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Hatch DJ, Dayton M, Dayton P. Sagittal Plane Alignment for First Metatarsal Phalangeal Arthrodesis Correlated with Postoperative Function: What is the Optimal Position? J Foot Ankle Surg 2024:S1067-2516(24)00095-4. [PMID: 38823766 DOI: 10.1053/j.jfas.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 05/03/2024] [Accepted: 05/11/2024] [Indexed: 06/03/2024]
Abstract
There have been many reports describing the proposed alignment of a first metatarsal phalangeal arthrodesis to obtain optimum function. Most of these recommendations are based upon historical and anecdotal evidence. Furthermore, there are few reports directly comparing alignment to patient reported function. We studied radiographic sagittal plane alignment in a group of 60 patients (80 feet) who had undergone a first metatarsal phalangeal joint arthrodesis (20 of the 60 had bilateral arthrodesis) to better understand how this component of the arthrodesis position translates to real world function. The patients in this study had completed a functional survey in 2022 at a mean of 28.4 (median 27.8; range 13.2-45.7) months with very high satisfaction for return to activities of daily living and recreational sports. We measured the sagittal plane position of the first metatarsal relative to the proximal phalanx in this cohort with known post operative activity data. We found that a mean (standard of deviation) sagittal plane angle (angle between the anatomic axis of the first metatarsal and the proximal phalanx) of 15.4 (SD 7.4) degrees and a proximal phalanx head to ground height of 12.7 (SD 3.3) mm was present in this group. Comparing the functional and positional results we conclude that this sagittal plane position provides a good recommendation for alignment.
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Giménez-López R, Barrios-Pitarque C. Cross-sectional study of the prevalence of hyperextension of the first metatarsophalangeal joint and its relationship to onycholysis in women with hallux valgus. BMC Musculoskelet Disord 2024; 25:111. [PMID: 38317173 PMCID: PMC10840269 DOI: 10.1186/s12891-024-07219-1] [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: 10/17/2023] [Accepted: 01/20/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Hallux Valgus (HV) deformity is associated with misalignment in the sagittal plane that affects the first toe. However, the repercussions of the first toe hyperextension in HV have been scarcely considered. The purpose of this study was to provide evidence of the association between first-toe hyperextension and the risk of first toenail onycholysis in HV. METHODS A total of 248 HV from 129 females were included. The extension of 1st MTP joint was measured while the patient was in the neutral position of the hallux using a two-branch goniometer. The classification of the HV severity stage was determined by the Manchester visual scale, and the height of the first toe in the standing position was measured using a digital meter. An interview and clinical examination were performed to collect information on the presence of onycholysis of the first toe. RESULTS Of the 248 HV studied, 100 (40.3%) had onycholysis. A neutral extension > 30 degrees was noted in 110 (44.3%) HV. The incidence of onycholysis was higher in HV type C than in type B (p = 0.044). The probability of suffering onycholysis in the right foot was 2.3 times greater when the neutral position was higher than 30 degrees (OR = 2.3; p = 0.004). However, this was not observed in the left foot (p = 0.171). Onycholysis was more frequent in HV with more than 2 cm height of the first toe (p < 0.001). For both feet, the probability of suffering onycholysis was greater for each unit increase in hallux height (right foot OR = 9.0402, p = 0.005; left foot OR = 7.6633, p = 0.010). CONCLUSIONS The incidence of onycholysis appears to be significantly associated with HV showing more than 30º extension, and more than 2 cm height of the first toe. Height and hyperextension of the first toe together with first toenail pathology should be mandatory in the evaluation of HV.
