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Choi JY, Song TH, Suh JS. Outcome comparison of minimally invasive proximal and distal chevron Akin osteotomies in patients with severe hallux valgus deformity: A randomized prospective study. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06204-6. [PMID: 38705891 DOI: 10.1007/s00264-024-06204-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/26/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE To date, the surgical treatment of severe hallux valgus deformity remains challenging despite the various methods presented. This study aimed to compare the effectiveness of minimally invasive distal chevron Akin osteotomies (d-MICA) and minimally invasive proximal chevron Akin osteotomies (p-MICA) in correcting severe hallux valgus deformities. METHODS This prospective follow-up study included patients randomly assigned to undergo p-MICA or d-MICA for hallux valgus deformities with a preoperative hallux valgus angle (HVA) ≥ 40° and/or a first to second intermetatarsal angle (IMA) ≥ 16°. After a minimum follow-up period of two years, we compared various clinico-radiographic parameters of patients whose HVA exceeded 15° at the final follow-up. RESULTS In the p-MICA and d-MICA groups, seven of 40 cases (17.5%) and 16 of 41 cases (39.0%), respectively, exhibited HVA > 15° at the final follow-up (P = 0.048). The preoperative parameters showed no significant differences. However, at the first weight-bearing assessment, the HVA, IMA, and relative second metatarsal length were significantly smaller, and the distal metatarsal articular angle (DMAA) was greater in the p-MICA group (all P < 0.05) compared with the d-MICA group. Postoperatively, both groups exhibited significant decreases in HVA and IMA at the final follow-up (P < 0.001 for all parameters). The p-MICA group showed no significant changes in DMAA and the relative length of the second metatarsal (P = 0.253 and 0.185, respectively). However, the d-MICA group showed a significant decrease in DMAA (P < 0.001) and an increase in the relative length of the second metatarsal at the final follow-up (P = 0.01). CONCLUSIONS p-MICA and d-MICA procedures demonstrated effective correction potential for severe hallux valgus deformities; however, the d-MICA procedure exhibited a notably higher incidence of unsatisfactory correction at the final follow-up than p-MICA. Therefore, d-MICA may be less predictable in achieving successful outcomes than p-MICA in treating severe hallux valgus deformities.
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Affiliation(s)
- Jun Young Choi
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-Ro, Ilsanseo-Gu, Goyang-Si, Gyeonggi-Do, South Korea
| | - Tae Hun Song
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-Ro, Ilsanseo-Gu, Goyang-Si, Gyeonggi-Do, South Korea
| | - Jin Soo Suh
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-Ro, Ilsanseo-Gu, Goyang-Si, Gyeonggi-Do, South Korea.
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Huh J, Louis-Ugbo J, Hembree WC, Wagner E, Chodos MD, Zingas CN, Vopat BG, Dalal A, Alhadhoud M, Sherman TI. 2023 Evidence-Based Medicine (EBM) Update. Foot Ankle Int 2024; 45:547-554. [PMID: 38676415 DOI: 10.1177/10711007241242133] [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] [Indexed: 04/28/2024]
Affiliation(s)
- Jeannie Huh
- Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | | | - Walter C Hembree
- MedStar Orthopaedic Institute, Georgetown University School of Medicine, Baltimore, MD, USA
| | - Emilio Wagner
- Traumatologo Subespecialista en Cirugia de Tobillo y Pie, Santiago, Chile
| | | | | | - Bryan G Vopat
- University of Kansas Health System, Kansas City, KS, USA
| | - Aliasgar Dalal
- St. Louis University Care Physician Group, St. Louis, MO, USA
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Cano DP, Lagos MA, Baduell A, González JTA, Torre CMDL, Rios J. Immediate effect of hallux valgus surgery on the biomechanical behavior of the first ray. Foot Ankle Surg 2024:S1268-7731(24)00074-2. [PMID: 38658291 DOI: 10.1016/j.fas.2024.04.001] [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: 11/08/2023] [Revised: 02/17/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The surgical treatment of hallux valgus (HV) deformity has been the subject of countless publications but few focus on the altered windlass mechanism or analyze the biomechanical behavior immediately after surgery. METHODS Patients treated for HV between January and March 2023 were included. The surgery consisted of a L-reverse first metatarsal osteotomy. To analyze the windlass mechanism we record two different measurements; the isolated first metatarsophalangeal joint (MTPJ) dorsiflexion angle (IDA) and dynamic plantarization of the first metatarsal head when performing first MTPJ dorsiflexion imprinting a mark on a modeling foam. RESULTS A total of 30 patients diagnosed with symptomatic HV were included. In all patients, a change in the IDA angle was evident, being overall statistically significant. About modeling foam imprinted mark, all measurements, in all planes of space, had a clear tendency to increase, which turned out to be statistically significant (p < 0.001). CONCLUSIONS An altered windlass mechanism may be successfully recovered immediately after hallux valgus deformity surgery. This could be evinced by an indirect measurement analyzing the imprint of the head of the first metatarsal in a modeling foam and the IDA. LEVELS OF EVIDENCE II None.
