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Tran-Minh D, Poirot-Seynaeve B, Vialla T, Ohl X, Diallo S, Siboni R. Comparison of the outcomes of first metatarsophalangeal joint arthrodesis by locking plate and compression screw in patients with severe hallux valgus or hallux valgus revision. Orthop Traumatol Surg Res 2024:103932. [PMID: 38987032 DOI: 10.1016/j.otsr.2024.103932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Arthrodesis of the first metatarsophalangeal joint (MTP1) is indicated for hallux rigidus, septic arthritis, severe hallux valgus (HV) or HV revision. Few studies have compared the functional and radiographic outcomes between indications. The goal of this study was to compare the results of MTP1 arthrodesis in patients with severe HV or HV revision at 6 months postoperative. The hypothesis was that there are no differences in the fusion rate, functional scores and radiological correction between the two groups. MATERIALS AND METHODS This was a retrospective, observational, single-center study conducted between January 1, 2018 and July 31, 2021. The inclusion criteria were patients treated for severe HV or HV revision by MTP1 arthrodesis with a compression screw and locking plate who were at least 18 years of age. The exclusion criteria were a history of septic arthritis of MTP1 without prior HV surgery, primary hallux rigidus, rheumatoid arthritis, incomplete medical record. The functional outcomes consisted of the Foot Function Index (FFi-f) and the European Foot and Ankle Society (EFAS) score. Radiographs were made to evaluate preoperative and postoperative deformity, the correction and the fusion rate. These outcomes were compared between two groups: severe HV and HV revision. RESULTS An analysis was done of 58 cases of MTP1 arthrodesis: 45 severe HV and 13 HV revisions. The mean patient age was 66 years, and the mean follow-up was 15.7 months. There were no significant differences between the two groups in the postoperative functional scores: EFAS (p = 0.85) and FFI-f (p = 0.14). At the final review, there were no significant differences between the two groups in the foot angle measurements (hallux valgus angle, p = 0.08 and intermetatarsal angle, p = 0.15) and fusion rate (p = 0.89) with a 93% fusion rate in patients with severe HV and 92% in patients with HV revision. CONCLUSION Given the good radiographic and functional outcomes, MTP1 arthrodesis by locking plate and compression screw is indicated as a first line surgical treatment for patients with severe HV or for patients undergoing HV revision. There is no evidence of a significant difference in the functional scores, fusion rate and radiographic correction between these two indications. LEVEL OF PROOF IV; retrospective case series.
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Affiliation(s)
- Dong Tran-Minh
- Université de Reims Champagne-Ardenne, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Maison Blanche, Centre Hospitalo-Universitaire de Reims, France
| | - Benoit Poirot-Seynaeve
- Université de Reims Champagne-Ardenne, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Maison Blanche, Centre Hospitalo-Universitaire de Reims, France
| | - Tristan Vialla
- Université de Reims Champagne-Ardenne, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Maison Blanche, Centre Hospitalo-Universitaire de Reims, France
| | - Xavier Ohl
- Université de Reims Champagne-Ardenne, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Maison Blanche, Centre Hospitalo-Universitaire de Reims, France
| | - Saidou Diallo
- Université de Reims Champagne-Ardenne, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Maison Blanche, Centre Hospitalo-Universitaire de Reims, France
| | - Renaud Siboni
- Université de Reims Champagne-Ardenne, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Maison Blanche, Centre Hospitalo-Universitaire de Reims, France.
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Colò G, Leigheb M, Surace MF, Fusini F. The efficacy of shoes modification and orthotics in hallux valgus deformity: a comprehensive review of literature. Musculoskelet Surg 2024:10.1007/s12306-024-00839-9. [PMID: 38922494 DOI: 10.1007/s12306-024-00839-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/23/2024] [Indexed: 06/27/2024]
Abstract
Hallux valgus (HV) is a frequent forefoot deformity affecting about 23% of adults and 35.7% of people over 65. The exact etiology is not fully understood. The first ray plays a significant role in walking cause it bears the principal amount of weight and maintains the position of the medial arch. Several factors that deteriorate the integrality of the first ray, such as foot deformities, restrictive footwear, and pes planus, may be ascribed to the HV occurrence. Before any surgical correction, conservative treatment should always be initiated first. Currently, there is no consensus that conservative management by shoe modification and foot orthoses could correct the pathology or terminate the clinical worsening of the condition.From a careful analysis of the literature, proper footwear should be a shoe with an adequate length, wide toe box, cushioned sole, and a lowered heel to not increase the load on the metatarsal heads and cause pain. Personalized 3D printed customized toe spreaders may be applied in patients with HV, improving symptoms and bringing pain relief. Compensating the subtalar joint hyperpronation through foot orthoses plays a fundamental role in the HV development, preventing or at least controlling the condition's progress; this, along with weight reduction and regular physical activity.Data obtained suggest that dynamic foot orthoses prefer a biomechanical type with 3/4-length, which is less likely to negatively affect the dorsal or medial pressures, which instead were noted to increase with the sulcus- and full-length orthoses.Although some studies suggest that foot orthoses would favor the correction of HV deformity, results have been very variable and just in few studies appear to correct HV or reduce its progression, improving symptoms and bringing pain relief. In the case of HV surgical correction, orthoses seem to maintain the correct position acquired over time.
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Affiliation(s)
- G Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Via Venezia 16, 16121, Alessandria, Italy.
| | - M Leigheb
- Orthopaedics and Traumatology Unit, Department of Health Sciences, ''Maggiore Della Carità'' Hospital, University of Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - M F Surace
- Circolo Hospital, Macchi Foundation 'Insubria University', Viale Borri 57, 21100, Varese, Italy
| | - F Fusini
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, University of Turin, Via Zuretti 29, Turin, Italy
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Ahumada X, Ortiz C, Carcuro G, Pellegrini M, Butteri A, Albarrán C, Chaparro F. Anatomy of the Flexor Hallucis Longus and Its Relationship With Hallux Valgus: A Cadaveric Study. Foot Ankle Int 2024:10711007241241261. [PMID: 38808793 DOI: 10.1177/10711007241241261] [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: 05/30/2024]
Abstract
BACKGROUND Hallux valgus (HV) is a complex deformity, with many associated risk factors. The flexor hallucis longus (FHL) tendon is a dynamic and potentially deforming force as it bowstrings laterally with HV. We hypothesized that FHL is more laterally inserted in the distal phalanx in cadavers with HV; therefore, it might be also a primary destabilizing force. We aim to compare the FHL distal insertion morphology and its relationship with osseous structures in cadavers with and without HV. METHODS Sixteen cadaver specimens, 8 with HV and 8 without (N-HV) were dissected. We evaluated FHL distal morphology in terms of its insertional footprint location and FHL long-axis position in relation to osseous anatomy. RESULTS Both the HV and N-HV groups displayed a laterally inserted footprint at the distal phalanx, with the HV group exhibiting median lateral translation of the footprint 6% greater than the N-HV group (P < .01). Both groups also demonstrated a laterally displaced position for the FHL long axis. The median FHL long axis for HV vs N-HV specimens 1 cm proximal to the IP joint was 9% more laterally displaced from the midaxis (P < .01), and at 1 cm proximal to the MTP joint was measured to be 15% more laterally displaced from the midaxis (P < .01). CONCLUSION FHL demonstrated an eccentric position in terms of insertion and trajectory in both the HV and N-HV groups, with greater lateralization in specimens exhibiting HV deformity. This eccentricity potentially creates a greater deforming force vector contributing to the development of HV. CLINICAL RELEVANCE The etiology and progression of HV deformity may include a lateralized insertion of the FHL tendon. Treatment implications remain unknown at this time.
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Affiliation(s)
| | | | - Giovanni Carcuro
- Clínica Universidad de Los Andes, Universidad de Chile, Las Condes, Chile
| | - Manuel Pellegrini
- Clínica Universidad de Los Andes, Universidad de Chile, Las Condes, Chile
| | - Ana Butteri
- Clínica Universidad de Los Andes, Universidad de Chile, Las Condes, Chile
| | | | - Felipe Chaparro
- Clínica Universidad de Los Andes, Universidad de Chile, Las Condes, Chile
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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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Bond M, Bicknell M, Crump T, Penner M, Veljkovic A, Wing K, Younger A, Liu G, Sutherland JM. Shared Decision Making in Hallux Valgus Surgery: A Prospective Observational Study. J Patient Exp 2024; 11:23743735241229376. [PMID: 38313865 PMCID: PMC10836134 DOI: 10.1177/23743735241229376] [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: 02/06/2024] Open
Abstract
Patient-physician communication has the potential to improve outcomes and satisfaction through the shared decision-making process (SDM). This study aims to assess the relationship between perception of SDM and demographic, clinical, and patient-reported outcomes in patients undergoing Hallux Valgus (HV) correction. A prospective analysis of 306 patients scheduled for HV surgery was completed. The CollaboRATE score was used to measure SDM. Multivariable linear regression model was used to assess whether SDM scores were associated with preoperative characteristics or postoperative outcome scores. The mean CollaboRATE score was 2.9 (SD 0.9) and did not differ by age, socioeconomic status, or sex. Lower CollaboRATE scores were associated with more symptoms of depression, lower socioeconomic status, and lower general health scores (p-value < 0.05). There was no association between SDM scores and postoperative outcome scores. In this study, patients with depressive symptoms and lower socioeconomic status had worse perceptions of SDM. There was no difference in postoperative outcomes among participants based on SDM scores. Level of Evidence: Level III, prospective observational study.
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Affiliation(s)
- Michael Bond
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Mattheus Bicknell
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Trafford Crump
- Faculty of Medicine, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Murray Penner
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea Veljkovic
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Wing
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alastair Younger
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Guiping Liu
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
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Hwang BH, Jeon IC. Comparison of abductor hallucis muscle activity in subjects with mild hallux valgus during three different foot exercises. J Back Musculoskelet Rehabil 2024; 37:47-54. [PMID: 37599517 DOI: 10.3233/bmr-220252] [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: 08/22/2023]
Abstract
BACKGROUND Normal alignment of the foot is important because the feet support the body's weight. The intrinsic muscles of the foot mainly maintain the alignment and movement of the foot, whereas the abductor hallucis (AbdH) aligns the first metatarsophalangeal joint and maintains the medial longitudinal arch. OBJECTIVE This study was conducted to investigate the muscle activity of the AbdH and hallux valgus (HV) angle during three different foot exercises. METHODS Participants included 15 subjects aged 20-24 years with mild HV. All subjects performed three different foot exercises in random order: short foot exercise (SF), toe spread out exercise (TSO), and TSO with a pressure bio-feedback unit (TSOP). The muscle activity of the AbdH and the HV angle were measured during each foot exercise using surface electromyography and X-ray and then compared using one-way repeated-measures analysis of variance, followed by Bonferroni adjustment. RESULTS AbdH muscle activity differed significantly among SF, TSO, and TSOP. AbdH muscle activity was greater in TSOP (89.60%) than in SF (19.99%) and TSO (60.96%) (p= 0.006). The HV angle was significantly smaller in TSOP (15.72∘) than in SF (18.85∘) and TSO (16.81∘) (p= 0.001). CONCLUSIONS TSOP can be recommended as an effective AbdH strengthening exercise in subjects with mild HV.
