Hallux Valgus Angle Research Articles

A Multi-Dimensional Systematic Review of Minimally Invasive Bunion Surgery (MIBS)

Background/Objectives: Hallux valgus, or a bunion, is a prevalent foot deformity associated with pain, limited mobility, and reduced quality of life. Surgical treatments include minimally invasive and traditional open techniques, but the optimal approach remains debated. This systematic review evaluates long-term outcomes, patient satisfaction, cost-effectiveness, the influence of patient-specific factors, rehabilitation protocols, and complication rates for these methods. Methods: A comprehensive search of PubMed, Medline, EMBASE, and Cochrane databases identified 22 studies published within the last 15 years, each with a minimum follow-up of 2 years. The systematic review adhered to PRISMA-ScR guidelines. Eligible studies reported on at least one of six key outcomes, and data were extracted on radiographic and clinical results, patient satisfaction, costs, rehabilitation timelines, and adverse events. Results: Minimally invasive bunion surgery (MIBS) showed faster recovery, higher patient satisfaction, and improved quality of life compared to open surgery. Radiographic outcomes, including hallux valgus and intermetatarsal angle correction, were durable, though outcomes were less consistent for severe deformities. MIBS was more cost-effective over time, owing to shorter operating times and faster recovery. Rehabilitation was accelerated, and wound complications were fewer with MIBS. However, open techniques remained preferable for severe deformities due to their reliability in complex corrections. Conclusions: MIBS offers substantial advantages for most patients undergoing bunion surgery, including faster recovery and fewer complications. However, open techniques may be better suited for severe deformities. Further research is needed to refine patient selection criteria and evaluate long-term outcomes in diverse populations.

The impact of corrective exercises, kinesiology taping, and mechanical correction on pain and foot shape in women with hallux valgus

BackgroundThis study aimed to assess the effect of corrective exercises and exercises supplemented by kinesiology taping or an orthosis on pain and foot alignment in women with hallux valgus (HV).MethodsEighty-two women with HV were randomly divided into groups: E (n = 24) who exercised for 12 weeks; EKT (n = 18) who exercised and used kinesiology taping on HV; EMC (n = 15) who performed exercise and used an orthosis to correct their big toe position; and CHV (25 women with HV without therapy). Additional control group C: (n = 31) women with normal hallux. The Wejsflog index, Clarke’s angle, alpha and beta angles, and pain intensity in the big toe area were assessed at the beginning and after therapy.ResultsThe Wejsflog index was significantly lower in women with HV and increased significantly after therapy in the E and EKT groups. Clarke’s angle did not differ between women with and without HV, and Clarke’s angle did not change after therapy. The HV angle decreased significantly in groups E and EKT but was still significantly greater than that in group C. The fifth toe varus angle did not differ between women with and without HV and decreased significantly in the right foot after therapy in group E. Pain in the HV area decreased significantly in all groups undergoing therapy.ConclusionWomen with HV have a greater forefoot width, but their longitudinal arch and fifth toe position do not differ. Exercises significantly reduce pain and improve hallux alignment. Combining exercises with kinesiology taping or an orthosis does not increase the therapeutic effect. Although the observed effects of conservative therapy are promising, it should be remembered that long-term effects have not been studied.Trial registrationThe Australian New Zealand Clinical Trials Registry (ACTRN12621000902897).

Double osteotomy in recurrence cases with distal metatarsal articular angle increase after hallux valgus distal surgery.

