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Boden AL, DiGiovanni GM, Masry SE, Ellis SJ, Johnson AH, Conti MS. Comparison of Minimally Invasive Chevron Akin and Open Lapidus Surgery in Older Patients at a Minimum 1-Year Follow-Up. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241266843. [PMID: 39091403 PMCID: PMC11292705 DOI: 10.1177/24730114241266843] [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: 08/04/2024] Open
Abstract
Background Hallux valgus deformity affects more than 35% of people aged ≥65 years. Surgical correction in this population can be more complicated because of poor bone quality, worse deformity, and postoperative recovery challenges. The purpose of this study was to compare the radiographic and clinical outcomes of patients aged ≥65 years who underwent either open Lapidus or minimally invasive chevron Akin osteotomy for bunion correction. Methods A retrospective review identified 62 patients aged ≥65 years who were treated surgically for hallux valgus with at least 1-year postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores (physical function and pain interference). Preoperative and at least 6-month postoperative radiographs were measured for the hallux valgus angle and intermetatarsal angle. PROMIS scores were obtained preoperatively and at 1 and/or 2 years postoperatively. Differences in demographic, clinical, and radiographic outcomes were assessed using the Mann Whitney U test and P values were adjusted for a false discovery rate of 5%. Results There was no difference between the MIS and open cohorts in pre- or postoperative radiographic measurements or clinical outcomes at any time point. At 1 year postoperatively, both groups had statistically significant improvements in the PROMIS pain interference domain but only the MIS group had a statistically significant improvement in the PROMIS physical function domain. Clinical significance was equivocal. At 2 years postoperatively, there were clinically and statistically significant improvements in the PROMIS pain interference and physical function domains for the open and MIS groups. Conclusion Patients in both surgical groups had improvement in radiographic measurements and 2-year PROMIS scores, although there was no clinical or statistical difference found between groups. MIS and open surgical techniques appear to be safe and effective in correcting hallux valgus in older patients; however, patients may need to be counseled that maximum improvement after surgery may take more than 1 year. Level of Evidence Level III, retrospective cohort study.
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Hsu WK, Tie THA, Hsu WL, Chen YY. Minimally Invasive Chevron Akin (MICA) Osteotomy Corrects Radiographic Parameters but Not Central Metatarsal Loading in Moderate to Severe Hallux Valgus without Metatarsalgia. Life (Basel) 2024; 14:734. [PMID: 38929717 PMCID: PMC11204634 DOI: 10.3390/life14060734] [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: 05/10/2024] [Revised: 05/30/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Central metatarsal pressure is increased in patients with hallux valgus, but the pedographic outcomes after hallux valgus (HV) correction are inconclusive. No known literature has reported the pedographic outcomes after HV correction with Minimally Invasive Chevron and Akin Osteotomy (MICA). METHODS A prospective cohort of 31 feet from 25 patients with moderate-to-severe symptomatic HV but without metatarsalgia underwent MICA and was evaluated using radiographic parameters and pedographic measurements (Footscan®, RSscan International, Olen, Belgium). Data were collected preoperatively and 3 months after surgery. RESULTS The radiographic parameters of the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, first metatarsal head lateral shape, and lateral sesamoid grade significantly improved after MICA. The corrected first metatarsal length was significantly shortened by 2.3 mm, with consistent second metatarsal protrusion distance, lateral Meary's angle, and calcaneal pitch angle. Max force, max pressure, cumulative force, and cumulative pressure on the central metatarsals did not show significant changes between pre- and post-operative measurements, while these parameters significantly decreased in the hallux and first metatarsal area. CONCLUSION MICA effectively corrects radiographic parameters but does not reduce central metatarsal loading in patients with moderate-to-severe HV without metatarsalgia.
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Affiliation(s)
- Wei-Kuo Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; (W.-K.H.); (T.-H.A.T.)
| | - Tung-Hee Albert Tie
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; (W.-K.H.); (T.-H.A.T.)