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Affiliation(s)
- Byeong-Hun Hwang
- Department of Physical Therapy, Graduate School, Hoseo University, Asan, Korea
- Department of Physical Therapy, College of Life and Health Sciences, Hoseo University, Asan, Korea
| | - In-Cheol Jeon
- Department of Physical Therapy, College of Life and Health Sciences, Hoseo University, Asan, Korea
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Erjanti T, Keskinen H, Rissanen T, Mäkelä K, Lankinen P, Laaksonen I, Koivu H. Radiological outcome of hallux valgus deformity correction with metatarsal osteotomy from a single-center cohort - Best results achieved by foot and ankle surgeons. Foot Ankle Surg 2024; 30:32-36. [PMID: 37673720 DOI: 10.1016/j.fas.2023.08.004] [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: 04/25/2023] [Revised: 07/10/2023] [Accepted: 08/27/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND To evaluate the radiological outcome, especially undercorrection of hallux valgus deformity correction with first metatarsal osteotomy. PATIENTS AND METHODS 439 1st metatarsal osteotomies including 241 distal (55 %), 175 midshaft (40 %), and 23 proximal (5 %) were available for analysis with median follow-up time was 48 days (range 27-990 days). RESULTS The postoperative HVA was normal in 237 (54 %), mild in 110 (25 %), moderate in 87 (20 %), and severe in 5 (1 %) of the cases. BMI (p = 0.0127), sex (p = 0.0004), preoperative HVA (p = 0.0028), and surgeons experience (p < 0.0001) were associated with radiological outcome, whereas age, hospital, and type of osteotomy had no effect. Foot and ankle surgeons achieved normal postoperative HVA in 76 %, general orthopedic surgeons in 41 %, and residents in 47 % of the operations. CONCLUSION Radiological undercorrection was common. As foot and ankle surgeons achieved best radiological correction, hallux valgus deformity should be operated by specialists.
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Affiliation(s)
- Tuuli Erjanti
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Luolavuorentie 2, 20700 Turku, Finland.
| | - Heli Keskinen
- Department of Pediatric Surgery and Orthopaedics, Turku University Hospital, Savitehtaankatu 5, 20520 Turku, Finland
| | - Tiia Rissanen
- Department of Biostatistics, University of Turku, Kiinamyllynkatu 10, Finland
| | - Keijo Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Luolavuorentie 2, 20700 Turku, Finland
| | | | - Inari Laaksonen
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Luolavuorentie 2, 20700 Turku, Finland
| | - Helka Koivu
- Hospital Pihlajalinna Turku, Joukahaisenkatu 9, 20520 Turku, Finland
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Kwolek K, Gądek A, Kwolek K, Kolecki R, Liszka H. Automated decision support for Hallux Valgus treatment options using anteroposterior foot radiographs. World J Orthop 2023; 14:800-812. [DOI: 10.5312/wjo.v14.i11.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Assessment of the potential utility of deep learning with subsequent image analysis to automate the measurement of hallux valgus and intermetatarsal angles from radiographs to serve as a preoperative aid in establishing hallux valgus severity for clinical decision-making.
AIM To investigate the accuracy of automated measurements of angles of hallux valgus from radiographs for further integration with the preoperative planning process.
METHODS The data comprises 265 consecutive digital anteroposterior weightbearing foot radiographs. 181 radiographs were utilized for training (161) and validating (20) a U-Net neural network to achieve a mean Sørensen–Dice index > 97% on bone segmentation. 84 test radiographs were used for manual (computer assisted) and automated measurements of hallux valgus severity determined by hallux valgus (HVA) and intermetatarsal angles (IMA). The reliability of manual and computer-based measurements was calculated using the interclass correlation coefficient (ICC) and standard error of measurement (SEM). Inter- and intraobserver reliability coefficients were also compared. An operative treatment recommendation was then applied to compare results between automated and manual angle measurements.
RESULTS Very high reliability was achieved for HVA and IMA between the manual measurements of three independent clinicians. For HVA, the ICC between manual measurements was 0.96-0.99. For IMA, ICC was 0.78-0.95. Comparing manual against automated computer measurement, the reliability was high as well. For HVA, absolute agreement ICC and consistency ICC were 0.97, and SEM was 0.32. For IMA, absolute agreement ICC was 0.75, consistency ICC was 0.89, and SEM was 0.21. Additionally, a strong correlation (0.80) was observed between our approach and traditional clinical adjudication for preoperative planning of hallux valgus, according to an operative treatment algorithm proposed by EFORT.
CONCLUSION The proposed automated, artificial intelligence assisted determination of hallux valgus angles based on deep learning holds great potential as an accurate and efficient tool, with comparable accuracy to manual measurements by expert clinicians. Our approach can be effectively implemented in clinical practice to determine the angles of hallux valgus from radiographs, classify the deformity severity, streamline preoperative decision-making prior to corrective surgery.
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Affiliation(s)
- Konrad Kwolek
- Department of Orthopedics and Traumatology, University Hospital, Kraków 30-688, Małopolska, Poland
| | - Artur Gądek
- Department of Orthopedics and Physiotherapy, Jagiellonian University Collegium Medicum, Kraków 30-688, Małopolska, Poland
| | - Kamil Kwolek
- Department of Spine Disorders and Orthopedics, Gruca Orthopedic and Trauma Teaching Hospital, Otwock 05-400, Poland
| | - Radek Kolecki
- Department of Orthopedics and Traumatology, University Hospital, Kraków 30-688, Małopolska, Poland
| | - Henryk Liszka
- Department of Orthopedics and Physiotherapy, Jagiellonian University Collegium Medicum, Kraków 30-688, Małopolska, Poland
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Tonogai I, Yamasaki Y, Nishisho T, Sairyo K. Republication of "Mucous Cyst at the Interphalangeal Joint of the First Toe Caused by Contact Pressure With the Second Toe due to Hallux Valgus: A Case Report". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231192974. [PMID: 37566681 PMCID: PMC10408337 DOI: 10.1177/24730114231192974] [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: 08/13/2023] Open
Abstract
A 77-year-old woman presented with a mucous cyst on the lateral aspect of the interphalangeal joint of the first toe caused by contact pressure with the second toe from hallux valgus. She complained of discomfort and discharge from the left first toe for approximately 4 months. Physical examination showed the second toe pressing strongly against the first toe due to hallux valgus and discharge from the skin on the lateral aspect of the interphalangeal joint of the first toe. Magnetic resonance imaging showed a cystic lesion at the same level. The patient underwent a modified scarf osteotomy of the first metatarsal for hallux valgus to resolve the contact pressure between the toes-considered the cause of the mucous cyst-and resection of mucous cyst. Forefoot weight bearing was allowed 6 weeks after surgery. As of 1 year after surgery, she has had no recurrence of the cyst. The score on the Japanese Society for Surgery of the Foot hallux metatarsophalangeal-interphalangeal scale improved from 59/100 points to 92/100. This outcome suggests that hallux valgus correction should be considered when a mucous cyst is associated with contact pressure due to a hallux valgus deformity. To the best of our knowledge, there are no previous reports of a mucous cyst caused by contact pressure between the first toe and second toe due to hallux valgus.
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Affiliation(s)
- Ichiro Tonogai
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan
| | - Yuhei Yamasaki
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan
| | - Toshihiko Nishisho
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan
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Elattar O, Smith T, Ferguson A, Farber D, Wapner K. Republication of "Uses of Braces and Orthotics for Conservative Management of Foot and Ankle Disorders". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231193419. [PMID: 37566687 PMCID: PMC10408344 DOI: 10.1177/24730114231193419] [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: 08/13/2023] Open
Abstract
Nonsurgical management is almost always considered the first-line treatment for the vast majority of foot and ankle pathologies. Foot orthoses, shoe modifications, and therapeutic footwear are considered essential tools for successful conservative management of different foot and ankle disorders. Orthopedic foot and ankle surgeons should have a meticulous understanding of the lower extremity biomechanics as well as the pathoanatomy and the sequelae of diseases affecting the foot and/or ankle. This is essential to the understanding of the desired effects of the different inserts, orthotics, shoe modifications, or braces that may be prescribed for these conditions. In this article, we will summarize the orthoses used for treatment of the most commonly encountered foot and ankle pathologies, with the exclusion of treatment for the diabetic foot because of the unique requirements of that disease process.
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Affiliation(s)
- Osama Elattar
- Department of Orthopedics, University of Pennsylvania Medicine, Philadelphia, PA, USA
| | - Tyler Smith
- Department of Orthopedics, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Adam Ferguson
- Department of Orthopedics, University of Pennsylvania Medicine, Philadelphia, PA, USA
| | - Daniel Farber
- Department of Orthopedics, University of Pennsylvania Medicine, Philadelphia, PA, USA
| | - Keith Wapner
- Department of Orthopedics, University of Pennsylvania Medicine, Philadelphia, PA, USA
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12
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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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Yamatsu K, Hayashi M, Takashima H, Watanabe K. Comparison of the three-dimensional bone morphology of the first proximal phalanx and first metatarsal between normal and hallux valgus foot using the homologous model technique. Foot (Edinb) 2023; 54:101968. [PMID: 36796254 DOI: 10.1016/j.foot.2023.101968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
Bone morphology is one of the factors involved in hallux valgus development. However, previous studies have not evaluated the overall bone shape in three dimensions. This study aimed to compare the overall shape of the first proximal phalanx and first metatarsal in hallux valgus with those of normal feet.Homologous models were created from computed tomography data of the first proximal phalanx and first metatarsal of 75 healthy men and 53 women in the control group and 10 men and 71 women in the hallux valgus group. Principal component analysis was performed to examine the differences in bone morphology between the control and hallux valgus groups. In men and women with hallux valgus, the proximal articular surface of the first proximal phalanx was characterized by a more lateral inclination and torsion of the pronated first metatarsal. Additionally, the first metatarsal head was characterized by a more lateral inclination in male hallux valgus. This study is the first to reveal the morphological characteristics of the first metatarsal and first proximal phalanx in hallux valgus as a whole bone using a homologous model technique. These characteristics are considered possible causes of hallux valgus development. The shapes of the first proximal phalanx and first metatarsal in hallux valgus were different from those in normal feet. This finding should be useful when considering the pathogenesis and treatment development for hallux valgus.
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Affiliation(s)
- Kenta Yamatsu
- Graduate School of Health Sciences, Sapporo Medical University, Japan.
