Hallux Valgus Research Articles

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.

Psychological factors associated with pain and function in adults with hallux valgus.

Psychological factors are linked to pain and function in various musculoskeletal conditions, but their impact on hallux valgus is unclear. Health-related quality of life declines with increasing severity of hallux valgus, affecting not only foot pain and physical function, but also general health, vitality and mental health. Previous studies have reported inconsistent associations between psychological factors, such as anxiety and depression, and surgical outcomes, which might relate to variability in measurement approaches. Understanding the associations between psychological factors, including anxiety, depression, pain catastrophizing and kinesiophobia, and hallux valgus-related pain and function may inform more holistic pre-operative care. Therefore, we aimed to assess these associations in adults with hallux valgus pre-surgery. A pre-operative cross-sectional study was conducted with 41 adults scheduled for hallux valgus surgery. Participants completed questionnaires measuring continuous psychological variables: depression, anxiety and stress (Depression Anxiety Stress Scale-21, a tool for general psychological distress), kinesiophobia (Tampa Scale for Kinesiophobia, which assesses fear of movement associated with pain) and pain catastrophizing (Pain Catastrophizing Scale, a tool used to evaluate maladaptive pain-coping strategies). Continuous outcomes were evaluated using the Manchester-Oxford Foot Questionnaire for foot function, pain and social interaction. Multiple linear regressions explored the associations between these psychological factors and the outcomes. When all exposure variables were considered simultaneously, pain catastrophizing emerged as a significant predictor of foot pain and foot function. A one-unit increase in the pain catastrophizing score was associated with a 1.41-point increase in foot pain (β=1.41, 95% confidence intervals (CIs) 0.73-2.09 and p<0.001) and a 1.83-point increase in worse foot function (β=1.83, 95% CI 1.12-2.54 and p<0.001). Assessing pain catastrophising pre-operatively is recommended for individuals with hallux valgus, although more structured education may be needed to support health professionals in assessing psychological factors. Future research should evaluate the longitudinal impact of pain catastrophizing on post-operative outcomes and explore other contributing factors, such as comorbidities, lifestyle variables and sex differences, to refine screening and treatment strategies.

Biokinetic gait differences between Hallux valgus patients and asymptomatic subjects.

Biokinetic gait differences between Hallux valgus patients and asymptomatic subjects.

Instrumented Correction of Metatarsus Adductus with Hallux Valgus - A Multicenter Radiographic Assessment.

Instrumented Correction of Metatarsus Adductus with Hallux Valgus - A Multicenter Radiographic Assessment.

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.

Comparing the stability of a novel h-shaped bone plate and commercial endosteal plating systems in hallux valgus correction

BackgroundIt is common for physicians to opt for surgical correction of hallux valgus deformities using implants, but post-operative complications are frequently reported. A novel h-shaped plate developed by the authors offers both endosteal and lateral fixation, helping to resist displacement in multiple directions. This study aims to assess the mechanical properties and stability of the h-shaped plate in comparison to various commercially available endosteal plating systems in a simulated hallux valgus correction model using finite element analysis.MethodsFinite element models of four different endosteal plates were developed and used to simulate a hallux valgus correction. The distal end of the metatarsal in each model was loaded at 87.5 N, which is the maximum load experienced during cyclic testing. The load was applied in various directions to simulate different metatarsal movements, including plantar flexion, dorsiflexion, abduction, and adduction of the first metatarsal bone. The mechanical properties and stability of each model was recorded for comparison.ResultsWhen placed under dorsal-to-plantar loading, the model with a h-shaped plate was the most stable of all models, with a displacement of 0.278 mm, plate stress of 429.51 MPa, and screw stress of 294.97 MPa. Under medial-to-lateral loading, the model with a h-shaped plate demonstrated the lowest displacement of 0.152 mm, and plate and screw stresses of 254.27 MPa and 195.40 MPa, respectively.ConclusionFor stabilizing distal chevron osteotomies, the h-shaped bone plate showed greater resistance to displacement in the dorsal-to-plantar and medial-to-lateral directions than the commercially available implants evaluated in this study. The h-shaped plate also presented a lower risk of screw pull-out, which helps to maintain bone alignment postoperatively.

Plate Fixation and Hallux Valgus Deformity Impact on Nonunion Rates in First Metatarsophalangeal Arthrodesis A Retrospective Cohort Study.

The combined effect of fixation type and preoperative deformity together might influence the union rate after the first metatarsophalangeal (MTP) arthrodesis. This study aimed to compare the nonunion and failure rate of dorsal locking plate versus cross-screws for the first MTP arthrodesis considering the preoperative deformity, including hallux valgus versus rigidus. We secondarily aimed to compare the observed nonunion rate with the rate in the systematic reviews. This was a retrospective cohort study including 372 patients and 378 feet. The surgical technique was identical except for the use of a dorsal locking plate in 181 (49%) and cross-screws in 191 (51%) MTP joints. The radiographic union was assessed at 3 months postoperative. Those who did not heal by the 3-month follow-up were categorized as a "symptomatic" versus "asymptomatic" nonunion. Those categorized as nonunion after 3 months were followed until union occurred. The results demonstrated that dorsal locking plate fixation (OR = 10.1, 95% CI: 1.3-80) and hallux valgus deformity (OR = 4.7, 95% CI: 1.2-18) were significantly associated with a higher nonunion rate. At 3-month follow-up, a total of 19 (5%) patients showed nonunion. Of the total nonunions, 15 (79%) were fixed by the locking plate, and 4 (21%) were fixed by cross-screws. Of the 15 nonunions with plate fixation, 6 (40%) underwent a second surgery due to device failure, while none of the cross-screws required a second surgery. Out of the 6 secondary surgeries, 5 (83%) demonstrated a nonunion with valgus deformity and 1 required removal of hardware due to prominent hardware. Our results support that a dorsal locking plate for the fusion of a hallux valgus deformity is associated with a significantly higher risk of symptomatic nonunion and a secondary surgery compared to cross-screws, possibly due to the failure of the plate in neutralizing the medio-lateral deforming forces. Level IV, Retrospective Cohort.

