Correction Of Hallux Valgus Deformity Research Articles

Analysis of Change in Patient Reported Outcome Measures Following Minimally Invasive Chevron Akin Osteotomies (MICA) in Hallux Valgus Surgery

Category:BunionIntroduction/Purpose:There is a need to understand the rate of improvement following minimally invasive chevron akin osteotomies (MICA) for correction of hallux valgus deformity using validated patient reported outcome measures (PROMs) and whether this change is clinically meaningful in order to help counsel patients as to their progress.Methods:Between July 2014 and November 2018, data was prospectively collected from consecutive patients pre-operatively and at 6, 12, and 24 months following MICA. The primary outcome measure was the change in Manchester Oxford Foot and Ankle Questionnaire (MOXFQ) score at each timepoint following MICA. Secondary outcomes include radiographic deformity correction, and exploration of cases where PROMs did not improve following MICA.Results:190 feet with complete PROM data at each time point, were identified from a cohort of 334 feet undergoing third generation MICA. There was a statistically significant improvement in MOXFQ score for each MOXFQ domain at each time point following MICA although the majority of the improvement was within the first 6 months. 17 feet had worse MOXFQ Index scores at the six month timepoint compared to pre-operatively. Of these feet, 82.4% (n=14) improved over time such that by two years their score had improved compared to their pre-operative score.Conclusion:There is a statistically significant improvement in MOXFQ score at every time point following MICA for hallux valgus. The majority of patients who scores are worse at 6 months following will go on to have improved function compared to their pre-operative state.

Two Year Patient Reported Outcomes of 334 Minimally Invasive Chevron Akin Osteotomies (MICA) in Hallux Valgus Surgery

Category:Bunion; Midfoot/ForefootIntroduction/Purpose:There 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. Objective: To assess the radiographic correction and 2-year clinical outcomes of third-generation MICA using validated outcome measures.Methods:This is a prospective single-surgeon case series of 420 consecutive feet undergoing MICA surgery between July 2014 and Jan 2019. 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.Results:Pre-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).Conclusion:Third-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.

Bilateral vs Unilateral Minimally Invasive Hallux Valgus Surgery: A Propensity Matched Case-Control Study with 2 Year Clinical Patient Reported Outcomes

Category:Bunion; Midfoot/ForefootIntroduction/Purpose:Hallux valgus deformity correction using a third-generation Minimally Invasive Chevron Akin osteotomy technique (MICA) is becoming increasingly popular. There is limited patient reported outcome measure (PROM) outcomes for patients undergoing bilateral hallux valgus corrective MICA surgery during a single operative case.Methods:Between July 2014 and May 2018, 59 consecutive patients comprising 118 feet underwent bilateral MICA in a single operative case. 1:1 propensity score matching based on preoperative PROM assessment, age, and radiographic deformity data was carried out to match each foot in the bilateral cohort with 118 feet who had undergone unilateral MICA. The primary outcome measure was the Manchester-Oxford Foot Questionnaire (MOXFQ) which was prospectively measured pre-operatively, six months and two years post-operatively. Secondary outcomes included complication rates and radiographic deformity correction with regards to the hallux valgus angle (HVA) and inter-metatarsal angle (IMA).Results:At minimum 2 year follow up, the MOXFQ post-operative scores had significantly improved for every domain (p <0.001) in both unilateral and bilateral cohorts compared to pre-operative assessment. For all domains of the MOXFQ, there was no statistically significant difference in 6 month or two year outcomes between patients undergoing bilateral and unilateral MICA surgery (p >0.05 for all outcome measures). There was no statistically significant difference between the two cohorts in complication rate (p=>0.05) or post-operative IMA or HVA (p >0.05).Conclusion:This study demonstrates that there is no significant difference in patient reported outcome measured at two year follow-up between patients who underwent bilateral versus unilateral MICA. This study should reassure surgeons who perform bilateral hallux valgus surgery in a single case that, in the medium-term, there is no difference in clinical or radiographic PROMs compared to unilateral surgery. There are potentially positive health economic benefits of performing bilateral surgery in a single sitting if clinically indicated.