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Affiliation(s)
- Daniel Poggio Cano
- Foot and Ankle Unit, Department of Orthopedic Surgery, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain
| | - Matías Andaur Lagos
- Foot and Ankle Unit, Department of Orthopedic Surgery, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain.
| | - Albert Baduell
- Foot and Ankle Unit, Department of Orthopedic Surgery, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain
| | | | | | - J Rios
- Foot and Ankle Unit, Department of Orthopedic Surgery, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain; Department of Clinical Pharmacology Hospital Clinic and Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Biostatistics Unit, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Nunes GA, Ferreira GF, Pereira Filho MV, de Carvalho KAM, Lewis TL, Castellini J, Ray R, Vernois J. Minimally Invasive Chevron Akin Osteotomy: Preoperative Planning Using the Radiographic First-Ray Squeeze Test. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241239331. [PMID: 38516058 PMCID: PMC10956160 DOI: 10.1177/24730114241239331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Background Recognizing preoperative first-ray hypermobility is important to planning hallux valgus (HV) surgery. A recent study showed the minimally invasive chevron Akin (MICA) osteotomy increased varus displacement of the proximal fragment of the first metatarsal osteotomy. The present study aims to evaluate the ability of the radiographic first-ray squeeze test to predict the varus displacement of the proximal fragment of the first metatarsal osteotomy when performing the MICA procedure. Methods A prospective case series of patients with moderate to severe HV who underwent MICA was performed. The HV deformity correction was analyzed by comparing the preoperative and 12-week postoperative hallux valgus angle (HVA) and the intermetatarsal angle between the first and second rays (1-2 IMA). The ability of the radiographic first-ray squeeze test to predict the varus displacement of the first metatarsal was done by comparing the preoperative 1-2 IMA measured in the AP radiographic first-ray squeeze test (IMA-ST) with the intermetatarsal angle between the second metatarsal and the axis of the first metatarsal osteotomy proximal fragment (IAPF) taken 12 weeks postoperatively. Results Between July 2022 and May 2023, a total of 39 feet in 28 patients underwent MICA. The mean IMA improved from 13.8 (SD = 2.2) to 3.8 degrees (SD = 1.5) (P < .001), and the mean HVA improved from 27.8 (SD = 6.1) to 4.9 degrees (SD = 2.5) (P < .001). A linear regression analysis revealed that IMA-ST is highly associated with the 12 week assessed IAPF (P < .001). Conclusion The preoperative radiographic first-ray squeeze test appears to predict with high fidelity the varus displacement of the proximal fragment of the first metatarsal that can occur after the MICA procedure.Level of Evidence: Level III, prospective cohort study.
