The effect of hallux valgus on the anatomy of the nerves around the first metatarsal bone

OBJECTIVE

To identify the variations in the location of the nerves that may be at risk in hallux valgus (HV) surgery, and to reveal whether these nerves are affected by the anatomical changes associated with HV.

METHOD

In the formalin fixed, 46 lower extremities (19 female, 27 male) (9 normal, 14 mild HV, 21 moderate/severe HV), extensor hallucis longus tendon (EHL), deep plantar artery, medial dorsal cutaneous (MDCN), deep fibular (DFN), common plantar digital (CPDN) and proper plantar digital (PPDN) nerves were examined. The branches of MDCN extending to the medial side of foot were recorded in three segments. The positional topography of nerves according to EHL were analyzed on 360° circle and clock models.

RESULTS

Sex-related differences observed in some parameters in direct measurements were not found in the clock model comparisons. In advanced HV angles (> 20°), DFN was closer to EHL in the distal part of the metatarsal bone, while there was no difference in the proximal. The intersection of the medial branch of the MDCN with the EHL was more proximal in HV cases than in normal feet. The location of the nerves in the clock pattern did not change in HV. Of the nerve branches reaching the medial side of the foot, 65.2% were in Part I, 71.7% in Part II, and 4.3% in Part III.

CONCLUSION

Sex differences in the distance of the nerves to the EHL disappeared when the size effect of the cross-section of the first metatarsal bone region was eliminated with the clock model. Only in advanced HVA (>20°) (not in mild HV), the DFN being closer to the EHL distally and the intersection of the medial branch of the MDCN with the EHL in HV being more proximal than in normal can be interpreted as specific reflections of HV progress. The variations we revealed in the number of branches reaching the inside of the foot may explain the diversity of neuromas or nerve injuries associated with HV surgery.

Comparison of abductor hallucis muscle activity in subjects with mild hallux valgus during three different foot exercises

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.

Hyperglycemia with hypogonadism and growth hormone deficiency in a 17-year-old male with H syndrome: the first case report from Syria

BACKGROUND

The nucleoside transport capabilities of the human equilibrative nucleoside transporter-3 (hENT3) are disrupted by mutations in SLC29A3 (10q22.2), which are genes for the nucleoside transporter and are the cause of the unusual autosomal recessive disease known as H syndrome. As a result, histiocytic cells invade a number of organs.

CASE PRESENTATION

A 17-year-old Syrian male was admitted to the internal medicine department with a one-month history of polyuria, polydipsia, general weakness, and pallor. He had a history of progressive bilateral sensorineural hearing loss and failure to gain weight for three years. Physical examination revealed various abnormalities, including scrotal mass, small penis and testicles, absence of pubic and axillary hair, joint abnormalities, short stature, hallux valgus, fibrous protrusion near the navel, and hyperpigmented non-itchy painful skin plaques. Clinical signs along with laboratory test results confirmed hyperglycemia, primary hypogonadism, osteopenia, and growth hormone deficiency. After a review of the relevant medical literature, this patient's presentation of hyperglycemia with hypogonadism, hyperpigmentation, hallux valgus, hearing loss, hematological abnormalities, and short stature suggested the diagnosis of H syndrome. The patient received treatment with insulin and testosterone, leading to a significant improvement in his presenting symptoms.

CONCLUSIONS

H syndrome is a very rare condition, and the fact that the first case has only recently been reported in Syria serves to emphasize how rare it is. H Syndrome should be suspected if a patient has short stature with signs of hyperglycemia and other endocrine and cutaneous abnormalities. We are reporting this case to increase physicians' awareness of this exceedingly rare and unique syndrome.

Challenges in Diagnosing Fibrodysplasia Ossificans Progressiva: A Case Report

CASE

A 5-year-old boy presented with multiple bony swellings in the dorsal spine region, restricted left shoulder movement, and a previous misdiagnosis of hereditary multiple exostoses (HMEs) resulting in unnecessary excision of the right scapular lesion. Clinical examination revealed hallux valgus, brachydactyly, and limited neck movement. Radiography and computed tomography confirmed a diagnosis of fibrodysplasia ossificans progressiva (FOP).

CONCLUSION

This case report underscores the importance of accurate diagnosis and differentiation between FOP and HME. Hallux valgus, brachydactyly, and restricted neck movement suggested FOP. It is paramount for orthopaedic surgeons to exclude rare disorders before performing any interventions. Biopsies or resections of bone formation areas should be avoided for patients with FOP.