The aim of this study was to evaluate the clinical and radiological results of the combined use of distal closed wedge and proximal open wedge osteotomies in cases of recurrent hallux valgus (HV) with an increased distal metatarsal articular angle (DMAA). Between January 2019 and December 2022, a total of 10 female patients (mean age: 48.8±10.8 years; range, 28 to 63 years) who underwent surgical treatment for recurrent HV with an increased DMAA were retrospectively analyzed. Pre- and postoperative anterior-posterior and lateral radiographs of the patients were taken. The intermetatarsal angle (IMA), DMAA, and HV angle (HVA) were measured and compared before and after surgery. The clinical outcomes of the patients were evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) score, Manchester-Oxford Foot Questionnaire (MOXFQ) score, and Maryland Foot Score (MARYLAND). The median follow-up was 33.1 (range, 24 to 78) months. Seven (70%) of the patients underwent surgery on the right side and three (30%) of the patients underwent surgery on the left side. The median time to recovery of osteotomies was 8 (range, 6 to 10) weeks. There was no loss of correction at minimal two years of follow-up. None of the patients developed postoperative infections. The postoperative HVA, IMA, DMAA values of the patients were statistically significantly lower than the preoperative values (p<0.05). The AOFAS and MARYLAND scores of the patients at six and 24 months after surgery were statistically significantly higher compared to the baseline (p<0.05). Considering the MOXFQ scores, the scores at six months and 24 months after surgery were statistically significantly lower than the scores before surgery (p=0.005 for both). Similarly, MOXFQ scores at 24 months after surgery were statistically significantly lower than those at six months (p=0.013), indicating that the clinical improvement obtained at six months continued to increase until 24 months. The combination of distal closed wedge and proximal open wedge osteotomies for HV recurrence seems to be an effective surgical technique for correction of the deformity. Plate and screw fixation can increase the rate of bone union and accelerate postoperative mobilization of the patients. Further large-scale, long-term studies are needed to provide more comprehensive findings on the effectiveness of HV surgery and elucidate the effects of postoperative rehabilitation processes on recovery in order to optimize the treatment protocols.

Association of Radiologic and Clinical Outcomes After Chevron Osteotomy Treatment of Hallux Valgus: Average 6.5-Year Follow-Up Study in Women.

Hallux valgus, the most common forefoot deformity, frequently leads to corrective foot surgery. Despite high surgical rates, patient dissatisfaction remains prevalent, and its causes are unclear. Surgeons often focus on radiologic corrections, assuming greater corrections yield higher satisfaction. This study aimed to investigate whether traditional radiologic measurements, rotational parameters associated with first metatarsal pronation (eg, lateral head shape and tibial sesamoid position), and routinely collected demographic variables (eg, age, body mass index [BMI], occupational status) can predict patient-reported outcomes following chevron osteotomy. In this retrospective analysis, we included 89 female patients who underwent chevron osteotomy from 2016 to 2018. Patients were evaluated on average 6.5 years postoperatively (range 5-8 years). Demographic variables, including age at surgery, BMI, occupational status, and activity level, along with radiographic variables, such as the hallux valgus angle (HVA), intermetatarsal angle (IMA), lateral head shape, and tibial sesamoid position, were collected pre- and postoperatively. The primary outcome was the Manchester-Oxford Foot Questionnaire (MOxFQ) pain subscore; secondary outcomes included visual analog scale (VAS) pain scores, and Likert scale satisfaction. A statistically significant association was observed between greater correction of the HVA and improved MOxFQ pain subscores (P = .014). Higher preoperative HVA values were associated with lower postoperative pain scores, indicating improved outcomes (P = .043), whereas higher postoperative HVA values were associated with increased pain, suggesting worse outcomes (P = .022). Despite these findings, the overall association of both preoperative and postoperative radiologic measurements, as well as demographic factors, for patient-reported outcomes was limited, with a pseudo-R2 value of just 0.0267. VAS pain scores showed no significant associations (all P > .05). Although the Likert satisfaction scale correlated with preoperative HVA (P = .049) and postoperative HVA (P = .026), the predictive strength of these variables remained modest. In this minimum-5-year retrospective study of 89 female patients who underwent chevron osteotomy and had not undergone a later secondary procedure, we found that HVA radiographic correction with a chevron osteotomy was weakly associated with improved pain and satisfaction.

The Learning Curve of Reverdin-Isham and Akin Percutaneous Osteotomies for Hallux Valgus Correction: A Bayesian Approach.

