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Choi YH, Kim JS, Ahn JH, Kim GJ, Jeong H, Kim YC. Preoperative increased pronation angle of the first metatarsus associated with correction loss after hallux valgus surgery: A semi-weight-bearing computed tomography study. Foot Ankle Surg 2024; 30:562-567. [PMID: 38704264 DOI: 10.1016/j.fas.2024.04.010] [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: 11/30/2023] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The effect of preoperative first metatarsal pronation on postoperative prognosis of hallux valgus (HV) surgery is under investigation. Utilizing semi-weight-bearing computed tomography, the preoperative pronation angle was assessed to quantify its impact on postoperative prognosis. METHODS In a retrospective analysis of 31 feet, those with re-increased hallux valgus angle postoperatively were classified as the non-maintained group, and the remainder as the maintained group. Preoperative pronation angles were compared to establish a threshold. Subsequently, feet were re-classified into high or low-pronation categories. The relative risk of non-maintenance in high-pronation category was calculated. RESULTS The non-maintained group exhibited a significantly higher preoperative pronation angle (p = 0.021), with a 28.4º threshold. The high-pronation category had a relative risk of 2.34 for non-maintenance. CONCLUSIONS Increased preoperative first metatarsal pronation angle is associated with correction loss after HV surgery. Utilizing sWBCT to measure the pronation angle provides valuable insights into postoperative prognosis. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Youn-Ho Choi
- Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Jin Su Kim
- Sejong Sports Medicine and Performance Center, Seoul, Republic of Korea.
| | - Jae Hoon Ahn
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Gyu Jin Kim
- Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Howon Jeong
- Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Yoon-Chung Kim
- Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Sacli Eksilmez B, Ucurum SG, Kirmizi M, Cansabuncu G. Comparison of foot function and physical performance between women with and without bilateral painful hallux valgus. Foot Ankle Surg 2024; 30:155-160. [PMID: 37957060 DOI: 10.1016/j.fas.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/16/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND We aimed to investigate whether foot function and physical performance differ between women with and without bilateral painful hallux valgus (HV). METHODS Forty-four women with bilateral painful HV and forty-three controls were included. The Foot Function Index, American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joints Scale, and Manchester-Oxford Foot Questionnaire were used. The time while walking 10 m-walkway at maximum speed and ascending and descending ten stairs as fast as possible also single-limb stance time were measured. RESULTS All self-reported and performance-based measures showed that women with HV had poorer foot function and physical performance than controls (p < 0.05). Women with mild HV had better self-reported foot function than those with moderate HV or severe HV (p < 0.05), but physical performance did not differ (p > 0.05). CONCLUSIONS Women with bilateral painful HV exhibited poorer self-reported foot function and performance-based physical function than those without HV. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- Busra Sacli Eksilmez
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Sevtap Gunay Ucurum
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Muge Kirmizi
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey.
| | - Gokhan Cansabuncu
- Department of Orthopedics and Traumatology, Bursa Medicana Hospital, Bursa, Turkey
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Bianco-Adames DN, Ginés-Cespedosa A, Gasol-Cudos B, Serrano-Chinchilla P, Gamba C, González-Lucena G. Halving the usage of rigid-soled postoperative shoes does not affect outcomes in forefoot reconstruction surgery. Foot Ankle Surg 2023; 29:380-383. [PMID: 36948920 DOI: 10.1016/j.fas.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/23/2023] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Postoperative shoes are commonly used after forefoot surgery. This study's aim was to demonstrate that reducing rigid-soled shoe time to 3 weeks neither compromises functional outcomes nor does it produce complications. METHODS Prospective cohort study: 6 weeks versus 3 weeks of rigid postoperative shoe (100 and 96 patients respectively), after forefoot surgery with stable osteotomies. Manchester-Oxford Foot Questionnaire (MOXFQ) and pain Visual Analog Scale (VAS) were studied preoperative and one year postoperative. Radiological angles were also assessed after removing the rigid shoe and at 6 months. RESULTS The MOXFQ index and pain VAS depicted similar results in each group (group A: 29.8 and 25.7; group B: 32.7 and 23.7) with no differences between them (p = .43 Vs. p = .58). Moreover, no differences were reported in their differential angles (HV differential-angle p = .44, IM differential-angle p = .18) or in their complication rate. CONCLUSION In forefoot surgery with stable osteotomies, shortening the postoperative shoe time to 3 weeks, neither impairs clinical results nor the initial correction angle.
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Affiliation(s)
- Daniel N Bianco-Adames
- Parc de Salut Mar, Orthopedic Department, Passeig Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Spain.
| | - Albert Ginés-Cespedosa
- Parc de Salut Mar, Orthopedic Department, Passeig Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Spain
| | - Berta Gasol-Cudos
- Parc de Salut Mar, Orthopedic Department, Passeig Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Spain
| | - Paula Serrano-Chinchilla
- Parc de Salut Mar, Orthopedic Department, Passeig Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Spain
| | - Carlo Gamba
- Parc de Salut Mar, Orthopedic Department, Passeig Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Spain
| | - Gemma González-Lucena
- Parc de Salut Mar, Orthopedic Department, Passeig Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Spain
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Hernández-Castillejo LE, Martínez-Vizcaíno V, Álvarez-Bueno C, Quijada-Rodríguez JL, Alonso-Galán M, Garrido-Miguel M. Effectiveness of hallux valgus surgery on improving health-related quality of life: A follow up study. Foot Ankle Surg 2022; 28:431-437. [PMID: 34454834 DOI: 10.1016/j.fas.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hallux valgus (HV) negatively impacts health-related quality of life (HRQoL). Patientreported outcome measures (PROMs) are increasingly used in clinical studies of the foot and ankle. We aimed to evaluate the effect of HV surgery on PROMs (i.e., pain scales, general HRQoL, and region-specific scales) and radiological angles. Additionally, we aimed to determine whether the effect on these outcomes depends on the type of surgery (including open and percutaneous techniques) and if it is influenced by potential confounding factors (i.e., age, HVA, 1-2 IMA, body mass index (BMI), and distal metatarsal articular angle (DMAA). METHODS This was a longitudinal prospective study. We collected the clinical data of all patients who underwent surgery for symptomatic HV deformity in the orthopedic department of the Virgen de la Luz Hospital of Cuenca (Spain).The clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) Hallux metatarsophalangeal-interphalangeal (HMI) scale, visual analogue scale (VAS), Manchester Oxford foot questionnaire (MOXFQ), short form health survey (SF-12) and European Quality of Life-5 Dimensions (EQ-5D). RESULTS A total of 72 patients (70 women, 97.2%) were included in the study 72 (72 feet).The AOFAS pre-post-surgery score changed from 42.16 (SD: 10.11) to 83.31 (SD: 6.23). Considering AOFAS domains, the pre-post change was from 14.17 (SD: 9.15) to 33.19 (SD: 4.69) for pain, from 27.22 (SD: 3.90) to 37.94 (SD: 2.78) for function, and from 0.78 (SD: 2.38) to 12.18 (SD: 3.45) for alignment. For other clinical outcomes was VAS score from 5.01(SD: 1.26) to 1.26 (SD: 0.96) and MOXFQ score from 61.44 (SD: 7.09) to 12.35 (SD: 4.85). SF-12 (physical) changed from 36.26 (SD: 5.32) to 47.06 (SD: 4.82), SF-12 (mental) from 38.23 (SD: 8.04) to 46.49 (SD: 4.16), and EQ5-D from 0.64 (SD: 0.008) to 0.90 (SD: 0.10). CONCLUSIONS Our data confirmed the improvements in the clinical and radiological outcomes after HV surgery, and provided some evidence of these improvements not depending on the type of surgery or on some potential confounding factors such as BMI, HVA, 1-2 IMA, and DMAA.
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Affiliation(s)
- Luis Enrique Hernández-Castillejo
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain; Hospital Virgen de La Luz, Department of Orthopedic Surgery, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain.
| | | | | | - Miriam Garrido-Miguel
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain; Faculty of Nursing, Universidad de Castilla-La Mancha, Albacete, Spain
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Saad A, Iyengar KP, Fitzpatrick J, Azzopardi C, Panchal H, Botchu R. The Linear Hallux Valgus Offset- A novel way to measure Hallux Valgus. J Clin Orthop Trauma 2022; 30:101898. [PMID: 35619938 PMCID: PMC9126759 DOI: 10.1016/j.jcot.2022.101898] [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: 02/05/2022] [Revised: 04/29/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Hallux Valgus (HV) is a complex deformity involving the first ray of the forefoot and a common cause of forefoot pain. Several radiological measurements such as Hallux Valgus Angle (HVA), First Metatarsophalangeal Angle (IMA) and Distal metatarsal articular angle (DMAA) exist to calculate the severity of HV and direct patient management. However, these are angular measurements are prone to error with variable intra- and inter-observer reliability. PURPOSE To describe a new radiological linear hallux valgus offset (LHVO) to measure HV deformity. PATIENT AND METHODS We performed a retrospective cohort study looking at Antero-posterior, weight-bearing foot radiographs of 100 consecutive patients with forefoot pain referred to our foot and ankle clinic. Demographic details, clinical indication, HVA (hallux valgus angle) and LHVO were measured for each patient and data were analyzed using the student t-test. Intraclass Correlation Coefficient (ICC) analysis was evaluated to assess the intra-class reliability between observers. RESULTS There was a female predominance of approximately 2:1, with 51.3 years (range 13-86 years). There was a statistically significant difference of LHVO between normal and hallux valgus cohorts with a p-value of 0.0001. The LHVO gave moderate intra-observer and inter-observer reliability on ICC analysis of 0.7. CONCLUSION The LHVO can be an additional measure of assessing severity of hallux valgus. In contrary to the traditional angular measurements, this linear measure is easier to calculate and reproducible on plain, weight bearing radiographs. LHVO measurement has shown a moderate inter-observer reliability in the study to complement traditional radiological evaluation of hallux valgus alignment.
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Affiliation(s)
- A. Saad
- Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK
| | | | - John Fitzpatrick
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - C. Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - H. Panchal
- Sanyapixel Diagnostics, Ahmedabad, India
| | - R. Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK,Corresponding author. Royal Orthopaedic Hospital, Bristol Road South Northfield, Birmingham, UK.
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Dragosloveanu S, Popov VM, Cotor DC, Dragosloveanu C, Stoica CI. Percutaneous Chevron Osteotomy: A Prospective Randomized Controlled Trial. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58030359. [PMID: 35334535 PMCID: PMC8948867 DOI: 10.3390/medicina58030359] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/13/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022]
Abstract
Introduction: Minimally invasive surgical techniques for hallux valgus have gained popularity, showing good results characterized by smaller postoperative scars, less pain, lower infection risk, and fewer wound complications. Given the lack of evidence available in our country regarding this subject, especially about this type of surgical technique, our paper aims to compare open and MIS approaches for chevron osteotomy. We evaluated the outcome and complications after 12 months. Materials and Methods: We undertook a prospective, randomized, controlled, single-center study between October 2017 and December 2020. The patients were randomized into two groups: one group that received percutaneous chevron osteotomy (MIS), and the other, open chevron osteotomy (OC). For clinical assessment, we determined the function and the level of pain using the Visual Analogue Scale (VAS) and The American Orthopaedic Foot and Ankle Surgery score (AOFAS). The VAS scale was measured before the surgical procedure, at discharge, and at 3 weeks, 6 weeks, 6 months, and 12 months after surgery. The AOFAS score was calculated preoperatively and after 6 months. The hallux angle (HVA) and intramedullary angle (IMA) were measured preoperatively, and at 6 weeks, 6 months and 12 months. Results: We included 26 cases in the open chevron osteotomy group (24 female, 2 male) and 24 in the MIS group (24 female, 0 male). Both groups demonstrated improvements regarding the IMA and HVA at the last follow-up without any significant differences between the groups at the final assessment. The VAS showed significantly better post-operative results for the MIS group at discharge (p < 0.001) and 3 weeks (p < 0.001), 6 weeks (p < 0.001), and 6 months (p = 0.004) post-surgery. The AOFAS showed no significant differences either before or after surgery. Four cases with screw prominence were reported, three of which belonged to the MIS group. Only one case with metatarsalgia was found in the OC group. Conclusions: This paper demonstrates that minimally invasive chevron osteotomy has comparable results with open chevron osteotomy, even though surgical time and radiological exposure are significantly longer. More studies are required to evaluate the complications and the risk of recurrences.
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Affiliation(s)
- Serban Dragosloveanu
- Faculty of medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (S.D.); (V.M.P.); (C.D.); (C.I.S.)
- Department of Orthopaedics, “Foisor” Orthopaedics Hospital, 020021 Bucharest, Romania
| | - Viola Maria Popov
- Faculty of medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (S.D.); (V.M.P.); (C.D.); (C.I.S.)
- Colentina Clinical Hospital Hematology Clinic, 020021 Bucharest, Romania
| | - Dragoș-Corneliu Cotor
- Department of Orthopaedics, “Foisor” Orthopaedics Hospital, 020021 Bucharest, Romania
- Correspondence: ; Tel.: +40-721-549743
| | - Christiana Dragosloveanu
- Faculty of medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (S.D.); (V.M.P.); (C.D.); (C.I.S.)
| | - Cristian Ioan Stoica
- Faculty of medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (S.D.); (V.M.P.); (C.D.); (C.I.S.)
