Hallux Abductus Angle Research Articles

Frontal Plane Correction of Hallux Valgus Deformity With a Minimally Invasive Third Generation Tecnique: Short-Term Radiographic Outcomes of a Prospective Case Series

A number of minimally invasive osteotomies have been described for the repair of hallux abducto valgus (HAV) deformities. However, there are no known published studies that evaluate the effects of minimally invasive surgery techniques on the reduction of frontal plane rotation in patients with HAV. The purpose of this study was to assess correction in the transverse and frontal planes in patients undergoing surgical repair of HAV deformity utilizing a modified percutaneous technique. One hundred and five feet in 105 patients with HAV deformity were treated with a third generation minimally invasive technique using a first metatarsal osteotomy that allowed for frontal plane correction in conjunction with an Akin osteotomy. The minimum follow-up time was 12 months. Preoperative and postoperative anteroposterior weightbearing x-ray images were assessed and four measurements were evaluated: hallux abductus angle (HAA), intermetatarsal angle (IMA), tibial sesamoid position and frontal plane rotation of the first metatarsal. There were statistically significant differences for each of the assessments between the preoperative and postoperative radiographs (p < .001). There was a mean reduction in the HAA of 23.5° ± 9.6°, in the IMA, 7.0° ± 3.5°, in the tibial sesamoid position, 2.6 ± 1.3, and an improvement in the assessment of first metatarsal pronation (1.4 ± 0.9). The overall complication rate was 18.1%, with 5.7% of the feet requiring reoperation. The minimally invasive procedure employed by the authors demonstrated suitable outcomes in reducing deformity in both the transverse and frontal planes.

Minimally Invasive Distal Metatarsal Osteotomy for Juvenile Hallux Valgus Correction: A Retrospective Radiographic Evaluation

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: The minimally invasive distal metatarsal osteotomy (MIDMO) is an increasingly popular technique for hallux valgus (HV) correction in the adult population. In juveniles, however, the use of minimally invasive methods to surgically resolve HV remains a comparatively new and under-reported concept. The primary objectives of this retrospective review are to provide radiographic findings of pediatric patients who underwent surgical correction of HV via the minimally invasive distal metatarsal osteotomy (MIDMO). Secondary objectives are the utilization of the mechanical axis of the first metatarsal to measure pre- and postoperative radiographic outcomes and time to osseous consolidation. Methods: A multi-center retrospective review was performed of two institution system’s records was conducted for consecutive patients who underwent surgical correction for HV between January 2012 and June 2022. Patients were included if they underwent HV correction using MIDMO, were aged &lt; 18 years, had ≥ 3 months of clinical and radiographic follow-up, and had radiographs on file of both pre- and postoperative anteroposterior (AP) and lateral views. The first IMA (anatomic and mechanical axes), hallux abductus angle (HAA), distal metatarsal articular angle (DMAA), and tibial sesamoid position (TSP) were measured in pre- and postoperative AP and lateral views. A paired sample t-test was used to compare pre- and postoperative absolute radiographic measured angles. Results were considered statistically significant at the 5% (P &lt; 0.05) level. Results: Forty-two feet amongst 30 patients met the inclusion criteria. Twenty seven were female (90%) and 3 of whom were male (10%). Temporary pin fixation (23.8%) or screw fixation (76.2%). Mean patient age was 15.2 years. Mean follow-up was 13.7 months. Mean time to osseous consolidation was 6.7 weeks. A statistically significant reduction was noted in all the radiographic values of every angle measured from preoperative to postoperative. The mean first anatomic IMA changed from 14.52° to 3.53° postoperatively and the first mechanical IMA changed from 14.24° to 4.64° postoperatively. The mean HAA was reduced from 32.98° to 12.83° postoperatively, the mean DMAA shifted from 12.40° to 2.93° postoperatively, and the mean TSP was revised from 3.60° preoperatively to 1.07° postoperatively. Conclusion: This is the first retrospective North American radiographic review in the known literature that evaluates short-term results of juvenile HV correction utilizing the MIDMO. Our results support the conclusion that the MIDMO is an effective method for pediatric patients with HV and provides statistically significant radiographic correction. Additionally, our results support the versatility of the mechanical axis in evaluating pre- and postoperative radiographic outcomes of the first IMA. We recommend future larger efforts with greater patient populations and longer follow-up times for further investigation.