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Yan-Yu Chen
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Department of Orthopaedic Surgery, Show Chwan Memorial Hospital, Changhua 500, Taiwan
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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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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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Söderpalm AC, Montgomery F, Helander KN, Cöster MC. Hallux valgus; An observational study on patient characteristics, surgical treatment and pre-operative HRQoL from the Swedish foot and ankle register (Swefoot). Foot (Edinb) 2023; 57:102060. [PMID: 37922633 DOI: 10.1016/j.foot.2023.102060] [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: 05/24/2023] [Revised: 10/21/2023] [Accepted: 10/29/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Hallux valgus (HV) is a common condition with impact on pain, function and HrQoL. International consensus does not exist on operative treatment of HV and population-level data regarding surgical treatment of HV is lacking. In this study we aimed to present base-line data from surgically treated HV patients reported to the Swedish register for foot and ankle surgery (Swefoot) during the period 2014-2021. MATERIAL AND METHODS In total, 7543 feet in 6770 patients were analyzed regarding patient characteristics, grading of HV, surgical procedures and pre-operative PROMs Euroqol-5 Dimension-3 L (EQ-5D-3 L) and Self-reported Foot and Ankle Score (SEFAS). RESULTS Median age was 55 years (range 15-91) and 87% were women. The surgeon classified 63% of the cases as moderate HV, 15% as mild and 22% as severe. The Chevron osteotomy was the preferred surgical method and was used in 74% of all cases. Out of these, 58% were fixated with a screw. The Offset-V osteotomy was the most performed shaft osteotomy. Proximal osteotomies and lateral releases were less common. The pre-operative mean EQ-5D-3 L index and SEFAS summary score were low and HV patients with overweight and rheumatoid arthritis had significantly lower scores. CONCLUSION This is the first report from Swefoot describing surgeon- and patient reported pre-operative data in patients with surgical treated HV.
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Affiliation(s)
- Ann-Charlott Söderpalm
- Capio Orthocenter, Gothenburg, Sweden; Department of Orthopedics and Clinical Sciences in Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.
| | - Fredrik Montgomery
- Department of Orthopedics and Clinical Sciences in Malmö, Lund University, Sweden
| | - Katarina Nilsson Helander
- Department of Orthopedics and Clinical Sciences in Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Maria C Cöster
- Department of Orthopedics and Clinical Sciences in Malmö, Lund University, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Capio Movement, Halmstad, Sweden
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Palmanovich E, Ohana N, Tavdi A, Atzmon R, Feldman V, Brin YS, Nyska M, Segal D. A modified minimally invasive osteotomy for hallux valgus enables reduction of malpositioned sesamoid bones. Arch Orthop Trauma Surg 2023; 143:6105-6112. [PMID: 37202550 DOI: 10.1007/s00402-023-04868-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 03/26/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND The current minimally invasive distal metatarsal osteotomy for hallux valgus (HV) is V-shaped, which prevents the correction of the rotational metatarsal head deformity and reduction of the sesamoid bones. We sought to determine the optimal method for sesamoid bone reduction during HV surgery. METHODS We reviewed the medical records of 53 patients who underwent HV surgery between 2017 and 2019 using one of three techniques: open chevron osteotomy (n = 19), minimally invasive V-shaped osteotomy (n = 18), and a modified straight minimally invasive osteotomy (n = 16). The sesamoid position was graded using the Hardy and Clapham method on weight-bearing radiographs. RESULTS When compared to open chevron and V-shaped osteotomies, the modified osteotomy resulted in significantly lower postoperative sesamoid position scores (3.74 ± 1.48, 4.61 ± 1.09, and 1.44 ± 0.81, respectively, P < 0.001). Furthermore, the mean change in postoperative sesamoid position score was greater (P < 0.001). CONCLUSION The modified minimally invasive osteotomy was superior to the other two techniques in correcting HV deformity in all planes, including sesamoid reduction.
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Affiliation(s)
- Ezequiel Palmanovich
- Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 56 Tchernichovsky St., 4428164, Kfar Saba, Israel.