Background/Objectives: Assessing the learning curve is essential for surgical techniques that require precision and technical adaptation. Although modified Reverdin-Isham and Akin percutaneous osteotomies (RIAOs) are well-established procedures for the treatment of hallux valgus (HV), their percutaneous nature and specific technical demands justify the evaluation of the learning curve. Therefore, this study aimed to assess the learning curve of RIAOs for the HV correction, using for the first time a Bayesian approach. Methods: Modified RIAOs were applied to treat mild-to-moderate HV in patients who were prospectively enrolled. The hallux valgus angle (HVA), inter-metatarsal angle (IMA), distal metatarsal articular angle (DMAA) and tibial sesamoid position were assessed. Clinical outcomes were evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) Scale, Visual Analog Scale (VAS) and Numerical Rating Scale (NRS). Surgery and fluoroscopy times were recorded. To evaluate the learning curve, a Bayesian analysis using a change point model was performed. Results: Analysis of 142 patients revealed three distinct phases in the learning curve, with a plateau reached after 112 procedures. Over time, the mean operation duration decreased from 55 to 27 min, and fluoroscopy time decreased from 60 to 28 s. Conclusions: A flexible change point model was used to model a learning curve, guaranteeing a robust interpretation of the data. The correction of the HV angles showed similar results in the three phases of the curve, demonstrating that the surgeon achieved positive results from the beginning of the surgery.

Instrumented correction of metatarsus adductus with hallux valgus - A multicenter radiographic assessment.

Instrumented correction of metatarsus adductus with hallux valgus - A multicenter radiographic assessment.

Association of calcaneal pitch angle with recurrence of postoperative hallux valgus in patients with rheumatoid arthritis.

Association of calcaneal pitch angle with recurrence of postoperative hallux valgus in patients with rheumatoid arthritis.

Prospective multicenter study assessing radiographic and patient outcomes following an instrumented mini-open triplanar tarsometatarsal arthrodesis with early weightbearing.

Prospective multicenter study assessing radiographic and patient outcomes following an instrumented mini-open triplanar tarsometatarsal arthrodesis with early weightbearing.

Correction of Distal Metatarsal Articular Angle in Hallux Valgus Surgery Utilizing a Minimally Invasive Extra-Articular Metaphyseal Distal Transverse Osteotomy.

Hallux valgus deformity frequently presents with an increased distal metatarsal articular angle (DMAA) which may require additional correction. Minimally invasive hallux valgus surgery is often used in patients with increased DMAA. We hypothesized that the triplanar correction with the minimally invasive extra-articular metaphyseal distal transverse osteotomy (META) would improve the DMAA, in addition to the hallux valgus angle (HVA), intermetatarsal angle (IMA), and patient-reported outcomes. A retrospective chart review was performed on patients who underwent an META procedure for hallux valgus correction. The DMAA, HVA, IMA were measured on preoperative, 2-week postoperative, and final follow-up radiographs. Patient demographics, complications, and Patient-Reported Outcomes Measure Information System (PROMIS) pain, function, and mobility scores were recorded. Univariate analysis and t-test were used to describe measurements between DMAA, HVA, and IMA. Twenty-seven META osteotomies were performed on 25 patients. At the final follow-up, mean DMAA, HVA, IMA decreased from 9.73 ± 1.96 to 4.35 ± 0.85 degrees, 30.45 ± 7.91 to 6.59 ± 2.75 degrees, and 15.37 ± 3.67 to 3.72 ± 1.84 degrees, respectively (P < .001). The PROMIS pain scores significantly improved from 58.96 ± 6.00 to 49.69 ± 9.35 at the final follow-up (P < .001). These observations imply successful resolution of hallux valgus, with a single META procedure. This approach may be an alternative to open or multiple corrections of hallux valgus, while preserving improvement in functional outcomes.Level of Evidence: Level IV.