First Tarsometatarsal Joint Fusion for Hallux Valgus Deformity: A Retrospective Comparison of Two Fixation Constructs Regarding Initial Maintenance of Correction and Complications: Traditional Crossing Screw Fixation Versus Dorsomedial Locking Plate and Intercuneiform Compression Screw

Various fixation constructs exist to address hallux valgus when performing a first tarsometatarsal joint arthrodesis. The goal of this present study is to compare complication rates, and degree and maintenance of angular correction between a dorsomedial locking plate with intercuneiform compression screw construct versus traditional crossing solid screw fixation construct. The plate plus intercuneiform compression screw construct fixation utilized a combined sagittal saw and curette method of joint preparation while the crossed screw fixation group utilized a curette and bur technique. A retrospective review was conducted of consecutive patients who underwent a midfoot fusion using either constructs. Sixty four total feet in 56 patients were enrolled in the study. Twenty four consecutive patients (32 feet) who underwent a midfoot arthrodesis using the locking plate and intercuneiform fixation were fully fused (100%) by 10 weeks postoperatively, with no incidents of nonunion and one deep vein thrombosis event. Thirty two consecutive patients (32 feet) who underwent midfoot arthrodesis with crossing screw fixation had 2 nonunion events, one that was asymptomatic and the other that required a revision midfoot fusion. There was a statistically significant improvement from the pre-operative intermetatarsal angle, hallux abductus angle compared to the 10 week and 1 year radiographs (p < .05) for the entire cohort for both fixation constructs. There was a statistically significant increase in American College of Foot and Ankle Surgery first ray scores from pre-op to 1 year follow-up for both fixation constructs. Overall, the dorsomedial locking plate plus intercuneiform compression screw fixation construct better maintains Intermetatarsal angle (IMA) correction at midterm follow-up compared to the traditional crossing screw construct. Both cohorts overall demonstrate similar fusion rates at 10 weeks, nonunion events, incidences of broken hardware, hardware removal, deep vein thrombosis, neuritis at 1 year postoperatively, and hallux varus.

Post-traumatic instability of the first metatarsophalangeal joint: a novel surgical technique of capsular reconstruction in a young kickboxer.

Aim To report a novel surgical technique of capsular reconstruction of post-traumatic instability of the first metatarsophalangeal joint (MTPJ). Methods The clinical case is related to a 24-year-old male athlete whose clinical symptoms began with pain and spontaneous dislocation of the left first MTPJ during a kickboxing fight. He received conservative treatment (cryotherapy and rest) at first. Afterwards, he referred persistent hallux instability associated with moderate pain, despite normal anatomic alignment with no evidence of first ray deformity. Plain traditional x-rays of the left foot, magnetic resonance imaging (MRI), static and dynamic ultrasonography (US) and clinical tests were performed in order to diagnose capsular ligamentous structure lesions. Results The plain x-rays showed hallux abductus angle of 3°. The MRI and US demonstrated a rupture of the lateral capsular ligamentous structures and detachment of the abductor tendon. The pull out medium-lateral of the capsule with the abductor suture was performed as a treatment for dynamic hallux varus deformity. At six-month follow up, the patient walked without lameness with complete active and passive range of motion and with a stable first MTPJ. Conclusion The patient presented with the post traumatic instability of the first metatarsophalangeal joint treated with a novel surgical technique of capsular reconstruction. The patient returned to the full weight-bearing in only 2 months of rehab. To the best of our knowledge, the surgical correction proposed has not been previously described.

Radiographic validation of a self-report instrument for hallux valgus.

Hallux valgus (HV) is a common condition causing substantial morbidity. Radiographic assessment is the gold standard for grading severity but is not always feasible in clinical/research settings. HV line-drawings, consisting of five drawings for each foot depicting a sequential increase in HV angle of 15°, have been clinically validated for self-reporting severity. We aimed to undertake radiographic validation of this self-report instrument. Adults aged ≥50 from four GP practices were sent a health survey. Responders self-reported HV severity for each foot using the line-drawing instrument. Those reporting foot pain in the last year had radiographs taken at a research clinic from which intermetatarsal, hallux abductus and hallux interphalangeal abductus angles were calculated. Ten feet were randomly selected for each HV line-drawing grade for both feet. Associations between self-reported HV line drawings and radiographic measurements were assessed using Spearman's ρ correlation coefficients, mean radiographic angle measurement (95% confidence interval) and one-way analysis of variance. Increasing HV line-drawing grade was positively correlated with radiographic measurements for intermetatarsal and hallux abductus angles (Spearman's ρ=0.602, p<0.001; 0.821, p<0.001, respectively). Hallux interphalangeal abductus angle showed an inverse correlation with increasing line-drawing grade (-0.204, p=0.053). Differences in radiographic measures between HV line drawing grades were significant for intermetatarsal (F=13.98, p<0.001) hallux abductus (F=38.90, p<0.001) but not hallux interphalangeal abductus angle (F=2.21, p=0.075). Grading HV severity by self-reported HV line-drawings provides a valid representation of deformity determined from radiographic measurements and is a useful screening/self-reporting tool.

