Forefoot Deformities Research Articles

Complication Rates of Minimally Invasive Chevron Osteotomy for Correction of Hallux Abductovalgus: A Systematic Review.

Recent advancements in minimally invasive surgery for correction of hallux abductovalgus has increased the popularity of this technique. To date, the incidence of complications with this updated technique has not been evaluated. The purpose of this systematic review was to determine the incidence of complications of third-generation minimally invasive chevron osteotomy, with or without an Akin osteotomy, for the correction of hallux abductovalgus. We conducted a systematic review of electronic databases and relevant peer-reviewed sources as outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the preparation of systematic reviews. Studies that reported hallux abductovalgus deformities corrected with minimally invasive surgery and fixated with one or two screws, provided detailed descriptions of all complications, and had mean follow-up of 12 months or more were included. Of 80 studies identified, nine (11.25%) met the inclusion criteria (N = 766 feet). Three of these studies were prospective and involved 426 feet. The weighted mean age for the entire cohort was 50.88 years (17-87 years), and the weighted mean follow-up was 27.65 months (12-66 months). The total incidence of complications was 21.28% (163 of 766 feet). Among the most reported complications were reoperation, postoperative infection, reoccurrence of hallux abductovalgus, and nerve injury. This systematic review revealed that this updated minimally invasive surgery technique provides a safe and reproducible surgical option to correct hallux abductovalgus deformities, with an incidence of complications comparable with that of open correction for this forefoot deformity.

Foot Anthropometry Measures in Relation to Treatment in Patients with Rheumatoid Arthritis: A Longitudinal Study.

Approximately 90% of patients with arthritis exhibit forefoot deformities, including deformities within the metatarsophalangeal and proximal interphalangeal joints. Current pharmacological treatment with Disease Modifying Antirheumatic Drugs (DMARDs) consists of two groups: synthetic drugs (sDMARDs) and biological drugs (bDMARDs). The objective of our study was to investigate foot anthropometry changes in RA patients based on the administered treatment over a five-year period Method: A longitudinal analysis was conducted with RA patients who were grouped based on their pharmacological treatment. The pharmacological treatment groups were categorized into (I) methotrexate (MTX), (II) MTX plus biological treatments (including all variables), (III) biological treatment alone, and (IV) a miscellaneous group comprising patients with diverse treatments, including patients for whom various drugs had failed or who had not achieved remission with pharmacological treatment. For the anthropometric measurements, a foot measurement platform validated by McPoil et al. was used. Post hoc analyses with Bonferroni correction were performed to identify pairwise differences between the treatment groups while controlling for Type I errors due to multiple comparisons. Results: In the period from 2018 to 2023, significant changes were observed in several foot measurements. For instance, the MTX group showed a statistically significant increase in left heel width (p = 0.026). The MTX group experienced a slight increase in left foot length, while the Biologics and MTX + Bio groups exhibited more substantial increases in both maximum medial arch height and midfoot width. Conclusions: Different RA treatments can have a significant impact on foot structure over a five-year period, showing notable changes in heel width and overall foot morphology. Combined treatments with MTX and biologics potentially offer better management of RA.

Clinical and radiological outcome of surgical hallux valgus correction: open versus minimally invasive

IntroductionHallux valgus (HV) is the most common forefoot deformity. Surgical correction of HV aims to reduce pain, preserve joints, and re-establish foot function while restoring the hallux valgus angle (HVA) and intermetatarsal angle (IMA). Many surgical procedures have been proposed, including open and minimally invasive (MI) techniques. This study aimed to compare the midterm outcomes of open vs. MI procedures and their impact on the duration of surgery, hospital stay, HVA, and IMA post-operatively.Materials and methodsOne hundred and twenty HV patients operated by open or MI surgery between October 2019 and October 2022 were included. One hundred three patients met the inclusion criteria and consented to the study. Patients were prospectively surveyed for foot functionality, post-operative pain, and complications using the AOFAS score. Radiographic measurements of HV angles, length of hospital stay, and surgery duration were analysed.ResultsMI surgery patients had significantly better AOFAS scores (p < 0.001) 12 months post-operatively compared to open surgery. Complication rates were lower in the MI group (3.8% vs. 33.3%, p < 0.001). MI surgery patients also had shorter hospital stays (0.9 ± 0.3 days vs. 2.0 ± 0.0 days) and surgery duration (19.7 ± 2.3 min vs. 80.7 ± 6.8 min). MI surgery was more effective in correcting the IMA but equally effective as open surgery for HVA correction.ConclusionMI surgery resulted in better patient satisfaction, fewer complications, and more precise correction of IMA values. Moreover, the duration of surgery and hospital stay were significantly lower in patients undergoing MI surgery. Further research is needed to validate these findings in controlled, prospective randomised trials.