| | - Mizuho Hayashi
- Graduate School of Health Sciences, Sapporo Medical University, Japan
| | - Hiroyuki Takashima
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, Sapporo, Japan
| | - Kota Watanabe
- Second Division of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Hokkaido, Japan
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14
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Kim TH, Choi YR, Lee HS, Bak GG, Moon SH. Relationship Between Hallux Valgus Recurrence and Sesamoid Position on Anteroposterior Standing Radiographs After Distal Chevron Metatarsal Osteotomy. Foot Ankle Int 2023; 44:130-138. [PMID: 36576025 DOI: 10.1177/10711007221140868] [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: 12/29/2022]
Abstract
BACKGROUND Recurrence of the hallux valgus deformity has various causes, and the incomplete reduction of sesamoids may be one of the important issues. However, we have seen several patients with postoperative lateral sesamoid displacement on anteroposterior (AP) standing radiographs who did not experience hallux valgus recurrence. Therefore, we hypothesized that lateral displacement of the sesamoid on AP standing radiographs does not cause hallux valgus recurrence. METHODS The study included 269 feet (185 patients) with hallux valgus treated with distal chevron metatarsal osteotomy. Mean patient age was 64.26 (range, 15-80) years. Patients were followed up for an average of 33.85 (range, 12-228) months between April 2002 and December 2019. The patients were divided into 4 groups, according to the presence or absence of hallux valgus recurrence and sesamoid reduction. RESULTS During outpatient follow-up, we discovered 99 feet (42.1%) in which hallux valgus did not recur despite lateral sesamoid displacement (grade IV-VII) on AP standing radiographs. Hallux valgus angle (HVA, 2.7 to 7.9 degrees), intermetatarsal angle (IMA, 4.6 to 6.2 degrees), and sesamoid grades (2.1 to 3.5) all deteriorated over time after surgery, and each indicator was statistically significantly altered, and changes in the 3 indicators had a statistically significant positive correlation. Changes in HVA and IMA between feet with and without sesamoid reduction on AP standing radiographs increased over time, with the differences in HVA (2.9 degrees) and IMA (0.9 degrees) being significant at final follow-up (P < .05 for each). Regardless of whether sesamoid reduction was achieved on AP standing radiographs, the final analysis showed that HVA and IMA in both groups worsened over time. Further, there were no differences between the 2 groups in the patterns of change over time. CONCLUSION In our cohort, postoperative sesamoid position on AP standing radiographs was not associated with hallux valgus recurrence based on radiographic criteria. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Tae-Hoon Kim
- Department of Orthopedic Surgery, Ulsan University Hospital, Dong-Gu, Ulsan, Republic of Korea
| | - Young-Rak Choi
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Ho-Seong Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Gyeong-Gu Bak
- Department of Orthopaedic Surgery, Haeundae Paik Hospital, University of Inje, Haeundae-gu, Busan, Republic of Korea
| | - Sung-Ho Moon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Songpa-gu, Seoul, Republic of Korea
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15
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Xiong B, Bai Z, Cao X, Nie D, Zhang C, Sun X, Guo Z, Wen J, Sun W. Causal relationship between thyroid dysfunction and hallux valgus: A two-sample Mendelian randomization study. Front Endocrinol (Lausanne) 2023; 14:1115834. [PMID: 36967762 PMCID: PMC10030973 DOI: 10.3389/fendo.2023.1115834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/21/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Previous observational studies have reported that thyroid dysfunction is associated with hallux valgus (HV). However, the causal effect of thyroid dysfunction on hallux valgus is still unknown. To assess whether there is a causal relationship between thyroid dysfunction and hallux valgus, we performed a two-sample Mendelian randomization (MR) study. METHODS The data of the two-sample Mendelian randomization study were obtained from public databases. In this study, hypothyroidism, hyperthyroidism, free thyroxine (FT4), and thyrotropin (TSH) were chosen as exposures. The single nucleotide polymorphisms (SNP) of hypothyroidism and hyperthyroidism were from the genome-wide association studies (GWAS) of the IEU database, including 337,159 subjects. Data for FT4 and TSH (72,167 subjects) were extracted from the ThyroidOmics Consortium. HV was used as the outcome. The SNPs associated with HV were selected from a GWAS of 202,617 individuals in the fignngen database. The inverse variance weighted (IVW) method was used as the primary analysis. Four complementary methods were applied, including MR-presso, MR-Egger, and weighted median. In addition, Cochran's Q test, MR-presso, MR-Egger regression, and the leave-one-out test were used as sensitivity analysis, and the MR-pleiotropy test was performed to examine pleiotropy. RESULTS According to the results of IVW, we found that there was a causal relationship between hypothyroidism and HV, and hypothyroidism increased the incidence of HV (OR = 2.838 (95% CI: 1.116-7.213); p = 0.028). There were no significant causal effects of hyperthyroidism, FT4, and TSH on HV (p > 0.05). Sensitivity analyses showed that the results were robust and reliable, and no horizontal pleiotropy was detected. CONCLUSIONS Our findings provided genetic support that hypothyroidism might increase the risk of HV. It will predict the occurrence of HV in patients with hypothyroidism and provide suggestions for early prevention and intervention.
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Affiliation(s)
- Binglang Xiong
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Zixing Bai
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Xuhan Cao
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Duorui Nie
- Graduate School, Hunan University of Traditional Chinese Medicine, Changsha, China
| | - Cheng Zhang
- Fourth Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Xudong Sun
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Ziyan Guo
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jianmin Wen
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Weidong Sun
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Weidong Sun,
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16
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Ishihara H, Komiya M, Esaki H, Tsuchida K, Ishida A, Tashiro T, Tsutsumi S, Maeda N, Urabe Y. Immediate association of navicular bone height and plantar intrinsic muscle size with toe flexion task: An ultrasound-based study. ISOKINET EXERC SCI 2022. [DOI: 10.3233/ies-220092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: Intrinsic foot muscle (IFM) dysfunction and poor foot arch are associated with various foot conditions. Toe flexor exercise (TFE) has been used to improve it; however, the immediate effects of TFE on each IFM and how it relates to changes in navicular bone height (NH) are unclear. OBJECTIVE: This study aimed to investigate acute muscle swelling in the IFM after TFE and the association between changes in NH and IFM size. METHODS: Fourteen adults participated in this study. NH and cross-sectional area (CSA) of the IFM were acquired pre and post- TFE. The CSA of the IFM, including the abductor hallucis (AbH), flexor hallucis brevis, flexor digitorum brevis, and quadratus plantae, was acquired with ultrasonography. In the TFE, each participant completed five sets of eight repetitions with maximum strength. RESULTS: The NH and CSA of all IFM significantly increased significantly post-TFE (p< 0.01). Only the increase in AbH was moderately and positively correlated with the change in NH (r= 0.54, p< 0.01). CONCLUSION: This study suggests that the acute swelling of AbH after TFE is associated with an immediate increase in NH, supporting the important role of AbH in the formation of foot arch.
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17
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Li G, Shen J, Smith E, Patel C. The Evaluation of Orthotics in Reducing Hallux Valgus Angle in Patients with Hallux Valgus over a Twelve-Month Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12531. [PMID: 36231830 PMCID: PMC9564465 DOI: 10.3390/ijerph191912531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Hallux valgus (HV) is one of the most common forefoot deformities among females, and its prevalence increases with age. This study aims to evaluate the effectiveness of three different types of orthotics on the reduction in hallux valgus angle (HVA) for patients with mild and moderate hallux valgus deformities. METHODS Twenty-six patients (42 feet) with mild or moderate HV participated in the treatment with three types of orthotics in the current study. Patients were divided into three groups depending on their HV severities and the consideration of different function of the orthotics. Orthotic Type 1 is a biomechanical style orthotic applied to moderated HV in Group 1. Orthotic Type 2 is a wrap style orthotic used on mild and moderate HV with two sub-groups: mild HV in Group 2A and moderate HV in Group 2B. Orthotic Type 3 is a gel style orthotic for mild HV. Patients were required to wear the orthotics for between 6 and 8 h per night over a period of 12 months. The HVA was measured every 3 weeks using a newly designed Measuring Block. A paired t-test was used to compare the differences between initial and final HVA at different stages of HVA treatment with orthotics. RESULTS After the 12-month treatment, for moderate HV patients treated with the Orthotic Type 1, their HVA reduced by 5.05° (95% CI 1.37, 8.73), (p < 0.05). For moderate HV patients treated with the Orthotic Type 2, their HVA reduced by 1.2° (95% CI -0.71, 3.11) (p > 0.05). For mild HV patients treated with the Orthotic Type 2, their HVA reduced by 2.44° (95% CI 1.39, 3.49) (p < 0.05). For mild HV patients treated with the Orthotic Type 3, their HVA reduced by 3.08° (95% CI -0.68, 6.83) (p > 0.05). CONCLUSIONS Orthotic Type 1 showed a consistent significance in reduction in the HVA during the 12-month treatment, so it could be recommended for treating moderate HV. Orthotic Type 2 reduced the HVA, but it did not show a consistent significance in reduction in the HVA for mild and moderate HV. Orthotic Type 3 reduced the HVA, but it showed a volatile trend during 12 months without significant differences.
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Affiliation(s)
- Guoli Li
- School of Art and Design, Guangzhou Panyu Polytechnic, Guangzhou 511483, China
| | - Jinsong Shen
- Textile Engineering and Materials Research Group, School of Fashion and Textiles, De Montfort University, Leicester LE1 9BH, UK
| | - Edward Smith
- Textile Engineering and Materials Research Group, School of Fashion and Textiles, De Montfort University, Leicester LE1 9BH, UK
| | - Chetna Patel
- The Maths Learning Centre, De Montfort University, Leicester LE1 9BH, UK
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18
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Burg A, Tal Frenkel R, Nyska M, Ohana N, Segal D, Palmanovich E. Treating Hallux Valgus Associated Metatarsus Adductus by Minimally Invasive Surgery: A Simple Solution for a Difficult Problem. J Foot Ankle Surg 2022; 61:1091-1097. [PMID: 35260325 DOI: 10.1053/j.jfas.2022.01.027] [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] [Received: 12/23/2020] [Accepted: 01/25/2022] [Indexed: 02/03/2023]
Abstract
This study aims to assess a novel minimally invasive surgical technique that addresses hallux valgus accompanied by metatarsus adductus. We retrospectively analysed the results of 20 patients (21 feet) that underwent a newly developed percutaneous osteotomy procedure of the lesser metatarsal bones in order to correct hallux valgus deformities accompanied by metatarsus adductus. We used x-ray studies in order to evaluate changes in the hallux valgus angle, the first intermetatarsal angle, and the metatarsal angle (using the modified Sgarlato method). We also compared the pre- and postoperative American Orthopaedic Foot and Ankle Society scores when available. The paired sample t test was used to compare variables. At a 1-y follow-up the mean hallux valgus angle, inter-metatarsal angle and the metatarsal angle have been reduced by 31.62 (-3 to 9), 3.86 (11-52) and 14.69 (4-36) respectively (p < .001 for all). The mean American Orthopaedic Foot and Ankle Society score (n = 15 feet available) has been improved by a mean of 44.53 (22-72, p < .001). In addition, the patient satisfaction rates were high. Patients suffered from mild to moderate midfoot pain during the first few weeks following surgery, which resolved when union occurred. No cases of lesser metatarsal nonunion have been documented. The presented minimally invasive method can be used effectively to correct hallux valgus that is associated with metatarsus adductus. Proximal minimally invasive metatarsal osteotomy can effectively correct hallux valgus accompanied by metatarsus adductus.
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Affiliation(s)
- Alon Burg
- Rabin Medical Center Petach Tikva, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rutenberg Tal Frenkel
- Rabin Medical Center Petach Tikva, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meir Nyska
- Meir Medical Center, Kfar Saba, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nissim Ohana
- Meir Medical Center, Kfar Saba, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Segal
- Meir Medical Center, Kfar Saba, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ezequiel Palmanovich
- Meir Medical Center, Kfar Saba, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Okawara H, Sawada T, Hakukawa S, Nishizawa K, Okuno M, Nakamura M, Hashimoto T, Nagura T. Footsteps required for reliable and valid in-shoe plantar pressure assessment during gait per foot region in people with hallux valgus. Gait Posture 2022; 97:21-27. [PMID: 35858528 DOI: 10.1016/j.gaitpost.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Plantar pressure assessment is commonly performed to identify pathognomonic gait characteristics and evaluate therapeutics against them in people with various foot disorders. Little is known about the reliability and validity of this assessment in people with hallux valgus (HV) per foot region. RESEARCH QUESTION This study aimed to assess the reliability and validity of the in-shoe plantar pressure measurement method during gait in people with HV and the required number of footsteps, as an intra-subject sample size, to ensure a reliable and valid use of this method. METHODS With an inserted disposable insole plantar pressure sensor in shoes, 17 females with HV (HV angle > 15°) completed three gait trials over the ground at a comfortable speed. Peak plantar pressure data and its distribution in 15 stance phases on the foot clinically diagnosed with HV in each participant were extracted by dividing the foot into eight regions. The intraclass correlation coefficient per foot region and the number of footsteps required to produce a valid peak plantar pressure and distribution (intraclass correlation coefficient > 0.90) were used to measure reliability. Based on the limit of agreement analysis, the coefficient of variation between the averaged value from each incremental footstep (2-14 footsteps) and 15 reference footsteps was calculated. RESULTS The intraclass correlation coefficient of plantar pressure assessment with the in-shoe sensor was 0.606-0.847 in the eight foot regions in people with HV. Additionally, the number of steps required for a valid assessment ranged from two to nine. Hence, the application of averaged values from more than nine footsteps is recommended for this evaluation. SIGNIFICANCE This reference sample size is intended to be used in future studies and clinical settings to determine the efficacy of HV treatment.
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Affiliation(s)
- Hiroki Okawara
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan.
| | - Tomonori Sawada
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan.
| | - Satoshi Hakukawa
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan.
| | - Kohei Nishizawa
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan.
| | - Masahiro Okuno
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan; Rapithela Corporation, Seto, Aichi 489-0979, Japan; Tomei Brace Co., Ltd, Seto, Aichi 489-0979, Japan.
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan.
| | - Takeshi Hashimoto
- Sports Medicine Research Center, Keio University, Yokohama, Kanagawa 223-8521, Japan.
| | - Takeo Nagura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan; Department of Clinical Biomechanics, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan.