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Affiliation(s)
- Gustavo Araujo Nunes
- COTE Brasília Clinic, Federal District, Brazil
- MIFAS by GRECMIP, Bordeaux-Merignac, France
| | - Gabrie Ferraz Ferreira
- Foot and Ankle Surgery Group, Orthopedic and Traumatology Unit Prevent Senior, São Paulo, Brazil
| | | | | | - Thomas Lorchan Lewis
- King’s Foot and Ankle Unit, King’s College Hospital National Health Service Foundation Trust, London, United Kingdom
| | | | - Robbie Ray
- King’s Foot and Ankle Unit, King’s College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Joel Vernois
- Institut de Chirurgie du Pied (ICP), Clinique Blomet, Paris, France
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Marciano G, Ashinsky BG, Mysore N, Vulcano E. Fracturing the Lateral Hinge Improves Radiographic Alignment and Does Not Affect Clinical Outcomes of the Minimally Invasive Akin Osteotomy. Foot Ankle Int 2024; 45:52-59. [PMID: 38047491 DOI: 10.1177/10711007231209765] [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: 12/05/2023]
Abstract
BACKGROUND Intraoperative fracture of the lateral cortex is common during Akin osteotomy. In a recent study, lateral cortex fracture did not impede healing or result in loss of correction in a combined cohort of open and percutaneous osteotomies stabilized by K-wire fixation. We hypothesize that undesired lateral cortex fracture will not affect radiographic correction and patient-reported outcomes in a percutaneous cohort stabilized by permanent, rigid screw fixation. METHODS Consecutive patients with hallux valgus who underwent first metatarsal osteotomy and percutaneous Akin osteotomy stabilized by permanent, rigid screw fixation between May 2020 and January 2022 were retrospectively reviewed. Patients were stratified based on fractured lateral cortex (FC) or its absence (nonfractured cortex [NFC]). Visual analog scale (VAS) and Foot Function Index (FFI) were used to assess pain and patient-reported outcomes at 1-year follow-up. Patients were polled for satisfaction at 1-year follow-up by yes/no survey. RESULTS Ninety-eight patients (89% female) were reviewed (98 feet; 43 NFC, 55 FC). Mean age was 48.3 years (range, 18-83 years). Mean preoperative VAS score was 7.5 and 7.7 in NFC and FC groups, which significantly decreased to 0.6 (P < .01) and 0.6 (P < .01), respectively. Mean total FFI was 53.9 and 54.2 and decreased to 17.9 (P < .01) and 17.2 (P < .01) in the NFC group and FC group, respectively. Overall, 97.8% of the NFC group and 96.4% of the FC group reported satisfaction.Mean HVA improved from 27.2 (16-42) degrees to 10.7 degrees (4-12) postoperatively in the NFC group. And in the FC group, HVA improved from 29.3 (19-39) degrees to 7.1 (4-12) degrees postoperatively. Postoperative HVA was significantly lower in the FC group (P < .05). CONCLUSION In an exclusively percutaneous surgical cohort with correction maintained by rigid screw fixation, fracture of the lateral cortex is associated with improved postoperative radiologic alignment without detriment to patient-reported outcomes. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Gerard Marciano
- Columbia University Medical Center/New York-Presbyterian Hospital, Department of Orthopedic Surgery, New York, NY, USA
| | - Beth G Ashinsky
- Columbia University Medical Center/New York-Presbyterian Hospital, Department of Orthopedic Surgery, New York, NY, USA
| | - Nishad Mysore
- Nova Southeastern University, College of Medicine, Fort Lauderdale, FL, USA
| | - Ettore Vulcano
- Mount Sinai Medical Center/Columbia University, Miami, FL, USA
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Motta LM, Manchado I, Blanco G, Quintana-Montesdeoca MP, Garcés L, Garcés GL. Temporal Changes in Clinical Outcomes after Minimally Invasive Surgery for Hallux Valgus Correction in Women without Postoperative Complications. J Clin Med 2023; 12:4368. [PMID: 37445403 DOI: 10.3390/jcm12134368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Minimally invasive surgery (MIS) is currently used to correct hallux valgus deformities. Most studies reporting on MIS techniques to correct hallux valgus deformities included patients with postoperative complications. These reported complications, with an average rate of 23%, had significant negative effects on the clinical outcomes in this patient population. In the present study, a cohort of 63 women who underwent MIS hallux valgus correction was assessed preoperatively and at a mean follow-up of 1.0, 4.7, and 6.5 years using the American Orthopaedic Foot and Ankle Society (AOFAS) scale and the Manchester Oxford Foot Questionnaire (MOXFQ). The main criterion for inclusion in this cohort was a lack of complications during the entire follow-up period. The results showed significant improvements in both AOFAS and MOXFQ scores between the preoperative and 1-year follow-up assessments. By contrast, clinically small and nonsignificant changes were observed among postoperative follow-up values. The number of enrolled patients needs to be increased in future studies, with different surgeons and techniques included. Nevertheless, our study findings will inform patients about the outcomes they can expect over the years if no complications occur.
