A retrospective study of 63 hallux valgus corrections using the osteodesis procedure

The Syndesmosis Procedure Correction of Hallux Valgus Feet Associated With the Metatarsus Adductus Deformity

Metatarsus adductus and hallux valgus are common foot deformities. Corrective surgery of hallux valgus feet with metatarsus adductus deformity can be challenging and experience a high deformity recurrence rate. The purpose of this study was to demonstrate if the syndesmosis procedure can correct such feet satisfactorily without osteotomies and arthrodesis. 75 hallux valgus feet in 45 patients with a Sgarlato's metatarsal adductus angle ≥15° were studied after having undergone the syndesmosis procedure for an average of 20.22 months. Their average preoperative intermetatarsal angle of 12.56° was improved to 6.00° (p < .001) and metatarsophalangeal angle from 35.61° to 23.46° (p < .001) significantly. Their average American Orthopedic Foot and Ankle Society's clinical scores improved significantly from 56.41 to 90.53 points (p < .001). Fifty-five feet (73.33%) had preoperative metatarsal calluses, and all but 3 had a noticeable reduction in severity. Forty-one patients (91.11%) were able to return to their desired activities and footwear. All relevant raw data formed this study, including x-ray and photographic images, were submitted as Supplementary Material for online viewing and reference. Despite the possible intrinsic rigidity of metatarsus adductus forefoot, this study demonstrated that hallux valgus feet with metatarsus adductus deformity could be corrected anatomically and functionally with the soft tissue syndesmosis procedure and without correcting the preexisting metatarsus adductus deformity. This study also supports the notion that the MA deformity accentuates hallux valgus alignment preoperatively and postoperatively, and possibly all feet in general.

Radiological Evaluation of a Preoperative First Metatarsal Realignment Test for Metatarsus Primus Varus and Hallux Valgus Correction by the Syndesmosis Procedure

BACKGROUND

Metatarsus primus varus correction is one of the primary surgical objectives for hallux valgus correction. Some soft tissue procedures have shown that the first metatarsal can be adequately realigned without osteotomy. The hypothesis of this study was that this correctability should also be demonstrable preoperatively. The purpose of this study was to assess whether a simple forefoot taping technique could do so and whether it could also be correlated with operative results after the syndesmosis procedure.

METHODS

Between May 2014 and December 2015, 147 feet with hallux valgus from 85 patients with an average age of 46.2 years underwent the syndesmosis procedure. All were followed prospectively with standing radiographic assessment of their first intermetatarsal angle, metatarsophalangeal angle, and medial sesamoid position preoperatively without and with a forefoot wrapping technique and postoperatively at 10 days, 6 months, and 1 year.

RESULTS

Their average preoperative intermetatarsal angle was reduced from 14.4 to 8.4 degrees by the wrapping technique, and their average metatarsophalangeal angle was spontaneously reduced from 31.8 to 21.8 degrees. After a minimum 1-year follow-up, they stabilized at 7.4 and 18.6 degrees, respectively. There was significant correlation between hallux valgus and metatarsus primus varus corrections by both forefoot wrapping and surgical methods with Spearman's rank correlation of metatarsophalangeal angle and intermetatarsal angle corrections (r = 0.6077, P < .0001 due to the wrapping method; r = 0.7157, P < .0001 due to the syndesmosis procedure). All raw working radiographic images for this study can be viewed in the Supplemental Material section.

CONCLUSION

This study found that a simple forefoot tape-wrapping technique could be used preoperatively to verify first metatarsal mobility for metatarsus primus varus correction by the soft tissue syndesmosis procedure without osteotomies.

LEVEL OF EVIDENCE

Level II, prospective comparative study.

Radiographic Outcomes of a Percutaneous, Reproducible Distal Metatarsal Osteotomy for Mild and Moderate Bunions: A Multicenter Study

