Correction Of Hallux Valgus Deformity Research Articles

Lower limb kinematic changes during gait after hallux valgus surgery: A prospective observational study

BackgroundPatients with hallux valgus are known to alter lower limb joint kinematics during gait. However, little information is available about gait changes following hallux valgus surgery. We aimed to longitudinally investigate lower limb kinematic changes at the mid and terminal stances of gait after hallux valgus surgery. MethodsThis prospective observational study included 11 female patients (17 ft), who underwent first metatarsal osteotomy. Gait analyses were performed preoperatively and 1- and 2-year postoperatively using a three-dimensional motion capture system. Toe-out angle, ankle, knee, and hip joint angles during gait were calculated from the recorded data. The spatiotemporal parameters and these angles at the mid and terminal stances of gait were statistically compared between preoperative and postoperative periods. FindingsAll spatiotemporal parameters remained unchanged postoperatively. The toe-out angle was significantly greater at 1- and 2-year postoperatively. The ankle pronation angle, the knee abduction angle, and the hip adduction angle at the mid and terminal stances of gait were smaller postoperatively compared to the preoperative. These angular changes showed a similar trend at 1 and 2 years postoperatively. However, the postoperative changes of the sagittal joint angles were relatively small. InterpretationHallux valgus surgery can affect the toe-out angle and the lower limb coronal kinematics at the mid and terminal stances of gait in patients with hallux valgus. However, surgical correction of hallux valgus deformity did not directly improve the gait characteristics in patients with hallux valgus.

TWO-YEAR FOLLOW-UP OF 334 THIRD-GENERATION MINIMALLY INVASIVE CHEVRON AKIN OSTEOTOMIES (MICA) IN HALLUX VALGUS SURGERY

BackgroundThere are many different procedures described for the correction of hallux valgus deformity. Minimally invasive surgery has become increasingly popular, with clinical and radiological outcomes comparable to traditional open osteotomy approaches. There is increasing interest in hallux valgus deformity correction using third-generation minimally invasive chevron akin osteotomy (MICA) technique.ObjectiveTo assess the radiographic correction and 2 year clinical outcomes of third-generation MICA using validated outcome measures.MethodsThis is a prospective single-surgeon case series of 420 consecutive feet undergoing MICA surgery between July 2014 and November 2018. Primary clinical outcome measures included the Manchester-Oxford Foot Questionnaire (MOXFQ), EQ-5D, and the Visual Analogue Pain Scale. Secondary outcome measures included radiographic parameters, and complication rates.ResultsPre-operative and 2 year post-operative patient reported outcomes were collected for 334 feet (79.5%). At minimum 2 year follow-up, the MOXFQ scores (mean ± standard deviation (SD)) had improved for each domain: pain; pre-operative 43.9±21.0 reduced to 9.1±15.6 post-operatively (p<0.001), walking and standing; pre-operative 38.2±23.6 reduced to 6.5±14.5 post-operatively (p<0.001) and social interaction; pre-operative 47.6±22.1, reduced to 6.5±13.5 post-operatively (p<0.001). At 2 year follow-up, the VAS Pain score (mean ± SD) improved from a pre-operative of 31.3±22.4 to 8.3±16.2 post-operatively (p<0.001). 1–2 intermetatarsal angle (mean ± SD) reduced from 15.4°±3.5° to 5.8°±3.1° (p<0.001) and hallux valgus angle reduced from 33.1°±10.2° to 9.0°±5.0° post-operatively (p<0.001).ConclusionThird-generation MICA showed significant improvement in clinical outcomes at 2 year follow-up and can be successfully used for correction of a wide range of hallux valgus deformities.

Metatarsosesamoid Arthroscopy for Management of Plantar Pain of the First Metatarsophalangeal Joint After Surgical Correction of Hallux Valgus Deformity

Residual pain in the early postoperative phase after hallux valgus surgery is common, but persistent plantar pain of the first metatarsophalangeal joint after surgery is rare. This can be due to intra- or extra-articular causes. Metatarsosesamoid arthroscopy is effective for the management of intra-articular causes of plantar pain. The purpose of this technical note is to describe the details of metatarsosesamoid arthroscopy for the management of plantar pain of the first metatarsophalangeal joint after surgical correction of hallux valgus deformity.

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 Chevron Akin Osteotomy: Preoperative Planning Using the Radiographic First-Ray Squeeze Test.