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Affiliation(s)
- Rosana Giménez-López
- School of Doctorate, Catholic University of Valencia "Saint Vincent Martyr", Plaza de San Agustín, 3 Esc. A, Entresuelo, 46001, Valencia, Spain.
| | - Carlos Barrios-Pitarque
- Institute for Research On Musculoskeletal Disorders, Catholic University of Valencia "Saint Vincent Martyr", Quevedo 2, 46001, Valencia, Spain
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Horita M, Nishida K, Nasu Y, Nakahara R, Saiga K, Hamada M, Ozaki T. Outcome after resection arthroplasty or shortening oblique osteotomy of the lesser metatarsals combined with arthrodesis of the first metatarsophalangeal joint for severe rheumatoid forefoot deformities. J Orthop Surg (Hong Kong) 2022; 30:10225536221117903. [PMID: 35938600 DOI: 10.1177/10225536221117903] [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] Open
Abstract
PURPOSE We investigated objective and patient-reported outcomes after resection arthroplasty or shortening oblique osteotomy (SOO) of the lesser metatarsals combined with arthrodesis of the first metatarsophalangeal (MTP) joint for severe rheumatoid forefoot deformities. METHODS 17 feet from 14 women (mean age, 67.8 years) underwent resection arthroplasty of the lesser metatarsal heads (MTH resection group), while 13 feet from nine women and two men (mean age, 68.7 years) underwent SOO of the lesser metatarsals (MTH preservation group). Arthrodesis of the first MTP joint was performed in all cases. Mean follow-up in the MTH resection and preservation groups was 25.0 and 21.3 months, respectively. Preoperative and postoperative clinical evaluation included Japanese Society for Surgery of the Foot (JSSF) scale and self-administered foot evaluation questionnaire (SAFE-Q) scores. RESULTS Mean total JSSF scale significantly improved from 53.4 to 76.4 in the MTH resection group (p < .001) and from 50.1 to 74.2 in the MTH preservation group (p = .002). Pain and pain-related and shoe-related SAFE-Q subscale scores significantly improved after surgery in both groups. In the MTH resection group, recurrence of painful callosities and claw toe deformity was observed in four and three feet, respectively. In the MTH preservation group, one patient experienced recurrence of painful callosities and one underwent revision surgery for IP joint dislocation. CONCLUSION Resection arthroplasty or SOO of the lesser metatarsals combined with arthrodesis of the first MTP joint achieved significant improvement with respect to pain relief, deformity correction, and footwear comfort.
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Affiliation(s)
- Masahiro Horita
- Department of Orthopaedic Surgery, 199491Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keiichiro Nishida
- Department of Orthopaedic Surgery, 199491Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshihisa Nasu
- Department of Orthopaedic Surgery, 92057Okayama University Hospital, Okayama, Japan
| | - Ryuichi Nakahara
- Department of Orthopaedic Surgery, 92057Okayama University Hospital, Okayama, Japan
| | - Kenta Saiga
- Department of Sports Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Masanori Hamada
- Department of Rehabilitation Medicine, 92057Okayama University Hospital, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, 199491Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Matsumoto T, Takeda R, Kasai T, Chang SH, Izawa N, Hirose J, Takuo J, Tanaka S. Clinical Outcomes After First Metatarsophalangeal Joint Arthrodesis by Flat Cut Joint Preparation With Individual Adjustment for Sagittal Alignment. J Foot Ankle Surg 2022; 61:60-66. [PMID: 34274242 DOI: 10.1053/j.jfas.2020.10.015] [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: 03/06/2020] [Revised: 10/03/2020] [Accepted: 10/11/2020] [Indexed: 02/03/2023]
Abstract
Sagittal misalignment is a major cause of patient dissatisfaction and re-operation after first metatarsophalangeal (MTP) joint arthrodesis. The stereotypical application of the fixed angle would be undesirable, especially in cases of flat or cavus foot. We retrospectively reviewed 31 cases (27 patients) in which first MTP joint arthrodesis was performed using the flat cut joint preparation technique with reference to the plantar clearance beneath the pulp of the toe while simulating weightbearing by pushing a board against the sole. The most common underlying cause of surgery was rheumatoid arthritis (22 cases [71%]). Clinical outcomes were evaluated by the Japanese of Surgery of the Foot (JSSF) hallux scale and the self-administered foot evaluation questionnaire (SAFE-Q). Twenty-three cases were also examined by pedobarography to evaluate postoperative walking plantar pressure. At the most recent follow-up of a mean 19.6 months, the toe-to-floor distance of the hallux in static standing posture was a mean of 2.5 mm (range, 0-10 mm). All but 1 foot (97%) achieved bone union. There were no complications or revisions due to misalignment of the fused MTP joint. JSSF hallux scales improved significantly from 47 preoperatively to 82 postoperatively. All subscale scores except general health and well-being in the SAFE-Q improved significantly at final follow-up versus preoperative period. Plantar pressure under the hallux was correlated with the toe-to-floor distance but not radiographic parameter. In conclusion, first MTP joint arthrodesis achieved good clinical outcomes when using toe-to-floor distance and Kirschner wire template for flat cut joint preparation.