Biokinetic Evaluation of Hallux Valgus during Gait: A Systematic Review

BACKGROUND

Foot pathologies can affect the kinetic chain during gait, leading to altered loading at other joints that can lead to subsequent pathologies. Although hallux valgus is the most common foot disease, little has been discussed about the biokinetic effects of hallux valgus on the foot and lower limb. This systematic review evaluated the kinematic, kinetic, and pedobarographic changes of the hallux valgus foot compared to a healthy one.

METHODS

Several electronic databases were searched up to January 2022, including only cross-sectional studies with clearly defined isolated hallux valgus diseases and healthy groups. Two investigators independently rated studies for methodological quality using the NIH Study Quality Assessment Tool for cross-sectional studies. Kinetic data were extracted, including temporal data, kinematics of the foot joint, kinematics of the proximal lower limb, and pedobarography. We did meta-analyses tests with a random effects model using the metafor package in R.

RESULTS

Hallux valgus patients walk slower compared to a disease-free control group -0.16 m/s (95% CI -0.27, -0.05). Hallux valgus patients exhibited significantly reduced coronal plane motion of the hindfoot-shank during preswing 1.16 degrees (95% CI 0.31, 2.00). Hallux valgus patients generated less force in the hallux region 33.48 N (95% CI 8.62, 58.35) but similar peak pressures in the hallux compared to controls. Hallux valgus patients generated less peak pressure at the medial and lateral hindfoot as compared to controls: 8.28 kPa (95% CI 2.92, 13.64) and 8.54 kPa (95% CI 3.55, 13.52), respectively.

CONCLUSION

Although hallux valgus is a deformity of the forefoot, the kinematic changes due to the pathology are associated with significant changes in the range of motion at other joints, underscoring its importance in the kinetic chain. This is demonstrated again with the changes of peak pressure. Nevertheless, more high-quality studies are still needed to develop a fuller understanding of this pathology.

Identifying Long-Term Trajectories of Foot Pain Severity and Potential Prognostic Factors: A Population-Based Cohort Study

OBJECTIVES

To identify distinct foot pain trajectories over 7 years and examine their associations with potential prognostic factors.

METHODS

Adults ages ≥50 years and registered with 4 general practices in North Staffordshire, UK were mailed a baseline health survey. Those reporting current or recent foot pain were invited to attend a research assessment clinic. Follow-up was by repeated postal surveys at 18, 36, 54, and 84 months. Distinct trajectories of foot pain were explored using latent class growth analysis (LCGA). Subsequently, identified trajectories were combined into most and least progressive groups, and covariate-adjusted associations with a range of prognostic factors were examined.

RESULTS

Of 560 adults with foot pain attending baseline research clinics, 425 (76%) provided data at baseline and 2 or more follow-up time points. LCGA for foot pain severity (0-10 numerical rating scale) identified a 4-trajectory model: "mild, improving" (37%); "moderate, improving" (33%); "moderate-severe, persistent" (24%); and "severe, persistent" (6%). Compared with individuals in more favorable (improving) pain trajectories, those in less favorable (persistent) pain trajectories were more likely to be obese, have routine/manual and intermediate occupations, have poorer physical and mental health, have catastrophizing beliefs, have greater foot-specific functional limitation, and have self-assessed hallux valgus at baseline.

CONCLUSIONS

Four distinct trajectories of foot pain were identified over a 7-year period, with one-third of individuals classified as having pain that is persistently moderate-severe and severe in intensity. The effect of intervening to target modifiable prognostic factors such as obesity and hallux valgus on long-term outcomes in people with foot pain requires investigation.

Contributions of age, gender, body mass index, and normalized arch height to hallux valgus: a decision tree approach

BACKGROUND

Hallux valgus (HV) is a common toe deformity with various contributory factors. The interactions between intrinsic risk factors of HV, such as arch height, sex, age, and body mass index (BMI) should be considered. The present study aimed to establish a predictive model for HV using intrinsic factors, such as sex, age, BMI, and arch height based on decision tree (DT) model.

METHODS

This is retrospective study. The study data were based on the fifth Size Korea survey, of the Korea Technology Standard Institute. Among 5,185 patients, 645 were excluded due to unsuitable age or missing data, and 4,540 (males = 2,236 and females = 2,304) were selected for inclusion in the study. Seven variables (i.e., sex, age, BMI, and four normalized arch height variables) were used to develop the prediction model for the presence of HV using a DT model.

