1
|
Coillard JY, Rey R, Civinini A, Billuart F, Schmidt E, de Cesar Netto C, Sacco R, Lalevée M. Spontaneous Reduction in the Intermetatarsal Angle in Distal First Metatarsal Osteotomies with No Lateral Head Displacement in Hallux Valgus. Biomedicines 2024; 12:1438. [PMID: 39062011 PMCID: PMC11275205 DOI: 10.3390/biomedicines12071438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The outcomes of first metatarsal (M1) distal osteotomies in hallux valgus (HV) can be improved, especially for intermetatarsal angle (IMA) correction, which is mainly based on lateral displacement of the M1 head (i.e., translation) through the osteotomy. Conversely, there is a spontaneous reduction in the IMA in first metatarsophalangeal joint (MTP1) arthrodesis. But we do not know whether this can be applied to distal osteotomies. We propose a distal osteotomy, called 3D chevron, which combines supination and varization of the M1 head. This might realign soft tissues around the MTP1, potentially leading to a spontaneous reduction in the IMA by an analogous mechanism to MTP1 fusion. Therefore, our study aimed to assess whether spontaneous reductions in IMAs exist in distal M1 osteotomies in the absence of lateral translations of M1 heads. METHODS A prospective continuous series of 25 3D chevrons was performed. Two groups were formed during surgery. Patients requiring no M1 head lateral displacement were included in the "successful correction without translation" group, and patients requiring M1 head lateral displacement were included in the "failed correction without translation" group. Radiographic analysis was performed preoperatively and at 1 year postoperatively. RESULTS Twenty-two women and three men, with a mean age of 44.8 ± 14.2 years and a mean body mass index of 22.6 ± 4.1 kg/m2, underwent follow-up at one year after surgery. The "successful correction without translation" group was composed of HV with milder deformities (13/25 HVs, median preoperative IMA = 13 (IQR 2)) compared to the "failed correction without translation" group (median IMA = 16 (IQR 2.25) p < 0.001). Spontaneous reductions in IMAs were observed in the "successful correction without translation" group, with a median decrease in the IMA of 6 degrees (CI95%[5.5; 8.0]; p < 0.001) between preoperative and 1-year radiographs. CONCLUSION Distal osteotomies allow for spontaneous reduction in the IMA in HV. First metatarsal head translation through an osteotomy should not be considered as the only procedure to correct IMAs in distal osteotomies.
Collapse
Affiliation(s)
- Jean-Yves Coillard
- Clinique du Parc, Elsan Group, 155 Boulevard de Stalingrad, 69006 Lyon, France;
| | - Romain Rey
- Orthopedic and Trauma, Surgery Department, Rouen University Hospital, 37 Boulevard Gambetta, 76000 Rouen, France; (R.R.); (R.S.)
| | - Alessandro Civinini
- Orthopedic Unit, Department of Health Sciences, University of Florence, C.T.O. Largo Palagi 1, 50139 Firenze, Italy;
| | - Fabien Billuart
- Laboratoire d’Analyse du Mouvement, Institut de Formation en Masso-Kinésithérapie Saint Michel, 75015 Paris, France;
- ERPHAN Research Unit, UR 20201, University of Versailles Saint Quentin, 78000 Versailles, France
| | - Eli Schmidt
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA;
| | | | - Riccardo Sacco
- Orthopedic and Trauma, Surgery Department, Rouen University Hospital, 37 Boulevard Gambetta, 76000 Rouen, France; (R.R.); (R.S.)
- CETAPS UR 3832, Research Center for Sports and Athletic Activities Transformations, University of Rouen Normandy, 76821 Mont-Saint-Aignan, France
| | - Matthieu Lalevée
- Orthopedic and Trauma, Surgery Department, Rouen University Hospital, 37 Boulevard Gambetta, 76000 Rouen, France; (R.R.); (R.S.)
