Bilateral Hallux Valgus Research Articles

Effects of hallux valgus deformity on rear foot position, pain, function, and quality of life of women.

[Purpose] To investigate the relationship between hallux valgus (HV) deformity and the position of rearfoot joints, and its effects on the quality of life, pain, and related functional status of women with bilateral hallux valgus (HV). [Subjects and Methods] The subjects were 27 right-dominant women. Demographic data, HV angle, weight-bearing and non-weight-bearing subtalar pronation (SP), and navicular height were recorded. Visual Analog Pain Scale, Foot Function Index (FFI), and the American Orthopaedic Foot and Ankle Society (AOFAS) first metatarsophalangeal- interphalangeal (MTP-IP) and AOFAS Mid foot (MF) Scales, and SF-36 were also used. [Results] HV angle, weight-bearing SP, and pain intensity of the left foot were higher. HV angle of left foot was correlated with all sub-scales of FFI, the pain parameter of AOFAS MTP-IP, and pain and total scores of AOFAS-MF Scale. HV angle of the left foot correlated with physical role, pain, and social function sub-domains of SF-36. Right HV angles were correlated with right foot pain and non-weight-bearing SP. [Conclusion] Increasing HV angle and pathomechanical changes in the rear foot are correlated, resulting in increasing pain and thus decreasing functional status as well as decreasing quality of life. Although all the participants were right-dominant, their left foot problems were more prominent.

G205(P) Fibrodysplasia ossificans progressiva (fop) an unfamiliar disease that is now important to diagnose

Background FOP is a rare but disabling condition characterised by congenital malformation of the great toes and progressive heterotopic endochondral ossification (HEO). FOP is the most catastrophic disorder of HEO in humans. Flare-ups are episodic; immobility is cumulative. The discovery of the ACVR1 gene as the cause of FOP has allowed identification of possible therapeutic targets. Palovarotene, a retinoic acid receptor gamma agonist, is currently in Phase 2 clinical trials to reduce HEO during acute flares. Aim To describe the clinical presentation and current management of FOP. Methods A 7 year old boy with a history of hallux valgus, recurrent painful episodes of soft tissue swelling and new abnormal bone formation, was assessed clinically and radiologically. Results Review of the clinical history and radiographs taken in infancy revealed the diagnosis of FOP. This had not been previously recognised, although he had been seen in a specialist Hallux Valgus clinic as a baby. Conclusions As specific treatments are now becoming available for this life-limiting condition, it is essential that all neonatologists, paediatricians, paediatric oncologists and orthopaedic surgeons consider a diagnosis of FOP if a baby or child presents with bilateral hallux valgus and/or episodes of swelling with evidence of ossification. These children should now be referred to a paediatric metabolic bone clinic to consider genetic testing and for specialist management.

Safety and effectiveness of bilateral continuous sciatic nerve block for bilateral orthopaedic foot surgery

Severe postoperative pain is a major problem after unilateral and bilateral foot surgery. Continuous regional anaesthesia is often used for unilateral surgery. However, for bilateral surgery, the incidence of complications of continuous bilateral compared with unilateral regional anaesthesia is unknown. To assess the incidence of catheter-related complications of bilateral compared with unilateral continuous regional anaesthesia. A prospective observational study. Bellinzona Regional Hospital, a tertiary teaching hospital. Patients (n = 130) scheduled for elective bilateral or unilateral hallux valgus repair treated with continuous popliteal sciatic nerve block using a continuous infusion of ropivacaine 0.15% at 5 ml h for each popliteal catheter by elastomeric pumps. The incidence of catheter-related complications, effectiveness, pain levels at rest and with motion, patient satisfaction for the first three postoperative days and the incidence of ambulatory visits or readmissions after discharge were measured. A follow-up for neurological or other complications related to regional anaesthesia was performed 6 to 8 weeks after surgery. The incidence of catheter-related complications comparing bilateral with unilateral continuous sciatic popliteal nerve block. There were no differences in the incidence of catheter-related complications between the groups. Pain scores at rest and with motion were comparable between the groups. All patients were fit for discharge home 3 days after surgery. Patient satisfaction was similar between the groups. There were no unplanned ambulatory visits or readmissions due to complications in either group. No complications related to regional anaesthesia were reported during the follow-up. The complication rate, effectiveness and patient satisfaction of bilateral continuous popliteal sciatic nerve block was comparable with unilateral continuous sciatic popliteal nerve block. The follow-up showed that bilateral continuous sciatic popliteal nerve block does not increase the complication rate. However, an outpatient-based study should confirm these data prior to introduction in the ambulatory setting.

The association between hallux valgus and proximal joint alignment in young female dancers.