Estimation of the Radiographic Parameters for Hallux Valgus From Photography of the Feet Using a Deep Convolutional Neural Network.

Hallux valgus (HV), also known as bunion deformity, is one of the most common forefoot deformities. Early diagnosis and proper evaluation of HV are important because timely management can improve symptoms and quality of life. Here, we propose a deep learning estimation for the radiographic measurement of HV based on a regression network where the input to the algorithm is digital photographs of the forefoot, and the radiographic measurement of HV is computed as output directly. The purpose of our study was to estimate the radiographic parameters of HV using deep learning, to classify the severity by grade, and to assess the agreement of the predicted measurement with the actual radiographic measurement. There were 131 patients enrolled in this study. A total of 248 radiographs and 337 photographs of the feet were acquired. Radiographic parameters, including the HV angle (HVA), M1-M2 angle, and M1-M5 angle, were measured. We constructed a convolutional neural network using Xception and made the classification model into the regression model. Then, we fine-tuned the model using images of the feet and the radiographic parameters. The coefficient of determination (R2) and root mean squared error (RMSE), as well as Cohen's kappa coefficient, were calculated to evaluate the performance of the model. The radiographic parameters, including the HVA, M1-M2 angle, and M1-M5 angle, were predicted with a coefficient of determination (R2)=0.684, root mean squared error (RMSE)=7.91; R2=0.573, RMSE=3.29; R2=0.381, RMSE=5.80, respectively. The present study demonstrated that our model could predict the radiographic parameters of HV from photography. Moreover, the agreement between the expected and actual grade of HV was substantial. This study shows a potential application of a convolutional neural network for the screening of HV.

New Insight into the Effects of Different Types of Midfoot and Hindfoot Deformities on the Functional Outcomes of Rheumatoid Arthritis Patients

In advanced stages of rheumatoid arthritis (RA), the pattern of joint involvement leads to varied types of foot deformities such as forefoot, midfoot, and hindfoot deformities. We aim to evaluate midfoot and hindfoot deformities and their effect on functional outcomes in RA patients. In this prospective cross-sectional study clinical and radiological evaluations of 100 adult RA patients were studied for midfoot and hindfoot deformities. The RA disease activity, functional disability level, specific foot and ankle assessments, gait speed, and balance tests were assessed. Radiological examinations of the weight-bearing feet in a standing position were done. We found that the most frequent deformity type was the planovalgus foot (24%). There were statistically significant differences between the types of foot deformities and disease duration, disease activity, falls, Tinetti and Berg balance Test, and health assessment questionnaire-disability index. The multivariate regression analysis of independent correlates of falling detected that patients with equinovarus deformity were 2.5 times more liable for falling with 63.5% predictive power. According to the predictive criteria of deformity type for falling, the equinocavovarus type had accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 91%, 84.5%, 98.5%, 99%, and 84%, respectively. We found in RA patients, midfoot and hindfoot deformities cause a significant reduction of functional ability and quality of life. The early detection of foot deformities requires a good awareness of the clinical and radiographic diagnosis of different types of deformities thus reducing the possible functional disabilities via early management by combined orthotic, physiotherapy, and surgical treatments.

Correction of progressive collapsing foot deformity classes after isolated arthroscopic subtalar arthrodesis