Second metatarsophalangeal joint dislocation in hallux valgus: a radiographic study using a two-dimensional coordinate system

BackgroundHallux valgus (HV) poses additional challenges when accompanied by second metatarsophalangeal (MTP) joint dislocation, often requiring complex surgical intervention. This study aimed to analyze HV feet with second MTP joint dislocation using a 2-dimensional coordinate system to better understand the anatomical structure of this condition.MethodsWeightbearing foot radiographs of 49 HV feet with second MTP joint dislocation (group D), 68 HV feet without second MTP joint dislocation (group W), and 54 control feet (group N) were analyzed. A 2-dimensional coordinate system was used to map standardized points on radiographs into X and Y coordinates, which were compared across groups. Radiographic parameters measured included hallux valgus angle (HVA), intermetatarsal angle (IMA), second toe MTP angle (2MTPA), metatarsus adductus angle (MAA), great toe length, first metatarsal (MT1) length, second toe length, and second metatarsal (MT2) length. The 2MTPA was further analyzed based on the deviation direction (medial, neutral, or lateral).ResultsThe proximal phalanx head of the third toe in groups D and W was lateral compared to group N (P <.05 and P <.001, respectively), while the distal point in group D was medial to group W (P <.001). The base of MT1 in group D was significantly medial compared to other groups (P <.001). Additionally, the distal point of the great toe in group D was significantly lateral compared to other groups (P <.01 and P <.001, respectively).ConclusionsPatients with second MTP joint dislocation exhibited a proximally translated second toe, an adducted third toe, a medialized MT1 base, and a lateralized great toe tip. The M1/2 angle influenced dislocation direction: higher angles led to medial or neutral deviation, while lower angles caused lateral deviation. Radiographic coordinate mapping provided novel insights into foot anatomy in HV with second MTP joint dislocation, laying the groundwork for future research on anatomical risk factors and optimizing surgical approaches to improve patient outcomes.

Minimally Invasive Lapidus Arthrodesis Associated with Distal Osteotomy of M1: A Combined Procedure for Hallux Valgus Correction.

Background: Hallux valgus is a common painful condition with tri-planar deformity of the first ray. Surgical correction consists of distal osteotomy of the first metatarsal and its lateral translation. However, in the case of hypermobility of the first cuneo-metatarsal joint (TMTJ), the associated Lapidus procedure is indicated to correct deformities along all three anatomical planes. Lapidus procedure is reported to have several contraindications and complications; for this reason, many surgeons proposed technical modification to the original procedure. We present the results of a novel surgical technique for hallux valgus correction with minimally invasive arthrodesis of first TMTJ without proximal correction of deformity, combined with a distal Austin-Chevron procedure. Materials and Methods: We retrospectively evaluated patients who underwent surgical correction of hallux valgus with our technique between January 2010 and January 2020. We collected data on demographics, anesthesiologic technique, associated surgical procedures, post-operative functional results, and complications. Dorso-plantar and lateral radiographs were performed at 6, 12, and 24 weeks after surgery or until fusion was documented. Clinical assessment considered gait analysis, pain or other disturbance, type of shoes worn, and use of orthosis. Results: A total of 240 patients were enrolled. AOFAS score, hallux valgus angle, and inter-metatarsal angle showed a significant improvement. Complications consisted of distal osteotomy non-union (1%), pain or protrusion of the screw (13%), and recurrence of deformity (2%). Overall, patients were very satisfied with the surgery in 192/278 (69%) cases, moderately satisfied in 67/278 (24%) cases, satisfied in 8/278 (3%) cases, and dissatisfied in 11/278 (4%) cases. Conclusions: Our novel surgical technique which combines in situ arthrodesis of the first tarso-metatarsal joint (TMTJ) with a distal Austin-Chevron procedure offers an effective alternative for correcting hallux valgus with first-ray hypermobility, minimizing complications associated with traditional methods.

