AOFAS Hallux Research Articles

A Joy-Stick Assistant Three-Dimensional Modified Technique of Minimally Invasive Surgery for Mild or Moderate Hallux Valgus.

Minimally invasive surgery (MIS) such as minimally invasive chevron osteotomy and Akin osteotomy (MICA) has become popular in the treatment of hallux valgus. However, how to correct three-dimensional deformities in hallux valgus effectively and simply in MICA is still difficult. Special equipment is required in MICA as has been reported before. It is meaningful and necessary to reduce the reliance on special equipment in MICA. From January 2021 to July 2022, patients with mild or moderate hallux valgus were treated with a joy-stick assistant three-dimensional modified technique (Joy-stick 3D technique) of MIS. VAS, AOFAS Hallux MTP-IP scores, hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were measured pre- and postoperatively at the last follow-up of at least 6 months. Scores and radiologic angles were compared using paired sample t-test. A total of 36 cases were included. HVA, IMA, and DMAA were (22.3 ± 6.1)°, (14.0 ± 3.2)°, and (8.9 ± 3.2)° preoperatively, and decreased to (7.0 ± 1.8)°, (3.7 ± 1.0)°, and (3.3 ± 1.1)° postoperatively. VAS decreased from 4.3 ± 1.7 to 0.7 ± 0.7. AOFAS Hallux MTP-IP scores improved from 68.6 ± 7.6 to 92.9 ± 6.1. Comparing mild and moderate cases, though HVA, IMA, and DMAA were significantly different preoperatively, the angles became statistically similar after surgery. A joy-stick assistant three-dimensional modified technique is proposed to control the three-dimensional position of the metatarsal head and to reduce dependence on special tools. Mild and moderate hallux valgus deformities are effectively corrected using Joy-stick 3D technique.

Reliability and Validity of the Turkish Version of the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joint Scale.

The American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP) scale is one of the most widely used outcome measures to evaluate hallux pathologies. This study aimed to translate the AOFAS Hallux MTP-IP scale into Turkish and investigate its psychometric properties. The psychometric properties of the Turkish version of the AOFAS Hallux MTP-IP (AOFAS Hallux MTP-IP-T) scale were tested in 66 patients with hallux pathologies (52 women; mean age, 47.64 ± 12.75 years). Cronbach's alpha was used to assess internal consistency. The intraclass correlation coefficient (ICC) was used to estimate test-retest. Construct validity was analyzed with the Turkish version of the Manchester-Oxford Foot Questionnaire (MOXFQ), Visual Analogue Scale (VAS), and 12-item Short-Form Health Survey(SF-12). The AOFAS Hallux MTP-IP-T scale had adequate internal consistency (α = 0.71) and test-retest reliability (ICC2,1 = 0.93 for pain, ICC2,1 = 0.97 for function, and ICC2,1 = 0.97 for total score). The AOFAS Hallux MTP-IP-T total score has a moderate to strong correlation with VAS-activity and MOXFQ (ρ = -0.77, P = .001; ρ = -0.69, P = .001, respectively). The weakest correlation was found between the AOFAS Hallux MTP-IP-T and the SF-12 mental component scale (ρ = 0.31, P = .01). AOFAS Hallux MTP-IP-T has sufficient reliability and validity to evaluate Turkish-speaking individuals with a variety of forefoot pathologies including the hallux. Level II.

Среднесрочные результаты лечения тяжелой деформации переднего отдела стопы у пациентов пожилого возраста

Severe complex deformities of the forefoot in elderly patients with no rheumatoid arthritis result in the pronounced decrease in quality of life, chronic pain, reduced mobility, failure to get shoes for everyday use, exacerbation of the concomitant somatic diseases. The use of conventional joint preservation techniques in such patients often leads to the deformity relapse, persistent pain, and the need for revision surgery that is often impossible due to worsening of the patients' general somatic status and local functional status. The study was aimed to improve surgical outcomes in elderly patients with no rheumatoid arthritis who had severe forefoot deformities. The prospective cohort study that involved allocation to the retrospective group for comparison of surgical outcomes in 65 patients was carried out in 2016–2019. The results obtained before and after surgery were assessed using the FFI, AOFAS Hallux, and AOFAS Lesser Toes scores. The Maryland scores were used to assess the outcomes during the postoperative period. The study revealed significant differences in treatment outcomes based on the AOFAS Hallux (p = 0.0001), AOFAS Lesser Toes (p = 0.0001), FFI (p = 0.0001), and Maryland (p = 0.0001) scores. In view of the elderly patients' specific nature, the radical surgical techniques that do not ensure joint preservation may be considered as effective and predictable methods of correction aimed at reducing the rate of revision surgeries. These techniques represent a one-step method to improve the quality of life of elderly patients.