- Department of Orthopaedics, “Foisor” Orthopaedics Hospital, 020021 Bucharest, Romania
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Risk factors for recurrence of hallux valgus deformity after minimally invasive distal linear metatarsal osteotomy. J Orthop Sci 2022; 27:435-439. [PMID: 33431255 DOI: 10.1016/j.jos.2020.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recurrence of hallux valgus deformity is a complication following surgical treatment of hallux valgus. This study was performed to identify risk factors for recurrence of hallux valgus deformity after minimally invasive distal linear metatarsal osteotomy (DLMO). METHODS Sixty-seven patients (100 feet) with mild to severe hallux valgus who underwent DLMO from 2007 to 2018 were retrospectively investigated. Their average age at the time of surgery was 54 years (range, 18-88 years). The average follow-up duration was 46 months. The feet were divided into two groups: with and without recurrence. A multivariate analysis was performed to identify the risk factors for recurrence of deformity based on preoperative and 3-month postoperative radiographic parameters. RESULTS Recurrence of deformity was found in 18 (18%) of the 100 feet at the final follow-up. The preoperative hallux valgus angle and 3-month postoperative hallux valgus angle, intermetatarsal angle, round sign positivity, and sesamoid position grade were significantly greater in the recurrence group than in the non-recurrence group. The logistic regression analysis revealed that a 3-month postoperative hallux valgus angle of ≥13.5°, positive round sign, and grade ≥2 sesamoid position were significantly associated with recurrence of deformity. CONCLUSIONS The present findings can help to identify patients at higher risk of recurrence of hallux valgus deformity after DLMO and to modify their surgical procedures.
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Clemente P, Mariscal G, Barrios C. Distal chevron osteotomy versus different operative procedures for hallux valgus correction: a meta-analysis. J Orthop Surg Res 2022; 17:80. [PMID: 35135564 PMCID: PMC8822667 DOI: 10.1186/s13018-022-02974-0] [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: 09/12/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Distal chevron osteotomy is commonly used for the operative treatment of hallux valgus (HV). However, there are several operative procedures that can be used to treat HV. The aim of this meta-analysis was to compare the efficacy of distal chevron osteotomy with different operative procedures. Materials and methods A systematic search was conducted using the MEDLINE and EMBASE databases to identify randomized clinical trials (RCTs). The variables were radiological (hallux metatarsal phalangeal angle [HVA] and intermetatarsal angle [IMA]) and clinical (American Orthopaedic Foot & Ankle Society Score [AOFAS]). Heterogeneity was assessed with chi2 and I2 statistics. A random effects model was used for significant heterogeneity. Publication bias was evaluated with funnel plots. Results Ten studies involving 985 patients were evaluated in the meta-analysis. Distal chevron osteotomy was associated with a mean IMA correction 2.18° greater than the scarf procedure (MD − 2.18; 95% CI − 3.67, − 0.69; p = 0.004; I2 = 0%). In addition, the proximal chevron was associated with a mean IMA correction 1.08° greater than the distal chevron (MD − 1.08; 95% CI − 1.86, − 0.29; p = 0.007; I2 = 0%). The AOFAS assessment showed an overall advantage of 3.2 points in favor of the Lingdren group compared with distal chevron osteotomy (MD 3.20; 95% CI 0.37, 6.04; p = 0.03; I2 = 0%). Conclusions Our findings indicate that distal chevron osteotomy provides a greater HVA correction than scarf osteotomy, and proximal chevron provides a larger IMA correction than distal chevron osteotomy. Lingdren osteotomy provides a greater AOFAS correction than distal chevron osteotomy. Level of evidence Level I, meta-analysis.
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Affiliation(s)
- Pablo Clemente
- Department of Traumatology and Orthopedic Surgery, Hospital Doctor Peset, Valencia, Spain
| | - Gonzalo Mariscal
- Institute for Research on Musculoskeletal Disorders, School of Medicine and Health Sciences, Valencia Catholic University, Quevedo 2, 46001, Valencia, Spain.
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, School of Medicine and Health Sciences, Valencia Catholic University, Quevedo 2, 46001, Valencia, Spain
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Day J, de Cesar Netto C, Richter M, Mansur NS, Fernando C, Deland JT, Ellis SJ, Lintz F. Evaluation of a Weightbearing CT Artificial Intelligence-Based Automatic Measurement for the M1-M2 Intermetatarsal Angle in Hallux Valgus. Foot Ankle Int 2021; 42:1502-1509. [PMID: 34088236 DOI: 10.1177/10711007211015177] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Weightbearing cone beam computed tomography (WBCT) has been gaining traction as a useful imaging modality in the diagnosis and follow-up of foot and ankle musculoskeletal pathologies due to the ability to perform quick, low-dose, 3-dimensional (3D) scans. However, the resulting wealth of 3D data renders daily clinical use time-consuming. The aim of this study was to evaluate a new artificial intelligence (AI)-based automatic measurement for the M1-M2 intermetatarsal angle (IMA) in hallux valgus (HV). We hypothesized that automatic and manual measurements would have a strong correlation, and that the AI software would yield better reproducibility and would be faster compared with manual measurements. METHODS This was a multicenter retrospective comparative case-control study in which a total of 128 feet were included from 93 patients who underwent WBCT scans as part of their routine follow-up: 59 feet with symptomatic HV and 69 controls. The IMA was measured automatically using the AI software and manually on digitally reconstructed radiographs (DRRs). The AI software produced both an automatic 2D (auto 2D) and 3D (auto 3D) measurement. RESULTS There were strong intermethod correlations between the DRR IMA and the auto 2D (HV, r = 0.61; control, r = 0.60; all P < .0001) and auto 3D (HV, r = 0.63; control, r = 0.52; all P < .0001) measurements, respectively. The intrasoftware reproducibility was very close to 100%. Measurements took 23.6 ± 2.31 seconds and 14.5 ± 1.18 seconds, respectively, when taken manually on DRRs and automatically. Controls demonstrated a mean DRR IMA of 8.6 (95% CI, 8.1-9.1), mean auto 2D of 11.2 (95% CI, 10.7-11.7), and mean auto 3D IMA of 11.0 (95% CI, 10.5-11.5). The HV group demonstrated significantly increased IMA compared with controls (P < .0001), with a mean DRR IMA of 15.4 (95% CI, 14.8-16.1), mean auto 2D of 17.8 (95% CI, 17.2-18.4), and mean auto 3D IMA of 16.8 (95% CI, 16.8-17.4). CONCLUSION Measurements generated by the WBCT AI-based automatic measurement system for IMA demonstrated strong correlations with manual measurements, with near-perfect reproducibility. Further developments are warranted in order to make this tool more usable in daily practice, particularly with respect to its use in the presence of hardware in the foot. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Jonathan Day
- Hospital for Special Surgery, New York, NY, USA.,Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Cesar de Cesar Netto
- Department of Orthopedic Foot and Ankle Surgery, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Martinus Richter
- Department for Foot and Ankle Surgery, Nuremberg and Rummelsberg, Schwarzenbruck, Germany
| | - Nacime Salomao Mansur
- Department of Orthopedic Foot and Ankle Surgery, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Celine Fernando
- Foot and Ankle Surgery Center, Clinique de l'Union, Saint-Jean, France
| | | | | | - François Lintz
- Foot and Ankle Surgery Center, Clinique de l'Union, Saint-Jean, France
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Zhong Z, Zhang P, Duan H, Yang H, Li Q, He F. A Comparison Between X-ray Imaging and an Innovative Computer-aided Design Method Based on Weightbearing CT Scan Images for Assessing Hallux Valgus. J Foot Ankle Surg 2021; 60:6-10. [PMID: 32253154 DOI: 10.1053/j.jfas.2018.12.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/25/2018] [Accepted: 12/31/2018] [Indexed: 02/03/2023]
Abstract
With the development of recent technology, radiographs can be saved digitally, and angular measurements can be processed using various software packages. We developed an innovative computer-aided design method with Materialize Interactive Medical Image Control System software to measure hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the distal metatarsal articular angle (DMAA) and assessed its concordance with traditional X-ray imaging methods. All measurements were carried out on 42 feet from 26 adult patients diagnosed with hallux valgus who were prospectively selected from July 2016 to April 2018. Standing X-ray radiograph and weightbearing computed tomography scans were conducted on all patients, and HVA, IMA, and DMAA were generated using both a traditional X-ray method and our innovative method. Two different observers assessed measurements for each patient. Finally, statistical analyses were conducted to assess the reliability of the measurements. Both X-ray imaging and our innovative method had strong interobserver and test-retest reliability. The ICC of X-ray imaging was 0.945, p < .001, and the ICC of the innovative method was 0.915, p < .001. There was no statistical difference between the 2 methods for HVA and IMA measurements (p > .05); however, a difference was detected for DMAA (p < .05). Bland-Altman analyses demonstrated a high degree of agreement between the 2 methods for HVA and IMA, but a significant difference for DMAA. From the results, we concluded that our innovative computer-aided design method is a feasible, reliable way to quantitatively assess HVA, IMA, and DMAA, and it is likely more accurate for measuring DMAA.
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Affiliation(s)
- Zongyu Zhong
- Department of Orthopedics, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Peng Zhang
- Xiangyang Central Hospital, Affiliated Hospital Of Hubei University of Arts and Science
| | - Hao Duan
- Department of Orthopedics, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hao Yang
- Department of Orthopedics, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qing Li
- Department of Orthopedics, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Fei He
- Department of Orthopedics, the First Affiliated Hospital of Kunming Medical University, Kunming, China.
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Suh DH, Kim HJ, Park JH, Park YH, Koo BM, Choi GW. Relationship between Hallux Valgus and Pes Planus in Adult Patients. J Foot Ankle Surg 2021; 60:297-301. [PMID: 33229243 DOI: 10.1053/j.jfas.2020.06.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/29/2020] [Accepted: 06/08/2020] [Indexed: 02/03/2023]
Abstract
This study aimed to determine whether the degree of pes planus was associated with hallux valgus severity and hallux valgus surgery outcomes. A total of 122 feet were retrospectively analyzed after hallux valgus surgery. The hallux valgus angle, inter-metatarsal angle, lateral talo-first metatarsal angle, calcaneal pitch, and talonavicular coverage angle were measured. The Foot and Ankle Outcome Score and Foot Function Index were evaluated. A significant correlation between radiographic parameters of pes planus and hallux valgus severity, radiographic outcomes, Foot and Ankle Outcome Score, and Foot Function Index were not noted. The hallux valgus angle and inter-metatarsal angle changed significantly after the surgery (p < .001 and p < .001, respectively); however, a significant difference was not noted between the pes planus and non-pes planus groups (p = .279 and p = .632, respectively). A significant interaction between the time points and groups was not observed with respect to the hallux valgus angle (p = .311) and inter-metatarsal angle (p = .417). Multivariable logistic regression revealed that none of the radiographic parameters for pes planus affected hallux valgus recurrence. Pes planus in adult patients is not significantly associated with hallux valgus severity and recurrence, radiographic outcomes, or clinical scores.
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Affiliation(s)
- Dong Hun Suh
- Professor, Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan-si, South Korea
| | - Hak Jun Kim
- Professor, Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Jung Ho Park
- Professor, Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan-si, South Korea
| | - Young Hwan Park
- Professor, Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Bong Mo Koo
- Resident, Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan-si, South Korea
| | - Gi Won Choi
- Professor, Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan-si, South Korea.
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Cao X, Bai Z, Sun C, Wen J, Lin X, Sun W. Bland-Altman Analysis of Different Radiographic Measurements of the Hallux Valgus Angle and the Intermetatarsal Angle After Distal Osteotomy. Orthop Surg 2020; 12:1621-1626. [PMID: 32856421 PMCID: PMC7767682 DOI: 10.1111/os.12759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 11/29/2022] Open
Abstract
Objective The aim of the present study was to evaluate commonly used approaches for detection of radiographic angles in hallux valgus deformity patients. Methods This retrospective study was conducted in patients with hallux valgus deformity at Wangjing Hospital of China Academy of Chinese Medical Sciences from January 2016 to January 2019. The inclusion criteria were: (i) postoperative dorsoplantar weight‐bearing radiographs for the feet of patients with the hallux valgus; (ii) patients had been managed with a distal osteotomy of the first metatarsal and the osteotomized bone ends recovered. The exclusion criteria applied were as follows: (i) age > 65 years or < 18 years old; (ii) blurry image; (iii) previous history of severe foot trauma and surgery. Postoperative radiographs for hallux valgus were analyzed using six methods: by a line drawn through the long axis of the first metatarsal bone (method 1); an extended line drawn to bisect the shaft of the metatarsal at two levels with joined points of bisection (method 2); a line drawn to connect the center of the articular surface of the metatarsal head and the center of the proximal articulation (method 3); a line drawn from the center of the head of the first metatarsal head through the center of the base of the first metatarsal bone (method 4); a line drawn through the center of the head and the center of the proximal shaft (method 5); and a line drawn from the center of the head of the first metatarsal head through the center of the proximal articulation (method 6). The measurement results obtained were subjected to Bland–Altman analysis and consistency evaluation. Results A total number of 20 radiographs were collected for measurement. No statistically significant differences were found in the measurement values among the six methods (P > 0.05). The lowest values of the average measurement, standard deviation, and confidence interval were established in method 3, followed by those in methods 1 and 4. The standard deviation of the measurement value and the confidence interval in method 2 were the largest. Methods 1 and 4 had similar confidence intervals and were with a high consistency. Due to the nature of the retrospective study, no follow‐up and complications were applicable in the present study. Conclusion Line drawn through the long axis of the first metatarsal bone (method 1) and line drawn from the center of the head of the first metatarsal head through the center of the base of the first metatarsal bone (method 4) were reliable and well repeatable, and may be used for postoperative radiographs.
