Hallux Valgus Research Articles

Feasibility Study for COSMIC Study - Comparing Open SCARF Osteotomy and Minimally Invasive Chevron Osteotomy for Hallux Valgus Correction

Category: Bunion; Other Introduction/Purpose: Minimally invasive surgery for hallux valgus deformity is gaining popularity over the traditional Open scarf osteotomy. Emerging evidences are showing similar clinical outcomes but further studies are needed to ascertain this. The aim of this study was to assess the feasibility of conducting a randomised controlled trial to compare the patient recorded and clinical outcomes for the surgical management of Hallux Valgus between open scarf osteotomy (OS) and minimally invasive chevron osteotomy (MICA). Methods: Patients suitable for surgical correction were invited to participate. Post op rehabilitation was standardised for both groups. Patients completed a validated questionnaire (Manchester Oxford Foot questionnaire and EQ-5D) preoperatively and post operatively at 6 months and 1 year. Radiological parameters and range of motion were measure pre and post operatively. A total of 41 patients were eligible for the study, 31 were successfully recruited and operated between Dec 2017 and June 2022. Results: 17 patients were randomised to MIS (15 female, mean age 51 years) and 14 to OS (13 female, mean age 51 years). Both groups have a significant improvement in the MOXFQ parameters (walking, pain and social) at 6m and 12m, as well as radiological parameters. VAS improved for OS at 6m (p=0.048) and 12m (p=0.025) but only improvement at 6m was seen for MICA (p=0.059 and p=0.054 at 12m). There was no improvement in EQ-5D in either group at 12 months and no difference in surgical time (p=0.53).There was a higher number of complication in the MICA group with 5 removal of metalwork (29.4%) and 2 superficial infections (11.8%) vs none in the OS group. Conclusion: Both surgical options show similar clinical results but higher complication rate was seen with MICA. A larger study is needed to evaluate further.

Influence of Normal and Pathologic Windlass Mechanism During Dorsiflexion of the Hallux

Category: Midfoot/Forefoot; Other Introduction/Purpose: When the windlass mechanism (WM) is engaged, the plantar aponeurosis (PA) is pulled distally by extension of the first metatarsophalangeal joint (MTPJ1), shortening the sole of the foot and raising the medial longitudinal arch (MLA). It has also been reported that the WM is associated with hallux valgus and hallux rigidus. Although this function has been known for a long time, there are few reports on the movement of the foot bones under pathological conditions. In this study, we used cadaveric feet to compare the movements of the foot bones under three conditions: normal tendon loads, an overpulled Achilles tendon, and a sectioned PA with normal tendon loads. Methods: Ten fresh cadaveric foot specimens were used. The foot was attached to a tibial loading frame with 20% body weight loads applied. Each specimen was scanned in seven configurations (first proximal phalanx angles 0-60°, each 10° apart) and three conditions (normal loads, overpulled Achilles, and sectioned PA) using a LineUP cone-beam computed tomography (CBCT) scanner. The foot bones in the neutral position under normal loading were segmented from the CBCT scan volumes in Mimics Research software v23.0. Bone kinematics between the 20 additional scans were determined via volumetric image registration in custom MATLAB software for each segmented bone. Using additional custom MATLAB code, we calculated the height of the navicular, the MLA angle defined as the three points (the farthest point of the first metatarsal head, the medial process of the calcaneus, and the apex of the navicular tuberosity), and the motion of the joints on the foot in 3D. Results: The height of the navicular was significantly lower at 0, 30, and 60 degrees in the pathological conditions compared to normal (Normal vs overpulled Achilles: 2.9, 3.2, 5.4 mm, p< 0.01, normal vs sectioned PA: 5.2, 5.6, 5 mm, p=0.04, at 0°, 30°, and 60° respectively). The MLA angle was significantly different at all angles for the overpulled Achilles compared to the normal (-3°, -3.5°, -3.6°, p< 0.02). At the tarsometatarsal (TMT) joint, there was no significant differences in any direction. At the cuneonavicular joint, there was less plantarflexion (normal: -6.1, -10.8, overpulled Achilles: -2.8, -6.6, p< 0.01 at 30° and 60° respectively) and less eversion (normal: 24.7, overpulled Achilles: 27.9, p< 0.01 at 60°) in the overpulled Achilles compared to normal. Conclusion: In this study, a three-dimensional model was used to measure the function of the WM. We found that the WM was affected by the pathological conditions of the Achilles tendon and sectioning the PA. The results of this study suggest that WM dysfunction may not affect the TMT joint but does affect the cuneonavicular joint. This might suggest the WM induced MTPJ1 pathologies are driven by the cuneonavicular joint.