- CETAPS UR 3832, Research Center for Sports and Athletic Activities Transformations, University of Rouen Normandy, 76821 Mont-Saint-Aignan, France
| |
Collapse
|
2
|
Ardakani AG, Rudran B, Stringer H, Welck M, Mason L, Malhotra K. The position, orientation, and relative size of the fibularis longus tubercle in normal patients: A weightbearing CT assessment. Clin Anat 2024. [PMID: 38475986 DOI: 10.1002/ca.24150] [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: 08/18/2023] [Revised: 01/03/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
The fibularis longus attaches to the base of the first metatarsal at the fibularis/peroneus longus tubercle (FLT/PLT). Theoretically, differences in FLT morphology may reflect changes in the function of the fibularis longus. This study defines the normal limits of the FLT position, orientation, and size in patients with morphologically normal foot anatomy. A retrospective analysis of 131 feet without deformity in 72 patients undergoing weightbearing CT (WBCT) at a single center was conducted. The position and morphology of the FLT was assessed with novel measurements including tubercle-floor distance, tubercle-metatarsal angle, and the angle between the floor and a line bisecting the FLT (bisecting angle). Roundness of the FLT was compared to a triangle limiting its shape (triangular ratio), with lower values indicating increasing roundness. We also report relative size of the FLT to the first metatarsal (X/Y ratio), and relative size of the first metatarsal and FLT to the second metatarsal (XY/Z ratio). There were no significant side to side differences for any measurement (p > 0.05). Mean values were: tubercle-floor distance 28.02 ± 2.63 mm, tubercle-metatarsal angle 32.7 ± 6.32 degrees, bisecting angle 65.58 ± 6.27 degrees, triangular ratio 0.69 ± 0.04, X/Y ratio 1.13 ± 0.20, and XY/Z ratio 3.44 ± -0.72. Bisecting angle strongly correlated with tubercle-metatarsal angle (Pearson correlation 0.840, p < 0.001) suggesting FLT rotation occurred independent of foot position. ICC was >0.943 for all measurements. This study reports the morphology of the FLT in individuals with normal feet. This normative data may be used in future studies examining differences between groups of patients with foot pathology, helping us better understand the role of fibularis longus in the development and treatment of foot disorders.
Collapse
Affiliation(s)
| | - Branavan Rudran
- Foot & Ankle Reconstruction Unit, Royal National Orthopaedic Hospital, London, UK
| | - Howard Stringer
- Foot & Ankle Reconstruction Unit, Liverpool University Hospitals, Liverpool, UK
| | - Matthew Welck
- Foot & Ankle Reconstruction Unit, Royal National Orthopaedic Hospital, London, UK
| | - Lyndon Mason
- Foot & Ankle Reconstruction Unit, Liverpool University Hospitals, Liverpool, UK
| | - Karan Malhotra
- Foot & Ankle Reconstruction Unit, Royal National Orthopaedic Hospital, London, UK
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Talaski GM, Baumann AN, Sleem B, Anastasio AT, Walley KC, O’Neill CN, Adams SB. Weightbearing Imaging Assessment of Midfoot Instability in Patients with Confirmed Hallux Valgus Deformity: A Systematic Review of the Literature. Diagnostics (Basel) 2024; 14:193. [PMID: 38248070 PMCID: PMC10814552 DOI: 10.3390/diagnostics14020193] [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: 11/20/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Hallux valgus deformity (HVD) involves subluxation of the first metatarsophalangeal joint. While HVD is primarily considered a forefoot condition, midfoot instability may play a significant role in its development and severity. However, very few studies have placed a heavy emphasis on studying this phenomenon. Therefore, this review had a particular focus on understanding midfoot instability based on weightbearing imaging assessments of the TMT joint. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched five databases for studies on midfoot instability in HVD patients. The severity of HVD was defined by hallux valgus angle (HVA) and distal metatarsal articular angle (DMAA). Data was extracted, and articles were graded using the Methodological Index for Non-Randomized Studies (MINORS). Of 547 initially retrieved articles, 23 met the inclusion criteria. Patients with HVD showed higher HVA and DMAA on weightbearing radiographs (WBRG) and weightbearing computed tomography (WBCT) compared to healthy individuals. Midfoot instability was assessed through intermetatarsal angle (IMA) and tarsometatarsal angle (TMT angle). Patients with HVD exhibited greater IMA and TMT angles on both WBRG and WBCT. This review highlights the importance of weightbearing imaging assessments for midfoot instability in HVD. IMA and TMT angles can differentiate between healthy individuals and HVD patients, emphasizing the significance of midfoot assessment in understanding HVD pathology. These findings validate the limited evidence thus far in the literature pertaining to consistent midfoot instability in HVD patients and are able to provide ample reasoning for physicians to place a larger emphasis on midfoot imaging when assessing HVD in its entirety.
