Correction Of Hallux Valgus Angle Research Articles

Shortening of the First Metatarsal During the Correction of Hallux Valgus: Never Be Allowed?

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Transfer metatarsalgia is one of the potential complications after hallux valgus correction, of which shortening of the first metatarsal is thought to be an important cause. Thus many surgeons believe that shortening of the first metatarsal should be avoided or kept to a limited extent. However, we found that many patients with first metatarsal shortening did not really develop postoprative transfer metatarsalgia, but instead had easier correction of the hallux valgus in operation and better outcomes and even more benefit in walking due to reduced tension around the metatarsophalangeal joints and improved joint mobility. Up to now, few investigations have truly conducted large-scale long-term follow-up on this issue, and little is known about the appropriate level of first metatarsal shortening. Methods: This retrospective study included 835 feet in 712 patients who were treated with first metatarsal osteotomies without Weill osteotomies for hallux valgus during the period of January 2013 to January 2023. Standard weight-bearing dorsoplantar and lateral radiographs were collected before and at different time more than six months after surgery. The hallux valgus angle (HVA), intermetatarsal 1-2 angle (IMA) were evaluated. The absolute length of the first metatarsal as well as its relative length to the second metatarsal was both measured. Clinical evaluation included preoperative and postoperative symptom assessment, the range of motion (ROM) at metatarsophalangeal joint and AOFAS Scale. The incidence of postoperative complications was also specifically recorded, as well as information on where the metatarsalgia occurred, the nature of the pain, and how the pain occurred and relieved. Patients were divided into different subgroups according to the level of shortening of the first metatarsal. Results: The level of shortening of the first metatarsal was positively correlated with the reduction of the HVA, and inversely correlated with the recurrence rate. Those with shortening of 3 mm or more had significantly better first metatarsophalangeal joint mobility compared with those without shortening. Patients with a shortening of 6 mm or more were significantly more likely to have a metatarsalgia under the central metatarsal heads postoperatively (5.88% vs 3.01%). 5 feet (2.67%) developed recurrence of the hallux valgus in patients with a shortening of 6 mm or more, compared with 23 feet (4.07%) in patients with a shortening of 6 mm or less, and 6 feet (7.23%) in patients without shortening. Conclusion: Taking into account the correction of HVA, joint mobility, postoperative recurrence and the risk of metatarsalgia, it is recommended that the relative length of the shortening in the first metatarsal osteotomy can be extended up to 6 mm, especially in patients with severe hallux valgus, in order to obtain the easier correction of the HVA in the operation and best therapeutic results and function.

Improvement of Valgus Deviation of the Lesser Toes of Moderate to Severe Hallux Valgus After Proximal Chevron Metatarsal Osteotomy and Akin Osteotomy.

This study examines the correction of lesser toe valgus deviation following proximal chevron metatarsal osteotomy (PCMO) and Akin osteotomy in moderate to severe hallux valgus patients, while identifying influencing factors. Among 89 patients (116 feet), those with moderate to severe hallux valgus underwent PCMO and Akin osteotomy. Radiologic assessments included preoperative metatarsus adductus angle (MAA), hallux valgus angle (HVA), intermetatarsal angle (IMA), valgus angles of the second to fourth metatarsophalangeal joints, and hallux valgus recurrence. Assessments included visual analog scale (VAS) pain scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores, and patient satisfaction over an average follow-up of 30.6 ± 21.2 (range, 12-99) months. The mean preoperative HVA of 34.4 degrees decreased to 8.7 degrees at final follow-up. The valgus angles of the second, third, and fourth toes improved by 37.1%, 27%, and 44.5%, respectively. In metatarsus adductus patients, lesser toe valgus angles were significantly higher both preoperatively and at final follow-up. Hallux valgus recurrence patients had higher preoperative and final follow-up IMA and valgus angles in the second and third toes. Nonrecurrence patients showed greater decreases in these angles. A larger HVA correction corresponded to a greater decrease in lesser toe valgus deviation. VAS and AOFAS scores improved significantly at the last follow-up. The study found a significant reduction in the valgus angle of the second, third, and fourth toes after PCMO and Akin osteotomy in moderate to severe hallux valgus cases, without additional surgeries on lesser toes. The lesser toe angular reductions were less pronounced in patients with metatarsus adductus or with hallux valgus recurrence. Level IV, case series.