Recognizing preoperative first-ray hypermobility is important to planning hallux valgus (HV) surgery. A recent study showed the minimally invasive chevron Akin (MICA) osteotomy increased varus displacement of the proximal fragment of the first metatarsal osteotomy. The present study aims to evaluate the ability of the radiographic first-ray squeeze test to predict the varus displacement of the proximal fragment of the first metatarsal osteotomy when performing the MICA procedure. A prospective case series of patients with moderate to severe HV who underwent MICA was performed. The HV deformity correction was analyzed by comparing the preoperative and 12-week postoperative hallux valgus angle (HVA) and the intermetatarsal angle between the first and second rays (1-2 IMA). The ability of the radiographic first-ray squeeze test to predict the varus displacement of the first metatarsal was done by comparing the preoperative 1-2 IMA measured in the AP radiographic first-ray squeeze test (IMA-ST) with the intermetatarsal angle between the second metatarsal and the axis of the first metatarsal osteotomy proximal fragment (IAPF) taken 12 weeks postoperatively. Between July 2022 and May 2023, a total of 39 feet in 28 patients underwent MICA. The mean IMA improved from 13.8 (SD = 2.2) to 3.8 degrees (SD = 1.5) (P < .001), and the mean HVA improved from 27.8 (SD = 6.1) to 4.9 degrees (SD = 2.5) (P < .001). A linear regression analysis revealed that IMA-ST is highly associated with the 12 week assessed IAPF (P < .001). The preoperative radiographic first-ray squeeze test appears to predict with high fidelity the varus displacement of the proximal fragment of the first metatarsal that can occur after the MICA procedure.Level of Evidence: Level III, prospective cohort study.

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

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

Correction of Distal Metatarsal Articular Angle in Hallux Valgus Surgery Utilizing a Minimally Invasive Percutaneous First Metatarsal Distal Transverse Osteotomy

Category: Midfoot/Forefoot; Other Introduction/Purpose: Hallux valgus, a common deformity treated by orthopedic foot and ankle surgeons, can frequently present with an increased distal metatarsal articular angle (DMAA), which may require correction in addition to the hallux valgus deformity. Minimally invasive (MIS) percutaneous hallux valgus surgery is becoming more popular and often used in patients with increased DMAA. Additional recent literature has shown low rates of recurrence, minimal pain and high patient functional outcomes with MIS hallux valgus correction. Thus, we investigated the efficacy of MIS percutaneous distal transverse first metatarsal osteotomy procedure, a triplanar correction, in correcting the DMAA in hallux valgus surgery. We hypothesize that give the ability to obtain a triplanar correction with this osteotomy no additional osteotomy will be needed to correct the DMAA. Methods: A retrospective chart review was performed on patients who underwent the hallux valgus reconstruction with a MIS percutaneous distal transverse first metatarsal osteotomy between September 2021 to December 2022. Exclusion criteria included patients with inadequate follow up and all patients not undergoing MIS percutaneous distal transverse first metatarsal osteotomy for hallux valgus correction. Hallux valgus angle (HVA), intermetatarsal angle (IMA) and DMAA were measured on pre- operative and 2-week post-operative radiographs to assess immediate correction of these angles. Univariate analysis was used to describe pre- and post- measurements for DMAA, HVA, and IMA. Differences in pre- and post- measurements were evaluated using paired t-test. Results: In total, 43 minimally invasive surgery (MIS) hallux valgus corrections on 39 patients were included. On average, the DMAA decreased from 9.5 degrees pre-operatively to 4.8 degrees two weeks post-operatively (decrease of 4.7 degrees, p-value &lt; 0.001). The average HVA decreased from 29.9 degrees pre-operatively to 4.2 degrees two weeks post-operatively (decrease of 25.7 degrees, p-value of &lt; 0.001). Lastly, the average IMA decreased from 15.1 degrees pre-operatively to 2.9 degrees 2 weeks post-operatively (decrease of 12.2 degrees, p-value &lt; 0.001). Conclusion: Our study showed that utilizing a MIS percutaneous distal transverse first metatarsal osteotomy for hallux valgus correction was able to significant reduce the DMAA without the need for supplementary metatarsal osteotomies. Additionally significant correction of the IMA and HVA was also obtained. MIS hallux valgus correction may be considered by orthopedic foot and ankle surgeons for those patients that need surgical correction for hallux valgus deformity that also requires DMAA correction.

