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Sanchís-Soria V, Nieto-González E, Nieto-García E, Fernández-Ehrling N, Ferrer-Torregrosa J, Lorca-Gutiérrez R. Radiological and functional outcomes of Reverdin Isham osteotomy in moderate Hallux Valgus: a systematic review and meta-analysis. Sci Rep 2024; 14:14781. [PMID: 38926591 PMCID: PMC11208448 DOI: 10.1038/s41598-024-65440-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/20/2024] [Indexed: 06/28/2024] Open
Abstract
This systematic review and meta-analysis addresses the effects of minimally invasive surgical techniques, specifically the Reverdin Isham osteotomy, on functional and radiological outcomes in patients with moderate Hallux Valgus, a common foot deformity. The review included randomized and non-randomized controlled trials, as well as case reports, assessing the osteotomy in adults with moderate to severe Hallux Valgus. Searches were conducted in electronic databases such as MEDLINE and Web of Science up until July 2023, and the Joanna Briggs Institute's critical appraisal tool was used to assess the risk of bias. Meta-analytical analyses employed a random-effects model with small-sample correction, presenting results as standardized mean differences and mean differences with 95% confidence intervals. Seven studies involving 554 patients and 643 operated feet were included, showing significant improvements in AOFAS scores (an average improvement of 36 points from 28.61 to 45.16) and reductions in radiological angles such as the distal metatarsal angle and hallux valgus angle post-surgery (IMA improved by - 3.07° from - 4.68 to - 1.46, DMAA by - 6.12° from - 9.52 to - 2.71, and HVangle by - 15.27° from - 17.98 to - 12.57). Despite these positive outcomes, most studies exhibited risks of bias and other methodological limitations, impacting the generalizability of the results. Overall, the findings highlight the efficacy of the Reverdin Isham osteotomy in improving both functional and radiological parameters in patients with moderate Hallux Valgus, although further research is warranted to solidify these results. No specific funding was received for this study, and the protocol was registered on PROSPERO with the number CRD-42023445886.
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Affiliation(s)
- Victoria Sanchís-Soria
- Doctorate School, Catholic University of Valencia San Vicente Mártir, 46001, Valencia, Spain
| | - Elena Nieto-González
- Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University San Vicente Mártir, Valencia, Spain
| | - Eduardo Nieto-García
- Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University San Vicente Mártir, Valencia, Spain
| | - Nadia Fernández-Ehrling
- Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University San Vicente Mártir, Valencia, Spain
| | - Javier Ferrer-Torregrosa
- Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University San Vicente Mártir, Valencia, Spain.
| | - Rubén Lorca-Gutiérrez
- Podiatry Department, Faculty of Medicine and Health Sciences, Valencia Catholic University San Vicente Mártir, Valencia, Spain
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Geng X, Teng Z, Chen L, Zhang C, Huang J, Wang X, Ma X. A Joy-Stick Assistant Three-Dimensional Modified Technique of Minimally Invasive Surgery for Mild or Moderate Hallux Valgus. Orthop Surg 2024; 16:1473-1479. [PMID: 38616159 PMCID: PMC11144513 DOI: 10.1111/os.14056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Minimally invasive surgery (MIS) such as minimally invasive chevron osteotomy and Akin osteotomy (MICA) has become popular in the treatment of hallux valgus. However, how to correct three-dimensional deformities in hallux valgus effectively and simply in MICA is still difficult. Special equipment is required in MICA as has been reported before. It is meaningful and necessary to reduce the reliance on special equipment in MICA. METHODS From January 2021 to July 2022, patients with mild or moderate hallux valgus were treated with a joy-stick assistant three-dimensional modified technique (Joy-stick 3D technique) of MIS. VAS, AOFAS Hallux MTP-IP scores, hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were measured pre- and postoperatively at the last follow-up of at least 6 months. Scores and radiologic angles were compared using paired sample t-test. RESULTS A total of 36 cases were included. HVA, IMA, and DMAA were (22.3 ± 6.1)°, (14.0 ± 3.2)°, and (8.9 ± 3.2)° preoperatively, and decreased to (7.0 ± 1.8)°, (3.7 ± 1.0)°, and (3.3 ± 1.1)° postoperatively. VAS decreased from 4.3 ± 1.7 to 0.7 ± 0.7. AOFAS Hallux MTP-IP scores improved from 68.6 ± 7.6 to 92.9 ± 6.1. Comparing mild and moderate cases, though HVA, IMA, and DMAA were significantly different preoperatively, the angles became statistically similar after surgery. CONCLUSIONS A joy-stick assistant three-dimensional modified technique is proposed to control the three-dimensional position of the metatarsal head and to reduce dependence on special tools. Mild and moderate hallux valgus deformities are effectively corrected using Joy-stick 3D technique.
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Affiliation(s)
- Xiang Geng
- Department of Orthopedic Surgery, Huashan HospitalFudan UniversityNo. 12 Wulumuqi Middle RoadShanghai200040China
| | - Zhaolin Teng
- Department of Orthopedic Surgery, Huashan HospitalFudan UniversityNo. 12 Wulumuqi Middle RoadShanghai200040China
| | - Li Chen
- Department of Orthopedic Surgery, Huashan HospitalFudan UniversityNo. 12 Wulumuqi Middle RoadShanghai200040China
| | - Chao Zhang
- Department of Orthopedic Surgery, Huashan HospitalFudan UniversityNo. 12 Wulumuqi Middle RoadShanghai200040China
| | - Jiazhang Huang
- Department of Orthopedic Surgery, Huashan HospitalFudan UniversityNo. 12 Wulumuqi Middle RoadShanghai200040China
| | - Xu Wang
- Department of Orthopedic Surgery, Huashan HospitalFudan UniversityNo. 12 Wulumuqi Middle RoadShanghai200040China
| | - Xin Ma
- Department of Orthopedic Surgery, Huashan HospitalFudan UniversityNo. 12 Wulumuqi Middle RoadShanghai200040China
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Mazzotti A, Zielli SO, Giacomo C, Artioli E, Arceri A, Abdi P, Langone L, Faldini C. Combined Distal Metatarsal and Akin Osteotomies for Concomitant Metatarsophalangeal and Interphalangeal Hallux Valgus: Clinical and Radiological Outcomes. J Foot Ankle Surg 2024; 63:366-371. [PMID: 38218344 DOI: 10.1053/j.jfas.2024.01.006] [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: 09/15/2023] [Revised: 12/08/2023] [Accepted: 01/06/2024] [Indexed: 01/15/2024]
Abstract
Combined metatarsal and Akin-type proximal phalanx osteotomies represent a surgical solution for concomitant metatarso-phalangeal and inter-phalangeal hallux valgus. This retrospective observational study aimed to evaluate clinical and radiographic outcomes following combined distal linear metatarsal and Akin osteotomies. The study included 42 feet from 37 patients, with a mean follow-up of 27.1 (range 24-37) months. Mean surgical time was 16.54 ± 4.17 minutes. Pre- and postoperative clinical scores and radiological parameters were collected. Positive outcomes with a low recurrence and complications rates were reported. A statistically significant improvement in the Manchester-Oxford foot questionnaire, the EuroQol 5D-5L dimensions instrument, the visual analogue scale, the intermetatarsal angle, the hallux valgus angle, the distal metatarsal articular angle, and the interphalangeal angle correction was observed. Despite the results reported, further prospective studies are needed to identify the most suitable patients for this combined osteotomy approach.
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Affiliation(s)
- Antonio Mazzotti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatologic Clinic, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Simone Ottavio Zielli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatologic Clinic, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Casadei Giacomo
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatologic Clinic, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Elena Artioli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatologic Clinic, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alberto Arceri
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatologic Clinic, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Pejman Abdi
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatologic Clinic, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Laura Langone
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatologic Clinic, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cesare Faldini
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatologic Clinic, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
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Li Z, Liu Z, Shi W, Liang X, Xu C, Zhang K, Li H, Zhang H. Eligibility for knee arthroplasty is associated with increased risk of acquired hallux valgus - a Mendelian randomized study. BMC Musculoskelet Disord 2024; 25:311. [PMID: 38649911 PMCID: PMC11034105 DOI: 10.1186/s12891-024-07458-2] [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: 01/14/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE Clinically, it has been found that patients undergoing knee replacement have a high incidence of concomitant hallux valgus. In this study, we analyzed whether patients with osteoarthritis who underwent surgery and those patient who did not have surgery had an increased risk of hallux valgus by Mendelian randomization and performed reverse causal analysis. DESIGN Genomewide association study (GWAS) data for osteoarthritis, categorized by knee arthritis with joint replacement, knee arthritis without joint replacement, hip arthritis with joint replacement, and hip arthritis without joint replacement.And acquired hallux valgus were downloaded for Mendelian randomized studies. MR analysis was performed using inverse variance-weighted (IVW), weighted median, and MR-Egger methods. MR-egger regression, MR pleiotropic residuals and outliers (MR-presso), and Cochran's Q statistical methods were used to evaluate heterogeneity and pleiotropy. RESULTS The IVW results indicate that, compared to healthy individuals, patients who meet the criteria for knee osteoarthritis joint replacement surgery have a significantly higher risk of acquired hallux valgus. There were no significant causal relationships found for the remaining results. No significant heterogeneity or multiplicity was observed in all the Mr analyses. CONCLUSION Our study supports the increased risk of acquired hallux valgus in patients eligible for knee replacement. There is necessary for clinicians to be concerned about the hallux valgus status of patients undergoing knee arthroplasty.
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Affiliation(s)
- Zhijun Li
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, P. R. China
| | - Zhengxuan Liu
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, P. R. China
| | - Wei Shi
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, P. R. China
| | - Xinyu Liang
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, P. R. China
| | - Chunlei Xu
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, P. R. China
| | - Kai Zhang
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, P. R. China
| | - Hui Li
- Department of Orthopedics, Tianjin Hospital of ITCWM Nankai Hospital, Tianjin, 300052, P. R. China
| | - Huafeng Zhang
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, P. R. China.
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Peiffer M, Karaismailoglu B, Ghandour S, Nassour N, Duggan J, Bejarano-Pineda L, Ashkani-Esfahani S, Miller CP. Effect of sequential burr passes on minimally invasive akin and first metatarsal dorsiflexion osteotomies. Foot Ankle Surg 2024; 30:258-262. [PMID: 38185597 DOI: 10.1016/j.fas.2023.12.008] [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: 09/23/2023] [Revised: 12/01/2023] [Accepted: 12/22/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Minimally invasive surgical (MIS) osteotomies are increasing as a surgical option for treating midfoot and forefoot conditions. This study aimed to evaluate the impact of each burr pass on the degree of correction, gap size, and alignment in MIS Akin and first metatarsal dorsiflexion osteotomies (DFO). METHODS MIS Akin and first metatarsal DFO were performed on ten cadaveric specimens. Fluoroscopic measurements included the metatarsal dorsiflexion angle (MDA), dorsal cortical length (MDCL), first phalangeal medial cortical length (PCML) and proximal to distal phalangeal articular angle (PDPAA). RESULTS The average decrease in PCML with each burr pass was as follows: 1.53, 1.33, 1.27, 1.23 and 1.13 mm at the 1st to 5th pass, respectively. The MDCL sequentially decreased by 1.80, 1.59, 1.35, 0.75, and 0.60 mm. The MDA consistently decreased, and the PDPAA incrementally became more valgus oriented. CONCLUSION On average, a first metatarsal dorsal wedge resection of 4.7 mm and first phalangeal medial wedge resection of 2.9 mm was achieved after 3 and 2 burr passes, respectively. This data may aid surgeons determine the optimal number of burr passes required to achieve the desired patient-specific surgical correction.
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Affiliation(s)
- Matthias Peiffer
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium.
| | - Bedri Karaismailoglu
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Samir Ghandour
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nour Nassour
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica Duggan
- Department of Orthopaedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Lorena Bejarano-Pineda
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Soheil Ashkani-Esfahani
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher P Miller
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopaedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Duggan JL, Guild TT, Stanwood KC, Miller CP. Minimally Invasive vs Open Approach for First Metatarsophalangeal Joint Arthrodesis: Short Report of Early Results. Foot Ankle Int 2024:10711007241238221. [PMID: 38501747 DOI: 10.1177/10711007241238221] [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] [Indexed: 03/20/2024]
Abstract
BACKGROUND We aim to compare early surgical results between groups who underwent minimally invasive surgery (MIS) vs open first metatarsophalangeal (MTP) arthrodesis to treat end-stage hallux rigidus. METHODS We conducted a retrospective cohort review of 65 patients who underwent a first MTP fusion procedure at an academic medical center between 2015 and 2023. Success of fusion was determined radiographically. Postoperative complications were identified through medical record review. RESULTS Sixty-seven first MTP fusion surgeries (41 open and 26 MIS) were performed on 65 patients with a primary diagnosis of hallux rigidus. Open surgery and MIS groups had similarly high fusion rates: 95% (39/41) and 96% (25/26), respectively (P = .84). We identified no difference in overall complication rates: 20% for open surgery and 23% for MIS (P = .73). CONCLUSION This retrospective analysis of 67 first MTP arthrodesis procedures showed no significant differences in fusion success or complications in the short term when comparing MIS to open surgery. Further studies are needed to elucidate potential differences between MIS vs open surgery. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
| | - Theodore T Guild
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
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Li G, Zhang H, Wang X, Yang Y, Xu H, Hong J, Kong SW, Chan KB, Chong KW, Yan A, Shi Z, Ma X. Clinical guideline on the third generation minimally invasive surgery for hallux valgus. J Orthop Translat 2024; 45:48-55. [PMID: 38500804 PMCID: PMC10945049 DOI: 10.1016/j.jot.2023.10.009] [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: 08/02/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 03/20/2024] Open
Abstract
Minimally invasive surgery for hallux valgus correction, has been attracting great interests in the recent decades, due to the potential benefits of less pain, decreased recovery times, smaller scars with better cosmesis, and improved early post-operative range of motion. The most recent developments in minimally invasive surgery have evolved into the third generation with modifications of the chevron-type osteotomy. This evidence-based clinical guideline of the third generation minimally invasive surgery for hallux valgus is initiated and developed collectively by the Foot and Ankle Committee of Orthopedic Branch of Chinese Medical Doctor Association, Foot and Ankle Committee of Sports Medicine Branch of Chinese Medical Doctor Association, and Foot and Ankle Expert Committee of Orthopedic Branch of the Chinese Association of the Integrative Medicine. This clinical guideline provides recommendations for indications, contraindications, operative planning and techniques, post-operative management, management of complications, and prognosis of the third generation minimally invasive surgery for hallux valgus. The Translational Potential of this Article This comprehensive guideline aims to establish standardized recommendations for the indications, contraindications, operative techniques, and post-operative management of the third generation minimally invasive surgery for hallux valgus. By adhering to this guideline, the success rate of the procedure could be maximized. This comprehensive guideline serves as a valuable reference for practitioners interested in or preparing to perform minimally invasive surgery for hallux valgus.