Radiological Analysis of the Syndesmosis Concept in Metatarsus Primus Varus and Hallux Valgus Deformities Recurrence Prevention

Hallux valgus (HV) is a common deformity of the foot. Its postoperative recurrence is not uncommon and is closely related to the recurrence of its underlying metatarsus primus varus (MPV) deformity. The syndesmosis procedure uses 1 to 2 intermetatarsal cerclage sutures to realign the first metatarsal and then induces a biological bonding between the 2 metatarsals to prevent the MPV deformity from recurring. This radiological study aimed to assess its effectiveness in long-term MPV and HV deformities recurrence prevention. Ninety-two feet of 51 consecutive patients had syndesmosis procedures that were prospectively followed up for more than 1 y and up to 14 y, averaging 100.5 (SD 45.2) months. Patients underwent X-ray examinations regularly at fixed intervals of their feet. We used Hardy's methods in measuring the intermetatarsal angle (IMA), hallux valgus angle (HVA), and medial sesamoid position from standing foot X-rays. More than 450 relevant X-ray and photo images were submitted as Supplementary Material for online viewing and reference. There was a significant final correction of IMA from 14.30° (SD 2.70) to 6.70° (SD 1.75) (p < .0001). There was no significant increase in IMA after the sixth postoperative month to their final follow-up endpoints, regardless of their lengths. There was a significant final correction of HVA from 31.95° (SD 7.45) to 19.1° (SD 7.45) (p < .0001). This study reconfirmed past findings that the MPV deformity could be corrected without osteotomies. Creating a syndesmosis-like intermetatarsal bonding was effective for long-term MPV recurrence prevention. Three feet had postoperative stress fracture of the second metatarsal. However, the HV deformity correction was less satisfactory, and the reasons were explained.

Growth Modulation for the Treatment of Juvenile Hallux Valgus: A Systematic Review of Literature.

Juvenile hallux valgus (JHV) is a forefoot deformity that causes pain and functional limitation. Treatment poses a challenge in terms of the optimal technique and timing of intervention. A systematic review of the literature on the use of growth modulation in treating JHV was conducted. The literature review was performed using PubMed and EMBASE searches for articles investigating growth modulation in the treatment of JHV published before December 1st, 2021. Seven articles were included in the final review that matched the inclusion and exclusion criteria. The primary outcomes included the degree of correction of hallux valgus angle and intermetatarsal angle. A qualitative assessment of the articles was done due to the heterogeneity of the growth modulation methods used in these articles. A total of 135 feet from 78 patients were included from the reviewed articles. Growth modulation methods included temporary screw lateral hemiepiphysiodesis of the first metatarsal, lateral drilling hemiepiphysiodesis of the first metatarsal, and a trephine plug removal of the lateral epiphysis followed by cancellous bone graft insertion. The degree of correction of the hallux valgus and intermetatarsal angles were found to be statistically significant in all studies, regardless of the technique. Growth modulation for JHV by lateral hemiepiphysiodesis using minimally invasive techniques produced favourable radiologic outcomes with some evidence of clinical improvement. Larger, prospective and comparative studies with objective clinical outcome measures may further consolidate this surgical approach as a mean to treating this deformity. AlZeedi M, Park JP, Marwan Y, et al. Growth Modulation for the Treatment of Juvenile Hallux Valgus: A Systematic Review of Literature. Strategies Trauma Limb Reconstr 2023;18(1):51-55.