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20
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Fuimaono Asafo A, Chan H(HY, Lim CS, Tomlinson M. Patient-Reported and Radiologic Outcomes With the Lapidus Procedure. FOOT & ANKLE ORTHOPAEDICS 2022. [DOI: 10.1177/24730114221104825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: This is a retrospective review of patients who have had a Lapidus procedure for hallux valgus deformity correction, performed by a single surgeon. Methods: The clinical records, operation notes and available weightbearing preoperative and postoperative radiographs of all patients who had a Lapidus procedure between February 2008 and July 2018 for hallux valgus deformity were reviewed. The preoperative and postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), and talometatarsal angle (TMT) on anteroposterior (AP) and lateral radiographs were recorded. The postoperative Foot and Ankle Ability Measure (FAAM) scores were obtained from phone interviews. Results: Two hundred thirteen Lapidus procedures were identified between February 2008 and July 2018 and included in the final analysis. The average preoperative and postoperative HVA was 36.3 and 18 degrees, respectively, with an average improvement of 18.3 degrees. The average TMT angles showed a preoperative and postoperative difference of 1.1 degrees on the AP radiograph and 2.4 degrees on the lateral. The average preoperative and postoperative IMA angles were 16.5 and 7.4 degrees, respectively, with an improvement of 9.1 degrees. There were 9 cases (4.2%) of nonunion confirmed on radiography, of which 3 cases (1.4%) had revision fixation with bone graft and went on to radiologic union. Final FAAM scores were available for 151 patients (70.9%). From this group, 74.8% (113/151) scored higher than 90%, 16.6% (25/151) scored between 70% and 90%, and 8.6% scored between 50% and 70%. The patient satisfaction rate was 92.9% overall. Conclusion: This single-surgeon retrospective review of a relatively large number of Lapidus procedures reports acceptable radiologic correction and patient satisfaction. Level of Evidence: Level IV, Large case series.
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Affiliation(s)
| | | | - Che Siu Lim
- University of Auckland, New Zealand
- Department of Orthopaedics, Northland District Health Board, Whangarei, New Zealand
- Royal Australasian College of Surgeons, New Zealand
| | - Matthew Tomlinson
- University of Otago, New Zealand
- Royal Australasian College of Surgeons, New Zealand
- Department of Orthopaedics, Counties Manukau District Health Board, Auckland, New Zealand
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21
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Tay AYW, Goh GS, Thever Y, Yeo NEM, Koo K. Impact of pes planus on clinical outcomes of hallux valgus surgery. Foot Ankle Surg 2022; 28:331-337. [PMID: 33888397 DOI: 10.1016/j.fas.2021.04.004] [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: 01/03/2021] [Revised: 02/24/2021] [Accepted: 04/07/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pes planus is associated with hallux valgus development. This study evaluated the impact of pes planus on clinical outcomes following hallux valgus surgery. METHODS 191 patients underwent Scarf osteotomy for hallux valgus. Pes planus angles including talonavicular coverage angle, lateral talus-first metatarsal angle (Meary's angle) and lateral talocalcaneal angle were measured. The cohort was stratified into control (0°-4.0°), mild (4.1°-14.9°), moderate (15.0°-30.0°) and severe (> 30.0°) pes planus groups according to Meary's angle. Clinical outcomes were compared at baseline, 6 months and 24 months. RESULTS There were 78 controls, 95 mild and 18 moderate cases of pes planus. Meary's angle was independently associated with preoperative hallux valgus angle. Pes planus angles were not associated with pain, AOFAS, SF-36 physical or mental scores. All three groups had similar clinical outcomes and patient satisfaction. CONCLUSION Compared to patients with neutral foot arches, those with pes planus presented with more severe hallux valgus deformity but had similar clinical outcomes following surgical correction.
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Affiliation(s)
- Adriel You Wei Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
| | - Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Yogen Thever
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Kevin Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore; The Bone and Joint Centre, Mount Elizabeth Hospital, Singapore
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Risk factors for recurrence of hallux valgus deformity after minimally invasive distal linear metatarsal osteotomy. J Orthop Sci 2022; 27:435-439. [PMID: 33431255 DOI: 10.1016/j.jos.2020.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recurrence of hallux valgus deformity is a complication following surgical treatment of hallux valgus. This study was performed to identify risk factors for recurrence of hallux valgus deformity after minimally invasive distal linear metatarsal osteotomy (DLMO). METHODS Sixty-seven patients (100 feet) with mild to severe hallux valgus who underwent DLMO from 2007 to 2018 were retrospectively investigated. Their average age at the time of surgery was 54 years (range, 18-88 years). The average follow-up duration was 46 months. The feet were divided into two groups: with and without recurrence. A multivariate analysis was performed to identify the risk factors for recurrence of deformity based on preoperative and 3-month postoperative radiographic parameters. RESULTS Recurrence of deformity was found in 18 (18%) of the 100 feet at the final follow-up. The preoperative hallux valgus angle and 3-month postoperative hallux valgus angle, intermetatarsal angle, round sign positivity, and sesamoid position grade were significantly greater in the recurrence group than in the non-recurrence group. The logistic regression analysis revealed that a 3-month postoperative hallux valgus angle of ≥13.5°, positive round sign, and grade ≥2 sesamoid position were significantly associated with recurrence of deformity. CONCLUSIONS The present findings can help to identify patients at higher risk of recurrence of hallux valgus deformity after DLMO and to modify their surgical procedures.
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Thier ZT, Seymour Z, Gonzalez TA, Jackson JB. Hallux Valgus Deformities: Preferred Surgical Repair Techniques and All-Cause Revision Rates. Foot Ankle Spec 2021:19386400211040344. [PMID: 34689574 DOI: 10.1177/19386400211040344] [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
INTRODUCTION Hallux valgus is a commonly treated condition by foot and ankle surgeons with more than 200 different described correction techniques. Recurrence rates range from 5% to 50%, with increasing support of the theory that arthrodesis procedures may have a lower recurrence rate than osteotomies. Arthrodesis procedures to the first metatarsophalangeal (MTP) joint or tarsometatarsal (TMT) joint for correction of hallux valgus deformity are becoming more commonly utilized. The purpose of this study is to investigate the surgical incidence and revision rates of hallux valgus deformities corrected by arthrodesis compared to osteotomy in the state of South Carolina. METHODS The South Carolina Revenue and Fiscal Affairs Office was queried from 2000 to 2017 to identify all surgically treated hallux valgus deformities. Data extraction included patient demographics, ICD-9 diagnoses, CPT procedure codes, and dates of surgery. A logistic regression model was used for statistical inference. RESULTS A total of 22 199 feet had surgical treatment for hallux valgus during this time period, with 20 422 (92.0%), 592 (2.7%), and 1185(5.3%) receiving an osteotomy, arthrodesis, or other procedure at initial treatment, respectively. There was an all-cause revision rate of 5.6% in the osteotomy group and 6.4% in the arthrodesis group. Demographic factors such as female sex, white race, and surgery pre-2010 were associated with higher revision rates. Multiple comorbidities were correlated with higher revision rates such as tobacco use, hypothyroidism, osteoarthritis, recurrent dislocations, hallux rigidus, lesser toe deformities, metatarsus varus, and talipes cavus. CONCLUSION Despite the recent increase in arthrodesis procedures for the treatment of hallux valgus deformity, our results suggest that osteotomy procedures are more commonly performed and there is no difference in all-cause revision surgery. However, there are multiple patient demographics and comorbidities that are associated with higher rates of revision surgery and should be considered and discussed during the preoperative planning period. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Zachary T Thier
- Lincoln Memorial University DeBusk College of Osteopathic Medicine, Knoxville, Tennessee (ZTT)
- Prisma Health, University of South Carolina Orthopedics, Columbia, South Carolina (ZTT, TAG, JBJIII)
- University of South Carolina School of Medicine, Columbia, South Carolina (ZS, TAG, JBJIII)
| | - Zachary Seymour
- Lincoln Memorial University DeBusk College of Osteopathic Medicine, Knoxville, Tennessee (ZTT)
- Prisma Health, University of South Carolina Orthopedics, Columbia, South Carolina (ZTT, TAG, JBJIII)
- University of South Carolina School of Medicine, Columbia, South Carolina (ZS, TAG, JBJIII)
| | - Tyler A Gonzalez
- Lincoln Memorial University DeBusk College of Osteopathic Medicine, Knoxville, Tennessee (ZTT)
- Prisma Health, University of South Carolina Orthopedics, Columbia, South Carolina (ZTT, TAG, JBJIII)
- University of South Carolina School of Medicine, Columbia, South Carolina (ZS, TAG, JBJIII)
| | - J Benjamin Jackson
- Lincoln Memorial University DeBusk College of Osteopathic Medicine, Knoxville, Tennessee (ZTT)
- Prisma Health, University of South Carolina Orthopedics, Columbia, South Carolina (ZTT, TAG, JBJIII)
- University of South Carolina School of Medicine, Columbia, South Carolina (ZS, TAG, JBJIII)
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Multiplanar instability of the first tarsometatarsal joint in hallux valgus and hallux rigidus patients: a case-control study. INTERNATIONAL ORTHOPAEDICS 2021; 46:255-263. [PMID: 34468786 DOI: 10.1007/s00264-021-05198-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hypermobility of the first ray has been considered associated with various forefoot diseases including hallux valgus (HV) and hallux rigidus (HR). Weightbearing CT scan can be a reliable method for analysis of the first tarsometatarsal (TMT) joint in axial, sagittal, and coronal planes. Our objective was to comparatively investigate signs of instability of the first TMT joint on weightbearing CT between three groups (control, HV, and HR). METHODS In this single-centre, retrospective, case-control study, 27 HV patients (30 feet; mean age 54.2 years), 26 HR patients (30 feet; mean age 56.6 years), and 30 controls (30 feet; mean age; 43 years) were enrolled. Measurements of signs of instability were performed in multiplanes including first TMT angle, dorsal translation of the first metatarsal (M1) at the first TMT joint, plantar distance between the medial cuneiform (C1) and M1 in sagittal plane, hallux valgus angle (HVA), intermetatarsal angle (IMA) in axial plane, rotational profiles of C1 and M1 in coronal plane. Analysis of variance (ANOVA) test and chi-square test were performed to compare each parameter between the three groups. Interobserver reliabilities were assessed using interclass correlation coefficients (ICCs). RESULTS The HV group had significantly increased first TMT angle (0.23° in controls, 1.15° in HV, 0.19° in HR, p < 0.001), HVA (7.52°, 33.50°, 11.21°, p < 0.001), IMA (9.46°, 16.98°, 11.87°, p < 0.001), C1-M1 angle (22.44°, 29.46°, 23.74°, p < 0.001), and rotational profile of the distal M1 (7.06°, 17.88°, 9.85°, p < 0.001) compared with the control and HR groups. Dorsal translation of M1 (23% in controls, 63% in HV, 70% in HR, p < 0.001) was frequently found in the HV and HR groups with significantly increased plantar distance (0.37 mm, 1.14 mm, 1.46 mm, p < 0.001) compared with controls. CONCLUSIONS Multiplanar instability of the first TMT joint was confirmed using weightbearing CT in HV and HR groups compared with controls. HV group demonstrated instability mainly in sagittal and axial planes; HR group had sagittal instability predominantly. Our measurement of rotational instability at the first TMT joint was not able to detect differences between groups. A surgical correction of the instability at the first TMT joint can be an option to address HV and HR. CLINICAL RELEVANCE First ray hypermobility at the first TMT joint is an important consideration when addressing HV and HR, a surgical correction of the instability at the first TMT joint should be taken in consideration as an option.