Collapse
Affiliation(s)
- Grayson M. Talaski
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA
| | - Anthony N. Baumann
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA;
| | - Bshara Sleem
- College of Medicine, American University of Beirut, Beirut 1107-2020, Lebanon;
| | - Albert T. Anastasio
- Department of Orthopaedic Surgery, Duke University, Durham, NC 27708, USA; (A.T.A.); (C.N.O.); (S.B.A.)
| | - Kempland C. Walley
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Conor N. O’Neill
- Department of Orthopaedic Surgery, Duke University, Durham, NC 27708, USA; (A.T.A.); (C.N.O.); (S.B.A.)
| | - Samuel B. Adams
- Department of Orthopaedic Surgery, Duke University, Durham, NC 27708, USA; (A.T.A.); (C.N.O.); (S.B.A.)
| |
Collapse
|
5
|
Erjanti T, Keskinen H, Rissanen T, Mäkelä K, Lankinen P, Laaksonen I, Koivu H. Radiological outcome of hallux valgus deformity correction with metatarsal osteotomy from a single-center cohort - Best results achieved by foot and ankle surgeons. Foot Ankle Surg 2024; 30:32-36. [PMID: 37673720 DOI: 10.1016/j.fas.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/10/2023] [Accepted: 08/27/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND To evaluate the radiological outcome, especially undercorrection of hallux valgus deformity correction with first metatarsal osteotomy. PATIENTS AND METHODS 439 1st metatarsal osteotomies including 241 distal (55 %), 175 midshaft (40 %), and 23 proximal (5 %) were available for analysis with median follow-up time was 48 days (range 27-990 days). RESULTS The postoperative HVA was normal in 237 (54 %), mild in 110 (25 %), moderate in 87 (20 %), and severe in 5 (1 %) of the cases. BMI (p = 0.0127), sex (p = 0.0004), preoperative HVA (p = 0.0028), and surgeons experience (p < 0.0001) were associated with radiological outcome, whereas age, hospital, and type of osteotomy had no effect. Foot and ankle surgeons achieved normal postoperative HVA in 76 %, general orthopedic surgeons in 41 %, and residents in 47 % of the operations. CONCLUSION Radiological undercorrection was common. As foot and ankle surgeons achieved best radiological correction, hallux valgus deformity should be operated by specialists.
Collapse
Affiliation(s)
- Tuuli Erjanti
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Luolavuorentie 2, 20700 Turku, Finland.
| | - Heli Keskinen
- Department of Pediatric Surgery and Orthopaedics, Turku University Hospital, Savitehtaankatu 5, 20520 Turku, Finland
| | - Tiia Rissanen
- Department of Biostatistics, University of Turku, Kiinamyllynkatu 10, Finland
| | - Keijo Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Luolavuorentie 2, 20700 Turku, Finland
| | | | - Inari Laaksonen
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Luolavuorentie 2, 20700 Turku, Finland
| | - Helka Koivu
- Hospital Pihlajalinna Turku, Joukahaisenkatu 9, 20520 Turku, Finland
| |
Collapse
|
6
|
Li J, Fang M, Van Oevelen A, Peiffer M, Audenaert E, Burssens A. Diagnostic applications and benefits of weightbearing CT in the foot and ankle: A systematic review of clinical studies. Foot Ankle Surg 2024; 30:7-20. [PMID: 37704542 DOI: 10.1016/j.fas.2023.09.001] [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: 05/28/2023] [Revised: 08/16/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Foot and ankle weightbearing CT (WBCT) imaging has emerged over the past decade. However, a systematic review of diagnostic applications has not been conducted so far. METHOD A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines after Prospective Register of Systematic Reviews (PROSPERO) registration. Studies analyzing diagnostic applications of WBCT were included. Main exclusion criteria were: cadaveric specimens and simulated WBCT. The Methodological Index for Non-Randomized Studies (MINORS) was used for quality assessment. RESULTS A total of 78 studies were eligible for review. Diagnostic applications were identified in following anatomical area's: ankle (n = 14); hindfoot (n = 41); midfoot (n = 4); forefoot (n = 19). Diagnostic applications that could not be used on weightbearing radiographs (WBRX) were reported in 56/78 studies. The mean MINORS was 9.8/24 (range: 8-12). CONCLUSION Diagnostic applications of WBCT were most frequent in the hindfoot, but other areas are on the rise. Post-processing of images was the main benefit compared to WBRX based on a moderate quality of the identified studies.