The causal relationship between hallux valgus and endogenous pathogenic factors: A 2-sample Mendelian randomization.

Notably, several factors are associated with hallux valgus (HV); however, their causal relationship remains unclear. In this study, a 2-sample Mendelian randomization (MR) analysis was performed to investigate the casual relationship between 9 endogenous risk factors and HV, aiming to provide a foundation for the clinical management of HV. Exposure factors such as body mass index (BMI), BMI (male), BMI (female), acquired flatfoot, rheumatoid arthritis, gout, knee osteoarthritis, hip osteoarthritis, and Ehlers-Danlos syndrome were considered, with HV as the outcome. Exposure and outcome data were obtained from the IEU Open Genome-wide association study project, UK Biobank, and FinnGen project. Strongly correlated (P < 5×10-08/5×10-06) single nucleotide polymorphisms (SNPs) were selected from the exposure dataset, and those associated with exposure were selected from the HV dataset. The intersection of these SNPs was used as instrumental variables. Five modes were used for the analysis: inverse variance-weighted (IVW), MR-Egger regression, weighted median (WME), simple mode, and weighted mode. MR analysis results of BMI show that except for MR-Egger, the other 4 modes are significant (P < .05), and the β directions are consistent among the 5 methods. For the 4 BMI (male) methods, except for the simple mode, the P- and β-values of the other results all suggest a positive causal relationship between BMI (male) and HV. Flatfoot-IVW and WME results were <.05, indicating statistical significance, whereas MR-Egger, simple mode, and median mode had no statistical significance. However, their β-values were consistent with those of IVW and WME. Further mediation MR analysis suggested that the effect mediated by HV accounts for 13.33% [95% CI (0.03-0.24)] of the total causal effect between the BMI and flatfoot, indicating HV as a mediator of the causal relationship between the BMI and flatfoot. However, the remaining 6 factors had no direct causal association with HV (P < .05). Flatfoot in all patients and elevated BMI in males are directly associated with HV. Therefore, treating acquired flatfoot and controlling the BMI to prevent HV are recommended.

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.

Possibilities of Scarf osteotomy in surgical correction of hallux valgus

Hallux valgus refers to a complex progressive deformity of the foot, caused by an imbalance of static and dynamic constraints leading to the deviation of the head of metatarsal bone in axial, coronal, and sagittal planes. The efficacy of surgical treatment for this deformity ranges from 80 % to 95 %, while 15 % to 40 % of patients report dissatisfaction with the outcomes of foot deformity surgeries. Scarf osteotomy is considered the optimal method for correcting hallux valgus deformity, involving a Z-shaped cut in the area of the first metatarsal bone, which reduces the intermetatarsal angle. The advantages of scarf osteotomy include providing stability and rigid compression at the osteotomy site, allowing for early weight-bearing and bilateralization. Scarf osteotomy prevents shortening of the first ray and facilitates early mobilization of the patient. It can be performed for varyious degrees of foot deformity, from mild to severe. The most common complications associated with surgical treatment of hallux valgus include persistent pain syndrome, recurrence of deformity, hallux varus, secondary fragment displacement, avascular necrosis of the first metatarsal head, nonunion, and infection.

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.

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.

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.

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.

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.

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.

MINIMALLY INVASIVE CHEVRON AKIN FOR HALLUX VALGUS SURGERY: A PROSPECTIVE OBSERVATIONAL STUDY WITH MEAN 6.7-YEAR FOLLOW-UP

IntroductionMinimally invasive (percutaneous) distal first metatarsal osteotomy with internal fixation is an established technique for hallux valgus deformity correction. Published data is limited to 2–3 years follow-up. This study aimed to assess patients undergoing MICA (Minimally Invasive Chevron and Akin) with minimum 5-year follow up, to evaluate the longer-term results of this procedure using validated patient reported outcome measures (PROMs).MethodsFive-year PROM data was prospectively collected from 117 patients who underwent 169 primary MICA osteotomies between July 2014 and April 2018, performed by a single surgeon. Primary clinical outcome measures included visual analogue scale for pain (VAS-pain), Manchester-Oxford Foot Questionnaire (MOXFQ) and EuroQol-5 Dimensions Index (EQ-5D). Data were collected preoperatively, at 2 years and after a minimum of 5 years. Statistical significance was set at p&lt; 0.05.Results169 MICA were performed on 117 patients (112 females, 5 males). Mean follow-up was 6.7 years (standard deviation (SD) 0.96 years). All patients completed minimum 5-year follow-up scores. The MOXFQ scores (mean ± SD) for all 169 feet improved for all domains: from 44.5 ± 22.1 preoperatively to 10.3 ± 17.0 post-operatively for Pain (p&lt;0.001), from 39.2 ± 24.5 to 9.3 ± 17.9 for Walking and Standing (p&lt;0.001) and from 48.2 ± 22.8 to 8.7 ± 17.6 for Social Interaction (p&lt;0.001). VAS-pain improved from 30.8 ± 22.7 to 12.9 ± 21. (p&lt;0.001). EQ-5D Index improved from 0.74 ± 0.14 to 0.90 ± 0.12 (p&lt;0.001).ConclusionThis is the largest study at this time point presenting PROM data following minimally invasive distal first metatarsal osteotomy. It is also the longest in follow up for this technique. This study demonstrates significant improvement in PROMs at the mid-term and MICA can be considered as an effective and long-lasting option for the management of hallux valgus deformity.