared. Targeted minimum-loss estimation (TMLE) was used for statistical analysis to control for confounders. RESULTS A total of 221 feet (134 isolated bunion correction, 87 concomitant hammertoe correction) with a minimum of 12 months follow-up were included in this study. Both cohorts demonstrated significant improvements in the physical function, pain interference, pain intensity, and global physical health PROMIS domains (all p < 0.001). However, patients in the concomitant hammertoe cohort had significantly less improvements in pain interference and pain intensity (p < 0.01, p < 0.05 respectively). The concomitant hammertoe cohort also had significantly higher postoperative pain interference scores than the isolated bunion cohort (p < 0.01). Radiographic outcomes did not differ between the two groups. CONCLUSION While both isolated bunion correction and concomitant hammertoe correction yielded clinically significant improvements in patient reported outcomes and normalized radiographic parameters, patients undergoing simultaneous bunion and hammertoe correction experienced substantially less improvement in postoperative pain-related outcomes than those who underwent isolated bunion correction.
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Affiliation(s)
- Lavan Rajan
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Jaeyoung Kim
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Tonya An
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Robert Fuller
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Jiaqi Zhu
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Stephen J Pinney
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Scott J Ellis
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
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Okuda R, Yoshimura Y, Shima H. Prevalence and radiological characteristics of the dislocation of the second metatarsophalangeal joint in patients undergoing hallux valgus surgery; a matched control study. J Orthop Sci 2022:S0949-2658(22)00168-3. [PMID: 35803857 DOI: 10.1016/j.jos.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/19/2022] [Accepted: 06/14/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Hallux valgus (HV) is occasionally associated with chronic subluxation or dislocation (CS/D) of the second metatarsophalangeal joint (2MTPj). The present study aimed to radiographically investigate the prevalence and characteristics of HV with CS/D of the 2MTPj compared with matched controls. METHODS Dorsoplantar and lateral weight-bearing radiographs of 79 female patients (79 feet) who had HV with an age of 50 years or more were reviewed. All feet were treated with a proximal supination osteotomy for correction of HV. CS/D of the 2MTPj was evaluated on preoperative dorsoplantar and lateral radiographs. HV and intermetatarsal (IM) angles were measured. Seventy-nine feet were divided into two groups: Group CD (16 feet) had HV with CS/D of the 2MTPj, and Group non-CD had HV without the CS/D of the 2MTPj (63 feet). The severity of HV was divided into two grades according to the HV angle: moderate deformity (Group M, 36 feet, HV angle of less than 40°) and severe deformity (Group S, 43 feet, HV angle of 40° or greater). Group CD and non-CD, and Group M and S were matched by age, gender, and BMI. RESULTS The prevalence of CS/D of the 2MTPj was 20.3%. Group CD had a significantly higher HV angle (p = 0.0001) and a significantly higher IM angle (p = 0.042) than Group non-CD. The prevalence of CS/D of the 2MTPj in Group S (34.9%) were significantly higher than that in Group M (2.8%) (p < 0.001). CONCLUSIONS CS/D of the 2MTPj was significantly associated with greater HV and IM angles compared with matched controls. The prevalence of CS/D of the 2MTPj (34.9%) in Group S was significantly higher than that in Group M. Severe HV can be at higher risk of acquiring CS/D of the 2MTPj in middle-aged and older females.
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Affiliation(s)
- Ryuzo Okuda
- Department of Orthopaedic Surgery, Rakusai-Shimizu Hospital, 13-107 Oe Kutsukake-cho, Nishikyo-ku, Kyoto, 610-1106, Japan.
| | - Yukiko Yoshimura
- Department of Orthopaedic Surgery, Rakusai-Shimizu Hospital, 13-107 Oe Kutsukake-cho, Nishikyo-ku, Kyoto, 610-1106, Japan.
| | - Hiroaki Shima
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-0801, Japan.