Comparative analysis between Reverdin-Isham Osteotomy (RIO) and minimally invasive intramedullary nail device (MIIND) in association with AKIN osteotomy for Hallux valgus correction

BackgroundHallux valgus (HV) is a widespread condition that leads to discomfort in daily life. There are different surgical techniques for HV. This retrospective and comparative study aimed to compare the clinical and radiographic outcomes of the Reverdin-Isham osteotomy (RIO) and the Minimally Invasive Intramedullary Nail Device (MIIND) surgical techniques.MethodsOne hundred ninety-six patients with mild-to-severe HV were enrolled and divided into two groups: 98 patients with mild-moderate HV and 98 with moderate-severe HV, treated with the RIO and MIIND techniques, respectively. Radiographic and clinical evaluations were assessed preoperatively at 3, 12 and 60 months after surgery. Radiologically, the Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), Distal Metatarsal Articular Angle (DMAA) and Tibial Sesamoid Position (TSP) were evaluated. Clinically, the AOFAS hallux metatarsophalangeal-interphalangeal scale and the Numeric Rating Scale (NRS-11) for pain were assessed. A propensity score matching (PSM) model was implemented to compare the two techniques.ResultsIn the RIO group, the mean HVA correction from preoperative value to 60 months of follow-up was 8.69° (p < 0.0001), the mean IMA correction was 2.42° (p < 0.0001), and the mean DMAA correction was 0.09°. In the MIIND group, the mean HVA correction was 24.92° (p < 0.0001), the mean IMA correction was 8.75° (p < 0.0001), and the mean DMAA correction was 6.28° (p < 0.0001). The mean AOFAS score improved over time, and NRS-11 decreased in both groups. After PSM model application, the variables that impacted the allocation to RIO or MIIND techniques were age, preoperative HVA values and HV severity.ConclusionOur study demonstrates the efficacy of RIO for mild-moderate HV and MIIND for moderate-severe HV. Radiographic and clinical outcomes improved in both groups, but older patients with higher HVA and severe HV should be treated with the MIIND technique to achieve satisfactory outcomes.Level of evidenceIII, retrospective cohort study.

Comparative study on changes in forefoot width after minimally invasive extra-articular osteotomy via small incision for hallux valgus

To compare the difference in forefoot width between minimally invasive extra-articular osteotomy via small incision and traditional Chevron osteotomy in the treatment of hallux valgus. A retrospective analysis was conducted on the clinical data of 45 patients with hallux valgus between April 2019 and July 2022. Among them, 22 cases underwent minimally invasive extra-articular osteotomy via small incision (minimally invasive group), and 23 cases underwent traditional Chevron osteotomy (traditional group). There was no significant difference in the baseline data between the two groups ( P>0.05), including gender, age, affected side, Mann classification of hallux valgus, disease duration, and preoperative intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), bony forefoot width, soft tissue forefoot width, osteophyte width, and American Orthopaedic Foot and Ankle Society (AOFAS) score. The osteotomy healing time and the occurrence of complications in the two groups were recorded. The differences between pre- and post-operation (changes) in various imaging indicators and AOFAS scores in the two groups were calculated. And the bony forefoot width and soft tissue forefoot width at 1, 6, and 12 months after operation were also recorded and compared between the two groups. One case of skin injury occurred during operation in the minimally invasive group, while 3 cases of poor wound healing occurred after operation in the traditional group. None of the patients experienced infections, nerve injuries, or other complications. All patients were followed up 12-31 months (mean, 22.5 months). The osteotomy healed in the two groups and no significant difference in healing time between the two groups was found ( P>0.05). The IMA, HVA, DMAA, osteophyte width, and AOFAS score at 12 months after operation significantly improved compared to those before operation ( P<0.05). There was no significant difference between the two groups in the changes of IMA, HVA, and osteophyte width ( P>0.05). However, the differences in the changes of AOFAS score and DMAA were significant ( P<0.05). There was no significant difference between the two groups in bony and soft tissue forefoot widths at different time points after operation ( P>0.05). However, there were significant differences in the two groups between the pre- and post-operation ( P<0.05). The minimally invasive extra-articular osteotomy via small incision for hallux valgus, despite not removing the medial osteophyte of the first metatarsal, can still effectively improve the forefoot width and osteophyte width. While correcting the IMA and HVA, it can more effectively restore the DMAA, resulting in better AOFAS scores.

Preoperative radiological parameters correlated to hallux valgus recurrence after distal chevron metatarsal osteotomy.

