Hallux Varus Deformity Research Articles

Arthroscopically Assisted Reconstruction of Lateral Metatarsosesamoid Suspensory and Lateral Metatarsophalangeal Collateral Ligaments in the Management of Iatrogenic Hallux Varus Deformity

The medial and lateral metatarsosesamoid suspensory ligaments together with the sesamoid apparatus are the main contributors to the rotational stability of the first metatarsophalangeal joint (MTPJ). Rotational instability of first MTPJ is a major factor in the development of hallux valgus and varus deformities. As the great toe starts to rotate, the muscle pulls across the first MTPJ, causing it to become imbalanced and lead to progressive medial or lateral deviation of the great toe. The gold standard and most reliable option for hallux varus deformity is first MTPJ fusion. However, it results in stiffness and loss of joint function and is reserved for arthritic and stiff first MTPJ. Flexible iatrogenic hallux varus is corrected by optimally anatomic ligament reconstruction. The purpose of this Technical Note is to describe the details of arthroscopically assisted reconstruction of lateral metatarsosesamoid suspensory and lateral metatarsophalangeal collateral ligaments in management of iatrogenic hallux varus deformity. We reconstruct the lateral metatarsosesamoid suspensory ligament to restore the rotational stability of the first MTPJ in hallux varus deformity. This together with reconstruction of the lateral metatarsophalangeal collateral ligament anatomically corrects both the medial deviation and rotation deformity of the great toe.

Midterm functional outcomes of synthetic cartilage implant (SCI) arthroplasty for hallux rigidus

Hallux rigidus is a common degenerative condition of first metatarso-phalangeal joint most commonly affecting patients above 50 years of age. The aim of our study is to evaluate the five-year results of synthetic cartilage implant (Cartiva) arthroplasty for hallux rigidus. A retrospective study of 70 patients who underwent synthetic cartilage implant interpositional arthroplasty were collected and analysed. Patients with Grade 3 to 4 hallux rigidus and who had failed conservative management were included. Patients who had previous forefoot surgery, hallux varus or valgus deformity of more than 250 and neuromuscular disease were excluded. Mean age at the time of operation was 63.4 years (range 42–84 years). The mean follow-up was 62.6 months. The functional evaluation was done using Manchester-Oxford Foot Questionnaire (MOxFQ). EQ-5D and EQVAS.86 patients were matriculated in the study with 70 patients being assessed at five years. The average preoperative MOxFQ score improved from 35.74 (31.44-40.04) to 19.11 (11.31- 26.91) at one year after surgery. The EQ-5D scores improved from preoperative average of 9.40 (8.14-10.66) to 4.26 (2.09-6.43) at one year. The preoperative EQVAS was 61.66 (51.25-72.07) to 71.45 (60.87-82.03 at one year. At five years follow up the average MOxFQ score was 17.6 (9.92-24.38), EQ-5D - 4.8 (2.26- 6.45) and EQVAS – 72.48 (62.40-82.56). Three patients had revision to first MTP fusion due to ongoing pain.Synthetic cartilage implant has demonstrated clinical efficacy and good functional outcomes at the end of five years for the treatment of Hallux rigidus.Level of Clinical Evidence: 4

Case Report: Postsurgical hallux varus in which metatarsophalangeal joint arthrodesis was useful

A 74-year-old Japanese woman who underwent Mann’s procedure with fibular sesamoidectomy for left hallux valgus 21 years ago complained of left hallucis pain. She was diagnosed with iatrogenic hallux varus and hammer toe deformities. Metatarsophalangeal joint arthrodesis and shortening oblique osteotomy were performed. After surgery, the hallux valgus angle improved from -28° to 0°, and the intermetatarsal angle between the first and the second metatarsus improved from 0° to 6°. The Japanese Society for Surgery of the Foot RA foot and ankle scale improved from 73 to 81 points. She could walk without pain and sustained no deformity at 4 years after the surgery.