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Affiliation(s)
- Guangyi Li
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Zhang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xu Wang
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Yunfeng Yang
- Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hailin Xu
- Department of Trauma and Orthopaedics, Peking University People's Hospital, Peking University, Beijing, China
| | - Jinsong Hong
- Department of Foot and Ankle Surgery, Guangzhou Orthopaedic Hospital, Guangdong, Guangzhou, China
| | | | | | | | - Alan Yan
- Sanford Health Orthopaedics & Sports Medicine, South Dakota, USA
- University of South Dakota School of Medicine, South Dakota, USA
| | - Zhongmin Shi
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Ma
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Foot and Ankle Committee of Orthopedic Branch of the Chinese Medical Doctor Association, Foot and Ankle Committee of Sports Medicine Branch of Chinese Medical Doctor Association, Foot and Ankle Expert Committee of the Chinese Association for Integrative Medicine
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
- Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Trauma and Orthopaedics, Peking University People's Hospital, Peking University, Beijing, China
- Department of Foot and Ankle Surgery, Guangzhou Orthopaedic Hospital, Guangdong, Guangzhou, China
- Asia Medical Specialists, Hong Kong, China
- Virtus Medical Centre, Hong Kong, China
- BJIOS Orthopaedics, Singapore
- Sanford Health Orthopaedics & Sports Medicine, South Dakota, USA
- University of South Dakota School of Medicine, South Dakota, USA
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Mizher R, Rajan L, Kim J, Srikumar S, Cororaton A, Cody E, Ellis S, Johnson AH. Does the Presence of Asymptomatic Flatfoot Deformity Impact the Clinical and Radiographic Outcomes of the Minimally Invasive Chevron and Akin Bunionectomy? Foot Ankle Int 2024; 45:252-260. [PMID: 38281125 DOI: 10.1177/10711007231220553] [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: 01/29/2024]
Abstract
BACKGROUND Flatfoot deformity is believed to play a role in hallux valgus development and recurrence. While symptomatic flatfoot deformity can be treated with separate procedures at the time of hallux valgus correction, the question remains whether the patient undergoing correction of a symptomatic hallux valgus deformity should have their asymptomatic flatfoot concurrently addressed. We aimed to investigate whether the presence of asymptomatic flatfoot influences patient-reported and radiographic outcomes of the minimally invasive chevron and Akin bunionectomy. METHODS A total of 104 patients were included in this study. Forty-two asymptomatic patients met the radiographic criteria for flatfoot while 62 had a normal arch. Patient-reported outcomes were evaluated and compared between the two groups using validated PROMIS measures preoperatively and at a minimum one-year postoperatively. Radiographic outcomes including hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary's angle, calcaneal pitch (CP), and talonavicular coverage angle (TNCA) were measured and compared preoperatively and minimum six-months postoperatively. RESULTS Both groups demonstrated similar preoperative and postoperative PROMIS scores with significant improvements in physical function, pain interference, pain intensity, and global physical health. Preoperatively, HVA was similar between both groups, however the flatfoot group showed a greater IMA, Meary's angle, TNCA, and lower CP. Postoperatively, HVA and IMA were similar between groups, although patients in the flatfoot group retained a significantly greater Meary's angle, TNCA, and lower CP. Both groups showed significant improvements in HVA, IMA, and TNCA. CONCLUSION Our study indicates that the minimally invasive chevron and Akin bunionectomy leads to improved clinical and radiographic hallux valgus outcomes without adversely impacting radiographic flatfoot parameters. Therefore, the MIS bunionectomy may be an effective option for hallux valgus correction in patients with mild, asymptomatic flatfoot. LEVEL OF EVIDENCE Level III, retrospective cohort.
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Affiliation(s)
- Rami Mizher
- Hospital for Special Surgery, New York, NY, USA
| | - Lavan Rajan
- Hospital for Special Surgery, New York, NY, USA
| | | | | | | | | | - Scott Ellis
- Hospital for Special Surgery, New York, NY, USA
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Fernández-Vizcaino C, Nieto-García E, Fernández-Ehrling N, Ferrer-Torregrosa J. Improving the Accuracy of Metatarsal Osteotomies in Minimally Invasive Foot Surgery Using a Digital Inclinometer: Preliminary Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:1022. [PMID: 38339738 PMCID: PMC10857759 DOI: 10.3390/s24031022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024]
Abstract
Minimally invasive foot surgery (MIS) has become a common procedure to treat various pathologies, and accuracy in the angle of metatarsal osteotomies is crucial to ensure optimal results. This randomized controlled trial with 37 patients investigates whether the implementation of a digital inclinometer can improve the accuracy of osteotomies compared to traditional freehand techniques. Patients were randomly allocated to group A (n = 15) receiving inclinometer-assisted surgery or group B (n = 22) receiving conventional surgery. Osteotomies were performed and outcomes were evaluated using an inclinometer. The inclinometer group showed a significant decrease in plantar pressure from 684.1 g/cm2 pretreatment to 449.5 g/cm2 post-treatment (p < 0.001, Cohen's d = 5.477). The control group decreased from 584.5 g/cm2 to 521.5 g/cm2 (p = 0.001, Cohen's d = 0.801). The effect size between groups was large (Cohen's d = -2.572, p < 0.001). The findings indicate a significant improvement in accuracy and reduction in outliers when using an inclinometer, suggesting that this technology has the potential to improve surgical practice and patient outcomes in minimally invasive metatarsal osteotomies.
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Affiliation(s)
- Carlos Fernández-Vizcaino
- Doctorate School, Catholic University of Valencia San Vicente Mártir, C/Quevedo, 2, 46001 Valencia, Spain;
| | - Eduardo Nieto-García
- Podiatry Department, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Ramiro de Maeztu, 14, 46900 Torrent, Spain; (E.N.-G.); (N.F.-E.)
| | - Nadia Fernández-Ehrling
- Podiatry Department, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Ramiro de Maeztu, 14, 46900 Torrent, Spain; (E.N.-G.); (N.F.-E.)
| | - Javier Ferrer-Torregrosa
- Podiatry Department, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Ramiro de Maeztu, 14, 46900 Torrent, Spain; (E.N.-G.); (N.F.-E.)
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Li Z, Yu W, Lin S, Fu K, Fang Z. Comparative effects of modified rotary scarf osteotomy and traditional scarf osteotomy in treating moderate to severe hallux valgus: a retrospective cohort study. BMC Musculoskelet Disord 2024; 25:61. [PMID: 38216881 PMCID: PMC10787438 DOI: 10.1186/s12891-023-07156-5] [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: 06/19/2023] [Accepted: 12/27/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Traditional Scarf osteotomy (TSO) is an effective procedure with a good record in moderate to severe hallux valgus (MSHV) surgery. In order to overcome shortcomings of TSO, Modified Rotary Scarf osteotomy (MRSO) was introduced in this study, which aimed to compare the clinical and radiological outcome in the patients treated with MRSO or TSO. METHODS Of 175 patients (247 feet) with MSHV, 100 patients (138 feet) treated with MRSO and 75 patients (109 feet) treated with TSO were evaluated according to relevant indicators in twenty-four months follow-up. Pre-surgical and post-surgical HVA, IMA, DMAA, MTP-1 ROM, sesamoid grade and AOFAS (American Orthopaedic Foot and Ankle Society) scores and postsurgical complications were evaluated. RESULTS Both groups manifested similar baseline characters. The mean follow-up was of 25.9 (range, 22-37) months. Significantly lower IMA, lower Sesamoid grade and higher DMAA at six months, twelve months and twenty-four months post-surgically had been showed in MRSO group compared to TSO group. There was no significant difference in HVA, MTP-1 ROM and AOFAS data at each follow-up time point post-surgically between the two groups. No major complications occurred in either group. CONCLUSION MRSO showed comparable results to TSO, and improved IMA and sesamoid grade to a greater extent, with a lower probability of throughing effect. Although DMAA could be increased by MRSO, MRSO could still be a reproducible, non-dangerous and efficacious alternative procedure for treating HV patients which do not have severe DMAA.
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Affiliation(s)
- Zi Li
- Department of Orthopaedics, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, Hubei, China
| | - Weiwei Yu
- Department of Orthopaedics, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, Hubei, China
| | - Shiwei Lin
- Department of Orthopaedics, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, Hubei, China
| | - Ke Fu
- Department of Orthopaedics, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, Hubei, China
| | - Zhenhua Fang
- Department of Orthopaedics, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, Hubei, China.
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11
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Balesar VV, Bruin LL, van Liebergen M, Deenik AR, Keizer SB. MICA Procedure vs Open Chevron Osteotomy for Hallux Valgus Correction: A Prospective Cohort Study. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114231224725. [PMID: 38288288 PMCID: PMC10823862 DOI: 10.1177/24730114231224725] [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: 01/31/2024] Open
Abstract
Background Currently, more than 150 surgical techniques have been described for the treatment of hallux valgus. The abundance of techniques indicates that there is no technique that has been designated as a gold standard. In recent years, a particular interest in the use of minimally invasive techniques has grown. The aim of this study was to prospectively compare clinical, radiologic, and postoperative outcomes between the MICA technique and open chevron technique over a 1-year follow-up period. Methods Between January 2016 and August 2020, data were prospectively collected from consecutive patients preoperatively and at 6 weeks, 3 months, and 12 months following minimally invasive chevron and Akin (MICA) or open chevron osteotomies. Radiographic outcomes were measured using weightbearing radiographs preoperatively and at 3 and 12 months postoperatively. Clinical outcomes were measured using the American Orthopaedic Foot & Ankle Society (AOFAS), Manchester-Oxford Foot Questionnaire (MOXFQ), VAS (visual analog scale), Foot Function Index (FFI), Foot and Ankle Outcome Score (FAOS), and Euro-QoL-5D (EQ5D) questionnaires. Results Of the 68 patients, 42 patients (62%) underwent a MICA surgery and 26 patients (38%) underwent open chevron osteotomy. Both groups showed significant improvement in HVA, IMA, and DMAA at the 1-year follow-up. Our findings show that both clinical and radiologic outcomes of the MICA technique are comparable to the conventional open technique. No significant differences were found in clinical outcomes (VAS, AOFAS, MOXFQ, FFI, and FAOS), complication rate, and operative times. Conclusion These results show that MICA is a safe alternative for chevron osteotomy. The clinical and radiologic outcomes of these 2 techniques by 12 months are comparable. Level of Evidence Level II, prospective cohort study.
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Affiliation(s)
- Vinay V. Balesar
- Department of Orthopaedic Surgery, Medisch Centrum Haaglanden, the Hague, the Netherlands
| | - Luca L. Bruin
- Department of Orthopaedic Surgery, Medisch Centrum Haaglanden, the Hague, the Netherlands
| | - Margo van Liebergen
- Department of Radiology, Medisch Centrum Haaglanden, the Hague, the Netherlands
| | - Axel R. Deenik
- Department of Orthopaedic Surgery, Medisch Centrum Haaglanden, the Hague, the Netherlands
| | - Stefan B. Keizer
- Department of Orthopaedic Surgery, Medisch Centrum Haaglanden, the Hague, the Netherlands
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12
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Del Vecchio JJ, Dealbera ED, Chemes LN, Slullitel G, Calvi JP, Dalmau-Pastor M. A Radiologic Triangle Sign for Percutaneous Adductor Tendon Release (PATR): Cadaveric Study and Case Series. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241241269. [PMID: 38559393 PMCID: PMC10981861 DOI: 10.1177/24730114241241269] [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: 04/04/2024] Open
Abstract
Background Combining osteotomies and soft tissue procedures is believed to reduce sesamoids in their anatomical position and maintain long-term correction when treating hallux valgus deformity. This study determines if a radiologic association exists between a radiolucent sign and a full percutaneous adductor tendon release (PATR), including a cadaveric study and a consecutive case series. Another aim was to determine the intra- and interobserver reliability of these observations. Methods A prospective observational study was made between 2018 and 2019. First, a PATR was done on cadaveric specimens and, after the procedures, dissected to correlate what was seen fluoroscopically. The clinical group included 39 feet that presented mild-to-moderate HV deformity and were treated with percutaneous osteotomies associated with PATR. Results Observers 1 and 2 saw a radioscopic radiolucent sign in 100% of cadavers and the patient population. They also observed a triangle-shaped image with an incidence of 75%, which we have named the "triangle sign." Conclusion The triangle sign may be helpful in the intraoperative confirmation of PATR and latero-plantar capsule release using this percutaneous technique. Level of Evidence Level II, development of diagnostic criteria.