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Affiliation(s)
- Xuhan Cao
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Zixing Bai
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Chengyi Sun
- Beijing University of Chinese Medicine, Beijing, China
| | - Jianmin Wen
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Xinxiao Lin
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Weidong Sun
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
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Radiographic Sagittal Tibio-Talar Offset in Ankle Arthrodesis-Accuracy and Reliability of Measurements. J Clin Med 2020; 9:jcm9030801. [PMID: 32187992 PMCID: PMC7141366 DOI: 10.3390/jcm9030801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/27/2020] [Accepted: 03/14/2020] [Indexed: 11/17/2022] Open
Abstract
Radiographic outcome assessment of ankle arthrodesis (AA) requires accurate measurement techniques. This study aimed to identify the most reliable methods for sagittal tibio-talar alignment measurements with regard to the tibio-talar offset after AA. Lateral weight-bearing radiographs of 38 fused ankles were selected for retrospective review. The sagittal tibio-talar angle (STTA), the modified tibio-talar ratio (mT-T ratio) and the sagittal tibio-talar offset (tibCOR, procLAT) were measured by three independent observers. Intra- and interobserver correlation coefficients (ICC) and mean measurement differences were calculated to assess measurement reliability and accuracy. By defining the talar longitudinal axis as a line from the inferior aspect of the posterior tubercle of the talus to the most inferior aspect of the talar neck, STTA showed excellent (ICC 0.924; CI 95% 0.862–0.959) and mTT-ratio provided high (ICC 0.836; CI 95% 0.721–0.909) interobserver reliability, respectively. For tibio-talar offset measurement the tibCOR method showed superior reliability and better interobserver agreement compared to the procLAT technique. The STTA and a modified T-T ratio are recommended for future scientific radiographic measurements in AA.
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van Deventer SJ, Strydom A, Saragas NP, Ferrao PNF. Morphology of the first metatarsal head as a risk factor for hallux valgus interphalangeus. Foot Ankle Surg 2020; 26:105-109. [PMID: 30630719 DOI: 10.1016/j.fas.2018.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 11/18/2018] [Accepted: 12/14/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aetiology of hallux valgus interphalangeus (HVI) is not well understood. First metatarsophalangeal joint stability, influenced by first metatarsal head shape, may be linked to HVI. We hypothesised that first metatarsal head shape is a risk factor for HVI. No published article could be found in the literature investigating this hypothesis. METHODS 127 standardised foot radiographs were analysed retrospectively. The hallux valgus angle (HVA) and interphalangeus angle (IPA) were measured. The first metatarsal head shape was divided into chevron, round and flat groups. Statistical analysis was then performed to investigate the relationship between first metatarsal head shape and the occurrence of HVI. RESULTS There was no statistically significant relationship between first metatarsal head shape and the occurrence of HVI. There was however a negative relationship between HVA and HVI. CONCLUSIONS The morphology of the first metatarsal head does not seem to be a risk factor for HVI. A known negative relationship between HVA and IPA is reinforced. LEVEL OF EVIDENCE Level III, retrospective cohort.
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Affiliation(s)
- Stephanus Johannes van Deventer
- The Orthopaedic Foot and Ankle Unit, Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa.
| | - Andrew Strydom
- The Orthopaedic Foot and Ankle Unit, Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa; Netcare Sunninghill Hospital, Johannesburg, South Africa.
| | - Nikiforos Pandelis Saragas
- The Orthopaedic Foot and Ankle Unit, Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa; The Orthopaedic Foot and Ankle Unit, Netcare Linksfield Hospital, Johannesburg, South Africa
| | - Paulo Norberto Faria Ferrao
- The Orthopaedic Foot and Ankle Unit, Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa; The Orthopaedic Foot and Ankle Unit, Netcare Linksfield Hospital, Johannesburg, South Africa
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Li HT, Bao BX, Zhang JZ. Effects of Single-Foot Centered and Double-Foot Centered X-ray Projection on Hallux Valgus Measurement. Orthop Surg 2019; 12:94-99. [PMID: 31840344 PMCID: PMC7031610 DOI: 10.1111/os.12588] [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: 05/15/2019] [Revised: 11/13/2019] [Accepted: 11/17/2019] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate whether use of single‐foot centered and double‐foot centered weight‐bearing X‐rays has an impact on the relevant indicators of hallux valgus. Methods A total of 55 female patients from the Department of Ankle Surgery of Beijing Tongren Hospital with hallux valgus (110 feet) were collected from September to December 2015. The age of these patients ranged from 18 to 43 years, with an average age of 47.9 ± 8.5 years. All selected patients fit the diagnostic criteria of hallux valgus and had weight‐bearing single foot centered and double foot centered radiographs taken. During the projection, all patients were instructed to stand on the X‐ray box, with the knee joint straightened and legs perpendicular to the floor. The projection center of the single foot was directed at the lateral part of the scaphoid bone of the foot, while the projection center was directed at the position between the scaphoid bones of both feet for the double‐foot shooting. The hallux valgus angle (HAV), the intermetatarsal angle between the first and second metatarsals (IMA), the intermetatarsal angle between the first and fifth metatarsals (IM1‐5), and the metatarsal adduction angle (MAA) were measured and examined. The difference between these two shooting conditions was compared and analyzed. Results The differences in X‐ray measurement results (IMA, HAV, IM1‐5, and MMA) between different measures for the same patient were not statistically significant. The values of HAV, IMA, IM1‐5, and MAA are common indexes for evaluating hallux valgus. The average IMA was 15.9° for single‐foot centered and 14.1° for double‐foot centered X‐rays. The average HAV was 30.2° for single‐foot centered and 29.7° for double‐foot centered X‐rays. The average IM1‐5 was 31.1° for single‐foot centered and 29.7° for double‐foot centered X‐rays. The average of metatarsal adduction angle was 13.8° for single‐foot centered and 14.1° for double‐foot centered X‐rays. The differences between single‐foot centered and double‐foot centered X‐rays were statistically significant in terms of the measurement index (P < 0.05). In addition, compared with double‐foot centered weight‐bearing X‐rays, the focus of single‐foot centered X‐rays was located on the lateral part of the scaphoid bone of the foot, and the ray was closer to the vertical foot in the single‐foot centered weight‐bearing X‐ray. Conclusion When the weight‐bearing position and projection distance are the same, the single‐foot centered weight‐bearing X‐ray is more effective in evaluating the severity of hallux valgus compared with the double‐foot centered weight‐bearing X‐ray.
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Affiliation(s)
- Hai-Tao Li
- Department of Orthopaedics, Tongren Hospital of China Capital Medical University, Beijing, China
| | - Bei-Xi Bao
- Department of Orthopaedics, Tongren Hospital of China Capital Medical University, Beijing, China
| | - Jian-Zhong Zhang
- Department of Orthopaedics, Tongren Hospital of China Capital Medical University, Beijing, China
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Sung IH, Kim KC, Kim SJ, Sung CH, Lee JH, Choi Y. Digital Measurements With Hallux Valgus Before and After Modified Long Oblique Osteotomy. J Foot Ankle Surg 2019; 58:458-464. [PMID: 30773251 DOI: 10.1053/j.jfas.2018.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Indexed: 02/03/2023]
Abstract
Radiographic measurements of the hallux valgus (HV) angle (HVA) and the first intermetatarsal angle (IMA1-2) are important for assessing the severity of HV. The purpose of the present study was to digitally investigate the intraobserver and interobserver reliability of various methods for measuring HVA and IMA1-2, as well as each axis composing them, such as axes of the first proximal phalanx (PP1), the first metatarsal (MT1), and the second metatarsal (MT2) in patients with a metatarsal shaft osteotomy-modified long oblique osteotomy. Three orthopedic surgeons measured the HVA, IMA1-2, and the angles between axes of PP1, MT1, and MT2, and the digitally-set reference line (α, β, and γ, respectively) using 6 different methods for 39 patients with a minimum of 1 year of follow-up after operative treatment. The intraobserver and interobserver intraclass correlation coefficients (ICC) and agreements were calculated. Significant differences were observed within the methods with regard to preoperative HVA, IMA1-2, α, and β, and postoperative IMA1-2 and β. Intraobserver and interobserver ICC were high or very high in most methods. For HVA and IMA1-2, the method connecting the center of the head through the center of the base showed the highest agreement. For α, β, and γ, this method showed the highest agreement, more than 80% intraobserver and interobserver agreement and a discrepancy of <2°. A digital method connecting the center of the head through the center of the base was regarded as the least variable for the HV evaluation and the assessment of the radiographic results in a metatarsal shaft osteotomy-modified long oblique osteotomy.
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Affiliation(s)
- Il-Hoon Sung
- Professor, Department of Orthopaedic Surgery, Hanyang University Medical Center, Seoul, South Korea
| | - Ki Chun Kim
- Surgeon, Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, South Korea.
| | - Sung-Jae Kim
- Assistant Professor, Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do, South Korea
| | - Chang Ho Sung
- Surgeon, Department of Orthopaedic Surgery, Hanyang University Medical Center, Seoul, South Korea
| | - Jung-Hwan Lee
- Surgeon, Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Yountaek Choi
- Resident, Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, South Korea
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17
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Montiel V, Alfonso M, Villas C, Valentí A. Medial and lateral exostoses of the distal phalanx of the hallux: A potentially painful bunion-like structure. Part 1: Incidence and clinical application. Foot Ankle Surg 2019; 25:158-164. [PMID: 29409186 DOI: 10.1016/j.fas.2017.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/20/2017] [Accepted: 10/10/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Exostoses at the base of the distal phalanx of the great toe are usually asymptomatic. The literature has not generally considered them as the origin of a possible problem resulting from a pressure conflict between hallux and shoe (medial aspect) or second toe (lateral aspect) nor a potential complication of surgical correction of hallux valgus deformity. No studies, to our knowledge, have evaluated its possible correlation with other foot disorders. When one of these neglected exostoses became painful after surgical correction of hallux valgus, we decided to start a study to determine their possible origin, prevalence in daily practice and histo-pathological morphology. METHODS Two hundred and fifty-four feet of patients (average age 41.7y.) were enrolled in the study from January 2007 to June 2009. Dorsoplantar weight-bearing radiographs were used to analyze the presence of exostoses and their correlation with the distal phalanx morphology, metatarsal formula (or transverse plane orientation of the metatarsal heads parabola) and hallux valgus angles. Patients were classified according to their age and main symptom for consultation. Four exostoses removed from cadaver feet were also analyzed microscopically. RESULTS Osseous excrescences arising on the medial or lateral aspect at the proximal part of the terminal phalanx of the hallux were observed in 132 feet (51.9%). Thirty-five feet out of these 132 (13.7%) had exostoses on both sides of the phalanx.A statistically significant positive correlation was found between the presence of a medial exostosis of the phalanx and the severity of HVA. Patients with higher IPH and asymmetry angles have a lower prevalence of medial exostoses (p<0.05). Amongst the different morphologies of the second phalanx, exostoses were most likely found in the standard form. CONCLUSIONS Prevalence of exostoses at the base of the distal phalanx is high (51.9% of the studied feet). Histological findings would suggest that these exostoses could be considered a mechanical reactive process, produced by a chronic irritation by shoes. We encourage surgeons to be aware of its potential clinical implications. Direct resection is very simple and the most appropriate treatment for symptomatic cases.
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Affiliation(s)
- V Montiel
- Dpto de COT, Clínica Univeristaria de Navarra, Avda Pio XII 36, 31008 Pamplona, Spain.
| | - M Alfonso
- Dpto de COT, Clínica Univeristaria de Navarra, Avda Pio XII 36, 31008 Pamplona, Spain
| | - C Villas
- Dpto de COT, Clínica Univeristaria de Navarra, Avda Pio XII 36, 31008 Pamplona, Spain
| | - A Valentí
- Dpto de COT, Clínica Univeristaria de Navarra, Avda Pio XII 36, 31008 Pamplona, Spain
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Weightbearing Digital Tomosynthesis of Foot and Ankle Arthritis: Comparison With Radiography and Simulated Weightbearing CT in a Prospective Study. AJR Am J Roentgenol 2019; 212:173-179. [DOI: 10.2214/ajr.18.20072] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Shibuya N, Kyprios EM, Panchani PN, Martin LR, Thorud JC, Jupiter DC. Factors Associated With Early Loss of Hallux Valgus Correction. J Foot Ankle Surg 2018; 57:236-240. [PMID: 29254849 DOI: 10.1053/j.jfas.2017.08.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/08/2017] [Indexed: 02/03/2023]
Abstract
Recurrence is common after hallux valgus corrective surgery. Although many investigators have studied the risk factors associated with a suboptimal hallux position at the end of long-term follow-up, few have evaluated the factors associated with actual early loss of correction. We conducted a retrospective cohort study to identify the predictors of lateral deviation of the hallux during the postoperative period. We evaluated the demographic data, preoperative severity of the hallux valgus, other angular measurements characterizing underlying deformities, amount of hallux valgus correction, and postoperative alignment of the corrected hallux valgus for associations with recurrence. After adjusting for the covariates, the only factor associated with recurrence was the postoperative tibial sesamoid position. The recurrence rate was ~50% and ~60% when the postoperative tibial sesamoid position was >4 and >5 on the 7-point scale, respectively.