A Novel Manipulation Technique for Lapidus Fusion in Correction of Hallux Valgus Deformity With Underlying Metatarsus Adductus: A Case Series

Underlying metatarsus adductus (MA) is commonly seen in patients with hallux valgus (HV) deformity, with implications regarding procedure selection and hallux valgus recurrence. Lapidus, or first tarsometatarsal fusion, is commonly performed allowing reduction in intermetatarsal angle (IMA) but this procedure has not been established as an approach to provide partial correction of MA deformity. Retrospective assessment of preoperative and postoperative metatarsus adductus angle (MAA), IMA and hallux abductus angle (HAA) in patients treated with Lapidus fusion for HV. Significance was determined via paired t test with a p value of <.05. All cases involved manual transverse plane manipulation to reduce both IMA and MAA during screw insertion. Intermetatarsal angle and Engel's angle were measured on preoperative AP radiographs to determine the presence of underlying MA in patients undergoing Lapidus fusion for HV. Ten weeks and 1 year postoperative radiographs were measured to determine degree of correction of IMA, HAA, and MAA. Thirty-four patients met inclusion criteria, which is approximately 46% of our sample population. The average preoperative IMA was 19.4˚ (range 12-32) and the average postoperative IMA was 9.7˚ (range 6-14). The average preoperative Engel's angle was 27.4˚ (range 24-34) and the average postoperative Engel's angle was 22.6˚ (range 15-28) with mean improvement in MA of 6.6˚. Of the 34, 27 (79.4%) patients had a normal Engel's angle at 10 weeks postoperatively. All measures of change met level of significance (p < .05). Of the 34 patients, 21 had radiographs taken beyond the 1 year mark (average 53 weeks). These patients were found to have an average Engel's angle of 23.0˚, which is not statistically significantly different from their 10 week measurements. Of the 21 patients, 17 (81%) maintained normal Engel's angle past 1 year. Metatarsus adductus varies regarding degree of reducibility and complicates preoperative angular measurement and correction of HV. Based on these findings, we recommend Lapidus fusion using this specified manipulation technique to obtain comprehensive transverse plane correction.

Short-Term, Retrospective Radiographic Evaluation Comparing Pre- and Postoperative Measurements in the Chevron and Minimally Invasive Distal Metatarsal Osteotomy for Hallux Valgus Correction

Various techniques exist for correction of mild to moderate hallux valgus (HAV) deformity. Recently, minimally invasive distal metatarsal osteotomy (MIDMO) has gained popularity for HAV correction. This retrospective radiographic review aims to report the surgical correction obtained by the chevron and MIDMO osteotomies at a single institution between January 2012 and December 2017. Radiographic parameters, such as intermetatarsal angle (IMA), hallux abductus angle (HAA), and tibial sesamoid position (TSP), were compared on weight-bearing anterior-posterior and lateral radiographs. Sixty-one patients who underwent distal first metatarsal osteotomies were separated into 2 groups. Group A included 30 patients with a chevron bunionectomy performed by Surgeon A; Group B consisted of 31 patients who had MIDMO performed by Surgeon B. Mean follow-up was 26.6 months for Group A and 18.7 months for Group B. Both groups had statistically significant radiographic correction for pre- and postoperative IMA, HAA, and TSP. Group A: IMA measured preoperatively 11.6° ± 4.0° to 6.8° ± 4.1° postoperatively, HAA preoperative 22.2° ± 9.1° to 12.3° ± 6.9° postoperative, and TSP preoperative 1.3 ± 0.9 to 0.7 ± 0.6 postoperative. Group B: IMA measured preoperatively 12.0° ± 2.9° to 5.9° ± 3.3° postoperatively, HAA preoperative 27.9° ± 8.6° to 12.0° ± 6.6° postoperative, and TSP preoperative 2.0 ± 0.8 to 0.7 ± 0.6 postoperative. Postsurgical retrospective radiographic review demonstrated chevron and MIDMO procedures provide comparable radiographic correction of IMA, HAA, and TSP.

Intermetatarsal Angle and Hallux Abductus Angle Reduction After First Metatarsophalangeal Joint Arthrodesis in Mild, Moderate, and Severe Hallux Valgus.