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Affiliation(s)
- Jorge Javier Del Vecchio
- Head Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro–Hospital Universitario, Ciudad Autónoma de Buenos Aires (CABA), Argentina
- Department of Kinesiology and Physiatry, Universidad Favaloro, CABA, Argentina
- MIFAS (Minimally Invasive Foot and Ankle Society) by GRECMIP, Merignac, France
| | - Eric Daniel Dealbera
- Foot and Ankle Section, Fundación Favaloro–Hospital Universitario, Buenos Aires, Ciudad Autónoma de Buenos Aires (CABA), Argentina
| | - Lucas Nicolás Chemes
- Foot and Ankle Section, Fundación Favaloro–Hospital Universitario, Buenos Aires, Ciudad Autónoma de Buenos Aires (CABA), Argentina
| | - Gastón Slullitel
- Department of Foot and Ankle Surgery, Institute of Orthopedics “Dr. Jaime Slullitel,” Santa Fe, Argentine
| | - Juan Pablo Calvi
- Department of Foot and Ankle Surgery, Institute of Orthopedics “Dr. Jaime Slullitel,” Santa Fe, Argentine
| | - Miki Dalmau-Pastor
- MIFAS (Minimally Invasive Foot and Ankle Society) by GRECMIP, Merignac, France
- Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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13
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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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14
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Baumann AN, Walley KC, Anastasio AT, Gong DC, Talusan PG. Learning curve associated with minimally invasive surgery for hallux valgus: A systematic review. Foot Ankle Surg 2023; 29:560-565. [PMID: 37524619 DOI: 10.1016/j.fas.2023.07.012] [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: 03/28/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND The purpose of this systematic review is to examine the learning curve associated with minimally invasive surgery (MIS) for the treatment of hallux valgus (HV). METHODS A systematic review was performed using PubMed, ScienceDirect, Web of Science, CINAHL and MEDLINE databases from database inception to February 16th, 2023. Inclusion criteria was articles with level of evidence I-III, any outcomes associated with learning curve, minimally invasive surgery, and diagnosis of hallux valgus' in adult patients. RESULTS Six articles out of 165 articles meet inclusion criteria. For all six articles, 368 total patients (422 total feet) were included in the study with an average age of 55.69 years. Three studies reported the number of surgeries needed to reach the plateau phase of the learning curve of MIS for HV, with a frequency weighted mean of 35.5 surgeries (range 27 - 40). In the selected articles, significant results were found for increased operating room (OR) time and fluoroscopy shots in the learning phase. There was no significant increase in complications in the learning phase. There was no significant decrease in patient outcomes, or the quality of correction performed during the learning phase. CONCLUSION An average of 35.5 surgeries (range 27 - 40) are needed to reach the plateau phase for MIS for HV. The learning phase of the learning curve of MIS for HV has a significant increase in OR time and fluoroscopy usage. However, the learning phase of the learning curve of MIS for HV is not associated with decreased outcomes or higher complication rates based on the small sample size in this study. LEVEL OF EVIDENCE Level III, Systematic Review.
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Affiliation(s)
- Anthony N Baumann
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Kempland C Walley
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, USA.
| | | | - Davin C Gong
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Paul G Talusan
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, USA
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15
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Mazzotti A, Zielli SO, Abdi P, Artioli E, Arceri A, Vannini F, Faldini C. Severe hallux valgus can be treated using a distal metatarsal osteotomy: Results of 144 cases treated with the SERI technique. Foot Ankle Surg 2023; 29:455-461. [PMID: 37468358 DOI: 10.1016/j.fas.2023.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/11/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE Aim of this study is to analyze the clinical and radiographic results of the simple, effective, rapid and inexpensive (SERI) technique, a linear distal metatarsal osteotomy, for treating severe hallux valgus (HV). METHODS Clinical outcomes were assessed pre- and postoperatively using the AOFAS, MOxFQ and VAS score. Pre and postoperative HV angle (HVA) and intermetatarsal angle (IMA) were measured. RESULTS 117 consecutive patients for a total of 144 feet were included. Pre and postoperatively, mean AOFAS changed from 44.8 ± 16.7 to 89 ± 10.3 (p < .001), mean MOxFQ changed from 76.2 ± 15.8 to 23.4 ± 7.9 (p < .001) and mean VAS score improved from 6.7 ± 2.1 to 1.5 ± 1.5 (p < .001). HVA diminished from 40.6° ± 6.9 preoperatively to 16.0° ± 7.3 postoperatively (p < .001). IMA decreased from 15.1° ± 2.8 preoperatively to 6.5° ± 2.4 postoperatively (p < .001). The main complication reported was stiffness (10.4 %). CONCLUSION SERI technique applied to severe HV showed positive clinical and radiological outcomes. A careful patient selection and a low grade first MTPJ arthritis are essential to obtain favorable results. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Antonio Mazzotti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Simone Ottavio Zielli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Pejman Abdi
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Elena Artioli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alberto Arceri
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesca Vannini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
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16
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Hwang YG, Park KH, Han SH. Medial Reduction in Sesamoid Position after Hallux Valgus Correction Surgery Showed Better Outcome in S.E.R.I. Osteotomy than DCMO. J Clin Med 2023; 12:4402. [PMID: 37445453 DOI: 10.3390/jcm12134402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The purpose of the present study was to compare the degree of sesamoid reduction after hallux valgus correction between distal chevron metatarsal osteotomy (DCMO) and S.E.R.I. (simple, effective, rapid, and inexpensive) osteotomy, and to analyze the effects on the recurrence of hallux valgus. METHODS We retrospectively analyzed the foot radiographs of 60 feet (30 DCMO and 30 SERI) treated for hallux valgus from August 2013 to July 2017. Radiographic assessments were performed preoperatively, at early follow-up (at a mean of 3.1 months) and at the most recent follow-up (at a mean of 16.7 months). The location of the medial sesamoid was classified into seven stages, in accordance with the method described by Hardy and Clapham; stage IV or less was defined as the normal position for the medial sesamoid, and stage V or greater was defined as lateral displacement of the sesamoid. The pre- and post-operative hallux valgus angle, 1-2 intermetatarsal angle, and sesamoid position were compared between the two groups. RESULTS The mean follow-up period was 18.4 (12-36) months in the DCMO group and 15.0 (12-36) months in the S.E.R.I. group (p = 0.108). The radiologic results showed that the hallux valgus angles were not significantly different between the two groups preoperatively and at the early follow-up: preoperatively, they were 28.8 ± 7.7 in the DCMO group and 32.6 ± 9.5 in the S.E.R.I. group (p = 0.101), and they were 10.4 ± 4.0 and 8.7 ± 5.0 (p = 0.148) at the early follow-up, respectively. However, at the most recent follow-up, the DCMO group (13.9 ± 5.6) showed significantly higher hallux valgus angles than the S.E.R.I. group (10.4 ± 6.4, p = 0.030), and there were no differences between the recurrence of hallux valgus in the DCMO group (13%)and that in the S.E.R.I. group (10%) (p = 0.553). There were no significant differences in the 1-2 intermetatarsal angles between the two groups at the early follow-up (6.1 ± 2.5 vs. 4.8 ± 3.1, p = 0.082) and at the most recent follow-up (7.3 ± 2.9 vs. 6.6 ± 3.5, p = 0.408). After hallux-valgus-correction surgery, the stage change of the tibia sesamoid position from the preoperative stage to the initial follow-up was significantly larger in the S.E.R.I. group (-4.4 ± 1.4) than in the DCMO group (-3.4 ± 1.1) (p = 0.003); the changes from the preoperative stage to the last follow-up were also significantly larger in the SERI group (-3.3 ± 1.7) than in the DCMO group (-2.4 ± 1.5) (p = 0.028); however, the changes from the initial follow-up to the last follow-up showed no significant differences between the two groups (+1.0 ± 1.1 in the DCMO group vs. +1.1 ± 1.2 in the S.E.R.I. group) (p = 0.822). The medial sesamoid was laterally subluxated in all the preoperative cases in the DCMO and S.E.R.I. groups. The lateral subluxation of the tibia sesamoid was more frequently observed in the DCMO group (four cases, 13%) than in the S.E.R.I. group (0 cases, 0%) (p = 0.038) at the early follow-up. CONCLUSION In conclusion, our results demonstrated that the S.E.R.I. procedure is superior to DCMO in decreasing the hallux valgus angle and showed that the early post-operative reduction in the sesamoids can be a risk factor for the recurrence of hallux valgus.
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Affiliation(s)
- Yeok Gu Hwang
- College of Medicine, Ewha Womans University, Seoul Hospital, Seoul 07804, Republic of Korea
| | - Kwang Hwan Park
- College of Medicine, Yonsei University, Severance Hospital, Seoul 03722, Republic of Korea
| | - Seung Hwan Han
- College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul 06273, Republic of Korea
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17
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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: 1] [Impact Index Per Article: 1.0] [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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18
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Kim SH, Kim YH, Cha JY, Lee YK. Correlations of Sesamoid Bone Subluxation with the Radiologic Measures of Hallux Valgus and Its Clinical Implications. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050876. [PMID: 37241108 DOI: 10.3390/medicina59050876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Hallux valgus is one of the most common chronic foot complaints, with prevalences of over 23% in adults and up to 35.7% in older adults. However, the prevalence is only 3.5% in adolescents. The pathological causes and pathophysiology of hallux valgus are well-known in various studies and reports. A change in the position of the sesamoid bone under the metatarsal bone of the first toe is known to be the cause of the initial pathophysiology. Purpose: The relationships between the changes in the location of the sesamoid bone and each radiologically measured angle and joint congruency in the hallux valgus remain as yet unknown. Therefore, this study investigated the relationships of sesamoid bone subluxation with the hallux valgus angle, intermetatarsal angle, and metatarsophalangeal joint congruency in hallux valgus patients. The goal is to know the hallux valgus angle, the intermetatarsal angle, and metatarsophalangeal joint congruency's correlation with hallux valgus severity and prognosis by revealing the relationship between each measured value and sesamoid bone subluxation. Materials and Methods: We reviewed 205 hallux valgus patients who underwent radiographic evaluation and subsequent hallux valgus correction surgery in our orthopedic clinic between March 2015 and February 2020. Sesamoid subluxation was assessed using a new five-grade scale on foot radiographs, and other radiologic measurements were assessed, such as hallux valgus angle, the intermetatarsal angle, distal metatarsal articular angle, joint congruency, etc. Conclusions: Measurements of the hallux valgus angle, interphalangeal angle, and joint congruency exhibited high interobserver and intraobserver reliabilities in this study. They also showed correlations with sesamoid subluxation grade.
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Affiliation(s)
- Sung Hwan Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Gyeonggi-do, Republic of Korea
| | - Young Hwan Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Gyeonggi-do, Republic of Korea
| | - Joo Young Cha
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Gyeonggi-do, Republic of Korea
| | - Young Koo Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Gyeonggi-do, Republic of Korea
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19
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Jackson JB, Encinas R, Gonzalez T. Lateral Decubitus Position for Minimally Invasive Surgery for Correction of Hallux Valgus Deformity: A Technique Tip. Foot Ankle Int 2023; 44:340-342. [PMID: 37002602 DOI: 10.1177/10711007231154893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Affiliation(s)
- J Benjamin Jackson
- Prisma Health Orthopedics, University of South Carolina, Lexington, SC, USA
| | - Rodrigo Encinas
- Prisma Health Orthopedics, University of South Carolina, Lexington, SC, USA
| | - Tyler Gonzalez
- Prisma Health Orthopedics, University of South Carolina, Lexington, SC, USA
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Lotan R, Shlomov B, Dotan A, Bermant A, Hershkovich O. Hallux Valgus Repair with Chevron Osteotomy Significantly Narrows Forefoot Width. J Clin Med 2023; 12:jcm12072607. [PMID: 37048690 PMCID: PMC10094931 DOI: 10.3390/jcm12072607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/01/2023] Open
Abstract
Background: Hallux valgus (HV) is a common adult foot deformity. There is uncertainty concerning the effect of HV surgery on foot width. We examined the effect of chevron first metatarsal osteotomy on forefoot width using calibrated pre and postoperative standing radiographs. Methods: A retrospective cohort of 50 patients underwent chevron osteotomy HV surgery. All had HVA > 30°, IMA > 11°, DMMA > 3°, >6-month follow-up, and calibrated pre and postoperative standing foot radiographs. Bony width (BW) and soft tissue width (STW) were used to measure the surgery’s effect on foot width. Measurements were made preoperatively and 3–6 months following surgery. Results: The study group included 42 women with an average age of 63.4 (±8.3) and a mean BMI of 28.7 (±4.9). Preoperative HVA and IMA were 31.7° (±6.8°) and 13.4° (±2.8°), respectively. Following surgery, HVA and IMA improved significantly, by 15.6° (±5.7°) and 8.7° (±2.3°), respectively. The preoperative average BW was 9.4 cm (±0.6), and the STW was 10.6 cm (±0.7). Following surgery, significant changes in BW and STW were measured, with a mean narrowing of 1.2 cm (±0.4) in BW (p < 0.001) and 0.95 cm (±0.5) in STW (p < 0.001). Paradoxically, an increase in age led to a lower correction of the IMA (p = 0.04, r = 0.57), but higher BW and STW reductions (p = 0.01, r = 0.35 and p = 0.008, r = 0.37, respectively). Conclusions: This study reinforced chevron osteotomy as a valid treatment option that significantly narrows forefoot width; it is thus expected to improve cosmetic outcomes, shoe selection options, and quality of life. This study also found that older age correlates with better forefoot narrowing following hallux valgus repair, possibly due to stiffer soft tissues.