Short-term results of minimally invasive Chevron osteotomy with lateral soft tissue release in treating mild to moderate hallux valgus

To explore short-term results of minimally invasive Chevron osteotomy with lateral soft tissue release in treating mild to moderate hallux valgus. Sixty patients (80 feet) with mild to moderate hallux valgus treated with minimally invasive Chevron osteotomy with lateral soft tissue release from January 2019 to December 2021 were retrospectively analyzed. Among them, there were 5 males (6 feet) and 62 females (74 feet), aged from 20 to 60 years old with an average of (47.2±9.7) years old;54 patients (64 feet) with mild hallux valgus, and 13 patients(16 feet) with moderate hallux valgus. Hallux valugs angle(HVA), Ⅰ-Ⅱ intermetatarsal anlge(Ⅰ-Ⅱ IMA), distal metatarsal articular angle(DMAA)and sesamoid Hardy score were compared before and after operation, and American Orthopaedic Foot and Ankle Society's Hallux Metatarsophalangeal- Interphalangeal (AOFAS Hallux MTP-IP) scale was used to evaluate clinical effects. Sixty-seven patients (80 feet) were followed-up from 6 to 23 months with an average of (13.7±6.5) months. Preopertive HVA, Ⅰ-Ⅱ IMA, DMAA, sesamoid Hardy score and AOFAS Hallux MTP-IP were (27.5±7.0)°, (17.4±4.1)°, (11.4±3.8)°, (4.9±2.6) and (58.2±9.1), respectively;while at the final follow up were(8.3±4.8)°, (6.9±3.0)°, (3.9±2.4)°, (2.7±1.1) and(91.3±2.2);and there were statistical differences between pre-operation and the latest follow-up(P<0.05). There were differences in preopertaive imaging indexes and AOFAS Hallux MTP-IP between 64 mild and 16 moderate hallux valgus feet(P<0.05);while no difference in above indexes at the final follow-up(P>0.05);from the view of degree of improvement, HVA, Ⅰ-Ⅱ IMA, sesamoid Hardy score and AOFAS Hallux MTP-IP in moderate hallux valgus were better than that of in mild hallux valgus(P<0.05). Four patients occurred redness and swelling around incision on the osteotomy site, and cured by local dressing change and oral antibiotics. Minimally invasive Chevron osteotomy combined with lateral soft tissue release has advantages of correction and functional improvement for mild to moderate hallux valgus.

Association of Visual Appearance on Outcomes After Hallux Valgus Surgery.

In this study, our aim was to determine the effect of cosmetic improvement on patient satisfaction and functional scores in hallux valgus (HV) surgery. Preoperative foot photographs of 105 patients who had undergone chevron osteotomy for HV between 2016 and 2018 were taken. The patients were divided into 2 groups. Twenty-four months after surgery, the preoperative foot photographs were shown to patients in group 1 (n = 52) but not to patients in group 2 (n = 53). The groups were then compared using the visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP), and the 36-Item Short Form Health Survey (SF-36) scores. Both groups were evaluated radiologically with preoperative and postoperative hallux valgus angles and intermetatarsal angles. There was no difference between the 2 groups in terms of radiologic parameters either pre- or postoperatively, or AOFAS Hallux MTP-IP scores postoperatively. However, for group 1, the VAS was lower (0.4±0.8 vs 1.8±1.6, P = .003) and both the SF-36 physical functioning (88.3±18.1 vs 79.1±23.2, P = .017) and SF-36 mental health scores were higher (78.8±19 vs 69.2±16.3, P = .022). Visualizing improvement in the cosmetic appearance of the foot appears associated with patients' perception of subjective pain and functional improvement. We recommend that preoperative foot photographs be taken and recorded. Level III, case-control study.

