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Cheung TP, Albright RH, Klein EE, Sorensen M, Weil L, Fleischer AE. How Important Is a Lesser Metatarsal Osteotomy in Preventing Second Hammertoe Recurrence? J Foot Ankle Surg 2024; 63:140-144. [PMID: 37806484 DOI: 10.1053/j.jfas.2023.09.011] [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: 11/28/2020] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/10/2023]
Abstract
Hammertoes with greater preoperative transverse plane deformity are more likely to recur after corrective surgery; however, it is unclear whether this represents an inherent (fixed, nonmodifiable) risk, or whether steps can be taken intraoperatively to mitigate this risk. In this study, we examined whether transverse plane transposition and/or shortening of the second metatarsal during second hammertoe surgery influenced recurrence. We performed a secondary analysis of pre-existing data from patients that had previously undergone second hammertoe surgery at our institution between January 1, 2011 and December 31, 2013. One hundred two patients (137 toes) were followed for a mean 28 ± 7.8 months postoperatively. Thirty-seven toes required, at the surgeon's discretion, an additional/concomitant Weil metatarsal osteotomy. Magnitude of transverse plane transposition and shortening of the second metatarsal, and joint angular measurements were obtained from the second metatarsophalangeal joint on weightbearing AP radiographs preoperatively and at 6 to 10 weeks postoperatively. Cox regression analysis was used to identify predictors of hammertoe recurrence using these new variables and a set of known predictors. In the final regression model, failure to establish a satisfactory postoperative metatarsal parabola (i.e., long second metatarsal; Nilsonne values <-4 mm, multivariate hazards ratio [HR] 1.96, p = .097), and intraoperative lateral transposition of the metatarsal head (multivariate HR 3.45, p = .028) seemed to confer additional risk for hammertoe recurrence. We conclude that shortening osteotomies may be assistive in some individuals, while further inquiry is still needed to determine whether similar benefits can be derived from medial head transposition in medial toe deformities.
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Affiliation(s)
- Timothy P Cheung
- DPM/PhD Student, Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine & Science, North Chicago, IL
| | - Rachel H Albright
- Fellowship Trained Podiatric Surgeon, Stamford Health, Foot & Ankle, Stamford, CT
| | - Erin E Klein
- Associate Director of Research, Weil Foot & Ankle Institute, Mount Prospect, IL; Clinical Instructor, Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine & Science, North Chicago, IL
| | - Matthew Sorensen
- Immediate Past Fellowship Director, Weil Foot & Ankle Institute, Mount Prospect, IL
| | - Lowell Weil
- CEO, Weil Foot & Ankle Institute, Mount Prospect, IL
| | - Adam E Fleischer
- Director of Research, Weil Foot & Ankle Institute, Mount Prospect, IL; Professor, Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine & Science, North Chicago, IL.
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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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Lee JY, Tay KS, Tan JHI, Abdul Kadir HB, Koo K, Yeo N. Hallux valgus with second metatarsalgia: Is second metatarsal Weil osteotomy necessary? Foot Ankle Surg 2022; 28:1433-1439. [PMID: 35995690 DOI: 10.1016/j.fas.2022.08.001] [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: 04/25/2022] [Revised: 07/20/2022] [Accepted: 08/02/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The role of concomitant Weil osteotomy to address second toe metatarsalgia during hallux valgus correction is unclear. We aimed to critically analyse outcomes of an additional Weil osteotomy versus isolated Scarf osteotomy.in the management of hallux valgus and second metatarsalgia. METHODS Patients with second toe metatarsalgia who underwent first metatarsal Scarf osteotomy for hallux valgus were enrolled retrospectively. Demographics, radiographic measurements and functional outcomes were assessed at baseline, 6-months and 2-years postoperatively. Between-group significance was established with Fisher exact test, Chi-square or Mann-Whitney U test. Within-group changes from baseline were assessed with paired t-test and Wilcoxon signed-rank test. RESULTS 48 feet (34 isolated Scarf, 14 concomitant Weil osteotomy) were included. Both cohorts demonstrated significant improvements across all measures of functional outcome. However, patients with additional Weil osteotomy reported poorer short-term outcomes. CONCLUSION Superiority of additional Weil osteotomy versus isolated Scarf osteotomy in addressing second toe metatarsalgia or improving functional outcomes was not demonstrated.