Bipartitism in Tarsal Bones: A Retrospective Analysis of Clinical and Radiological Features

Background: Bipartitism in the foot, especially in the tarsal bones, is a rare anatomical variant characterised by dividing one bone into two separate ossification centers. This condition can be congenital or acquired, often remains asymptomatic, and is only discovered incidentally during radiological imaging. This study aims to present a comprehensive retrospective analysis of bipartitism in tarsal bones, assessing its prevalence, type of articulation and associated clinical features in a cohort of patients. Methods: A total of 4,645 patients were retrospectively evaluated from 6,145-foot images consisting of 4,975 computed tomography (CT) and 1,170 magnetic resonance imaging (MRI) scans obtained between 2015 and 2023. 15 patients with tarsal bipartitism were identified and contacted through the hospital system for in-person medical history and examination. Radiological exams assessed partial and complete bipartition, diastasis, and exostosis in the tarsal bones. Age, sex, side, trauma history, pain, foot deformity, gait disturbance, and other clinical findings were also recorded. Results: Bipartitism was detected in 15 patients (0.32%), predominantly affecting males (87%). The most common variant was medial cuneiform bipartitism, observed in 13 patients (0.28%). Talus and calcaneus bipartitism were each observed in one patient (0.02%). Bilateral involvement was present in 67% of the cases, with 60% of patients reporting chronic pain. Complete dissociation of bipartite bones was noted in 80% of cases. Accompanying bipartitism, two patients had pes planovalgus, and one had hallux varus deformity. Conclusion: Although bipartitism of the tarsal bones is rare, it remains a diagnostic challenge due to variability in clinical presentation and possible association with other foot deformities. Accurate diagnosis through advanced imaging techniques is essential to differentiate these variants from fractures and guide appropriate treatment. This study contributes valuable insights into the prevalence and clinical impact of bipartitism in the tarsal bones, emphasising the importance of early diagnosis and individualised treatment strategies.

Joint-Preserving Surgery for Hallux Valgus Deformity in Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a chronic autoimmune disorder that frequently causes forefoot deformities. Arthrodesis of the first metatarsophalangeal joint is a common surgery for severe hallux valgus. However, joint-preserving surgery can maintain the mobility of the joint. This study aimed to investigate the clinical and radiographic outcomes of distal chevron metatarsal osteotomy (DCMO) for correcting hallux valgus deformity associated with RA. Between August 2000 and December 2018, 18 consecutive patients with rheumatoid forefoot deformities (24 feet) underwent DCMO for hallux valgus with/without lesser toe surgery. Radiological evaluations were conducted, assessing the hallux valgus angle, the intermetatarsal angle between the first and second metatarsals, and the Sharp/van der Heijde score for erosion and joint space narrowing. Clinical outcomes were quantified using a visual analog scale for pain and the American Orthopaedic Foot and Ankle Society forefoot scores to measure function and alignment. The mean hallux valgus angle decreased from 38.0° (range, 25°-65°) preoperatively to 3.5° (range, 0°-17°) at the final follow-up (p < 0.05). The mean intermetatarsal angle decreased from 14.9° (range, 5°-22°) preoperatively to 4.3° (range, 2°-11°) at the final follow-up. (p < 0.05). Regarding the Sharp/van der Heijde score, the mean erosion score (0-10) showed no significant change, decreasing from 3.83 (range, 0-6) preoperatively to 3.54 (range, 0-4) at the final follow-up (p = 0.12). Recurrent hallux valgus was observed in 1 patient and postoperative hallux varus deformity was observed in 2 feet. Spontaneous fusion of the metatarsophalangeal joint developed in 1 case. DCMO resulted in satisfactory clinical and radiographic outcomes for correcting RA-associated hallux valgus deformity.

Outcomes following Surgical Intervention for Hallux Varus deformity: A Systematic Review