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O' Reilly M, Merghani K, McKenna J, Bayer T. The Association of Gastrocnemius Tightness, Genu Valgum and Hallux Valgus: A Prospective Case-Control Study. J Foot Ankle Surg 2021; 60:258-261. [PMID: 33422443 DOI: 10.1053/j.jfas.2020.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 02/03/2023]
Abstract
There has been much debate regarding the aetiology and pathogenesis of hallux valgus and it appears to be multifactorial with contracture or tightness of the Achilles tendon and more specifically the gastrocnemius being implicated as an intrinsic factor. The purpose of this study was to look at the association of gastrocnemius tightness, genu valgum and hallux valgus. A prospective case-control study with 25 patients in each group was carried out over a 12-month period. The case group observed adult patients who were referred primarily because of symptomatic hallux valgus and were assessed for the following: hallux valgus stage; presence or absence of isolated gastrocnemius tightness; presence or absence of genu valgum. The control group excluded those with pre-existing hallux valgus, genu valgum and rheumatoid arthritis and were assessed for isolated gastrocnemius tightness. There was a statistically significant association between the presence of genu valgum and hallux valgus when comparing both groups with a p < .001. There was also a statistically significant association between the Silfverskiöld test and the presence of hallux valgus, as well as the Silfverskiöld test and the presence of genu valgum with a p < .001. This study is the first to describe the association of gastrocnemius tightness, genu valgum and hallux valgus. Further studies are required to assess this relationship but knowledge and awareness of it can be applied by clinicians when considering the most appropriate management options with patients.
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Affiliation(s)
- Marc O' Reilly
- Consultant Orthopaedic Surgeon, Department of Trauma and Orthopaedic Surgery, Tullamore Hospital, Tullamore, Offaly, Ireland.
| | - Khalid Merghani
- Consultant Orthopaedic Surgeon, Department of Trauma and Orthopaedic Surgery, Tullamore Hospital, Tullamore, Offaly, Ireland
| | - Johnny McKenna
- Consultant Orthopaedic Surgeon, Department of Trauma and Orthopaedic Surgery, St James's Hospital, Ushers, Dublin, Ireland
| | - Thomas Bayer
- Consultant Orthopaedic Surgeon, Department of Trauma and Orthopaedic Surgery, Tullamore Hospital, Tullamore, Offaly, Ireland
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Bayraktar TO, Yüce A, Yerli M, Tekin AC, Gürbüz H. Distal metatarsal osteotomy and dorsal neutralization plate in the treatment of hallux valgus. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:753-758. [PMID: 34120238 DOI: 10.1007/s00590-021-03044-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/28/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Hallux valgus is a disease that can be treated with many different surgical procedures. In our study, we aimed to compare patients with and without dorsal neutralization plate after distal metatarsal osteotomy and fixation with compression screws. METHODS The files of 59 patients with 89 feet operated with the diagnosis of moderate degree hallux valgus have been examined retrospectively. Hallux valgus angles, AOFAS, VAS and satisfaction scores, time to return to work of both groups were compared. The cases in which only screw fixation was performed were mobilized with the hallux valgus apparatus for 6 weeks postoperatively, while the cases in which dorsal neutralization plate was performed were immediately mobilized full weightbearing without using an additional apparatus. Patients with a minimum follow-up of 2 years were included in the study. RESULT There was no statistically significant difference between the two groups in terms of being bilateral (p = 0.457), mean age (p = 0.105) and gender data (p = 0.105). There was no significant difference in the preop and postop second year hallux valgus angles, AOFAS, VAS and satisfaction scores of the patients. There was a significant difference in the time to return to work (p < 0.001) and the 6th week AOFAS (p < 0.001), VAS (p < 0.001) and postop satisfaction (p < 0.001) scores between the two groups. CONCLUSION The dorsal neutralization plate performed in addition to the compression screw after distal metatarsal osteotomy can cause painless early postoperative results that do not require the use of an additional apparatus, and early good functional results.
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Affiliation(s)
- Tahsin Olgun Bayraktar
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Tascioglu City Hospital, Darülaceze Street No:27, 34384, Sisli, İstanbul, Turkey.
| | - Ali Yüce
- Department of Orthopedic and Traumatology, Basaksehir Pine And Sakura City Hospital, İstanbul, Turkey
| | - Mustafa Yerli
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Tascioglu City Hospital, Darülaceze Street No:27, 34384, Sisli, İstanbul, Turkey
| | - Ali Cagri Tekin
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Tascioglu City Hospital, Darülaceze Street No:27, 34384, Sisli, İstanbul, Turkey
| | - Hakan Gürbüz
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Tascioglu City Hospital, Darülaceze Street No:27, 34384, Sisli, İstanbul, Turkey
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Abstract
Rotation of the first metatarsal (M1) as a potential etiological factor of hallux valgus (HV) deformity was described relatively early in the description of HV pathoanatomy. However, because biplanar radiographs have been the standard method for imaging HV, clinicians primarily developed measurement methods and corrective operations confined to 2 dimensions, medial-lateral and inferior-superior. Recently, as our understanding of HV pathoanatomy has further developed, aided in part by advanced imaging technology, M1 rotation about its axis ("axial rotation") and its implications for HV deformity and treatment has reemerged. The goal of this review is to summarize M1 rotation in HV from a historical perspective, to present the current understanding of its potential role in the etiology/pathogenesis of HV, and to summarize relevant imaging and operative considerations with respect to M1 rotation.Level of Evidence: Level III, systematic review.
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Affiliation(s)
- Jesse Steadman
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.,Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Hamburg, Hamburg, Germany
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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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Bertolo F, Pautasso A, Cuocolo C, Invernizzi D, Atzori F. The Endolog technique for moderate to severe hallux valgus treatment: Clinical and radiographic analysis of 194 patients. Foot Ankle Surg 2021; 27:46-51. [PMID: 32085948 DOI: 10.1016/j.fas.2020.02.001] [Citation(s) in RCA: 3] [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: 09/16/2019] [Revised: 01/10/2020] [Accepted: 02/02/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endolog is an intra-medullary titanium device used for a minimally-invasive hallux valgus correction. The aim of this study was to evaluate clinical and radiographic outcomes of this device. METHODS A retrospective study with a prospective data collection was conducted. Patients underwent to Endolog procedures from September 2009 to April 2017 were enrolled. Mild HV deformity (HVA ≤ 19° and IMA ≤ 13°) or associated procedure to Endolog technique were excluded. The radiological (HVA, IMA and PASA) and clinical (AOFAS score) pre and post-operative data were compared through Wilcoxon Signed-Rank test. RESULTS 194 feet (144 moderate and 50 severe HV) underwent HV correction respecting study's criteria. AOFAS scores significantly improved from 31.0 ± 12.7 points preoperatively to 88.5 ± 8.0 at 24 months. Even all radiographic measurements significantly improved during 2 years' follow-up. Only 6 patients experienced complications: 4 cases of HV recurrence and 2 cases of intolerance device-related pain. CONCLUSIONS Endolog technique proved to be a valid option in the moderate-to-severe hallux valgus treatment, comparable to other surgical techniques described in literature.
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Affiliation(s)
- Federico Bertolo
- University of Turin, Via Gianfranco Zuretti 29, Turin, 10126, Italy.
| | - Andrea Pautasso
- University of Turin, Via Gianfranco Zuretti 29, Turin, 10126, Italy.
| | - Claudio Cuocolo
- Orthopaedic Department, Piccola Casa Della Divina Provvidenza, Via San Giuseppe Benedetto Cottolengo, Turin, 10152, Italy.
| | - Daniela Invernizzi
- Orthopaedic Department, Piccola Casa Della Divina Provvidenza, Via San Giuseppe Benedetto Cottolengo, Turin, 10152, Italy.
| | - Francesco Atzori
- Orthopaedic Department, Piccola Casa Della Divina Provvidenza, Via San Giuseppe Benedetto Cottolengo, Turin, 10152, Italy.
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Park YH, Kim W, Kim JY, Choi GW, Kim HJ. Impact of crossover second toe on the postoperative outcome of distal chevron osteotomy for moderate to severe hallux valgus. Foot Ankle Surg 2020; 26:845-850. [PMID: 31839479 DOI: 10.1016/j.fas.2019.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Crossover second toe is often presented in moderate to severe hallux valgus. However, its clinical impact on the postoperative outcome of hallux valgus is still unknown. METHODS Thirty-five patients who had moderate to severe hallux valgus with crossover second toe were matched with 35 controls who did not have crossover second toe, according to preoperative hallux valgus angle and first-second intermetatarsal angle. Radiological parameters, Foot Function Index (FFI), and Visual Analog Scale (VAS) were assessed as postoperative outcomes at 3, 6, and 12 months after surgery. RESULTS At 3 months, the FFI in the crossover second toe group was lower than in the control group (p=0.001), while other outcomes were similar. On the other hand, there were no significant differences between the groups at 6 and 12 months, in terms of radiological parameters, FFI, and VAS. CONCLUSIONS Patients who had moderate to severe hallux valgus with crossover second toe were at risk for slow functional recovery after surgical treatment in the short term, but, in the long-term, there was no difference in overall postoperative outcomes in patients with and without crossover second toe. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Young Hwan Park
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
| | - Woon Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
| | - Jae Young Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
| | - Gi Won Choi
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, South Korea.
| | - Hak Jun Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
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Willems C, Curtis R, Pataky T, D’Août K. Plantar pressures in three types of indigenous footwear, commercial minimal shoes, and conventional Western shoes, compared to barefoot walking. FOOTWEAR SCIENCE 2020. [DOI: 10.1080/19424280.2020.1825535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Catherine Willems
- Department of Design, KASK & Conservatorium, the School of Arts of HoGent and HoWest, Ghent, Belgium
| | - Rory Curtis
- Department of Musculoskeletal and Ageing Science, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Todd Pataky
- Department of Human Health Sciences, Kyoto University, Kyoto, Japan
| | - Kristiaan D’Août
- Department of Musculoskeletal and Ageing Science, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Department of Biology, University of Antwerp, Antwerp, Belgium
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Akaras E, Guzel NA, Kafa N, Özdemir YA. The acute effects of two different rigid taping methods in patients with hallux valgus deformity. J Back Musculoskelet Rehabil 2020; 33:91-98. [PMID: 31033456 DOI: 10.3233/bmr-181150] [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: 02/04/2023]
Abstract
BACKGROUND Hallux valgus (HV) is one of the most common deformities of the foot, and it causes great difficulties for the patients. OBJECTIVE We aimed to investigate the effects of different rigid taping techniques on HV angle, foot motor performance, balance and walking parameters. METHODS Twenty-two voluntary individuals (12 males, 10 females) with flexible HV deformities between 18 and 35 years of age were included in the study. All measurements were done before and after placebo, athletic and Mulligan tapings were applied. After a three-day interval, new taping was applied on the same subject. HV angle was measured by goniometer. Foot motor performance (single leg heel rise test), balance (unilateral stance, limits of stability, sensory integration of balance) and temporospatial parameters of gait (step length, stride length, step width, foot angle and cadence) were evaluated. RESULTS HV angles were reduced in all taping groups (p< 0.05). The Mulligan taping method was the most effective method in reducing HV angle. Foot motor performance was not affected by any type of taping (p> 0.05). Athletic taping increased step length and step width but reduced foot angle and cadence. The Mulligan taping increased cadence and reduced foot angle (p< 0.01). Both taping methods did not affect the postural stability and fall risk (p> 0.05). Stability limits were increased in Mulligan taping group (p< 0.05). CONCLUSION It can be concluded that Mulligan taping method may be an alternative treatment method for HV rehabilitation especially as it increased the limits of stability and maintaining the balance. Mulligan method is more effective than athletic taping in terms of reducing instant HV angle.