Orthogonal C-arms for Third-Generation Minimally Invasive Correction of Hallux Valgus: A Technique Tip.

Graphical AbstractThis is a visual representation of the abstract.

Establishment of Minimum Clinically Important Difference and Patient Acceptable Symptom State Thresholds in Foot and Ankle Ability Measure and Visual Analogue Scale Scores After Hallux Valgus Surgery

Category: Bunion Introduction/Purpose: The purpose of this study was to determine the minimal clinically important difference (MCID) and the patient acceptable symptom state (PASS) threshold for the Visual Analogue Scale (VAS) and Foot and Ankle Ability Measure (FAAM) Scores after Hallux Valgus surgery. Methods: A retrospective review of prospective collected data was performed in patients undergoing hallux valgus surgery at a single institution from January 2021 through December 2022. Patient-reported outcome measures (PROMs) were collected pre-operatively and 1 year post-operatively. The specific PROMs utilized were the FAAM- Activities of Daily Living (FAAM-ADL), Single Assessment Numeric Evaluation (SANE), and VAS scale. The study measured change in PROMs from before surgery to one year after surgery to determine delta. Two methods were used to calculate MCID and PASS thresholds: A distribution-based approach and an anchor-based approach using responses to a one-year postoperative satisfaction question. The analysis identified optimal cut-off points that maximized sensitivity and specificity based on the Youden index. The percentage of patients reaching these optimal MCID and PASS thresholds was also determined. Results: Overall, 86% (136/158) completed baseline PROMs, and 72.7% (99/136) completed 1-year PROMs. The distribution-based MCID for FAAM-ADL, FAAM-ADL-SANE, , and VAS were calculated to be 10.8, 14.1, and 1.2 respectively. The rate of patients who achieved MCID thresholds was 54% for FAAM-ADL, 42% for FAAM-ADL-SANE, and 95.8% for VAS. The PASS threshold for FAAM-ADL, FAAM-ADL-SANE, and VAS were ≥78.5, ≥85, and ≤ 2, respectively. The rate of patients who achieved PASS thresholds was 77.5% for FAAM-ADL, 71.4% for FAAM-ADL-SANE, and 68.7% for VAS. Conclusion: This study identified useful values for the MCID and PASS thresholds at 1-year follow-up for patient undergoing hallux valgus surgery of FAAM-ADL, FAAM-ADL-SANE, and VAS scores.

Biomechanical Evaluation of Different Fixation Methods for Percutaneous Extracapsular Transverse Cervical Metatarsal Osteotomy in a Hallux Valgus Sawbone Model.

There is limited literature available that provide information about fixation methods for minimally invasive hallux valgus osteotomies. Our objective was to evaluate the strength of different fixation methods for a percutaneous extracapsular transverse cervical metatarsal (PTCM) osteotomy in a sawbone model. Thirty solid foam sawbone foot models were used. Percutaneous extracapsular transverse cervical metatarsal osteotomies were performed and fixed in a standardized fashion in 6 different groups: (1) one 4.0-mm screw; (2) 2 (one 4.0-mm and one 3.0-mm) parallel screws; (3) 2 (one 4.0-mm and one 3.0-mm) divergent screws; (4) same as group 3, but with lateral metatarsal head cortex purchase with the 4.0-mm screw; (5) same as group 4, but with two 4.0-mm screws; (6) same as group 5, but with two 3.5-mm screws. Cyclic and load to failure testing were performed applying a plantar load to the metatarsal head. The measured variables were stiffness and force needed to create deformity using a Zwick Roell Universal Testing Machine. Group 1 failed as a result of rotational instability in cyclic testing. In load to failure testing, group 3 did not achieve difference compared with group 2 (P = .09) (181 vs 131 N). Group 4 was stronger (P = .02) (250 N) than groups 1-3. Group 5 did not show differences relative to group 4 (P = .1) (223 N). Group 6 was stronger only than groups 1 and 2 (P = .01) (193 N). In this sawbones-based study, we found that the use of two 4.0-mm screws or use of a 3.0-mm screw and a 4.0-mm screw with lateral first metatarsal head cortical purchase was superior to other screw configurations.