RESULTS

The DT model correctly classified 68.79% (95% confidence interval [CI] = 67.25-70.29%) of the training data set (3,633 cases). The predicted presence of HV based on the DT was verified against the testing data set (907 cases) and showed an accuracy of 69.57% (95% CI = 66.46-72.55%).

CONCLUSIONS

The DT model predicted the presence of HV on the basis of sex, age, and normalized arch height. According to our model, women aged over 50 years and those with lower normalized arch height were at high risk of HV.

Comparison of hallux valgus deformed ballerinas and sedentary individuals in terms of balance parameters

BACKGROUND

We aimed to compare static and dynamic balance parameters and health quality parameters in ballerina and non-ballerina adolescents with hallux valgus deformity.

METHODS

Forty five volunteer female adolescent ballet students between the ages of 7 and 17, with hallux valgus were recruited. Group 1 = in the control group, 31 sedentary adolescents with hallux valgus were included. Group 2 = Romberg test and Flamingo test were used for static balance. The SEBT (Star Excursion Balance Test) was used to measure dynamic balance.

RESULTS

Age, sex, and body mass index (BMI) characteristics were similar between ballerina and control groups (P < .05). The Romberg test stands upright with closed eyes, with a significant difference 47.22 in group 1 and 38.13 in group 2. In contrast there was a significant difference between the two groups in the Romberg test single limb with eyes open and closed. For open eyes single limb test mean score was 55.06 in ballerinas and 44.2 in sedentary group, similarly single limb test with closed eyes mean score was 25.68 in group 1 and 18.67 in group 2.

CONCLUSION

In conclusion, the results of this study show that ballerinas have better single-limb and closed-eye balance than sedentary individuals with HV deformities.

Quantitative evaluation of the vertical mobility of the first tarsometatarsal joint during stance phase of gait

We determined how the in vivo mobility of the first tarsometatarsal (TMT) joint can be quantified during gait. Twenty-five healthy participants (12 females) with no history of foot disorders were included. Non-invasive ultrasound (US) with a three-dimensional motion analysis (MA) system was used to evaluate the kinematic characteristics of first TMT joint during stance phase of gait. US probe was positioned longitudinally above the first TMT joint and adjusted to its proximal dorsal prominence. Gait analysis was conducted by the MA system starting with the activation of B-mode US video at 80 frames per second and 60-mm depth for simultaneous capture. During stance phase, the first metatarsal was translated dorsally with respect to the medial cuneiform, returning to a neutral level at toe-off in all subjects. During middle stance phase, the medial cuneiform was stable in males but displaced in the plantar direction in females and was the primary contributor to the differences in sagittal mobility observed between groups. Quantitatively measuring sagittal mobility of the first TMT joint could be useful for the early detection of foot abnormalities. The dynamic characteristics of the medial cuneiform during gait in healthy females may be associated with a high prevalence of hallux valgus.

3rd generation MICA with the "K-wires-first technique" - a step-by-step instruction and preliminary results

BACKGROUND

Minimally-invasive techniques for hallux valgus correction are becoming increasingly popular. In the last decades, multiple techniques for minimally-invasive hallux valgus correction have been described. MICA (Minimally-invasive Chevron & Akin), representing the 3rd generation of minimally-invasive hallux valgus correction, combines the advantages of an extraarticular osteotomy, stable internal fixation, and high potential for correction. This report aims to provide a step-by-step instruction of the surgical technique with the "K-wires-first" MICA modification, illustrated by detailed imaging of both intraoperative fluoroscopy and clinical imaging as well as corresponding sawbone models for each step. Preliminary results including radiological outcome and complications of the first 50 cases will be discussed.

METHODS

Between May 2018 and May 2021, 50 consecutive MICAs in 47 patients were performed with the K-wires-first technique. There were 40 women and 7 men with an average of 57.4y (range 25-78). The mean preoperative IMA was 16.2° (range 11.0-21.5), the HVA 30.6° (range 21.8-42.1).

RESULTS

There was one intraoperative conversion to an open surgical bunion correction corresponding to a 2% conversion rate respectively (1/50). On 3 feet (2 patients), removal of the Chevron screws was performed after 7, 9, and 12 months due to prominent and disturbing screw heads at the level of the medial cortex, accounting for a revision rate of 6% (3/50). There were no other secondary revision surgeries. The IMA decreased after MICA by a mean of 10.8° from 16.2° to 5.4° and the HVA by a mean of 22.1° from 30.6° to 8.5°, demonstrating MICA's high potential for correction.