Radiographic Outcomes of Hallux Valgus Deformity Correction With Chevron and Scarf Osteotomies

There is no gold standard in the treatment of hallux valgus deformity. The purpose of our study was to compare various aspects of radiographic assessment following scarf and chevron osteotomies and try to determine which technique helps achieve a more pronounced intermetatarsal angle (IMA) and hallux valgus angle (HVA) correction and produces lower rates of complications, including adjacent-joint arthritis. This study included patients who underwent hallux valgus correction with the scarf (n=32) or chevron (n=181) method with a follow-up period of over 3 years. We evaluated the following parameters: HVA, IMA, duration of hospital stay, complications, development of adjacent-joint arthritis. The scarf technique helped achieve a mean HVA and IMA correction of 18.3° and 3.6°, respectively, and the chevron technique helped achieve a mean correction of 13.1° and 3.7°, respectively. The achieved deformity correction in terms of both the HVA and IMA was statistically significant in both patient groups. The loss of correction assessed with the HVA was statistically significant only in the chevron group. Neither group showed a statistically significant loss of IMA correction. The duration of hospital stay, reoperation rates, and fixation instability rates were comparable in the 2 groups. Neither of the evaluated methods caused a significant increase in total arthritis scores in the evaluated joints. Our study showed good outcomes of hallux valgus deformity correction in both evaluated groups; however, scarf osteotomy yielded somewhat better radiographic outcomes in HVA correction and no loss of HVA correction at 3.5 years of follow-up.

Hallux Valgus in Osteoporosis.

The aim of this study is to evaluate the outcomes of the surgical treatment in patients with osteoporosis with moderate or severe hallux valgus regarding the correction of Hallux Valgus Angle (HVA) and Intermetatarsal Angle (IMA) compared to non-osteoporotic patients.&#x0D; Materials and Methods: The timeline of the study was from 2015 to 2020 with 20 patients with the mean age of 61.6±4.1 within the osteoporotic group and 63.5±5.0 within the non-osteoporotic group. 12 osteotomies in osteoporotic patients and eight osteotomies in non-osteoporotic patients were seen at follow-up after 2 years after surgery. Preoperative bone density of T-Score 2.5 SD or more below is named osteoporosis and IMA and was used to define patient groups; mild hallux valgus was defined with IMA of 11-16 degrees, moderate hallux valgus was defined with IMA from 16 to twenty degrees, and severe hallux valgus was defined with IMA from 20 degrees or more.&#x0D; Results: No statistical differences were found in HVA, IMA and between the osteoporotic patients and non-osteoporotic patients preoperatively, postoperatively, and therefore the final follow-up in mild to moderate hallux valgus. The mean AOFAS score ameliorated from 52.6 preoperatively to 89.1. Regarding satisfaction, ~ 83 you look after patients were very satisfied or satisfied. No evidence of complications and every one of the patients resulted with complete union of the osteotomy.&#x0D; Conclusion: We believed that the surgical treatment is a safe, effective procedure for the correction of elderly patients with osteoporosis. In patients with moderate and severe hallux valgus the results of osteotomy have not any specific difference between the osteoporotic and non-osteoporotic groups

Incidence of Nonunion Following First Metatarsophalangeal Joint Arthrodesis for Hallux Valgus Deformity: A Retrospective Analysis of Four Different Constructs

Arthrodesis of the great toe joint is a valuable procedure for hallux valgus deformities. The primary aim of this study was to determine nonunion rates of a first metatarsophalangeal joint (MTPJ) arthrodesis for bunion deformity. This was a retrospective review of 166 consecutive limbs that underwent a first metatarsal phalangeal joint arthrodesis at Wake Forest Baptist Medical Center (WFBMC). Procedures were performed using 4 different constructs for the arthrodesis. Incidence of nonunion, intermetatarsal correction, infection, and recurrence were measured. Overall, 20 patients (12%) experienced nonunion following a first metatarsophalangeal joint arthrodesis. Eighty-seven patients (86%) of plate and screw patients achieved union while 14 (78%) of crossing screw patients achieved union. The minimum time of follow-up was 3 months and the maximum time was 15.4 months. The mean change in intermetatarsal and hallux valgus angle correction was 3.4° and 20.3°, with no statistical difference based on hardware construct or being diabetic. First metatarsophalangeal joint arthrodesis is a viable option for hallux valgus. However, the results of the present study suggest that there is a lower fusion rate of the first MTPJ using crossing screws for bunion deformities.