IntroductionSubtalar osteoarthritis in the context of flatfoot (recently renamed Progressive Collapsing Foot Deformity (PCFD)) may be treated through subtalar joint (SJ) arthrodesis with anticipated consequences on three-dimensional bony configuration. This study investigates the correction of PCFD-related deformities achieved after Anterolateral Arthroscopic Subtalar Arthrodesis (ALAPSTA). MethodsIn this retrospective study, we evaluated pre- and post-operative (at 6 months) weight bearing computed tomography (WBCT) images of patients diagnosed with PCFD with a degenerated SJ (2 A according to PCFD classification) and/or peritalar subluxation (2D) with or without associated flexible midfoot and/or forefoot deformities (1B, 1 C and 1E) which underwent ALAPSTA as a standalone procedure between 2017 and 2020. Multiple measurements were used to assess and compare pre and post-operative PCFD classes. ResultsThirtythree PCFD (33 patients, median age 62) were included in the study. Preoperative medial facet subluxation was 28.3 % (IQR, 15.1 to 49.3 %). Overall PCFD 3D deformity improved with a reduction of the foot and ankle offset from 9.3 points (IQR, 7.8 to 12) to 4 (IQR, 0.9 to 7) (p < 0.001). Class A-hindfoot valgus (median tibiocalcaneal angle and median calcaneal moment arm improved by 9.4 degrees (p < 0.001) and 11 mm (p < 0.001), respectively), class B-midfoot abduction (median talonavicular coverage angle improved by 20.5 degrees, p < 0.001) and class C-forefoot varus (median sagittal talo-first metatarsal angle improved by 10.2 degrees (p < 0.001)) were significantly corrected after surgery. Class D was difficult to assess due to the fusion procedure. No patient had a pre-operative valgus deformity at the ankle (no class E), and no significant change of the talar tilt was observed (p = 0.12). ConclusionIn this series, ALAPSTA performed as a standalone procedure to treat patients diagnosed with PCFD with a degenerated subtalar joint and/or peritalar subluxation was effective not only at correcting hindfoot alignment but also flexible midfoot abduction and flexible forefoot varus. Level of evidenceLevel IV, case series

The relationship between Foot Posture Index and plantar pressure in a community-dwelling adult population with Type 2 diabetes

AimsTo investigate the contribution of foot type to plantar pressures in a community-dwelling adult population with type 2 diabetes. MethodsFoot Posture Index-6 (FPI-6) as a measure of foot type, barefoot plantar pressure (peak pressures and pressure-time integrals), presence of forefoot deformities, peripheral neuropathy, ankle and first metatarsophalangeal joint (MTPJ) dorsiflexion range of motion (ROM), and demographic variables were measured. Standard multiple regression models were used to investigate the independent contribution of FPI-6 on plantar pressure variables at the hallux, forefoot, and rearfoot. Results122 adults (mean age 70.9 ± 9.3, n = 58 female) with type 2 diabetes were recruited. A lower (more supinated) FPI-6 significantly contributed to an increased forefoot pressure-time integral (β = −0.285, p = 0.04). FPI-6 was not a statistically significant independent predictor of peak pressure at the hallux, forefoot or rearfoot. ConclusionsWhen screening for at-risk sites of elevated plantar pressure in adults with type 2 diabetes, clinicians should consider performing the FPI-6 along with other clinical measures that have been shown to be associated with increased plantar pressures including first MTPJ dorsiflexion ROM, and presence of digital deformities. Evidence-based treatments to offload these areas should then be considered.

The efficacy of shoes modification and orthotics in hallux valgus deformity: a comprehensive review of literature.

Hallux valgus (HV) is a frequent forefoot deformity affecting about 23% of adults and 35.7% of people over 65. The exact etiology is not fully understood. The first ray plays a significant role in walking cause it bears the principal amount of weight and maintains the position of the medial arch. Several factors that deteriorate the integrality of the first ray, such as foot deformities, restrictive footwear, and pes planus, may be ascribed to the HV occurrence. Before any surgical correction, conservative treatment should always be initiated first. Currently, there is no consensus that conservative management by shoe modification and foot orthoses could correct the pathology or terminate the clinical worsening of the condition.From a careful analysis of the literature, proper footwear should be a shoe with an adequate length, wide toe box, cushioned sole, and a lowered heel to not increase the load on the metatarsal heads and cause pain. Personalized 3D printed customized toe spreaders may be applied in patients with HV, improving symptoms and bringing pain relief. Compensating the subtalar joint hyperpronation through foot orthoses plays a fundamental role in the HV development, preventing or at least controlling the condition's progress; this, along with weight reduction and regular physical activity.Data obtained suggest that dynamic foot orthoses prefer a biomechanical type with 3/4-length, which is less likely to negatively affect the dorsal or medial pressures, which instead were noted to increase with the sulcus- and full-length orthoses.Although some studies suggest that foot orthoses would favor the correction of HV deformity, results have been very variable and just in few studies appear to correct HV or reduce its progression, improving symptoms and bringing pain relief. In the case of HV surgical correction, orthoses seem to maintain the correct position acquired over time.