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Lewis TL, Robinson PW, Ray R, Dearden PMC, Goff TAJ, Watt C, Lam P. Five-Year Follow-up of Third-Generation Percutaneous Chevron and Akin Osteotomies (PECA) for Hallux Valgus. Foot Ankle Int 2023; 44:104-117. [PMID: 36692121 DOI: 10.1177/10711007221146195] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Recent large studies of third-generation minimally invasive hallux valgus surgery (MIS) have demonstrated significant improvement in clinical and radiologic outcomes. It remains unknown whether these clinical and radiologic outcomes are maintained in the medium to long term. The aim of this study was to investigate the minimum 5-year clinical and radiologic outcomes following third-generation MIS hallux valgus surgery in the hands of a high-volume MIS surgeon. METHODS A retrospective observational single highly experienced MIS surgeon case series of consecutive patients undergoing primary isolated third-generation percutaneous chevron and Akin osteotomies (PECA) for hallux valgus with a minimum 60-month clinical and radiographic follow-up. Primary outcome was radiographic assessment of the hallux valgus angle (HVA) and intermetatarsal angle (IMA) preoperatively, 6 months, and ≥60 months following PECA. Secondary outcomes included the Manchester-Oxford Foot Questionnaire, patient satisfaction, EuroQol-5D visual analog scale and the visual analog scale for pain. RESULTS Between 2012 and 2014, 126 consecutive feet underwent isolated third-generation PECA, with complete data available for 78 (61.9%) feet. The median follow-up was 65.0 (IQR 64-69; range 60-88) months. There was a significant improvement in radiographic deformity correction; the median IMA improved from 12.0 degrees (interquartile range [IQR]: 10.8-14.2) to 6.0 degrees (IQR: 4.2-7.3) (P < .001), and the median HVA improved from 27.2 degrees (IQR: 20.6-34.4) to 7.2 degrees (IQR: 3.4-11.6). Median MOXFQ Index score at ≥60-month follow-up was 2.3 (IQR: 0.0-7.8). The radiographic recurrence rate (defined as HVA >15 degrees) was 7.7% at final follow-up. The complication rate was 4.8%. CONCLUSION Radiologic deformity correction for the 78 feet we were able to follow that had third-generation PECA performed by a single highly experienced MIS surgeon was found to be maintained at a mean follow-up of average 66.8 months, with a radiographic recurrence rate of 7.7%. Clinical PROMs and patient satisfaction levels were high and comparable to other third-generation studies with shorter duration of follow-up. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Thomas L Lewis
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Peter W Robinson
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, United Kingdom
| | - Robbie Ray
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Thomas A J Goff
- Mid Yorkshire Hospitals NHS Trust, Wakefield, United Kingdom
| | - Clare Watt
- Orthopaedic and Arthritis Specialist Centre, Chatswood, Sydney, Australia
| | - Peter Lam
- Orthopaedic and Arthritis Specialist Centre, Chatswood, Sydney, Australia
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22
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Li X, Zhang J, Fu S, Wang C, Yang F, Shi Z. First metatarsal single-screw minimally invasive chevron-akin osteotomy: A cost effective and clinically reliable technique. Front Surg 2023; 9:1047168. [PMID: 36684313 PMCID: PMC9849553 DOI: 10.3389/fsurg.2022.1047168] [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: 09/17/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose The common disease hallux valgus results in foot discomfort and dysfunction. Less soft tissue damage and faster wound healing have made minimally invasive surgery (MIS) more popular. However, little research has compared the fixation results of minimally invasive chevron-akin (MICA) osteotomy thus far. In this study, the clinical and radiographic results of MICA with first metatarsal single- or dual-screw fixation are being examined. Methods A total of 107 feet of 103 patients with mild to moderate symptomatic hallux valgus treated MICA from January 2018 to June 2020 were retrospective evaluated, with at least 12-months follow-up. 51 patients underwent single-screw fixation procedures and 52 patients received dual-screw fixation procedures. Patients were assessed preoperatively and at the final follow-up with radiographic measurements [hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA)] and clinical scores (american orthopaedic foot and ankle society (AOFAS) forefoot score, visual analog scale (VAS) and Manchester-Oxford Foot Questionnaire (MOxFQ) scores). The coughlin satisfaction scores were also obtained. Results Both groups showed significantly improved HVA, IMA and DMAA at the final follow-up (P < 0.001). Regarding clinical outcomes, the AOFAS, VAS and MOxFQ in two categories also significantly improved postoperatively (P < 0.001). There was no obvious difference in the clinical and radiographic outcomes between the two groups (HVA, P = 0.833; IMA, P = 0.073; DMAA, P = 0.35; AOFAS, P = 0.48; VAS, P = 0.86; MOxFQ, P = 0.87). However, the single-screw fixation group showed significantly lower operation time and less number of intraoperative fluoroscopy (P < 0.001). No serious complications were observed in either group. The single-screw fixation technique saves at least $1,086 compared with the dual-screw group. Conclusion At the final follow-up, both the single- and dual-screw fixation groups had comparable good to excellent clinical and radiographic outcomes, as well as a similar incidence of complications. Additionally, the single-screw fixation group reduces overall surgical costs, number of intraoperative fluoroscopy and operational time.
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Affiliation(s)
| | | | | | | | - Fan Yang
- Correspondence: Fan Yang Zhongmin Shi
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23
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Batar S, Söylemez MS, Kemah B, Cepni SK. A cross-sectional study on reliability and quality of YouTube® videos related to hallux valgus and evaluation of newly developed hallux valgus-specific survey tool. Digit Health 2023; 9:20552076231171239. [PMID: 37113253 PMCID: PMC10126661 DOI: 10.1177/20552076231171239] [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] [Received: 11/03/2022] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
Objective Previous studies have reported low quality and reliability on YouTube videos about various medical issues including videos related to hallux valgus (HV) treatment. Therefore, we aimed to evaluate the reliability and quality of YouTube videos on HV and develop a new HV-specific survey tool that physicians, surgeons, and the medical industry can use to create high-quality videos. Methods Videos viewed over 10,000 times were included in the study. We used the Journal of the American Medical Association (JAMA) benchmark criteria, global quality score (GQS), DISCERN tool, and new HV-specific survey criteria (HVSSC) developed by us to evaluate the quality, educational utility and reliability of the videos, the popularity of which was assessed using the Video Power Index (VPI) and view ratio (VR). Results Fifty-two videos were included in this study. Fifteen videos (28.8%) were posted by medical companies producing surgical implants and orthopedic products, 20 (38.5%) by nonsurgical physicians, and 16 (30.8%) by surgeons. The HVSSC indicated that the quality, educational value, and reliability of only 5 (9.6%) videos were adequate. Videos posted by physicians and surgeons tended to be more popular (p = 0.047 and 0.043). Although no correlation was detected among the DISCERN, JAMA, and GQS scores, or between the VR and VPI, we found correlations of the HVSSC score with the number of views and the VR (p = 0.374 and p = 0.006, respectively). A good correlation was detected among the DISCERN, GQS, and HVSSC classifications (rho = 0.770, 0.853, and 0.831, respectively, p = 0.001). Conclusions The reliability of HV-related videos on YouTube is low for professionals and patients. The HVSSC can be used to evaluate the quality, educational value, and reliability of videos.
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Affiliation(s)
| | - Mehmet Salih Söylemez
- Mehmet Salih Söylemez, Department of
Orthopaedics and Traumatology, Umraniye Training and Research Hospital, Yaprak
Street, Acıbadem District, No. 32, D: 12, 34660 Uskudar, Istanbul, Turkey.
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24
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Bai Z, Cao X, Yang Y, Sun X, Dong Y, Wen J, Sun W. Establishment and Validation of a Predictive Nomogram for Hallux Valgus with Pain Under the Second Metatarsal. J Pain Res 2022; 15:3523-3536. [PMID: 36394054 PMCID: PMC9651065 DOI: 10.2147/jpr.s386315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022] Open
Abstract
Objective To investigate the risk factors for hallux valgus complicated with pain under the second metatarsal and construct an effective model and method for predicting hallux valgus complicated with pain under the second metatarsal based on risk factors. Methods A total of 545 patients with hallux valgus who were admitted to our hospital were divided randomly into a training set and a validation set. The demographic characteristics, imaging indices and gait test indices of the patients were collected. The risk factors were identified by univariate and multivariate logistic regression analyses. A risk prediction model for hallux valgus with pain under the second metatarsal was established, and the area under the curve (AUC) of the receiver operating characteristic and a decision curve analysis were used for verification and identification. The value of the model was tested in the verification group. Results Second metatarsal length, second metatarsal peak pressure, hallux valgus angle (HVA), intermetatarsal angle 1–2 (IMA1–2) and weight were the risk factors for hallux valgus complicated with pain under the second metatarsal. Based on the weighting of these seven risk factors, a prediction model was established. The AUC of the prediction model was 0.84 (95% confidence interval [CI]: 0.802~0.898, P < 0.05), and the results of a Hosmer–Lemeshow test showed a good degree of calibration (χ2 = 10.62, P > 0.05). The internal validation of the AUC was 0.83 (95% CI: 0.737–0.885, P < 0.05). The model had obvious net benefits when the threshold probability was 10%–70%. Conclusion Second metatarsal length, second metatarsal peak pressure, HVA, IMA1–2 and weight were the risk factors for hallux valgus combined with second metatarsal pain. The risk prediction model for hallux valgus complicated with pain under the second metatarsal based on these seven variables was proven effective. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Zixing Bai
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Xuhan Cao
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Yanjun Yang
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Xudong Sun
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Yongli Dong
- Scientific Research Department, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Jianmin Wen
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Weidong Sun
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
- Correspondence: Weidong Sun, Wangjing Hospital of China Academy of Chinese Medical Sciences, No. 6 Central South Road, Wangjing, Chaoyang District, Beijing, 100102, People’s Republic of China, Tel +86-84739140, Email
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25
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Lewis TL, Ray R, Gordon DJ. Time to maximum clinical improvement following minimally invasive chevron and Akin osteotomies (MICA) in hallux valgus surgery. Foot Ankle Surg 2022; 28:928-934. [PMID: 35063362 DOI: 10.1016/j.fas.2022.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is increasing evidence of positive improvement in clinical and radiological outcomes following minimally invasive hallux valgus deformity correction surgery (MIS). This study investigated the rate of improvement in clinical patient reported outcome measures (PROMs) following MIS as this is not well understood. METHODS Between July 2014 and July 2019, data was prospectively collected from consecutive patients pre-operatively and at 6, 12, and 24 months following third-generation minimally invasive chevron and Akin osteotomies (MICA). Radiographic deformity and correction was assessed using weight-bearing radiographs pre-operatively and 6 weeks post-operatively. The primary outcome measure was the change in Manchester Oxford Foot Questionnaire (MOXFQ) score at each time point. Secondary outcomes include radiographic deformity correction, health-related quality of life PROMs and exploration of cases where PROMs did not improve. RESULTS There were 202 feet with complete PROM data for every time point. There was a statistically significant improvement in MOXFQ Index score at each time point (p < 0.05) following MICA surgery. The majority of the improvement occurred within the first 6 months. A subgroup of 17 feet (8.4%) were identified which had worse MOXFQ Index scores 6 months following MICA. For 14 feet in this subgroup (82.4%), the MOXFQ Index score subsequently improved over time such that by two years, their score had significantly improved compared to their pre-operative score. CONCLUSION The majority of PROM improvement with MICA is gained by 6 months post-operatively but further significant improvement can be seen up to 2 years. Those patients who have not improved at 6 months, are likely to do so with time. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- T L Lewis
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, UK
| | - R Ray
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, UK
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26
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de Carvalho KAM, Baptista AD, de Cesar Netto C, Johnson AH, Dalmau-Pastor M. Minimally Invasive Chevron-Akin for Correction of Moderate and Severe Hallux Valgus Deformities: Clinical and Radiologic Outcomes With a Minimum 2-Year Follow-up. Foot Ankle Int 2022; 43:1317-1330. [PMID: 36000192 DOI: 10.1177/10711007221114123] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The minimally invasive chevron-Akin (MICA) technique has already demonstrated efficacy compared with other known surgical treatments for mild to moderate hallux valgus (HV). MICA combines percutaneous osteotomies with the benefits of modern, rigid internal fixation. The aim of study was to evaluate the radiographic parameters, clinical improvement, and potential complications in moderate to severe HV cases, operated using the MICA technique. METHODS Retrospective study including 70 feet with HV operated using the MICA technique. The AOFAS hallux MTP-IP score and radiographics for HV evaluation were applied preoperatively, and after 6 months, 1 year, and 2 years of follow-up. The following radiographic parameters were measured: metatarsophalangeal hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), interphalangeal angle (IPA), and intermetatarsal angle (IMA). RESULTS The average preoperative VAS pain score was 8.2 ± 1.5, which improved to 1.2 ± 2.2 at 24 months. The mean preoperative IMA was 14.8 ± 3.6 degrees compared with a mean of 7.5 ± 2.1 degrees (P < .01) at 24 months. The preoperative HVA value averaged 30.4 ± 9.8 degrees and at 6 months postoperatively 11.1 ± 6.8 degrees (P < .01), which remained stable until measured at 24 months. The mean preoperative DMAA was 16.3 ± 8.6 degrees and at the 6-month follow-up was 7.8 ± 5.4 degrees (P < .01). The mean preoperative IPA was 7.63 ± 4.4 degrees compared with a mean of 6.28 ± 3.5 degrees (P > .05) at 24 months. Complications included painful hardware (14.28%), neuropathic pain (2.85%), and loss of correction (4.28%). CONCLUSION In this retrospective review from a single center, we found the MICA technique to be an effective procedure for correcting moderate to severe HV, with a low rate of recurrence and an acceptable rate of complications. Patients undergoing the surgical procedure in our series showed a significant reduction in radiographic parameters and a significant improvement in clinical scores, maintaining these results over time. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- Kepler Alencar Mendes de Carvalho
- Carver College of Medicine, Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.,Nossa Senhora do Pari Beneficent Association, São Paulo, SP, Brazil
| | | | - Cesar de Cesar Netto
- Carver College of Medicine, Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Anne H Johnson
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Miki Dalmau-Pastor
- Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,MIFAS By GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
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27
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Caravelli S, Vocale E, Di Ponte M, Fuiano M, Massimi S, Zannoni F, Zaffagnini S, Mosca M. SERI Technique for Isolated Juvenile Hallux Valgus Patients: A Retrospective Evaluation With Mid-term to Long-term Follow-up. Foot Ankle Spec 2022:19386400221121409. [PMID: 36113025 DOI: 10.1177/19386400221121409] [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: 11/16/2022]
Abstract
INTRODUCTION Many different operative procedures have been described to treat hallux valgus, but many of them are inappropriate for active, skeletally immature patients. This retrospective evaluation aimed to show the efficacy of SERI (Simple, Effective, Rapid, Inexpensive) technique in young patients affected by mild to moderate hallux valgus deformity at a mid-term to long-term follow-up. METHODS All patients were clinically and radiographically evaluated, independently by 2 researchers, by American Orthopaedic Foot and Ankle Society (AOFAS) Hallux-Metatarsophalangeal-Interphalangeal score and radiographic examination. RESULTS Twenty-nine feet, undergone SERI procedure, have been reviewed at a mean follow-up of 5 years. The mean AOFAS score was significantly improved from 59.7 preoperatively to a mean value of 90.7 at last follow-up. Mean correction degrees have been recorded for both angles (hallux valgus angle [HVA] -13.7° and intermetatarsal angle [IMA] -6.7°). CONCLUSIONS The SERI technique represents a powerful surgical procedure for the treatment of painful, mild to moderate, juvenile hallux valgus. Recurrence and complication rate make this surgical approach effective, repeatable, and safe. LEVEL OF EVIDENCE Level IV, Retrospective case series.