Collapse
Affiliation(s)
- Jing Li
- Department of Orthopaedics, Ghent University Hospital, Ghent, Belgium
| | - Mengze Fang
- Department of Orthopaedics, Ghent University Hospital, Ghent, Belgium
| | - Aline Van Oevelen
- Department of Orthopaedics, Ghent University Hospital, Ghent, Belgium
| | - Matthias Peiffer
- Department of Orthopaedics, Ghent University Hospital, Ghent, Belgium
| | | | - Arne Burssens
- Department of Orthopaedics, Ghent University Hospital, Ghent, Belgium.
| |
Collapse
|
7
|
Lewis TL, Ferreira GF, Nunes GA, Lam P, Ray R. Impact of Sesamoid Coverage on Clinical Foot Function Following Fourth-Generation Percutaneous Hallux Valgus Surgery. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241230560. [PMID: 38384770 PMCID: PMC10880538 DOI: 10.1177/24730114241230560] [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: 02/23/2024] Open
Abstract
Background The impact of pronation and sesamoid coverage on clinical outcomes following percutaneous hallux valgus surgery are not currently known. The aim of this study was to investigate if sesamoid coverage was associated with worse clinical outcomes at 12-month follow-up following percutaneous hallux valgus surgery. Methods Retrospective comparative observational study of clinical and radiographic outcomes based on a previously published prospective dataset. Patients were stratified into 3 cohorts based on the degree of sesamoid coverage (normal, mild, or moderate) on 12-month weightbearing radiographs following fourth-generation percutaneous hallux valgus surgery. Primary outcome was a validated patient-reported outcome measure (PROM), the Manchester-Oxford Foot Questionnaire (MOXFQ). Secondary outcomes included Euroqol-5D, VAS Pain, and radiographic deformity correction. Results Forty-seven feet underwent primary fourth-generation HV surgery and were stratified into 3 cohorts. There were 19, 16, and 12 feet in the normal, mild, and moderate cohorts respectively. There was no significant difference in either pre- or postoperative foot function (all MOXFQ domains, P > .05) or health-related quality of life (EQ-5D Index or VAS, P > .05). The MOXFQ Index preoperatively was as follows: normal cohort, 56.1 ± 26.9; mild cohort, 54.1 ± 17.9; and severe cohort, 49.6 ± 23.8; and postoperatively was as follows: normal cohort, 15.6 ± 21.5; mild cohort, 11.4 ± 15.5; and severe cohort, 11.4 ± 13.6 (P = .737-.908). There was significantly worse hallux valgus angle (HVA) and intermetatarsal angle (IMA) between the cohorts (P < .01). Although HVA and IMA were corrected to normal parameters following surgery in all cohorts, there was a significantly worse postoperative HVA in the moderate sesamoid coverage (5.3 ± 3.9 vs 7.9 ± 5.3 vs 11.4 ± 3.7, P < .01); however, IMA was not significantly different (3.4 ± 2.2 vs 4.1 ± 2.7 vs 5.2 ± 2.9, P = .168). Conclusion This study found that cases where the sesamoids were not reduced had a poorer correction and had worse preoperative deformity. Clinical outcomes and foot function following fourth-generation percutaneous hallux valgus surgery were not affected by sesamoid coverage at the 12-month follow-up. The long-term implications in the difference in radiographic deformity between the 3 cohorts are not known, and further work should explore the relationship of first ray pronation and sesamoid position, particularly with regard to recurrence. Level of evidence Level III, retrospective comparative study of prospectively collected data.