CONCLUSIONS

Compared to other MICA techniques, the K-wires-first modification helps to reduce hardware malpositioning and the risk of conversion to open surgery. Furthermore, our preliminary results demonstrate a high potential for correction even for severe hallux deformities.

TRIAL REGISTRATION

Retrospectively registered, swissethics BASEC-ID 2021-01537, July 16th, 2021 ( www.raps.swissethics.ch ).

Paul W. Lapidus: The Father of Foot and Ankle Surgery

Paul W. Lapidus' work has formed the foundation of modern foot and ankle surgery. Variations of his popularizedtechnique, the Lapidus procedure, remain in regular usetoday for the management and correction of hallux valgus.We revisit Dr. Lapidus' career and accomplishments withan emphasis on his importance to the expanding divisionof foot and ankle surgery at the Hospital for Joint Diseases.

The Combination of Modified Mitchell's Osteotomy and Shortening Oblique Osteotomy for Patients with Rheumatoid Arthritis: An Analysis of Changes in Plantar Pressure Distribution

The present study aims to evaluate changes in plantar pressure distribution after joint-preserving surgery for rheumatoid forefoot deformity. A retrospective study was performed on 26 feet of 23 patients with rheumatoid arthritis (RA) who underwent the following surgical combination: modified Mitchell's osteotomy (mMO) of the first metatarsal and shortening oblique osteotomy of the lateral four metatarsals. Plantar pressure distribution and clinical background parameters were evaluated preoperatively and one year postoperatively. A comparison of preoperative and postoperative values indicated a significant improvement in the visual analog scale, Japanese Society for Surgery of the Foot scale, and radiographic parameters, such as the hallux valgus angle. A significant increase in peak pressure was observed at the first metatarsophalangeal joint (MTPJ) (0.045 vs. 0.082 kg/cm²; p < 0.05) and a significant decrease at the second and third MTPJs (0.081 vs. 0.048 kg/cm²; p < 0.05, 0.097 vs. 0.054 kg/cm²; p < 0.05). While overloading at the lateral metatarsal heads following mMO has been reported in previous studies, no increase in peak pressure at the lateral MTPJs was observed in our study. The results of our study show that this surgical combination can be an effective and beneficial surgical combination for RA patients with mild to moderate joint deformity.

Quality Analysis of Hallux Valgus Videos on YouTube

BACKGROUND

The aim of this study was to evaluate the information quality of YouTube videos on hallux valgus.

METHODS

A YouTube search was performed using the phrase "hallux valgus" to determine the first 300 videos related to hallux valgus. A total of 54 videos met our inclusion criteria and were evaluated for information quality by using DISCERN, Journal of the American Medical Association (JAMA), and hallux valgus information assessment (HAVIA) scores. Number of views, time since the upload date, view rate, number of comments, number of likes, number of dislikes, and video power index values were calculated to determine video popularity. Information regarding video length (in seconds), video source, and video content was also noted. The relation between information quality and these factors were statistically evaluated.

RESULTS

The mean DISCERN score was 30.35 ± 11.56 (poor quality) (range, 14-64), the mean JAMA score was 2.28 ± 0.96 (range, 1-4), and the mean HAVIA score was 3.63 ± 2.42 (moderate quality) (range, 0.5-8.5). Although videos uploaded by physicians had higher mean DISCERN, JAMA, and HAVIA scores than videos uploaded by nonphysicians, the difference was not statistically significant. In addition, view rates and video power index values were higher for videos uploaded by health channels, but the difference did not reach statistical significance. A statistically significant positive correlation was found between video length and DISCERN (r = 0.294; P = .028), and HAVIA scores (r = 0.326; P = .015).

CONCLUSIONS

This study demonstrated that the quality of information available on YouTube videos about hallux valgus was low and insufficient. Videos containing accurate information from reliable sources are needed to educate patients on hallux valgus, especially with regard to less frequently mentioned topics such as postoperative complications and healing period.