Clinical results of scarf osteotomy

Background/Aim. There are a few research papers in Serbia that report on the clinical results of scarf osteotomy (SO) and its long-term effects. The aim of this retrospective study was to evaluate the efficacy of SO in hallux valgus (HV) deformity correction, as well as the degree of recurrence and its possible causes. Methods. The study included 48 patients (52 feet) who underwent SO. The average follow-up time was 103.9 (63?156) months. In order to clinically evaluate the results, the American Orthopedic Foot and Ankle Society (AOFAS) scale and the Visual Analog Scale (VAS) of pain were used. In order to radiographically determine the degree of deformity, preoperative and postoperative radiographs of the feet were taken in the standing position, and the following parameters were determined: HV angle (HVA), intermetatarsal angle, distal metatarsal articular angle, and sesamoid position. Results. The AOFAS scores increased from 19 (5?45) points preoperatively to 92 (54?100) points at the time of the latest follow-up examination (p &lt; 0.001). The VAS values significantly improved from 10 (8?10) preoperatively to 0 (0?6). The average HVA correction was 24.8?. The recurrence rate in patients in whom the HVA was greater than 20? was 26.9%. Conclusion. Although SO is a proven procedure for the correction of HV, long-term results still show a relatively high rate of recurrence.

Complications in the surgical treatment of adolescent hallux valgus

Objective: Evaluation the degree of complications in the surgical treatment of adolescent hallux valgus Material and method: The study examines 47 cases of surgically treated children with adolescent hallux valgus with a mean age of 14.3 years. Most of the patients were female - 93.75%. and the most affected is the right foot - 51.21%. For diagnosis and follow-up of the treatment result, X-ray methods were used with angular imaging measurements - hallux valgus angle (HVA) and intrametatarsal angle (IMA).&#x0D; Results: The mean follow-up period was 15.8 m. The mean preoperative angle of hallux valgus was 30.19 o and the mean preoperative intrametatarsal angle was 11.44o. In the final results we report a loss of correction of HVA on average to - 20.46 o (min 6.8 o max 38.2 o) and preservation of IM with an average value of 7.35 o. The Clavien Dindo classification was used to account of the postoperative complications. The recurrence rate reported at 10 months postoperatively were 15 cases or 31.91%. The following postoperative complications were reported for the follow-up period: avascular necrosis of the metatarsal head 1 year postoperatively and intraoperative fracture of the first metatarsal bone.&#x0D; Conclusions: Despite the many described surgical techniques, there are still no long-term indicative results for successfully used surgery. After processing our data and compare it with those of the world literature, we come to the conclusion that the rate of possible recurrence in the surgical treatment of AHV is high. The closure of the growth zone is confirmed as one of the criteria for the outcome of the treatment and the degree of postoperative recurrence of the deformity.

Actual tendencies of Hallux Valgus surgical treatment.

The purpose of this study is to evaluate which of the methods selected in patients with moderate or severe hallux valgus a result in a better correction of hallux valgus angle (HVA) and intermetatarsal angle (IMA) in Scarf osteotomy as compared to Chevron osteotomy.&#x0D; Material and methods; In our study, we selected 36 patients, 16 scarf and 20 chevron osteotomies, with all surgical options from skin incision, capsular and bunionectomy to bone reorientation. Deformities of patients were classified as mild, moderate and severe according to clinical and radiological findings. The results were measured using radiographic HVA, IMA and distal metatarsal articular angle (DMAA).&#x0D; Results: No statistical differences were found in HVA, IMA and DMAA between scarf and chevron osteotomy in mild to moderate hallux valgus. In severe hallux valgus, Scarf osteotomy corrected HVA better than Chevron, although this group consisted of twelve patients. Two patients in the Chevron group and three in the Scarf group developed subluxation of the metatarsophalangeal joint.&#x0D; Conclusion: In patients with moderate and severe hallux valgus the results of Scarf and Chevron osteotomy have no specific difference. Change to IMA angle with the subluxation of the first metatarsophalangeal joint some months after operation were the main cause for insufficient correction. We favor the Scarf osteotomy because it is more profitable, with correction of HVA and IMA.