Outcomes of Modified Scarf Osteotomy for Male Hallux Valgus

Category:BunionIntroduction/Purpose:Compared to women, hallux valgus in men is less common, more severe, and has higher rates of undercorrection, recurrence and greater distal metatarsal articular angle (DMAA). Bunionectomies that correct metatarsus primus varus (MPV) by valgus rotation paradoxically increase 1stMTP valgus in high DMAA, contributing to recurrence and undercorrection. While proximal valgus osteotomy or arthrodesis plus distal varus-producing metatarsal osteotomy can correct both components, there is a simpler solution. A modified Scarf osteotomy technique was developed in which the osteotomy is simultaneously translated laterally to correct MPV, while rotating the distal metatarsal in varus to correct DMAA. While previous literature on male hallux valgus is comprised of many studies using a combination of surgical techniques, all patients in this series had the same procedure.Methods:A retrospective review of prospectively collected data was performed in male patients treated with modified scarf osteotomy and soft tissue realignment for symptomatic hallux valgus, who failed conservative treatment. Preop and postop range of motion (ROM), radiographs, and validated patient reported outcome (PROM) scores including Pain VAS and SF-36, were tabulated, as well as complications, and AOFAS Hallux scores for historical comparison. There were 22 patients (26 feet), mean age 53 (17-79). Mean clinical and radiographic follow up was 24 months, and mean postop PROM’s follow up was 4.7 years. Six of 26 feet (23%) required a modified Akin osteotomy for a congruent 1stMTP joint. A subset of patients with minimum 4-year and mean 7.6 -year follow up (9 patients, 10 feet), was also analyzed. Weightbearing radiographs were evaluated for DMAA, hallux valgus angle (HVA) and 1st-2ndintermetatarsal angles (IMA).Results:Statistically significant improvements were found in VAS scores (5.8 to 1, p<0.001); SF-36 physical (44 to 56.7, p<0.001); IMA (15.9 to 8.7, p<0.001), HVA (36.1 to 15.1, p<0.001), DMAA (12.7 to 6.9, p=0.01) and AOFAS scores (44 to 79, p<0.001). Total 1stMTP ROM decreased from 60.9 to 50.8 degrees (p=0.06). One patient had delayed wound healing requiring oral antibiotics and wound vacuum application. Statistically significant improvements were maintained over time in the 7.6-year follow up sub-group, with VAS scores 6.2 to 1.3 (p<0.001), SF-36 physical from 40.8 to 61.3 (p=0.008), and SF-36 mental from 55.7 to 62.3 (p=0.002).Conclusion:This study found statistically significant improvements in both subjective validated PROM’s and objective radiographic measures using a special modification of the scarf osteotomy to address the characteristic increased DMAA that underlies complications and under correction previously reported in male hallux valgus. The corrections were well maintained at long-term follow-up including a robust correction of the DMAA.

Short Term Radiographic and Patient Outcomes of a Biplanar Plating System for Triplanar Hallux Valgus Correction

Hallux valgus is a complex deformity with a variety of techniques described for correction. A biplanar plating system for triplanar correction system has been developed to address both the translation and rotational component of the hallux valgus deformity and allow an accelerated weightbearing protocol. The purpose of this study was to determine the correction and complications using radiographic parameters and patient reported outcomes. We sought to determine prognostic factors for successful correction, including age, gender, and preoperative deformity. From the medical records, we collected preoperative data. Patient-reported outcomes were obtained using AOFAS Hallux Metatarsophalangeal-Interphalangeal score, FAAM, and SF-12 scores preoperatively and postoperatively. Imaging was reviewed at preoperative and postoperative visits to determine hallux valgus angle, intermetatarsal angle, and tibial sesamoid position. Fifty-seven procedures, in 55 patients, were performed. There were 7 complications and mean follow-up time was 45.7 weeks (+ 28.3 weeks). Age over 62.5 years were associated with an increased risk of complications (p = .018). Males had an increased rate of complications (71%) compared with females. Radiographic parameters were significantly improved from preoperative values at alltime points (p < .05). Only the AOFAS Hallux Metatarsophalangeal-Interphalangeal score was statistically significant at 3, 6 and 12 months. We sought to determine the effectiveness of biplanar plating and triplanar correction procedure with early weightbearing. Over a 12 month follow-up period, our results showed significant improvement in deformity and maintained correction. AOFAS Hallux Metatarsophalangeal-Interphalangeal scores significantly improved from the preoperative to the postoperative state. Our results show a nonunion rate of 5.2%, which is comparable to prior studies.

American Orthopedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joint Scale: A Cross-Cultural Adaptation and Validation Study in the Persian Language

We evaluated the reliability and validity of the Persian translation of the American Orthopedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal joint scale (AOFAS Hallux MTP-IP). The translated AOFAS Hallux MTP-IP scale form was completed for 101 patients with hallux deformities; the subjective questions were answered by the patients, whereas the orthopedic foot and ankle surgeon and his assistant answered the objective questions. The validated Persian version of the 36-Item Short Form Survey Instrument (SF-36) was used for validity assessment. Eighty-five females and 16 males with a mean age of 49 years were enrolled. Hallux valgus and hallux rigidus was the diagnosis in 73 and 28 patients, respectively. Intrarater reliability had a high level of correlation (rho >0.6) for all subscales and total score. Although the correlation between the total score of the AOFAS Hallux MTP-IP scale and role: physical subscale of SF-36 was the highest (rho = 0.47), the total score of AOFAS Hallux MTP-IP scale and the other 7 domains of SF-36 had a correlation ranging between –0.17 and 0.43. Moreover, the correlation between total score of AOFAS-Hallux MTP-IP and SF-36 physical component summary scale was 0.50, which was higher than the correlation between total score of AOFAS and SF-36 mental component summary scale (rho = 0.35). Convergent validity was approved for MTP joint motion (0.59), IP joint motion (0.51), and callus (0.56) items of AOFAS-Hallux MTP-IP. Spearman's rank correlation coefficient between all items of the functional subscale of AOFAS Hallux MTP-IP scale with its own subscales was higher than the coefficient between these items and other subscales, including pain and alignment (discriminate validity). Floor and ceiling effects were calculated as 2% and 1%, respectively. Our findings indicate that the translated Persian version of the AOFAS Hallux MTP-IP scale is a reliable instrument, but its validity is not satisfactory.

Results of Hallux Abducto Valgus Surgical Correction Using Two 1.1mm Mini TightRope Constructs

Hallux valgus represents an acquired foot deformity defined by medial deviation of the first metatarsal bone combined with lateral shift of the hallux and medial metatarsophalageal joint eminence enlargement. The functional impairment and metatarsalgia generated stem from the biomechanical imbalance which does not allow for normal transfer of weight trough the first ray during walking. The results generated with our experience with the 1.1mm Mini TightRope� Disposable Kitin the treatment of hallux valgus are analyzed in this paper. A total number of 24 feet (12 bilateral cases) with hallux valgus, surgically treated in our department were followed for a period of minimum twelve months and evaluated. The results showed an improvement of the mean preoperative IMA 14.6�to 7.9� postoperatively and 9.2� at six months after surgery. The preoperative measured HVA was reduced from 28.4to 14.2� at once and 16.1� after six months. The AOFAS hallux metatarsophalangeal-interphalangeal score resulted improvement reflects the functional benefits. These results confirm the good correction potential of the technique and support it as avalid treatment option for mild to moderate severity hallux valgus.

Management of Juvenile Hallux Valgus Deformity: the role of combined Hemiepiphysiodesis

BackgroundThis study aimed to investigate the efficacy of percutaneous hemiepiphysiodesis for gradual correction of symptomatic juvenile hallux valgus (HV) deformity.MethodsBetween 2012 to 2014, 24 patients with symptomatic juvenile HV were treated by combined percutaneous medial drilling hemiepiphysiodesis of the first proximal phalanx and lateral transphyseal screw hemiepiphysiodesis of the first metatarsal at our institution. Twenty-one of 24 patients fulfilled inclusion criteria had a complete radiological and clinical follow-up of at least 2 years. Preoperative and postoperative radiographs of the feet were reviewed for measurements of hallux valgus angle (HVA), intermetatarsal angle (IMA), proximal metatarsal articular angle (PMAA), proximal phalangeal articular angle (PPAA), and metatarsal length ratio (MTLR). Clinical outcomes were assessed using the AOFAS hallux metatarsophalangeal-interphalangeal score.ResultsThe study included 21 consecutive patients (37 ft) for analysis. The mean age at surgery was 12.0 years (SD = 1.3) and mean follow-up after surgery was 35.1 months (SD = 6.0). With the data available, the HV deformity improved in terms of the reduction of HVA by a mean of 4.7 degrees (P < .001) and the reduction of IMA by 2.2 degrees (P < .001). The PMAA and PPAA also improved significantly in the anteroposterior plane; however, the PMAA difference was insignificant in lateral plane as expected. The mean difference in the MTLR was 0.00 (P = .216) which was indicative of no length discrepancy between first and second metatarsals. The AOFAS score increased from 68.7 to 85.2 (P < .001). In correlation analysis, time to physeal closure was significantly correlated with the final HVA change (r = −.611, P = .003).ConclusionAlthough combined hemiepiphysiodesis does not create a large degree of correction as osteotomy, yet it did improve HV deformity with adequate growth remaining in our series. It is a procedure that can be of benefit to patients with symptomatic juvenile HV from this minimal operative approach before skeletal maturity.Level of evidenceLevel IV, retrospective case series.