[Inveterate dislocation of the first metatarsophalangeal joint]

Injuries in the metatarsophalangeal joint complex of the hallux are seen with greater frequency in athletes, their importance lies in the functional limitation it generates. Early diagnosis and treatment can reduce the sequelae, however, the recognition of chronic lesions and with it the implementation of adequate therapeutic management generate improvements in quality of life. This document records a case of inveterate dislocation of the metatarsophalangeal joint of the hallux of more than one year of evolution with involvement of the intersesamoid ligament which was corrected with arthrodesis achieving immediate satisfactory results, in the medium and long term with the subsequent functional recovery and total reduction of pain.

The Influence of Short-Term Kinesiology Taping on Foot Anthropometry and Pain in Patients Suffering from Hallux Valgus

Background and Objectives: Hallux valgus, one of the most common foot disorders, contributes to the formation of pain, changes foot proportions and hinders everyday functioning. In this study we wanted to verify if kinesiology taping improves hallux valgus and affects the position as well as reducing pain. Materials and Methods: Forty feet with hallux valgus were examined and the parameters were measured at three stages: before the kinesiology taping was applied, just after its application and after a month of use. Measurements were taken with a 3D scanner and a baropodometric platform. Results: When taping was applied, the hallux valgus angle decreased statistically significantly compared with pre-taping (p < 0.01). The use of taping for a month significantly reduced this angle compared with pre-taping (p < 0.05). Parameters such as foot length, the surface of the hindfoot and forefoot and hindfoot pressure on the ground changed. A change in the hallux position due to the taping produced significant changes in the perception of pain (p < 0.001). Conclusion: Kinesiology taping acts on the hallux valgus and foot position mechanically. This makes kinesiology taping an effective method of conservative treatment for patients who are not qualified for surgery.

Longitudinal Epiphyseal Bracket as an Overlooked Etiology of Congenital-Residual Hallux Varus: A Case Report

Longitudinal epiphyseal bracket is a rare ossification disorder of the short tubular bones. The affected bone becomes deformed as a result of the bracket. The normal growth pattern cannot occur, and when it affects the first metatarsal bone, hallux varus may develop with the abnormal growth pattern. We present such a 6-year-old patient who had undergone surgery at 6 months of age for hallux varus and polydactyly. The deformity had worsened gradually after the initial operation because of the overlooked longitudinal epiphyseal bracket. The patient was treated with surgical excision of the epiphyseal bracket, with corrective medial open wedge osteotomy and split transfer of the extensor hallucis longus tendon. The result was excellent at the 20-month follow-up. At an early age, patients who present with hallux varus must be checked for the epiphyseal bracket, which can be invisible on radiographs because of the chondral structure. Untreated or overlooked patients with epiphyseal bracket will need revision operations for recurrent deformities.

Lateral Collateral Ligament Repair for Hallux Metatarsophalangeal Joint Instability in a Collegiate Sumo Wrestler: A Case Report

Although sprains of the hallux metatarsophalangeal (MTP) joint ligaments occur in barefooted martial arts athletes, few studies discuss the surgical treatments for lateral collateral ligament damage. We report herein a case of lateral collateral ligament repair for chronic hallux MTP joint instability. A 21-year-old male collegiate sumo wrestler injured his left hallux by snagging it on a sumo straw bale at 14 years of age. After entering university (4 years after the injury), he could no longer put weight on his foot at the left hallux; his athletic performance deteriorated, and he was referred to our department by his doctor. He had instability in the MTP joint of the left hallux, and magnetic resonance imaging revealed a tear in the attachment of the lateral collateral ligament to the metatarsal bone. Conservative treatment, such as taping, did not improve the symptoms; thus, surgery was performed, which consisted of passing a strong suture attached to the capsular ligament through a burr hole made in the metatarsal bone and fixing it to the burr-hole wall using an anchor. Postoperatively, the patient's joint instability improved, and he returned to competitive wrestling 4 months after surgery. He was able to put weight on his left hallux, and his athletic performance improved. The follow-up period after surgery was 2 years. In competitive sumo wrestling, hallux weakness and joint instability lead to a significant reduction in performance. Thus, ligament repair is an effective treatment for hallux MTP joint instability that cannot be treated by conservative means.

From Turnip to Onion: Humanities, Curiosities, and Anecdotes of Hallux Valgus

BACKGROUND

We sought to highlight the humanistic aspect of hallux valgus.

METHODS

We conducted a bibliographic search between 2013 and 2017 of scientific, historic, and humanistic articles, in search of the anthropological dimension of hallux valgus. Museums and works of art by relevant painters were analzyed for the presence of hallux valgus.