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Affiliation(s)
- Jia Ying Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Rd, 169608, Singapore
| | - Kae Sian Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Rd, 169608, Singapore.
| | - Joelle Hwee Inn Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore
| | | | - Kevin Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Rd, 169608, Singapore
| | - Nicholas Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Rd, 169608, Singapore; Consultant, Head of Foot and Ankle Service, Singapore
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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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Murahashi Y, Iba K, Teramoto A, Takahashi K, Okada Y, Kamiya T, Takashima H, Watanabe K, Ohnishi H, Yamashita T. Relationship Between Plantar Callosity and Foot Deformity in Hallux Valgus Using Weightbearing Computed Tomography. J Foot Ankle Surg 2021; 60:1207-1211. [PMID: 34158227 DOI: 10.1053/j.jfas.2021.05.007] [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: 03/17/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 02/03/2023]
Abstract
Plantar callosities under lesser metatarsals are often accompanied by the hallux valgus, and the cause of callosity is thought to be associated with the foot deformity, such as the metatarsal length discrepancy, the abnormal metatarsal head height, cavus, flat foot, and rheumatoid conditions. However, it is unclear which variable is most involved in the cause of callosity in hallux valgus deformity. To clarify the factors associated with the callosity with hallux valgus deformity, we conducted multiple image assessments based on weightbearing radiography and computed tomography. A retrospective review was performed based on the collection of clinical records from all patients with hallux valgus treated from 2010 to 2019 in our institution. We measured the hallux valgus angle, intermetatarsal angles, calcaneal pitch angles, talo-first metatarsal angles, metatarsal length, metatarsal head height, first metatarsal pronation angles, and sesamoid position with weightbearing radiography and computed tomography. We analyzed the relation between callosity formation and imaging assessments using univariate and multivariate logistic regression models. Fifty feet were retrospectively evaluated, and multiple logistic analyses by the stepwise method revealed that the first metatarsal-lateral-sesamoid distance was the only radiographical variable associated with callosity formation among all the tested variables (p < .001). As the grade of the callosity became more severe, the lateral shift of the lateral sesamoid increased. The position of the sesamoid bone appears to have a critical role in the assessment and choice of treatment protocols and further research needs to be conducted on the relationship with the position of sesamoid bone to elucidate the mechanism of callus formation.
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Affiliation(s)
- Yasutaka Murahashi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kousuke Iba
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Katsunori Takahashi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yohei Okada
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomoaki Kamiya
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroyuki Takashima
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, Sapporo, Japan
| | - Kota Watanabe
- Department of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Japan
| | - Hirofumi Ohnishi
- Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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Guo JL, Dong WC, Shang MS, Zhao K, Li JY, Hou ZY, Zhang YZ. Triplanar Chevron Osteotomy: A Newly Proposed Method to Treat Hallux Valgus Deformities. Orthop Surg 2020; 12:1826-1834. [PMID: 33073495 PMCID: PMC7767668 DOI: 10.1111/os.12806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/17/2020] [Accepted: 08/23/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To present a novel method called triplanar chevron osteotomy to treat hallux valgus (HV). Methods This is a retrospective study. In this study, the CT data of HV patients with painful callosities were evaluated retrospectively between 1 June 2018 and 1 June 2020. CT data from 49 consecutive patients (59 feet) with HV were evaluated. The average age at the time of surgery was 49.6 years (range, 30–63 years). The apex of the chevron osteotomy procedure was located at the center of the first metatarsal and was defined as the line formed by the central point perpendicular to the fourth metatarsal bone. The cut planes of the plantarward oblique chevron osteotomy (POCO) were defined as follows: chevron osteotomy along with 20° of plantarward obliquity. The triplanar osteotomy incision was made using the POCO method, with the direction inclined by 10° distally. The intermetatarsal angle (IMA), the HV angle (HVA), the projection of the second metatarsal (PSM), the metatarsal protrusion index (MPI), and the metatarsal protrusion distance (MPD) were all calculated before and after the operations. The length of the first metatarsal was measured and calculated with an equation. Results The results showed that the HVA was significantly decreased after surgery (32.7° ± 4.6° vs 14.9° ± 2.1°, t = 25.583, P < 0.001) in the triplanar, traditional, and POCO groups. The IMA was also significantly decreased (14.7° ± 2.0°) compared with the results before surgery (8.0° ± 1.1°, t = 22.739, P < 0.001) in these groups. Compared with traditional osteotomy and POCO, there were no differences in correcting deformities on axial planes for the HVA (14.5° ± 1.7° vs 14.9° ± 2.1°, t = 1.835, P = 0.072) and IMA (8.1° ± 1.1° vs 8.0° ± 1.1°, t = −0.97, P = 0.336). There was a statistically significant decrease following surgery in terms of the PSM, MPI, and MPD after triplanar osteotomy. The length of the first metatarsal increased (10.9 ± 1.3 mm), as measured through three‐dimensional images in the triplanar osteotomy group. The length was calculated as follows: H = L2 * Tan θ ≈ L/COS β * Tan θ. Conclusion The new triplanar osteotomy technique is safe and effective for treating HV, and in simulation experiments reveals potential benefits of correction and preventing transfer metatarsalgia.
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Affiliation(s)
- Jia-Liang Guo
- Trauma Centre, Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei-Chong Dong
- Clinical Pharmacy, Department of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Mei-Shuang Shang
- Trauma Centre, Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Kuo Zhao
- Trauma Centre, Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jun-Yong Li
- Trauma Centre, Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhi-Yong Hou
- Trauma Centre, Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ying-Ze Zhang
- Trauma Centre, Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Chinese Academy of Engineering, Beijing, China
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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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