Biomechanical Consequences of Proximal Screw Placement in Minimally Invasive Surgery for Hallux Valgus Correction

Hallux valgus is one of the most common surgically corrected forefoot deformities. Studies evaluating clinical outcomes of minimally invasive chevron and akin (MICA) procedure have shown shorter operation time, faster recovery, and smaller scars compared to the open approach. Previous biomechanical cadaveric studies have largely focused on the open approach with minimal on MICA. To our knowledge, no studies have compared different proximal screw placements in MICA which can either be three-point fixation or intramedullary. This study aims to compare the biomechanical properties of fixation between these 2 techniques in MICA. Six matched pairs of human fresh frozen cadaveric feet were randomized to either 3-point fixation or intramedullary groups. Both procedures were performed by a single fellowship-trained orthopedic foot and ankle surgeon. Using a material testing machine, each specimen underwent 1000 cycles of plantar-to-dorsal uniaxial loads from 0 to 31 N in cantilever configuration while monitoring bending stiffness and distal fragment dorsal angulation. They were then subjected to load until failure at a compression rate of 10 mm/min. Specimens from both groups tolerated the walking fatigue test. Mean bending stiffness of 3-point fixation was 84% higher than intramedullary constructs (p = .002). Mean dorsal angulation of intramedullary was thrice that of 3-point fixation constructs (p = .008). Mean load to failure of 3-point fixation was 30% higher than intramedullary constructs (p = .001). Three-point fixation provide superior biomechanical stability compared to intramedullary proximal screw placement. The surgical technique using 3-point proximal screw fixation can offer robust fixation and lead to better clinical outcomes.

FOREFOOT MORPHOTYPES IN CAVOVARUS FEET: A NOVEL CLASSIFICATION

BackgroundThe cavovarus foot is a complex 3-dimensional deformity. Although a multitude of techniques are described for its surgical management, few of these are evidence based or guided by classification systems. Surgical management involves realignment of the hindfoot and soft tissue balancing, followed by forefoot balancing. Our aim was to classify the pattern of residual forefoot deformities once the hindfoot is corrected, to guide forefoot correction.MethodsWe included 20 cavovarus feet from adult patients with Charcot-Marie-Tooth who underwent weightbearing CT (mean age 43.4 years, 14 males). Patients included had flexible deformities, with no previous surgery. Previous work established majority of rotational deformity in cavovarus feet occurs at the talonavicular joint, which is often reduced during surgery. Using specialised software (Bonelogic 2.1, Disior) a 3-dimensional, virtual model was created. Using data from normal feet as a guide, the talonavicular joint of the cavovarus feet was digitally reduced to a ‘normal’ position. Models of the corrected position were exported and geometrically analysed using Blender 3.6 to identify anatomical trends.ResultsWe identified 3 types of cavovarus forefoot morphotypes. Type 1 was seen in 13 cases (65%) and was defined as a foot where only the first metatarsal was relatively plantarflexed to the rest of the foot, with no significant residual adduction after talonavicular correction. Type 2 was seen in 4 cases (20%) and was defined as a foot where the second and first metatarsals were progressively plantarflexed, with no significant adduction. Type 3 was seen in 3 cases (15%) and was defined as a foot where the metatarsals were still adducted after talonavicular de-rotation.ConclusionWe classify 3 forefoot morphotypes in cavovarus feet. It is important to recognise and anticipate the residual forefoot deformities after hindfoot correction as different treatment strategies may be required for different morphotypes to achieve balanced correction.

Advances in the Causes and Treatment of Floating Toes after the Weil Osteotomy: A Scoping Review.