Is First Metatarsal Shortening Correlated with Clinical and Functional Outcomes Following the Lapidus Procedure?

Category:Bunion; Midfoot/ForefootIntroduction/Purpose:Lapidus procedure (LP) is a powerful technique to correct hallux valgus (HV) deformities, with good long-term outcomes. However, postoperative complications may arise, as undercorrection of the deformity, nonunion, elevation and shortening of the first metatarsal (M1). The objective of this study was to correlate M1 shortening with transfer metatarsalgia, and clinical and functional outcomes in patients who underwent the LP.Methods:a retrospective review of 29 patients (36 feet) who were submitted to the LP for HV correction was performed. The average follow-up was 20 months. M1 length was analyzed using the Relative First Metatarsal Length (RML) measurement (Figure 1). When M1 shortens in relation to the second metatarsal, the RML measurements increase. The intermetatarsal angle (IMA) and hallux valgus angle (HVA) were also measured. Clinical and functional analyses were based on the VAS for pain, AOFAS, LEFS and SF-12 health survey. SF-12 is divided into physical and mental health composite scales (PCS-12 and MCS-12, respectively). Transfer metatarsalgia diagnosis was based on the clinical exam. Radiographic, clinical and functional measurements were compared using paired Wilcoxon signed-rank test and Student t test. Interobserver reliability of RML measurements was calculated using Intraclass Correlation Coefficients (ICC). A linear regression was performed to assess the correlation between RML and the clinical and functional questionnaires.Results:There was a significant M1 shortening of 2.28mm after the LP (p<.001), with mean preoperative RML of 3.06 mm and mean postoperative of 5.34 mm (Table 1). No patient developed transfer metatarsalgia. Intraclass Coefficient Correlation (ICC) of the RML measures showed a excellent reliability of 0.94 and 0.98 in the pre- and postoperative setting, respectively. IMA and HVA presented significant improvements (p<.001) (Table 1). Clinical and functional improvements were observed in all questionnaires applied, except in the MCS-12 (Table 2). In the linear regression, RML was inversely correlated to LEFS (p=<.05), which means that LEFS scores increased as RML measurements decreased (Table 3). There was no significant correlation with the other questionnaires.Conclusion:The present study demonstrated that M1 shortening led to a decreased LEFS following the LP. Comparative studies with prospective design and larger populations are required to assess the role of M1 shortening on clinical and functional outcomes.

Percutaneous Chevron Akin (PECA) for surgical correction of hallux valgus deformity

Hallux valgus deformity is a common pedal pathology treated by foot and ankle surgeons. Greater than 100 surgical procedures have been described for deformity correction, and so it is not surprising that surgeons continue to search for a superior technique. Over the last decade minimally invasive hallux valgus correction has been gaining popularity in both the Orthopedic and Podiatry sub-specialty arenas. The purpose of this article is to review the Percutaneous Chevron Akin (PECA) surgical technique, including the most up-to-date associated technologies. Additionally, authors review preoperative and postoperative considerations associated with the procedure supported through figures and a step-by-step video tutorial including patient case examples.

Hallux valgus surgery in children with cerebral palsy: A systematic review

BackgroundChildren with cerebral palsy are highly likely to develop foot deformities, some of which may require surgical intervention. Hallux valgus is a common forefoot deformity which can cause issues with pain, footwear, orthotic splints and soft tissues. It remains unclear what the optimal surgical treatment is for children with cerebral palsy and hallux valgus deformity. ObjectiveTo systematically review studies reporting the clinical and radiological outcomes of surgical correction of hallux valgus deformity in children with cerebral palsy. MethodsA systematic review of studies published in electronic databases (Medline, Embase, Pubmed and Cochrane library) from inception until January 2021. Keywords related to hallux valgus and cerebral palsy were included. Results58 studies were identified of which 7 met the criteria for inclusion. 200 feet in 134 patients with a mean age of 13.5 years were included, with a mean follow up period of 43 months. A range of clinical and radiographic outcomes were assessed. A treatment framework for the assessment and management of hallux valgus in children with cerebral palsy based on the published evidence is presented. ConclusionNon-ambulant children with cerebral palsy with symptomatic hallux valgus should primarily undergo first MTPJ arthrodesis whilst those who are ambulant should undergo first metatarsal osteotomy± soft tissue correction.