Radiographs Over-Estimates Joint Space Narrowing in Hallux Rigidus in Comparison to Weight-Bearing Computed Tomography

Category: Other; Bunion Introduction/Purpose: Twenty years ago, Coughlin and Shurnas proposed a clinical and radiographic classification grading scale for hallux rigidus (HR). Radiographic grading was based on weight-bearing anteroposterior and lateral conventional radiographs. Radiographic metrices include joint space width, a narrowing percentage of the dorsal joint space, and sesamoidal changes such as enlargement, irregularities, and sclerosis. Dorsal osteophytes were the main findings in all grades. The aim of this study was to compare hallux rigidus radiographic findings between conventional and weight-bearing computed tomography (WBCT). We hypothesized that radiographs overestimate joint space narrowing due to bone overlap and osteophytes. Methods: In this IRB approved study, all patients who had weight-bearing radiographs and WBCT for HR were included. Patients with previous hallux surgeries or associated severe hallux valgus were excluded. The first metatarsophalangeal joint (1st MTPJ) was measured using the summation method. (figure1) Dorsal osteophytes were measured. We measured the percentage of narrowing of the dorsal articular surface on a weight-bearing lateral/sagittal view. We evaluated the proximal phalanx (P1), first metatarsal (M1), and sesamoids (SS) for cysts. (Figure 1) All measurements were performed by two fellowship-trained orthopaedic foot and ankle surgeons. A comparison between groups was performed using the t-test or the Mann-Whitney U test according to data normality. Inter-rater reliability was evaluated using inter class correlation coefficient. Significant differences were established for p-values under 0.05. Results: The study included 21 patients; 13 were males. The average age was 55.9 ± 12.5 and the BMI was 28.9 ± 6.5. The joint space width was significantly larger on WBCT (1.9mm ± 0.44) vs. (0.92mm ± 0.53) (P < 0.001). WBCT showed less narrowing of the dorsal articular surface (46.59% ± 18.8%) vs. (22.78% ± 8.71). There was no difference in the size of dorsal spurs (4.57 mm ± 1.49) vs. (4.39 mm ± 1.56) (P = 0.684). WBCT detected loose bodies in nine patients, while radiographs detected them only in six patients. Sesamoid changes were appreciated on the WBCT image of all patients. Conclusion: Radiographic parameters of the Coughlin classification of hallux rigidus are better evaluated with WBCT. WBCT showed less narrowing of the dorsal joint space as it’s not affected by the overlap of other bones. Dorsal spurs may give the false impression of joint space narrowing on radiographs. Dedicated radiographic sesamoid views (not routinely ordered) are required to study sesamoid changes. The detection of less joint space affection could potentially lead to more joint sparing surgeries.

Nerve Complications with Regional Anesthesia in Foot and Ankle Surgery Avoiding the Popliteal Fossa

Category: Other Introduction/Purpose: Popliteal nerve blocks are often used to aid intraoperative general anesthesia and provide post-operative pain control for many foot and ankle surgeries. Unfortunately, there is conflicting data regarding complication rates from popliteal nerve blocks, specifically when comparing studies from (the) orthopedic and anesthesia literature. Orthopedic literature notes long term effects (foot drop/sensation deficits) whereas anesthesia literature focuses on immediate post-operative pain control. An approach to block more distal nerves and avoid the popliteal fossa altogether may provide equal anesthetic and pain relief with fewer motor and sensory complications. Our study seeks to address such complications by utilizing an alternative anesthetic approach that targets sensory distributions of nerves that may be affected during the procedure while avoiding major motor neve contributions within the popliteal fossa. Methods: We conducted a retrospective chart review between 2019 and 2023, analyzing complications associated with regional anesthesia achieved via a distal ankle block rather than a popliteal nerve block. Two hundred thirty-seven patients who underwent a variety of foot and ankle procedures (e.g., ankle arthroscopy, ankle fracture repair, cavovarus foot reconstruction, hallux valgus arthrodesis, lateral ankle stabilization, calf tendon revision, midfoot fusion, metatarsal arthrodesis) were included in this study. Results: Out of 237 patients who received a distal ankle block, only three patients were found to have superficial peroneal neuropathy confirmed with EMG, yielding a complication rate of 1.3%. Additionally, six patients required post-operative rescue block for pain control. The remaining 234 patients recovered without complications caused by the distal nerve block approach. Conclusion: The low rate of complications, specifically motor complications, from the distal nerve blocks demonstrate a beneficial alternative to the popliteal nerve blocks for various foot and ankle orthopedic surgeries. This finding is important to consider when choosing an appropriate approach to augment intraoperative general anesthesia accompanying foot and ankle surgeries in the outpatient setting.