Functional outcome of FHL transfer for treatment of chronic tendo Achilles (CAT) tear using single incision

Introduction: Chronic Tendo Achilles Tears are common and surgically challenging problems. FLexor Hallucis longus transfer is used to improve pain and functional outcomes. The aim of our study is to study clinical outcome of foot and ankle post-surgery. We also aim to study the effect of FHL transfer using AOFAS Hallux scores. Materials and Methods: 24 cases were enrolled who had irreparable gap of tendon Achilles on MRI scans. 4 were lost in follow-up. 20 cases were studied. These cases had a gap between 2 cut ends of Tendo Achilles, as seen intraoperatively. The FHL was harvested by cutting distal end through the same incision. FHL cut end was sutured with whip stitch and tenodesed with a suture anchor in calcaneus at 40 degrees plantar flexion. Below Knee cast is applied. Patient was followed up at 3rd, 6th, 10th weeks. Later followed up every month. Results: The average age of patients were 56.35 years (45-68). The Male to female ratio was 13:7. 6 patients had diabetes as medical comorbidity and 50% of patients had tobacco addiction. The mean BMI of patients was 32.55 (Range 25-38). The FAOS score improved from an average score of 58.05 preoperatively (Range 38-72) to average score of 88 postoperatively (Range 77-98). Wilcoxon Signed rank test was used which suggested the results are statistically significant. The effect of FHL transfer was gauged by AOFAS Hallux score postoperatively with mean score of 85.35 (Range 76-95). Conclusion: We conclude that FHL transfer is an effective and safe method of surgical option in chronic Tendo Achilles tears, with minimal adverse effect on donor site based on AOFAS Hallux scores.

A new minimally extended distal Chevron osteotomy (MEDCO) with percutaneous soft tissue release (PSTR) for treatment of moderate hallux valgus

PurposeSurgical treatment of moderate hallux valgus (HV) onwards by Chevron osteotomy and all variants described to date including the recent extended distal Chevron osteotomy (EDCO), yields improvable outcome but with recurrence rate. A new modification of this technique is needed to achieve better results. Methods34 consecutive female patients suffering from moderate HV underwent a new minimally extended distal Chevron osteotomy (MEDCO) with percutaneous soft tissue release (PSTR). Outcome was assessed using pre-post operative VAS-Pain, AOFAS Hallux Score and radiological measurements. Mean age was 53.7 years, follow-up 2.7 years and satisfaction score 8. ResultsVAS improved from 7 to 1 (p < 0.001) and AOFAS score from 64 to 90.7 (p < 0.001). Comparing postoperative HV and intermetatarsal (IM) angles of previous studies (either employing a Chevron osteotomy alone or a double Chevron-Akin) with our results, an improvement from 15.6/14.8 to 9.1 and 8.2 /8.8 to 5.6 respectively (p < 0.05) was achieved. Complication and recurrence rates were both 5.8%, lower than the documented rates of other techniques. ConclusionThe modified technique in the present study was found to be a more effective and reliable method of correcting hallux valgus when compared to other previous procedures. It provides a higher level of satisfaction and excellent outcomes with low complication and recurrence rates. Furthermore, the percutaneous lateral incision improved the cosmetic results by avoiding formation of a dorsal first web space scar. Medial incision is also shorter than the one used for EDCO. Level of evidenceLevel IV, case series.

Surgical treatment of rheumatoid forefoot

Objective: To evaluate the functional outcome and quality of life of patients with rheumatoid arthritis (RA) who underwent resection arthroplasty of the first to fifth metatarsal heads. Methods: Prospective case series study in which 8 feet of 5 patients underwent resection arthroplasty of the five metatarsal heads via a plantarapproach to the lateral rays and via a medial approach to the first metatarsal. Dressing and orthotics were used for 3 months to correct the position of the toes. Patients were evaluated in the preoperative period and at least one year after the procedure using two functional evaluation scales (AOFAS lesser toes and AOFAS hallux) and one quality of life scale (EQ-5D). All results were subjected to statistical validation using theMann-Whitney U test. Results: The subjects had a mean age of 71 years, with a prevalence of the female gender. The mean AOFAS lesser toe and AOFAS hallux scores increased from 38.6 and 24.5 preoperatively to 85.7 and 83.1 postoperatively, respectively (p&lt;0.001). The quality of life scores measured through the EQ-5D improved from 8.0 to 5.6, on average. Conclusion: Resection arthroplasty of the five metatarsal heads improves the function and quality of life in the short term of patients with rheumatoid foot.Level of Evidence IV; Therapeutic Studies; Case Series.