Hallux Valgus Deformities: Preferred Surgical Repair Techniques and All-Cause Revision Rates.

Hallux valgus is a commonly treated condition by foot and ankle surgeons with more than 200 different described correction techniques. Recurrence rates range from 5% to 50%, with increasing support of the theory that arthrodesis procedures may have a lower recurrence rate than osteotomies. Arthrodesis procedures to the first metatarsophalangeal (MTP) joint or tarsometatarsal (TMT) joint for correction of hallux valgus deformity are becoming more commonly utilized. The purpose of this study is to investigate the surgical incidence and revision rates of hallux valgus deformities corrected by arthrodesis compared to osteotomy in the state of South Carolina. The South Carolina Revenue and Fiscal Affairs Office was queried from 2000 to 2017 to identify all surgically treated hallux valgus deformities. Data extraction included patient demographics, ICD-9 diagnoses, CPT procedure codes, and dates of surgery. A logistic regression model was used for statistical inference. A total of 22 199 feet had surgical treatment for hallux valgus during this time period, with 20 422 (92.0%), 592 (2.7%), and 1185(5.3%) receiving an osteotomy, arthrodesis, or other procedure at initial treatment, respectively. There was an all-cause revision rate of 5.6% in the osteotomy group and 6.4% in the arthrodesis group. Demographic factors such as female sex, white race, and surgery pre-2010 were associated with higher revision rates. Multiple comorbidities were correlated with higher revision rates such as tobacco use, hypothyroidism, osteoarthritis, recurrent dislocations, hallux rigidus, lesser toe deformities, metatarsus varus, and talipes cavus. Despite the recent increase in arthrodesis procedures for the treatment of hallux valgus deformity, our results suggest that osteotomy procedures are more commonly performed and there is no difference in all-cause revision surgery. However, there are multiple patient demographics and comorbidities that are associated with higher rates of revision surgery and should be considered and discussed during the preoperative planning period. Level IV.

Minimally invasive hallux valgus correction: Is it better than open surgery?

BackgroundThe aim was to compare the minimally invasive (MIS) chevron osteotomy to the well-established open chevron osteotomy for the correction of hallux valgus deformity. MethodsTwo retrospective cohorts of patients treated with MIS or open chevron osteotomy for hallux valgus correction, matched for age and gender with a minimum follow up of six months were reviewed. Functional outcomes were evaluated using pre and post-operative Manchester Oxford Foot and Ankle Questionnaire (MOXFQ), Visual Analog Score (VAS) for pain and the Unified Elective Orthopaedic Score (UnEOS). Two independent, blinded examiners evaluated the radiographic correction of hallux valgus (HV) and intermetatarsal (IM) angle. ResultsA Total of 54 cases (27 per study group) with a mean follow-up of 25.9 months were included in the study. Pre-operatively, VAS (p = 0.76) and MOXFQ (p = 0.46) scores and HV angle (p = 0.1) were comparable in both groups. However, IM angle was significantly larger in the MIS group (p = 0.005). Post-operatively there was significant improvement in VAS and MOXFQ scores as well as significant correction of the HV and IM angles (p < 0.0001) for both groups. Comparing the two procedures, there was no significant difference between groups for VAS (p = 0.34), MOXFQ scores (p = 0.56) and HV angles (p = 0.069) but the MIS technique was significantly better in improving the IM angle (p = 0.016). The post-operative UnEOS score and the Satisfaction UnEOS domain reached excellent levels for the entire cohort with no statistical difference between the two groups (p = 0.2 and 0.28 respectively). ConclusionResults show MIS chevron osteotomy provides better radiographic correction of the IM angle but functional outcomes for all parameters were comparable to the open technique. It can therefore be considered at least equivalent to standard open surgery when compared using validated Patient Reported Outcome Measures (PROMs).