Influence of Outsole Structures on Foot Loading and Gait Stability

As the downstream products most relevant to the leather industry, leather shoes perform well in the global market. Consumers have put forward high requirements for the comfort and safety of leather shoes in recent years, especially for high heels, whose unique outsole structure often causes foot overloading. The outsole structure varies in ground-contacted mode and heel base size, and plays a decisive role in its function, affecting gait patterns. This study aimed to investigate differences in foot loading and gait stability induced by different outsole structures, at two typical heel heights. Six pairs of customized high heels (3 outsole structures × 2 heel heights) were tested on eighteen healthy females while walking by the Novel Pedar-X in-shoe plantar pressure system. Taking the thick high heels for the intermediate control group, the main effects of the outsole structures and the heel heights, and their interactions on the plantar pressures were analyzed by Two-way repeated ANOVAs. The center of pressure displacements and velocities were calculated throughout the whole stance phase. The results indicated that the whole ground-contacted mode of the outsole displayed better stability in the medial-lateral direction in the early stance phase but may increase the risk of hallux valgus because of the elevated load there. On the contrary, the smaller heel base size exhibited poorer stability in the medial-lateral direction in the early stance phase and would increase forefoot loading. The response of gait characteristics to heel height change is more prominent, which could cause a more vulnerable gait posture. The results could be relevant to improving high-heel functional design, positively motivating the transformation and upgrading of the leather shoe industry.

Biomechanical Evaluation of Popular Lapidus Fixation Plates

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: A 1st Tarsometatarsal (TMT) fusion or Lapidus is increasingly popular for moderate to severe hallux valgus with pronation. Hardware utilized for fixation consists of different combinations of plates, screws, and staples. Prior studies have suggested that constructs including a plate are superior to those consisting of screws or staples only. This biomechanical report compares a novel 1st TMT fusion U-plate to a predicate biplanar locking plating system. Methods: A total of 7 TMT U-plate systems were utilized for mechanical testing, with 3 samples undergoing static testing and 4 samples undergoing dynamic testing. Their mechanical properties were compared to those of one predicate device for static testing and 4 devices for dynamic testing. Standard 4th generation Sawbones models and bicortical screws were utilized in all cases. Static testing consisted of a uniform ramp to catastrophic failure using a cantilever bending model. Dynamic testing consisted of an incremental step procedure. A step size of 50,000 cycles at 3 Hz was used. The peak tensile load defined the step size with the valley tensile loading at one-tenth the peak loading. The first step used a 3.6 Nm moment with a peak tensile loading at 120 N. Results: Static testing of the TMT U-plate system demonstrated comparable or superior performance in load to failure testing than the predicate device (U-plate: mean = 351.3N, SD = 29.6; predicate: 324.4N). Dynamic testing demonstrated that the U-plate system survived 76,602 ± 43,275 cycles which was 261% greater than tested predicate constructs 29,338 ± 33,080 cycles. Additionally, cyclic failure loads were 151.3 ± 23.9 N for the U-plating system which was 120% greater than the predicate constructs at 126.3 ± 12.5 N. Conclusion: The TMT U-Plate demonstrated superior or comparable biomechanical properties to the predicate device in static and dynamic mechanical testing. Further investigation is needed to ascertain if these biomechanical differences have clinical correlations.