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Outcomes of modified chevron osteotomy for hallux valgus. Foot Ankle Surg 2022; 28:514-517. [PMID: 35227590 DOI: 10.1016/j.fas.2022.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/20/2021] [Accepted: 02/16/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to detect the effect of a modified chevron osteotomy on hallux valgus (HV) deformity at five-year follow up. METHODS Twenty patients with symptomatic HV who underwent modified chevron osteotomy between June 2014 and January 2016 were included in the present study. The minimum follow-up duration was five years. Each patient was evaluated preoperatively, six weeks postoperatively and five years postoperatively using the visual analog scale (VAS) pain score, the American Orthopedic Foot & Ankle Society (AOFAS) score and cosmetic and radiological outcomes. RESULTS The AOFAS score improved from 54.40 ( ± 4.58) preoperatively to 94.30 ( ± 2.15) six weeks postoperatively (p < 0.001) and 96.95 ( ± 1.54) five years postoperatively (p < 0.001). The VAS scores decreased from 6.30 ( ± 1.17) preoperatively to 0.15 ( ± 0.37) five years postoperatively (p < 0.001). The mean intermetatarsal angle improved from 16.00° ( ± 2.20°) preoperatively to 4.15° ( ± 1.22°) six weeks postoperatively (p < 0.001) and 4.40° ( ± 1.39°) five years postoperatively (p < 0.001). The mean HV angle also improved, from 32.70° ( ± 5.34°) preoperatively to 4.80° ( ± 1.40°) six weeks postoperatively (p < 0.001) and 5.20° ( ± 1.32°) five years postoperatively (p < 0.001). The cosmetic results were either excellent or good in 19 patients (95%). There was no recurrence in this study during the five postoperative years. CONCLUSION A modified chevron osteotomy can achieve successful correction of moderate-to-severe HV, with excellent outcomes at five-year follow up.
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de Cesar Netto C, Ehret A, Walt J, Chinelati RMK, Dibbern K, de Carvalho KAM, Tazegul TE, Lalevee M, Mansur NSB. Early results and complication rate of the LapiCotton procedure in the treatment of medial longitudinal arch collapse: a prospective cohort study. Arch Orthop Trauma Surg 2022; 143:2283-2295. [PMID: 35312845 PMCID: PMC10110656 DOI: 10.1007/s00402-022-04399-0] [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: 12/21/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Instability/collapse of the medial column has been associated with many conditions, particularly progressive collapsing foot deformity (PCFD), hallux valgus (HV), and midfoot arthritis (MA). Restoration of first ray length and sagittal plane alignment to restore the foot tripod is essential when treating these deformities. This study aimed to assess early results, healing, and complication rate of a distraction dorsal opening plantarflexion wedge allograft first tarsometatarsal joint fusion (LapiCotton Procedure) in patients with collapse/instability of the medial column. METHODS In this prospective cohort study, we included PCFD, HV, and MA patients that underwent a LapiCotton procedure. Fusion site healing was defined by > 50% bone bridging in both interfaces between allograft wedge and host bone using weight-bearing computed tomography (WBCT) after 3 months. First ray collapse radiographic correction and minor and major complications (deep dehiscence, deep infection, and reoperation) were assessed. RESULTS A total of 22 patients (22 feet) were included (11 PCFD, 6 MA, and 5 of HV patients). Mean follow-up was 5.9 months (range 3-12) and median allograft size was 8 mm (range 5-19 mm). Bone healing was observed in 91% of cases. Two minor complications (9%, both superficial dehiscence) and one major complication (4.5%, deep infection) were observed. Statistically significant improvement of the sagittal plane talus-first metatarsal angle was observed, with mean improvement of 9.4° (95% CI 6.7-12.1°; p < 0.0001). CONCLUSION In this prospective cohort study of 22 patients treated with the LapiCotton procedure for medial longitudinal arch collapse/instability, we observed a low complication rate (9% minor, 4.5% major), high healing rate after 3 months (91%), one clinically stable radiographic non-union (4.5%) and one unstable non-union (4.5%) needing reoperation. Our results demonstrate promising initial results for LapiCotton technique in treating collapse of the medial longitudinal arch in patients with PCFD, MA and HV deformities. Long-term results are needed to confirm these promising results. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Amanda Ehret
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Jennifer Walt
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | | | - Kevin Dibbern
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Kepler Alencar Mendes de Carvalho
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Tutku Erim Tazegul
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Matthieu Lalevee
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA.,Department of Orthopedic Surgery, Rouen University Hospital, Rouen, France
| | - Nacime Salomão Barbachan Mansur
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA.,Department of Orthopedics and Traumatology, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