Very little is known about the relationship between proximal joint alignment and hallux valgus among young dancers. This study sought to determine the extent to which spinal and lower extremity alignments are involved in hallux valgus, and to identify predicting variables for its development in young dancers. A group of 1336 young female dancers aged 8-16 years, and 226 control participants of the same age cohort were screened for the presence of hallux valgus, body physique characteristics, joint range of motion, and anatomical anomalies. Hallux valgus was common in the 2 young female populations studied. Among the dancers, 40.0% had bilateral hallux valgus and 7.3% unilateral. Among the controls, 32.3% had bilateral and 1.8% unilateral hallux valgus (χ2=8.27, df=1, p=0.004). Following logistic regression analysis, age (OR=1.028, 95% CI=0.968-1.091), genu varum (OR=1.514; CI=1.139-2.013) and scoliosis (OR=2.089; CI=1.113-3.921) were found to be significant predicting factors for hallux valgus in the dancer group, whereas in the control group, the predicting factors were age (OR=0.911, 95% CI=0.801-1.036) and ankle plantar flexion range of motion (OR=0.972; CI=0.951-0.992). In conclusion, it was found that spinal deformity, lower extremity alignment, and joint range of motion are strongly related to hallux valgus.

Gait changes in individuals with bilateral hallux valgus reduce first metatarsophalangeal loading but increase knee abductor moments

Hallux valgus (HV), one of the most common foot pathologies in modern society, affects not only the foot itself, but also the other lower limb joints. The purpose of the study was to investigate the kinematic and kinetic changes in the lower limb joints in patients with bilateral HV during level walking. Twelve female patients with bilateral HV and 12 healthy female controls walked while three-dimensional kinematic and kinetic data were measured. Patients with HV were found to shift their center of pressure (COP) laterally away from the 1st metatarsophalangeal joint (MPJ), which helped unload the joint during late stance. The lateral shift of the COP in these patients was associated with the reduced toe-out angles of the foot as a result of increased internal rotation of the hip. However, this strategy increased the abductor moments at the knee, an index closely correlated with the medial load at the knee and a predictor of the onset and progression of medial OA. Early treatment of HV may be helpful not only for reducing foot pain and deformity, but also for preventing the potentially harmful loading at the knee, especially in those at risk of medial knee OA.

Experiencia con la técnica percutánea mínimamente invasiva para el tratamiento del hallux valgus

IntroductionThis research study presents the results of implementing a minimally invasive percutaneous technique in the surgical treatment of forefoot disorders. Materials and methodsThe study included 104 patients who met the inclusion criteria of having a bilateral Hallux Valgus procedure, between 1998 and 2010. Each patient had pre- and post-surgical treatment assessment of their quality of life, using the American Orthopedic Foot and Ankle Society (AOFAS) rating scale. Statistical analysis was performed measuring pre- and post-surgical variables by applying univariate analysis and paired multivariate hypothesis testing. ResultsThe univariate analysis performed before and after surgery showed a statistically significant difference in the quality of life parameter for the right foot (P=001). Similar results were found for the left foot (P=001). When comparing the before and after surgery variables, the last post-surgery control showed that the surgical procedure had a significantly positive effect on the quality of life of patients. DiscussionThis technique is safe and reliable, and must be performed by qualified personnel that have experience in both traditional and minimally invasive surgery. This allows efficient use of time by experts during the procedure and assures a permanent functional and aesthetic correction, which improves the quality of life and self-esteem of patients.

AB1135 Arthropathy of down syndrome: From child to adult. Case report

BackgroundDown syndrome (DS), the result of trisomy of chromosome 21 causing mental retardation, various structural abnormalities or disturbance of organ systems, is one of the most common chromosomal abnormalities. Orthopedic...

The SERI Distal Metatarsal Osteotomy and Scarf Osteotomy Provide Similar Correction of Hallux Valgus

Ideal surgical treatment for hallux valgus is still controversial. A traditional distal metatarsal osteotomy with rigid fixation (Scarf procedure) and a more minimally invasive approach to a distal metatarsal osteotomy, termed SERI (Simple, Effective, Rapid, Inexpensive), have proven successful with short-term followup. However, no data are available directly comparing the two procedures. We performed a prospective randomized trial to determine which technique (SERI or Scarf) was associated with (1) better functional outcomes, (2) better radiographic correction, and (3) fewer complications at 2 and 7 years followup. Twenty patients, 53 ± 11 years of age, with bilateral hallux valgus, clinically and radiographically similar, underwent bilateral surgery with Scarf on one side and SERI on the other, at random. Clinical (AOFAS score) and radiographic assessments were considered before surgery, and at 7 years followup. SERI and Scarf techniques provided correction of the hallux valgus angle, intermetatarsal angle, and distal metatarsal angle in the range of normal. Both led to similar clinically important improvements in the AOFAS. No differences were observed between the groups. All osteotomies healed, and two patients who underwent the Scarf procedure required hardware removal. Reduction of ROM with respect to preoperative was observed in three patients for SERI and three patients for Scarf procedures. Scarf and SERI techniques resulted in effective correction of hallux valgus with similar outcomes, however the SERI technique required a shorter skin incision, less surgical time, less expensive fixation device, and was without residual pain attributable to hardware. Level II, prospective comparative study. See Guidelines for Authors for a complete description of levels of evidence.