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Affiliation(s)
- Esedullah Akaras
- Institute of Health Sciences, Physiotherapy and Rehabilitation Department, Gazi University, Ankara, Turkey
| | - Nevin A Guzel
- Institute of Health Sciences, Physiotherapy and Rehabilitation Department, Gazi University, Ankara, Turkey
| | - Nihan Kafa
- Institute of Health Sciences, Physiotherapy and Rehabilitation Department, Gazi University, Ankara, Turkey
| | - Yaprak A Özdemir
- Institute of Science and Technology, Department of Statistics, Gazi University, Ankara, Turkey
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Palmanovich E, Ohana N, David S, Small I, Hetsroni I, Amar E, Sharfman ZT, Segal D, Atzmon R. Distal Chevron Osteotomy vs The Simple, Effective, Rapid, Inexpensive Technique (SERI) for Mild to Moderate Isolated Hallux Valgus: A Randomized Controlled Study. Indian J Orthop 2020; 55:110-118. [PMID: 34122763 PMCID: PMC8149498 DOI: 10.1007/s43465-020-00209-0] [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] [Received: 03/21/2020] [Accepted: 07/21/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hallux valgus is a common foot deformity that leads to functional disability with serious sequelae. Minimally invasive surgery is often used to treat hallux valgus in order to reduce wound complications and improve recovery time. The objective of this study was to compare a Simple, Effective, Rapid, Inexpensive (SERI) technique with a simple Chevron technique in patients with minimum of 1-year follow-up. METHODS AND MATERIALS Between the years 2014-2015, we performed a prospective study comparing the SERI minimally invasive technique to treat symptomatic hallux valgus with a standard chevron osteotomy technique. All procedures were performed by a single fellowship trained foot and ankle surgeon. Twenty-one patients were randomized to the SERI cohort and 15 to the standard Chevron technique. RESULTS The mean preoperative intermetatarsal angle (IMA) of the SERI group was 14.8 ± 1.9 (11.9-22.9). The mean preoperative IMA of the Chevron control group was 13.3 ± 2.3 (10.4-18.2) (p = 0.038). The mean IMA two weeks after the surgery was 6.0 ± 2.3 (2.4-12) in the SERI group, and 6.1 ± 3 (2.6-13.1) in the control group. At the two-week and 1-year follow-up, there was no significant difference found in the IMA between the two groups (p = 0.871). The mean hallux valgus angle reduction was 11.85 ± 4.88 (3-20.8) and 11.09 ± 6.51 (- 1.1 to 22.5) in the SERI and Chevron groups, respectively (p = 0.69). Neither groups reported symptomatic transfer metatarsalgia throughout the follow-up period. The SERI group had increased metatarsophalangeal joint (MTPJ) motion (p < 0.001); however, all other parameters with similar. CONCLUSION The SERI technique provided comparable outcomes at up to 1-year follow-up when compared with a standard Chevron osteotomy for moderate hallux valgus. This study demonstrated good reproducible results using the SERI technique for moderate hallux valgus. LEVEL OF EVIDENCE Level II Prospective Study. TRIAL REGISTRATION Approved by local IRB at MMC.
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Affiliation(s)
- Ezequiel Palmanovich
- Department of Orthopaedic Surgery, Meir Medical Center, Affiliated with the Sackler Faculty of Medicine, Kfar Saba, Israel
| | - N. Ohana
- Department of Orthopaedic Surgery, Meir Medical Center, Affiliated with the Sackler Faculty of Medicine, Kfar Saba, Israel
| | - Segal David
- Department of Orthopaedic Surgery, Meir Medical Center, Affiliated with the Sackler Faculty of Medicine, Kfar Saba, Israel
| | - I. Small
- Department of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv University, Affiliated with the Sackler Faculty of Medicine, Tel Aviv, Israel
| | - I. Hetsroni
- Department of Orthopaedic Surgery, Meir Medical Center, Affiliated with the Sackler Faculty of Medicine, Kfar Saba, Israel
| | - E. Amar
- Department of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv University, Affiliated with the Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Z. T. Sharfman
- Department of Orthopaedic Surgery Montefiore, Bronx, NY USA
| | - D. Segal
- Department of Orthopaedic Surgery, Meir Medical Center, Affiliated with the Sackler Faculty of Medicine, Kfar Saba, Israel
| | - R. Atzmon
- Department of Orthopaedic Surgery, Assuta Medical Center, Affiliated with the Faculty of Health and Science, Ben Gurion University, Ashdod, Israel
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Effect of Isometric Hip Abduction on Foot and Ankle Muscle Activity and Medial Longitudinal Arch During Short-Foot Exercise in Individuals With Pes Planus. J Sport Rehabil 2020; 30:368-374. [PMID: 32717719 DOI: 10.1123/jsr.2019-0310] [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: 07/10/2019] [Revised: 04/04/2020] [Accepted: 04/26/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT The improvement of hip joint stability can significantly impact knee and rearfoot mechanics. Individuals with pes planus have a weak abductor hallucis (AbdH), and the tibialis anterior (TA) may activate to compensate for this. As yet, no studies have applied isometric hip abduction (IHA) for hip stability during short-foot exercise (SFE). OBJECTIVE To compare the effects of IHA on the muscle activity of the AbdH, TA, peroneus longus (PL), and gluteus medius (Gmed), as well as the medial longitudinal arch (MLA) angle during sitting and standing SFE. DESIGN Two-way repeated analyses of variance were used to determine the statistical significance of AbdH, TA, PL, and Gmed electromyography activity, as well as the change in MLA angle. SETTING University research laboratory. PARTICIPANTS Thirty-two participants with pes planus. INTERVENTION(S) The participants performed SFE with and without isometric hip abduction in sitting and standing positions. MAIN OUTCOME MEASURES Surface electromyography was used to measure the activity of the AbdH, TA, PL, and Gmed muscles, and Image J was used to measure the MLA angle. RESULTS Significant interactions between exercise type and position were observed in terms of the PL muscle activity and in the change in MLA angle only, while other muscles showed significant main effects. The IHA during SFE significantly increased the AbdH muscle activity, while the TA muscle activity was significantly lower. The muscle activity of Gmed and PL was significantly increased in the standing position compared with sitting, but there was no significant difference with or without IHA. The change in the MLA angle was significantly greater in SFE with IHA in a standing position than in the other SFE conditions. CONCLUSIONS IHA may be an effective method for reducing compensatory TA activity and increasing AbdH muscle activity during SFE for individuals with pes planus.
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Ünal AM, Budeyri A, Baykal B. Comparison of contact surface areas of metatarsal diaphyseal osteotomies for correction of hallux valgus: Experimental study. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:430-437. [PMID: 32812876 DOI: 10.5152/j.aott.2020.17481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to determine, pre-correction, the potential change in the osteotomy-site bony contact surface area that would occur during standard metatarsal diaphyseal procedures with the Baran-Unal modification of Mau osteotomy and then to compare it, post-correction, with the actual osteotomy-site bony contact surface area changes for a standard degree of deformity correction. METHODS A total of 30 standard, same sized, biomechanically equivalent, left first metatarsal sawbones were included in this experimental study. They were divided equally into five groups for each of the planned osteotomy techniques: Myerson's modification of Ludloff, Mau, scarf, Offset V, and Baran-Unal modification of Mau osteotomy. The normal osteotomy for each sample was considered as the control, while the corrective osteotomy was the test. Computerized tomography scans and three-dimensional (3D) reconstruction imaging were performed for objective and accurate measurements. The techniques of the osteotomy and post-corrective osteotomy bony contact surface areas were investigated by the two independent research assistants. RESULTS There was a statistically significant difference between the contact surface area changes of all pre- and post-corrective osteotomy groups (P<0.05). When the pre- and post-correction contact surface areas of any one group were compared with the other groups, the differences were or were not statistically significant. Mean differences between pre-correction and post-correction areas for Ludloff, Mau, scarf, Offset V, and Baran-Unal osteotomies were 180.7, 122.3, 226.2, 191.9, and 68.9 mm2, and the percentages of area loss were 22.9%, 15.5%, 28.6%, 24.3%, and 8.7%, respectively. The most bony contact area was found in the scarf osteotomy group (mean pre-correction area: 490.5 mm2 and mean post-correction area: 264.3 mm2), but the Baran-Unal modification group has significantly the highest post-correction bony contact area among the all other groups (mean pre-correction area: 413.3 mm2 and mean post-correction area: 344.4 mm2). CONCLUSION Metatarsal diaphyseal osteotomies for hallux valgus deformity have the potential not only for deformity correction, but also for contact surface area preservation. This study reaffirms the considerable potential of this new Baran-Unal modification to confer outstanding contact surface area values, even with the operative correction of hallux valgus deformity.
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Affiliation(s)
- A Meriç Ünal
- Department of Sports Medicine, Süleyman Demirel University, School of Medicine, Isparta, Turkey;Clinic of Orthopaedics and Traumatology, Isparta City Hospital, Isparta, Turkey
| | - Aydın Budeyri
- Department of Orthopaedics and Traumatology, SANKO University, School of Medicine, Gaziantep, Turkey
| | - Bahattin Baykal
- Department of Radiology, Süleyman Demirel University, School of Medicine, Isparta, Turkey
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Castioni D, Fanelli D, Gasparini G, Iannò B, Galasso O. Scarf osteotomy for the treatment of moderate to severe hallux valgus: Analysis of predictors for midterm outcomes and recurrence. Foot Ankle Surg 2020; 26:439-444. [PMID: 31208876 DOI: 10.1016/j.fas.2019.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/25/2019] [Accepted: 05/16/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Controversies remain regarding the predictors for outcomes and recurrence after scarf osteotomy for hallux valgus deformity. METHODS Sixty-two patients (70 feet) underwent scarf osteotomy for hallux valgus deformity. The radiological angles, tibial sesamoid position, articular congruence, demographics, comorbidities, AOFAS, VAS and SF-12 scores, and the postoperative compliance were tested as predictors for outcomes and recurrence. RESULTS After a mean 38±15.4 months follow-up, all of the radiological angles, the total AOFAS, PCS-12 and VAS scores significantly improved (all P<0.001). Preoperative MCS-12 was directly related to the total postoperative AOFAS score (P=0.003). A higher number of cardiovascular risk factors negatively affected the postoperative total AOFAS score, VAS and PCS-12 (β=-3.42, P=0.030; β=0.262, P=0.022; β=-0.181, P=0.025, respectively). The BMI influenced postoperative PCS-12 (β=-0.244, P=0.002). Preoperative HVA was directly related to postoperative DMAA (P=0.002) and tibial sesamoid position (P=0.005). Preoperative joint incongruence and postoperative noncompliance were associated with recurrence (P=0.043 and P=0.035, respectively). CONCLUSIONS Satisfactory results can be expected after scarf osteotomy. Higher BMI and number of cardiovascular risk factors, and low mental status should be carefully considered when counselling patients for this procedure. Adherence to postoperative care instructions influences deformity recurrence.
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Affiliation(s)
- Davide Castioni
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, (loc. Germaneto), 88100, Catanzaro, Italy
| | - Daniele Fanelli
- Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, UK
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, (loc. Germaneto), 88100, Catanzaro, Italy.
| | - Bruno Iannò
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, (loc. Germaneto), 88100, Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, (loc. Germaneto), 88100, Catanzaro, Italy
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Abstract
Hallux valgus deformity is a progressive forefoot deformity consisting of a prominence derived from a medially deviated first metatarsal and laterally displaced great toe, with or without pronation. Although there is agreement that the deformity is likely caused by multifactorial intrinsic and extrinsic factors, the best method of operative management is debated despite the creation of basic algorithms. Our understanding of the deformity and the development of newer techniques is continuously evolving. Here, we review the general orthopaedic principles of operative decision-making and management of hallux valgus deformity.