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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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Conti MS, Caolo KC, Ellis SJ, Cody EA. Radiographic and Clinical Outcomes of Hallux Valgus and Metatarsus Adductus Treated With a Modified Lapidus Procedure. Foot Ankle Int 2021; 42:38-45. [PMID: 32869652 DOI: 10.1177/1071100720952079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous studies have found an increased rate of deformity recurrence in hallux valgus (HV) patients with concomitant metatarsus adductus (MA) undergoing metatarsal osteotomies. The purpose of this paper was to determine if there were radiographic or clinical outcome differences between HV patients with and without MA undergoing a modified Lapidus procedure. METHODS One hundred forty-seven feet that underwent a modified Lapidus procedure for HV were divided into 2 groups based on their preoperative modified Sgarlato's angle: (1) the MA group had an angle ≥20 degrees and (2) the HV-only group had an angle <20 degrees. HV angle (HVA) and intermetatarsal angle (IMA) were measured on preoperative and ≥5-month postoperative weightbearing radiographs. Patient-Reported Outcome Measurement Information System (PROMIS) physical function (PF) and pain interference (PI) scores were obtained preoperatively and postoperatively. RESULTS Patients in the MA group had a significantly higher mean postoperative HVA (10.8 vs 7.5 degrees; P = .038). There was a trend toward higher PROMIS PI scores in the MA group at 1 year postoperatively (51.9 vs 47.6; P = .088). Patients in the MA group were more likely to have a revision surgery (7.3% vs 0%; P = .021), and there was a trend toward those patients having a higher recurrence rate (17.1% vs 6.6%; P = .064). CONCLUSION Despite potentially worse postoperative outcomes in patients with HV and MA who undergo a modified Lapidus procedure, the recurrence rates reported here are lower than those reported in the literature for patients with MA undergoing metatarsal osteotomies, indicating that a modified Lapidus procedure may be an acceptable choice in these patients. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Matthew S Conti
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Kristin C Caolo
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Scott J Ellis
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Elizabeth A Cody
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
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Conti MS, Willett JF, Garfinkel JH, Miller MC, Costigliola SV, Elliott AJ, Conti SF, Ellis SJ. Effect of the Modified Lapidus Procedure on Pronation of the First Ray in Hallux Valgus. Foot Ankle Int 2020; 41:125-132. [PMID: 31617413 DOI: 10.1177/1071100719883325] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux valgus (HV) is a triplanar deformity of the first ray including pronation of the first metatarsal with subluxation of the sesamoids. The purpose of this study was to investigate if a first tarsometatarsal fusion (modified Lapidus technique), without preoperative knowledge of pronation measured on weightbearing computed tomographic (CT) scans, changed pronation of the first metatarsal and determine if reduction of the sesamoids was correlated with changes in first metatarsal pronation. METHODS Thirty-one feet in 31 patients with HV who underwent a modified Lapidus procedure had preoperative and at least 5-month postoperative weightbearing CT scans and radiographs. Differences in preoperative and postoperative pronation of the first metatarsal using a 3-dimensional computer-aided design, HV angle, and intermetatarsal angle (IMA) were calculated using Wilcoxon signed-rank tests. After dividing patients into groups based on sesamoid station, Kruskal-Wallis H tests were used to compare first metatarsal pronation between the groups. RESULTS The mean preoperative and postoperative pronation of the first metatarsal was 29.0 degrees (range 15.8-51.1, SD 8.7) and 20.2 degrees (range 10.4-32.6, SD 5.4), respectively, which was a mean change in pronation of the first ray of -8.8 degrees (P < .001). There was no difference in pronation of the first ray when stratified by postoperative sesamoid position (P > .250). The average preoperative and postoperative IMA was 16.7 degrees (SD 3.2) and 8.8 degrees (SD 2.8), which demonstrated a significant change (P < .001). CONCLUSIONS The modified Lapidus procedure was an effective tool to change pronation of the first ray. Reduction of the sesamoids was not associated with postoperative first metatarsal pronation. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Joseph F Willett
- University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, USA
| | | | - Mark C Miller
- University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, USA
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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.
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Affiliation(s)
| | | | - Nicholas Williams
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
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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.
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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
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Ray JJ, Friedmann AJ, Hanselman AE, Vaida J, Dayton PD, Hatch DJ, Smith B, Santrock RD. Hallux Valgus. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419838500. [PMID: 35097321 PMCID: PMC8696753 DOI: 10.1177/2473011419838500] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Hallux valgus is a common condition that results from a complex positional deformity of the first ray. The bunion or medial prominence that results from the lateral deviation and pronation of the hallux is only one component of the 3-dimensional deformity. Hallux valgus can lead to considerable pain and altered joint mechanics. The precise biomechanical etiology remains under debate. Predisposing factors include female sex, age, constricting footwear, and family history. Metatarsus adductus, equinus contracture, hammertoe deformity, and pes planus often coexist with hallux valgus. Nonoperative treatment involves patient education, shoe modifications, toe pads and positioning devices, and activity modifications. Surgery is considered in patients who fail nonoperative treatment with the goal of pain relief, correction of the deformity, improved first ray stability, and improved quality of life. More than 100 different procedures have been described to treat hallux valgus; they include combinations of soft tissue balancing, metatarsal osteotomies, and fusion of either the metatarsophalangeal (MTP) or tarsometatarsal (TMT) joint. The choice of procedures depends on the severity and location of the deformity as well as surgeon preference. Recent advances in operative techniques include minimally invasive surgery and correction of rotational deformity.