Temporary Screw Lateral Hemiepiphysiodesis of the First Metatarsal for Juvenile Hallux Valgus Deformity: A Case Series of 23 Feet

Juvenile hallux valgus (JHV) can limit the quality of life of the affected children. This study aims to evaluate the outcomes of temporary screw lateral hemiepiphysiodesis of the base of the first metatarsal. A chart review of patients who underwent temporary screw lateral hemiepiphysiodesis of the first metatarsal at a tertiary care pediatric orthopedic center was done. A total of 23 feet of 14 patients were included. The mean age of the patients was 10.6 ± 1.8 years, while the bone age was 11.1 ± 1.8 years. The mean follow-up duration was 24.7 ± 13.4 months (range: 12-60 months). The hallux valgus angle (HVA) improved from a mean of 30.9° ± 6.7° to a mean of 27.6° ± 8.2° (p = .001), while the intermetatarsal angle (IMA) improved from a mean of 14.6° ± 2.3° to a mean of 12.5° ± 3.0° (p < .001). Revision surgery was done for 5 (21.7%) feet of 3 patients for symptomatic uncorrected deformity (4 feet) or screw migration due to bone growth (1 foot). The mean HVA correction was 5.00° ± 3.7° in patients with bone age of 12 years or less compared to 1.50° ± 4.6° in patients with bone age of more than 12 years (p = .060). The radiological outcomes of temporary screw lateral hemiepiphysiodesis of the first metatarsal for JHV deformity correction are promising, especially in children with lesser bone age. The procedure was technically simple to perform and had minor complications.

Assessment of Kinesio Taping Versus Phonophoresis for the Treatment of Painful Hallux Valgus: A Pilot Study

Background: Hallux valgus (HV) is a deformity that affects the quality of life and function in a negative manner causing disturbed balance and walking and even alters the foot kinematics. Conservative treatments are the choice for mild to moderate HV, but the question about the best method has not been responded yet. In the current study, it is aimed to assess and compare the efficacy of kinesiotaping (KT) versus phonophoresis (PH) for the treatment of painful HV. Materials and Methods: This randomized clinical trial has been conducted on a total number of 37 toes (37 toes of a total number of 24 patients) randomly divided into two subgroups of either KT or PH with 1% hydrocortisone among which the total numbers of 31 toes from 20 patients fulfilled the study protocol. The variables including pain (using VAS score), function (using Manchester-Oxford Foot questionnaire)(MOXFD), hallux valgus angle (HVA), and intermetatarsal angle (IMA) were assessed and compared between two groups before and after two months following the interventions. Results: The pain score decreased significantly within the time in both groups (P-value&lt;0.001), while the comparison of KT with PH revealed insignificant difference (P-value=0.08). MOXFD assessments showed significantly improved status within two months for both interventions (P-value&lt;0.001) with no remarkable difference between the groups (P-value=0.55). The IMA and HVA altered following both of the techniques. KT was superior to PH for the correction of HVA, but not for IMA (P-value&gt;0.05). Conclusion: We found both of the KT and PH techniques could successfully rehabilitate the patients’ pain and improve function, however the KT was slightly better than PH due to HVA reduction. [GMJ.2021;10:e1888]

Assessment of Kinesio Taping Versus Phonophoresis for the Treatment of Painful Hallux Valgus: A Pilot Study

Background: Hallux valgus (HV) is a deformity that affects the quality of life and function in a negative manner causing disturbed balance and walking and even alters the foot kinematics. Conservative treatments are the choice for mild to moderate HV, but the question about the best method has not been responded yet. In the current study, it is aimed to assess and compare the efficacy of kinesiotaping (KT) versus phonophoresis (PH) for the treatment of painful HV. Materials and Methods: This randomized clinical trial has been conducted on a total number of 37 toes (37 toes of a total number of 24 patients) randomly divided into two subgroups of either KT or PH with 1% hydrocortisone among which the total numbers of 31 toes from 20 patients fulfilled the study protocol. The variables including pain (using VAS score), function (using Manchester-Oxford Foot questionnaire)(MOXFD), hallux valgus angle (HVA), and intermetatarsal angle (IMA) were assessed and compared between two groups before and after two months following the interventions. Results: The pain score decreased significantly within the time in both groups (P-value&lt;0.001), while the comparison of KT with PH revealed insignificant difference (P-value=0.08). MOXFD assessments showed significantly improved status within two months for both interventions (P-value&lt;0.001) with no remarkable difference between the groups (P-value=0.55). The IMA and HVA altered following both of the techniques. KT was superior to PH for the correction of HVA, but not for IMA (P-value&gt;0.05). Conclusion: We found both of the KT and PH techniques could successfully rehabilitate the patients’ pain and improve function, however the KT was slightly better than PH due to HVA reduction. [GMJ.2021;10:e1888]