Collapse
Affiliation(s)
- Thomas Lorchan Lewis
- King’s Foot and Ankle Unit, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Gabriel Ferraz Ferreira
- Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, Brazil
| | | | - Peter Lam
- Orthopaedic and Arthritis Specialist Centre, Chatswood, Sydney, Australia
| | - Robbie Ray
- King’s Foot and Ankle Unit, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
8
|
Lalevée M, de Carvalho KAM, Barbachan Mansur NS, Kim KC, McGettigan L, Dibbern K, Easley M, de Cesar Netto C. Distribution, prevalence, and impact on the metatarsosesamoid complex of first metatarsal pronation in hallux valgus. Foot Ankle Surg 2023; 29:488-496. [PMID: 37400328 DOI: 10.1016/j.fas.2023.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 05/25/2023] [Accepted: 06/18/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Previous simulated weight-bearing CT (WBCT) studies classifying first metatarsal (M1) pronation suggested a high prevalence of M1 hyper-pronation in hallux valgus (HV). These findings have prompted a marked increase in M1 supination in HV surgical correction. No subsequent study confirms these M1 pronation values, and two recent WBCT investigations suggest lower normative M1 pronation values. The objectives of our WBCT study were to (1) determine M1 pronation distribution in HV, (2) define the hyperpronation prevalence compared to preexisting normative values, and (3) assess the relationship of M1 pronation to the metatarso-sesamoid complex. We hypothesized that the M1 head pronation distribution would be high in HV. METHODS We retrospectively identified 88 consecutive feet with HV in our WBCT dataset and measured M1 pronation with the Metatarsal Pronation (MPA) and α angles. Similarly, using two previously published methods defining the pathologic pronation threshold, we assessed our cohort's M1 hyper-pronation prevalence, specifically (1) the upper value of the 95% confidence interval (CI95) and (2) adding two standard deviations at the mean normative value (2 SD). Sesamoid station (grading) was assessed on the coronal plane. RESULTS The mean MPA was 11.4+/-7.4 degrees and the α angle was 16.2+/-7.4 degrees. According to the CI95 method, 69/88 HV (78.4%) were hyperpronated using the MPA, and 81/88 HV (92%) using the α angle. According to the 2 SD method, 17/88 HV (19.3%) were hyperpronated using the MPA, and 20/88 HV (22.7%) using the α angle. There was a significant difference in MPA among sesamoid gradings (p = 0.025), with a paradoxical decrease in MPA when metatarsosesamoid subluxation was increased. CONCLUSION M1 head pronation distribution in HV was higher than in normative values, but threshold change demonstrated contradictory hyper-pronation prevalences (85% to 20%), calling into question the previously reported high prevalence of M1 hyper-pronation in HV. An increase in sesamoid subluxation was associated with a paradoxical decrease in M1 head pronation in our study. We suggest that a greater understanding of the impact of HV M1 pronation is warranted before routine M1 surgical supination is recommended for patients with HV. LEVEL OF EVIDENCE Level III, retrospective cohort study.
Collapse
Affiliation(s)
- Matthieu Lalevée
- Department of Orthopedic Surgery, Rouen University Hospital, 37 Boulevard Gambetta, 76000 Rouen, France; University of Iowa, Carver College of Medicine, Department of Orthopedics and Rehabilitation, Iowa City, IA, USA.
| | | | | | - Ki Chun Kim
- University of Iowa, Carver College of Medicine, Department of Orthopedics and Rehabilitation, Iowa City, IA, USA.
| | - Lily McGettigan
- University of Iowa, Carver College of Medicine, Department of Orthopedics and Rehabilitation, Iowa City, IA, USA.
| | - Kevin Dibbern
- University of Iowa, Carver College of Medicine, Department of Orthopedics and Rehabilitation, Iowa City, IA, USA.
| | - Mark Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA.
| | - Cesar de Cesar Netto
- University of Iowa, Carver College of Medicine, Department of Orthopedics and Rehabilitation, Iowa City, IA, USA.