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Affiliation(s)
- Justin J. Ray
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | | | | | - Justin Vaida
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - Paul D. Dayton
- College of Podiatric Medicine and Surgery, Des Moines University, UnityPoint Clinic, Trinity Regional Medical Center, Des Moines, IA, USA
| | - Daniel J. Hatch
- Department of Podiatric Medicine and Surgery, North Colorado PMS Residency, Greeley, CO, USA
| | - Bret Smith
- Orthopedics, University of South Carolina, Palmetto Health-USC Orthopedic Center, Lexington, SC, USA
| | - Robert D. Santrock
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
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Ažman D, Hrabač P, Demarin V. Use of Multiple Ultrasonographic Parameters in Confirmation of Carpal Tunnel Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:879-889. [PMID: 28960430 DOI: 10.1002/jum.14417] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Ultrasonography (US) of the median nerve has been increasingly studied and used for confirmation of carpal tunnel syndrome (CTS). However, a consensus on the choice of parameters to be evaluated is still not established. The aim of this diagnostic accuracy study was to assess the diagnostic value of multiple parameters individually, as well as in different combinations of variable complexity, and to find an optimal approach for US-based confirmation of a CTS diagnosis. METHODS All participants completed clinical and electrophysiologic evaluations, and their hands were scanned with a 5-13-MHz linear US transducer. Eighty-six patients with CTS (135 symptomatic hands) and 50 control participants (93 asymptomatic hands) were analyzed. The median nerve was recorded transversely at the forearm, at the carpal tunnel inlet, in the mid tunnel, and at the carpal tunnel outlet. For determining the parameters' diagnostic value, sensitivities, specificities, and area under the curve (AUC) values were calculated. RESULTS The inlet cross-sectional area, inlet circumference, and outlet cross-sectional area of the median nerve had the highest AUCs (0.962, 0.920, and 0.913, respectively), sensitivities (87.4%, 80.0%, and 74.1%), and specificities (94.6%, 91.4%, and 92.5%) among single-measurement parameters. An analysis of 2-level parameters (wrist-to-forearm-ratio, inlet-to-outlet-ratio, outlet-to-forearm-ratio, and inlet-outlet mean) yielded the highest AUC (0.974) for the mean cross-sectional area of the median nerve [(inlet + outlet cross-sectional area)/2], with high sensitivity (93.5%) and specificity (91.1%). A compound regression-based index yielded a marginally higher AUC (0.989) than the previously mentioned parameters. CONCLUSIONS Results of the study show that the mean cross-sectional area and inlet cross-sectional area may be valid and easy-to-acquire parameters for routine clinical use in confirming CTS.
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Affiliation(s)
- Dražen Ažman
- Department of Neurology, Dr J. Benčević General Hospital, Medical School of University of Osijek Education Base, Slavonski Brod, Croatia
| | - Pero Hrabač
- Department of Croatian Institute for Brain Research, Medical School of University of Zagreb, Zagreb, Croatia
| | - Vida Demarin
- Department of International Institute for Brain Health, Medical School of University of Zagreb, Zagreb, Croatia
- Department of Croatian Academy of Sciences and Arts, Medical School of University of Zagreb, Zagreb, Croatia
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[Malalignment of the first ray : Clinical and radiological diagnostics]. DER ORTHOPADE 2017; 46:388-394. [PMID: 28361192 DOI: 10.1007/s00132-017-3409-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Clinical and radiological examination of the foot are mandatory before surgical correction of the forefoot. The clinical examination includes leg axis, position of the hind foot, deformity of the first ray as well as skin conditions, pulse status and possible sensitive deficits. A shortening of the gastrocnemius muscle can be identified using the Silfverskiöld test. Discomfort in the midfoot can indicate pathologies of the tarsometatarsal joint and the same applies for osteophyte infiltration around the Lisfranc joint line, whereby the second tarsometatarsal joint often shows more advanced degenerative arthritis than the first tarsometatarsal joint. Callosities under the second and third metatarsal heads correlate with a faulty load transmission of the first ray. A limitation of the range of movement of the first metatarsophalangeal joint is usually associated with degenerative arthritis in X‑ray imaging. Under weight bearing, X‑rays of the foot in two planes represent the standard imaging examination. In addition to the intermetatarsal angle, the hallux valgus angle and the interphalangeal angle as well as the width of the first metatarsal bone influence the therapy decision. The same applies to degenerative changes or an obvious instability of the first tarsometatarsal joint. In many cases, initial signs of degenerative arthritis can be found in the metatarsophalangeal joint and around the sesamoid bones, although these often do not correlate to clinical symptoms.
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