Comparative Study of Staples vs Plate and Screws for Arthrodesis of the First Metatarsophalangeal Joint

Category: Midfoot/Forefoot; Other Introduction/Purpose: Nitinol technology has revolutionized foot and ankle orthopaedic surgery, offering a quick and low-profile means of achieving bone healing. One application of this technology has been in the development of a first metatarsophalangeal (MTP) joint staple, utilized in place of crossing screws or a plate and interlocking screws constructs to achieve fusion at the first MTP joint. The objectives of this study were to compare radiographically and subjective outcomes for patients who had a first MTP joint fusion treated with an Enovis Dynaclip Delta staple vs those treated with a plate and interlocking screws. The hypothesis is the staple provides a quicker surgical time and equivalent rate of union compared to patients who were treated with standard plate and screws. Methods: A single-surgeon, consecutive case series of prospectively collected data was reviewed retrospectively for patients who underwent primary first MTP arthrodesis using a staple. Patients were age and gender matched to those who underwent primary first MTP arthrodesis with a plate and associated interlocking screws. Dates of surgery were November 2017 - December 2023. Exclusions included revision surgeries, prior forefoot/midfoot fusions, and ancillary fusions at the time of the index surgery. Preoperative and postoperative patient-reported outcome measures (PROMs) [Foot and Ankle Ability Measure (FAAM), Veterans-Rand 12 (VR-12) General Health Survey, visual analog pain scale (VAS), and radiographs (hallux valgus angle, dorsiflexion angle) were evaluated to compare the two groups. Comorbidities, operative time, fusion rates, and a patient satisfaction survey were also collected. Statistical analysis was performed using sutdent’s t-tests. Results: Twenty-two feet were included in both groups. Preoperative and postoperative PROMs between groups demonstrated no significant differences in all questionnaire categories assessed. The staple group demonstrated significant differences from preoperative to postoperative in FAAM ADL (p=0.004), FAAM sport (p=0.010), and VAS (p< 0.001) while plate and screws demonstrated significant differences in FAAM ADL (p=0.032) and VAS (p=0.033). The radiographic measurements revealed a significant difference in the postoperative dorsiflexion angle for staple vs plate and screws 21.81±5.72 vs 26.47±6.99, respectively (p=0.012) and there were no other significant differences noted (table). Operative time revealed a significant difference between staple vs plate and screws (30.0 minutes vs 35.73 minutes, respectively) (p=0.006). The fusion rate was 95% in both groups. Conclusion: This study reports early results for a comparison of first MTP joint fusion treated with an Enovis Dynaclip Delta staple vs those treated with the standard plate and interlocking screws. While there were statistical differences within each group between most of the preoperative and postoperative PROMs, comparing the two groups, there was none. The fusion rate was the same in both groups. The staple group had an average of 5.7 minutes less operative time. Staple fixation achieves similar union rates to plate and screw constructs with a shorter operative time. Further patients are needed to expand this cohort.

Arthroscopically Assisted Reconstruction of Lateral Metatarsosesamoid Suspensory and Lateral Metatarsophalangeal Collateral Ligaments in the Management of Iatrogenic Hallux Varus Deformity

The medial and lateral metatarsosesamoid suspensory ligaments together with the sesamoid apparatus are the main contributors to the rotational stability of the first metatarsophalangeal joint (MTPJ). Rotational instability of first MTPJ is a major factor in the development of hallux valgus and varus deformities. As the great toe starts to rotate, the muscle pulls across the first MTPJ, causing it to become imbalanced and lead to progressive medial or lateral deviation of the great toe. The gold standard and most reliable option for hallux varus deformity is first MTPJ fusion. However, it results in stiffness and loss of joint function and is reserved for arthritic and stiff first MTPJ. Flexible iatrogenic hallux varus is corrected by optimally anatomic ligament reconstruction. The purpose of this Technical Note is to describe the details of arthroscopically assisted reconstruction of lateral metatarsosesamoid suspensory and lateral metatarsophalangeal collateral ligaments in management of iatrogenic hallux varus deformity. We reconstruct the lateral metatarsosesamoid suspensory ligament to restore the rotational stability of the first MTPJ in hallux varus deformity. This together with reconstruction of the lateral metatarsophalangeal collateral ligament anatomically corrects both the medial deviation and rotation deformity of the great toe.