| | - Nissim Ohana
- Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 56 Tchernichovsky St., 4428164, Kfar Saba, Israel
| | - Alex Tavdi
- Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 56 Tchernichovsky St., 4428164, Kfar Saba, Israel
| | - Ran Atzmon
- Assuta Medical Center, Department of Orthopaedic Surgery, Affiliated with the Faculty of Health and Science and Ben Gurion University, 7747629, Ashdod, Israel
| | - Viktor Feldman
- Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 56 Tchernichovsky St., 4428164, Kfar Saba, Israel
| | - Yaron S Brin
- Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 56 Tchernichovsky St., 4428164, Kfar Saba, Israel
| | - Meir Nyska
- Orthopaedic Surgery Specialist, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Segal
- Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 56 Tchernichovsky St., 4428164, Kfar Saba, Israel
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7
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Rougereau G, Sandiford MH, Lévêque R, Ménigaux C, Bauer T, Hardy A. Management of Anxiety for Ambulatory Hallux Valgus Surgery With a Virtual Reality Hypnosis Mask: Randomized Controlled Trial. Foot Ankle Int 2023; 44:539-544. [PMID: 37118916 DOI: 10.1177/10711007231162816] [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: 04/30/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the impact of using virtual reality masks for the management of preoperative anxiety and its impact on postoperative and predischarge anxiety as well as postoperative analgesia during outpatient hallux valgus surgery. METHODS From June 2020 to September 2021, preoperative anxiety of patients scheduled for a percutaneous hallux valgus surgery were analyzed using the State Trait Anxiety Inventory (STAI) questionnaire completed during the consultation. All patients with major anxiety, defined as a STAI score above 40, were included in a randomized prospective comparative single-center study. Sixty patients were included in the study and randomized into 2 arms of 30 patients according to whether or not they underwent a preoperative hypnosis session with a virtual reality mask before surgery. RESULTS There was an improvement in the postoperative (42.5 vs 45.2, P < .04) and predischarge (25.3 vs 30.2 P < .03) anxiety scores in the group that used the mask before the procedure. There was a notable decrease in immediate higher-level postoperative analgesics such as morphine or ketamine (3.3% vs 26.6%, P < .03) in the arm using the mask. CONCLUSION In this study cohort undergoing percutaneous hallux valgus surgery, we found that use of a virtual reality hypnosis mask before surgery modestly reduced postoperative and predischarge anxiety as well as early postoperative consumption of higher-level analgesics in adults with significant preoperative anxiety. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Grégoire Rougereau
- Department of Orthopedic Surgery, Hospital Ambroise Paré, UVSQ University, Boulogne-Billancourt, France
- Department of Orthopedic Surgery, Hospital Pitié Salpêtrière, Sorbonne University, Paris, France
| | - Marie Hélène Sandiford
- Department of Orthopedic Surgery, Hospital Ambroise Paré, UVSQ University, Boulogne-Billancourt, France
| | - Robin Lévêque
- Department of Orthopedic Surgery, Hospital Ambroise Paré, UVSQ University, Boulogne-Billancourt, France
| | - Christophe Ménigaux
- Department of Orthopedic Surgery, Hospital Ambroise Paré, UVSQ University, Boulogne-Billancourt, France
| | - Thomas Bauer
- Department of Orthopedic Surgery, Hospital Ambroise Paré, UVSQ University, Boulogne-Billancourt, France
| | - Alexandre Hardy
- Department of Orthopedic Surgery, Clinique du Sport, Paris, France
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Kim SH, Kim YH, Cha JY, Lee YK. Correlations of Sesamoid Bone Subluxation with the Radiologic Measures of Hallux Valgus and Its Clinical Implications. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050876. [PMID: 37241108 DOI: 10.3390/medicina59050876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Hallux valgus is one of the most common chronic foot complaints, with prevalences of over 23% in adults and up to 35.7% in older adults. However, the prevalence is only 3.5% in adolescents. The pathological causes and pathophysiology of hallux valgus are well-known in various studies and reports. A change in the position of the sesamoid bone under the metatarsal bone of the first toe is known to be the cause of the initial pathophysiology. Purpose: The relationships between the changes in the location of the sesamoid bone and each radiologically measured angle and joint congruency in the hallux valgus remain as yet unknown. Therefore, this study investigated the relationships of sesamoid bone subluxation with the hallux valgus angle, intermetatarsal angle, and metatarsophalangeal joint congruency in hallux valgus patients. The goal is to know the hallux valgus angle, the intermetatarsal angle, and metatarsophalangeal joint congruency's correlation with hallux valgus severity and prognosis by revealing the relationship between each measured value and sesamoid bone subluxation. Materials and Methods: We reviewed 205 hallux valgus patients who underwent radiographic evaluation and subsequent hallux valgus correction surgery in our orthopedic clinic between March 2015 and February 2020. Sesamoid subluxation was assessed using a new five-grade scale on foot radiographs, and other radiologic measurements were assessed, such as hallux valgus angle, the intermetatarsal angle, distal metatarsal articular angle, joint congruency, etc. Conclusions: Measurements of the hallux valgus angle, interphalangeal angle, and joint congruency exhibited high interobserver and intraobserver reliabilities in this study. They also showed correlations with sesamoid subluxation grade.