Outcome of proximal triple derotational metatarsal osteotomy for three-dimensional correction of hallux valgus deformity.

To correct hallux valgus deformities in patients with a greater pronation of the first metatarsal, we designed a novel proximal triple derotational metatarsal osteotomy (PTDMO), which could be used to achieve three-dimensional correction of hallux valgus deformities at the proximal metatarsal level. We prospectively evaluated the radiographic and clinical outcomes of 13 consecutive cases underwent PTDMO between November 2018 and May 2020. The minimum follow-up for inclusion was 12months. The hallux valgus angle (HVA), first-to-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), relative length of the second metatarsal, and medial sesamoid position on the weight bearing foot anteroposterior radiographs, and the degree of the first metatarsal pronation on forefoot axial radiographs were measured pre-operatively, at sixweeks post-operatively, and at the final follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) score and Foot Ankle Outcome Scores (FAOS) were measured. In the comparison of pre-operative and final follow-up parameters, HVA, IMA, and DMAA were significantly improved post-operatively (all, P < 0.001). The relative length of the second metatarsal did not differ significantly post-operatively (P = 0.724). The medial sesamoid was significantly reduced (P = 0.01), and the first metatarsal pronation decreased by 10.16° (P = 0.034). Regarding clinical parameters, the AOFAS score and FAOS in all categories significantly improved post-operatively (all, P < 0.001). PTDMO resulted in satisfactory radiographic and clinical outcomes with respect to deformity correction and pain relief, with significant post-operative reduced pronation of the first metatarsal.

Clinical and Radiographic Outcomes of Percutaneous Chevron-Akin Osteotomies for the Correction of Hallux Valgus Deformity.

Hallux valgus is a common cause of pain and dysfunction of the foot, sometimes requiring surgical correction when conservative measures fail. Although there are many methods of correction, one of the newer techniques is minimally invasive chevron-Akin (MICA). The aim of the current study is to evaluate clinical and radiographic effectiveness of MICA and narcotic use in a large patient cohort. All patients in this retrospective study were treated by a single fellowship-trained foot and ankle orthopaedic surgeon. Patient demographics were collected for all cases. Preoperative and postoperative intermetatarsal angle (IMA) and hallux valgus angle (HVA) were measured in all patients on weightbearing 3-views radiographs. The Foot Function Index (FFI) was obtained pre- and postoperatively at each visit. All patients were prescribed regular use of ibuprofen for 3 days with acetaminophen and oxycodone reserved for breakthrough pain. Use of narcotic pain medication was recorded. A total of 274 feet in 248 patients were included in the study. Overall, 87.9% were female and 12.1% were male. The mean preoperative IMA and HVA were 13.4 and 29.1 degrees, respectively. The postoperative IMA and HVA were 4.9 and 8.9 degrees, respectively. The mean FFI score part A was 92 preoperatively and 43 postoperatively. Patient satisfaction was 91.6%. The mean postoperative 5 mg oxycodone pill consumption was 2.2. MICA is good method to correct hallux valgus deformity with low postoperative narcotic use. Level III, restrospective cohort study of a single surgeon practice.

Radiographic Outcomes, Union Rates, and Complications Associated With Plantar Implant Positioning for Midfoot Arthrodesis.