Radiographic Evaluation of Time to Union in Minimally Invasive Hallux Valgus Correction

Radiographic Evaluation of Time to Union in Minimally Invasive Hallux Valgus Correction

Impact of Social Deprivation on Forefoot Surgical Outcomes

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: The impact of social environment on specific health outcomes is a topic of increasing interest in orthopedics. Conflicting lines of research suggest that social deprivation may impact orthopedic outcomes. There are limited reports on the influence of social deprivation on orthopedic foot and ankle procedures. The purpose of this study was to examine the effect of social deprivation on patient reported outcomes for patients undergoing forefoot surgery. Methods: This retrospective cohort study included 477 patients who underwent hallux valgus correction or hallux rigidus procedures between 2015 and 2022. Patient social deprivation was defined using the Area Deprivation Index (ADI), a validated metric of deprivation discretized geographically by zip code and defined by factors including education, income, employment, and housing quality. Patients meeting inclusion criteria were categorized into either a high or low social deprivation group based on the national median ADI of 50. PROMIS (Patient-Reported Outcomes Measurement Information System) Physical Function (PF) and Pain Interference (PI) scores were collected pre-operatively and then at 6 weeks and 6 months post-operatively. We compared high and low social deprivation groups at baseline and then longitudinally at 6 weeks and 6 months post-operatively, adjusting for demographic covariates including age, gender, race/ethnicity, marital status, and employment status. Statistical significance was defined as p < 0.05. Results: At baseline before surgery, PROMIS-PF and PROMIS-PI scores were similar between high and low social deprivation groups. At 6 weeks and 6 months after surgery, there were also no significant differences between high and low deprivation groups for either PROMIS-PF or PROMIS-PI. The only variable that delineated outcomes was employment status, with disabled and unemployed patients exhibiting greater pain (p < 0.001, p = 0.006, respectively) and less function (p < 0.001, p = 0.010, respectively) before surgery. When adjusting for baseline pain score, disabled patients also had greater pain on average after surgery (p = 0.031). Both groups (high and low social deprivation) demonstrated similar improvements in pain and function at 6 months after surgery. Conclusion: Patients undergoing forefoot surgery with greater social deprivation reported similar pain and physical function outcomes as patients with low deprivation before and after surgery. These findings suggest that patients with higher social deprivation can achieve equivalent post-surgical outcomes after forefoot surgery as compared to patients with lower social deprivation. Further investigations are needed to explore these relationships at longer-term follow-up as well with other common foot and ankle surgeries.

Investigation of the relationship between hallux valgus, quadriceps angle, and body image perception in young adults

Purpose: Our study aimed to identify the presence and severity of hallux valgus deformity in young adults, using both by the Manchester classification and goniometry, to evaluate the Quadriceps angle (Q angle), and to examine the relationship between some anatomical parameters and body image perception. Materials and Methods: A total of 158 individuals aged 18-30 (111 females, 47 males) who voluntarily agreed to participate in the study were included. Demographic characteristics, Quadriceps angle, and hallux valgus angle were measured. Hallux valgus and Quadriceps angles were determined using a goniometer, while the Manchester scale was employed to evaluate the level of Hallux valgus deformity. The Golden Ratio for the lower extremity was calculated by taking the ratio of lower extremity length to leg length, and the body image perception score was determined. Results: Body weight, height and body mass index showed statistically significant differences in terms of gender, while age parameter did not show statistically significant difference between genders. Also, no significant difference in Quadriceps angle was observed between genders for both right and left sides, while a significant difference in Hallux valgus angle was noted. A high, positive, and significant relationship was found between Manchester classification and hallux valgus, while Golden ratio values did not significantly differ by gender. Additionally, body image perception scores were higher in males (162.60±25.45 points) than in females (153.51±25.89 points). Conclusion: Deviations from their normal values of the hallux valgus and quadriceps angle which affect the musculoskeletal system, may lead to some health problems, as well as difficulties in performing daily life activities, and concerns about aesthetics. Failure to fulfil one’s normal functions or not to find oneself aesthetically insufficient will also make it likely that the body image perception will deteriorate.