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Affiliation(s)
- Takumi Matsumoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan; Department of Rheumatology, JCHO Yugawara Hospital, Kanagawa, Japan.
| | - Ryutaro Takeda
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taro Kasai
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Song Ho Chang
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naohiro Izawa
- Department of Rheumatology, JCHO Yugawara Hospital, Kanagawa, Japan
| | - Jun Hirose
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Juji Takuo
- Department of Rheumatology, JCHO Yugawara Hospital, Kanagawa, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Onodera T, Nakano H, Homan K, Kondo E, Iwasaki N. Preoperative radiographic and clinical factors associated with postoperative floating of the lesser toes after resection arthroplasty for rheumatoid forefoot deformity. BMC Musculoskelet Disord 2019; 20:87. [PMID: 30782150 PMCID: PMC6381651 DOI: 10.1186/s12891-019-2462-y] [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: 12/14/2017] [Accepted: 02/07/2019] [Indexed: 11/16/2022] Open
Abstract
Background This study aimed to clarify the characteristics associated with postoperative floating of the lesser toes, especially focusing on the medial and lateral lessor toes, after arthrodesis of the first metatarsophalangeal joint and resection arthroplasty of the lessor toes in rheumatoid forefoot deformity. Methods Fourty-seven feet of 43 people who underwent resection arthroplasty of the metatarsal head of the lesser toes for rheumatoid arthritis of the metatarsophalangeal joints were included. We retrospectively evaluated the preoperative radiographic findings and clinical characteristics of the patients, and the occurrence of postoperative floating of the lesser toes. The mean duration of follow-up was 36.5 (range 12 to 114) months. Results Preoperative dislocation grades of the second and third toes that demonstrated postoperative floating were significantly higher than those of toes that did not experience postoperative floating. The hallux valgus deformity before surgery was significantly more severe in toes with postoperative floating of the second and third lessor toes than those with no floating (p < 0.05). In addition, the Japanese Society for Surgery of the Foot (JSSF) hallux scale scores before surgery in toes with postoperative floating of the fourth and fifth lessor toes were significantly worse than those in non-dislocating toes (p < 0.05). Conclusions The preoperative condition of the first metatarsophalangeal joint, including hallux valgus deformity, pain, range of motion, activity of daily living, and function is significantly different between postoperative floating of the lesser toes and non-floating of them after resection arthroplasty for rheumatoid forefoot deformity.
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Affiliation(s)
- Tomohiro Onodera
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Hiroaki Nakano
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Kentaro Homan
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Eiji Kondo
- Department of Advanced Therapeutic Research for Sports Medicine, Hokkaido University School of Medicine, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
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Little JB. First metatarsophalangeal joint arthrodesis in the treatment of hallux valgus. Clin Podiatr Med Surg 2014; 31:281-9. [PMID: 24685193 DOI: 10.1016/j.cpm.2013.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
First metatarsophalangeal joint arthrodesis is a reliable procedure with predictable outcomes in the treatment of moderate-to-severe hallux valgus with degenerative changes of the joint. It offers better functional outcome compared to arthroplasty with or without prosthesis in appropriate patient populations. Recent studies have shown that with appropriate fixation, early weight bearing may be initiated without an increase in nonunion.
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Affiliation(s)
- J Braxton Little
- Private Practice, University Foot and Ankle Institute, 2121 Wilshire Boulevard, Santa Monica, CA 90403, USA.
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