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Affiliation(s)
- Sung Hwan Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Gyeonggi-do, Republic of Korea
| | - Young Hwan Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Gyeonggi-do, Republic of Korea
| | - Joo Young Cha
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Gyeonggi-do, Republic of Korea
| | - Young Koo Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Gyeonggi-do, Republic of Korea
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Drago S, Nazaroff H, Britton J, Veljkovic A. Assessment and Management of Atraumatic First Metatarsophalangeal Joint Pain. J Am Acad Orthop Surg 2023:00124635-990000000-00679. [PMID: 37126849 DOI: 10.5435/jaaos-d-22-00821] [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: 09/03/2022] [Accepted: 03/11/2023] [Indexed: 05/03/2023] Open
Abstract
Nontraumatic pain in the first metatarsophalangeal joint is frequent and can be debilitating. The metatarsophalangeal joint complex comprises four articulating surfaces including the first metatarsal, the proximal phalanx, and tibial and fibular sesamoids, which are all contained within a synovial capsule. The most common causes of pain are hallux valgus and hallux rigidus. However, other diagnoses, such as functional hallux limitus, sesamoiditis, gout, and inflammatory autoimmune arthritis, need to be considered as well. A systematic approach is key to accurately diagnose the source of pain, which can sometimes be the result of more than one condition. The most important clinical information to obtain is a focused history, meticulous clinical examination based on understanding the precise anatomy and biomechanics of the first metatarsophalangeal joint, and analysis of the relevant imaging. Each pathology has a different treatment algorithm, as such, understanding the pathoanatomy and biomechanics is important in forming an effective treatment plan.
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Affiliation(s)
- Sebastián Drago
- From the Universidad de los Andes, facultad de medicina, Santiago, Chile (Drago), Department of Orthopedic Surgery, Hospital Félix Bulnes, Santiago, Chile (Drago), Faculty of Medicine, University of British Columbia, Kelowna, BC (Nazaroff, Britton, and Veljkovic), Footbridge clinic, Vancouver, BC (Veljkovic)
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10
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Attia AK, Heier KA. First Metatarsophalangeal Arthrodesis for the Failed Hallux. Foot Ankle Clin 2022; 27:723-744. [PMID: 36368794 DOI: 10.1016/j.fcl.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hallux metatarsophalangeal joint (MTPJ) arthrodesis was first described in 1894 by Clutton, who recommended ankylosing the MTPJ to treat painful hallux valgus (HV). He used ivory pegs to stabilize the MTP joint. Surgeons over the last century have modified the procedure and added indications, including hallux rigidus, rheumatoid arthritis, and revision of failed surgeries. This article addresses many common yet challenging clinical scenarios, and a few hot topics, related to hallux MTPJ arthrodesis, including matarsus primus elevatus, severe hallux valgus, avascular necrosis, and infections. The article provides a condensed evidence-based discussion on how to manage these challenges using MTPJ arthrodesis.
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Affiliation(s)
- Ahmed Khalil Attia
- Orthopedic Surgery and Rehabilitation Department, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
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11
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Ledermann G, Baduell A, Testa E, Vega R, Ruiz P, Barrientos M, Poggio D. Short- and long-term results for severe hallux valgus correction using a first metatarsal distal osteotomy. Foot Ankle Surg 2022; 28:1458-1462. [PMID: 36055900 DOI: 10.1016/j.fas.2022.08.009] [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: 04/19/2022] [Revised: 07/29/2022] [Accepted: 08/17/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study is to analyze the short- and long-term results of severe hallux valgus (HV) treated with a L-Reverse osteotomy. METHODS Patients treated with L-Reverse osteotomy for severe HV between the years 2006-2015 were included. Patients were evaluated preoperatively, at 3 months and 4 or more years postoperatively. Changes in the HV angle (HVA) and intermetatarsal angle (IMA) were measured. Clinical outcomes were assessed using the AOFAS score. RESULTS 28 patients were included. Pre-operative IMA changed from 18.1° (18-18.9°) to 7° (6.3-8.5°), and HVA from 38.5° (34.5-41.3°) to 10.0° (8.4-11.8°) at 3 month follow up (p < 0.005). Long term follow up was of 5.6 (4.9-6.4) years. IMA value was 7.5° (6.1°-8.1°) and HVA was 10.1° (6.7°-16.3°), with no statistical difference with initial correction (p = 0.14). Median AOFAS score was 92.7 (89-4-96.1). CONCLUSION L-Reverse osteotomy can achieve correction of HV severe deformities with good outcomes in long term follow up. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Albert Baduell
- Department of Orthopedic Surgery, Hospital Clinic, Barcelona, Spain.