Operative Outcomes of Grade 3 Turf Toe Injuries in Competitive Football Players.

Turf toe is a term used to describe a hyperextension injury to the first metatarsophalangeal joint. Although the vast majority of turf toe injuries can be treated successfully without operative intervention, there are instances where surgery is required to allow the athlete to return to play. Although there is a plethora of literature on turf toe injuries and nonoperative management, there are currently few reports on operative outcomes in athletes. We obtained all cases of turf toe repair according to the ICD-10 procedural code. The inclusion criteria included: age greater than 16, turf toe injury requiring operative management and at least a varsity level high school football player. The charts were reviewed for age, BMI, level of competition, injury mechanism, football position, setting of injury and playing surface. In addition, we recorded the specifics of the operative procedure, a listing of all injured structures, the implants used and the great toe range of motion at final follow-up visit. The AOFAS Hallux score and VAS was used postoperatively as our outcome measures. Our patient population included 15 patients. The average follow-up time was 27.5 months. The average patient was 19.3 years old with a body mass index of 32.3. The average playing time missed was 16.5 weeks. The average dorsiflexion range of motion at the final follow-up was 42.3 degrees. At final follow-up, the average AOFAS Hallux score was 91.3. The average VAS pain score was 0.7 at rest and 0.8 with physical activity. Complete turf toe injuries are often debilitating and may require operative management to restore a pain-free, stable, and functional forefoot. This study represents the largest cohort of operatively treated grade 3 turf toe injuries in the literature and demonstrates that good clinical outcomes were achieved with operative repair. Level IV, case series.

Shortened First Metatarsal Bone and Newly Developed Second Metatarsalgia after Parallel-shaped Modified Scarf Osteotomy for Hallux Valgus Deformity

Category: Bunion Introduction/Purpose: The scarf osteotomy has gained in popularity for the treatment of a symptomatic hallux valgus deformity due to its inherent stability, versatility of correction and early mobilization. We have reported parallel-shaped modified scarf osteotomy(PSMSO) with good functional outcomes and no complication as stress fracture or troughing. However, we encountered second transfer metatarsalgia after the osteotomy. The scarf osteotomy can be shortened, but there was no specific amount of shortening that will produce transfer metatarsalgia in limitation of our literature review. In this study, we measured the shortening of first metatarsal length and investigated the relation of first metatarsal length and second transfer metatarsalgia after PSMSO for hallux valgus deformity. Methods: We retrospectively reviewed 168 consecutive PSMSOs performed in 124 patients with hallux valgus deformity between March 2009 and August 2015. Concomitant other pathologies of foot or previous second metatarsalgia were excluded. After excluding 45 cases, 123 cases in 88 patients were included. For clinical assessment, VAS, the AOFAS Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP) Scale were obtained. The hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA), the first metatarsal length measured by a modified Davies and Saxby’s method and the protrusion of second metatarsal relative to first metatarsal using the Maestro’s method were assessed on standard weight bearing radiographs of the foot. For evaluation of the development of second transfer metatarsalgia, callosity or tenderness beneath the second metatarsal head was investigated. After identifying the lesion, we divided two groups with and without second transfer metatarsalgia and compared the variables after propensity score matching. Results: Mean follow-up period was 20.6±7.8 (12-66) months. The mean VAS and AOFAS Hallux MTP-IP score improved significantly (p&lt;0.001). Significant corrections in the HVA, IMA and DMAA were obtained and the mean shortening of the first metatarsal length and the mean relative lengthening of second metatarsal protrusion were -3.1±2.5 mm and +2.5±2.8 mm at last follow-up (p&lt;0.001, p&lt;0.001). Eleven (8.9%, 11/123) cases developed second transfer metatarsalgia after PSMSO. After propensity score matching considered baseline characteristics, 9 cases with second transfer metatarsalgia were compared to 31 cases without it. The group with transfer metatarsalgia showed significant shortening in first metatarsal length and lengthening of second metatarsal protrusion relative to first metatarsal compared to those without the transfer lesion (-4.8±3.8 vs -2.0±2.1, p=0.013, +4.2±1.6 vs +1.9±2.1, p=0.005). Conclusion: Transfer metatarsalgia is one of numerous possible complications after scarf osteotomy. To avoid complications, we suggest that shortening of first metatarsal bone length should be minimized within -2 mm and second metatarsal protrusion relative to first metatarsal kept within +1.9 mm with considering the metatarsal parabola. If the shortening of first metatarsal was done over -4.8 mm, the additional procedure for second metatarsal may be considered.