Category: Midfoot/Forefoot; Other Introduction/Purpose: The purpose of this systematic review was to evaluate the clinical and radiological outcomes together with the complication rates and failure rates following surgical intervention for hallux varus deformity. Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following surgical intervention for hallux varus deformity. Data regarding study characteristics, patient demographics, osteoarthritis severity, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. In addition, the level of evidence and quality of evidence for each individual study was also assessed. Results: Twelve studies were included. In total, 168 patients (186 feet) underwent surgical intervention for hallux varus deformity. at a weighted mean follow-up of 49.6±36.6 months. The weighted mean AOFAS score improved from a pre-operative score of 60.5±18.4 to a post-operative score of 83.9±9.0. The weighted mean hallux valgus angle improved from a pre-operative angle of 16.9±6.5° of varus to a post-operative angle of 5.9±6.6° of valgus. The weighted mean inter-metatarsal angle improved from a pre- operative angle of 12.7±10.0° to a post-operative angle of 7.7±3.4°. The complication rate was 21.5%, the most common of which was 1st MTPJ joint pain and stiffness. Eleven failures (5.9%) were observed at a mean time of 25.0 months following the index procedure. Conclusion: This systematic review demonstrated improvements in subjective clinical outcomes together with a low failure rate following surgical intervention for hallux varus deformity at mid-term follow-up. A high complication rate was recorded. However, the marked heterogeneity between included studies and paucity of high quality comparative studies limits the generation of any robust conclusions. Further research with a longer follow-up is warranted to determine the optimal surgical technique for hallux varus deformity correction.

Acquired Hallux Varus Deformity Correction: Pivotless Distraction Technique.

Acquired hallux varus deformity secondary to postburn contracture is a rare condition. It causes cosmetic disfigurement, pain, and inability to wear a shoe. Soft-tissue procedures and tendon transfers have been described for correction; however, these may require multiple operations and the outcome may be poor. We report a 6-year-old neglected case of hallux varus deformity secondary to burn contracture successfully managed by contracture release with pivotless distraction technique using a biplanar distractor and skin grafting with Z-plasty in the same procedure. The deformity was corrected to a lesser extent and with good functional outcomes. The scar was excised and Z-plasty was performed. The medial joint capsule was released. We used gradual differential distraction with monitoring on sequential radiographs. Pain-free flexion of 45° and extension of 40° were achieved and the patient was able to wear shoes after 4 weeks postoperatively. Hallux varus is a multidimensional deformity. A severe and rigid deformity might not respond well to tendon transfers in a single stage. Our described technique can be used to correct rigid hallux varus deformity with preservation of joint function.

An Open Hallux Interphalangeal Joint Dislocation: A Rare Case

Background: The interphalangeal (IP) joint dislocation of hallux is a rare occurrence probably due to the presence of strong ligamentous attachments around it. Closed reduction of this kind of dislocation proves to be unsatisfactory. Herein, we are presenting a case of an open dorsomedial type of IP joint dislocation following a road traffic accident.&#x0D; Case Report: A 36-year-old woman with injury to her right great toe following a road traffic accident presented in the casualty of Chettinad Hospital, Kelambakkam, India. On examination, there was a 3 × 2 cm laceration present over the medial-plantar aspect. The bone was exposed. Hallux varus deformity was noted due to the dislocation of the IP joint. The reduction of IP joint dislocation was quite unstable and was fixed with two 1mm Kirschner wires (K-wires) under fluoroscopic guidance. The patient was sequentially followed up on the 4th and 6th weeks post-op. Joint integrity and stability were assessed which were found to be satisfactory after the removal of K-wire on the 6th week post-op.&#x0D; Conclusion: Open IP dislocations of the hallux Miki type 2 are unstable types of injury to deal with. Closed reduction in these injuries is difficult owing to the impinging sesamoid bone along with other soft tissues. These types of injuries should be reduced and fixed with K-wires to have better stability followed by long-term immobilization of around 3 to 4 weeks.

Rare Case of a Right Hallux Varus: About a Case and Review of the Literature

Hallux varus deformity is generally defined by three components: medial deviation of the hallux at the first metatarsophalangeal (MTP) joint, supination of the phalanx, and interphalangeal (IP) flexion or claw toe deformity. The deformation can be congenital or acquired. Hallux varus is most commonly seen as an iatrogenic complication of bunion surgery, resulting from overcorrection of hallux valgus. The incidence is relatively rare, with reports ranging between 2% and 15.4% in the literature. Besides iatrogenic hallux varus, several other etiologies cause acquired hallux varus: trauma, severe burn injury with contracture, systemic inflammatory disorders such as rheumatoid or psoriatic arthritis, Charcot-Marie-Tooth disease, avascular necrosis of the first metatarsal head, and paralysis or poliomyelitis. The goal of treatment is to obtain a functional, pain-free, shoeable foot. It is desirable to achieve a stable, aligned hallux while maintaining or maximizing joint mobility when possible.