Background:Midfoot arthrodesis has long been successfully included in the treatment paradigm for a variety of pathologic foot conditions. A concern with midfoot arthrodesis is the rate of nonunion, which historically has been reported between 5% and 10%. Plantar plating has also been noted to be more biomechanically stable when compared to traditional dorsal plating in previous studies. Practical advantages of plantar plating include less dorsal skin irritation and the ability to correct flatfoot deformity from the same medial incision. The purpose of this study is to report the arthrodesis rate, the success of deformity correction, and the complications associated with plantar-based implant placement for arthrodesis of the medial column.Methods:A retrospective review was undertaken of all consecutive patients between 2012 and 2019 that underwent midfoot arthrodesis with plantar-positioned implants. Radiographic outcomes and complications are reported on 62 patients who underwent midfoot arthrodesis as part of a correction for hallux valgus deformity, flatfoot deformity, degenerative arthritis, Lisfranc injury, or Charcot neuroarthropathy correction.Results:Statistically significant improvement was seen in the lateral talus–first metatarsal angle (Meary angle) and medial arch sag angle for patients treated for flatfoot deformity correction. In patients treated for hallux valgus deformity, there was a reduction in the intermetatarsal angle from 15.4 to 6.8 degrees. The overall nonunion rate was 6.45% in all patients. The rate of nonunion was higher at the NC joint compared to the TMT joint and with compression claw plates. One symptomatic nonunion required revision surgery (1.7%). There were no nonunions when excluding neuroarthropathy patients and smokers. The odds ratio (OR) for nonunion in patients with neuroarthropathy was 6.05 (P < .05), and in active smokers the OR was 2.33 (P < .05).Conclusion:Plates placed on the plantar bone surface for midfoot arthrodesis achieved and maintained deformity correction with rare instances of symptomatic hardware for a variety of orthopedic conditions. An overall clinical and radiographic union rate of 94% was achieved. The radiographic union rate improved to 100% when excluding both neuroarthropathy patients and smokers. The incidence of nonunion was higher in smokers, neuroarthropathy patients, naviculocuneiform joint fusions, use of compression claw plates, and when attempting to fuse multiple joints. Incisional healing complications were rarely seen other than in active smokers.Level of Evidence:Level IV, case series.

Percutaneous Chevron and Akin (PECA) Osteotomies for Severe Hallux Valgus Deformity With Mean 3-Year Follow-up.

Patients with severe hallux valgus deformity present technical and operative challenges with high rates of recurrence and residual deformity. The clinical and radiologic outcomes of percutaneous surgery for severe hallux valgus are not known. A retrospective review of consecutive patients with a hallux valgus angle (HVA) >40 degrees or intermetatarsal angle (IMA) >20 degrees who underwent third-generation percutaneous chevron and Akin osteotomy (PECA) for hallux valgus deformity correction. Between December 2012 and August 2019, 59 feet in 50 patients underwent PECA. Preoperative and follow-up radiographic data were available for 53 feet (89.8%). Postoperative clinical patient-reported outcome measures and satisfaction results were available for 51 feet (86.4%). The mean clinical and radiographic follow-up was 3.1 years and the mean postoperative Manchester-Oxford Foot Questionnaire Index score was 15.1. There was a statistically significant improvement (P < .001) in both IMA and HVA following surgery (IMA 17.5-5.1 degrees; HVA 44.1-11.5 degrees). All patients reported they were satisfied with their outcome, with 76.8% reporting they were highly satisfied. The hallux valgus recurrence rate was 7.5%. Percutaneous surgery for severe hallux valgus deformity can achieve a large deformity correction, patient satisfaction, and quality of life, with reasonable rates of residual deformity and low rates of recurrence. Level IV, case series.

Minimally invasive osteotomy and manual reduction for hallux valgus

To explore clinical effects of minimally invasive osteotomy and manual reduction in treating hallux valgus. From January 2018 to May 2019, 31 patients (42 feet) with hallux valgus were treated with minimally invasive osteotomy and manual reduction, including 3 males and 28 females aged from 18 to 76 years old with an average of (50.1± 4.9) years old. Preoperative and postoperative hallux valgus (HVA), intermetatarsal angles(IMA), length difference between 1 and 2 metatarsals were recorded and compared, and American Orthopedic Foot and Ankle Society (AOFAS)score were observed and measured. Thirty-one patients (42 feet) were followed up from 14 to 18 months with an average of (15.1± 1.2) months. HVA, IM before operation were (38.5±5.4)°, (13.0± 1.1)°, and improved to (14.3±4.7)°and (9.1±1.5)°after operation respectively(P<0.05). Preopertaive length difference between 1 and 2 metatarsals was 2-4(-0.59±1.80) mm, and 0 to -6(-3.53±1.60) mm after operation, the average shortening of the first metatarsal was 2.94 mm. There were significant difference between preoperative and postoperative. Preoperative AOFAS score was 57.8±9.7, increased to 92.1±9.3 at the final follow-up, there was significant differences (P<0.05). According to standard of AOFAS score, 32 feet obtain excellent results, 16 good and 3 moderate. Minimally invasive osteotomy and manual reduction in treating hallux valgus have advantages of shorter operation time, less length of incision, and could correct hallux valgus deformity, improve front feet and receive good clinical effect in further.