Bone-block arthrodesis procedure in failures of first metatarsophalangeal joint replacement.

The treatment for the failure of a first metatarsophalangeal joint (MTP1) prosthesis can be complex. There is no consensus regarding the ideal treatment. One of the main issues is the available bone stock after prosthesis removal. The aim of the study was to report the clinical and radiographic results for MTP1 arthrodesis with autologous calcaneus bone graft (bone-block fusion) as a revision procedure of a previous MTP1 implant failure. This study included 12 patients diagnosed with failure of a MTP1 prosthesis. All patients were treated with MTP1 arthrodesis using ipsilateral calcaneal bone graft. Patients were evaluated with the Foot Ankle Disability Index (FADI), the visual analogue pain scale (VAS) and AOFAS Hallux Metatarsophalangeal Interphalangeal scoring system (AOFAS-HMI), weight-bearing radiograph of the foot, and a computed tomography scan. The 1-2 intermetatarsal angle, hallux valgus angle, and first ray length were measured before surgery and at final follow-up. Complications included 3 cases of arthrodesis nonunion, (1 symptomatic, 2 asymptomatic) with 2 of the 3 patients experiencing hardware failure and 1 superficial wound infection. The average FADI improved from 41.8 preoperatively to 84.6 at final follow-up (p<0.05); the average VAS improved from 8.5 preoperatively to 2 at final follow-up (p<0,05); the average AOFAS-HMI significantly improved from 50.7 preoperatively to 73.8 at final follow-up (p<0.05). The average length of the bone-block used was 14.3mm (range 11-19mm). The 1-2 intermetatarsal angle decreased from 9.5° preoperatively to 8.4° at final follow-up (p<0.05); hallux valgus angle improved from 19.7° preoperatively to 14.3° at final follow-up (p<0.05). The management of a failed first metatarsophalangeal joint prosthesis remains controversial. Bone-block arthrodesis using ipsilateral calcaneal autograft appears to be a viable option restoring the bone loss, and avoiding hallux shortening. Nonunion is the most frequent complication with 25% of patients affected, but only 1/3 of patients with nonunion were symptomatic and required revision.

The Results of Medial Horizontal Suture Fixation of Akin Osteotomy in Hallux Valgus

Purpose The purpose of this study was to analyze the clinical results of medial horizontal suture fixation of Akin osteotomy in hallux valgus and present its advantages. Materials and Methods This study was based on 48 cases of 35 patients with Akin osteotomy, who underwent surgery of hallux valgus between December 2014 and July 2015, and with at least 12 months of follow-up. The mean age of patients was 46.9 years (range, 16~71 years). The mean follow-up duration was 15.9 months (range, 12~18 months). Clinical evaluations included pain visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS hallux metatarsophalangeal interphalangeal scale) score, and satisfaction score. Weightbearing anteroposterior radiographs were taken to measure the distal articular set angle (DASA) of the hallux. Radiographic bone union at 6 months follow-up was regarded as a success, while a loss of reduction and nonunion was regarded as a failure. Results The mean pre- and postoperative pain VAS scores were 4.27 and 1.67, respectively (p<0.05). The mean AOFAS score improved from 59.7 to 80.5 (p<0.05). The DASA was improved from 8.15 to –2.57 (p<0.05). There was no case of skin irritation, cortical breakage, inflammation from the knot, and infection. All patients showed union without fixation failure. Conclusion The clinical and radiological evaluations in this study demonstrate reliable results without complication. The medial horizontal suture fixation of the Akin osteotomy was effective, and the advantage of this procedure was unnecessity of the material removal, preservation of the joint, and no skin irritation.