Utility of the modified 5-item frail index to predict complications and reoperations after hallux valgus surgery

IntroductionThe modified 5-item frailty index (mFI-5) has been recently proposed as a useful tool for predicting postoperative complications in orthopedic surgery. We aimed to analyze the utility of this score in predicting complications and reoperations after hallux valgus (HV) deformity surgery. Methods551 patients undergoing percutaneous HV corrective surgery were retrospectively reviewed. The mFI-5 was calculated based and patients were categorized in three groups: (1) non-frail: patients without any of the 5 comorbidities, (2) pre-frail: patients with one comorbidity and (3) frail: patients with two or more comorbidities. Complications and surgical reoperations were recorded. ResultsIn the study period 772 percutaneous surgeries were performed to correct hallux valgus deformity, 551 patients were included with a median age of 60 (IQR 48–70). 389 patients were non-frail (70.6%), 132 were pre-frail (23.9%) and 30 were frail (5.4%). 75 patients suffered complications (13.6%). Even though the rate of complications was higher in frailty patients (23.3%) compared with pre-frail (13.6%) and non frail (12.8%), no significant differences were observed among groups. 48 patients required reoperation (8.7%) but the rate of reoperations among frailty groups was not significantly different (p=0.11). Frailty patients had worse AOFAS scores at final follow up (p=0.011). ConclusionThe mFI-5 was not useful to predict postoperative complications and reoperations after hallux valgus corrective surgery. Therefore, other factors should be considered when analyzing the risk of complications after HV corrective surgery.

Radiological outcome of hallux valgus deformity correction with metatarsal osteotomy from a single-center cohort – Best results achieved by foot and ankle surgeons

BackgroundTo evaluate the radiological outcome, especially undercorrection of hallux valgus deformity correction with first metatarsal osteotomy. Patients and methods439 1st metatarsal osteotomies including 241 distal (55 %), 175 midshaft (40 %), and 23 proximal (5 %) were available for analysis with median follow-up time was 48 days (range 27–990 days). ResultsThe postoperative HVA was normal in 237 (54 %), mild in 110 (25 %), moderate in 87 (20 %), and severe in 5 (1 %) of the cases. BMI (p = 0.0127), sex (p = 0.0004), preoperative HVA (p = 0.0028), and surgeons experience (p < 0.0001) were associated with radiological outcome, whereas age, hospital, and type of osteotomy had no effect. Foot and ankle surgeons achieved normal postoperative HVA in 76 %, general orthopedic surgeons in 41 %, and residents in 47 % of the operations. ConclusionRadiological undercorrection was common. As foot and ankle surgeons achieved best radiological correction, hallux valgus deformity should be operated by specialists.

Republication of "Percutaneous Basal Closing Wedge Osteotomy of the First Metatarsal in the Treatment of Moderate to Severe Hallux Valgus and Its Short-Term Clinical Outcomes".

Although percutaneous surgery for the treatment of hallux valgus is popular in Europe, there is sparse English written literature documenting its efficacy. This study described the operative techniques using percutaneous basal closing wedge osteotomy of the first metatarsal in correction of moderate to severe hallux valgus (HV) and its short-term clinical outcomes. We postulated that satisfactory correction of hallux valgus (HV) angle, intermetatarsal (IM) angle, and patients' clinical outcomes could be achieved with this technique. We conducted a retrospective review of 25 feet in 23 patients who underwent a percutaneous basal closing wedge osteotomy of the first metatarsal (MT1) combined with a mini-open modified McBride procedure and mini-open resection of medial eminence. Follow-up averaged 21.5 months. Radiographic outcomes included pre- and postoperative HV angle, IM angle, absolute and relative shortening of MT1, and time to union. American Orthopaedic Foot & Ankle Society (AOFAS) scores were compared between pre- and postoperatively. The average HV angle improved from 39.4 (range, 29-58.3) degrees preoperatively to 14.7 (range, 0.1-23.2) degrees postoperatively (P < .05). IM angle improved from 14.9 (range, 6.7-22.4) degrees to 6.6 (range, 0.9-14.8) degrees (P < .05). The average absolute shortening was 3.8 (range, 0.27-12.91) mm and the relative shortening was 0.8 (range, 0.05-1.91) mm. There was no delayed union or malunion at the osteotomy site. The average AOFAS score improved from 39 (range, 12-50) to 81 (range, 70-93) (P < .05). Satisfactory hallux valgus deformity correction and patients' outcomes were achieved with this technique. Our results are similar to results reported in other studies using open techniques. There was no malunion or delayed union of the osteotomy. Level IV, case series study.