The floating toe deformity is classified as a forefoot deformity wherein the distal portion of the toe does not establish touch with the ground, resulting in a suspended or elevated position while the finger is in a relaxed state. At first, it garnered considerable interest as a complication It is worth noting that this condition is particularly common in children under the age of 8, which usually disappears as the individual reaches maturity. Studies have shown that with the aggravation of floating toe deformity, its adverse effects on patients' gait and overall quality of life also increase. Despite the prevalence of floating toe deformity in clinical settings, there is a lack of comprehensive literature investigating its underlying causes and potential preventive strategies. This scope review follows the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) statement guidelines for scope reviews. The literature was obtained from various full-text databases, including China National Knowledge Infrastructure Database (CNKI), Wanfang Database, PubMed, and Web of Science Database. Our search focused on published literature related to floating toes, Weil osteotomy, and distal metatarsal osteotomy, up until March 1, 2023. The literature search and data analysis are conducted by two independent reviewers. If there are any disagreements, a third researcher will participate in the discussion and negotiate a decision. Furthermore, two experienced foot and ankle surgeons conducted a thorough literature analysis for this review. Sixty-two articles were included. Through the clinical analysis of the structural changes of the forefoot before and after operation, the classification of floating toe was described, the causes of pathological floating toe were summarized, and the possible intervention measures for the disease were put forward under the advice of foot and ankle surgery experts. We comprehensively summarize the current knowledge system about the etiology of floating toe and put forward the corresponding intervention strategy. We recommend that future studies will focus on the improvement of surgical procedures, such as the combination of Weil osteotomy, proximal interphalangeal (PIP) arthrodesis and flexor tendon arthrodesis.

Forefoot Morphotypes in Cavovarus Feet: A Novel Assessment of Deformity.

The cavovarus foot is a complex 3-dimensional deformity. Although a multitude of techniques are described for its surgical management, few of these are evidence based or guided by classification systems. Surgical management involves realignment of the hindfoot and soft tissue balancing, followed by forefoot balancing. Our aim was to analyze the pattern of residual forefoot deformities once the hindfoot is corrected, to guide forefoot correction. We included 20 cavovarus feet from 16 adult patients with Charcot-Marie-Tooth who underwent weightbearing CT (mean age 43.4 years, range: 22-78 years, 14 males). Patients included had flexible deformities, with no previous surgery. Using specialized software (Bonelogic 2.1, Disior) a 3-dimensional, virtual model was created. Using morphologic data captured from normal feet in patients without pathology as a guide, the talonavicular joint of the cavovarus foot was digitally reduced to a "normal" position to simulate the correction that would be achieved during surgical correction. Models of the corrected position were exported and geometrically analyzed using Blender 3.64 to identify anatomical trends. We identified 4 types of cavovarus forefoot morphotypes. Type 0 was defined as a balanced forefoot (2 cases, 10%). Type 1 was defined as a forefoot where the first metatarsal was relatively plantarflexed to the rest of the foot, with no significant residual adduction after talonavicular joint correction (12 cases, 60%). Type 2 was defined as a forefoot where the second and first metatarsals were progressively plantarflexed, with no significant adduction (4 cases, 20%). Type 3 was defined as a forefoot where the metatarsals were adducted after talonavicular derotation (2 cases, 10%). In this relatively small cohort, we identified 4 forefoot morphotypes in cavovarus feet that might help surgeons to recognize and anticipate the residual forefoot deformities after hindfoot correction. Different treatment strategies may be required for different morphotypes to achieve balanced correction. Level IV, retrospective case series.

Clinical comparative study on resection and non-resection of the fifth metatarsal to rheumatoid forefoot deformity