First metatarsophalangeal joint fusion is a commonly used procedure for treating many pathologic disorders of the first ray. Historically, hallux valgus deformity with severely increased intermetatarsal angle or metatarsus primus adductus indicated need for a proximal metatarsal procedure. However, the effectiveness and reliability of first metatarsophalangeal joint arthrodesis in reducing the intermetatarsal angle has been increasingly described in the literature. We compared findings at our institution with current literature for further validation of this well-accepted procedure in correcting hallux valgus deformity with high intermetatarsal angle. Weightbearing preoperative and postoperative radiographs of 43 patients, 31 women and 12 men, meeting the inclusion and exclusion criteria were identified. Two independent investigators measured the hallux abductus and intermetatarsal angles. Preoperative and postoperative measurements for each angle were compared and average reduction calculated. The data were further analyzed by grouping deformities as mild, moderate, and severe. Mean follow-up was 10 months. The overall mean preoperative intermetatarsal and hallux abductus angles decreased significantly (from 13.09° to 9.33° and from 23.72° to 12.19°, respectively; both P < .01). When grouping deformities as mild, moderate, and severe, all of the categories maintained reduction of intermetatarsal and hallux abductus angles (P < .01). Furthermore, the mean reduction of the intermetatarsal and hallux abductus angles seemed to correlate with preoperative deformity severity. In patients undergoing correction of hallux valgus deformity, first metatarsophalangeal joint arthrodesis produced consistent reductions in the intermetatarsal and hallux abductus angles. Furthermore, these findings are consistent with those reported by other institutions.

Radiographic Outcomes of a Percutaneous, Reproducible Distal Metatarsal Osteotomy for Mild and Moderate Bunions: A Multicenter Study

Hallux valgus is a prevalent condition. Many open surgical methods of correction have been described. We performed a percutaneous, extra-articular distal metatarsal osteotomy for mild to moderate bunion deformity. The minimally invasive technique was used in 217 feet (180 patients; age 49 ± 4.7 years, mean ± standard deviation) at 4 centers in North America (Center 1: November 2012 to March 2017; Center 2: January 2010 to May 2016; Center 3: October 2013 to June 2016; Center 4: January 2015 to June 2017). The procedure was used in simultaneous bilateral cases in 28 patients (15.6%) and in nonsimultaneous bilateral cases in 9 patients (5.0%). Immediate postoperative weightbearing was used in all cases. The mean preoperative intermetatarsal angle, hallux abductus angle, and tibial sesamoid position were 14.6° ± 3.5°, 30.7° ± 7.8°, and 5.4 ± 1.4, respectively. At final follow-up of 9.3 ± 6.1 months, the mean intermetatarsal angle, hallux abductus angle, and tibial sesamoid position were 4.7° ± 2.8°, 8.4° ± 6.1°, and 2.0 ± 1.0, respectively (p < .0001 for all comparisons). No major complications were noted. All 217 osteotomies achieved union; 3 feet (1.4%) in 3 patients (1.7%) experienced asymptomatic malunion. Superficial pin-site infection was seen in 42 (19.4%) of the 217 feet (39 patients, 21.7%). The radiographic results of this percutaneous technique appear to be reproducible across multiple centers, and the technique is useful when correcting intermetatarsal and hallux abductus angles. This percutaneous osteotomy for realignment of the first ray allows immediate postoperative weightbearing and, in this initial review, appears to be safe and effective, even in simultaneous bilateral cases.

Maintenance of Correction of the First Tarsometatarsal Joint Arthodesis Procedure with a First Metatarsal to Second Metatarsal Screw Technique: A Preliminary Report