Functional and Radiographic Outcomes of Minimally Invasive Intramedullary Nail Device (MIIND) for Moderate to Severe Hallux Valgus.

This study was aimed at assessing clinical and radiographic outcomes of the Minimally Invasive Intramedullary Nail Device (MIIND) to correct moderate to severe hallux valgus (HV) and the long-term persistence of its effects. This case series study involved 100 patients, 84 women and 16 men (mean age, 59 years), who underwent the MIIND procedure with a mean follow-up of 97 months. Assessment was performed preoperatively, postoperatively, at 6 and 12 months, and at last follow-up. Clinical outcomes were evaluated with American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), and patient satisfaction. Intermetatarsal angle (IMA), metatarsophalangeal hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), and tibial sesamoid position were assessed. Statistical analysis was performed. The mean AOFAS score improved from 57.9 to 90.5 points, VAS scale was 1.5 ± 2.0, and patients' satisfaction was 8.7 ± 1.4. The mean correction of the HVA and IMA showed a significant correction; however, the effect of time was not statistically significant on DMAA. Sex (P = .047), severity (P = .050), associated procedures (P = .000), and preoperative angle (P = .000) showed significant association with HVA correction and its persistence over time. Age was not statistically significant. Complications were 9 cases of superficial wound infection and 6 recurrences. The MIIND technique proved a viable procedure to correct moderate to severe HV with a low rate of complications and recurrence, producing significant correction of most radiographic parameters assessed and their persistence, even at long term. Level IV, case series study.

Radiographic Correction after Hallux Valgus Surgery: A Meta-analysis

Category:Bunion; Midfoot/ForefootIntroduction/Purpose:There are over 100 different means by which to surgically correct hallux valgus. None have been proven to be more effective in radiographic correction over another. Frequently, recurrence is noted. There has been no large-scalemeta-analysis of studies reporting radiographic outcomes of surgical treatment for hallux valgus deformity. The purpose of the meta-analysis was to pool data to see if certain osteotomies have higher complication or recurrence rates.Methods:We performed a meta-analysis of studies reporting the radiographic outcomes of surgical correction for hallux valgus deformity. We pooled the data of 287 studies since 1980 that met our inclusion criteria. We divided the surgical procedures into proximal-based osteotomies (PB, n=2047), shaft-based (SB, n=1569), and distal-based (DB, n=7835). We calculated the hallux valgus angle (HVA) and intermetatarsal angle (IMA) correction as well as metatarsal shortening, recurrence, and hallux varus after surgery. ANOVA analysis was used to compare the means among the groups.Results:A total of 287 treatment studies met the inclusion criteria. The pooled rates of HVA correction between the PB, SB, and DB were: 20.7, 20, and 16.8 degrees respectively (p=.0004). The pooled rates of IMA correction between the PB, SB, and DB were: 8.5, 7.3, and 6.0 degrees respectively (p<.0001).There was a significant difference among the groups with the development of hallux varus (p=.003) and with metatarsal shortening (p=.025). There was no difference in the rate of recurrence.Conclusion:Despite the large pooling of data, no consistent superiority of any corrective osteotomy stood out. Fortunately, there is no difference in the recurrence rate among the osteotomies. Further randomized studies could help elucidate the best surgery for each patient.

Metatarsal Pronation: Does It Matter?