Evaluation of Brake Response Time Following Primary Bunionectomy Surgery

Category: Bunion Introduction/Purpose: Although primary bunionectomies are among the most common procedures performed by Foot and Ankle surgeons, there are currently no studies investigating postoperative driving safety in this group of patients. The purpose of this study was to evaluate postoperative brake response time (BRT) in primary right-sided bunionectomy patients as a means to determine driving preparedness. Brake response time is defined as the time, in milliseconds, between presentation of a perceived hazardous stimulus and the application of pressure to the brake pedal. We hypothesized that primary bunionectmomy patients would demonstrate BRTs comparable to control subjects at their 6-week follow-up appointment. Methods: Following IRB approval, 45 primary right-sided bunionectomy patients were prospectively identified and enrolled. All patients were managed with the same postoperative protocols. Patients were excluded if they were under the age of 18, were not in possession of a current driver’s license, had undergone a revision surgery for recurrent hallux valgus, or opted not to partake in the study. All patients were tested for their BRT utilizing a validated driving simulator at their 6-week postoperative follow-up appointment. Those patients that failed to achieve a safe brake response time less than 0.850 seconds were re-tested at weekly intervals until a safe braking time was achieved. The passing brake response time of 0.850 seconds was determined from the published control data and from testing 20 healthy volunteers in the same simulator. At each BRT test, patients were also asked to fill out an AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale and a Driving Preparedness survey. Results: Each subject underwent 3 sequential drive-braking simulation tests, with their BRT being calculated as an average of the 3 times. At six weeks, the overall average BRT for all 45 patients was 0.769 seconds. 40 out of 45 patients (89%) demonstrated safe average BRT at their 6-week appointment of equal to or less than 0.850 seconds. 4 out of 45 patients (9%) were cleared to drive at their 7-week re-test, and 1 out of 45 patients (2%) was cleared to drive at an 8-week re-test. 37 of the 40 patients whose test demonstrated a safe BRT at 6 weeks responded in their survey that they “Agreed” or “Strongly Agreed” they were ready to drive at the time of testing. The average AOFAS-MT-IP score was 65.2/100. Conclusion: The present study revealed that approximately 90% of primary right-sided bunionectomy patients were able to demonstrate a BRT comparable to those of healthy control subjects at their 6-week post-op appointment. 37 of these 40 patients (93%) also reported that after completing the test, they felt ready to return to driving. Therefore, we believe that it is reasonable to offer bunionectomy patients an estimate of 6-weeks recovery time before driving.

Prevalence of Metatarsus Adductus in Symptomatic Hallux Valgus and Its Influence on Functional Outcome.

Metatarsus adductus (MA) increases the risk of developing symptomatic hallux valgus (HV). This study aimed to determine the prevalence of MA in patients with symptomatic HV and to evaluate how it affected the functional outcome after scarf osteotomy. Between January 2007 and June 2012, a total of 206 patients who underwent scarf osteotomy for symptomatic HV at a tertiary hospital were included. The metatarsus adductus angle (MAA) was determined using the Modified Sgarlato method, and these patients were categorized into 2 groups: MA (MAA > 20 degrees); and Control (MAA ≤ 20 degrees). The patients were prospectively followed for 2 years. The prevalence of MA was 33% (68/206) with a mean MAA of 24 ± 4 degrees (range = 20-39). There was a 21 ± 12 degrees and 18 ± 9 degrees improvement in hallux valgus angle for the MA and Control groups, respectively (P = .061), whereas there was a 6 ± 4 degrees and 6 ± 3 degrees improvement in intermetartarsal angle for the MA and Control groups, respectively (P = .475). The visual analog scale, AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale, and Physical and Mental Component Scores were comparable between the 2 groups both preoperatively and at 2 years' follow-up (all P > .05). Two patients in the control group required revision surgery for recurrence symptomatic HV. The authors conclude that MA did not predispose the patient to poorer functional outcome after scarf osteotomy with the advent of good operative techniques. Level II, prospective comparative study.

Clinical study on three osteotomy in the treatment of severe hallux valgus

Objective To explore the application value of three osteotomy in the treatment of severe hallux valgus.Methods 25 patiens with severe hallux valgus who were treated were selected.The results of surgical treatment and postoperative complications were retrospectively analyzed,and preoperative and postoperative AOFAS score,HVA and IMA were comparatively analyzed.Results AOFAS hallux valgus feet with reference to evaluation standard,35 foot excellent prognosis was 94.3％.Postoperative AOFAS score(88.7±5.2) compared to the preoperative (41.7±8.4) was significantly higher(P＜0.05),while the postoperative HVA values(10.2 ±2.1)° and IMA value (7.4±1.3)° compared to preoperative(55.7±14.2)° and IMA values(22.7±4.8) ° were significantly lower(P＜0.05).35 feet,the inside of the front foot after the numbness in 8 feet,metatarsophalangeal joints slightly limited by 3 feet,while the remainder were serious complication.Conclusion Three osteotomy for severe hallux valgus had acute efficacy and fewer complications,which is worth dirtical application. Key words: Hallux valgus; Osteotomy