Category:BunionIntroduction/Purpose:Fusion of the first tarsometatarsal joint is common for the treatment of moderate to severe hallux abductovalgus deformity. Despite arthrodesis of the first tarsometatarsal joint, recurrence of the deformity remains a concern. The addition of a screw from the 1st metatarsal base to the 2nd metatarsal base allows for increased stability and can help create a “spot weld” between the metatarsal bases to prevent loss of deformity correction. The additional screw construct is termed the intermetatarsal screw in this study. The purpose of the current study is to determine the long-term maintenance of angular correction of the 1st and 2nd intermetatarsal angle, hallux abductus angle, and tibial sesamoid position after undergoing a 1st tarsometatarsal joint arthrodesis with the addition of the intermetatarsal screw.Methods:A retrospective, single-center chart and radiographic review was performed of 17 consecutive patients who underwent primary hallux abductovalgus correction with a 1st tarsometatarsal joint arthrodesis using the intermetatarsal screw fixation by the senior author. The study period was from January 1, 2017 to May 14, 2018. Three observers independently reviewed radiographic data including preoperative weight bearing, 1st weight bearing, and final weight bearing plain film radiographs.Preoperative films were used if they were within 3 months of the surgery and the radiographic time line for the post-operative intervals were at 12 ± 2 weeks, 18 ± 4 weeks, 26 ± 4 weeks, 52 ± 12 weeks, and the final follow-up visit. Radiographic data evaluated were initial improvement and long-term maintenance of intermetatarsal angle, hallux abductus angle, and tibial sesamoid position.Results:17 consecutive patients were identified for review that met inclusion criterea. Mean follow up time was 8.12 months (SD ± 3.68). Bony union was achieved in all patients. There was 1 symptomatic recurrent bunion, 1 case of symptomatic hardware, and 1 case of transient neuritis. Average preoperative IMA was 16.05º (±2.34), HAA was 33.05º (±6.24), and tibial sesamoid position was 5.77 (±0.9). Average IMA improvement was 8.38º (±2.21), HAA improvement was 17.25º (±8.21), and TSP improvement was 3.29 (±1.36) positions. Average loss of IMA was 1.03º (±1.24), HAA was 4.14º (±5.34), and tibial sesamoid position was 0.65 (±0.86) positions. Wilcoxon signed rank test showed statistical significance in all radiographic parameters; both in initial improvements and loss of correction (p<0.005).Conclusion:The current study shows the addition of an intermetatarsal screw for 1st tarsometatarsal joint arthrodesis has good union rates, a low complication rate, and maintains correction. Further clinical and comparative studies with a larger patient cohort may yield additional useful information.

Maintenance of Correction of First Tarsometatarsal Joint Arthrodesis Using the First Metatarsal to Intermediate Cuneiform Cross Screw Technique: A Retrospective Review

Category:BunionIntroduction/Purpose:The Lapidus procedure is common for the treatment of moderate to severe hallux abductovalgus deformity. Standard fixation consists of a combination of crossing screws and plates. Despite arthrodesis of the first tarsometatarsal joint, recurrence of the deformity remains a concern. A recently described construct adds an additional point of fixation from the plantar medial first metatarsal to the intermediate cuneiform. This construct is termed the cross screw intermediate cuneiform construct. The purpose of this study is to determine the long-term angular maintained correction of the 1st and 2nd intermetatarsal angle, hallux abductus angle, and tibial sesamoid position after undergoing a 1st tarsometatarsal joint arthrodesis utilizing the cross screw intermediate cuneiform construct to correct and maintain the hallux abductovalgus deformity.Methods:A retrospective, single-center chart and radiographic review was performed of all patients with HAV treated with a 1st tarsometatarsal joint arthrodesis with cross screw intermediate cuneiform construct fixation by the senior author. The study period was from June 1st, 2016 to June 1st, 2017. Patients who underwent 1st tarsometatarsal joint arthrodesis for a primary diagnosis of HAV were studied. Three observers independently reviewed radiographic data including preoperative weight bearing, 1st weight bearing, and final weight bearing plain films radiographs. Preoperative films were used if they were within 3 months of the surgery, and the radiographic time line for the post-operative intervals were at 12 ± 2 weeks, 18 ± 4 weeks, 26 ± 4 weeks, 52 ± 12 weeks, and the final follow-up visit. Radiographic data evaluated were initial improvement and long-term maintenance of intermetatarsal ankle, hallux abductus angle, and tibial sesamoid position.Results:Forty-five patients met inclusion criteria and were included in the study. Mean follow-up time was 9.76 months (SD ± 7.62). Bony union was achieved in 43 of 45 patients (95.6%). Two patients required revision bunionectomy as result of recurrence (4.4%). Other complications included symptomatic hardware in 2 patients requiring hardware removal and neuritis in 2 patients. Average preoperative IMA was 15.95º (±2.55), HAA was 31.14º (±6.19), and tibial sesamoid position was 4.36 (±1.07). Final average improvement of IMA was 6.26º (±2.9), HAA was 13.89º (±7.02), and tibial sesamoid position was 2.07 (±1.34) positions. Average loss of IMA correction was 1.70º (±1.64), HAA was 2.45º (±4.6), and tibial sesamoid position was 0.8 (±0.82) positions. Wilcoxon signed rank test showed statistical significance in all radiographic parameters both in initial improvements and loss of correction (p<0.005).Conclusion:The current study shows the cross screw intermediate cuneiform construct for 1st tarsometatarsal joint arthrodesis has good union rates, a low complication rate, and maintains correction. Further clinical and comparative studies may yield additional useful information.