| |
Collapse
|
9
|
Lewis TL, Lau B, Alkhalfan Y, Trowbridge S, Gordon D, Vernois J, Lam P, Ray R. Fourth-Generation Minimally Invasive Hallux Valgus Surgery With Metaphyseal Extra-Articular Transverse and Akin Osteotomy (META): 12 Month Clinical and Radiologic Results. Foot Ankle Int 2023; 44:178-191. [PMID: 36788732 DOI: 10.1177/10711007231152491] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Fourth-generation minimally invasive surgery (MIS) includes the multiplanar rotational deformity correction achieved through manipulation of an extra-articular distal first metatarsal osteotomy that is held with rigid fixation using 2 fully threaded screws, of which one must be bicortical to provide rotational and biomechanical stability. The aim of this study is to report the clinical and radiologic outcomes of an evolved fourth-generation MIS hallux valgus technique. METHODS A prospective single-surgeon series of consecutive patients undergoing fourth-generation MIS was performed using a distal transverse osteotomy with a minimum 12-month follow-up. The primary outcome was the Manchester-Oxford Foot Questionnaire (MOXFQ), a validated clinical patient-reported outcome measure (PROM). Secondary outcomes included radiographic deformity correction, clinical assessment, and EuroQol-5D-5L PROMs. RESULTS Between September 2019 and June 2021, 50 feet underwent fourth-generation MIS. The mean age was 55.8±15.3 years with a mean follow-up of 1.4 years. Preoperative and minimum 12-month primary outcome data were available for 100% of feet. There was a significant improvement in all MOXFQ domain scores, with the index domain improving from 53.4 to 13.1 (P < .001). There was a significant improvement (P < .001) in hallux valgus angle (32.7 to 7.9 degrees), intermetatarsal angle (14.0 to 4.2 degrees) and distal metatarsal articular angle (18.5 to 5.6 degrees). There was a significant improvement in general health-related quality of life EQ-5D-5L index and EQ-VAS scores (P < .05). CONCLUSION The fourth-generation MIS technique is a safe and effective approach to hallux valgus deformity correction with significant improvement in clinical and radiographic outcomes. LEVEL OF EVIDENCE Level IV, prospective case series.
Collapse
Affiliation(s)
- Thomas L Lewis
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, United Kingdom
| | - Benjamin Lau
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, United Kingdom
| | - Yousif Alkhalfan
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, United Kingdom
| | - Samuel Trowbridge
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, United Kingdom
| | | | - Joel Vernois
- Institut de Chirurgie du Pied (ICP), Clinique Blomet, Paris, France
| | - Peter Lam
- Orthopaedic and Arthritis Specialist Centre, Chatswood, Sydney, Australia
| | - Robbie Ray
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, United Kingdom
| |
Collapse
|
10
|
Lewis TL, Robinson PW, Ray R, Dearden PMC, Goff TAJ, Watt C, Lam P. Five-Year Follow-up of Third-Generation Percutaneous Chevron and Akin Osteotomies (PECA) for Hallux Valgus. Foot Ankle Int 2023; 44:104-117. [PMID: 36692121 DOI: 10.1177/10711007221146195] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Recent large studies of third-generation minimally invasive hallux valgus surgery (MIS) have demonstrated significant improvement in clinical and radiologic outcomes. It remains unknown whether these clinical and radiologic outcomes are maintained in the medium to long term. The aim of this study was to investigate the minimum 5-year clinical and radiologic outcomes following third-generation MIS hallux valgus surgery in the hands of a high-volume MIS surgeon. METHODS A retrospective observational single highly experienced MIS surgeon case series of consecutive patients undergoing primary isolated third-generation percutaneous chevron and Akin osteotomies (PECA) for hallux valgus with a minimum 60-month clinical and radiographic follow-up. Primary outcome was radiographic assessment of the hallux valgus angle (HVA) and intermetatarsal angle (IMA) preoperatively, 6 months, and ≥60 months following PECA. Secondary outcomes included the Manchester-Oxford Foot Questionnaire, patient satisfaction, EuroQol-5D visual analog scale and the visual analog scale for pain. RESULTS Between 2012 and 2014, 126 consecutive feet underwent isolated third-generation PECA, with complete data available for 78 (61.9%) feet. The median