| | - Enrique Testa
- Department of Orthopedic Surgery, Hospital Clinic, Barcelona, Spain.
| | - Ricardo Vega
- Department of Orthopedic Surgery, Hospital Clinic, Barcelona, Spain.
| | - Pablo Ruiz
- Hospital de la Florida, Santiago, Chile.
| | | | - Daniel Poggio
- Department of Orthopedic Surgery, Hospital Clinic, Barcelona, Spain.
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Xie W, Lu H, Zhan S, Li G, Yuan Y, Xu H. A Better Treatment for Moderate to Severe Hallux Valgus: Scarf + Akin Osteotomy Combined with Lateral Soft Tissue Release in a Single Medial Incision. Orthop Surg 2022; 14:2633-2640. [PMID: 36102216 PMCID: PMC9531105 DOI: 10.1111/os.13479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Traditional lateral soft tissue release (LSTR) was conducted by an additional dorsal first web incision, as the malformed thick scar and neuritis were common after surgery. A new method of lateral soft tissue release in a single medial incision via dorsal flap over the first metatarsal (LSTR‐SMI‐DFFM) should be recommended. The objective is to investigate the clinical effectiveness and safety of scarf + Akin osteotomy (SAO) combined with lateral soft tissue release in a single medial incision via dorsal flap over the first metatarsal (LSTR‐SMI‐DFFM) for moderate to severe hallux valgus. Methods Patients who were performed surgery for hallux valgus from April 2014 to June 2020 were retrospectively reviewed. The visual analog scale (VAS) was recorded before surgery and during follow‐up, as well as the forefoot score of the American Orthopaedic Foot and Ankle Society (AOFAS). Patient satisfaction was evaluated at the follow‐up time. The preoperative and follow‐up weightbearing X‐ray were conducted in all patients. The radiological parameters of hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were measured. Tibial sesamoid position (TSP) was also recorded according to seven‐part grading system. The quantitative data were performed as mean ± standard deviation or median ± interquartile range. Student's t test was performed in HVA, IMA, and DMAA. The TSP, VAS, and AOFAS were statistical analyzed by Mann–Whitney U test. p value of <0.05 was considered significant. Results There were 123 feet conducted surgery in 96 patients. The AOFAS score improved a lot which was preoperative 39 to 100 at the follow‐up time and VAS was 4 to 0 (p < 0.001). A total of 63 (51.2%) patients were very satisfied, 47 (38.2%) were satisfied, five (4.1%) were undecided and eight (6.5%) were not satisfied. The HVA, IMA, DMAA, and TSP were all decreased after surgery and were statistically significant (p < 0.001). Conclusion The SAO combined with a LSTR‐SMI‐DFFM for moderate to severe hallux valgus is effective and safe with pretty good clinical and radiographic results, as well as minimal complications. The corrections of AOFAS and VAS conformed to the minimum clinically important difference (MCID).