Quantitative Assessment of the Obliquity of the First Metatarsal-Medial Cuneiform Articulation

The so-called obliquity of the first metatarsal-medial cuneiform articulation has been described as an atavistic trait of human foot morphology, and it is commonly proposed as a relative risk factor for development of the hallux abductovalgus (HAV) deformity. The objectives of this investigation were to 1) provide descriptive normative radiographic data on a series of first metatarsal-medial cuneiform articulations and 2) correlate these findings to other common radiographic parameters used to define the HAV deformity. We measured radiographic parameters including the first intermetatarsal angle, hallux abductus angle, tibial sesamoid position, Engel's angle, and 2 measures of obliquity in the transverse and sagittal planes on a consecutive series of 136 weightbearing foot radiographic projections from subjects without a history of foot/ankle surgery or fracture/dislocation. Measurements were considered as continuous variables, graphically depicted against each other on frequency scatter plots, and analyzed by means of Pearson correlation coefficients. Only 1 bivariate comparison demonstrated a weak negative correlation (Engel's angle versus Obliquity_1 [Pearson –0.259; p = .002]). The results of this investigation did not demonstrate a statistically significant or clinically substantial relationship between the obliquity of the first metatarsal-cuneiform joint and common radiograph parameters of the HAV deformity. Although not specifically studied here, these results might potentially indicate function, as opposed to structure, in the developmental pathogenesis of the HAV deformity.

Triplanar Quantitative Radiographic Analysis of the First Metatarsal-Phalangeal Joint in the Hallux Abductovalgus Deformity

Although hallux abductovalgus (HAV) is widely considered to be a triplanar deformity involving the transverse, sagittal, and frontal planes, most of the published literature has focused on evaluating the deformity in only the transverse plane, and we are unaware of any investigation objectively evaluating the relationship among the 3 planes in the setting of HAV deformity. The objective of this investigation was to quantitatively evaluate radiographic measurement of the relationship between the transverse, sagittal, and frontal planes in the HAV deformity. Anteroposterior, lateral, and sesamoid axial radiographs from 42 consecutive feet were evaluated with measurement of the first intermetatarsal angle, hallux abductus angle, metatarsal sesamoid position, first metatarsal inclination angle, sesamoid rotation angle, and tibial sesamoid grade. Variables were graphically depicted against each other on frequency scatter plots with calculation of a regression line and Pearson's correlation coefficient. As transverse plane deformity increased, the frontal plane deformity also tended to increase and the first metatarsal inclination angle tended to decrease. And as frontal plane deformity increased, the first metatarsal inclination angle tended to decrease. To our knowledge, these are the first quantitative and objective data in support of a triplanar component to the HAV deformity, and we believe this reinforces the evaluation of this deformity with emphasis on all 3 planes.

Rate of Development of Hallucal Interphalangeal Degenerative Joint Disease After First Metatarsophalangeal Joint Arthrodesis: A Retrospective Radiographic Analysis.

The development of hallux interphalangeal joint (IPJ) arthritis after an arthrodesis of the first metatarsophalangeal joint has been established in the literature. However, the significance has not been well reported. A retrospective, radiographic review of patients who had undergone a first metatarsophalangeal joint arthrodesis was performed. The Coughlin classification for degree of arthritic degeneration, hallux abductus angle, and hallux interphalangeus angle were measured in 107 radiographs of 103 patients preoperatively and postoperatively. Postoperative angles were measured immediately following surgery at approximately 6 weeks, 3 months, 6 months, 12 months, and 24 months. We found that the hallux abductus angle had decreased in the patients postoperatively; however, the hallux abductus interphalangeus angle increased on average after first metatarsophalangeal fusion. The majority of patients started with a Coughlin classification I of the hallux IPJ, which remained unchanged over the postoperative period, with no statistically significant difference in IPJ degeneration in the patients with or without fusion of the first metatarsophalangeal joint. In addition, no patients had a symptomatic hallux IPJ postoperatively within our limited study period. Further prospective studies would be beneficial with longer follow-up times to assess IPJ degeneration following first metatarsophalangeal joint fusions. Levels of Evidence: Level III: Retrospective, comparative study.