RESULTS

We showcase the linguistic origin of the terms related to hallux valgus, the evolution of its incidence depending on the footwear and social habits throughout history, the presence of hallux valgus in the work of great painters, and some other curiosities of this pathology.

CONCLUSIONS

The knowledge of the humanistic aspect of pathologies we treat, if not imperative for its proper surgical resolution, can help to improve the understanding of them.

Hallux valgus severity, great toe pain, and plantar pressures during gait: A cross-sectional study of community-dwelling adults

BACKGROUND

Hallux valgus (HV) is a common disabling condition affecting 36% of adults aged 65 years and over. Identifying whether the severity of the deformity alters weight-bearing patterns during walking may assist clinicians optimize offloading interventions. Therefore, we examined how plantar pressure distributions during walking are affected by HV severity.

METHODS

Plantar pressures and maximum forces in ten regions of the foot were obtained from 120 participants (40 men, 80 women) aged ≥50 years using a pressure platform (RSscan® International, Olen, Belgium). HV severity was documented using a validated line-drawing instrument with participants separated into four groups: none (n = 30), mild (n = 30), moderate (n = 30) and severe (n = 30). Pressure and force values were compared across HV severity, stratified by the presence or absence of great toe pain.

RESULTS

Participants with severe HV were more likely to have great toe pain. More severe HV was associated with significant reductions in peak pressure and maximum force under the hallux but not at other sites of the foot. This association appeared strongest in those reporting great toe pain.

CONCLUSIONS

Greater HV severity is associated with great toe pain and reduced loading under the hallux when walking. These observed changes in plantar pressure and maximum force may reflect a pain avoidance mechanism.

The Adolescent Bunion

The management of bunion deformities in adolescent patients is often a source of consternation for orthopaedic surgeons. Reports of recurrence and surgical failure along with a multitude of procedures to choose from create a wariness to manage the problem surgically. The biggest challenge in managing this problem is a lack of understanding by orthopaedic surgeons that adolescent bunions and adult bunions frequently arise from two distinct etiologies. The main difference between the two is that unlike adult bunion deformities, the hallux metatarsophalangeal joint in the adolescent bunion is congruent as the deformity is caused by a dysplasia of the metatarsal head. This dysplasia results in a valgus orientation of the first metatarsal articular surface (ie, elevated DMAA [distal metatarsal articular angle]). The recognition of this difference has implications for the evaluation and treatment of these deformities in adolescents.

[Hallux metatarsophalangeal arthrodesis: retrospective comparison between blocked plate and cannulated screws]

INTRODUCTION

There are multiple methods and implants used for the metatarsophalangeal arthrodesis of hallux without evidence in favor of one or the other in the bibliography. The goal was to compare the clinical and radiological results of 2 methods and implants used in our center.

MATERIAL AND METHODS

Retrospective review of 37 feet between 2013 and 2017 (22 feet by plate and 15 by cannulated screws). Clinical and radiological variables were collected and the AOFAS and Manchester-Oxford scales were applied. Variables were studied descriptively and analytically through the SPSSv15 program.

RESULTS

The group intervened by plate was composed of 77% of women, with an average age of 65 years and a distribution by diagnosis of severe hallux valgus (HV) (36%), hallux valgus relapse (HVR) (36%) and hallux rigidus (HR) (28%), compared to 80% of women, 68 years old and HV (34%), HVR (46%) HR (20%) in the group of cannulated screws. No significant differences were found in the correction of angles for HV or HVR. The rate of painful pseudoarthrosis was 13% in both and the re-intervention was 18% in the plate group and 26% in the screw group. Both the AOFAS and M-O scales were better in the plate group 63.8 vs 52.6 (p = 0.07); 30.1 vs 41.0 (p = 0.10); as well as patient satisfaction 86% vs 66% (p 0.05) and postoperative pain 3.68 vs 5.58 (p 0.05).

CONCLUSION

Small study groups, not implant randomization, both options are functional without being able to find a preferred one.

[Evaluation of radiographic results in geriatric population with moderate to severe degree hallux valgus intervened with surgical technique of Lelièvre and Vidalot]

BACKGROUND

Hallux valgus (HV) defines a valgo deviation from the metatarsophalangeal joint and in a varo of the first metatarsal. The surgery aims to restore joint congruence, correct deformity and decrease pain. There is little literature on the results in the geriatric population. The purpose of this study is intended to demonstrate that the open surgical technique of Lelièvre and Vidalot achieves acceptable radiographic results in that population.