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The Biomechanical Relationship between Hallux Valgus Deformity and Metatarsal Pain. JOURNAL OF HEALTHCARE ENGINEERING 2020; 2020:8929153. [PMID: 32300473 PMCID: PMC7136777 DOI: 10.1155/2020/8929153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/27/2019] [Indexed: 11/17/2022]
Abstract
Metatarsal pain is a common pathological outcome in patients with a hallux valgus (HV) deformity. However, the relationship between the degree of HV deformity and metatarsal pain has not been systematically examined. The purpose of the present study was to investigate the correlation between metatarsal pain and the degree of HV deformity. Between October 2017 and September 2018, 512 HV patients (944 feet) participated in an evaluation of their HV angle (HVA) using X-ray images. The participants were divided into four groups corresponding to their HVA (<15°, 15° to 20°, 21° to 40°, or >40°). Load rate, impulse, contact duration, and contact area were measured and recorded as dynamic gait parameters using the RsScan system. Data were evaluated using SPSS statistical software. The visual analog scale (VAS) was used to assess metatarsal pain. For the four HV deformity groups, the peak value of impulse and contact duration was concentrated on the second and third metatarsals (Meta2 and Meta3) (P < 0.05); contact area was also shown on metatarsals 1, 2, and 5 (P < 0.05). Metatarsal pain on Meta2 had the highest VAS score (VAS: 6.57), followed by Meta3 (Mean VAS: 5.72). In the HV > 40° group, the load location on Meta2 was transferred to Meta1. The percent of pain attributed to Meta2 and Meta3 was also increased in this group. These findings illustrated that metatarsal pain was primarily located on Meta2 and Meta3 in the different degrees of HV deformity. This information can provide the location to target for pain relief and help guide further rehabilitation.
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Helito PVP, Rocha SRR, Ortiz RT, Cerri GG, Leite CDC, Rodrigues MB. Accuracy of magnetic resonance imaging for diagnosing hallux valgus. Radiol Bras 2020; 53:81-85. [PMID: 32336822 PMCID: PMC7170584 DOI: 10.1590/0100-3984.2019.0054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective To assess the accuracy of magnetic resonance imaging (MRI) for the diagnosis of hallux valgus using radiography during weight bearing as the gold standard. Materials and Methods This was a retrospective analysis of all patients undergoing MRI of the foot and radiography of the foot during weight bearing at our institution between January and June of 2015. The hallux valgus angle (HVA) was measured on MRI and radiography. The Wilcoxon signed-rank test and simple linear regression were used in order to compare measurements. Patients were divided into two groups according to the HVA determined on radiography: > 15° (hallux valgus) and ≤ 15° (control). Qualitative and quantitative assessments of MRI scans were performed. For quantitative assessment, receiver operating characteristic curves were used in order to determine the HVA cutoff with the highest accuracy. Results A total of 66 MRI scans were included, 22 in the hallux valgus group and 44 in the control group. Wilcoxon signed-rank tests indicated a significant difference between the radiography and MRI measurements. Simple linear regression showed a nonlinear relationship between the measurements and values did not present a strong correlation. In comparison with the radiography measurements, MRI with an HVA cutoff of 16.4° exhibited the highest accuracy (86%). The accuracy of the subjective (qualitative) assessment was inferior to the objective assessment (measurement of the HVA). Conclusion Hallux valgus can be diagnosed by measuring the HVA on MRI, satisfactory accuracy being achieved with an HVA cutoff of 16.4°.
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GÜL D, Akpancar S. Proximal crescentric osteotomy in the treatment of severe hallux valgus deformity. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.04978-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Plaass C, Karch A, Koch A, Wiederhoeft V, Ettinger S, Claassen L, Daniilidis K, Yao D, Stukenborg-Colsman C. Short term results of dynamic splinting for hallux valgus - A prospective randomized study. Foot Ankle Surg 2020; 26:146-150. [PMID: 30718168 DOI: 10.1016/j.fas.2019.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 12/06/2018] [Accepted: 01/02/2019] [Indexed: 02/04/2023]
Abstract
Background Hallux valgus is a common diagnosis in orthopedics. Only a few studies have analyzed the effects of conservative therapy. Therefore, the current study analyzed the effect of a dynamic hallux valgus splint. Methods Seventy patients were included in this prospective randomized trial. Patients with a hallux valgus were treated using a dynamic splint or underwent no treatment. Clinical and radiological parameters were evaluated. Results We found no significant changes in hallux valgus angle, intermetatarsal I-II angle, AOFAS score, FAOS or SF-36 score between the groups. However, a significant between-group difference was found for pain during walking and running and in the FAOS subscale for pain and pain at rest at follow-up. Conclusions Wearing a dynamic hallux valgus splint does provide some pain relief in patients with a symptomatic hallux valgus, but showed no effect on hallux valgus position. Level of evidence: 1.
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Affiliation(s)
- Christian Plaass
- Department for Foot and Ankle Surgery, Clinic for Orthopedics, Hannover Medical School, Anna-von-Borries Strasse 1-7, 30625, Hannover, Germany.
| | - Annika Karch
- Institute for Biostatistics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Armin Koch
- Institute for Biostatistics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Vivien Wiederhoeft
- Department for Foot and Ankle Surgery, Clinic for Orthopedics, Hannover Medical School, Anna-von-Borries Strasse 1-7, 30625, Hannover, Germany
| | - Sarah Ettinger
- Department for Foot and Ankle Surgery, Clinic for Orthopedics, Hannover Medical School, Anna-von-Borries Strasse 1-7, 30625, Hannover, Germany
| | - Leif Claassen
- Department for Foot and Ankle Surgery, Clinic for Orthopedics, Hannover Medical School, Anna-von-Borries Strasse 1-7, 30625, Hannover, Germany
| | - Kiriakos Daniilidis
- Department for Foot and Ankle Surgery, Clinic for Orthopedics, Hannover Medical School, Anna-von-Borries Strasse 1-7, 30625, Hannover, Germany; OTC Orthopädie Traumatologie Centrum Regensburg, Paracelsusstrasse 2, 93053, Regensburg, Germany
| | - Daiwei Yao
- Department for Foot and Ankle Surgery, Clinic for Orthopedics, Hannover Medical School, Anna-von-Borries Strasse 1-7, 30625, Hannover, Germany
| | - Christina Stukenborg-Colsman
- Department for Foot and Ankle Surgery, Clinic for Orthopedics, Hannover Medical School, Anna-von-Borries Strasse 1-7, 30625, Hannover, Germany
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Mahieu C, Salvia P, Beyer B, Rooze M, Feipel V, Van Sint Jan S. Metatarsal arch deformation and forefoot kinematics during gait in asymptomatic subjects. Int Biomech 2019; 6:75-84. [PMID: 34042007 PMCID: PMC7857307 DOI: 10.1080/23335432.2019.1642142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This study aimed to investigate both foot arch-shaped architecture and forefoot kinematics during gait. Using a dedicated three-compartment forefoot subdivision, we studied asymptomatic subjects and quantified disorders related to the metatarsal arch. Foot motion and arch shape were measured in 30 healthy subjects with a motion-capture system and force plates. Kinematic results were expressed using a novel model, which anatomically divides the forefoot into three parts. This model integrated the medial longitudinal arch angle and the metatarsal arch height and width. During the first part of stance phase, the medial longitudinal arch flattens and all foot segments move toward dorsiflexion. During terminal stance and preswing phase, medial longitudinal and metatarsal arch restoration was noted with plantarflexion of all segments, an eversion and abduction of the medial forefoot, and an inversion and adduction of the lateral forefoot. Kinematics obtained with the proposed forefoot model corroborates metatarsal arch restoration in late stance. This observation supports the fact that foot architecture is supple until midstance and subsequently creates a rigid lever arm with restored arches to support propulsion. This study’s results and methods highlight the potential of the three-compartment model for use in clinical decision-making.
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Affiliation(s)
- Céline Mahieu
- Laboratory of Anatomy, Biomechanics and Organogenesis, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Patrick Salvia
- Laboratory of Anatomy, Biomechanics and Organogenesis, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.,Center for Functional Evaluation, Université Libre de Bruxelles, Brussels, Belgium
| | - Benoît Beyer
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Marcel Rooze
- Laboratory of Anatomy, Biomechanics and Organogenesis, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.,Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Véronique Feipel
- Laboratory of Anatomy, Biomechanics and Organogenesis, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.,Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge Van Sint Jan
- Laboratory of Anatomy, Biomechanics and Organogenesis, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
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Incidence of hallux valgus primary surgical treatment. Finnish nationwide data from 1997 to 2014. Foot Ankle Surg 2019; 25:761-765. [PMID: 31796164 DOI: 10.1016/j.fas.2018.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/26/2018] [Accepted: 10/08/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Many surgical procedures have been described for hallux valgus. Evidence provided by the current literature on the different procedures is, however, poor. The purpose of this study was to assess the incidence of HV surgery in Finland between 1997 and 2014 and to find out whether changes in operation techniques of HV have occurred during the study period. METHODS The study included all adult patients (≥18 years) who underwent primary HV operation. Patients were included into study if they had been operated with a diagnosis of HV (ICD-10 code M20.1). The data were collected by the Finnish National Hospital Discharge Register (NHDR). RESULTS The total incidence of primary HV operations was 66.7 per 100,000 person-years in 1997 and 41.4 per 100,000 person-years in 2014. The incidence of arthroplasty operations of the MTP-1 joint decreased while at the same time the incidence of the MTP-1 joint arthrodesis and TMT-1 arthrodesis increased. The gender difference (13% men, 87% women) is consistent with previous studies. CONCLUSION This study shows a significant decreasing trend of HV operations in Finland between 1997 and 2014. During the study period, the incidence of MTP I joint arthroplasty decreased, and since 2005 the incidence of MT-1-osteotomies has almost halved. At the same time, the incidence of MTP-1 joint arthrodesis increased by over 1000% and TMT-1 joint arthrodesis by nearly 2000%.
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Cruz EP, Wagner FV, Henning C, Sanhudo JAV, Pagnussato F, Galia CR. Does Hallux Valgus Exhibit a Deformity Inherent to the First Metatarsal Bone? J Foot Ankle Surg 2019; 58:1210-1214. [PMID: 31679674 DOI: 10.1053/j.jfas.2018.09.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/15/2018] [Accepted: 09/15/2018] [Indexed: 02/03/2023]
Abstract
Hallux valgus is a common condition, and it still poses some challenges. The identification of factors associated with the development of the deformity is of paramount importance in obtaining a full correction of the disorder. Hallux pronation is one of the frequently found components, especially in larger deformities, but the cause and exact location of this condition are not fully understood. The aim of the present study was to investigate whether there is a rotational deformity inherent to the first metatarsal bone. A case-control study was conducted on patients with and without hallux valgus who were subjected to computed tomography with multiplanar reconstruction. Statistical analysis was performed by means of a mixed model adjusted for foot and gender to compare metatarsal rotation between cases and controls. Correlations between numerical quantitative measurements were investigated by means of Pearson's correlation coefficient obtained in a linear mixed model. A total of 82 feet (tests) were analyzed in the hallux valgus group and 64 feet (tests) in the control group (N = 146). The hallux valgus group was significantly different from the control group (p< .001). Mean metatarsal bone rotation was 15.36° (range 1.65° to 32.52°) in the hallux valgus group and 3.45° (range -7.40° to 15.56°) in the control group. The difference between the means was 11.9° (confidence interval 9.2° to 14.6°). In conclusion, patients with hallux valgus exhibited increased exclusive bone rotation of the first metatarsal toward pronation compared with the population without this condition.