Temporal Changes in Clinical Outcomes after Minimally Invasive Surgery for Hallux Valgus Correction in Women without Postoperative Complications.

Minimally invasive surgery (MIS) is currently used to correct hallux valgus deformities. Most studies reporting on MIS techniques to correct hallux valgus deformities included patients with postoperative complications. These reported complications, with an average rate of 23%, had significant negative effects on the clinical outcomes in this patient population. In the present study, a cohort of 63 women who underwent MIS hallux valgus correction was assessed preoperatively and at a mean follow-up of 1.0, 4.7, and 6.5 years using the American Orthopaedic Foot and Ankle Society (AOFAS) scale and the Manchester Oxford Foot Questionnaire (MOXFQ). The main criterion for inclusion in this cohort was a lack of complications during the entire follow-up period. The results showed significant improvements in both AOFAS and MOXFQ scores between the preoperative and 1-year follow-up assessments. By contrast, clinically small and nonsignificant changes were observed among postoperative follow-up values. The number of enrolled patients needs to be increased in future studies, with different surgeons and techniques included. Nevertheless, our study findings will inform patients about the outcomes they can expect over the years if no complications occur.

Effects of Foot-Toe Orthoses on Moment and Range of Motion of Knee Joint in Individuals with Hallux Valgus.

Although various types of hallux valgus (HV) orthoses have been used to manage hallux valgus deformity, few previous studies have determined the biomechanical effects of applying a foot-toe orthosis as a therapeutic intervention for HV deformity on the kinetics and kinematics of the knee joint. Biomechanical variables were collected from 24 patients with HV. A three-dimensional motion capture system and force platforms were used to analyze the kinetic and kinematic variables in HV orthosis conditions during gait. To determine the biomechanical effect of each orthosis for HV on knee kinetic and kinematic values, repeated-measures ANOVA was used. The knee adduction moment was significantly decreased under a hard plastic orthosis (HPO) condition compared to that under a without foot-toe orthosis (WTO) condition (p = 0.004). There was a significant decrease in maximal external rotation of the knee joint in HPO than in WTO at the stance phase during gait (p = 0.021). All of the kinetic and kinematic data showed no significant differences between WTO and soft silicone orthosis conditions (p > 0.05). This study indicates that a stronger foot-toe orthosis, such as HPO, to correct HV deformity has a positive effect on the moment and joint motion occurring in the knee joint during walking. In particular, the application of this type of HV orthosis can reduce knee adduction moments associated with the development and progression of knee OA.

Radiographic Evaluation of First Tarsometatarsal Joint Arthrodesis for Hallux Valgus Deformity: Does the Fusion of the First to the Second Metatarsal Base Reduce the Radiological Recurrence Rate?

Modified Lapidus arthrodesis (MLA) is a well-established treatment option for symptomatic hallux valgus deformity (HVD). However, recurrence of the deformity remains a concern. The goal of this study was to evaluate the effect of an additional intermetatarsal fusion on the radiographic recurrence rate after first tarsometatarsal (TMT-I) arthrodesis. This is a retrospective evaluation of 56 feet that underwent TMT-I arthrodesis for moderate to severe HVD. Twenty-three feet received an isolated arthrodesis of the TMT-I joint (TMT-I), whereas 33 feet received an additional fusion between the base of the first and the second metatarsal bone (TMT-I/II). Various radiological parameters were determined preoperatively, 6 weeks and at a mean of 2 years postoperatively. The intermetatarsal angle (IMA) and the hallux valgus angle (HVA) were significantly lowered at both follow-up evaluations in both groups. In the TMT-I/II group, the initial reduction of HVA was significantly higher (29.3° vs 21.1°). This difference disappeared by the second follow-up, leaving no significant differences between both techniques at final follow-up. Radiological recurrence rates of HVD were comparable in both groups. Isolated TMT-I arthrodesis provides reliable radiological results in the correction of HVD. Whether additional fusion of the first and second metatarsal base should be routinely performed remains unclear. Level 3.

Lateral Decubitus Position for Minimally Invasive Surgery for Correction of Hallux Valgus Deformity: A Technique Tip.