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Affiliation(s)
- Naohiro Shibuya
- Professor, Department of Surgery, Texas A&M University, College of Medicine, Bryan, TX; Chief, Section of Podiatry, Central Texas Veterans Health Care System, Temple, TX; Staff, Baylor Scott and White Health Care System, Temple, TX.
| | - Evangelos M Kyprios
- Podiatric Medicine and Surgery Resident, Scott and White Health Care System, Texas A&M Health Science Center, Temple, TX
| | - Prakash N Panchani
- Podiatric Medicine and Surgery Resident, Scott and White Health Care System, Texas A&M Health Science Center, Temple, TX
| | - Lanster R Martin
- Podiatric Medicine and Surgery Resident, Scott and White Health Care System, Texas A&M Health Science Center, Temple, TX
| | - Jakob C Thorud
- Staff, Baylor Scott and White Health Care System, Temple, TX; Staff, Section of Podiatry, Surgical Services, Central Texas Veterans Health Care System, Temple, TX
| | - Daniel C Jupiter
- Associate Professor, Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX
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Bock P, Pittermann M, Chraim M, Rois S. The inter- and intraobserver reliability for the radiological parameters of flatfoot, before and after surgery. Bone Joint J 2018; 100-B:596-602. [PMID: 29701104 DOI: 10.1302/0301-620x.100b5.bjj-2017-1279] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Various radiological parameters are used to evaluate a flatfoot deformity and their measurements may differ. The aims of this study were to answer the following questions: 1) Which of the 11 parameters have the best inter- and intraobserver reliability in a standardized radiological setting? 2) Are pre- and postoperative assessments equally reliable? 3) What are the identifiable sources of variation? Patients and Methods Measurements of the 11 parameters were recorded on anteroposterior and lateral weight-bearing radiographs of 38 feet before and after surgery for flatfoot, by three observers with different experience in foot surgery (A, ten years; B, three years; C, third-year orthopaedic resident). The inter- and intraobserver reliability was calculated. Results Preoperative interobserver reliability was high for four, moderate for five, and low for two parameters. Postoperative interobserver reliability was high for four, moderate for five, and low for two parameters. Intraobserver reliability was excellent for all parameters preoperatively as recorded by observer A (PB) and B (MP), and for eight parameters as recorded by observer C (SR). Intraobserver reliability was excellent for ten parameters postoperatively as recorded by observer A and B, and for eight parameters as recorded by observer C. Conclusion The following parameters can be recommended. For preoperative and postoperative evaluation of flatfoot: anteroposterior, talonavicular coverage angle; lateral, talometatarsal I angle, calcaneal pitch angle, and cuneiform-medial height (high interobserver reliability); and anteroposterior, talometatarsal II angle; lateral, talocalcaneal angle,tibiocalcaneal angle (moderate interobserver reliability). For more experienced observers, we also recommend the anteroposterior talometatarsal I angle (moderate reliability). The inter- and intraobserver reliability for most parameters were similar pre- and postoperatively. The experience of the observer and the definition and ability to measure the parameters themselves were sources of variation. Cite this article: Bone Joint J 2018;100-B:596-602.
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Affiliation(s)
- P Bock
- Orthopaedic Hospital Speising, Vienna, Austria
| | | | - M Chraim
- Orthopaedic Hospital Wien Speising, Vienna, Austria
| | - S Rois
- Landes-Krankenhaus Freistadt, Freistadt, Austria
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Jo YH, Park KC, Song YS, Sung IH. Comparison of outcomes according to fixation technique following the modified Ludloff osteotomy for hallux valgus in patients with rheumatoid arthritis. BMC Musculoskelet Disord 2017; 18:371. [PMID: 28841865 PMCID: PMC5574211 DOI: 10.1186/s12891-017-1729-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 08/16/2017] [Indexed: 12/04/2022] Open
Abstract
Background Clinical and radiological outcomes including fixation stability of osteotomy site were compared in rheumatoid arthritis (RA) patients who underwent modified Ludloff osteotomy to correct hallux valgus with osteotomy site fixation using two screws versus those who underwent additional fixation using a plate. Methods The fixation technique performed with two screws was used to fix the osteotomy sites following modified Ludloff osteotomy in 15 patients (15 feet, Group S), while the augmented plate fixation technique was used in 14 patients (16 feet, Group P). Surgical outcomes were analysed using the American Orthopedic Foot and Ankle Society (AOFAS) scores, and radiologic parameters measured before surgery and during follow-up examinations. To evaluate the stability of each osteotomy site fixation technique, the 1–2 inter-metatarsal angle (IMA) and angle of the altered margin of the lateral cortex (AMLC) were measured immediately and 6 weeks after surgery, and variations in the angles were compared. In addition, bone mineral density (BMD) values were compared between patients with correction loss at the osteotomy site and those with no loss of correction. Results No significant differences between groups were found for total AOFAS scores before surgery and at the final follow-up. However, significant differences were observed in the 1–2 IMA, beginning at 6 weeks postoperatively and continuing through the final follow-up. The 1–2 IMA and angle of AMLC measured immediately after and 6 weeks after surgery showed significantly greater variation in Group S than in Group P. In Group S, patients with correction loss (5 feet) at osteotomy site showed significantly lower BMD values than those with no loss of correction (10 feet). Despite the lower BMD values of patients in Group P than in Group S, a loss of correction did not occur in these patients. Conclusions Correction loss occurred at the osteotomy site within 6 weeks postoperatively in patients who underwent fixation using only the two-screw fixation technique following modified Ludloff osteotomy; such loss could be reduced using the augmented plate fixation technique even in patients with osteoporosis.
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Affiliation(s)
- Young-Hoon Jo
- Department of Orthopaedic Surgery, Hanyang University College of Medicie, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Ki-Chul Park
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital, 153 Kyoungchun-ro, Guri-si, Gyeonggi-do, 11923, Republic of Korea
| | - Young-Sik Song
- Department of Orthopaedic Surgery, Hanyang University College of Medicie, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Il-Hoon Sung
- Department of Orthopaedic Surgery, Hanyang University College of Medicie, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
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Abstract
BACKGROUND Hallux valgus is the lateral deviation of the great toe at the MTPJ that has many attributing aetiologies. This study will aim to identify whether hallux valgus progresses over time in the oriental Chinese population in Hong Kong. METHODS Patients with acquired symptomatic hallux valgus who presented to clinic between 2008 and 2013 were included. The deformities were analysed radiologically at presentation and pre-operative and angles were measured. These angles were analysed in relation to the waiting time from presentation to surgery. RESULTS A sample of 43 cases from 38 patients (Mean age 63 years, range 48-80 years) were included. Forty-one cases had a hallux valgus angle (HVA) >24° at presentation (Mean 40.4°) and all had an intermetatarsal angle (IMA) >9°. A significant difference is seen with HVA (p=0.040, t=-2.128) at presentation and pre-op but not IMA (p=0.281, t=-1.095). The average wait for surgery was 705.7days which had shown significant correlation with progression in HVA (p=0.031). No significant difference was seen between IMA and waiting time to surgery (p=0.195). DISCUSSION The findings suggests severe hallux valgus deformity does progress over time in Hong Kong. Shorter waiting times for surgery could be beneficial to this population. Level III, retrospective comparative series.
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Affiliation(s)
- Kenneth Kin-Hoo Koo
- Central Manchester Foundation Trust, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom.
| | - Lung Fung Tse
- The Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong.
| | - Hi Shan Cheng
- The Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong
| | - Kevin Ki Wai Ho
- The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong.
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Lee M, Walsh J, Smith MM, Ling J, Wines A, Lam P. Hallux Valgus Correction Comparing Percutaneous Chevron/Akin (PECA) and Open Scarf/Akin Osteotomies. Foot Ankle Int 2017; 38:838-846. [PMID: 28476096 DOI: 10.1177/1071100717704941] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Minimally invasive surgery is being used increasingly, including for hallux valgus surgery. Despite the growing interest in minimally invasive procedures, there have been few publications on percutaneous chevron/akin (PECA) procedures, and no studies have been published comparing PECA to open scarf/akin osteotomies (SA). METHODS This was a prospective, randomized study of 50 patients undergoing operative correction of hallux valgus using one of 2 techniques (PECA vs open SA). Data were collected preoperatively and on 1 day, 2 weeks, 6 weeks, and 6 months postoperatively. Outcome measures include the American Orthopaedic Foot & Ankle Society Hallux-Metatarsophalangeal-Interphalangeal (AOFAS-HMI) Score, visual analog pain score, hallux valgus angle (HVA), and 1-2 intermetatarsal angle (IMA). Twenty-five patients underwent PECA procedures and 25 patients received SA procedures. RESULTS Both groups showed significantly improved AOFAS-HMI scores after surgery (PECA group: 61.8 to 88.9, SA group: 57.3 to 84.1, P = .560) with comparable final scores. HVA and IMA also presented similar outcomes at final follow-up ( P = .520 and P = .270, respectively). However, the PECA group showed significantly lower pain level (VAS) in the early postoperative phase (postoperative day 1 to postoperative week 6, P < .001 and P = .004, respectively). No serious complications were observed in either group. CONCLUSION Both groups showed comparable good to excellent clinical and radiologic outcomes at final follow-up. However, the PECA group had significantly less pain in the first 6 weeks following surgery. Level of Evidence Level II, prospective comparative study.
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Affiliation(s)
- Moses Lee
- 2 Department of Orthopaedic Surgery, Ilsan Paik Hospital, South Korea
| | - James Walsh
- 3 Cappagh National Orthopaedic Hospital, Dublin, Ireland
| | - Margaret M Smith
- 4 Kolling Institute of Bone and Joint Research, University of Sydney, St Leonards, New South Wales, Australia
| | - Jeff Ling
- 5 Sydney Orthopaedic Specialist, Randwick, Australia
| | - Andrew Wines
- 6 North Sydney Orthopaedic and Sports Medicine Centre, St Leonards, New South Wales, Australia
| | - Peter Lam
- 1 Orthopaedic and Arthritis Specialist Centre, Chatswood, Sydney, Australia
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Park CH, Lee WC. Recurrence of Hallux Valgus Can Be Predicted from Immediate Postoperative Non-Weight-Bearing Radiographs. J Bone Joint Surg Am 2017; 99:1190-1197. [PMID: 28719558 DOI: 10.2106/jbjs.16.00980] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aims of this study were to identify risk factors for the recurrence of hallux valgus deformity and to clarify whether recurrence after surgery to treat hallux valgus can be predicted using radiographic parameters assessed on immediate postoperative non-weight-bearing radiographs. METHODS A proximal chevron osteotomy combined with a distal soft-tissue procedure was performed by a single surgeon to treat moderate to severe hallux valgus deformity in 93 patients (117 feet). The feet were grouped according to nonrecurrence or recurrence. Changes in the hallux valgus angle, the intermetatarsal angle, and sesamoid position over time were analyzed by comparing values measured during each postoperative period. The relative risks of recurrence as indicated by preoperative and postoperative radiographic parameters were determined. RESULTS Twenty (17.1%) of the 117 feet showed hallux valgus recurrence at the time of the last follow-up. The hallux valgus angle and the intermetatarsal angle stabilized at 6 months after surgery in the nonrecurrence group. An immediate postoperative hallux valgus angle of ≥8°, an immediate postoperative sesamoid position of grade 4 or greater, a preoperative metatarsus adductus angle of ≥23°, and a preoperative hallux valgus angle of ≥40° were significantly associated with recurrence. CONCLUSIONS Recurrence of hallux valgus after a proximal chevron osteotomy can be reliably predicted from immediate postoperative non-weight-bearing radiographs. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Chul Hyun Park
- 1Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea 2Seoul Foot and Ankle Center, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
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Strydom A, Saragas NP, Ferrao PNF. A radiographic analysis of the contribution of hallux valgus interphalangeus to the total valgus deformity of the hallux. Foot Ankle Surg 2017; 23:27-31. [PMID: 28159039 DOI: 10.1016/j.fas.2015.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/09/2015] [Accepted: 12/18/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The hallux valgus interphalangeus (HVI) deformity is described as rare, but improved outcomes in hallux valgus (HV) surgery is associated with its surgical correction via an Akin osteotomy. The hypothesis of this study is that HVI is common and makes a significant contribution to the total valgus deformity of the hallux (TVDH). METHODS 285 pre-operative foot radiographs (193 with HV, 92 non-HV), utilising standardised radiographic and measurement techniques, were analysed retrospectively. The hallux valgus angle (HVA), intermetatarsal angle (IMA), interphalangeal angle (IPA) and distal metatarsal articular angle (DMAA) were measured. The TVDH was calculated as the sum of the HVA and IPA. RESULTS 163 (57.2%) of the study population were Caucasian, 119 (41.8%) African and 3 Indian (1.0%). 236 (82.8%) of the population was female. There was a statistically significant difference in the proportion of abnormal IPA in the Caucasian population 112 (68.7%) compared to the proportion of abnormal IPA in the African population 64 (53.8%), p=0.01. The average contribution of the IPA to the TVDH across the whole study population was a mean (SD) of 37.9% (21.2). The average contribution of IPA to TVDH was greater in feet without HV (58.0%) when compared to feet with HV (28.3%). HVI is common, particularly in Caucasians (p=0.01) and makes a significant contribution to the TVDH (p<0.01). The contribution to the TVDH is more significant in mild HV. There is an inverse relationship between the IPA and other angular measurements in the foot. CONCLUSION HVI is a common entity. The significant contribution of the IPA to the TVDH dictates that HVI must be incorporated in management algorithms. The TVDH should replace the isolated concepts of HV and HVI. LEVEL OF EVIDENCE Level III, retrospective cohort.