follow-up was 65.0 (IQR 64-69; range 60-88) months. There was a significant improvement in radiographic deformity correction; the median IMA improved from 12.0 degrees (interquartile range [IQR]: 10.8-14.2) to 6.0 degrees (IQR: 4.2-7.3) (P < .001), and the median HVA improved from 27.2 degrees (IQR: 20.6-34.4) to 7.2 degrees (IQR: 3.4-11.6). Median MOXFQ Index score at ≥60-month follow-up was 2.3 (IQR: 0.0-7.8). The radiographic recurrence rate (defined as HVA >15 degrees) was 7.7% at final follow-up. The complication rate was 4.8%. CONCLUSION Radiologic deformity correction for the 78 feet we were able to follow that had third-generation PECA performed by a single highly experienced MIS surgeon was found to be maintained at a mean follow-up of average 66.8 months, with a radiographic recurrence rate of 7.7%. Clinical PROMs and patient satisfaction levels were high and comparable to other third-generation studies with shorter duration of follow-up. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
Collapse
Affiliation(s)
- Thomas L Lewis
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Peter W Robinson
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, United Kingdom
| | - Robbie Ray
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Thomas A J Goff
- Mid Yorkshire Hospitals NHS Trust, Wakefield, United Kingdom
| | - Clare Watt
- Orthopaedic and Arthritis Specialist Centre, Chatswood, Sydney, Australia
| | - Peter Lam
- Orthopaedic and Arthritis Specialist Centre, Chatswood, Sydney, Australia
| |
Collapse
|
11
|
Kim TH, Choi YR, Lee HS, Bak GG, Moon SH. Relationship Between Hallux Valgus Recurrence and Sesamoid Position on Anteroposterior Standing Radiographs After Distal Chevron Metatarsal Osteotomy. Foot Ankle Int 2023; 44:130-138. [PMID: 36576025 DOI: 10.1177/10711007221140868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Recurrence of the hallux valgus deformity has various causes, and the incomplete reduction of sesamoids may be one of the important issues. However, we have seen several patients with postoperative lateral sesamoid displacement on anteroposterior (AP) standing radiographs who did not experience hallux valgus recurrence. Therefore, we hypothesized that lateral displacement of the sesamoid on AP standing radiographs does not cause hallux valgus recurrence. METHODS The study included 269 feet (185 patients) with hallux valgus treated with distal chevron metatarsal osteotomy. Mean patient age was 64.26 (range, 15-80) years. Patients were followed up for an average of 33.85 (range, 12-228) months between April 2002 and December 2019. The patients were divided into 4 groups, according to the presence or absence of hallux valgus recurrence and sesamoid reduction. RESULTS During outpatient follow-up, we discovered 99 feet (42.1%) in which hallux valgus did not recur despite lateral sesamoid displacement (grade IV-VII) on AP standing radiographs. Hallux valgus angle (HVA, 2.7 to 7.9 degrees), intermetatarsal angle (IMA, 4.6 to 6.2 degrees), and sesamoid grades (2.1 to 3.5) all deteriorated over time after surgery, and each indicator was statistically significantly altered, and changes in the 3 indicators had a statistically significant positive correlation. Changes in HVA and IMA between feet with and without sesamoid reduction on AP standing radiographs increased over time, with the differences in HVA (2.9 degrees) and IMA (0.9 degrees) being significant at final follow-up (P < .05 for each). Regardless of whether sesamoid reduction was achieved on AP standing radiographs, the final analysis showed that HVA and IMA in both groups worsened over time. Further, there were no differences between the 2 groups in the patterns of change over time. CONCLUSION In our cohort, postoperative sesamoid position on AP standing radiographs was not associated with hallux valgus recurrence based on radiographic criteria. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Tae-Hoon Kim
- Department of Orthopedic Surgery, Ulsan University Hospital, Dong-Gu, Ulsan, Republic of Korea
| | - Young-Rak Choi
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Ho-Seong Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Gyeong-Gu Bak
- Department of Orthopaedic Surgery, Haeundae Paik Hospital, University of Inje, Haeundae-gu, Busan, Republic of Korea
| | - Sung-Ho Moon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Songpa-gu, Seoul, Republic of Korea
| |
Collapse
|