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Affiliation(s)
- Wenyong Xie
- Department of Orthopaedics and Trauma Peking University People's Hospital Beijing China
- Beijing Jishuitan Hospital Beijing China
| | - Hao Lu
- Department of Orthopaedics and Trauma Peking University People's Hospital Beijing China
| | - Sizheng Zhan
- Department of Orthopaedics and Trauma Peking University People's Hospital Beijing China
| | - Guicheng Li
- Department of Orthopaedics and Trauma Peking University People's Hospital Beijing China
| | - Yusong Yuan
- Department of Orthopaedics and Trauma Peking University People's Hospital Beijing China
| | - Hailin Xu
- Department of Orthopaedics and Trauma Peking University People's Hospital Beijing China
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Li T, Wang Y, Qu Y, Dong R, Kang M, Zhao J. Feasibility study of hallux valgus measurement with a deep convolutional neural network based on landmark detection. Skeletal Radiol 2022; 51:1235-1247. [PMID: 34748073 DOI: 10.1007/s00256-021-03939-w] [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: 05/15/2021] [Revised: 10/03/2021] [Accepted: 10/08/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop a deep learning algorithm based on automatic detection of landmarks that can be used to automatically calculate forefoot imaging parameters from radiographs and test its performance. MATERIALS AND METHODS A total of 1023 weight-bearing dorsoplantar (DP) radiographs were included. A total of 776 radiographs were used for training and verification of the model, and 247 radiographs were used for testing the performance of the model. The radiologists manually marked 18 landmarks on each image. By training our model to automatically label these landmarks, 4 imaging parameters commonly used for the diagnosis of hallux valgus could be measured, including the first-second intermetatarsal angle (IMA), hallux valgus angle (HVA), hallux interphalangeal angle (HIA), and distal metatarsal articular angle (DMAA). The reference standard was determined by the radiologists' measurements. The percentage of correct key points (PCK), intragroup correlation coefficient (ICC), Pearson correlation coefficient (r), root mean square error (RMSE), and mean absolute error (MAE) between the predicted value of the model and the reference standard were calculated. The Bland-Altman plot shows the mean difference and 95% LoA. RESULTS The PCK was 84-99% at the 3-mm threshold. The correlation between the observed and predicted values of the four angles was high (ICC: 0.89-0.96, r: 0.81-0.97, RMSE: 3.76-6.77, MAE: 3.22-5.52). However, there was a systematic error between the model predicted value and the reference standard (the mean difference ranged from - 3.00 to - 5.08°, and the standard deviation ranged from 2.25 to 4.47°). CONCLUSION Our model can accurately identify landmarks, but there is a certain amount of error in the angle measurement, which needs further improvement.
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Affiliation(s)
- Tong Li
- The Second Hospital of Jilin University, Jilin University, Changchun, 130000, China
| | - Yuzhao Wang
- College of Computer Science and Technology, Jilin University, Changchun, 130000, China
| | - Yang Qu
- The Second Hospital of Jilin University, Jilin University, Changchun, 130000, China
| | - Rongpeng Dong
- The Second Hospital of Jilin University, Jilin University, Changchun, 130000, China
| | - Mingyang Kang
- The Second Hospital of Jilin University, Jilin University, Changchun, 130000, China
| | - Jianwu Zhao
- The Second Hospital of Jilin University, Jilin University, Changchun, 130000, China.
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14
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Reddy SC, Schipper ON. A Double-Edged Sword: Direct-to-Consumer Advertising. Foot Ankle Int 2022; 43:872-873. [PMID: 35073768 DOI: 10.1177/10711007211069568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sudheer C Reddy
- Shady Grove Orthopaedics, Adventist HealthCare, Rockville, MD, USA
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Wagner E, Wagner P, Pacheco F, López M, Palma F, Guzmán-Venegas R, Berral-de la Rosa FJ. Biomechanical Cadaveric Evaluation of the Role of Medial Column Instability in Hallux Valgus Deformity. Foot Ankle Int 2022; 43:830-839. [PMID: 35369789 DOI: 10.1177/10711007221081461] [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: 02/01/2023]
Abstract
BACKGROUND Medial column instability is a frequent finding in patients with flatfeet and hallux valgus, within others. The etiology of hallux valgus is multifactorial, and medial ray axial rotation has been mentioned as having an individual role. Our objective was to design a novel cadaveric foot model where we could re-create through progressive medial column ligament damage some components of a hallux valgus deformity. METHODS Ten fresh-frozen lower leg specimens were used, and fluorescent markers were attached in a multisegment foot model. Constant axial load and cyclic tibial rotation (to simulate foot pronation) were applied, including pull on the flexor hallucis longus tendon (FHL). We first damaged the intercuneiform (C1-C2) ligaments, second the naviculocuneiform (NC) ligaments, and third the first tarsometatarsal ligaments, leaving the plantar ligaments unharmed. Bony axial and coronal alignment was measured after each ligament damage. Statistical analysis was performed. RESULTS A significant increase in pronation of multiple segments was observed after sectioning the NC ligaments. Damaging the tarsometatarsal ligament generated small supination and varus changes mainly in the medial ray. No significant change was observed in axial or frontal plane alignment after damaging the C1-C2 ligaments. The FHL pull exerted a small valgus change in segments of the first ray. DISCUSSION In this biomechanical cadaveric model, the naviculocuneiform joint was the most important one responsible for pronation of the medial column. Bone pronation occurs along the whole medial column, not isolated to a certain joint. Flexor hallucis longus pull appears to play some role in frontal plane alignment, but not in bone rotation. This model will be of great help to further study medial column instability as one of the factors influencing medial column pronation and its relevance in pathologies like hallux valgus. CLINICAL RELEVANCE This cadaveric model suggests a possible influence of medial column instability in first metatarsal pronation. With a thorough understanding of a condition's origin, better treatment strategies can be developed.