Deep Venous Thrombosis and Pulmonary Embolism as Rare Complications After Hallux Valgus Surgery

The incidence and life-threatening complications of thromboembolic disease after major orthopedic surgical procedures have been extensively defined in the medical literature. However, there are few studies concerning the incidence of thromboembolic disease after foot and ankle surgery. We describe a 57-year-old female patient who underwent surgery for bilateral hallux valgus deformities and was diagnosed as having deep venous thrombosis and pulmonary embolism after the surgery despite early mobilization and mechanical prohylaxis. Her preoperative physical examination revealed varicose veins in both cruris. She was treated for pulmonary embolism with low-molecular-weight heparin and an oral anticoagulant in the postoperative period. Although venous thromboembolism is more commonly described after proximal lower-extremity procedures, it can occur after foot and ankle surgery, particularly if the patient has certain risk factors. Therefore, in addition to mechanical prophylaxis, pharmacologic prophylaxis should be kept in mind in such patients.

Unilateral Hallux Valgus

This study was undertaken to determine whether unilateral hallux valgus progresses unilaterally and to evaluate the demographics, etiologies, and radiographic findings associated with symptomatic unilateral hallux valgus deformities. Patients treated for hallux valgus between January 2004 and December 2008 were identified, and of these, 33 patients with unilateral deformities were enrolled. Progression of deformities in normal feet were evaluated at last follow-up visit, and the clinical information and radiographic measurements of those with a deformed normal foot or an unchanged normal foot were compared. Thirty-three patients (3.4%) had a unilateral hallux valgus deformity on preoperative radiographs. The mean length of follow up was 4.7 years (range, 2.4-11). Twenty-four cases had no deformity of the normal foot at last follow-up (the unchanged group), but 15 cases had developed hallux valgus deformity (the deformed group). No significant intergroup differences were found in terms of metatarsus adductus angle (P = .412), Meary angle (P = .771), talocalcaneal angle (P = 1.000), or calcaneal pitch angle (P = .267). However, members of the deformed group were significantly younger at disease onset (P = .045), exhibited a curved first metatarsal head (P = .046), and had a larger initial hallux valgus angle (P < .001). The frequency of bilateral symptomatic hallux valgus was found to be over 97.3%, and significant differences were found between the deformed and unchanged groups in terms of age of onset, metatarsal head shape, and hallux valgus angle.

Marfanoid habitus, inguinal hernia, advanced bone age, and distinctive facial features: A new collagenopathy?

We report on two sibs, a girl, and a boy, with tall stature, long, and triangular faces, prominent foreheads with high frontal hairlines, telecanthus, downward slanting of the palpebral fissures, ptosis of the eyelids, everted lower eyelids, large ears, long noses, full, and everted vermilions, highly arched and narrow palates, tooth crowding, thin and long uvulae, coloboma of the alae, hyperextensible joints, long digits, positive thumb signs, flat feet, slightly diminished muscle strength, myopia, astigmatia, inguinal hernia, and vesical diverticula. Total body X-rays showed the presence of advanced bone age in both sibs and bilateral hallux valgus in the girl. Array-CGH did not reveal any pathological CNV. Molecular analysis of FBN1, FBN2, TGFBR1, TGFBR2, and CHST14 gene was normal, and SNP linkage analysis excluded more candidate genes. Differential diagnoses and the possibility that we might be reporting on a hitherto unreported syndrome are discussed.