Category:BunionIntroduction/Purpose:Hallux Valgus is a complex deformity with several attendant components that are present to varying degrees in each patient. Historically primary attention has been paid to correction of the coronal plane deformity, but recent investigations suggest a substantial contribution to the deformity from the axial rotational abnormality of the metatarsal. While the effect of this metatarsal pronation has been demonstrated, the relative contribution of this parameter compared to other components has not been considered. This study aims to investigate the rotational aspect of the deformity and its contribution to successful radiographic correction of the deformity.Methods:A retrospective review of 100 consecutive Lapidus bunionectomy procedures was performed. There were 80 of patients and 89 feet. patients <18yrs, revision surgery and combined surgery, other than forefoot procedures were excluded. There were 79 (88%) females and 10 (12) males. The mean age was55. All feet were followed till radiographic healing was complete. Each foot was examined radiographically and pre and post-operative findings were compared. Along with the typical measurements of Hallux valgus parameters in the coronal plane, an additional measurement was included to estimate metatarsal head pronation (MT head shape and sesamoid position). The radiographic outcomes were then compared to determine the independent effect of metartarsal rotation on outcomes (recurrence, time to fusion). Pearson correlation was utilized to determine significant associations with the outcome parameters for recurrence, time to fusion, and failure to correct the hallux valgus angle (HVA).Results:The average HVA correction was 20.08 degrees and 6.86 degrees for IMA. A total of 68 feet had a positive preop round head sign and correction to a normal MT head shape was observed in 47 feet. A significant increase in recurrence was associated with patients that had persistent MT round sign following correction (p=0.001) and in patients with a higher sesamoid position in the preop period p<0.001). The average time to fusion was 9.56 with 47 (52%) feet were healed at 6 weeks postop. A higher (more lateral) sesamoid position and a higher postop HVA were also associated with longer time to fusion or delayed union.Conclusion:Adequate preoperative radiographic assessment is of the utmost importance to assess the various forces that can contribute to hallux valgus deformity. Newer techniques address coronal and sagittal plane deformity. Failure to correct MT head pronation may lead to increased hallux valgus recurrence, despite sagittal correction measured by improvement of the HVA and IMA angles. Factors that impact time to fusion are also associated with a higher risk of HV recurrence. Sesamoid position and metatarsal head pronation should be considered, and correction of these parameters may be necessary to avoid delayed healing and persistent or recurrent HV.

Long-term clinical outcomes of scarf osteotomy in regional hospital Hong Kong

Background: Lack of local data concerning the long-term clinical outcomes of scarf osteotomy in Hong Kong. Methods: This is a retrospective review of 75 patients (88 feet) who underwent scarf osteotomy with a mean follow-up of 94.20 months (60–144 months). Clinical ratings were based on visual analog scale (VAS) and American Orthopaedic Foot &amp; Ankle Society (AOFAS) scale. Weight-bearing radiographs were used to perform angular measurements: (i) hallux valgus angle (HVA), (ii) intermetatarsal angle, (iii) distal metatarsal articular angle, and (iv) tibial sesamoid position before operation and at the time of latest follow-up. Results: The mean overall AOFAS scales improved from 29.66 (5–49) points preoperatively to 86.83 (39–100) points at the time of final follow-up. The VAS improved from 6.61 (5 to 9) to 0.66 (0 to 4). The average HVA correction was 25.42 (8–46). The 8- to10-year recurrence rate (HVA &gt; 20) was 31.80%. A higher degree of preoperative HVA predicts higher recurrence rate. Conclusion: Scarf osteotomy is an effective procedure for symptom control and improvement in radiological parameters for hallux valgus deformity. However, recurrence rate is relatively high.

Need for concomitant Akin osteotomy in patients undergoing Chevron osteotomy can be determined preoperatively: a retrospective comparative study of 859 cases