To explore clinical effect of the fifth metatarsal head excision and non-excision in rheumatoid arthritis (RA) forefoot deformity reconstruction. Retrospective analysis was performed on 50 patients (76 feet) with moderate to severe forefoot deformity caused by RA treated from May 2015 to January 2019. According to degeneration of the fifth metatarsophalangeal joint,the fifth metatarsal head was retained or excised by wind-like forefoot reconstruction,and divided into the fifth metatarsal head preservation group (preservation group) and the fifth metatarsal head resection group (resection group). Twenty-four female patients in preservation group,aged from 47 to 81 years old with an average of (60.37±8.60) years old;the course of disease ranged from 13 to 22 years with an average of (19.00±3.06) years;body mass index (BMI) ranged from 21 to 28 kg·m-2 with an average of (23.53±2.47) kg·m-2;six patients (6 feet) with moderate hallux valgus deformity and 18 patients (30 feet) with severe hallux valgus deformity;treated with the first metatarsophalangeal joint fusion combined with the second th the fourth metatarsophalangeal joint arthroplasty and the fifth metatarsophalangeal joint cleanup. Twenty-six female patients in resection group were female,aged from 30 to 80 years old with an average of (58.53±13.70) years old;the course of disease ranged from 8 to 25 years with an average of (17.94±3.92) years;BMI raged from 20 to 28 kg·m-2 with an average of (24.60±2.03) kg·m-2;4 patients (4 feet) with moderate bunion valgus deformity and 22 patients (36 feet) with severe bunion valgus deformity;treated by the first metatarsophalangeal joint fusion combined with the second th the fifth metatarsophalangeal joint resection of the metatarsophalangeal head. Operation time and postoperative complications between two groups were observed,hallux valgus angle (HVA),intermetatarsal angles between the first and the second metatarsals (IMAFS),intermetatarsal angles between the first and fifth metatarsals (IMAFF),Japanese Society for Surgery of Foot (JSSF) score before surgery and at the latest follow-up were compared. Fifty patients were followed-up from 14 to 46(25.30±8.83) months in resection group and 12 to 48 with an average of (24.30±11.12) months in preservation group,while no significant difference between two groups (P>0.05). There were no significant difference in operation time and postoperative complications between two groups (P>0.05). JSSF scores,HVA,IMAFS and IMAFF in fesection group were improved from (45.09±3.35) points,(38.90±13.67) °,(12.88±1.72) °,(32.50±2.99) ° before operation to (81.60±3.27) points,(15.40±0.90),(9.06±2.27) °,(22.20±1.98) ° at the latest follow-up (P<0.05);preservation group were improved from (47.09±3.96) points,(43.30±12.65) °,(13.99±3.13) °,(33.20±6.14) ° to (83.10±3.66) points,(15.20±1.54) °,(8.99±1.02) °,(24.70±1.88) °,respectively. There were no significant difference in JSSF score,HVA,IMAFS and IMAFF between two groups before operation and the latest follow-up (P>0.05). At the latest follow-up,there were statistically significant differences in pain and deformity in JSSF scores between two groups (P<0.05). Both rheumatoid anterior foot reconstruction and anterior foot reconstruction fifth metatarsophalangeal joint debridement showed significant improvement in clinical efficacy and imaging results. Compared with rheumatoid prefoot reconstruction,the fifth metatarsophalangeal joint reconstruction for the treatment of moderate and severe deformity of rheumatoid prefoot showed better improvement in pain,but worse improvement in deformity. For the moderate to severe deformity of the forefoot caused by rheumatoid disease,patients with mild to moderate degenerative deformity of the articular surface of the fifth metatarsal phalanges may be considered for use.

Automatic software-based 3D-angular measurement for weight-bearing CT (WBCT) is valid

BackgroundThe purpose of this study was to compare automatic software-based angular measurement (AM) with validated measurement by hand (MBH) regarding angle values and time spent for Weight-Bearing CT (WBCT) generated datasets. MethodsFive-hundred WBCT scans from different pathologies were included in the study. 1st - 2nd intermetatarsal angle, talo-1st metatarsal angle dorsoplantar and lateral, hindfoot angle, calcaneal pitch angle were measured and compared between MBH and AM. ResultsThe pathologies were ankle osteoarthritis/instability, n = 147 (29%); Haglund deformity/Achillodynia, n = 41 (8%); forefoot deformity, n = 108 (22%); Hallux rigidus, n = 37 (7%); flatfoot, n = 35 (7%); cavus foot, n = 10 (2%); osteoarthritis except ankle, n = 82 (16%). The angles did not differ between MBH and AM (each p > 0.36). The time spent for MBH / AM was 44.5 / 1 s on average per angle (p < .001). ConclusionsAM provided angles which were not different from validated MBH and can be considered as a validated angle measurement method. The time spent was 97% lower for AM than for MBH. Levels of evidenceLevel III

Foot involvement in psoriatic arthritis: Prevalence, clinical and radiological features

BackgroundThe purpose of this study was to evaluate the prevalence of foot involvement in psoriatic arthritis and to describe its different clinical and radiological features. Patients and MethodsWe conducted a cross sectional study including 40 patients with psoriatic arthritis over a period of 12 months. Anamnesis, clinical examination of feet, podoscopic examination, X-rays of feet and heels, and ultrasound in B mode and power Doppler mode were done for each patient. ResultsFoot involvement was found in 95% of cases. It was symptomatic in 70% and inaugural of the disease in 20% of cases. The hindfoot and the forefoot were the sites most affected (77.5% and 47.5% respectively). The involvement of the midfoot was rarer (25%). Dactylitis was found in 17.5% and deformities of forefoot were found in 22.5% of cases. Antalgic gait was noted in 17.5% and static disorders of foot at podoscopic examination were identified in 35% of cases. Feet dermatological manifestations were found in 45% of cases. Diagnosis of different rheumatological manifestations was based on clinical findings and caracteristic radiological images on X-rays. We demonstrate he sensitivity of ultrasound in the detection and the diagnosis of different foot lesions including enthesitis, synovitis and tenosynovitis, dactylitis, bone erosions and psoriatic nail dystrophy.