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Affiliation(s)
- Silvio Caravelli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Emanuele Vocale
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Di Ponte
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mario Fuiano
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Simone Massimi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Zannoni
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano Mosca
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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28
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Pain Management of Hallux Valgus Surgery Is Achieved by Cocktail Therapy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1084815. [PMID: 36091582 PMCID: PMC9463003 DOI: 10.1155/2022/1084815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 11/18/2022]
Abstract
Background. Hallux valgus is a relatively common forefoot disease in clinical practice. The aim of our study was to assess the role of local cocktail drugs and postoperative pain after hallux valgus surgery. Methods. A retrospective case-control study was conducted to analyze 75 moderate to severe hallux valgus patients from June 1, 2018 to December 1, 2019. All patients were divided into cocktail and control groups according to whether the cocktail therapy was used or not after the operation. The anesthesiologist did not provide analgesic treatment other than nerve block anesthesia and intravenous anesthesia, such as analgesic pumps. The operative region of the cocktail group received a mixture of 10 ml of 0.75% ropivacaine, 10 ml of flurbiprofen axetil injection, and 1 ml of compound betamethasone injection, whereas the control group received nothing in the surgical spot. We recorded patients’ VAS scores preoperatively and at 6, 24 hours postoperatively; the length of hospital stay and the number of hospitalization expenses; the scores of Kolcaba comfort level; and the scores of Pittsburgh sleep quality. Result. There was no significant difference in age or sex between the two groups. The VAS scores at 6 and 24 hours postoperatively were significantly lower in the cocktail group. The average length of hospital stay was 8.24 days in the control group and 3.73 days in the cocktail group. The average total hospitalization cost of the control group was ¥28285.16, and that of the cocktail group was ¥22366.31. In expenses of total hospitalization costs, the cocktail group was lower than the control group. Kolcaba’s comfort various scores and the total score of the cocktail group were higher than the control group. The total score of PSQI and all dimensions in the experimental group were lower than those in the control group. Conclusion. We found a significant difference in the results of postoperative pain management except for age, sex, and hospitalization expenses. After hallux valgus surgery, inject cocktail drugs around the first metatarsophalangeal joint did reduce postoperative pain level. Level of Evidence. Level III, case-control study.
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29
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Abstract
In more than 30 years of scientific literature (1986-2021), the few published studies on the management of CPDFUs by DMOs showed satisfactory clinical and radiographic outcomes. Although these reports were all case series, their data suggest that DMOs, performed at a different level of the distal metatarsal bones, are an effective surgical treatment option for achieving rapid healing of CPDFUs and preventing their recurrence after balancing the pressures in diabetic forefeet. Hence, DMOs can be a valid alternative treatment method also for CPDFUs with chronic infection, ulcers penetrating deep structures, and even ulcers with osteomyelitis at the metatarsophalangeal level.
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30
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Fukushi JI, Tanaka H, Nishiyama T, Hirao M, Kubota M, Kakihana M, Nozawa D, Watanabe K, Okuda R. Comparison of outcomes of different osteotomy sites for hallux valgus: A systematic review and meta-analysis. J Orthop Surg (Hong Kong) 2022; 30:10225536221110473. [PMID: 35836406 DOI: 10.1177/10225536221110473] [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: 11/16/2022] Open
Abstract
BACKGROUND Hallux valgus (HV) is a common foot deformity for which several corrective surgical procedures, with different osteotomy sites, have been reported. The purpose of the present study was to systematically review randomized (RCTs) or controlled (CCTs) clinical trials and perform meta-analysis on outcomes of different osteotomy sites of the first metatarsal. METHODS An extensive literature search was conducted in PubMed and the Cochrane Library from January 1983 to July 2020. Studies were identified using the terms "hallux valgus" and "osteotomy". We included RCTs or CCTs comparing different locations of osteotomy for the first metatarsal bone (distal vs. mid-shaft, distal vs. proximal, and mid-shaft vs. proximal). The surgical outcomes included postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), American Orthopaedic Foot and Ankle Society (AOFAS) score, pain visual analog scale (VAS) score, perioperative complications and recurrence of deformity. We enrolled 10 studies with a total of 793 feet in the qualitative synthesis following full-text screening. RESULTS A majority of patients included in the enrolled trials showed mild to moderate deformity, with mean HVA <40°. Out of the 10 enrolled studies; six compared distal osteotomies with mid-shaft osteotomies and showed no significant differences in the surgical outcomes between the scarf and chevron groups; three RCTs compared distal osteotomies with proximal osteotomies with conflicting results, one RCT showed the superiority of proximal osteotomy while the other two RCTs showed equivalent outcomes; one study that compared between mid-shaft and proximal osteotomies showed equivalent outcomes between the groups. CONCLUSION For the management of mild to moderate HV deformity, we found no significant clinical and radiological differences between patients treated with scarf and chevron osteotomies. Further controlled trials comparing different sites of osteotomies for moderate to severe HV deformity are needed.
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Affiliation(s)
- Jun-Ichi Fukushi
- Guideline Committee of Hallux Valgus, Japanese Society for Surgery of the Foot, Tokyo, Japan.,Department of Orthopaedic Surgery, Clinical Research Center, 37085National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hirofumi Tanaka
- Guideline Committee of Hallux Valgus, Japanese Society for Surgery of the Foot, Tokyo, Japan.,Hyakutake Orthopedic Surgery and Sports Clinic, Saga, Japan
| | - Takayuki Nishiyama
- Guideline Committee of Hallux Valgus, Japanese Society for Surgery of the Foot, Tokyo, Japan.,Department of Orthopaedic Surgery, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Makoto Hirao
- Guideline Committee of Hallux Valgus, Japanese Society for Surgery of the Foot, Tokyo, Japan.,Department of Orthopaedics, Graduate School of Medicine, 38637Osaka University, Osaka, Japan
| | - Makoto Kubota
- Guideline Committee of Hallux Valgus, Japanese Society for Surgery of the Foot, Tokyo, Japan.,Department of Orthopaedic Surgery, Katsushika Medical Center, 428795The Jikei University School of Medicine, Tokyo, Japan
| | - Masataka Kakihana
- Guideline Committee of Hallux Valgus, Japanese Society for Surgery of the Foot, Tokyo, Japan.,First Department of Orthopaedic Surgery, 26263Dokkyo Medical University, Saitama Medical Center, Koshigaya, Japan
| | - Daisuke Nozawa
- Guideline Committee of Hallux Valgus, Japanese Society for Surgery of the Foot, Tokyo, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, 38515University of Tsukuba, Tsukuba, Japan
| | - Kota Watanabe
- Guideline Committee of Hallux Valgus, Japanese Society for Surgery of the Foot, Tokyo, Japan.,Second Division of Physical Therapy, School of Health Sciences, 13035Sapporo Medical University, Sapporo, Japan
| | - Ryuzo Okuda
- Guideline Committee of Hallux Valgus, Japanese Society for Surgery of the Foot, Tokyo, Japan.,Department of Orthopaedic Surgery, 605105Rakusai-Shimizu Hospital, Kyoto, Japan
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Cody EA, Caolo K, Ellis SJ, Johnson AH. Early Radiographic Outcomes of Minimally Invasive Chevron Bunionectomy Compared to the Modified Lapidus Procedure. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221112103. [PMID: 35898792 PMCID: PMC9310241 DOI: 10.1177/24730114221112103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Minimally invasive (MIS) bunion surgery has become increasingly popular. Although early reports on outcomes have been encouraging, no study to date has compared outcomes from the MIS chevron and Akin procedures to the modified Lapidus procedure. Our primary aim was to compare early radiographic outcomes of the MIS chevron and Akin osteotomies to those of the modified Lapidus procedure in patients with comparable deformities, and secondarily to compare clinical outcomes. Methods Patients were retrospectively reviewed for inclusion from a prospectively collected foot and ankle registry. Patients were eligible if they underwent either the MIS bunionectomy or modified Lapidus procedure and had preoperative and minimum 5-month postoperative weightbearing radiographs. Forty-one patients who underwent MIS bunionectomy were matched to 41 patients who underwent Lapidus bunionectomy based on radiographic parameters. Demographics, radiographic parameters, complications, reoperations, and PROMIS scores were compared between groups. Results Both groups achieved similar radiographic correction. There was no significant difference in pre- or postoperative PROMIS scores between groups. Procedure duration was significantly faster in the MIS group (P < .001). Bunion recurrence (hallux valgus angle ≥20 degrees) occurred in 1 MIS patient and 2 Lapidus patients, with all patients asymptomatic. The most common reason for reoperation was removal of hardware (4 patients in the MIS group, 2 patients in the Lapidus group). Conclusion This is the first study to our knowledge to compare early radiographic outcomes between MIS bunionectomy and the modified Lapidus procedure in patients matched for bunion severity. We found that patients with similar preoperative deformities experience similar radiographic correction following MIS chevron and Akin osteotomies vs modified Lapidus bunionectomy. Further research is needed to investigate satisfaction differences between the procedures, longer-term outcomes, and which deformities are best suited to each procedure. Level of Evidence Level III, Retrospective case control study.
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Affiliation(s)
- Elizabeth A. Cody
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Kristin Caolo
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Scott J. Ellis
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - A. Holly Johnson
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Motta LM, Manchado I, Blanco G, García-Flemate F, González J, Garcés GL. Pre- and Post-Operative Relationship between Radiological Measures and Clinical Outcomes in Women with Hallux Valgus. J Clin Med 2022; 11:jcm11133626. [PMID: 35806910 PMCID: PMC9267403 DOI: 10.3390/jcm11133626] [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] [Received: 04/27/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 11/22/2022] Open
Abstract
The surgical correction of a hallux valgus (HV) deformity improves radiological parameters and clinical outcomes. However, it is not known how these improvements are related between themselves. In this retrospective study, 73 women were assessed preoperatively and 60 months after HV surgical correction. Several radiological parameters were measured: the hallux valgus angle (HVA), I−II intermetatarsal angle (IMA) and sesamoid position. The functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal (HMI) scale, and patient-reported outcomes (PROMs) were recorded with the Manchester−Oxford Foot Questionnaire (MOXFQ). A pre−post-surgery comparison of radiological and clinical values was performed, the correlation among them was studied and the differences pre−post-surgery in the radiological measurements compared with those for the clinical outcomes were studied. The results show that all the radiological parameters, functional outcomes and PROMs improved significantly from their pre-operative values to the follow-up values. Multivariate regression analysis showed a significant relationship (p < 0.001) between the differential pre−post-surgery AOFAS scoring only with two sesamoid position differential pre−post-surgery measures: position of medial sesamoid (PMS) and translation of the first metatarsal head (TMH). However, no significant association was observed between the pre−post-surgery radiological differences and the pre−post-surgery MOXFQ scoring.
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Affiliation(s)
- Luci M. Motta
- Hospital Perpetuo Socorro, 35007 Las Palmas, Spain; (L.M.M.); (I.M.); (G.B.); (F.G.-F.)
- Departamento de Ciencias Médicas y Quirúrgicas, University of Las Palmas de Gran Canaria, 35016 Las Palmas, Spain
| | - Ignacio Manchado
- Hospital Perpetuo Socorro, 35007 Las Palmas, Spain; (L.M.M.); (I.M.); (G.B.); (F.G.-F.)
- Departamento de Ciencias Médicas y Quirúrgicas, University of Las Palmas de Gran Canaria, 35016 Las Palmas, Spain
| | - Gustavo Blanco
- Hospital Perpetuo Socorro, 35007 Las Palmas, Spain; (L.M.M.); (I.M.); (G.B.); (F.G.-F.)
| | - Felipe García-Flemate
- Hospital Perpetuo Socorro, 35007 Las Palmas, Spain; (L.M.M.); (I.M.); (G.B.); (F.G.-F.)
| | - Jesús González
- Unidad de Investigación, Hospital Dr Negrin, 35007 Las Palmas, Spain;
| | - Gerardo L. Garcés
- Hospital Perpetuo Socorro, 35007 Las Palmas, Spain; (L.M.M.); (I.M.); (G.B.); (F.G.-F.)