Evaluation of the Mechanical Axis of the First Ray Before and After First Metatarsal-Phalangeal Joint Reconstructive Surgery

LaPorta et al published a description of measurement of the mechanical axis of the first ray in an attempt to introduce center-of-rotation angulation principles into forefoot reconstructive surgery. They found significant differences in the measurement of the first intermetatarsal angle between groups of feet with and without hallux abducto valgus deformity, but they found no difference in the measurement of the M1-M2 mechanical axis angle between groups. The objectives of this study were to further investigate the proposed M1-M2 mechanical axis angle and to examine the effect of hallux abducto valgus corrective surgery on its measurement. We retrospectively evaluated weight-bearing dorsal-plantar projection radiographs taken in the angle and base of gait of 56 consecutive feet before and after first metatarsal-phalangeal joint corrective surgery. On each radiograph, we calculated the first intermetatarsal angle, the hallux abductus angle, the tibial sesamoid position, the M1-M2 mechanical axis angle, and the position of the sesamoids relative to the mechanical axis of the medial column. Statistically significant decreases were observed when comparing pre- versus post-operative measurement of the first intermetatarsal angle (−4.83°; p < .001), hallux abductus angle (−11.46°; p < .001), and tibial sesamoid position (−1.99 positional grade; p < .001). Statistically significant differences were also observed for the M1-M2 mechanical axis angle (−0.47°; p = .007) and the position of the sesamoids relative to the mechanical axis of the medial column (0.38 positional grade; p < .001), but it is unlikely that these results would be considered clinically significant given the differences of less than 1° and less than 1 positional grade, respectfully. The results of this investigation add to the body of knowledge and will hopefully lead to future investigations into the progression, evaluation, and treatment of the hallux abducto valgus deformity.

Minimalist shoes running intervention can alter the plantar loading distribution and deformation of hallux valgus: A pilot study

BackgroundHallux valgus (HV) is one common deformity of the human foot. Metatarsal pain, gait deviation and foot function disorder may occur when HV is severe.Research question: It was hypothesized that a 12-week minimalist shoes running intervention among mild and moderate hallux valgus males may alter foot morphology and plantar pressure distribution during walking and running. MethodsThe foot morphology and plantar pressure data, in this study, were collected from eleven participants using the Easy-Foot-Scan (EFS) and Novel EMED force plate. ResultsCompared to pre-intervention sessions, the hallux abductus angle and forefoot width decreased significantly with increased metatarsal waist girth in the post-intervention session. The peak pressure, maximum force and force time integral in the first metatarsal reduced significantly due to the distribution of plantar pressure to the central foot regions. SignificanceThe findings suggest that minimalist shoes may deform forefoot morphology and neutralize loading concentration for mild and moderate hallux valgus.

Rate of Development of Hallucal Interphalangeal Degenerative Joint Disease After First Metatarsophalangeal Joint Arthrodesis

Category: Midfoot/Forefoot Introduction/Purpose: The first metatarsophalangeal joint (MTPJ) is an integral part of the foot during the gait cycle. Arthrodesis of this joint is gold standard, especially in patients with rheumatoid arthritis. The development of IPJ arthritis after an arthrodesis of the MTPJ has been established in the literature; however, the significance of this has not. The purpose of this study was to determine the rate of IPJ degenerative joint disease (DJD) in patients who underwent first MTPJ fusion by evaluating the degree of IPJ arthritic degeneration through 2 years post-surgery and to compare radiographic parameters over time among patients with and without DJD in order to determine whether non-fusion (less than 50% fusion) or the hallucal position was associated with the subsequent development of DJD. Methods: Retrospective clinical and radiographic review of patients who had undergone a first metatarsophalangeal joint arthrodesis was performed. Inclusion criteria were adult patients 18 and older who underwent first MPJ arthrodesis between January 2012 and January 2015 with internal fixation of any type. Patients were excluded if they were under 18 years of age, underwent concomitant procedures that would affect postoperative weight bearing course, suspected or diagnosed with osteomyelitis of the foot, had prior surgical procedures of the MTPJ or IPJ joints, or concomitant hallucal IPJ arthritis or preexisting IPJ fusion. Postoperative radiographs were obtained immediately following surgery and at approximately 6 weeks, 3 months, 6 months, 12 months, and 24 months. Results: Ultimately, 103 patients met all the inclusion criteria and none of the exclusion criteria. Four of the 103 patients (3.9%) had undergone bilateral procedures, thus providing 107 surgical procedures. Demographic characteristics can be found on Table 1. The hallux abductus (HA) angle and hallux abductus interphalangeus (HAI) angle were measured preoperatively and postoperatively (Fig. 1-2). The average postoperative follow-up radiograph was taken at 22.9 weeks. The HA angle average preoperatively was 31.4 degrees, which decreased to 11.8 degrees postoperatively. The HAI angle average preoperatively measured 10.8 degrees and increased to 11.9 degrees postoperatively. No patients had symptomatic hallux IPJ postoperatively within the study period. However, 7 patients needed hardware removal and second surgery at an average of 36.3 weeks due to hardware pain and nonunion. Conclusion: Arthrodesis is often the treatment of choice for first MTPJ pathology, which is commonly arthritis or hallux valgus. We found the incidence of IPJ arthritis to be lower than the reported literature and unchanged over the postoperative period. Furthermore, no patients reported symptomatic hallux IPJ within the study period. Also, we found the HA angle had decreased in the patients postoperatively; however, there was a mixed trend with HAI increasing after first MTPJ fusion. The significance of this trend is unclear, but the increase of the HAI could possibly cause further pain and deterioration of the joint in the future.