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Affiliation(s)
- Andrew Strydom
- The Orthopaedic Foot and Ankle Unit, Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa.
| | - Nikiforos Pandelis Saragas
- The Orthopaedic Foot and Ankle Unit, Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa; The Orthopaedic Foot and Ankle Unit, Netcare Linksfield Hospital, Johannesburg, South Africa
| | - Paulo Norberto Faria Ferrao
- The Orthopaedic Foot and Ankle Unit, Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa; The Orthopaedic Foot and Ankle Unit, Netcare Linksfield Hospital, Johannesburg, South Africa
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van Groningen B, van der Steen MCM, Reijman M, Bos J, Hendriks JGE. Outcomes in chevron osteotomy for Hallux Valgus in a large cohort. Foot (Edinb) 2016; 29:18-24. [PMID: 27888787 DOI: 10.1016/j.foot.2016.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 09/18/2016] [Indexed: 02/04/2023]
Abstract
Clinical and radiological related outcomes have been reported for Chevron osteotomy as correction for mild to moderate hallux valgus, but only for relatively small patient series. Moreover, evaluation of the patient's point of view has mostly been conducted by means of more physician-based outcome measures. The goal of this study was to evaluate the effect of the Chevron osteotomy for hallux valgus on patients' daily lives using the Foot and Ankle Outcome Score (FAOS) as a validated and a hallux valgus specific patient reported outcome measure (PROM). Secondary outcome measures were radiological correction, complication rate, and re-operations. All 438 Chevron procedures (336 patients), at two surgical hospital sites in the period between January 2010 and October 2014, were retrospectively evaluated with a follow-up of at least 6 months. Patients were invited to fill in a cross-sectional online FAOS. For the FAOS, a total response of 60% was achieved. The FAOS ranged between 71 and 88 with a follow-up of on average 36 months. Patients with an undercorrection of their hallux valgus (11.6% of the procedures) scored significantly lower on three subscales of the FAOS (range between 61 and 77 versus 72-84). Patients who had a reoperation (12.6% of the procedures) also scored significantly lower on four subscales: 58-100 versus 73-89. Postoperative radiological measurements improved significantly with a mean difference of 6.1 (5.9; 6.4) degrees for the intermetatarsal angle and 13.7 (13.0; 14.5) degrees for the hallux valgus angle. In this large study cohort, Chevron osteotomy for hallux valgus offers good PROM scores on FAOS. These scores were significantly lower in patients with radiological undercorrection or with a reoperation. Results of the FAOS appear to modulate with physician based outcomes and therapeutic incidents. Improvement of outcome may therefore well be possible by increased attention on these surgical details.
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Affiliation(s)
- Bart van Groningen
- Orthopaedic Center Máxima, Máxima Medical Center, Postbus 90052, 5600 PD Eindhoven, The Netherlands.
| | - M C Marieke van der Steen
- Department of Orthopaedic Surgery, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA Eindhoven, The Netherlands
| | - Max Reijman
- Orthopaedic Center Máxima, Máxima Medical Center, Postbus 90052, 5600 PD Eindhoven, The Netherlands
| | - Janneke Bos
- Department of Orthopaedic Surgery, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA Eindhoven, The Netherlands
| | - Johannes G E Hendriks
- Orthopaedic Center Máxima, Máxima Medical Center, Postbus 90052, 5600 PD Eindhoven, The Netherlands; Department of Orthopaedic Surgery, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA Eindhoven, The Netherlands
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Jeyaseelan L, Chandrashekar S, Mulligan A, Bosman HA, Watson AJS. Correction of moderate to severe hallux valgus with combined proximal opening wedge and distal chevron osteotomies: a reliable technique. Bone Joint J 2016; 98-B:1202-7. [PMID: 27587521 DOI: 10.1302/0301-620x.98b9.35984] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 04/19/2016] [Indexed: 11/05/2022]
Abstract
AIMS The mainstay of surgical correction of hallux valgus is first metatarsal osteotomy, either proximally or distally. We present a technique of combining a distal chevron osteotomy with a proximal opening wedge osteotomy, for the correction of moderate to severe hallux valgus. PATIENTS AND METHODS We reviewed 45 patients (49 feet) who had undergone double osteotomy. Outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) and the Short Form (SF) -36 Health Survey scores. Radiological measurements were undertaken to assess the correction. The mean age of the patients was 60.8 years (44.2 to 75.3). The mean follow-up was 35.4 months (24 to 51). RESULTS The mean AOFAS score improved from 54.7 to 92.3 (p < 0.001) and the mean SF-36 score from 59 to 86 (p < 0.001). The mean hallux valgus and intermetatarsal angles were improved from 41.6(o) to 12.8(o) (p < 0.001) and from 22.1(o) to 7.1(o), respectively (p < 0.001). The mean distal metatarsal articular angle improved from 23(o) to 9.7(o). The mean sesamoid position, as described by Hardy and Clapham, improved from 6.8 to 3.5. The mean length of the first metatarsal was unchanged. The overall rate of complications was 4.1% (two patients). CONCLUSION These results suggest that a double osteotomy of the first metatarsal is a reliable, safe technique which, when compared with other metatarsal osteotomies, provides strong angular correction and excellent outcomes with a low rate of complications. Cite this article: Bone Joint J 2016;98-B:1202-7.
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Affiliation(s)
- L Jeyaseelan
- Princess Alexandra Hospital, Hamstel Rd, Harlow CM20 1QX, UK
| | - S Chandrashekar
- Princess Alexandra Hospital, Hamstel Rd, Harlow CM20 1QX, UK
| | - A Mulligan
- Barts and the London NHS Trust, Whitechapel Rd, London, Whitechapel E1 1BB, UK
| | - H A Bosman
- Homerton NHS Trust, Homerton Row, London E9, UK
| | - A J S Watson
- Princess Alexandra Hospital, Hamstel Rd, Harlow CM20 1QX, UK
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Ginés-Cespedosa A, Pérez-Prieto D, Muñetón D, González-Lucena G, Millán A, de Zabala S, Busquets R. Influence of Hindfoot Malalignment on Hallux Valgus Operative Outcomes. Foot Ankle Int 2016; 37:842-7. [PMID: 27103656 DOI: 10.1177/1071100716645403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hindfoot deformity has been described as a risk factor for poor hallux valgus (HV) surgery outcomes. However, there has been no study that demonstrates it. The purpose of this investigation was to evaluate the influence of hindfoot misalignment in HV surgery results. METHODS All patients operated on for HV during 2010 and 2011 at 3 university hospitals were included. The preoperative and 2-year postoperative radiologic data included the HV and the intermetatarsal (IM) angles, the naviculocuboid overlap (NC), the talonavicular coverage (TN) angle, the talus-first metatarsal (T-1MT) angle, as well as the calcaneal pitch (CP) angle. Additionally, the Short Form-36 questionnaire version 2.0 (SF-36) and the American Orthopaedic Foot & Ankle Society (AOFAS) score, satisfaction and recurrence were also analyzed. A total of 207 met the inclusion criteria. There were 26 patients (12.6%) who could not be assessed at the 2-year follow-up. Patients were allocated to a varus, normal, or a valgus hindfoot tertile using the values for the CP, NC, TN, and T-1MT angles. RESULTS No significant differences (P > .05) were found between the groups when the HV or IM angles, AOFAS, SF-36 Mental Composite Scale, SF-36 Physical Composite Scale, or satisfaction were compared. Similarly, no significant and strong correlations were observed (P > .05, ρ < 0.3) between any of the mentioned hindfoot measures and the outcomes scales. CONCLUSION No influence of hindfoot misalignment on HV surgery outcomes was found in the present study in terms of correction, pain, function, satisfaction, or quality of life. Patients with hindfoot misalignment did not obtain worse outcomes in HV surgery. LEVEL OF EVIDENCE Level II, prognostic, comparative study.
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Affiliation(s)
| | - Daniel Pérez-Prieto
- Orthopedic Department, Hospital del Mar. Universitat Autónoma de Barcelona, Spain
| | - David Muñetón
- Orthopedic Department, Hospital Vall d'Hebron. Barcelona, Spain
| | | | - Angelica Millán
- Orthopedic Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Santiago de Zabala
- Orthopedic Department, Hospital del Mar. Universitat Autónoma de Barcelona, Spain
| | - Rosa Busquets
- Orthopedic Department, Hospital Vall d'Hebron. Barcelona, Spain
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Seo JH, Ahn JY, Boedijono D. Point-Connecting Measurements of the Hallux Valgus Deformity: A New Measurement and Its Clinical Application. Yonsei Med J 2016; 57:741-7. [PMID: 26996576 PMCID: PMC4800366 DOI: 10.3349/ymj.2016.57.3.741] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/14/2015] [Accepted: 08/28/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to investigate new point-connecting measurements for the hallux valgus angle (HVA) and the first intermetatarsal angle (IMA), which can reflect the degree of subluxation of the first metatarsophalangeal joint (MTPJ). Also, this study attempted to compare the validity of midline measurements and the new point-connecting measurements for the determination of HVA and IMA values. MATERIALS AND METHODS Sixty feet of hallux valgus patients who underwent surgery between 2007 and 2011 were classified in terms of the severity of HVA, congruency of the first MTPJ, and type of chevron metatarsal osteotomy. On weight-bearing dorsal-plantar radiographs, HVA and IMA values were measured and compared preoperatively and postoperatively using both the conventional and new methods. RESULTS Compared with midline measurements, point-connecting measurements showed higher inter- and intra-observer reliability for preoperative HVA/IMA and similar or higher inter- and intra-observer reliability for postoperative HVA/IMA. Patients who underwent distal chevron metatarsal osteotomy (DCMO) had higher intraclass correlation coefficient for inter- and intra-observer reliability for pre- and post-operative HVA and IMA measured by the point-connecting method compared with the midline method. All differences in the preoperative HVAs and IMAs determined by both the midline method and point-connecting methods were significant between the deviated group and subluxated groups (p=0.001). CONCLUSION The point-connecting method for measuring HVA and IMA in the subluxated first MTPJ may better reflect the severity of a HV deformity with higher reliability than the midline method, and is more useful in patients with DCMO than in patients with proximal chevron metatarsal osteotomy.
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Affiliation(s)
- Jeong-Ho Seo
- Department of Orthopaedic Surgery, Dong-A University Medical Center, College of Medicine, Dong-A University, Busan, Korea
| | - Ji-Yong Ahn
- Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea.
| | - Dimas Boedijono
- Department of Orthopaedic & Traumatology, Foot and Ankle, Musculoskeletal Clinic, Fatmawati General Hospital, Jakarta, Indonesia
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Willegger M, Holinka J, Nemecek E, Bock P, Wanivenhaus AH, Windhager R, Schuh R. Reliability of the Radiographic Sagittal and Frontal Tibiotalar Alignment after Ankle Arthrodesis. PLoS One 2016; 11:e0154224. [PMID: 27124403 PMCID: PMC4849723 DOI: 10.1371/journal.pone.0154224] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 04/10/2016] [Indexed: 11/18/2022] Open
Abstract
Background Accurate measurement of the tibiotalar alignment is important in radiographic outcome assessment of ankle arthrodesis (AA). In studies, various radiological methods have been used to measure the tibiotalar alignment leading to facultative misinterpretation of results. However, to our knowledge, no previous study has investigated the reliability of tibiotalar alignment measurement in AA. We aimed to investigate the reliability of four different methods of measurement of the frontal and sagittal tibiotalar alignment after AA, and to further clarify the most reliable method for determining the longitudinal axis of the tibia. Methods Thirty-eight weight bearing anterior to posterior and lateral ankle radiographs of thirty-seven patients who had undergone AA with a two screw fixation technique were selected. Three observers measured the frontal tibiotalar angle (FTTA) and the sagittal tibiotalar angle (STTA) using four different methods. The methods differed by the definition of the longitudinal tibial axis. Method A was defined by a line drawn along the lateral tibial border in anterior to posterior radiographs and along the posterior tibial border in lateral radiographs. Method B was defined by a line connecting two points in the middle of the proximal and the distal tibial shaft. Method C was drawn „freestyle”along the longitudinal axis of the tibia, and method D was defined by a line connecting the center of the tibial articular surface and a point in the middle of the proximal tibial shaft. Intra- and interobserver correlation coefficients (ICC) and repeated measurement ANOVA were calculated to assess measurement reliability and accuracy. Results All four methods showed excellent inter- and intraobserver reliability for the FTTA and the STTA. When the longitudinal tibial axis is defined by connecting two points in the middle of the proximal and the distal tibial shaft, the highest interobserver reliability for the FTTA (ICC: 0.980; CI 95%: 0.966–0.989) and for the STTA (ICC: 0.997; CI 95%: 0.996–0.999) is provided. Intergroup analysis for FTTA measurements revealed a statistically significant difference between the method in which the lateral border of the tibia was used to determine the longitudinal axis of the tibia, and the other methods in which the longitudinal axis was defined by bisecting the tibia. Conclusions When the longitudinal axis of the tibia is defined by connecting two points in the middle of the proximal and the distal tibial shaft for measuring the FTTA and STTA, the most favorable interobserver reliability is provided. Therefore, this method can be recommended for evaluating the frontal and the sagittal alignment on anterior to posterior and lateral radiographs after ankle arthrodesis.