Correction Power of Percutaneous Adductor Tendon Release (PATR) for the Treatment of Hallux Valgus: A Cadaveric Study

Osteotomies are commonly used in order to correct hallux valgus deformity. However, soft tissue structures also play an essential role in the etiology, progression, and treatment of hallux valgus (HV). The purpose of the present study was to analyze the correcting power (varus), reduction strength (sesamoid) and rotation of metatarsal and proximal phalanx after percutaneous adductor tendon release (PATR). To date, no study addresses this issue. Eleven cadaveric fresh-frozen below-the-knee cadaveric lower limbs with associated hallux valgus deformity were used. These specimens were subjected to a constant abduction force after PATR. HV and intermetatarsal angles showed statistically significant differences when comparing the preoperative and postoperative periods. PATR showed to be a reliable technique as the adductor tendon was completely released in 9 cases, and 75% released in the remaining 2 feet. The study supports that PATR provides powerful and quantifiable correction of HV deformity and can be accurately performed percutaneously.

Bunion Surgery: An Evolution

While correction of hallux valgus deformities has been a subject of interest in the medical literature for over 2 centuries, the major contributions and published evidence has occurred over the last 75 years. Mc Bride, Keller, Mitchell, Mann, and Lapidus are names which reference techniques but they also present principles of treatment that establish the basis for current bunion surgery. Many components of these methods are used today and incorporated into modern bunion surgery. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.

Third-Generation Minimally Invasive Chevron and Akin Osteotomies (MICA) in Hallux Valgus Surgery: Two-Year Follow-up of 292 Cases.

Background:There is interest in hallux valgus deformity correction using internal fixation with the minimally invasive chevron and Akin osteotomies (MICA) technique. The objective of this study was to assess the correction measured on postoperative radiographs and clinical outcomes, using validated outcome measures, at 2 years following third-generation MICA.Methods:This is a prospective single-surgeon case series of 333 consecutive feet that underwent MICA surgery between July 2014 and April 2018. The primary clinical outcome measures included the Manchester-Oxford Foot Questionnaire (MOXFQ), EuroQol-5 Dimensions-5 Level (EQ-5D-5L) Index, EuroQol-visual analogue scale (EQ-VAS), and a VAS for pain (VAS-pain). Secondary outcome measures included radiographic parameters and complication rates.Results:Preoperative and 2-year postoperative patient-reported outcome measures (PROMs) were collected for 292 feet (87.7%). At a minimum 2-year follow-up, the MOXFQ scores (mean ± standard deviation [SD]) had improved in each domain—i.e., reduced from 44.5 ± 21.0 preoperatively to 9.4 ± 15.8 postoperatively for pain (p < 0.001), from 38.7 ± 23.4 to 6.5 ± 14.6 for walking and standing (p < 0.001), and from 48.0 ± 22.3 to 6.6 ± 13.5 for social interaction (p < 0.001). The VAS-pain score improved from 31.4 ± 22.7 preoperatively to 8.4 ± 16.4 at the 2-year follow-up (p < 0.001), the 1-2 intermetatarsal angle was reduced from 15.3° ± 3.6° preoperatively to 5.7° ± 3.2° at the 2-year follow-up (p < 0.001), and the hallux valgus angle was reduced from 32.9° ± 10.2° to 8.7° ± 5.2° (p < 0.001).Conclusions:The third-generation MICA provided significant improvement in clinical outcome measures at the 2-year follow-up and can be successfully used for correction of a range of hallux valgus deformities with a low rate of symptomatic recurrence.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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.