Joint-Preserving Surgery for Hallux Valgus Deformity in Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a chronic autoimmune disorder that frequently causes forefoot deformities. Arthrodesis of the first metatarsophalangeal joint is a common surgery for severe hallux valgus. However, joint-preserving surgery can maintain the mobility of the joint. This study aimed to investigate the clinical and radiographic outcomes of distal chevron metatarsal osteotomy (DCMO) for correcting hallux valgus deformity associated with RA. Between August 2000 and December 2018, 18 consecutive patients with rheumatoid forefoot deformities (24 feet) underwent DCMO for hallux valgus with/without lesser toe surgery. Radiological evaluations were conducted, assessing the hallux valgus angle, the intermetatarsal angle between the first and second metatarsals, and the Sharp/van der Heijde score for erosion and joint space narrowing. Clinical outcomes were quantified using a visual analog scale for pain and the American Orthopaedic Foot and Ankle Society forefoot scores to measure function and alignment. The mean hallux valgus angle decreased from 38.0° (range, 25°-65°) preoperatively to 3.5° (range, 0°-17°) at the final follow-up (p < 0.05). The mean intermetatarsal angle decreased from 14.9° (range, 5°-22°) preoperatively to 4.3° (range, 2°-11°) at the final follow-up. (p < 0.05). Regarding the Sharp/van der Heijde score, the mean erosion score (0-10) showed no significant change, decreasing from 3.83 (range, 0-6) preoperatively to 3.54 (range, 0-4) at the final follow-up (p = 0.12). Recurrent hallux valgus was observed in 1 patient and postoperative hallux varus deformity was observed in 2 feet. Spontaneous fusion of the metatarsophalangeal joint developed in 1 case. DCMO resulted in satisfactory clinical and radiographic outcomes for correcting RA-associated hallux valgus deformity.

Long-term clinical and radiological results of metatarsophalangeal resection arthroplasty in patients with large forefoot deformities

metatarsophalangeal resection arthroplasty is considered a salvage surgical procedure able to improve the quality of life of patients with major forefoot deformities. a retrospective observational study of 31 patients (36 feet) with major forefoot deformities operated at our institution was performed. Thirty two feet required additional surgery involving the first ray, most of them (72.2%) through MTP joint fusion. The mean follow-up period was 10.3 ± 4.6 years. Most patients were women (87.1%), the mean age was 74.2 ± 11.5 years. at the final follow-up, mean AOFAS score was 77.9 ± 10.2 points and mean MOxFQ score was 18.3 ± 8.3 points. Visual analog scale (VAS) for pain improved significantly from 7.5 ± 1.2 points to 3.4 ± 2.1 points on average. Good clinical results were also reported on ability to put on shoes comfortably. The mean resection arthroplasty spaces at the end of the study were 1.3, 1.8, 2.5 and 4.4 mm, for second to fifth rays, respectively. The mean sizes of remodeling osteophytes at the end of the study were 1.6, 1.4, 1.1 and 0.7 mm, respectively. Significant improvement was also achieved in the hallux valgus angle (HVA) and intermetatarsal angle (IMA) at the end of the study. in our experience, metatarsophalangeal resection arthroplasty continues to be a valid choice in patients with major forefoot deformities, with satisfactory long-term clinical and radiographic results.

Preoperative patient's expectations and clinical outcomes after rheumatoid forefoot deformity reconstruction by joint sacrificing surgery.