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Affiliation(s)
- Madeleine Willegger
- Department of Orthopaedics, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Johannes Holinka
- Department of Orthopaedics, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Elena Nemecek
- Department of Orthopaedics, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Peter Bock
- Foot and Ankle Unit, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - Axel Hugo Wanivenhaus
- Department of Orthopaedics, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedics, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Reinhard Schuh
- Department of Orthopaedics, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
- * E-mail:
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Choi GW, Kim HJ, Kim TS, Chun SK, Kim TW, Lee YI, Kim KH. Comparison of the Modified McBride Procedure and the Distal Chevron Osteotomy for Mild to Moderate Hallux Valgus. J Foot Ankle Surg 2016; 55:808-11. [PMID: 27066871 DOI: 10.1053/j.jfas.2016.02.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Indexed: 02/03/2023]
Abstract
Distal metatarsal osteotomy and the modified McBride procedure have each been used for the treatment of mild to moderate hallux valgus. However, few studies have compared the results of these 2 procedures for mild to moderate hallux valgus. The purpose of the present study was to compare the results of distal chevron osteotomy and the modified McBride procedure for treatment of mild to moderate hallux valgus according to the severity of the deformity. We analyzed the data from 45 patients (49.5%; 48 feet [49.0%]), who had undergone an isolated modified McBride procedure (McBride group), and 46 patients (50.5%; 50 feet [51.0%]), who had a distal chevron osteotomy (chevron group). We subdivided each group into those with mild and moderate deformity and compared the clinical and radiologic outcomes between the groups in relation to the severity of the deformity. The improvements in the American Orthopaedic Foot and Ankle Society scale score and the visual analog scale for pain were significantly better for the chevron group for both mild and moderate deformity. The chevron group experienced significantly greater correction in the hallux valgus angle and intermetatarsal angle for both mild and moderate deformity. The chevron group experienced a significantly greater decrease in the grade of sesamoid displacement for patients with moderate deformity. The McBride group had a greater risk of recurrence than did the chevron group for moderate deformity (odds ratio 14.00, 95% confidence interval 3.91 to 50.06, p < .001). The results of the present study have demonstrated the superiority of the distal chevron osteotomy over the modified McBride procedure for mild to moderate deformity. For patients with moderate deformity, the McBride group had a greater risk of hallux valgus recurrence than did the distal chevron group. Therefore, we recommend distal chevron osteotomy rather than a modified McBride procedure for the treatment of mild and moderate hallux valgus.
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Affiliation(s)
- Gi Won Choi
- Clinical Assistant Professor, Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan-si, Korea
| | - Hak Jun Kim
- Professor, Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea.
| | - Taik Seon Kim
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Sung Kwang Chun
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Korea University Guro Hospital
| | - Tae Wan Kim
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Korea University Guro Hospital
| | - Yong In Lee
- Orthopaedic Surgery Resident, Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Kyoung Ho Kim
- Orthopaedic Surgery Resident, Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
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Akpinar E, Buyuk AF, Cetinkaya E, Gursu S, Ucpunar H, Albayrak A. Proximal Intermetatarsal Divergence in Distal Chevron Osteotomy for Hallux Valgus: An Overlooked Finding. J Foot Ankle Surg 2016; 55:504-8. [PMID: 26923689 DOI: 10.1053/j.jfas.2016.01.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Indexed: 02/03/2023]
Abstract
The goal of distal chevron osteotomy for hallux valgus is to restore proper first-toe joint alignment by performing lateral translation of the distal first metatarsal fragment (the metatarsal head). We hypothesized that in some patients this procedure might also result in involuntary medial translation of the proximal first metatarsal fragment, which we called proximal intermetatarsal divergence. The aim of the present study was to compare the pre- and postoperative radiographs of patients with hallux valgus to determine whether we could identify proximal intermetatarsal divergence. We retrospectively compared the pre- and postoperative radiographs of 29 feet in 28 patients treated with distal chevron osteotomy. Two different methods were used to measure the intermetatarsal angles: the anatomic intermetatarsal angle (aIMA) and the mechanical intermetatarsal angle (mIMA). The maximum intermetatarsal distance (MID) was also measured. We defined proximal intermetatarsal divergence as a postoperative increase in the aIMA or MID, coupled with a decrease in the mIMA. For data analysis, we divided the patients into low-angle (mild deformity) and high-angle (severe deformity) groups, according to their preoperative mIMA. The mean ± standard deviation patient age was 41 ± 14 years. In the low-angle group, the mean mIMA decreased (from 10.91° to 7.00°), the mean aIMA increased (from 11.80° to 13.55°), and the mean MID increased (from 17.97 mm to 20.60 mm; p = .001, for all). In the high-angle group, the mean mIMA decreased (from 14.30° to 6.90°; p = .001), the mean aIMA decreased (from 14.77° to 13.54°; p = .06), and the mean MID decreased (from 20.74 mm to 20.37 mm; p = .64). The results of our study suggest that proximal intermetatarsal divergence might occur after distal chevron osteotomy for hallux valgus, primarily in patients with a low preoperative mIMA.
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Affiliation(s)
- Evren Akpinar
- Orthopedist, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, İstanbul, Turkey.
| | - Abdul Fettah Buyuk
- Orthopedist, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, İstanbul, Turkey
| | - Engin Cetinkaya
- Orthopedist, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, İstanbul, Turkey
| | - Sarper Gursu
- Orthopedist, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, İstanbul, Turkey
| | - Hanifi Ucpunar
- Orthopedist, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, İstanbul, Turkey
| | - Akif Albayrak
- Orthopedist, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, İstanbul, Turkey
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Ortiz C, Wagner P, Vela O, Fischman D, Cavada G, Wagner E. "Angle to Be Corrected" in Preoperative Evaluation for Hallux Valgus Surgery: Analysis of a New Angular Measurement. Foot Ankle Int 2016; 37:172-7. [PMID: 26525223 DOI: 10.1177/1071100715604000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The most common methods for assessing severity of hallux valgus deformity and the effects of an operative procedure are the angular measurements in weightbearing radiographs, specifically the hallux valgus angle and intermetatarsal angle (IMA). Our objective was to analyze the interobserver variability in hallux valgus patients of a new angle called the "angle to be corrected" (ATC), and to compare its capacity to differentiate between different deformities against IMA. METHODS We included 28 symptomatic hallux valgus patients with 48 weightbearing foot x-rays. Three trained observers measured the 1 to 2 IMA and the ATC. We then identified retrospectively 45 hallux valgus patients, which were divided into 3 operative technique groups having used the ATC as reference, and analyzed the capacity of the IMA to differentiate between them. RESULTS The IMA average value was 13.6 degrees, and there was a significant difference between observer 3 and observer 1 (P = .001). The average value for the ATC was 8.9 degrees, and there was no difference between observers. Both angles showed a high intraclass correlation. Regarding the capacity to differentiate between operative technique groups, the ATC was different between the 3 operative technique groups analyzed, but the IMA showed differences only between 2. CONCLUSIONS The ATC was at least as reliable as the intermetatarsal angle for hallux valgus angular measurements, showing a high intraclass correlation with no interobserver difference. It can be suggested that the ATC was better than the IMA to stratify hallux valgus patients when deciding between different operative treatments. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Cristian Ortiz
- Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Pablo Wagner
- Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Omar Vela
- Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | | | - Gabriel Cavada
- Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Emilio Wagner
- Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
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Abstract
BACKGROUND The effect of lateral soft tissue release (LSTR) regarding the position of the sesamoid is not clear. The purpose of this study was to evaluate the effect of LSTR by comparing the radiologic and clinical outcomes of operative treatment for hallux valgus with or without LSTR. METHODS This study included a consecutive series of chevron osteotomy of 119 feet of 90 patients with symptomatic hallux valgus with incongruent first metatarsophalangeal (MTP) joints. Fifty-one feet underwent an operation with the LSTR procedure (LSTR group), and the remaining 68 feet underwent treatment without LSTR (control non-LSTR group). We evaluated the differences regarding the distance of the fibular sesamoid from the second metatarsal bone between these 2 groups to evaluate the effect of LSTR on sesamoid position. The tibial sesamoid position was also investigated to evaluate the degree of reduction of the metatarsal head to the sesamoids. The hallux valgus angle, intermetatarsal angle, and distal metatarsal articulation angle were analyzed as radiologic outcomes. Additionally, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society hallux MTP-IP scores and complications were evaluated as clinical assessments. The mean follow-up period was 43.3 weeks (range = 12-144). RESULTS There were no significant differences in the amount and direction of movement of the fibular sesamoid between the LSTR group and non-LSTR group (1.9 mm and 1.6 mm, respectively) (P = .23). The direction was close to the second metatarsal bone in both groups. The complication rate in the LSTR group was 7.8% (n = 4) and 2.9% (n = 2) in the non-LSTR group (P = .40). CONCLUSIONS Although there were significantly improved clinical and radiologic outcomes after surgery, the LSTR procedure did not result in medial shift or reduction of the sesamoid position. LEVEL OF EVIDENCE Level III, retrospective case control study.
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Affiliation(s)
- Kyungjei Woo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - In-Sang Yu
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jun-Ho Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ki-Sun Sung
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Arie EK, Moreira NSA, Freire GS, Dos Santos BS, Yi LC. Study of the metatarsal formula in patient with primary metatarsalgia. Rev Bras Ortop 2015; 50:438-44. [PMID: 26401502 PMCID: PMC4563042 DOI: 10.1016/j.rboe.2015.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 07/17/2014] [Indexed: 11/25/2022] Open
Abstract
Objectives The aims of this study were (i) to ascertain the prevalence of different types of metatarsal formula among patients with primary metatarsalgia; (ii) to compare the variable of “shortening of the first metatarsal in relation to the second” (I/II) between the metatarsalgia and control groups; and (iii) to analyze the intra and interobserver concordance by means of Morton's transverse line method and Hardy and Clapham's arc method. Methods A cross-sectional observational study was conducted on 56 patients by means of radiographs on their 112 ft, of which 56 were in the metatarsalgia group and 56 in the control group. The evaluations were done between December 2012 and June 2013. The measurements were made by three third-year orthopedics residents with prior training in the methods used, and a template was used. Results There was no concordance between the two methods, as shown by Bland–Altman plots, although the intraclass correlation coefficients showed that the intra and interobserver reproducibility was high using the transverse line method (0.78 and 0.85) and moderate using the arc method (0.73 and 0.60). Comparison between the groups showed that there was a statistical difference (p ≤ 0.05) such that there was greater shortening of the first metatarsal (3.39 mm) in the control group than in the metatarsalgia group (2.14 mm). In the patients with primary metatarsalgia, the index minus metatarsal formula was more prevalent according to the transverse line method (62.5%) and the zero plus type according to the arc method (71.4%). Conclusion In the present study, it was observed that the metatarsal formula prevalences depended on the measurement method. In both groups, shortening of the first metatarsal predominated. There was no intra or interobserver concordance in either of the two proposed methods.
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Lin CS, Wu TY, Wang TM, Hou SM, Shih KS, Liaw CK. A New Technique to Increase Reliability in Measuring the Axis of Bone. J Foot Ankle Surg 2015; 55:106-11. [PMID: 26364234 DOI: 10.1053/j.jfas.2015.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Indexed: 02/03/2023]
Abstract
Measuring bone angles is an important method for diagnosing disease and predicting the prognosis in orthopedics. Traditionally, the angle is measured using lines drawn manually and adjusted by the naked eye. The purpose of the present study was to propose new methods to measure the bone angles formed by the axes of the calcaneus with good reliability and low operational error. The 2 new methods used linear regression analysis of the points inside and on the "envelope" line. The traditional method used the vector of the lines drawn for calculation. Digital radiographs of the lateral view of the feet from 51 patients were collected, and the angles were measured using these 3 methods. Next, we analyzed the reliability, differences, and correlations of these 3 methods. The intra- and interobserver comparisons revealed significant differences between the results of the 2 new methods and those of the traditional method. In addition, the new methods had greater reliability and better intra- and interobserver correlations than did the traditional method. We suggest that these 2 new methods to measure bone axis should be added to the Picture Archiving and Communication System to obtain more reliable and standardized data in clinical practice and for future research purposes.
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Affiliation(s)
- Chia-Sheng Lin
- Orthopedist, Department of Orthopedics, National Taiwan University Hospital, Taipei City, Taiwan
| | - Tai-Yin Wu
- Medical Doctor, Department of Family Medicine, Renai Branch, Taipei City Hospital, Taipei City, Taiwan; Assistant Professor, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei City, Taiwan
| | - Ting-Ming Wang
- Orthopedist, Department of Orthopedics, National Taiwan University Hospital, Taipei City, Taiwan
| | - Sheng-Mou Hou
- Orthopedist, Department of Orthopedics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan
| | - Kao-Shang Shih
- Orthopedist, Department of Orthopedics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan
| | - Chen-Kun Liaw
- Orthopedist, Department of Orthopedics, National Taiwan University Hospital, Taipei City, Taiwan; Orthopedist, Department of Orthopedics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan; Surgeon, Department of Traumatology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan; Assistant Professor, Fu-Jen Catholic University School of Medicine, New Taipei City, Taiwan.