Lateral Decubitus Position for Minimally Invasive Surgery for Correction of Hallux Valgus Deformity: A Technique Tip.

Outcomes After Chevron Osteotomy with and Without Additional Akin Osteotomy: A Retrospective Comparative Study

BackgroundChevron osteotomy is one of the most common approaches to hallux valgus corrective surgery. This procedure is often combined with Akin osteotomy of the proximal phalanx of the hallux. There are no definitive guidelines specifying the indications for a given osteotomy technique nor data on postoperative loss of correction or the effect of the type of first-ray surgery on the development of adjacent-joint arthritis. The aim of this study was to assess radiographic treatment outcomes via chevron osteotomy with and without Akin osteotomy.MethodsThe study evaluated 117 patients treated in the period 2016–2019. Ninety-nine of those patients underwent distal chevron osteotomy alone, and 18 patients underwent a combined chevron–Akin double osteotomy. The analyzed radiograms had been obtained preoperatively, at 6 weeks after surgery, and after a long-term follow-up. The following parameters were assessed: the intermetatarsal angle (IMA), hallux valgus angle (HVA), interphalangeal angle (IPA), postoperative recurrence of valgus deformity, adjacent-joint arthritis, and complications.ResultsChevron-Akin osteotomy helped maintain lower HVA and IPA values in long-term follow-up in comparison with those in the patients who underwent chevron osteotomy alone. The chevron osteotomy group showed a significant increase in the mean HVA from 18.37° at the first follow-up visit to 20.81° at the last follow-up visit. There were no differences between the groups in terms of the remaining assessed radiographic parameters. Hallux valgus surgery does not increase adjacent-joint arthritis.ConclusionThe use of combined chevron-Akin osteotomy does not affect HVA or IMA correction. The combination of chevron and Akin osteotomies reduces the risk of increased HVA and IPA in long-term follow-up. The additional Akin osteotomy does not increase the risk of adjacent-joint arthritis. Combining chevron osteotomy with Akin osteotomy is recommended in hallux valgus deformity correction.

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

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

Fourth-Generation Minimally Invasive Hallux Valgus Surgery With Metaphyseal Extra-Articular Transverse and Akin Osteotomy (META): 12 Month Clinical and Radiologic Results.

Fourth-generation minimally invasive surgery (MIS) includes the multiplanar rotational deformity correction achieved through manipulation of an extra-articular distal first metatarsal osteotomy that is held with rigid fixation using 2 fully threaded screws, of which one must be bicortical to provide rotational and biomechanical stability. The aim of this study is to report the clinical and radiologic outcomes of an evolved fourth-generation MIS hallux valgus technique. A prospective single-surgeon series of consecutive patients undergoing fourth-generation MIS was performed using a distal transverse osteotomy with a minimum 12-month follow-up. The primary outcome was the Manchester-Oxford Foot Questionnaire (MOXFQ), a validated clinical patient-reported outcome measure (PROM). Secondary outcomes included radiographic deformity correction, clinical assessment, and EuroQol-5D-5L PROMs. Between September 2019 and June 2021, 50 feet underwent fourth-generation MIS. The mean age was 55.8±15.3 years with a mean follow-up of 1.4 years. Preoperative and minimum 12-month primary outcome data were available for 100% of feet. There was a significant improvement in all MOXFQ domain scores, with the index domain improving from 53.4 to 13.1 (P < .001). There was a significant improvement (P < .001) in hallux valgus angle (32.7 to 7.9 degrees), intermetatarsal angle (14.0 to 4.2 degrees) and distal metatarsal articular angle (18.5 to 5.6 degrees). There was a significant improvement in general health-related quality of life EQ-5D-5L index and EQ-VAS scores (P < .05). The fourth-generation MIS technique is a safe and effective approach to hallux valgus deformity correction with significant improvement in clinical and radiographic outcomes. Level IV, prospective case series.