To study the clinical and radiologic factors related with overall patient satisfaction of joint scarifying reconstruction on severe rheumatoid forefoot deformity (RFD). Forty cases of RFD were retrospectively enrolled. A questionnaire on the factors for patient's expectations and satisfactions of the greater and lesser toes was administered, including repression of relapse in deformity (D), pain reduction (P), improvement in shoe wearing (S), barefoot activity (B), and appearance (A). Overall satisfaction were assessed using the 5-digit-scale. Hallux valgus angle, 1, 2 intermetatarsal angle, and other radiologic parameters were measured. Pearson's correlation and multiple linear regression analyses were used to evaluate the relationships between these factors and overall satisfaction. Overall satisfaction was 4.0±0.82. Postoperative radiologic parameters were corrected in adequate range. Visual analog scale (VAS) was reduced from 7.2±2.1 to 2.2±1.8. For the greater toe, patient's expectations (D, P, S, B, and A) were 4.2, 4.1, 3.0, 2.5, 2.7 and satisfactions were 4.2, 4.0, 3.4, 3.5, 3.3, respectively. For the lesser toes, patient's expectations (D, P, S, B, and A) were 3.9, 4.1, 3.4, 3.0, 2.8, and satisfactions were 3.4, 4.0, 3.4, 3.6, 2.9, respectively. Satisfactions with P and B, and reduction amounts of VAS were significantly correlated with overall satisfaction. Although forefoot reconstruction with a joint sacrificing procedure is non-physiological, it could be a good surgical option for severe RFD. Each patient's expectations and satisfactions with this procedure could vary. Thus, it seems important to inform patients preoperatively that expectation could be fulfilled well or less.

Analysis of medium-term outcomes after surgical correction hallux valgus deformity

BACKGROUND: One of the most prevalent foot abnormalities is valgus deformity of the first toe. Many procedures have been proposed to correct this deformity, but one of the most Scarf osteotomy of the first metatarsal bone, which is complemented by the Akin osteotomy of the proximal phalanx of the first finger, is one of the most widely used. This publication analyzes the mid-term effect of repairing the deformity of the first toe using the methods described above.&#x0D; AIMS: To evaluate the mid-term outcomes of hallux valgus correction using Scarf osteotomy and the combination of Scarf and Akin osteotomies to the literature.&#x0D; MATERIALS AND METHODS: This is a cross-sectional, observational study. From January to December 2017, 129 patients (147 ft.) received forefoot deformity. Clinical and radiographic parameters were studied using the AOFAS, FFI, and VAS scales and questions related to the subjective assessment of patients by the treatment.&#x0D; RESULTS: The studys findings revealed an increase in AOFAS scores from 59.0 (1688, SD=18.6) before surgery to 85.0 (53100, SD=13.3; p 0.001) 5 yr later. The VAS scores fell from 5.7 (010, SD=2.2) to 2.4 (05, SD=1.4; p 0.001). After surgery, the FFI scale score decreased from 40.9 (1078, SD=18.1) to 11.3 (019, SD=5.0; p 0.001). According to the survey, 96.7% of patients would agree to a second operation, 96.9% of those who had surgery would recommend it to their relatives, and 94.6% were satisfied with the aesthetic result of the operation. Most patients (95.4%) were satisfied with the treatment in terms of the disappearance of pain and discomfort. The functional results of the surgical surgery were satisfactory to 98.4% of the patients who were consulted. Radiographic HVA, IMA angle, and Hardy and Clapham sesamoid position scores all indicated favorable mid-term outcomes with no deformity recurrence. In 46.3% of patients (68 patients), there was limited mobility in the first metatarsophalangeal joint. A complication in superficial soft tissue irritation occurred in four patients (2.7%). Iatrogenic varus deviation of one toe was observed in one patient. Metal fixators were removed from patients in 34 patients (23.1%). The removal was completed within a year in 17 cases (11.6%).&#x0D; CONCLUSIONS: Scarf osteotomy, alone or in combination with Akin osteotomy, is a successful treatment for hallux valgus.

Definition of a Global Coordinate System in the Foot for the Surgical Planning of Forefoot Corrections

Forefoot osteotomies to improve the alignment are difficult procedures and can lead to a variety of complications. Preoperative planning in three dimensions might assist in the successful management of forefoot deformities. The purpose of this study was to develop a global coordinate system in the foot for the planning of forefoot corrections. Two strategies (CS1 and CS2) were developed for defining a global coordinate system that meets the criteria of being well-defined, robust, highly repeatable, clinically relevant, compatible with foot CT scans, independent of the ankle joint angle, and does not include bones in the forefoot. The absolute angle of rotation was used to quantify repeatability. The anatomical planes of the coordinate systems were visually inspected by an orthopedic surgeon to evaluate the clinical relevancy. The repeatability of CS1 ranged from 0.48° to 5.86°. The definition of CS2 was fully automated and, therefore, had a perfect repeatability (0°). Clinically relevant anatomical planes were observed with CS2. In conclusion, this study presents an automated method for defining a global coordinate system in the foot according to predefined requirements for the planning of forefoot corrections.