BackgroundThe Chevron osteotomy is a frequently used surgical method for hallux valgus correction. This method is often combined with an Akin osteotomy. To date, clear guidelines for the implementation of an additional Akin osteotomy are missing. The purpose of this study was to elucidate the impact of concomitant phalangeal correction on the outcome after hallux valgus surgery and to define indication criteria for an additional Akin osteotomy.MethodsPatients (859 feet) undergoing distal Chevron osteotomy at our department were retrospectively grouped into group C (Chevron, 785 feet) and group AC (Chevron plus Akin, 74 ft). Radiological assessment including the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), and the proximal to distal phalangeal articular angle (PDPAA) was performed preoperatively, postoperatively, after 6 weeks, and after 3 months. Longer-term follow-up with a mean of 36.4 months was available for 248 cases (29%).ResultsA significant improvement of all parameters could be found to all points of survey (p < 0.001). Loss of correction was detected for HVA (p < 0.001) and IMA (p < 0.007) with higher levels in group C. Preoperative PDPAA exceeding 8° correlated significantly with loss of HVA correction in group C (p < 0.001).ConclusionThe combined Chevron and Akin osteotomy allowed for better correction of the hallux valgus deformity with better maintenance of the achieved correction. Recommendation for concomitant Akin osteotomy may be determined by a preoperative PDPAA exceeding 8°.Trial registrationRetrospectively registered. UN5080.Level of evidence Therapeutic, Level III, retrospective comparative series.

Outcomes after scarf osteotomy with and without Akin osteotomy a retrospective comparative study

BackgroundThe scarf osteotomy is a well-established surgical method for correcting a hallux valgus deformity. It is often combined with an Akin osteotomy. However, clear guidelines defining indication criteria are missing. The purpose of this study was to analyze the radiological outcome after scarf osteotomy in dependence of additional Akin osteotomy.MethodsThis study included 184 patients in whom a hallux valgus deformity was corrected with a scarf osteotomy (group S), and 63 patients in whom an additional Akin osteotomy was performed (group SA). Weight-bearing radiographs were evaluated preoperatively, postoperatively, after 6 weeks, after 3 months and at a follow-up with a mean of 45.4 months. Analysis was made for the following radiological parameters: the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), the proximal to distal phalangeal articular angle (PDPAA), and the position of the sesamoids as well as the joint congruity.ResultsRadiographic recurrence (HVA > 20°) was detected in 1 patient (1.6% of recurrence) in the SA group, and in 27 patients in the S group (14.7% of recurrence) at follow-up. Outcome between the two groups differed significantly showing reduced loss of HVA correction in the SA group (p < 0.001). The subgroup with a preoperative PDPAA above eight degrees showed significant inferiority of outcome for the S group compared to the SA group.ConclusionRadiological outcome after scarf osteotomy is superior with concomitant Akin osteotomy. A preoperative PDPAA above eight degrees makes additional Akin osteotomy recommendable.Level of evidenceTherapeutic, Level III, retrospective comparative series

Does preoperative deformity diminish radiographic outcome after hallux valgus correction with scarf osteotomy?: A retrospective study of 102 cases

BackgroundScarf osteotomy is a frequently used technique to correct moderate to severe hallux valgus deformities. Recurrence of a deformity is a commonly reported complication after surgery. The aim of our study was to evaluate the impact of preoperative deformity on radiological outcome in terms of postoperative loss of correction after scarf osteotomy. Methods102 patients, in which a hallux valgus deformity was corrected with an isolated scarf osteotomy were included. Weightbearing radiographs were analyzed preoperatively, postoperatively, after 6 weeks and after three months (mean 10.9 months SD 17.2 months). The following radiological parameters were used for analysis: the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), position of the sesamoids, first metatarsal length, and first metatarsophalangeal joint congruity. ResultsSignificant correction of IMA, HVA, DMAA, sesamoid position and joint congruity was achieved (p < 0.001). The IMA improved from 15.8 ± 2.3 to 4.3 ± 2.8°, the HVA from 32.6 ± 6.8 to 9.1 ± 7.2, and the DMAA from 11.4 ± 6.9 to 8.4 ± 5.2°, respectively. In contrast to DMAA, throughout followup we could detect loss of correction for HVA and for IMA amounting 6.3° ± 5.8 and 3.8° ± 2.8 respectively. Loss of HVA correction revealed a significant correlation with preoperative DMAA, but not with the other preoperative radiological parameters. ConclusionsPreoperative deformity does not correlate with postoperative loss of correction after scarf osteotomy, except DMAA. Clinical relevanceOur results may be helpful in counseling patients regarding recurrence of hallux valgus deformity after scarf osteotomy. Level of evidenceTherapeutic, Level IV, retrospective case series.