MATERIAL AND METHODS

68 patients between 60 and 85 years of age were involved with Lelièvre Technique and Vidalot for moderate to severe HV of Isham, between January 2014 and January 2017. Immediate postoperative and six month radiographs were evaluated with conventional radiometry for this condition; All measurements were made in digital system. The data was entered in Microsoft Excel. p values 0.05 were considered statistically significant.

RESULTS

Out of 68 patients (54 women and 14 men), average age 68.0 years. 12 had bilateral concern. 28 second finger claw. The metatarsphasopalangic angle with a preoperative mean was 36.6o, increased by 100% of cases of intermetatarsal angle 1-2, with a correlation p 0.05 between intermetatarsal angle and metatarsal angle increase. Immediate and six-month post-surgical results with a correlation of p = 0.3107.

CONCLUSIONS

The treatment of moderate to severe HV in our geriatric population under technique Lelièvre and Vidalot achieves an acceptable correction demonstrated radiographically in the immediate postoperative period and at six month, this translates a viable option of surgical treatment in these population.

Revision of the Failed Bunion Surgery

Complications and failures of corrective surgery for hallux valgus are not infrequent, and their reported rates vary widely. This is at least partly because of the variety of surgical techniques performed as well as a lack of consensus regarding what constitutes a successful outcome. Some of the most commonly encountered reasons for failure include recurrence, hallux varus, nonunion, and malunion. These problems present a challenging scenario for both the patient and surgeon. A comprehensive understanding of these complications and a nuanced, critical analysis of each case is paramount to effective management of failed surgery for hallux valgus. There are several strategies for both minimizing complications in surgery for hallux valgus and salvaging a successful outcome through revision surgery.

[Second Köhler disease]

Les auteurs rapportent 17 cas de la deuxième maladie de Köhler. Il s'agit de jeunes femmes (13 cas), qui ont consulté pour des douleurs métatarso-phalangiennes unilatérales de type mécanique. La maladie touche la deuxième tête métatarsienne dans 14 cas. Le diagnostic est posé grâce à la radiologie: le stade III est retrouvé dans 11 cas. Nous avons opté pour l'intervention de Gauthier: Ostéotomie de dorsiflexion de la tête métatarsienne par résection cunéiforme à base dorsale de la zone nécrotique. Les suites opératoires sont bonnes et l’évolution est favorable pour nos patients, avec un recul moyen de 3 ans.

Hyperphalangism, facial anomalies, hallux valgus, and bronchomalacia: a new syndrome?

We report on a boy with hyperphalangism, partial syndactyly, facial anomalies, and diffuse bronchomalacia, born to a nonconsanguineous French-Canadian couple. To our knowledge, this is a hitherto undescribed syndrome.

Common foot problems. Relieving the pain of bunions, keratoses, corns, and calluses

Many of the painful foot problems seen in adults are easily treated. Bunions and bunionettes often respond to a change to wide, soft-toed shoes or sandals and the temporary use of a mild anti-inflammatory agent. Initial treatment of plantar keratoses is trimming and use of cushioning shoe inserts. Diffuse keratoses may require reconstructive surgery if metatarsal deformity is the cause. Seed corns and soft corns respond to trimming, and alleviation of pressure with padding and wearing of open-toed shoes is beneficial in these lesions as well as in hard corns. Surgical resection of any underlying exostosis may be required for hard or soft corns or "pump bumps," which are caused by pressure from the shoe's heel. In all cases, patients should be advised to change to shoes that provide plenty of room in the toe box and that minimize friction on painful areas.

The painful foot

The inventive physician may find ways of making releasing cuts or openings with existing shoes to alleviate points of pressure. Many patients will suffer misery of pressure in shoes without giving a thought to cutting them, or opening them to allow for more freedom of movement. Releasing cuts may be made along seams, or between sole and upper with leather inserts to increase shoe size at points of major need for improved fit. Soft shoes may be resorted to. Elasticized material or sandals are preferable to the hard, resistant leather which aggravates so many lesions in our offices. Shoes custom made for disordered feet are very expensive. They may have to be ordered for some feet deformed beyond the capacity for ordinary shoes. Again, unless foot care is convenient and helpful in offsetting pain, the patient will usually not comply. Careful explanation of objectives for present and future is as important here as in any condition treated by family practitioners.

Association of Wolff-Parkinson-White syndrome with congenital abnormalities of hands and feet

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