- Departamento de Ciencias Médicas y Quirúrgicas, University of Las Palmas de Gran Canaria, 35016 Las Palmas, Spain
- Correspondence: ; Tel.: +34-696-471-915
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Xie W, Lu H, Li G, Yuan Y, Xu H. Rotation scarf + Akin osteotomy for severe hallux valgus with a new evaluation index: distance between the first and second metatarsals. BMC Musculoskelet Disord 2022; 23:421. [PMID: 35513866 PMCID: PMC9069789 DOI: 10.1186/s12891-022-05356-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/13/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Although rotation scarf + Akin osteotomy has been described for correcting hallux valgus deformity, the treatment efficacy of rotation scarf + Akin osteotomy for severe hallux valgus should be further studied. The purpose of our study was to evaluate the outcomes of rotation scarf + Akin osteotomy on severe hallux valgus. METHODS We conducted a retrospective study of patients with hallux valgus who underwent surgery using rotation scarf + Akin osteotomy in our hospital between June 2014 and January 2020. The parameters evaluated include (1) the hallux valgus angle (HVA), (2) intermetatarsal angle (IMA), (3) distal metatarsal articular angle (DMAA), (4) tibial sesamoid position (TSP), (5) the length of first metatarsal bone and (6) ratio between the vertical distance from the lateral of the first metatarsal head to the medial of the second metatarsal head and the vertical distance of lateral of the second metatarsal head to the medial of the third metatarsal head (MT-I to II/II to III distance). A visual analog scale (VAS) was used to evaluate the degree of pain before and at the last follow-up after the operation. The American Orthopaedic Foot & Ankle Society (AOFAS) Forefoot Score wasassessed before and at the last follow-up after the operation. Patient satisfaction assessment was also conducted at the time. RESULTS All radiological parameters including, HVA, IMA, DMAA and TSP,, significantly improved (p < 0.001). The length of the first metatarsal was shortened 3.1 mm on average. The MT-I to II/II to III distance was also reduced to 1.8 after surgery and 3.3 before surgery. The VAS score and AOFAS score was also statistically significant before operation and at the last follow-up after the operation (p < 0.001). Forty-one (82%) feet in patients were very satisfied or satisfied. CONCLUSION Rotation scarf + Akin osteotomy is demonstrated to be safe, effective, and feasible for correcting severe hallux valgus. It can obtain good long-term correction with a low incidence of recurrence and metatarsalgia. Postoperative satisfaction and functional recovery of patients are significantly improved. The MT-I to II/II to III distance, a new evaluation indicator, can be better evaluate the correction of hallux valgus.
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Affiliation(s)
- Wenyong Xie
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
| | - Hao Lu
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
| | - Guicheng Li
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
| | - Yusong Yuan
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
| | - Hailin Xu
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China.
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Toepfer A, Strässle M. 3rd generation MICA with the "K-wires-first technique" - a step-by-step instruction and preliminary results. BMC Musculoskelet Disord 2022; 23:66. [PMID: 35042485 PMCID: PMC8767719 DOI: 10.1186/s12891-021-04972-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Minimally-invasive techniques for hallux valgus correction are becoming increasingly popular. In the last decades, multiple techniques for minimally-invasive hallux valgus correction have been described. MICA (Minimally-invasive Chevron & Akin), representing the 3rd generation of minimally-invasive hallux valgus correction, combines the advantages of an extraarticular osteotomy, stable internal fixation, and high potential for correction. This report aims to provide a step-by-step instruction of the surgical technique with the "K-wires-first" MICA modification, illustrated by detailed imaging of both intraoperative fluoroscopy and clinical imaging as well as corresponding sawbone models for each step. Preliminary results including radiological outcome and complications of the first 50 cases will be discussed. METHODS Between May 2018 and May 2021, 50 consecutive MICAs in 47 patients were performed with the K-wires-first technique. There were 40 women and 7 men with an average of 57.4y (range 25-78). The mean preoperative IMA was 16.2° (range 11.0-21.5), the HVA 30.6° (range 21.8-42.1). RESULTS There was one intraoperative conversion to an open surgical bunion correction corresponding to a 2% conversion rate respectively (1/50). On 3 feet (2 patients), removal of the Chevron screws was performed after 7, 9, and 12 months due to prominent and disturbing screw heads at the level of the medial cortex, accounting for a revision rate of 6% (3/50). There were no other secondary revision surgeries. The IMA decreased after MICA by a mean of 10.8° from 16.2° to 5.4° and the HVA by a mean of 22.1° from 30.6° to 8.5°, demonstrating MICA's high potential for correction. CONCLUSIONS Compared to other MICA techniques, the K-wires-first modification helps to reduce hardware malpositioning and the risk of conversion to open surgery. Furthermore, our preliminary results demonstrate a high potential for correction even for severe hallux deformities. TRIAL REGISTRATION Retrospectively registered, swissethics BASEC-ID 2021-01537, July 16th, 2021 ( www.raps.swissethics.ch ).
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Affiliation(s)
- Andreas Toepfer
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, CH-9007, St. Gallen, Switzerland.
| | - Michael Strässle
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, CH-9007, St. Gallen, Switzerland
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Zhang Q, Zhang Y, Huang J, Teo EC, Gu Y. Effect of Displacement Degree of Distal Chevron Osteotomy on Metatarsal Stress: A Finite Element Method. BIOLOGY 2022; 11:127. [PMID: 35053125 PMCID: PMC8772834 DOI: 10.3390/biology11010127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The stress of foot bone can effectively evaluate the functional damage caused by foot deformity and the results of operation. In this study, the finite element method was used to investigate the degree of displacement of distal chevron osteotomy on metatarsal stress and metatarsophalangeal joint load; Methods: Four finite element models of displacement were established by using the CT images of a patient with moderate hallux valgus (hallux valgus angle and intermetatarsal angle were 26.74° and 14.09°, respectively), and the validity of the model was verified. Each finite element model consisted of bones and various cartilage structures, ligaments, and plantar fascia, as well as encapsulated soft tissue. Except for soft tissue, the material properties of other parts were isotropic linear elastic material, and the encapsulated soft tissue was set as nonlinear hyperelastic material. The mesh was tetrahedral mesh. Link elements were used in ligament and plantar fascia. A ground reaction force with a half-body weight was applied at the bottom of the floor to simulate the ground reaction when standing. The upper surfaces of the encapsulated soft tissue, distal tibia, and distal fibula were fixed. The stress distribution of metatarsals and the stress of cartilage of the first metatarsophalangeal joint were compared and analyzed; Results: Compared with the hallux valgus without osteotomy, the stress of the first metatarsals and second metatarsals of 2-4 mm decreased, and the stress of the interarticular cartilage of the first metatarsophalangeal joint with 4 mm was reduced. In the case of 6 mm, the stress value between the first metatarsal and the first metatarsophalangeal joint increased, and 4 mm was the most suitable distance; Conclusions: Compared with the hallux valgus without osteotomy, the stress of the first metatarsals and second metatarsals of 2-4 mm decreased, and the stress of the interarticular cartilage of the first metatarsophalangeal joint with 4 mm was reduced. In the case of 6 mm, the stress value between the first metatarsal and the first metatarsophalangeal joint increased, and 4 mm was the most suitable distance. For the degree of displacement of the distal chevron osteotomy, the postoperative stability and the stress distribution of metatarsal bone should be considered. Factors such as hallux valgus angle, intermetatarsal angle, patient's age, body weight, and metatarsal width should be considered comprehensively. The factors affecting osteotomy need to be further explored. The degree of displacement of osteotomy can be evaluated by FE method before the operation, and the most suitable distance can be obtained.
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Affiliation(s)
- Qiaolin Zhang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (Q.Z.); (Y.Z.); (J.H.)
| | - Yan Zhang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (Q.Z.); (Y.Z.); (J.H.)
| | - Jialu Huang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (Q.Z.); (Y.Z.); (J.H.)
| | - Ee Chon Teo
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (Q.Z.); (Y.Z.); (J.H.)
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (Q.Z.); (Y.Z.); (J.H.)
- Faculty of Engineering, University of Szeged, 6720 Szeged, Hungary
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The effect of Scarf osteotomy on the distal metatarsal articular angle in hallux valgus: a case series. LA TUNISIE MEDICALE 2022; 100:66-71. [PMID: 35822335 PMCID: PMC9006791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hallux valgus is a deformity of the forefoot involving a phalangeal valgus and a metatarsal adductus. In most cases its correction requires surgical treatment with different types of osteotomies. The best known is Scarf osteotomy. AIM To study the effet of Scarf osteotomy on distal metatarsal articular angle (DMAA) as well as the validitiy of this angle and the value of its correction after review of the literature. METHODS It was a retrospective study including patients operated on for severe hallux valgus by a Scarf osteotomy. The clinical assessment was based on the the American-Orthopedic-Foot-and-Ankle-society (AOFAS) score. Radiologically, we calculated the metatarsophalangeal angle, the inter-metatarsal angle and the DMAA. This assessment was performed preoperatively and one year postoperatively. RESULTS We collected 37 cases of evolved hallux valgus. The average AOFAS score went from 60.7 to 85.8 / 100 postoperatively with a gain of 25 points. We've noted a significant correction of the 3 angular measurements at one year postoperatively (the metatarsophalangeal angle, the inter-metatarsal angle and the DMAA) which went from 38.8° to 20.5°, from 17° at 10° and 13.5° to 8.5° respectively (p<0.05). CONCLUSION The literature has shown that there is no consensus regarding the effect of HV surgery on the DMAA. As for the accuracy, reproducibility and interest of correcting this angle we deduce that the DMAA is an interesting measure in the pathology of HV. Its correction seems not to be necessary in order not to hamper the correction of metatarsus varus. But in cases where the preoperative DMAA is high (> 15 °), efforts should be made to correct it to avoid recurrence.
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Biz C, de Iudicibus G, Belluzzi E, Dalmau-Pastor M, Bragazzi NL, Funes M, Parise GM, Ruggieri P. Prevalence of chronic pain syndrome in patients who have undergone hallux valgus percutaneous surgery: a comparison of sciatic-femoral and ankle regional ultrasound-guided nerve blocks. BMC Musculoskelet Disord 2021; 22:1043. [PMID: 34911525 PMCID: PMC8675526 DOI: 10.1186/s12891-021-04911-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/24/2021] [Indexed: 12/21/2022] Open
Abstract
Background Chronic pain syndrome (CPS) is a common complication after operative procedures, and only a few studies have focused on the evaluation of CPS in foot-forefoot surgery and specifically on HV percutaneous correction. The objective of this study was to compare postoperative pain levels and incidence of CPS in two groups of patients having undergone femoral-sciatic nerve block or ankle block regional anaesthesia before hallux valgus (HV) percutaneous surgery and the association between postoperative pain levels and risk factors between these patient groups. Methods A consecutive patient series was enrolled and evaluated prospectively at 7 days, 1, 3 and 6 months after surgery. The participants were divided into two groups according to the regional anaesthesia received, femoral-sciatic nerve block or ankle block, and their outcomes were compared. The parameters assessed were postoperative pain at rest and during movement by the numerical rating scale (NRS), patient satisfaction using the Visual Analogue Scale (VAS), quality of life and return to daily activities. Statistical analysis was performed. Results One hundred fifty-five patients were assessed, 127 females and 28 males. Pain at rest (p < 0.0001) and during movement (p < 0.0001) significantly decreased during the follow-ups; at 6 months, 13 patients suffered from CPS. Over time, satisfaction remained stable (p > 0.05), quality of life significantly increased and patients returned to daily activities and work (p < 0.0001). No significant impact of type of anaesthesia could be detected. ASA 3 (p = 0.043) was associated to higher pain during movement; BMI (p = 0.005) and lumbago (p = 0.004) to lower satisfaction. No operative-anaesthetic complications were recorded. Postoperative pain at rest and during movement improved over time independently of the regional block used, with low incidence of CPS at last follow-up. Among risk factors, only a higher ASA was associated to higher pain during movement, while higher BMI and lumbago to lower satisfaction. Conclusions Both ultrasound-guided sciatic-femoral and ankle blocks were safe and effective in reducing postoperative pain with low incidence of CPS at last follow-up. Trial registration Clinical Trial NCT02886221. Registered 1 September 2016.
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Affiliation(s)
- Carlo Biz
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 3, 35128, Padova, Italy. .,Minimally Invasive Foot and Ankle Society (MIFAS By Grecmip), 2 Rue Georges Negrevergne, 33700, Merignac, France.
| | - Gianfranco de Iudicibus
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 3, 35128, Padova, Italy
| | - Elisa Belluzzi
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 3, 35128, Padova, Italy. .,Musculoskeletal Pathology and Oncology Laboratory, Orthopaedics and Orthopedics Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 3, 3518, Padova, Italy.
| | - Miki Dalmau-Pastor
- Minimally Invasive Foot and Ankle Society (MIFAS By Grecmip), 2 Rue Georges Negrevergne, 33700, Merignac, France.,Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, Canada
| | - Manuela Funes
- Institute of Anesthesia and Reanimation, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Gian-Mario Parise
- Institute of Anesthesia and Reanimation, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Pietro Ruggieri
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 3, 35128, Padova, Italy
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Del Vecchio JJ, Cordier G, Dealbera ED, Slullitel G, Lopez V, Manzanares-Céspedes MC, Dalmau-Pastor M. Correction Power of Percutaneous Adductor Tendon Release (PATR) for the Treatment of Hallux Valgus: A Cadaveric Study. J Foot Ankle Surg 2021; 60:1103-1109. [PMID: 34039513 DOI: 10.1053/j.jfas.2021.02.012] [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] [Received: 06/21/2020] [Revised: 01/19/2021] [Accepted: 02/21/2021] [Indexed: 02/03/2023]
Abstract
Osteotomies are commonly used in order to correct hallux valgus deformity. However, soft tissue structures also play an essential role in the etiology, progression, and treatment of hallux valgus (HV). The purpose of the present study was to analyze the correcting power (varus), reduction strength (sesamoid) and rotation of metatarsal and proximal phalanx after percutaneous adductor tendon release (PATR). To date, no study addresses this issue. Eleven cadaveric fresh-frozen below-the-knee cadaveric lower limbs with associated hallux valgus deformity were used. These specimens were subjected to a constant abduction force after PATR. HV and intermetatarsal angles showed statistically significant differences when comparing the preoperative and postoperative periods. PATR showed to be a reliable technique as the adductor tendon was completely released in 9 cases, and 75% released in the remaining 2 feet. The study supports that PATR provides powerful and quantifiable correction of HV deformity and can be accurately performed percutaneously.