The Surgical Treatment of Hallux Valgus Utilization Minimally Invasive and Percutaneous Techniques with a Shannon Burr: A Systematic Review

Category: Midfoot/Forefoot; Bunion Introduction/ Purpose: Recently there has been an increase in minimally invasive surgery (MIS) for the correction of hallux valgus deformity. This systematic review aims to evaluate and present the current literature on MIS hallux valgus correction in studies reporting the use of the Shannon burr with distal metatarsal osteotomies to help establish evidence-based guidelines for surgeons utilizing this technique. Methods: Two independent authors performed a systematic literature search using the following databases: PubMed, Embase, and the Cochrane library. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol and the Cochrane Handbook guidelines were followed. All studies included were published from 2008 to 2022 and included the use of the Shannon burr during distal metatarsal osteotomies minimally invasive surgery for hallux valgus and at least 12-month follow-up. The MINORS score criteria was utilized to evaluate the strength and quality of 17 studies by three authors. Statistical analysis and meta-analysis were not performed due to the heterogeneity of the included studies and the data being descriptive. Results: A total of 17 studies were reviewed. A total of 911 subjects were included, and 1088 MIS procedures were performed. The average follow-up was 23.8 (12-59.1) months. AOFAS and VAS scores improved from 52.1 (41-62.5) to 90.3 (83.3-97.1) and 4.9 (3-8.2) to 0.8 (0-1.9). Satisfaction rates were very high among the studies that reported it. The HVA, IMA and DMAA angle improved from 31.4 (23.5-44.1) to 11.1 (7-17.2).), 13.4 (8.1-18.6) to 7.3 (4.2-10.3), and 12.3 (9-16.3) to 4.1 (1-6.7). Complication rate was 16.6%. Recurrence was 2.2%. Nonunion 0.4%, infections 1.1%, nerve injury 2.2%, avascular necrosis 0%, hallux varus 0.09%, transfer metatarsalgia 0.1% and hardware removal 6.2%. Conclusion: Minimally invasive surgery for the treatment of hallux valgus utilizing the Shannon burr appears to be a safe and effective therapy with appropriate correction of the hallux valgus deformity, improvement in functional outcomes, high patient satisfaction, low recurrence, and acceptable complication rates.

Minimally Invasive Surgery Using a Shannon Burr for the Treatment of Hallux Valgus Deformity: A Systematic Review.

Recently there has been an increase in minimally invasive surgery (MIS) for the correction of hallux valgus deformity. This systematic review aims to evaluate and present the current literature on MIS hallux valgus correction in studies reporting the use of the Shannon burr with distal metatarsal osteotomies to help establish evidence-based guidelines for surgeons using this technique. Two independent authors performed a systematic literature search using the following databases: PubMed, Embase, and the Cochrane library. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol and the Cochrane Handbook guidelines were followed. All studies included were published from 2008 to 2022 and included the use of the Shannon burr during distal metatarsal osteotomies MIS for hallux valgus and at least 12-month follow-up. The MINORS score criteria was used to evaluate the strength and quality of 17 studies by 3 authors. Statistical analysis and meta-analysis were not performed because of the heterogeneity of the included studies and the data being descriptive. A total of 17 studies were reviewed. A total of 911 subjects were included, and 1088 MIS procedures were performed. The average follow-up was 23.8 (12-59.1) months. American Orthopaedic Foot & Ankle Society scale and visual analog scale scores improved from 52.1 (41-62.5) to 90.3 (83.3-97.1) and 4.9 (3-8.2) to 0.8 (0-1.9). Satisfaction rates were very high among the studies that reported it. The hallux valgus angle, intermetatarsal angle, and distal metatarsal articular angle improved from 31.4 (23.5-44.1) to 11.1 (7-17.2), 13.4 (8.1-18.6) to 7.3 (4.2-10.3), and 12.3 (9-16.3) to 4.1 (1-6.7), respectively. The complication rate was 16.6%, and recurrence was 2.2%. Nonunion comprised 0.4%, infections 1.1%, nerve injury 2.2%, avascular necrosis 0%, hallux varus 0.09%, transfer metatarsalgia 0.1%, and hardware removal 6.2%. MIS for the treatment of hallux valgus using the Shannon burr appears to be a safe and effective therapy, with appropriate correction of the hallux valgus deformity, improvement in functional outcomes, high patient satisfaction, low recurrence, and acceptable complication rates. Level II, systematic review.

Does Minimally Invasive Surgery Provide Better Clinical or Radiographic Outcomes Than Open Surgery in the Treatment of Hallux Valgus Deformity? A Systematic Review and Meta-analysis.

Does Minimally Invasive Surgery Provide Better Clinical or Radiographic Outcomes Than Open Surgery in the Treatment of Hallux Valgus Deformity? A Systematic Review and Meta-analysis.