Preoperative radiological parameters correlated to hallux valgus recurrence after distal chevron metatarsal osteotomy.

Comparison of different osteotomy schemes in the repair and treatment of moderate to severe hallux valgus deformities.

To explore the application efficacy and safety of different osteotomy schemes in the repair and treatment of moderate to severe hallux valgus deformities. A sum of 117 patients with moderate to severe acute hallux valgus who underwent treatment at our hospital from April 2020 to April 2022 were selected. The envelope method was used to group the patients. The control group (n = 58) underwent double-plane osteotomy of the first metatarsal bone, while the observation group (n = 59) underwent Scarf osteotomy. The clinical efficacy of the 2 groups was compared, the differences in imaging results between the 2 groups at 6 months after surgery were analyzed, and the occurrence of complications during the follow-up period was observed. The excellent rate of the study group patients was 83.05% (49/59), which was compared to that of the control group (81.03%, 47/58) (P > .05). In comparison to the control group patients, the pain, force line, and joint function scores of the study group were compared before surgery and at 3 months after surgery (P > .05). Compared to before surgery, the pain, force line, joint function scores, The American Orthopaedic Foot & Ankle Society (AOFAS) total score, and Berg Balance Scale (BBS) score of the patients in both groups increased at 3 months after surgery. Additionally, the AOFAS total score and BBS score of the study group patients were higher than those of the control group patients (P < .05). The visual analog scale (VAS) scores of the patients in the 2 groups were compared before surgery (P > .05). The VAS scores of the study group patients were higher than those of the control group patients at 1, 2, and 3 months after surgery (P < .05). The study group patients were compared with the control group patients in terms of the hallux valgus angle, the lengths of the first and second metatarsals, the angle between the first and second metatarsals, the angle of the metatarsophalangeal joint surface, the position of the sesamoids, and the shortening length of the first metatarsal (P > .05). The Scarf osteotomy has shown advantages in postoperative gait balance and functional scoring. Therefore, when choosing an osteotomy plan, the Scarf osteotomy can be given priority to enhance the patient's balance ability and enhance their postoperative quality of life.

FOURTH-GENERATION PERCUTANEOUS TRANSVERSE OSTEOTOMIES FOR HALLUX VALGUS: A SERIES OF 729 FEET

BackgroundFourth-generation percutaneous or minimally invasive hallux valgus surgery utilizes a transverse osteotomy to achieve deformity correction. There are only a small number of series reporting the clinical and radiological outcomes of transverse osteotomies, many of which have methodological limitations such as small sample size, limited radiographic follow up or use of non-validated outcome measures. The aim of this study was to provide a methodological robust investigation into percutaneous transverse osteotomies for hallux valgus deformity.MethodA prospective series of consecutive patients undergoing fourth generation metatarsal extra-capsular transverse osteotomy (META) performed by a single surgeon (PL) between November 2017 and January 2023. The primary outcomes were radiographic deformity correction and clinical foot function assessed using the Manchester-Oxford Foot questionnaire (MOXFQ). Radiographic deformity (Hallux valgus angle (HVA) and intermetatarsal angle (IMA), sesamoid position) was assessed according to AOFAS guidelines. Secondary outcomes included Visual Analogue Scale for Pain and radiographic deformity recurrence (defined as HVA &amp;gt;20° at final radiographic follow up).Results729 feet from 483 patients (456 Female, 27 Male, mean age 57.9±11.9 years) underwent META. Radiographic data (minimum 12 months post-surgery) was available for 99 .7% of feet with mean follow up of 2.6±1.3 years (range 1.0–5.7). There was a statistically significant improvement (p&amp;lt;0.05) in both HVA; 29.5±8.5° to 7.3±6.7°, and IMA, 12.9±3.4° to 4.6±2.5°. All MOXFQ domains showed significant improvement (p&amp;lt;0.05); Index 36.6±19.1 to 11.8±13.8, Pain 40.1±22.1 to 15.6±16.4, Walking/Standing 32.2±23.2 to 10.2±15.8 and Social Interaction 40.0±20.6 to 9.7±14.0. The recurrence rate was 4.5% (n=33). The complication rate was 6.1% which included a screw removal rate of 2.9%ConclusionThis is the largest consecutive series of any percutaneous osteotomy technique to correct hallux valgus deformity. This study demonstrates that the technique leads to significant improvement in clinical and radiographic outcomes with a low rate of recurrence.