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Affiliation(s)
- Eduardo Pedrini Cruz
- Orthopedist, Traumatologist, and Foot and Ankle Orthopaedic Surgeon, Department of Orthopaedics, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Felipe Victora Wagner
- Musculoskeletal Radiologist, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carlo Henning
- Foot and Ankle Orthopedic Surgeon, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - José Antônio Veiga Sanhudo
- Foot and Ankle Orthopaedic Surgeon, Department of Orthopaedics, Hospital Mãe de Deus, Department of Orthopaedics and Trauma, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernando Pagnussato
- Staff Member, Research Group in the Hip, Biomaterials and Tissue Bank, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carlos Roberto Galia
- Adjunct Professor and Post-Graduate Program of Surgical Sciences, Medicine School, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Hip Orthopaedic Surgeon, Department of Orthopaedics, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Chief, Research Group in the Hip, Biomaterials and Tissue Bank, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Eken F, Özcan Ç, Kurtulmus T, Sağlam N. Scarf osteotomisi ileri seviye halluks valguslarda Turan ve Distal chevron osteotomileri kadar etkili midir ? ACTA MEDICA ALANYA 2019. [DOI: 10.30565/medalanya.486477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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van der Woude P, Keizer SB, Wever-Korevaar M, Thomassen BJW. Intra- and Interobserver Agreement in Hallux Valgus Angle Measurements on Weightbearing and Non-Weightbearing Radiographs. J Foot Ankle Surg 2019; 58:706-712. [PMID: 31256898 DOI: 10.1053/j.jfas.2018.11.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Indexed: 02/03/2023]
Abstract
The choice of treatment of hallux valgus deformity is influenced by angles measured on radiographs. Angles of interest are the hallux valgus angle (HVA), 1,2-intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA), as well as the presence of first metatarsophalangeal joint (MTPJ) subluxation. Guidelines for measuring those angles have been distributed by American Orthopaedic Foot and Ankle Society (AOFAS), although the influence of weightbearing on these angles and its clinical relevance is not clear. We conducted a study to determine the influence of weightbearing and the inter- and intraobserver agreement in the measurement. A total of 104 patients were enrolled in this study. Both weightbearing and non-weightbearing radiographs were obtained. In 2 rounds, 2 orthopedic surgeons and 2 musculoskeletal radiologists measured the angles in blinded digital radiographs according to AOFAS guidelines. Agreement on measurement of HVA, IMA, and DMAA in both weightbearing and non-weightbearing radiographs, as well as the presence of MTPJ subluxation, was calculated using the linear-weighted kappa coefficient and the intraclass correlation coefficient (ICC). Examiner agreement strength was defined according to the guidelines of Landis and Koch. HVA decreases significantly with weightbearing, whereas IMA significantly increases. The change in magnitude was 1° to 2° on average. No significant influence on DMAA could be noted. Interobserver agreement was excellent in both weightbearing and non-weightbearing radiographs for HVA (ICC 0.99 and ICC 0.99, respectively), IMA (ICC 0.98 and ICC 0.86, respectively), and DMAA (ICC 0.95 and ICC 0.97, respectively). The agreement on presence of subluxation was moderate to good (Fleiss kappa 0.50 to 0.63). Weightbearing alters forefoot geometry significantly. Adhering to AOFAS guidelines yields excellent interobserver agreement on HVA, IMA, and DMAA. First MTPJ subluxation presence is not an alternative for DMAA. The magnitude of change in IMA and HVA is small and therefore not clinically important. Both weightbearing and non-weightbearing radiographs can be used for determination of the correct treatment of hallux valgus deformity.
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Affiliation(s)
- Pieter van der Woude
- Orthopedic Surgeon, Department of Orthopaedic Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands; Orthopedic Surgeon, Department of Orthopaedic Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Stefan B Keizer
- Orthopedic Surgeon, Department of Orthopaedic Surgery, Haaglanden Medical Center, The Hague, The Netherlands.
| | - Martine Wever-Korevaar
- Radiologist, Department of Radiology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Bregje J W Thomassen
- Research Scientist, Department of Orthopaedic Surgery, Haaglanden Medical Center, The Hague, The Netherlands
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Minokawa S, Yoshimura I, Kanazawa K, Hagio T, Yamamoto T. Effect of minimally invasive distal first metatarsal osteotomy on blood flow of the metatarsal head. J Orthop Sci 2019; 24:693-696. [PMID: 30583939 DOI: 10.1016/j.jos.2018.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 06/15/2018] [Accepted: 11/18/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Distal first metatarsal osteotomy is an option for operative treatment of mild to severe hallux valgus (HV) deformities. Minimally invasive distal linear metatarsal osteotomy (DLMO) provides good outcomes without avascular necrosis (AVN) of the metatarsal head. However, no reports have described the in vivo blood flow changes in the metatarsal head after osteotomy. This study was performed to evaluate the in vivo blood flow of the pre- and post-osteotomy metatarsal head in patients with HV using laser Doppler flowmetry and thus clarify the effect of minimally invasive distal first metatarsal osteotomy on the change in blood flow. METHODS From April 2015 to October 2016, DLMO was performed on 13 feet with HV in 10 patients (2 men, 8 women). Blood flow measurements of the pre- and post-osteotomy first metatarsal head in all feet were performed by laser Doppler flowmetry. AVN was evaluated using plain radiographs at the final postoperative follow-up. RESULTS The median pre- and post-osteotomy blood flow was 1.5 (0.97-1.95) and 1.46 (0.98-1.77) ml/min/100 g, respectively (median change in blood flow, 0.00; 95% CI, -0.23-0.13; P = 0.72). The rate of change in the blood flow was 0.0% (95% CI, -11.9%-8.7%; range, -28.6%-64.7%), and only three patients (23.1%) showed a decrease of ≥10%. The median pre- and post-osteotomy systolic blood pressure was 90 (84.5-97) and 93 (84.5-95) mmHg, respectively (median change in blood pressure, 0.00; 95% CI, -3.0-2.0; P = 0.82). The rate of change in the systolic blood pressure was 0.0% (95% CI, -3.1%-2.2%; range, -9.1%-24.0%). No radiographic evidence of AVN was present at the final follow-up. CONCLUSIONS No significant difference was found in the rate of change in blood flow pre- and post-osteotomy, suggesting that minimally invasive distal first metatarsal osteotomy does not influence blood flow of the metatarsal head.
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Affiliation(s)
- So Minokawa
- Department of Orthopaedic Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Ichiro Yoshimura
- Department of Orthopaedic Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Kazuki Kanazawa
- Department of Orthopaedic Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Tomonobu Hagio
- Department of Orthopaedic Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
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Ray JJ, Friedmann AJ, Hanselman AE, Vaida J, Dayton PD, Hatch DJ, Smith B, Santrock RD. Hallux Valgus. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419838500. [PMID: 35097321 PMCID: PMC8696753 DOI: 10.1177/2473011419838500] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Hallux valgus is a common condition that results from a complex positional deformity of the first ray. The bunion or medial prominence that results from the lateral deviation and pronation of the hallux is only one component of the 3-dimensional deformity. Hallux valgus can lead to considerable pain and altered joint mechanics. The precise biomechanical etiology remains under debate. Predisposing factors include female sex, age, constricting footwear, and family history. Metatarsus adductus, equinus contracture, hammertoe deformity, and pes planus often coexist with hallux valgus. Nonoperative treatment involves patient education, shoe modifications, toe pads and positioning devices, and activity modifications. Surgery is considered in patients who fail nonoperative treatment with the goal of pain relief, correction of the deformity, improved first ray stability, and improved quality of life. More than 100 different procedures have been described to treat hallux valgus; they include combinations of soft tissue balancing, metatarsal osteotomies, and fusion of either the metatarsophalangeal (MTP) or tarsometatarsal (TMT) joint. The choice of procedures depends on the severity and location of the deformity as well as surgeon preference. Recent advances in operative techniques include minimally invasive surgery and correction of rotational deformity.
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Affiliation(s)
- Justin J. Ray
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | | | | | - Justin Vaida
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - Paul D. Dayton
- College of Podiatric Medicine and Surgery, Des Moines University, UnityPoint Clinic, Trinity Regional Medical Center, Des Moines, IA, USA
| | - Daniel J. Hatch
- Department of Podiatric Medicine and Surgery, North Colorado PMS Residency, Greeley, CO, USA
| | - Bret Smith
- Orthopedics, University of South Carolina, Palmetto Health-USC Orthopedic Center, Lexington, SC, USA
| | - Robert D. Santrock
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
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Almalki T, Alatassi R, Alajlan A, Alghamdi K, Abdulaal A. Assessment of the efficacy of SERI osteotomy for hallux valgus correction. J Orthop Surg Res 2019; 14:28. [PMID: 30678713 PMCID: PMC6345025 DOI: 10.1186/s13018-019-1067-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND SERI (Simple, Effective, Rapid, and Inexpensive) osteotomy is an accepted minimally invasive distal first metatarsal osteotomy performed to correct hallux valgus (HV). In the absence of reports of efficacy of the SERI technique in the Middle East, we studied 1-year outcomes of SERI osteotomy performed at our hospital in Saudi Arabia. METHODS We reviewed the medical charts of patients aged 20 to 60 years who underwent SERI osteotomy for HV between August 2013 and September 2016 and identified 29 patients, 2 (6.9%) men and 27 (93.1%) women, who met the criteria for inclusion in the study. Patients' clinical and operative characteristics were examined, their pre- and postoperative (1-year) radiographic measurements were compared, and the occurrence of any postoperative complication/event was noted. RESULT Patients' mean age was 34.9 ± 13.6 years. Six patients (20.7%) were treated for severe HV. Mean operation time was 11.1 ± 2.3 min. Four patients (13.8%) reported postoperative pain. No revision surgery was done. Congruency of the hallux metatarsophalangeal joint increased significantly, documented in only 4 patients (13.8%) preoperatively but in 17 (58.6%) at 1 year. The mean hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were significantly decreased at 1 year. The HVA normalized in 20 patients (69.0%), the IMA normalized in 25 patients (86.2%), but the DMAA normalized in only 4 patients (13.8%). The number of patients with sesamoid subluxation decreased from 29 (100%) to 13 (44.8%). CONCLUSION Our study data indicate that SERI osteotomy reliably reduces a wide spectrum of HV deformities and it is a safe procedure with very minimal complications. TRIAL REGISTRATION This study is registered in ClinicalTrials.gov under the following reference number: NCT03669900 .
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Affiliation(s)
- Talal Almalki
- Department of Orthopedic Surgery, Security Forces Hospital, P.O. Box: 3643, Riyadh, 11481, Saudi Arabia
| | - Raheef Alatassi
- Department of Orthopedic Surgery, Security Forces Hospital, P.O. Box: 3643, Riyadh, 11481, Saudi Arabia.
| | - Ahmad Alajlan
- Department of Orthopedic Surgery, Security Forces Hospital, P.O. Box: 3643, Riyadh, 11481, Saudi Arabia
| | - Khalid Alghamdi
- Department of Orthopedic Surgery, Security Forces Hospital, P.O. Box: 3643, Riyadh, 11481, Saudi Arabia
| | - Abdullah Abdulaal
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences,, Riyadh, Saudi Arabia
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Guo J, Wang L, Mao R, Chang C, Wen J, Fan Y. Biomechanical evaluation of the first ray in pre-/post-operative hallux valgus: A comparative study. Clin Biomech (Bristol, Avon) 2018; 60:1-8. [PMID: 30292061 DOI: 10.1016/j.clinbiomech.2018.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/18/2018] [Accepted: 06/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Deformity of the first ray in hallux valgus patient has been deemed to mainly contribute to instability of the metatarsophalangeal joint. However, it is not clear whether the fixation of the distal osteotomy fragment and transposition of the sesamoid represent the best method for hallux valgus treatment. The aim of this study was to examine how postoperative hallux valgus osteotomy affects the stability of the first ray. METHODS To accurately investigate the biomechanical behavior of the first ray in pre-/postoperative hallux valgus patients, we described the relative displacement and stress distribution of the first metatarsal bone and sesamoid by imageology, test measurement and foot finite element model. FINDINGS Compared with the preoperative hallux valgus, the plantar pressure decreased by 47.8% and was redistributed on second metatarsal region. The peak stress and relative displacement of the distal osteotomy fragment increased by +55.7% and -59.9%, respectively. The movement of this component shifted toward the positive sagittal axis direction. In addition, the relative displacement of sesamoid decreased by 87.4% (0.18 mm) in vertical axis direction and the stress was also redistributed on medial and lateral region. Moreover, the strain of the medial main ligament was more favorable to reconstruct function of the first ray. INTERPRETATION The findings showed that the osteotomy method was helpful for stability of the first ray. This would provide the stability suggestions for postoperative hallux valgus fixation and guide further rehabilitation.
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Affiliation(s)
- Junchao Guo
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, 100176 Beijing, PR China
| | - Lizhen Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100191 Beijing, PR China
| | - Rui Mao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100191 Beijing, PR China
| | - Cheng Chang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, PR China
| | - Jianmin Wen
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, PR China.
| | - Yubo Fan
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, 100176 Beijing, PR China; Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100191 Beijing, PR China.
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