Case Report: Postsurgical hallux varus in which metatarsophalangeal joint arthrodesis was useful

A 74-year-old Japanese woman who underwent Mann’s procedure with fibular sesamoidectomy for left hallux valgus 21 years ago complained of left hallucis pain. She was diagnosed with iatrogenic hallux varus and hammer toe deformities. Metatarsophalangeal joint arthrodesis and shortening oblique osteotomy were performed. After surgery, the hallux valgus angle improved from -28° to 0°, and the intermetatarsal angle between the first and the second metatarsus improved from 0° to 6°. The Japanese Society for Surgery of the Foot score improved from 75 to 81 points. She could walk without pain and sustained no deformity at 4 years after the surgery.

Značaj mekotkivnih hirurških intervencija na distalnom dijelu stopala u liječenju hallux valgus-a

Since pathological anatomical changes in the distal soft tissues of the front part of the foot in hallux valgus deformity are degenerative in nature and more pronounced than changes in the bony structures, interventions on ligamentous, capsular and tendinous structures are an indispensable part of its surgical treatment. A consensus has not been established regarding the nature and method of performing distal soft tissue interventions. To avoid the risk of consequent aseptic necrosis of the first metatarsal bone head in case of simultaneous osteotomy at its distal level, it is necessary that the osteotomy be performed in a safe place and the plantar and dorsal segments of this capsule must remain preserved. To avoid the occurrence of iatrogenic hallux varus deformity, lateral sesamophalangeal ligament, lateral sesamoid and associated part of the plantar aponeurosis must remain preserved. Since the deep transverse metatarsal ligament keeps the sesamoid apparatus in the anatomical position, its release should be avoided. Lateral release of adductor tendons of the thumb, lateral collateral ligament and associated part of the capsule facilitate correction of the position of the thumb with a modest contribution to the overall correction of deformity and allow access to the shortened lateral metatarsosesamoid ligament, which must be completely released, making the greatest contribution to overall correction. At the same time, the mentioned interventions are safe from the aspect of risk of possible complications, especially when performed using a special dorsal intermetatarsal approach. Reconstructive interventions on the soft tissues of the medial side of the metatarsophalangeal joint of the thumb include their tightening while stabilizing the thumb in a neutral position.

Longitudinal Epiphyseal Bracket of the First Metatarsal: A Case Series on Treatment of Deformities Associated.

Longitudinal epiphyseal bracket of the first metatarsal, also known as first enclosed metatarsal, is a rare congenital disorder characterized by an abnormal development in the length of the first metatarsal ray because of the asymmetric presence of a longitudinal epiphyseal bracket. This causes interruption in the lengthways development of the affected bone, which becomes squat and short, with a trapezoidal or triangular shape, leading to a hallux varus deformity. First enclosed metatarsal occurs in 2% to 14% of all congenital defects in the hands and feet; with bilateralism in 75% of cases and a greater incidence in male patients. The deformity is classified as a differentiation defect; it is frequently associated with abnormalities such as syndactyly or polydactyly. There are different surgical treatments reported in the literature. Most of them are aimed at the excision of the epiphyseal bracket before complete skeletal maturity and frequently in the first year of life to promote a normal lengthways growth of the bone. In this study, the authors present three cases of bilateral first enclosed metatarsal in which the surgical treatment, aimed at lengthening the first metatarsal ray by using the Penning Minifixator, was instead carried out at the end of growth. This different surgical approach allowed the planning of a surgical operation involving both the skeletal structures and the surrounding soft tissue.