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Han SH, Park EH, Jo J, Koh YG, Lee JW, Choi WJ, Kim YS. First metatarsal proximal opening wedge osteotomy for correction of hallux valgus deformity: comparison of straight versus oblique osteotomy. Yonsei Med J 2015; 56:744-52. [PMID: 25837181 PMCID: PMC4397445 DOI: 10.3349/ymj.2015.56.3.744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to compare clinical and radiographic outcomes of proximal opening wedge osteotomy using a straight versus oblique osteotomy. MATERIALS AND METHODS We retrospectively reviewed 104 consecutive first metatarsal proximal opening wedge osteotomies performed in 95 patients with hallux valgus deformity. Twenty-six feet were treated using straight metatarsal osteotomy (group A), whereas 78 feet were treated using oblique metatarsal osteotomy (group B). The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle, and distance from the first to the second metatarsal (distance) were measured for radiographic evaluation, whereas the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was used for clinical evaluation. RESULTS Significant corrections in the HVA, IMA, and distance from the first to the second metatarsal were obtained in both groups at the last follow-up (p<0.001). There was no difference in the mean IMA correction between the 2 groups (6.1±2.7° in group A and 6.0±2.1° in group B). However, a greater correction in the HVA and distance from the first to the second metatarsal were found in group B (HVA, 13.2±8.2°; distance, 25.1±0.2 mm) compared to group A (HVA, 20.9±7.7°; distance, 28.1±0.3 mm; p<0.001). AOFAS scores were improved in both groups. However, group B demonstrated a greater improvement relative to group A (p=0.005). CONCLUSION Compared with a straight first metatarsal osteotomy, an oblique first metatarsal osteotomy yielded better clinical and radiological outcomes.
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Affiliation(s)
- Seung Hwan Han
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Eui Hyun Park
- Department of Orthopaedic Surgery, Yonsei Altair Hospital, Seoul, Korea
| | - Joon Jo
- Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea
| | - Yong Gon Koh
- Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Jin Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Sang Kim
- Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea.
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Abstract
PURPOSE With differences between the sexes in foot bone anatomy and ligamentous laxity, there is the possibility that the results of hallux valgus surgery may also differ between the sexes. We aimed to compare the results of hallux valgus surgery between the sexes. MATERIALS AND METHODS The authors retrospectively reviewed 60 males (66 feet) and 70 females (82 feet) who underwent distal or proximal chevron osteotomy for the treatment of hallux valgus deformity between June 2005 and December 2011. We compared the clinical and radiologic outcomes between the sexes. RESULTS There were no statistically significant differences in demographics between the sexes. The mean American Orthopedic Foot and Ankle Society score, visual analogue scale for pain, and patient satisfaction at the last follow-up did not differ significantly between the sexes. The mean preoperative hallux valgus angle (HVA) and inter-metatarsal angle (IMA) were not significantly different between the sexes. At the last follow-up, the mean HVA was significantly greater in females (p=0.003) than in males; mean IMA was not significantly different between the sexes. The mean correction of HVA in males was significantly greater than that in females (p=0.014). CONCLUSION There were no significant differences between the sexes regarding clinical outcomes after distal and proximal chevron osteotomy. However, male patients achieved greater correction of HVA than female patients. There is a possibility that sexual dimorphism of the foot may affect postoperative HVA.
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Affiliation(s)
- Gi Won Choi
- Department of Orthopaedic Surgery, Korea University College of Medicine, Ansan Hospital, Ansan, Korea
| | - Hak Jun Kim
- Department of Orthopaedic Surgery, Korea University College of Medicine, Guro Hospital, Seoul, Korea.
| | - Tae Wan Kim
- Department of Orthopaedic Surgery, Korea University College of Medicine, Guro Hospital, Seoul, Korea
| | - Ji Wun Lee
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Sung Bum Park
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Jin Kak Kim
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
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Moraiti C, Klouche S, Stiglitz Y, Hardy P, Bauer T. Reliability of a new radiological method for assessment of the postoperative immobilization of the first metatarsophalangeal joint. Foot Ankle Int 2015; 36:310-7. [PMID: 25344247 DOI: 10.1177/1071100714555713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The success of the operative treatment of mild to moderate hallux valgus (HV) relies greatly on the osseous union of the osteotomies at the desired position. Full weight-bearing is often allowed immediately postoperatively with special forefoot off-loading shoes. No precise methodology exists for the estimation of foot immobilization inside those shoes. The aim of this study was to assess the reliability of a new radiological measurement method to assess the immobilization of the first metatarsophalangeal (M1P1) joint inside a postoperative forefoot off-loading rocker shoe. METHODS A prospective single-center study was conducted during 2012. Patients operated on for mild or moderate HV deformity with a percutaneous technique by the same surgeon were included. Twenty-four patients (33 feet) fulfilled the inclusion criteria, all women and mean age of 56.6 ± 12.7 years. Standard lateral foot X-rays were obtained 1 week postoperatively with the patient standing in 2 positions, wearing the same forefoot off-loading rocker shoe: the foot flat on the ground (imitating midstance) and on the toes (imitating propulsion). The main evaluation criterion was the immobilization of the M1P1 joint estimated through the difference between the values of the M1P1 angle in the sagittal plane in these positions. Validity and reliability of this new measurement were assessed with Pearson's correlation coefficients (r) and intraclass correlation (ICC, ρ) coefficients. RESULTS The inter- and intraobserver reliability of the measurement was excellent to good. The mean M1P1 angle was 17.5 ± 7 degrees in the position imitating the midstance and 20.7 ± 7.5 degrees in the position imitating propulsion (P < 10(-5)). CONCLUSION This new radiological measurement for assessing immobilization of the M1P1 joint was a valid and reliable method.
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Affiliation(s)
- Constantina Moraiti
- Hôpitaux Universitaires Paris Ile-de-France Ouest, Boulogne-Billancourt, France
| | - Shahnaz Klouche
- Hôpitaux Universitaires Paris Ile-de-France Ouest, Boulogne-Billancourt, France
| | - Yves Stiglitz
- Hôpitaux Universitaires Paris Ile-de-France Ouest, Boulogne-Billancourt, France
| | - Philippe Hardy
- Hôpitaux Universitaires Paris Ile-de-France Ouest, Boulogne-Billancourt, France Université de Versailles Saint-Quentin-en-Yvelines, UFR de Santé, Versailles, France
| | - Thomas Bauer
- Hôpitaux Universitaires Paris Ile-de-France Ouest, Boulogne-Billancourt, France
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Koller U, Willegger M, Windhager R, Wanivenhaus A, Trnka HJ, Schuh R. Plantar pressure characteristics in hallux valgus feet. J Orthop Res 2014; 32:1688-93. [PMID: 25130961 DOI: 10.1002/jor.22707] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 07/03/2014] [Indexed: 02/04/2023]
Abstract
Due to the pathoanatomical changes in hallux valgus feet, the plantar flexion moment of the first metatarsophalangeal joint is reduced. Therefore, load bearing of the hallux is decreased during push-off. We assessed loading parameters in hallux valgus feet. Based on dorsal-plantar weight bearing radiographs of 61 feet, the intermetatarsal-, hallux valgus-, distal metatarsal articulation-angle, and sesamoid position were evaluated. Plantar pressure assessment was performed with the emed® system during level walking. We found negative correlations between hallux valgus angle and peak pressure in the great toe (r=-0.301, p<0.023), the maximum force of the hallux (r=-0.481, p<0.001), and contact time of the great toe (r=-0.448, p<0.001), and positive correlations for force time integral (r=0.348, p<0.001), contact area (r=0.307, p<0.020), maximum force (r=0.430, p<0.001), and peak pressure (r=0.361, p<0.006) of the fifth metatarsal head. A positive correlation between the sesamoid and the metatarsal subluxation regarding maximum force (r=0.294, p<0.034), and a negative correlation between the contact area of the hallux (r=-0.232, p<0.020) was shown. Depending on the severity, hallux valgus angle, and sesamoid subluxation, load shows significant lateral transmission in hallux valgus feet.
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Affiliation(s)
- Ulrich Koller
- Department of Orthopaedics, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
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Buciuto R. Prospective randomized study of chevron osteotomy versus Mitchell's osteotomy in hallux valgus. Foot Ankle Int 2014; 35:1268-76. [PMID: 25209122 DOI: 10.1177/1071100714550647] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We conducted a prospective randomized trial to compare the most popular osteotomy types of operative treatment of hallux valgus (HV) used in Norway, Mitchell's osteotomy (MO) and chevron osteotomy (CO). METHODS One hundred twenty adult female patients were prospectively randomized to treatment with either MO or CO. All operative procedures were performed with ankle block and with tourniquet applied. None of the patients received any antibiotic or antithrombotic prophylaxis. The follow-up period was 3 years. Clinical results were rated according to the American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating System (CRS). RESULTS HV in the MO group was reduced from 30 (range, 20 to 44) to 15 (range, 8 to 24) degrees and IM angle from 11 (range, 6 to 14) to 7 (range, 4 to 11) degrees. HV in the CO group was reduced from 31 (range, 22 to 42) to 16 (range, 6 to 24) degrees and IM angle from 14 (range, 8 to 20) to 6 (range, 2 to 10) degrees. Transfer metatarsalgia occurred in 36 (60%) patients and hammertoe in 6 (10%) patients in the MO group. In the CO group, metatarsalgia occurred in 5 patients. The median loss of postoperative HV correction was 4 (range, 2 to 10) degrees in mild deformity and 6 (6 to 10) degrees in moderate deformity. CONCLUSION Patients treated with CO had significantly better results for AOFAS CRS, number of postoperative complications, patient satisfaction, and length of sick leave for the employed patients. Based on our results, we consider that in female patients CO should be regarded as the first-line procedure for treatment of mild and moderate HV. LEVEL OF EVIDENCE Level I, prospective randomized study.
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Affiliation(s)
- Robert Buciuto
- Orthopaedic Department, St Olavs Hospital University Hospital, Trondheim, Norway
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Janssen DMC, Sanders AP, Guldemond NA, Hermus J, Walenkamp GHIM, van Rhijn LW. A comparison of hallux valgus angles assessed with computerised plantar pressure measurements, clinical examination and radiography in patients with diabetes. J Foot Ankle Res 2014; 7:33. [PMID: 25075224 PMCID: PMC4114410 DOI: 10.1186/1757-1146-7-33] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 07/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hallux valgus deformity is a common musculoskeletal foot disorder with a prevalence of 3.5% in adolescents to 35.7% in adults aged over 65 years. Radiographic measurements of hallux valgus angles (HVA) are considered to be the most reproducible and accurate assessment of HVA. However, in European countries, many podiatrists do not have direct access to radiographic facilities. Therefore, alternative measurements are desired. Such measurements are computerised plantar pressure measurement and clinical goniometry. The purpose of this study was to establish the agreement of these techniques and radiographic assessments. METHODS HVA was determined in one hundred and eighty six participants suffering from diabetes. Radiographic measurements of HVA were performed with standardised static weight bearing dorsoplantar foot radiographs. The clinical goniometry for HVA was measured with a universal goniometer. Computerised plantar pressure measurement for HVA was executed with the EMED SF-4® pressure platform and Novel-Ortho-Geometry software. The intra-class correlation coefficients (ICC) and levels of agreement were analysed using Bland & Altman plots. RESULTS Comparison of radiographic measurements to clinical goniometry for HVA showed an intraclass correlation coefficient (ICC) of 0.81 (95% confidence interval, 0.76 to 0.86; p<0.001). Radiographic measurement versus computerised plantar pressure measurement showed an ICC of 0.59 (95% confidence interval, 0.49 to 0.68; p<0.001). In addition, clinical goniometry versus computerised plantar pressure measurement showed an ICC of 0.77 (95% confidence interval, 0.70 to 0.82; p<0.001). The systematic difference of the computerised plantar pressure measurement compared with radiographic measurement and clinical goniometry was 7.0 degrees (SD 6.8) and 5.2 degrees (SD 5.0), respectively. The systemic difference of radiographic measurements compared with clinical goniometry was 1.8 degrees (SD 5.0). CONCLUSIONS The agreement of computerised plantar pressure measurement and clinical goniometry for HVA compared to radiographic measurement of HVA is unsatisfactory. Radiographic measurements of HVA and clinical goniometry for HVA yield better agreement compared to radiographic measurements and computerised plantar pressure measurement. The traditional radiographic measurement techniques are strongly recommended for the assessment of HVA.
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Affiliation(s)
- Daniël MC Janssen
- Orthopaedic Surgery Department, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht, The Netherlands
| | - Antal P Sanders
- Dorati Consultancy for Feet and Health, Los Angelesstraat 74, The Hague, The Netherlands
| | - Nick A Guldemond
- University of Technology Delft, Faculty Electrical Engineering, Mathematics & Computer Science, Department Man-machine Interaction, University of Technology Delft, Mekelweg 4, Delft, The Netherlands
| | - Joris Hermus
- Orthopaedic Surgery Department, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht, The Netherlands
| | - Geert HIM Walenkamp
- Orthopaedic Surgery Department, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht, The Netherlands
| | - Lodewijk W van Rhijn
- Orthopaedic Surgery Department, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht, The Netherlands
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Vopat BG, Lareau CR, Johnson J, Reinert SE, DiGiovanni CW. Comparative study of scarf and extended chevron osteotomies for correction of hallux valgus. Foot Ankle Spec 2013; 6:409-16. [PMID: 24154993 DOI: 10.1177/1938640013508431] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Scarf and chevron osteotomies are two described treatments for the correction of hallux valgus deformity, but they have traditionally been employed for different levels of severity. We hypothesized that there would be no statistically significant difference between the results of these two treatments. METHODS This study is a retrospective review of 70 consecutive patients treated operatively for moderate and severe hallux valgus malalignment. The two groups based on their operative treatment: scarf osteotomy (Group A) and extended chevron osteotomy (Group B). Preoperative and postoperative hallux valgus angle (HVA), intermetatarsal angle and distal metatarsal articular angle (DMAA) were measured at final follow-up. Charts were also assessed to determine the postoperative rate of satisfaction, stiffness, and pain. RESULTS There were no statistically significant differences between Groups A and B with regard to the HVA preoperatively and postoperatively. The DMAA was statistically significantly higher for Group B both preoperatively (p=0.0403) and postoperatively (p<0.0001). The differences in HVA correction and IMA correction were not statistically significant. There were no statistically significant differences with regard to post-operative stiffness, pain, and satisfaction. DISCUSSION The scarf and extended chevron osteotomies are capable of adequately reducing the HVA and IMA in patients with moderate to severe hallux valgus. These two techniques yielded similar patient outcomes in terms of stiffness, pain and satisfaction. Based on these results, we recommend both the scarf and extended chevron osteotomy as acceptable forms of correction for moderate to severe hallux valgus.