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Affiliation(s)
- Jorge Javier Del Vecchio
- Head Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro-Hospital Universitario-Solis 461, Ciudad Autónoma de Buenos Aires (CABA), Argentine; Department of Kinesiology and Physiatry, Universidad Favaloro, CABA, Argentina; Minimally Invasive Foot and Ankle Society (MIFAS by Grecmip), Merignac, France.
| | - Guillaume Cordier
- Minimally Invasive Foot and Ankle Society (MIFAS by Grecmip), Merignac, France; Clinique du Sport Bordeaux-Mérignac, Institut du Sport, Merignac, France
| | - Eric Daniel Dealbera
- Foot and Ankle Surgery and Limb Salvage Fellowship, Foot and Ankle Section, Fundación Favaloro-Hospital Universitario, Ciudad Autónoma de Buenos Aires (CABA), Buenos Aires, Argentina
| | - Gastón Slullitel
- Department of Foot and Ankle Surgery, Institute of Orthopedics "Dr. Jaime Slullitel", Santa Fe, Argentina
| | - Valeria Lopez
- Department of Foot and Ankle Surgery, Institute of Orthopedics "Dr. Jaime Slullitel", Santa Fe, Argentina
| | - Maria Cristina Manzanares-Céspedes
- Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Miki Dalmau-Pastor
- Minimally Invasive Foot and Ankle Society (MIFAS by Grecmip), Merignac, France; Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Reilly ME, Conti MS, Day J, MacMahon A, Chrea B, Caolo KC, Williams N, Drakos MC, Ellis SJ. Modified Lapidus vs Scarf Osteotomy Outcomes for Treatment of Hallux Valgus Deformity. Foot Ankle Int 2021; 42:1454-1462. [PMID: 34085579 DOI: 10.1177/10711007211013776] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Lapidus procedure and scarf osteotomy are indicated for the operative treatment of hallux valgus; however, no prior studies have compared outcomes between the procedures. The aim of this study was to compare clinical and radiographic outcomes between patients with symptomatic hallux valgus treated with the modified Lapidus procedure versus scarf osteotomy. METHODS This retrospective cohort study included patients treated by 1 of 7 fellowship-trained foot and ankle surgeons. Inclusion criteria were age older than 18 years, primary modified Lapidus procedure or scarf osteotomy for hallux valgus, minimum 1-year postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores, and minimum 3-month postoperative radiographs. Revision cases were excluded. Clinical outcomes were assessed using 6 PROMIS domains. Pre- and postoperative radiographic parameters were measured on anteroposterior (AP) and lateral weightbearing radiographs. Statistical analysis utilized targeted minimum-loss estimation (TMLE) to control for confounders. RESULTS A total of 136 patients (73 Lapidus, 63 scarf) with an average of 17.8 months of follow-up were included in this study. There was significant improvement in PROMIS physical function scores in the modified Lapidus (mean change, 5.25; P < .01) and scarf osteotomy (mean change, 5.50; P < .01) cohorts, with no significant differences between the 2 groups (P = .85). After controlling for bunion severity, the probability of having a normal postoperative intermetatarsal angle (IMA; <9 degrees) was 25% lower (P = .04) with the scarf osteotomy compared with the Lapidus procedure. CONCLUSION Although the modified Lapidus procedure led to a higher probability of achieving a normal IMA, both procedures yielded similar improvements in 1-year patient-reported outcome measures. LEVEL OF EVIDENCE Level III, retrospective cohort.
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Affiliation(s)
| | | | | | | | - Bopha Chrea
- School of Medicine, Orthopedic Surgery, Oregon Health & Science University, Portland, OR, USA
| | | | - Nicholas Williams
- Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, NY, USA
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Del Vecchio JJ, Ghioldi ME, Chemes LN, Dealbera ED, Brue J, Dalmau-Pastor M. Percutaneous, intra-articular, chevron osteotomy (PeICO) for the treatment of mild-to-moderate hallux valgus: a case series. INTERNATIONAL ORTHOPAEDICS 2021; 45:2251-2260. [PMID: 34347130 DOI: 10.1007/s00264-021-05111-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Treatment for hallux valgus (HV) remains challenging. Third-generation percutaneous procedures try to reproduce chevron-type osteotomies to replicate their benefits, such as intrinsic stability and reproducibility. We report the first results using a percutaneous, intra-articular, chevron osteotomy (PeICO) technique that mimics the classic intra-articular open chevron procedure, associated with a percutaneous adductor tendon release (PATR) for the treatment of mild-to-moderate HV. METHODS From May 2015 to October 2018, a total of consecutive 114 feet (74 patients) were included. Primary outcome measures included radiographic (hallux valgus and intermetatarsal angles) and clinical parameters such as visual analog scale (VAS), FAAM Activities of Daily Living (ADL), and FAAM Sport, AOFAS Score, and MOXFQ, preoperatively and at final follow-up (Minimum 18 months). A patient satisfaction survey was also performed. Pronation and length of the first metatarsal were also assessed. Secondary outcomes included fluoroscopic time, length of surgery, complications, recurrence, and re-operation rates. RESULTS At 24.09 months on average, the AOFAS score improved from 52.1 points preoperatively to 91.1 (p < 0.001) at the latest follow-up. VAS decreased from 6.3 to 1. Also, FAAM ALD, FAAM Sport, and MOXFQ showed statistically significant differences (p < 0.001) when comparing pre-operative and post-operative periods. Patients found the procedure to be excellent in 82% and very good in 13.5% of cases. Our global complication and re-operation rates were 5.26% and 3.5% (screw removal), respectively. CONCLUSION PeICO combined with PATR proved to be a safe, reliable, and effective technique for the correction of mild-to-moderate HV deformity.
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Affiliation(s)
- Jorge Javier Del Vecchio
- Head Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro, Hospital Universitario, Solis 461, CP 1078, Ciudad Autónoma de Buenos Aires (CABA), Argentina. .,Department of Kinesiology and Physiatry, Universidad Favaloro, Av. Entre Ríos 495, CABA, CP 1079, Argentina. .,Minimally Invasive Foot and Ankle Society (MIFAS By Grecmip), 2 Rue Georges Negrevergne, 33700, Merignac, France.
| | | | - Lucas Nicolás Chemes
- Foot and Ankle Section, Fundación Favaloro, Hospital Universitario, Buenos Aires, Argentina
| | - Eric Daniel Dealbera
- Foot and Ankle Section, Fundación Favaloro, Hospital Universitario, Buenos Aires, Argentina
| | - Julieta Brue
- Foot and Ankle and Limb Salvage Surgery Fellowship, Fundación Favaloro, Hospital Universitario, Buenos Aires, Argentina
| | - Miki Dalmau-Pastor
- Minimally Invasive Foot and Ankle Society (MIFAS By Grecmip), 2 Rue Georges Negrevergne, 33700, Merignac, France.,Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Torrent J, Baduell A, Vega J, Malagelada F, Luna R, Rabat E. Open vs Minimally Invasive Scarf Osteotomy for Hallux Valgus Correction: A Randomized Controlled Trial. Foot Ankle Int 2021; 42:982-993. [PMID: 34024185 DOI: 10.1177/10711007211003565] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Minimally invasive (MI) surgery is becoming increasingly popular in the treatment of hallux valgus (HV). The scarf osteotomy is an effective procedure with a track record in open HV surgery. We adapted this effective osteotomy to MI surgery as a novel technique never reported before. The aim of this study was to compare the clinical and radiologic outcomes of patients who underwent open or MI scarf. METHODS Between 2017 and 2018, 58 patients were randomized to either open or MI scarf to treat HV deformity. Prospective patient-reported outcome measures and weightbearing radiographs were obtained. Data included the AOFAS score, radiologic angular correction, operative time, fluoroscopy radiation dose, and postoperative pain on visual analog scale (VAS). RESULTS The mean follow-up was of 21 (range, 12-38) months. Radiologic measurements (postoperative hallux valgus angle, first-to-second intermetatarsal angle, and distal metaphyseal articular angle) were similar in both groups and showed statistically significant improvement from preoperative measures. The mean operative time for the MI group was 16.7 vs 26.1 minutes in the open group, a statistically significant difference. Radiation exposure was 14 times higher in the MI group when compared to the open group (mean: 34 vs 2.4 mGy/cm2, P < .001). There were no major complications in either group. CONCLUSIONS The MI scarf provides a clinically and radiologically equivalent outcome to open scarf for the treatment of HV with reduced operative time and immediate postoperative VAS for pain but is associated with a small increase in radiation exposure. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Josep Torrent
- Foot and Ankle Unit, Hospital Universitari Mutua Terrassa, Barcelona, Spain.,Foot and Ankle Unit, Institut Rabat-Hospital Quirón Barcelona, Barcelona, Spain.,Foot and Ankle Unit, iMove Clinica Tres Torres, Barcelona, Spain.,MIFAS by GRECMIP: Minimally Invasive Foot and Ankle Society, Merignac, France
| | | | - Jordi Vega
- Foot and Ankle Unit, Institut Rabat-Hospital Quirón Barcelona, Barcelona, Spain.,Foot and Ankle Unit, iMove Clinica Tres Torres, Barcelona, Spain.,MIFAS by GRECMIP: Minimally Invasive Foot and Ankle Society, Merignac, France.,Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain
| | - Francesc Malagelada
- Foot and Ankle Unit, Orthopaedic and Trauma Surgery, Heatherwood and Wexham Park Hospitals, Frimley Health NHS Trust, Ascot, Berkshire, United Kingdom
| | - Rodrigo Luna
- Foot and Ankle Unit, Hospital Universitari Mutua Terrassa, Barcelona, Spain
| | - Eduard Rabat
- Foot and Ankle Unit, Institut Rabat-Hospital Quirón Barcelona, Barcelona, Spain
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42
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Kaufmann G, Weiskopf D, Liebensteiner M, Ulmer H, Braito M, Endstrasser F, Wagner M, Ban M, Dammerer D. Midterm Results Following Minimally Invasive Distal Chevron Osteotomy: Comparison With the Minimally Invasive Reverdin-Isham Osteotomy by Means of Meta-analysis. In Vivo 2021; 35:2187-2196. [PMID: 34182496 DOI: 10.21873/invivo.12490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/20/2021] [Accepted: 05/19/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To date, multiple different surgical techniques have been established for hallux valgus surgery, with each technique having its unique advantages and limitations. The open distal chevron osteotomy is widely accepted, but increasing patient demands have led several minimally invasive (MIS) techniques to be described in recent years. The aim of this study was to compare outcomes after minimally invasive (MIS) distal chevron osteotomy and the minimally invasive Reverdin-Isham method. PATIENTS AND METHODS We assessed clinical and radiographic outcomes after MIS chevron osteotomy in 57 feet of 49 consecutive patients with a mean follow-up of 58.9 (range=39.0-85.4) months. Outcomes after MIS Reverdin-Isham osteotomy were analyzed by means of a systematic literature review with a minimum follow-up of 6 months. RESULTS Radiographic outcomes were significantly better in the MIS chevron cohort for intermetatarsal angle (p<0.001), hallux valgus angle and distal metacarpal articular angle (p<0.05). Concerning clinical outcomes, both methods provided comparable improvement. CONCLUSION MIS distal chevron osteotomy in mild to moderate hallux valgus deformity correction results in superior radiographic outcomes compared to the MIS Reverdin-Isham osteotomy. Sufficient correction of IMA cannot be achieved with the MIS Reverdin-Isham osteotomy.
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Affiliation(s)
- Gerhard Kaufmann
- OFZ Innsbruck, Orthopedic and Foot Center Innsbruck, Innsbruck, Austria
| | - Daniel Weiskopf
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Liebensteiner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Matthias Braito
- Department of Orthopaedics and Traumatology, St. Johann in Tirol, Austria
| | - Franz Endstrasser
- Department of Orthopaedics and Traumatology, St. Johann in Tirol, Austria
| | - Moritz Wagner
- Department of Orthopaedics and Traumatology, St. Johann in Tirol, Austria
| | - Michael Ban
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria;
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43
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Miranda MAM, Martins C, Cortegana IM, Campos G, Pérez MFM, Oliva XM. Complications on Percutaneous Hallux Valgus Surgery: A Systematic Review. J Foot Ankle Surg 2021; 60:548-554. [PMID: 33579548 DOI: 10.1053/j.jfas.2020.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/14/2020] [Accepted: 06/18/2020] [Indexed: 02/03/2023]
Abstract
Lately there has been a growing interest in the use of percutaneous surgery for the correction of hallux valgus (HV). The purpose of the present study was to systematically review the published data about this topic and establish the efficacy and safety, stressing the complication rates found on this percutaneous technique. A systematic review of the literature available in PubMed was performed. The radiological and clinical outcomes were evaluated as well as complication rates. A total of 16 studies were included and 1157 procedures reported for percutaneous HV on 1246 patients. The mean angle correction of HV deformity improved postoperatively. Reported complications vary among the studies. The highest complication rate was joint stiffness in 18.47% of cases, followed by HV recurrence and shortening of M1, both in 15.2%, material intolerance in 10.1%, osteoarthritic changes in 9.1%, infection in 7.6%, and transfer metatarsalgia in 5.4%. There is a lack of randomized control trials and insufficient comparative case control studies to assess whether one technique is more effective than another or if the percutaneous surgery is recommended rather than open surgery with respect to complications.