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Affiliation(s)
- Luci M Motta
- Hospital Perpetuo Socorro, 35007 Las Palmas, Spain
- Department of Ciencias Médicas y Quirúrgicas, University of Las Palmas de Gran Canaria, 35007 Las Palmas, Spain
| | - Ignacio Manchado
- Hospital Perpetuo Socorro, 35007 Las Palmas, Spain
- Department of Ciencias Médicas y Quirúrgicas, University of Las Palmas de Gran Canaria, 35007 Las Palmas, Spain
| | | | | | - Laura Garcés
- Terapias Acuáticas Canarias SL, 35007 Las Palmas, Spain
| | - Gerardo L Garcés
- Hospital Perpetuo Socorro, 35007 Las Palmas, Spain
- Department of Ciencias Médicas y Quirúrgicas, University of Las Palmas de Gran Canaria, 35007 Las Palmas, Spain
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Lewis TL, Lau B, Alkhalfan Y, Trowbridge S, Gordon D, Vernois J, Lam P, Ray R. Fourth-Generation Minimally Invasive Hallux Valgus Surgery With Metaphyseal Extra-Articular Transverse and Akin Osteotomy (META): 12 Month Clinical and Radiologic Results. Foot Ankle Int 2023; 44:178-191. [PMID: 36788732 DOI: 10.1177/10711007231152491] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Fourth-generation minimally invasive surgery (MIS) includes the multiplanar rotational deformity correction achieved through manipulation of an extra-articular distal first metatarsal osteotomy that is held with rigid fixation using 2 fully threaded screws, of which one must be bicortical to provide rotational and biomechanical stability. The aim of this study is to report the clinical and radiologic outcomes of an evolved fourth-generation MIS hallux valgus technique. METHODS A prospective single-surgeon series of consecutive patients undergoing fourth-generation MIS was performed using a distal transverse osteotomy with a minimum 12-month follow-up. The primary outcome was the Manchester-Oxford Foot Questionnaire (MOXFQ), a validated clinical patient-reported outcome measure (PROM). Secondary outcomes included radiographic deformity correction, clinical assessment, and EuroQol-5D-5L PROMs. RESULTS Between September 2019 and June 2021, 50 feet underwent fourth-generation MIS. The mean age was 55.8±15.3 years with a mean follow-up of 1.4 years. Preoperative and minimum 12-month primary outcome data were available for 100% of feet. There was a significant improvement in all MOXFQ domain scores, with the index domain improving from 53.4 to 13.1 (P < .001). There was a significant improvement (P < .001) in hallux valgus angle (32.7 to 7.9 degrees), intermetatarsal angle (14.0 to 4.2 degrees) and distal metatarsal articular angle (18.5 to 5.6 degrees). There was a significant improvement in general health-related quality of life EQ-5D-5L index and EQ-VAS scores (P < .05). CONCLUSION The fourth-generation MIS technique is a safe and effective approach to hallux valgus deformity correction with significant improvement in clinical and radiographic outcomes. LEVEL OF EVIDENCE Level IV, prospective case series.
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Affiliation(s)
- Thomas L Lewis
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, United Kingdom
| | - Benjamin Lau
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, United Kingdom
| | - Yousif Alkhalfan
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, United Kingdom
| | - Samuel Trowbridge
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, United Kingdom
| | | | - Joel Vernois
- Institut de Chirurgie du Pied (ICP), Clinique Blomet, Paris, France
| | - Peter Lam
- Orthopaedic and Arthritis Specialist Centre, Chatswood, Sydney, Australia
| | - Robbie Ray
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, United Kingdom
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