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Affiliation(s)
- Bryan G Vopat
- Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island (BGV, CRL, CWD)
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Gines-Cespedosa A, Alentorn-Geli E, Sanchez JF, Leal-Blanquet J, Rigol P, Puig L, de Zabala S. Influence of common associated forefoot disorders on preoperative quality of life in patients with hallux valgus. Foot Ankle Int 2013; 34:1634-7. [PMID: 23943654 DOI: 10.1177/1071100713502321] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux valgus (HV) is frequently associated with other forefoot disorders, but its influence on preoperative quality of life (QOL) has not been well characterized. The main purpose of this study was to assess the influence of common associated forefoot disorders (metatarsalgia and lesser toe deformities) on preoperative QOL in patients with HV. METHODS Preoperative QOL assessed through the Short Form-36 (SF-36, version 2) was obtained from 94 patients with HV from a database. Patients were classified according to their condition: HV alone, HV and metatarsalgia, HV and lesser toe deformities, and HV and both metatarsalgia and lesser toe deformities. Values of each domain were compared among groups. In addition, a correlational study between SF-36 and radiographic severity of HV was performed. The mean age of the 94 patients was 62.6 ± 12.3 years. There were 42.6% patients with HV alone, 30.8% with HV and metatarsalgia, 16% with HV and lesser toe deformities, and 10.6% with HV and both metatarsalgia and lesser toe deformities. RESULTS Patients with HV and associated metatarsalgia and lesser toe deformities had significantly worse physical function (P = .029), role-physical (P = .017), bodily pain (P = .045), role-emotional (P = .016), mental health (P = .001), and mental component summary (P = .003) compared to patients with HV alone. There were no significant correlations between radiographic HV and intermetatarsal angles and any of the domains or summaries of the SF-36. CONCLUSION Patients with HV and both metatarsalgia and lesser toe deformities have significantly worse QOL compared to patients with HV alone. The presence of associated forefoot deformities may be a discriminating factor for the prioritization of surgical treatment of HV. LEVEL OF EVIDENCE Level III, cross-sectional study.
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Affiliation(s)
- Alberto Gines-Cespedosa
- Hospital del Mar i l'Esperança - Parc de Salut Mar, Universitat Autonoma de Barcelona, Barcelona, Spain
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46
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Faber FWM, van Kampen PM, Bloembergen MW. Long-term results of the Hohmann and Lapidus procedure for the correction of hallux valgus: a prospective, randomised trial with eight- to 11-year follow-up involving 101 feet. Bone Joint J 2013; 95-B:1222-6. [PMID: 23997136 DOI: 10.1302/0301-620x.95b9.31560] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As it remains unproven that hypermobility of the first tarsometatarsal joint (TMTJ-1) is a significant factor in hallux valgus deformity, the necessity for including arthrodesis of TMTJ-1 as part of a surgical correction of a hallux valgus is questionable. In order to evaluate the role of this arthrodesis on the long-term outcome of hallux valgus surgery, a prospective, blinded, randomised study with long-term follow-up was performed, comparing the Lapidus procedure (which includes such an arthrodesis) with a simple Hohmann distal closing wedge metatarsal osteotomy. The study cohort comprised 101 feet in 87 patients: 50 feet were treated with a Hohmann procedure and 51 with a Lapidus procedure. Hypermobility of TMTJ-1 was assessed pre-operatively by clinical examination. After a mean of 9.25 years (7.25 to 11.42), 91 feet in 77 patients were available for follow-up. There was no difference in clinical or radiological outcome between the two procedures. Also, there was no difference in outcome between the two procedures in the subgroup clinically assessed as hypermobile. This study does not support the theory that a hallux valgus deformity in a patient with a clinically assessed hypermobile TMTJ-1 joint requires fusion of the first tarso-metatarsal joint.
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Affiliation(s)
- F W M Faber
- HAGA Hospital, Sportlaan 600, 2566 MJ Den Haag, the Netherlands
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Arunakul M, Amendola A, Gao Y, Goetz JE, Femino JE, Phisitkul P. Tripod index: a new radiographic parameter assessing foot alignment. Foot Ankle Int 2013; 34:1411-20. [PMID: 23657663 DOI: 10.1177/1071100713488761] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND No single radiographic measurement takes into account complete foot alignment. We have created the Tripod Index (TI) to allow assessment of complex foot deformities using a standing anteroposterior (AP) radiograph of the foot. We hypothesized that TI would demonstrate good intraobserver and interobserver reliability and correlate with currently accepted radiographic parameters, in both flatfoot and cavovarus foot deformities. METHODS Three groups of patients were studied: 26 patients (30 feet) with flatfoot, 29 patients (30 feet) with cavovarus foot, and 51 patients (60 feet) without foot deformity as controls. Weight-bearing radiographs were obtained: foot AP with a hemispherical marker around the heel plus standard lateral and hindfoot alignment views. Radiographic measurements were made by 2 blinded investigators. Statistical analysis included intraclass correlation coefficients (ICCs), correlation of the TI with existing radiographic measurements using Pearson coefficients, and comparison between patient groups using analysis of variance. RESULTS Intraobserver and interobserver ICCs of TI (0.99 and 0.98, respectively) were excellent. In the flatfoot group, TI significantly correlated with AP talonavicular coverage angle (r = 0.43), medial cuneiform-fifth metatarsal height (r = -0.59), coronal plane hindfoot alignment (r = 0.53), and clinical hindfoot alignment (r = 0.39). In the cavovarus foot group, TI correlated significantly with AP talonavicular coverage angle (r = 0.77), calcaneal pitch angle (r = 0.39), medial cuneiform-fifth metatarsal height (r = -0.65), coronal plane hindfoot alignment (r = 0.55), and clinical hindfoot alignment (r = 0.61). Statistically significant differences between flatfoot-control and cavovarus foot-control were found in TI, AP talonavicular coverage angle, lateral talo-first metatarsal angle, calcaneal pitch angle, medial cuneiform-fifth metatarsal height, coronal plane hindfoot alignment, and clinical assessment of hindfoot alignment (all with P < .001). CONCLUSION The TI was demonstrated to be a valid and reliable radiographic measurement to quantify the magnitude of complex foot deformities when evaluating flatfoot and cavovarus foot. CLINICAL RELEVANCE The TI may be helpful as an integrated assessment of complex foot deformities. Further clinical studies are recommended. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Marut Arunakul
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA
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Windhagen H, Radtke K, Weizbauer A, Diekmann J, Noll Y, Kreimeyer U, Schavan R, Stukenborg-Colsman C, Waizy H. Biodegradable magnesium-based screw clinically equivalent to titanium screw in hallux valgus surgery: short term results of the first prospective, randomized, controlled clinical pilot study. Biomed Eng Online 2013; 12:62. [PMID: 23819489 PMCID: PMC3702514 DOI: 10.1186/1475-925x-12-62] [Citation(s) in RCA: 247] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 06/25/2013] [Indexed: 02/06/2023] Open
Abstract
Purpose Nondegradable steel-and titanium-based implants are commonly used in orthopedic surgery. Although they provide maximal stability, they are also associated with interference on imaging modalities, may induce stress shielding, and additional explantation procedures may be necessary. Alternatively, degradable polymer implants are mechanically weaker and induce foreign body reactions. Degradable magnesium-based stents are currently being investigated in clinical trials for use in cardiovascular medicine. The magnesium alloy MgYREZr demonstrates good biocompatibility and osteoconductive properties. The aim of this prospective, randomized, clinical pilot trial was to determine if magnesium-based MgYREZr screws are equivalent to standard titanium screws for fixation during chevron osteotomy in patients with a mild hallux valgus. Methods Patients (n=26) were randomly assigned to undergo osteosynthesis using either titanium or degradable magnesium-based implants of the same design. The 6 month follow-up period included clinical, laboratory, and radiographic assessments. Results No significant differences were found in terms of the American Orthopaedic Foot and Ankle Society (AOFAS) score for hallux, visual analog scale for pain assessment, or range of motion (ROM) of the first metatarsophalangeal joint (MTPJ). No foreign body reactions, osteolysis, or systemic inflammatory reactions were detected. The groups were not significantly different in terms of radiographic or laboratory results. Conclusion The radiographic and clinical results of this prospective controlled study demonstrate that degradable magnesium-based screws are equivalent to titanium screws for the treatment of mild hallux valgus deformities.
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Affiliation(s)
- Henning Windhagen
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str,1-7, 30625 Hannover, Germany
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49
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Giannini S, Faldini C, Nanni M, Di Martino A, Luciani D, Vannini F. A minimally invasive technique for surgical treatment of hallux valgus: simple, effective, rapid, inexpensive (SERI). INTERNATIONAL ORTHOPAEDICS 2013; 37:1805-13. [PMID: 23820757 DOI: 10.1007/s00264-013-1980-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 06/12/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Several bony and soft tissue procedures have been described for the treatment of hallux valgus, and currently mini-invasive surgical techniques are preferred in order to reduce surgical trauma, complications, time of surgery and to allow an earlier recovery. The aim of this study is to analyse a series of 1,000 consecutive cases of hallux valgus, surgically treated by the minimally invasive SERI technique, reporting results at mid-term follow-up. METHODS We prospectively studied 641 patients (1,000 feet) with symptomatic hallux valgus surgically treated by SERI osteotomy. Inclusion criteria were: age between 20 and 65 years, reducible mild or moderate hallux valgus, HVA ≤ 40°, IMA ≤ 20°, and arthritis of the first metatarsophalangeal joint up to grade 2 according to the Regnauld classification. RESULTS The American Orthopaedic Foot and Ankle Society (AOFAS) score rose from 46.8 ± 6.7 preoperatively to 89 ± 10.3 at last follow-up. Radiographic control at follow-up showed a complete healing of the osteotomy and remodelling of the metatarsal bone. Low rate of complication has been reported. CONCLUSIONS This study demonstrated that the SERI technique is effective in treating mild to moderate hallux valgus in terms of relief from symptoms and functional improvement. This technique allowed correction of the main parameters of the deformity, with durable clinical and radiographic results at a mid-term follow-up.
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Affiliation(s)
- Sandro Giannini
- I Clinic of Orthopaedic and Traumatology, Rizzoli Orthopaedic Institute, University of Bologna, Italy
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50
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Choi GW, Choi WJ, Yoon HS, Lee JW. Additional surgical factors affecting the recurrence of hallux valgus after Ludloff osteotomy. Bone Joint J 2013; 95-B:803-8. [DOI: 10.1302/0301-620x.95b6.31172] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We reviewed 91 patients (103 feet) who underwent a Ludloff osteotomy combined with additional procedures. According to the combined procedures performed, patients were divided into Group I (31 feet; first web space release), Group II (35 feet; Akin osteotomy and trans-articular release), or Group III (37 feet; Akin osteotomy, supplementary axial Kirschner (K-) wire fixation, and trans-articular release). Each group was then further subdivided into severe and moderate deformities. The mean hallux valgus angle correction of Group II was significantly greater than that of Group I (p = 0.001). The mean intermetatarsal angle correction of Group III was significantly greater than that of Group II (p < 0.001). In severe deformities, post-operative incongruity of the first metatarsophalangeal joint was least common in Group I (p = 0.026). Akin osteotomy significantly increased correction of the hallux valgus angle, while a supplementary K-wire significantly reduced the later loss of intermetatarsal angle correction. First web space release can be recommended for severe deformity. Additionally, K-wire fixation (odds ratio (OR) 5.05 (95% confidence interval (CI) 1.21 to 24.39); p = 0.032) and the pre-operative hallux valgus angle (OR 2.20 (95% CI 1.11 to 4.73); p = 0.001) were shown to be factors affecting recurrence of hallux valgus after Ludloff osteotomy. Cite this article: Bone Joint J 2013;95-B:803–8.
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Affiliation(s)
- G. W. Choi
- Veterans Health Service Medical Center, Department
of Orthopaedic Surgery, 6-2 Dunchon-dong, Kangdong-gu, Seoul
134-060, Korea
| | - W. J. Choi
- Yonsei University College of Medicine, Department
of Orthopaedic Surgery, 50 Yonsei-ro, Seodaemun-gu, Seoul
120-752, Korea
| | - H. S. Yoon
- Yonsei University College of Medicine, Department
of Orthopaedic Surgery, 50 Yonsei-ro, Seodaemun-gu, Seoul
120-752, Korea
| | - J. W. Lee
- Yonsei University College of Medicine, Department
of Orthopaedic Surgery, 50 Yonsei-ro, Seodaemun-gu, Seoul
120-752, Korea
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