The metatarsaus adductus effect by the syndesmosis procedure for hallux valgus correction.

AimsThe purpose of this study is to examine the adductus impact on the second metatarsal by the nonosteotomy nonarthrodesis syndesmosis procedure for the hallux valgus deformity correction, and how it would affect the mechanical function of the forefoot in walking. For correcting the metatarsus primus varus deformity of hallux valgus feet, the syndesmosis procedure binds first metatarsal to the second metatarsal with intermetatarsal cerclage sutures.MethodsWe reviewed clinical records of a single surgical practice from its entire 2014 calendar year. In total, 71 patients (121 surgical feet) qualified for the study with a mean follow-up of 20.3 months (SD 6.2). We measured their metatarsus adductus angle with the Sgarlato’s method (SMAA), and the intermetatarsal angle (IMA) and metatarsophalangeal angle (MPA) with Hardy’s mid axial method. We also assessed their American Orthopaedic Foot & Ankle Society (AOFAS) clinical scale score, and photographic and pedobarographic images for clinical function results.ResultsSMAA increased from preoperative 15.9° (SD 4.9°) to 17.2° (5.0°) (p < 0.001). IMA and MPA corrected from 14.6° (SD 3.3°) and 31.9° (SD 8.0°) to 7.2° (SD 2.2°) and 18.8° (SD 6.4°) (p < 0.001), respectively. AOFAS score improved from 66.8 (SD 12.0) to 96.1 (SD 8.0) points (p < 0.001). Overall, 98% (119/121) of feet with preoperative plantar calluses had them disappeared or noticeably subsided, and 93% (113/121) of feet demonstrated pedobarographic medialization of forefoot force in walking. We reported all complications.ConclusionThis study, for the first time, reported the previously unknown metatarsus adductus side-effect of the syndesmosis procedure. However, it did not compromise function restoration of the forefoot by evidence of our patients' plantar callus and pedobarographic findings.Level of Clinical Evidence: IIICite this article: Bone Jt Open 2021;2(3):174–180.

Three-Dimensional Correction of Hallux Valgus Deformity: A Novel Technique

Background: Minimally invasive techniques for forefoot surgery are increasingly used nowadays with short operative time and smaller incisions allowing early rehabilitation. Consequently, the purpose of this study was to evaluate a novel technique for 3-dimensional correction of hallux valgus deformity using small incisions. Materials and methods: A single-center, prospective study was conducted from February 2016 to February 2019. The study included a total of 36 feet in 34 patients with hallux valgus deformity treated with soft tissue release combined with osteotomy of the first metatarsal base with correction of angular, rotational deformities of the hallux and fixation by transverse pinning to the second metatarsal. Patients were assessed radiographically for union and measurements as well as clinically using the “The American Orthopedic Foot and Ankle Society (AOFAS)” for functional assessment. Results: Union was achieved in all cases. Hallux valgus angle improved from a mean of 40±5.9 degrees to a mean of 9.1±2.3 degrees (P&lt;0.001). Intermetatarsal angle improved from a mean of 17.5±2.1 degrees to a mean of 6.1±1.5 degrees (P&lt;0.001). At the final follow-up period (2 y), the mean hallux valgus angle was 10.9±2.8 degrees (P&lt;0.001) and the mean intermetatarsal angle was 7±1.7 degrees (P&lt;0.001). Conclusion: This technique yielded good radiographic and functional outcomes and can be a viable option in management of mild, moderate, and severe cases of hallux valgus deformity. Level of Evidence: Level IV, Therapeutic study.

The Scarf Osteotomy

The Scarf osteotomy is one of the most widely used techniques for hallux valgus deformity correction. We present a literature review on the evolution of this technique and our results with a specific remark to flat foot deformity as a risk factor for the recurrence of hallux valgus deformity. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.