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

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

Sesamoidectomy Utilizing a Medial Approach with a Bur: Patient Outcomes and Early Complications

Category:Midfoot/Forefoot; SportsIntroduction/Purpose:Patients with pathology of the sesamoids can have significant pain and disability both with activities of daily living and high impact athletic movements. Sesamoidectomy is a widely used procedure for patients who fail conservative treatment measures. Traditional dorsal or plantar approaches for sesamoidectomy have shown to successfully alleviate pain but complications are noted, including hallux varus deformity, painful plantar incision, and clawing of the hallux. Additionally, the dorsal approach is technically difficult because of poor visualization, which can lead to unnecessary disruption of important plantar ligamentous structures. An alternative medial approach using a bur provides many advantages compared to traditional approaches.Methods:This was a retrospective chart review of patients undergoing sesamoidectomy using a bur with a medial approach to the sesamoid metatarsal articulation. Data collected included patient demographics, radiographic analysis, and outcomes: Veterans Rand 12 Item Health Survey (VR-12), Foot and Ankle Ability Measure (FAAM), Visual Analog Scale (VAS), patient satisfaction, and complications.Results:In patients (10 feet) with an average age of 36.5 (range, 13-77) years were analyzed. Six patients underwent medial sesamoidectomy, three underwent lateral sesamoidectomy, and one patient underwent excision of both medial and lateral sesamoids using a bur. The average latest follow up was 11.9 months. Scores were improved from pre-operatively to most recent follow-up for VR-12 Physical (29.43 vs 53.86), FAAM ADL (48.8 vs 94.1 points), FAAM Sports (7.8 vs 87.4 points), and VAS (57.8 vs 8.6). Patient satisfaction with the treatment was 96.4%. There were zero complications or additional procedures performed.Conclusion:In this series, sesamoidectomy utilizing a medial approach with a bur provided excellent pain relief, zero complications, and significantly improved outcome scores at early follow up. The medial approach is familiar to orthopedic foot and ankle surgeons, provides adequate exposure, and eliminates the possibility of a painful plantar incision. Furthermore, this technique allows for maintenance of the plantar plate, flexor hallucis brevis (FHB) tendon, and all other ligamentous structures that attach to the sesamoids. Larger studies with longer term follow up are needed to further our knowledge on this surgical technique.

SURGICAL TREATMENT OF VALGUS DEFORMITY OF GREAT TOE (LITERATURE REVIEW)

The most common manifestation of static deformity of the forefoot is hallux valgus. This symptom complex consists of valgus deviation of the first toe, varus deviation of the first metatarsal bone, and the presence of osteochondral exostosis along the medial surface of the head of the first metatarsal bone. The objective of the work was to determine the most common methods of treatment of hallux valgus and varus deformities of the first metatarsal bone on the basis of the analyzed published literature. Methods. We analyzed publications from the Google search engine, electronic databases PubMed, Google Scholar, archives of specialized journals and other relevant sources of scientific and medical information. Results. Based on the analysis of literary sources, the development of forefoot surgery from the 18th century to the present day was highlighted in the historical aspect. The greatest attention is paid to the use of various osteotomies of the first metatarsal bone for the correction of hallux valgus. In addition, special attention is paid to the developmentof various complications at osteotomies. Conclusions. The problem of surgical correction of hallux valgus is multifaceted and extremely interesting, containing a large number of nuances and hidden complexities. For quite a long time, there has been an improvement in various surgical techniques and methods of fixation. Considering the great variability of the clinical manifestations of hallux valgus, for many years no universal method of treatingthis pathology has been proposed. Therefore, in the future, most likely, individual and differentiated approaches to the choice of one or another method of surgical intervention will be considered, depending on what type of deformity of the forefoot the orthopedisttraumatologist has to meet in his practice.

Arthroscopic Arthrodesis of the First Metatarsophalangeal Joint in Hallux Varus

Hallux varus deformity most commonly occurs as a complication of bunion surgery. Surgical option depends on the underlying cause, flexibility of the deformity, and presence of osteoarthritis of the first metatarsophalangeal joint. Joint-preserving surgery including medial soft tissue release, metatarsal osteotomy, and tendon transfer can be considered in flexible deformity without degeneration of the first metatarsophalangeal joint. First metatarsophalangeal arthrodesis is indicated in cases of inflammatory arthritis, avascular necrosis, osteoarthritis, neuromuscular disorder, or failed previous hallux varus corrective surgery. The purpose of this technical note is to describe the technique of arthroscopic arthrodesis of the first metatarsophalangeal joint to correct hallux varus deformity. It has the potential advantages of less surgical trauma, preservation of blood supply, less postoperative pain, and better cosmetic results.

Combination of Modified Scarf Osteotomy and Metatarsal Shortening Offset Osteotomy for Rheumatoid Forefoot Deformity.