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Affiliation(s)
| | - Carla Martins
- Orthopedic Surgeon, Department of Orthopedics, Centro Hospitalar Tondela - Viseu, Viseu, Portugal
| | | | - Gustavo Campos
- Orthopedic Surgeon, Department of Orthopedics, Hospital Roosevelt, Guatemala
| | | | - Xavier Martin Oliva
- Orthopedic Surgeon, Department of Orthopedics, Clinica Del Remei, Barcelona, Spain; Professor, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain
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Kotlarsky P, Gannot G, Katsman A, Eidelman M. Treatment of Adolescent Hallux Valgus With Percutaneous Distal Metatarsal Osteotomy. Foot Ankle Spec 2021; 14:238-248. [PMID: 32228233 DOI: 10.1177/1938640020913182] [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] [Indexed: 11/17/2022]
Abstract
Background. Hallux valgus is a complex deformity of the first ray of the foot, and a significant number of adolescents develop this deformity. More than 130 surgical procedures have been described to treat hallux valgus, but there is no compelling evidence to prefer one method over another. Minimal invasive techniques have been proposed and reported to be successful and cost-effective. The objective of this study was to describe the clinical course of adolescent patients treated with percutaneous distal metatarsal osteotomy. Methods. A retrospective study included patients who had a percutaneous hallux valgus correction during the years 2008 to 2015. The following measurements were compared before surgery up to last follow-up: AOFAS Hallux-Metatarsophalangeal-Interphalangeal questionnaire and radiological measurements (HVA, IMA, DMAA). Any postoperative complications were extracted from the medical records. Results. The procedure was performed on 32 feet (27 patients). All patients were <18 years of age. There were 10 male patients (12 feet) and 17 female patients (20 feet). Average age at surgery was 15.8 years (range = 13-18 years). Average follow-up time was 43 months (range= 24-94 months). The average AOFAS score before surgery was 66, and after surgery, at last follow-up was 96. This difference was significant (P value <.0001). Most patients were pain free after the procedure and returned to appropriate age functioning. Significant improvement was noted in all radiological criteria. Conclusions. Percutaneous distal metatarsal osteotomy is safe, reliable, and effective for the correction of mild to moderate symptomatic hallux valgus in adolescents.Levels of Evidence: Level IV.
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Affiliation(s)
- Pavel Kotlarsky
- Pediatric Orthopedics, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Gil Gannot
- Pediatric Orthopedics, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Alexander Katsman
- Pediatric Orthopedics, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Mark Eidelman
- Pediatric Orthopedics, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
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45
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Surgical Reconstruction of Nonunion after Iatrogenic Scarf Osteotomy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115620. [PMID: 34070270 PMCID: PMC8197363 DOI: 10.3390/ijerph18115620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 12/02/2022]
Abstract
We present the case of a young patient, 32 years old, with nonunion in the diaphysis of the first metatarsal after scarf osteotomy for correction of hallux valgus. After removal of the failed osteosynthesis material and preparation of the bone fragments, a calcaneal bone autograft, previously extracted from the patient, was placed in the nonunion area. The new physiological position of the first metatarsal in the three planes was checked intraoperatively, and autograft and fragment fixation was performed using a combination of a low-profile plate with six screws and two interfragmentary screws. The advantage of using an autogenous graft is that it provides corticocancellous bone and great osteogenic capacity with little antigenic capacity. This makes it an excellent option in many situations in foot and ankle surgery. Regarding the fixation method, we used the two most commonly used techniques for osteosynthesis of bone grafts in cases of bone nonunion, combining plates with locking screws and two interfragmentary screws. This provides greater stability of the bone fragments in the three planes and makes it possible to bring forward when the patient starts postsurgical loading.
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46
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Biz C, Crimì A, Fantoni I, Tagliapietra J, Ruggieri P. Functional and Radiographic Outcomes of Minimally Invasive Intramedullary Nail Device (MIIND) for Moderate to Severe Hallux Valgus. Foot Ankle Int 2021; 42:409-424. [PMID: 33319594 DOI: 10.1177/1071100720969676] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study was aimed at assessing clinical and radiographic outcomes of the Minimally Invasive Intramedullary Nail Device (MIIND) to correct moderate to severe hallux valgus (HV) and the long-term persistence of its effects. METHODS This case series study involved 100 patients, 84 women and 16 men (mean age, 59 years), who underwent the MIIND procedure with a mean follow-up of 97 months. Assessment was performed preoperatively, postoperatively, at 6 and 12 months, and at last follow-up. Clinical outcomes were evaluated with American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), and patient satisfaction. Intermetatarsal angle (IMA), metatarsophalangeal hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), and tibial sesamoid position were assessed. Statistical analysis was performed. RESULTS The mean AOFAS score improved from 57.9 to 90.5 points, VAS scale was 1.5 ± 2.0, and patients' satisfaction was 8.7 ± 1.4. The mean correction of the HVA and IMA showed a significant correction; however, the effect of time was not statistically significant on DMAA. Sex (P = .047), severity (P = .050), associated procedures (P = .000), and preoperative angle (P = .000) showed significant association with HVA correction and its persistence over time. Age was not statistically significant. Complications were 9 cases of superficial wound infection and 6 recurrences. CONCLUSIONS The MIIND technique proved a viable procedure to correct moderate to severe HV with a low rate of complications and recurrence, producing significant correction of most radiographic parameters assessed and their persistence, even at long term. LEVEL OF EVIDENCE Level IV, case series study.
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Affiliation(s)
- Carlo Biz
- Orthopaedic, Traumatology and Oncology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Alberto Crimì
- Orthopaedic, Traumatology and Oncology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Ilaria Fantoni
- Orthopaedic, Traumatology and Oncology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Jacopo Tagliapietra
- Orthopaedic, Traumatology and Oncology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Pietro Ruggieri
- Orthopaedic, Traumatology and Oncology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
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47
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Abstract
BACKGROUND Minimally invasive techniques of Akin osteotomy have grown in popularity, as early results suggest faster recovery, earlier return to work, and minimized wound healing problems. Preserving lateral cortex integrity during first phalanx osteotomy thereby presents a challenge because of the lack of direct visual control. This retrospective comparative study investigated clinical and radiographic outcomes of minimally invasive and open Akin osteotomy with different fixation methods and analyzed whether or not intraoperative violation of the lateral cortex caused loss of correction or delayed bone healing. METHODS One hundred eighty-four patients (210 feet) with symptomatic hallux valgus and pathologic interphalangeal angle (IPA) of at least 10 degrees underwent surgery combined with Akin osteotomy. Minimally invasive Akin osteotomies were fixed in 124 feet with 2 crossing percutaneous K-wires and compared to 86 Akin osteotomies by open technique with double-threaded (head and shank) screw fixation. At 1 day and 6 and 12 weeks postoperatively, IPA and bony consolidation were radiographically and clinically assessed. RESULTS Mean preoperative IPA was 13.4 ± 3.6 degrees in minimally invasive (MI) and 13.3 ± 3.5 degrees in open surgery (OS) cases (P > .05). Intraoperative breach of the lateral cortex occurred in 12 (13.9%) in OS and 64 (51.6%) in MI cases. Whereas the breach occurred in open technique mainly during manual correction by applying a medial closing force, it was caused predominantly by the use of the burr in minimally invasive technique. After 12 weeks, the mean IPA was 4.1 ± 1.4 degrees in MI and 4.8 ± 1.2 degrees in OS cases (P > .05). Bony consolidation was complete after 6 and 12 weeks in OS and MI, respectively. Three deep infections occurred in the OS Group after Lapidus arthrodesis and 2 deep infections were registered in the MI Group after minimally invasive chevron and Akin osteotomy. The infections were not at the site of the Akin osteotomy. CONCLUSION Breach of the lateral cortex did not impair bone healing or correction of IPA. Minimally invasive Akin osteotomy with K-wire fixation provided equivalent correction of IPA compared to open surgery with screw fixation. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Sebastian Schilde
- Department of Orthopaedics and Traumatology, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Karl-Stefan Delank
- Department of Orthopaedics and Traumatology, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Dariusch Arbab
- Department of Orthopaedic Surgery, Klinikum Dortmund GmbH, Dortmund, Germany
| | - Natalia Gutteck
- Department of Orthopaedics and Traumatology, Martin Luther University Halle Wittenberg, Halle, Germany
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Hernández-Castillejo LE, Álvarez-Bueno C, Garrido-Miguel M, Torres-Costoso A, Reina-Gutiérrez S, Martínez-Vizcaíno V. The effect of hallux valgus open and percutaneous surgery on AOFAS scale: a systematic review and meta-analysis. Qual Life Res 2021; 30:957-966. [PMID: 33387287 DOI: 10.1007/s11136-020-02715-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE To estimate the comparative effect of open and percutaneous hallux valgus (HV) surgery on patients' quality of life (QoL) using the American Orthopedic Foot and Ankle Society (AOFAS) scale including total score and individual domains (pain, function, and alignment). METHODS MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to March 2020 for studies on the effect of HV surgery on patients' QoL using the AOFAS score. A standardized mean difference score was calculated on the total AOFAS score and on each AOFAS domain (pain, function, and alignment) using Cohen's d index. RESULTS Considering the 53 published studies included, the pooled effect size (ES) estimates for the AOFAS total score were 3.69 (95% CI 3.37-4.01; I2 = 95.5%) for open surgery and 3.40 (95% CI 2.99-3.80, I2 = 88.2%) for percutaneous surgery. The total pooled ES estimate was 3.61 (95% CI 3.35-3.87, I2 = 94.5%). Considering the pain domain, the pooled ES estimates were 2.21 (95% CI 1.98-2.43, I2 = 64%) for open surgery and 2.52 (95% CI 1.83-3.20, I2 = 92.6%) for percutaneous surgery. For the function domain, the pooled ES estimates were 1.37 (95% CI 0.93-1.81, I2 = 91%) for open surgery and 2.28 (95% CI 1.10-3.47, I2 = 96.8%) for percutaneous surgery. Finally, the pooled ES estimates for the alignment domain were 3.99 (95% CI 3.51-4.47, I2 = 85.7%) for open surgery and 2.66 (95% CI 2.23-3.09, I2 = 78.5%) for percutaneous surgery. CONCLUSION Our data support that HV surgery increases the total AOFAS score as well as the AOFAS scores by domain (pain, function, and alignment). Furthermore, our data show that HV surgery increases patients' QoL, after both open and percutaneous surgery, without differences between them.
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Affiliation(s)
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain. .,Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay.
| | | | - Ana Torres-Costoso
- School of Nursing and Physiotherapy, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Sara Reina-Gutiérrez
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain.,Facultad de Ciencias de La Salud, Universidad Autónoma de Chile, Talca, Chile
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49
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Del Vecchio JJ, Dalmau-Pastor M. Percutaneous Lateral Release in Hallux Valgus: Anatomic Basis and Indications. Foot Ankle Clin 2020; 25:373-383. [PMID: 32736735 DOI: 10.1016/j.fcl.2020.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In the last decade, minimally invasive or percutaneous surgery has evolved rapidly through the development of novel techniques. Treatment of hallux valgus deformity is one of the indications for percutaneous surgery, both for bony and soft tissue correction. The release of the structures on the lateral part of the first metatarsophalangeal joint (lateral release) is one of the best indications for percutaneous surgery in the forefoot. In this article, a detailed description of the anatomy of the metatarsophalangeal joint is provided, along with the indications and tips to perform a safe percutaneous lateral release.
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Affiliation(s)
- Jorge Javier Del Vecchio
- GRECMIP - MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied - Minimally Invasive Foot and Ankle Society), Merignac, France; Head Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro -Hospital Universitario, Solis 461, Ciudad Autónoma de Buenos Aires (CABA) CP 1078, Argentine; Department of Kinesiology and Physiatry, Universidad Favaloro, Av. Entre Ríos 495, CABA CP 1079, Argentina
| | - Miki Dalmau-Pastor
- GRECMIP - MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied - Minimally Invasive Foot and Ankle Society), Merignac, France; Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona. C/ Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Office 5304, Barcelona, Spain.
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50
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Jeyaseelan L, Malagelada F. Minimally Invasive Hallux Valgus Surgery-A Systematic Review and Assessment of State of the Art. Foot Ankle Clin 2020; 25:345-359. [PMID: 32736733 DOI: 10.1016/j.fcl.2020.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Minimally invasive techniques in the treatment of hallux valgus deformity have seen growing popularity since the 1990s. The purpose of this article is to assess the existing body of literature as to the safety and efficacy of minimally invasive techniques and identify areas for further development. The appeal of minimizing soft tissue damage, reducing surgical time, and faster recovery is currently offset by the initial learning curve and a lack of high-quality studies regarding minimally invasive techniques. There is currently insufficient evidence to recommend one minimally invasive technique over another and further high-level evidence studies are warranted.
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Affiliation(s)
- Luckshmana Jeyaseelan
- The Foot & Ankle Unit, Department of Trauma & Orthopaedics, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK
| | - Francesc Malagelada
- The Foot & Ankle Unit, Department of Trauma & Orthopaedics, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.
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