IS THE DISTAL METATARSAL METAPHYSEAL ANGLE REALLY JUST METATARSAL PRONATION? A WEIGHTBEARING CT ANALYSIS

AimsThe distal metatarsal metaphyseal articular angle (DMMA) is a measurement used in the surgical decision making of hallux valgus correction. However, it is difficult to measure on plain radiographs, is subject to projection bias, and its role in pathology is unclear. With the advent of weight-bearing CT (WBCT), our understanding of hallux valgus as a multiplanar deformity has evolved. The aim of this study was to investigate whether there is a relationship between the DMAA and pronation of the first metatarsal head in patients with hallux valgus.MethodsThis was a single-centre, retrospective analysis of 50 patients with hallux valgus deformity who had WBCTs obtained as part of routine pre-operative work-up. Patients with metatarsophalangeal joint arthritis, hindfoot deformity and previous surgery were excluded. From the WBCT images digital radiographs were created and the DMMA measured. Measurements were taken by 2 authors, each repeated twice and the average of all four measurements used in analysis. We also measured intermetatarsal angle (IMA), hallux valgus angle (HVA) and metatarsal pronation angle (MPA).ResultsThere were 41 females and 9 males, mean age 52.4±15.8 years. IMA was 14.5±3.3 degrees, HVA was 29.3±8.4 degrees, MPA was 11.7±6.3 degrees, and DMMA was 15.5±5.3 degrees. Intraclass correlation coefficient (ICC) for intra-observer reliability was 0.829 for assessor 1 and 0.910 for assessor 2. ICC for inter-observer reliability was 0.727. Pearsons correlation revealed no link between IMA and DMAA, nor HVA and DMMA. However, there was a significant (albeit small) correlation between MPA and DMMA (r=0.337, p=0.017).ConclusionThere was reasonable reliability in measuring DMMA between authors on WBCT. Despite this, DMMA appeared to increase with increasing metatarsal pronation. The DMMA may therefore be (in part) projection artefact secondary to metatarsal pronation and surgeons should be aware of this during surgical planning.

REVISION OF RECURRENT HALLUX VALGUS DEFORMITY USING A PERCUTANEOUS DISTAL TRANSVERSE OSTEOTOMY: SURGICAL CONSIDERATIONS AND MEAN 3.6-YEAR RESULTS

BackgroundHallux Valgus (HV) is a common forefoot deformity that can cause pain and difficulty with walking. There are a range of surgical techniques to treat HV deformity, but there is a risk of recurrence. This paper reviews the clinical assessment and management of recurrent HV as well as a detailed description of how percutaneous surgical techniques can be used to treat recurrent HV. This paper identifies technical challenges of percutaneous HV surgery for recurrent HV deformity as well as strategies to address and mitigate these.MethodThis was a multicenter retrospective review of adult patients who had recurrent hallux valgus deformity (defined as hallux valgus angle&amp;gt;15° and having previously undergone primary surgical intervention for HV deformity correction) who were treated with a percutaneous metatarsal extra-capsular transverse osteotomy (META) technique, with at least one year of follow-up data. Demographic information, hallux valgus angle, intermetatarsal angle, Manchester-Oxford Foot Questionnaire (MOXFQ), visual analog scale (VAS), and EQ-5D-5L scores were collected.ResultsWe retrospectively evaluated 34 feet from 32 patients with a mean age of 63.1±9.2 (range 41–82) who underwent revision hallux valgus surgery using a percutaneous technique. The mean follow up was 3.6±2.3 (range 0.5–8.7 years. The breakdown of index HV surgeries was: 17 Chevron, 9 Scarf/Akin, 6 medial bunionectomy, 1 Lapidus, 1 proximal rotation osteotomy. There was a statistically significant improvement in both clinical foot function and radiographic deformity after surgery. The mean HV angle decreased from 32.9±8.6° to 13.4±7.3°, and the intermetatarsal angle decreased from 12.7±3.8° degrees to 3.8±3.1°(p&lt;0.05). The mean MOXFQ Index score significantly improved from 49.4±23.1 to 14.6±19.4 (p&lt;0.05).ConclusionThis paper suggests that percutaneous surgical techniques using a transverse osteotomy and screw fixation can successfully treat a wide range of recurrent HV deformity severities with significant improvement in clinical and radiographic outcomes.