Incidence of hallux valgus deformity among Iranian university students

Background and Aim: Materials and Methods: This descriptive study was carried out using a self-constructed and the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaires among 290 university students with the mean age of 21±2 years old. The HV angles (HVA) was described as normal for up to 20o, mild for angles between 21o and 25o, moderate for angles between 26o and 40o, and severe for angles higher than 40 o. Then, the HVA of the subjects of this study was compared with the data from other societies. Results: The results of this study showed a 34.1% involvement of the participants (30% females and 41% males). 58% of the subjects showed a bilateral hallux valgus involvement. No significant differences were found between the males and females in terms of the severity of the deformity and the right or left side involvement (P>0.05). 71% of the involved subjects showed a mild degree and 29% showed a moderate degree of deformity. No severe deformity (above 40o) was found in this study. In terms of the associated deformities, in subjects with mild deformity, 25% showed flat foot and 69% showed bunion disorder; While these were 21% and 82% in subjects with moderate deformity, respectively. In terms of inheritance correlation, while this deformity was shown in only 7% of normal subjects’ first degree relatives (father, mother, brothers or sisters), it increased to 21.1% in mild degree and 46.4% in moderate degree groups. Conclusion: This study revealed a very high incidence of HV deformity in Iranian university students as a sample of Iranian youngsters, which is much higher than those in some Western societies. This deformity showed to be highly inherent due to the increasing level of this deformity among first degree relatives. Routine use of high heel or round tip shoes showed no influence on the rate of HV deformity. Keywords: Hallux valgus, incidence, hereditary, shoes, university students. The dramatically increased incidence of hallux valgus (HV) deformity is more related to the cultural rather than genetic parameters. Due to the lack of reliable information about the rate of this disorder in Iraninan societies, the researchers of the current study aimed to find out the incidence of this disorder in Iranian university students as a sample of Iranian youngsters.

Bilateral Tibial Hallux Sesamoid Agenesis and Fibular Hallux Sesamoid Hypoplasia in a Patient with Bilateral Hallux Valgus

We report the clinical features, radiographic findings, management, and results of a patient with bilateral hallux valgus and associated bilateral tibial hallux sesamoid agenesis and fibular hallux sesamoid hypoplasia. Our patient was managed operatively with good clinical results. Combined tibial sesamoid agenesis and fibular sesamoid hypoplasia do not seem to negatively influence the management of hallux valgus.

The influence of hallux valgus on pelvis and lower extremity movement during gait

Background: The hallux and the first metatarsophalangeal joint play a major role in load transmission during walking. Objective: The main aim of this study was to investigate differences in kinematics of the pelvis and lower extremities during gait by comparing people with hallux valgus (HV) and a control group (CG). Methods: We compared subjects with asymptomatic bilateral HV (n = 6, 57.8 ± 5.64 years) with those who had CG (n = 11, 50.7 ± 4.41 years). Gait analysis was investigated using an optoelectronic system Vicon MX. The subjects walked at self-selected speeds. In total, five trials of each subject were analyzed. The statistical processing was performed by means of the Student t-test. The effect size was determined using the ω2 measure. Results: In people with HV there was a significantly smaller maximum of dorsal flexion during the stance phase (p 0.06) and a greater maximum of plantar flexion at the beginning of the stance phase (p 0.06). The maximum of knee extension at the end of the swing phase was significantly greater (p 0.06) in subjects with HV. In the frontal plane, a significantly smaller maximum of hip abduction (p 0.06) during the gait cycle was observed in people with HV. The range of the pelvic obliquity (p 0.06) and the pelvic rotation (p 0.06) were significantly smaller in people with HV. Conclusion: This study demonstrated that HV does not exclusively concern the foot. The valgus deformity of the big toe can negatively influence function of the lower extremities and can cause overloading of those segments as well.

Black bone disease of the foot. Minocycline related pigmentation

Black bone disease is a rare manifestation of long term treatment with tetracyclines. We report the case of a patient who underwent surgery for bilateral hallux valgus and was found to have black discolouration of both first rays. This was subsequently related to previous long term Minocycline use. The unique features of this case relate to the location of the discolouration and the normal physical properties of the bone and soft tissues at surgery despite heavy pigmentation. Healing is now complete and follow-up at two years confirmed excellent clinical and radiological outcomes.

Prevalence of Hallux Valgus Among Youth Population in Lagos, Nigeria

This study was aimed at evaluating the prevalence of Hallux Valgus (HV) and related foot problems among the youth population in Lagos, Nigeria. A structured questionnaire was administered to 1, 200 subjects from 10 secondary schools and undergraduate students of the College of Medicine University of Lagos, Lagos, Nigeria. The participants were requested to provide information on demographic data, severity of HV, and the functional limitation imposed on the participants by HV. Nine hundred and seventy (970) of the 979 returned questionnaires were analyzed using descriptive statistics. The prevalence of HV in this study was 15.4% of which 43.6% and 56.4% were male and female respectively. 36 (3.7%) out of total number of participants had bilateral HV (both feet), 57 (5.9%) and 56 (5.8%) had HV on left and right foot only respectively. Eighty four (25.2%) of the 333 (34.3%) subjects that complained of pain at the first metatarsophalangeal joint had HV. Inability to stand for long periods due to pain at the first metatarsophalangeal joint was reported by 90 (9.3%) participants, while 136 (14.0%) reported inability to walk long distances. Prevalence of HV among youths in Lagos, Nigeria is low. HV is more common among females and its prevalence increases with age. More attention should be focused on foot pain and deformities. Preventive measures and education on the HV deformity is advocated.