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Affiliation(s)
- Emilio Wagner
- Clínica Alemana - Universidad del Desarrollo, Santiago, Chile.,Department of Informatics and Sports, University Pablo de Olavide, Seville, Spain
| | - Pablo Wagner
- Clínica Alemana - Universidad del Desarrollo, Santiago, Chile.,Hospital Militar de Santiago - Universidad de los Andes, Santiago, Chile
| | | | - Mario López
- Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Felipe Palma
- Laboratorio LIBFE, Escuela de kinesiología, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | - Rodrigo Guzmán-Venegas
- Laboratorio LIBFE, Escuela de kinesiología, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
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Abstract
BACKGROUND In this study, our aim was to determine the effect of cosmetic improvement on patient satisfaction and functional scores in hallux valgus (HV) surgery. METHODS Preoperative foot photographs of 105 patients who had undergone chevron osteotomy for HV between 2016 and 2018 were taken. The patients were divided into 2 groups. Twenty-four months after surgery, the preoperative foot photographs were shown to patients in group 1 (n = 52) but not to patients in group 2 (n = 53). The groups were then compared using the visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP), and the 36-Item Short Form Health Survey (SF-36) scores. Both groups were evaluated radiologically with preoperative and postoperative hallux valgus angles and intermetatarsal angles. RESULTS There was no difference between the 2 groups in terms of radiologic parameters either pre- or postoperatively, or AOFAS Hallux MTP-IP scores postoperatively. However, for group 1, the VAS was lower (0.4±0.8 vs 1.8±1.6, P = .003) and both the SF-36 physical functioning (88.3±18.1 vs 79.1±23.2, P = .017) and SF-36 mental health scores were higher (78.8±19 vs 69.2±16.3, P = .022). CONCLUSION Visualizing improvement in the cosmetic appearance of the foot appears associated with patients' perception of subjective pain and functional improvement. We recommend that preoperative foot photographs be taken and recorded. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Hakan Bahar
- Orthopaedics & Traumatology Department, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey
| | - Kadir Ilker Yildiz
- Orthopaedics & Traumatology Department, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey
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17
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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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Matar HE, Platt SR. Overview of randomised controlled trials in hallux valgus surgery (2,184 patients). Foot Ankle Surg 2021; 27:351-356. [PMID: 32518028 DOI: 10.1016/j.fas.2020.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study is to provide an overview of randomised controlled trials (RCTs) in hallux valgus correction surgery summarising the available high-quality evidence. METHODS Following PRISMA guidelines, we searched the Cochrane Central Register of Controlled Trials, Ovid MEDLINE (1946 to 1 February 2020) and Embase (1980 to 1 February 2020). We excluded non-randomised trials, systematic reviews and case-series. We also excluded trials of MTPJ arthrodesis. Trials that met our inclusion criteria were assessed by two authors using a binary outcome measure of whether they reported statistically significant findings. These were then classified according to intervention groups. RESULTS 32 RCTs met the inclusion criteria and were included. The total number of patients in those trials was 2,184. Only 4 RCTs (12.5%) reported significant differences between the intervention and the control groups. The remaining trials evaluated scarf or chevron osteotomies in 18 RCTs, and 10 RCTs compared other osteotomies or technical aspects of hallux valgus surgery using functional and radiological outcome measures with none reporting significant differences. CONCLUSION Evidence from RCTs of hallux valgus surgery suggest that scarf and chevron osteotomies are the most popular techniques and lead to similar clinical outcomes.
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Affiliation(s)
- Hosam E Matar
- Arthroplasty & Adult Reconstruction Fellow, North West Health Education, Liverpool, UK.
| | - Simon R Platt
- Department of Orthopaedic Surgery, Gold Coast University Hospital, Hospital Blvd, Southport, Australia; Associate Professor, Griffth Univerity, QLD, Australia; Honorary Adjunct Associate Professor, Bond University, QLD, Australia.
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