DOES CLINICAL PRONATION OF THE TOE CORRELATE WITH METATARSAL ROTATION? A RETROSPECTIVE ANALYSIS OF WEIGHTBEARING CT IMAGES

AimsFirst metatarsal Pronation is increasingly recognised as an important component of Hallux valgus (HV) and can contribute towards intraoperative malreduction, postoperative recurrence and patient reported outcome measures (1,2,3). There are numerous radiological ways to measure metatarsal rotation on plain radiographs and weight bearing CT (WBCT), however there are no clinical tests to evaluate metatarsal pronation pre- or intra-operatively. This study therefore aimed to examine the relationship between clinical pronation of the toe and metatarsal pronation.MethodsSingle-centre, retrospective analysis over 5 years. Measurements were performed on WBCT images with digital reconstructions to add soft tissues. First metatarsal rotation was measured using the Metatarsal Pronation Angle as previously described (4). Toe rotation was measured by the Phalangeal Condylar Angle (PCA), the angle between the condyles of the proximal phalanx and the floor, and the Nail Plate Angle (NPA), the angle of the base of the nail plate to the floor in the coronal Plane. These were obtained from 50 feet in Hallux valgus patients, and 50 control patients with CTs done for osteochondral lesions without hallux valgus or hindfoot malalignment.ResultsThe HV group comprised 41 women and 9 men, mean age 52.4. Control group, 23 women and 23 male, mean age 40.25. Inter and Intra Observer reliability both excellent (ICC &amp;gt;0.95) for all measurements. When comparing HV vs control, MPA was 11.7 vs 6.0 (p&amp;lt;0.001), PCA 31.8 vs 4.7 (p&amp;lt;0.001), NPA 18.3 vs 6.0 (p&amp;lt;0.0001). NPA correlated with PCA. NPA and PCA correlate with Hallux valgus Angle (p&amp;lt;0.001), but not with MPA (p 0.567).ConclusionThese results suggest that clinical toe pronation increases as HV angle increases but not with metatarsal pronation, which therefore cannot be used as a clinical marker. Toe pronation is similar at the base and at the nail, suggesting rotation happens at the MTPJ.

Factors Associated With Hallux Valgus Progression in Patients With Rheumatoid Arthritis: Insights From Non-Weight-Bearing Radiographs in the KURAMA Cohort.

This longitudinal study investigated the factors associated with hallux valgus (HV) progression in patients with rheumatoid arthritis (RA). We included 316 patients with RA who underwent foot radiography in 2015 and more than four years later. The HV angle (HVA), first-second intermetatarsal angle (IMA), first-fifth intermetatarsal angle (M1/M5 angle), and calcaneal pitch (CP) angle were measured. Sesamoid position on a non-weight-bearing radiograph was divided into seven grades with reference to the Hardy classification. Factors of HV progression were examined. During a mean follow-up period of 6.1 years, HVA increased significantly. According to the grade of the sesamoid position, feet classified as grade VI or VII showed a greater change in HVA than those classified as below grade V. In feet below grade V, high disease activity, M1/M5 angle and right side were associated with the yearly increase > 1° in the HVA. For grades VI and VII, a large CP angle was correlated with greater annual changes in the HVA. Sesamoid position relates with the increase in HVA in patients with RA. Disease activity, the existence of splay foot, and the right side are significant risk factors for an HVA increase in grades I to V.