Bilateral Second Metatarsal Stress Fractures After Hallux Valgus Correction With the Use of a Tension Wire and Button Fixation System

The pathomechanics and treatments of hallux valgus vary widely by deformity and surgeon, and are extensively described in the orthopedic and podiatric literature. With each newly described treatment, new complications can be encountered. In this report, we describe the case of a 22-year-old woman who underwent bilateral hallux valgus repair with a tension wire and button fixation system, and developed bilateral second metatarsal stress fracture at the point of fixation application during the postoperative period. Although this fixation system has been useful in our practice, like other surgical implants, it conveys a certain amount of risk that should be considered by surgeons using the device.

Efficacy of Outpatient Bilateral Simultaneous Hallux Valgus Surgery

Bilateral simultaneous hallux valgus correction is traditionally performed as an inpatient procedure due to concerns regarding adequate postoperative analgesia and difficulty mobilizing. We prospectively evaluated 40 consecutive patients (80 feet) who underwent outpatient surgical correction of bilateral symptomatic hallux valgus. Patients underwent preoperative radiological and clinical assessment using pain and American Orthopaedic Foot & Ankle Society (AOFAS) hallux assessment scores. Patients underwent preoperative counseling and were assessed for medical suitability for outpatient surgery. They were instructed to have responsible adult caregivers available for 24 hours postoperatively, easy access to after-hours emergency medical care, and access to a telephone. Procedures were performed under general anesthesia with local anesthetic ankle block. Postoperatively, patients were discharged after assessment by medical, nursing, and physiotherapy staff with an oral analgesia regimen. Cast immobilization was not used. Patients were reviewed at 6 weeks and 3 months postoperatively with repeated clinical and radiological assessment. All patients were discharged home and none required inpatient ward admission. Post-discharge, no patient presented to the emergency department or their general practitioner as a consequence of poor pain control. At final follow-up assessment, mean AOFAS hallux scores had improved from 58.1 (range, 29-80) to 89.0 (range, 47-100) (P<.001). The mean hallux valgus angle improved from 33.2 degrees (range, 15 degrees -53 degrees) to 16.9 degrees (range, 3 degrees -39 degrees) and the intermetatarsal angle had improved from 13.2 degrees (range, 6 degrees -23 degrees) to 8.5 degrees (range, 4 degrees -15 degrees) (P<.001). Eighty-five percent of patients reported that they would recommend outpatient surgery. Bilateral hallux valgus surgery can be performed safely as an outpatient procedure in selected patients with acceptable levels of patient satisfaction.

Scarf Osteotomy for the Correction of Adolescent Hallux Valgus

Adolescent hallux valgus deformity is a complex surgical condition. Although several techniques have been described to correct this deformity in adults, limitations exist for adolescents because of the presence of open growth plates and high recurrence rates. This retrospective study reports results of 7 patients (14 feet) using the Scarf osteotomy for correction of adolescent hallux valgus deformity. All patients underwent concomitant bilateral hallux valgus surgery. Radiographic evaluation measures included intermetatarsal 1-2 angle, hallux valgus angle, and distal metatarsal articular angle. Data recorded from the lateral radiograph evaluated the first metatarsal declination angle. Postoperative patient satisfaction was assessed using a standard patient satisfaction survey. Postoperative, subjective, and objective measurements were calculated using the American College of Foot and Ankle Surgeons (ACFAS) Scoring Scale for the First Metatarsophalangeal Joint and First Ray and the American Orthopaedic Foot & Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scoring Scale. Average patient age and follow-up were 14.43 years and 57 months, respectively. There was 100% maternal inheritance of hallux valgus deformity. The average postoperative ACFAS Metatarsophalangeal Joint and First Ray Scale (module 1) score was 94.72, and the average AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale score was 96.43. Complications included 1 patient who underwent revision surgery on 1 foot 18 years after the date of index surgery because of painful recurrence of the deformity. The authors believe the Scarf osteotomy is a safe, effective, and versatile procedure for the correction of juvenile and adolescent hallux valgus deformity.

L-Shaped Big Toe

A case report of bilateral severe hallux valgus interphalangeus is presented. This is an interesting case because of the possible etiology that could not be found in any other previous publications.