With the progress of medical treatment for rheumatoid arthritis (RA), several joint-preserving forefoot surgical procedures have been established and performed. In this situation, we have been choosing the combined surgery: modified scarf osteotomy for the great toe and metatarsal shortening offset osteotomy for the lesser toes in RA cases. A retrospective observational study of 53 RA patients (mean follow-up period: 4.6 years) who underwent the surgery was completed. RA foot ankle scores were assessed, using the Japanese Society for Surgery of the Foot (JSSF) standard rating system, and a self-administered foot evaluation questionnaire (SAFE-Q) was also checked to evaluate clinical outcomes. For radiological evaluations, deformity parameters were measured using radiographs of the feet with weight-bearing. JSSF hallux and lesser toes scores and the SAFE-Q score showed significant improvement in all indices. HVA, M1-M2A, M1-M5A, M2-M5A, and sesamoid position were significantly improved after surgery. At the final follow-up, the hallux valgus deformity had recurred in 4 feet (7.5%), and hallux varus deformity had developed in 8 feet (15.1%). No case of recurrent hallux valgus deformity required revision surgery. Recurrence of dorsal dislocation/subluxation of the lesser toe MTP joint was seen in 6 feet (11.3%) after surgery. A combination of modified scarf osteotomy for the great toe and modified metatarsal shortening offset osteotomy for the lesser toes is one of the novel surgical procedures for rheumatoid forefoot deformity. Preoperative disease activity of RA negatively affected the clinical score of the hallux. The spread of M2-M5A was a risk factor for resubluxation of the lesser toe MTP joint.

Outcomes of Simultaneous Bilateral vs Unilateral Distal Chevron Metatarsal Osteotomy in Hallux Valgus Patients Aged ≥60 Years.

The purpose of this study was to compare radiographic outcomes of simultaneous bilateral and unilateral distal chevron metatarsal osteotomy (DCMO) in hallux valgus patients aged ≥60 years. This retrospective study analyzed consecutive outcomes of simultaneous bilateral DCMO and unilateral DCMO performed between June 2010 and August 2018 in 90 feet of 60 patients. Thirty patients underwent simultaneous bilateral DCMO, and 30 underwent unilateral DCMO. Comparative analysis of radiographic and clinical parameters between a simultaneous bilateral DCMO group (SB) and a unilateral DCMO group (U) was performed. Mean age at surgery (65.7±4.8 vs 65.2±5.2 years), mean length of follow-up period (20.0 vs 18.6 months), and preoperative radiographic parameters were similar between the 2 groups (SB vs U). Mean hallux valgus angle (HVA) improved from 34.2 to 5.4 degrees (correction angle SB 28.8 vs U 28.8 degrees). Mean first-to-second intermetatarsal angle improved from 15.8 to 6.8 degrees (correction angle SB 8.9 vs U 8.9 degrees). Hallux varus deformity was observed in 4 feet (SB 3 vs U 1), and mechanical instability with callus formation in 1 foot in the unilateral group. DCMOs in patients aged ≥60 years were radiographically effective and safe, even performed in one stage bilaterally. Radiographic parameters were similar in patients who underwent simultaneous bilateral and unilateral DCMO. Level III, retrospective cohort study.

Tubercular dactylitis with deformity ipsilateral involvement of hand and foot in an adult: a case report

&lt;p&gt;Tubercular dactylitis is a rare entity and usually involves bones of hands and feet, involvement of feet is less common. Here we report case of 18 years old female with neglected tubercular involvement of her left thumb and left great toe of foot with hallux varus deformity. Her diagnosis was delayed as she did not seek any healthcare advice for a long time and also lack of suspicion of entity. This entity which should be kept in mind when making differential diagnosis that can be treated conservatively when diagnosed early.&lt;/p&gt;

Minimally Invasive Surgery with Tenorrhaphy for Postoperative Hallux Varus Deformity Combined with Flexor Hallucis Longus Rupture after Hallux Valgus Correction: A Case Report

Minimally Invasive Surgery with Tenorrhaphy for Postoperative Hallux Varus Deformity Combined with Flexor Hallucis Longus Rupture after Hallux Valgus Correction: A Case Report