A Global Bibliometric Analysis of Hallux Valgus Research (1999-2019)

Hemiepiphysiodesis for juvenile hallux valgus deformity: A systematic review

BACKGROUND

Among the numerous surgical interventions for correcting hallux valgus deformity in skeletally immature patients, hemiepiphysiodesis is a simple technique with a low complication rate yet its effectiveness remains unclear. This systematic review evaluates hemiepiphysiodesis of the first metatarsal for treating juvenile hallux valgus (JHV) deformities with respect to radiological outcomes, postoperative clinical outcomes, and postoperative complications.

METHODS

EMBASE, MEDLINE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) database were searched from inception to September 15th, 2022, for studies investigating hemiepephysiodesis for JHV and its effect on clinical and radiological outcomes. The search, data extraction and methodologic assessment were performed in duplicate for all included studies.

RESULTS

Six studies out of 488 with a total of 147 feet in 85 patients were included in the final qualitative synthesis. The American Orthopaedic Foot & Ankle Society hallux metatarsophalangeal interphalangeal scale (AOFAS Hallux MTP-IP scale) was used in two studies. The mean pooled preoperative score was 62.2 ± 8.9 and improved to 88.6 ± 4.8 postoperatively in 33 patients. All six studies reported significant improvement in the hallux valgus angle (HVA) from mean preoperative angle of 29.2° ± 3.7-23.8° ± 4.5° postoperatively, while the intermetatarsal angle (IMA) preoperative and postoperative means corrected from 13.9° ± 1.1-11.4° ± 1.2°, respectively. Out of 147 feet, 21 (14.2%) had reported complications including recurrence and need for revision surgery.

CONCLUSION

This systematic review confirms that hemiepiphysiodesis of the first metatarsal in patients with JHV has improved clinical and radiological outcomes.

LEVEL OF EVIDENCE

Level IV, Systematic review.

Global research trends and hotspots analysis of hallux valgus: A bibliometric analysis from 2004 to 2021

Background

Hallux valgus (HV) is a common foot and ankle surgery disease. The correction of HV deformity relies on a highly challenging surgical treatment. Thus, widely adopted evidence-based clinical guidelines are still needed to guide the selection of the most appropriate interventions. Recently, the study of HV has been growing and scholars are increasingly paying particular attention to this area. However, bibliometric literature remains lacking. Therefore, this study aims to reveal the hotspots and future research trends in HV via bibliometric analysis to fill this knowledge gap.

Methods

Literature related to HV from 2004 to 2021 was retrieved from the Science Citation Index Expanded (SCI-expanded) of the Web of Science Core Collection (WoSCC). Quantitative and qualitative analyses of scientific data are performed using software such as CiteSpace, R-bibliometrix, and VOSviewer.

Results

A total of 1,904 records were identified for analysis. The United States had the most number of published articles and total citations. Thus, the United States has made an essential contribution to the field of HV. Meanwhile, La Trobe University in Australia was the most productive institution. Menz HB and Foot & Ankle International were the most influential authors and the most popular journals among researchers, respectively. In addition, “older people,” “chevron osteotomy,” “Lapidus,” and “hallux rigidus” have always been the hotspots of attention. Changes and developments in the surgery of HV have gained researchers' interest. Future research trends are more focused on “radiographic measurement,” “recurrence,” “outcome,” “rotation,” “pronation,” and “minimally invasive surgery.” Thus, focusing on these subject directions can facilitate academic progress and provide the possibility of better treatments for HV.

Conclusion

This study summarizes the hotspots and trends in the field of HV from 2004 to 2021, which will provide researchers with an updated view of essential information and somehow guide future research.

Characteristics and research trends of 50 most-cited hallux rigidus papers

BACKGROUND

The bibliometric studies in the field of orthopaedics have gained popularity since they can determine the characteristics and research trends of most influential papers in specific subjects. This study aimed to evaluate the 50 most-cited articles related to hallux rigidus, and analyze possible factors associated with increased citation counts.

METHODS

The available literature about hallux rigidus on Web of Science database until January 2021 were analyzed and the 50 most-cited articles were determined. The characteristics of the papers were documented and analyzed for any relationship or correlation with total citation or citation per year (citation density) values.

RESULTS

The average citation number and citation density were 52.8 (range: 26-243) and 3 (range: 0.8-12.8), respectively. The average author number was 3.4, while the average institution number was 1.9. The USA had the highest number of articles with 29. Twenty-six papers were case-series, only 3 studies had level 1 and only 2 had level 2 evidence. The highest number of articles were published in Foot and Ankle International with 22 papers. Forty papers were clinical studies while 10 were reviews. Five studies were multicentric.

CONCLUSION

This study provided the general characteristic and research trends of 50 most influential hallux rigidus papers. The number of institutions and references were positively correlated with citation density, indicating a higher chance of getting cited for papers with collaborations from different institutions and papers using more references from other works. Publication year was also positively correlated with citation density, indicating the better performance of more recent articles.

LEVEL OF CLINICAL EVIDENCE

Level 3.

A Retrospective Study Characterizing the Radiographic Progression of Hallux Valgus

Background: Hallux valgus deformity is the lateral deviation of the metatarsophalangeal (MTP) joint and is the most common pathology of the great toe, affecting 2%-4% of the population. It is commonly believed that the condition progresses over time both in the magnitude of deformity and development of arthritic changes. To our knowledge, there are rare studies describing the rate of deformity progression and the development of arthritic changes. Our aim is to quantify the progression of hallux valgus and associated arthritic changes in an adult population using radiographs.

Methods: Patients who are 18 years of age and older (mean age: 61.7 years and range: 18.6-94.2) who presented to our institutions between January 1, 2004, and December 1, 2019, were included. Patients were included in the study if they had hallux valgus on weight-bearing radiographs and two such radiographs at least six months apart. Hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsophalangeal (MTP) arthritis, tarsometatarsal (TMT) osteoarthritis, Hardy-Clapham sesamoid position, and round sign were collected per patient in the initial and final radiographs. Included cases were first studied together in a whole group. Then, cases were separated into three groups based on the time between initial and final radiographs.

Results: A total of 52 radiographic records for 43 patients were included. HVA and IMA progress with time; however, progression does not follow a direct relationship with the time elapsed between initial and final radiographs (p = 0.92 and p = 0.35, respectively). The progression of TMT osteoarthritis, sesamoid position, and round sign do not show a dependence on the time elapsed (p = 0.20, p = 0.11, and p = 0.42, respectively). An increase of one sesamoid unit position over baseline is associated with a 0.85-degree increase in IMA. A one-unit progression of sesamoid position at baseline raises the odds of MTP osteoarthritis progression at the follow-up visit by 2.14 (OR = 2.14, p = 0.0007, CI = [1.35, 3.83]). A HVA increase of one degree increases the odds of TMT osteoarthritis progression at follow-up by a factor of 1.17 (OR = 1.17, p = 0.0005, CI = [1.07, 1.34]). Patients with MTP arthritis at the initial visit have 3.77 times higher odds of round sign progression on their follow-up visit (OR = 3.77, p = 0.027, CI = [1.16, 13.13]).

Discussion: Hallux valgus progression can be quantified. Upon their first visit, a patient’s hallux valgus parameters can be utilized to demonstrate expected progression. Progression of the deformity and arthritic changes is slow. Nonetheless, the results should be considered by surgeons and patients when developing a treatment plan with patients.