Hallux valgus is a prevalent condition. Many open surgical methods of correction have been described. We performed a percutaneous, extra-articular distal metatarsal osteotomy for mild to moderate bunion deformity. The minimally invasive technique was used in 217 feet (180 patients; age 49 ± 4.7 years, mean ± standard deviation) at 4 centers in North America (Center 1: November 2012 to March 2017; Center 2: January 2010 to May 2016; Center 3: October 2013 to June 2016; Center 4: January 2015 to June 2017). The procedure was used in simultaneous bilateral cases in 28 patients (15.6%) and in nonsimultaneous bilateral cases in 9 patients (5.0%). Immediate postoperative weightbearing was used in all cases. The mean preoperative intermetatarsal angle, hallux abductus angle, and tibial sesamoid position were 14.6° ± 3.5°, 30.7° ± 7.8°, and 5.4 ± 1.4, respectively. At final follow-up of 9.3 ± 6.1 months, the mean intermetatarsal angle, hallux abductus angle, and tibial sesamoid position were 4.7° ± 2.8°, 8.4° ± 6.1°, and 2.0 ± 1.0, respectively (p < .0001 for all comparisons). No major complications were noted. All 217 osteotomies achieved union; 3 feet (1.4%) in 3 patients (1.7%) experienced asymptomatic malunion. Superficial pin-site infection was seen in 42 (19.4%) of the 217 feet (39 patients, 21.7%). The radiographic results of this percutaneous technique appear to be reproducible across multiple centers, and the technique is useful when correcting intermetatarsal and hallux abductus angles. This percutaneous osteotomy for realignment of the first ray allows immediate postoperative weightbearing and, in this initial review, appears to be safe and effective, even in simultaneous bilateral cases.

Can the Syndesmosis Procedure Prevent Metatarsus Primus Varus and Hallux Valgus Deformity Recurrence? A 5-Year Prospective Study

One of the main objectives of hallux valgus surgery is correction of the metatarsus primus varus deformity by osteotomy, arthrodesis, or soft tissue correction. The syndesmosis procedure uses intermetatarsal cerclage sutures to realign the first metatarsal and also induces a syndesmotic bonding between the first and second metatarsals to prevent metatarsus primus varus deformity recurrence. The purpose of the present study was to demonstrate radiologic evidence of the effectiveness of the syndesmosis concept and to identify the incidence and nature of deformity recurrence. A total of 55 feet from 60 consecutive procedures were followed regularly at 6 fixed points for 5 years. The radiologic inclusion criterion was a first intermetatarsal angle >9° or metatarsophalangeal angle >20°. The initial postoperative radiographs showed significant correction of the intermetatarsal angle from a preoperative average of 14.5° to 4.3° (p < .0001). It had increased to 7.0° during the first 6 postoperative months but remained within the normal upper limit of 9° and exhibited no further significant changes for the subsequent 4.5 years (p = .0792). Hallux valgus deformity correction also correlated with metatarsus primus varus deformity correction. Three (5%) second metatarsal stress fractures occurred, and all recovered uneventfully. In conclusion, we have report the findings from a detailed medium long-term follow-up study showing, to the best of our knowledge, for the first time that metatarsus primus varus and hallux valgus deformities can be effectively corrected and maintained using a specific surgical technique. Also included are 6 relevant radiographs and photographs of the included and excluded feet in the online Supplementary Material for reference.

Use of 3D Printed Bone Plate in Novel Technique to Surgically Correct Hallux Valgus Deformities

Three-dimensional (3-D) printing offers many potential advantages in designing and manufacturing plating systems for foot and ankle procedures that involve small, geometrically complex bony anatomy. Here, we describe the design and clinical use of a Ti-6Al-4V ELI bone plate (FastForward™ Bone Tether Plate, MedShape, Inc., Atlanta, GA) manufactured through 3-D printing processes. The plate protects the second metatarsal when tethering suture tape between the first and second metatarsals and is a part of a new procedure that corrects hallux valgus (bunion) deformities without relying on doing an osteotomy or fusion procedure. The surgical technique and two clinical cases describing the use of this procedure with the 3-D printed bone plate are presented within.

Salvaging of a failed Lapidus procedure by the soft tissue osteodesis procedure: A six-year follow-up case report

Soft tissue approach to hallux valgus deformity correction has not been popular due to concerns of its effectiveness. Osteodesis procedure is a soft tissue technique that has been reported with favorable results, especially its long term deformity recurrence rate was very low. Recurrence complication after Lapidus procedure has seldom been reported and its remedial surgery not much discussed yet. Soft tissue approach has never been recommended or reported for salvaging failed hallux valgus surgery. This case report is a failed Lapidus procedure due to symptomatic recurrence of deformity that was successfully salvaged by osteodesis procedure and followed up for six years to ensure no late symptoms and deformity recurrence.