Tophus size is associated with hallux valgus deformity in gout.

Hallux valgus (HV) and gout are common pathologies of the first metatarsophalangeal joint (MTP1) leading to pain and deformation. In this study, we aimed to determine the correlation between tophus size and characteristics of HV in gouty patients. In this case-control study, we included patients with gout (the presence of monosodium urate crystals in synovial fluid) and control patients with spondyloarthritis, without crystal disease disorders. Radiographic assessment and ultrasound (US) assessment were performed by two blinded operators. US features of gout (double contour [DC] sign and/or tophus) were collected. HV was defined by hallux abductus (HA) angle ≥20° and/or intermetatarsal angle (IM) ≥10°. Correlation between US findings and HV angles was estimated by Spearman correlation coefficient. We included 56 gouty patients (87.5% males, mean age of 63.9±12.2years) and 41 control patients (90% males, mean age of 59.0±12.8years). HV was more frequent in patients with gout than controls (62% vs 37%, P=.0007). Regardless of HV status, correlations were found between the size of US tophi and IM (r=.3381, P=.003) and HA angles (r=.2344, P=.043). Our results confirm a high prevalence of HV in gouty patients. We also observed a correlation between the size of the US tophus and the angles defining HV, which suggests a link between urate deposition load and HV. Early urate-lowering therapy for gout could limit the occurrence of HV.

The Mau-Reverdin Osteotomy: A Short-Term Retrospective Analysis

We reviewed 33 consecutive Mau-Reverdin osteotomies in 23 patients performed for correction of hallux abducto valgus from November 2010 to May 2013. All patients were followed up and evaluated for a mean of 401 days and median of 360 days after surgery. In each foot, the preoperative first intermetatarsal angle, hallux abductus angle, and proximal articular set angle were obtained. The mean correction of these angles was as follows: intermetatarsal angle 10.5° ± 3.31°, hallux abductus angle 24.4° ± 8.8°, and proximal articular set angle 28.39° ± 11.2°. Furthermore, we evaluated for metatarsus elevates, and no statistically significant first metatarsal elevation was present in any of the 33 feet (p < .0001). Additionally, 21 of the 33 feet (63.6%) were available for first metatarsophalangeal joint American Orthopaedic Foot and Ankle Society scale score evaluation. The mean preoperative score was 25.5 ± 16.7. After correction, the mean American Orthopaedic Foot and Ankle Society scale score had increased to 95.4 ± 5.7. All these differences were statistically significant (p < .0001), and the patients had a very high level of satisfaction. In all 33 feet, no deep infection, malunion, nonunion, avascular necrosis of the first metatarsal, or hardware failure developed. One patient developed hallux varus deformity. The Mau-Reverdin osteotomy is a very effective and reproducible procedure that successfully corrects large bunion deformities and provides patients with a high level of satisfaction and a low complication rate.

Quantitative Analysis of the Degree of Frontal Rotation Required to Anatomically Align the First Metatarsal Phalangeal Joint During Modified Tarsal-Metatarsal Arthrodesis Without Capsular Balancing

The data from 35 consecutive patients with hallux valgus undergoing triplane arthrodesis at the first tarsal metatarsal joint were studied to determine the amount of first metatarsal frontal plane rotation (supination) needed to anatomically align the first metatarsal phalangeal joint on an anterior posterior radiograph without soft tissue balancing at the first metatarsal phalangeal joint. Radiographs were measured both pre- and postoperatively to assess the 1-2 intermetatarsal angle, hallux abductus angle, and tibial sesamoid position (TSP). The mean amount of varus (supination) rotation performed during correction was 22.1° ± 5.2° and the mean amount of intermetatarsal angle reduction achieved after completion of the procedure was 6.9° ± 3.0°. The TSP changed by a mean of 3.3° ± 1.2°. A series of univariate linear regression analyses was performed to analyze the relationship between the frontal plane rotation of the first metatarsal performed during the operation and the preoperative intermetatarsal angle, hallux abductus angle, and TSP. Greater preoperative TSP scores were associated with greater intraoperative varus (supination) rotation required for joint alignment. Direct observation of the alignment changes at the first metatarsal phalangeal joint after metatarsal rotation without distal procedures strengthened the notion that the frontal plane rotational position plays an important role in the bunion deformity.