Orthoses and other conservative methods in hallux valgus

Orthoses and other conservative methods in hallux valgus

Unveiling hidden challenges: impaired foot posture due to skin involvement in systemic sclerosis

Systemic sclerosis [SSc] is a chronic autoimmune disease characterized by fibrosis, vasculopathy, and immune dysregulation, primarily affecting the skin and various internal organs. Musculoskeletal manifestations, particularly foot involvement, are common but often underrecognized. Foot problems, including pain, Raynaud's phenomenon, digital ulcers, and deformities such as hallux valgus, are reported in SSc patients and can significantly impair mobility and quality of life. Skin thickening, especially around the ankles and toes, may disrupt foot alignment and posture, potentially leading to gait abnormalities. Current literature on the relationship between skin involvement, foot posture, and gait characteristics in SSc is limited, highlighting the need for comprehensive studies to explore these associations. The current hypothesis posits that skin involvement in SSc may significantly influence foot posture, leading to subsequent alterations in gait dynamics.

Unraveling the genetic association between knee osteoarthritis and hallux deformities

ObjectiveKnee osteoarthritis (KOA), hallux valgus (HV) and hallux rigidus (HR) are common musculoskeletal problems of the lower extremities. However, their underlying causal relationships are unclear. This study attempts to clarify the cause-and-effect relationship between KOA and the two common hallux deformities (HV and HR).DesignThe summary-level statistics for KOA, HV, and HR were collected from genome-wide association studies (GWAS). The causal analysis of KOA on HV or HR was carried out using two-sample Mendelian randomization (MR). In order to assess the robustness of the MR results, sensitivity analyses were performed. In addition, multivariable MR (MVMR) was implemented to assess the influence of KOA in causation as well as calibrate the effect of anthropometric characteristics. Supplementary backward MR analysis was conducted to determine the causal effect of hallux diseases on KOA.ResultsThe univariable analysis indicated that KOA has a causative influence on HR (odds ratio [OR] = 1.29, 95% confidence interval [CI] = 1.18–1.41, P = 2.25E-8) and HV (OR = 1.43, 95% CI = 1.21–1.68, P = 2.76E-5). In the backward MR analyses, hallux deformities did not appear to be the cause of KOA. In the MVMR analysis, after jointly adjusting for the effects of waist-to-hip ratio (WHR), waist circumference (WC), hip circumference (HC) and BMI, the causal impact of KOA on HV and HR remained robust.ConclusionIn this study, the genetic causality between KOA and increased risk of hallux deformities (HV and HR) is established, which can provide evidence-based recommendations for reducing the incidence of hallux deformities in KOA patients. Further high-level studies are warranted to validate the associations and explore its broader implications.

Rigid iatrogenic hallux varus: a decades’ worth experience with arthrodesis of the metatarsophalangeal joint

PurposeArthrodesis of the first ray metatarsophalangeal joint (MPJ) is the gold standard in iatrogenic hallux varus (IHV) in the presence of stiffness and osteoarthritis. The purpose of this study is to collect clinical and radiographic results and complications of MPJ arthrodesis in rigid iatrogenic HV.MethodsA retrospective evaluation of rigid iatrogenic HV undergoing arthrodesis with a minimum follow-up (FU) of two years was performed. The clinical parameters assessed were visual analog scale (VAS), the AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale score and the satisfaction scale. The radiological parameters evaluated the first to second metatarsal angle (IMA) and the angle of hallux valgus (HVA). Complications were also analysed.ResultA total of 18 patients (19 procedures) with a mean FU of 5.5 ± 2.5 years were included. The mean VAS improved from 7.3 ± 1.6 to 1.3 ± 1.2 (p < 0.05) at the last FU. Similarly, the AOFAS Hallux Metatarsophalangeal-Interphalangeal scale score significantly improved to 82 ± 9.2 (p < 0.05). Radiological evaluation demonstrated a 1–2 IMA improvement from 4.4 ± 2.2° preoperatively to 8.9 ± 2.4° at 3 months post-operatively. Similarly, there was a significant (p < 0.05) improvement of the HVA from − 22.7 ± 4.1° to 13.1 ± 4.1° at three months post-operative (p < 0.05). No signification loss of correction was noted at the last follow-up (p > 0.05). In one case, a delayed fusion at the arthrodesis site required surgical revision to promote fusion. No patient experienced pain with stress from the first MTP joint arthrodesis site or identified the arthrodesis site as a source of pain. No patient required implant removal. Re-operation and revision rates were 5.3%. The overall complications rate was 15.8%.ConclusionsMPJ fusion effectively corrects Iatrogenic Hallux Varus in cases of rigid and fixed deformities in the medium- to long-term follow-up, with lasting improvements in AOFAS and VAS scores. The procedure is characterised by a non-negligible risk of complications, reoperations and revisions.Level of evidenceLevel IV, case series.

Effects of Pathological Characteristics on Functional Scores and Surgical Satisfaction in Patients after Hallux Valgus Surgery.

Few studies have explored the relationship between the pathological characteristics of hallux valgus and surgical outcomes. The aim of our study was to report the influence of pathological characteristics such as the tibial sesamoid position (TSP) and first metatarsal pronation on postoperative functional scores and patient satisfaction with hallux valgus surgery. From June 2017 to December 2022, a retrospective analysis was conducted on patients who underwent hallux valgus surgery at our hospital. Anteroposterior (AP) x-ray parameters (hallux valgus angle [HVA], intermetatarsal angle [IMA], distal metatarsal articular angle [DMAA], TSP, first metatarsal pronation, and first metatarsophalangeal joint dislocation) (preoperative weight-bearing, immediate postoperative non-weight-bearing, and early postoperative weight-bearing), visual analog scale (VAS) scores, American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores, SAFE-Q self-administered foot evaluation questionnaire (excluding the Sports Activity subscale), complications, and patient satisfaction were used to describe the outcomes. Correlation analysis and multiple linear regression models were used to identify factors influencing postoperative functional scores and patient satisfaction after hallux valgus surgery. Eighty-one patients (92 feet) whose early radiographic parameters and latest follow-up scores improved significantly (p < 0.01) were included in the present study. The overall complication rate was 27.2%, with recurrence being the most common complication (20.7%). Functional scores and patient satisfaction were associated with age; preoperative, immediate postoperative, and early postoperative HVA; and immediate postoperative IMA (p < 0.05), but not with TSP, first metatarsal pronation, DMAA, callosities, toe deformities, or first metatarsophalangeal joint dislocation (p > 0.05). The R 2 values of the multiple linear regression models predicting postoperative functional scores and patient satisfaction ranged from 0.042 to 0.351. TSP and first metatarsal pronation were unrelated to postoperative functional scores or patient satisfaction. This finding enhances surgeons' understanding of the functional prognosis of hallux valgus surgery, particularly aiding in explaining the condition and assessing surgical outcomes.

Trends in the Use of Weightbearing Computed Tomography.

Background: This review aimed to critically appraise the most recent orthopedic literature around cone beam weightbearing computed tomography (WBCT), summarizing what evidence has been provided so far and identifying the main research trends in the area. Methods: This scoping review was performed on studies published between January 2013 and December 2023 on the Pubmed database. All studies (both clinical and nonclinical) in which WBCT had been used were critically analyzed to extract the aim (or aims) of the study, and the main findings related to the role of this imaging modality in the diagnostic pathway. Results: Out of 1759 studies, 129 were selected. One hundred five manuscripts (81%) dealt with elective orthopedic conditions. The majority of the analyses (88 studies; 84%) were performed on foot and ankle conditions, while 13 (12%) studies looked at knee pathologies. There was a progressive increase in the number of studies published over the years. Progressive Collapsing Foot Deformity (22 studies; 25%) and Hallux Valgus (19 studies; 21%) were frequent subjects. Twenty-four (19%) manuscripts dealt with traumatic conditions. A particular interest in syndesmotic injuries was documented (12 studies; 60%). Conclusions: In this review, we documented an increasing interest in clinical applications of weightbearing CT in the orthopedic field between 2013 and 2023. The majority of the analyses focused on conditions related to the foot and the ankle; however, we found several works investigating the value of WBCT on other joints (in particular, the knee).