Interphalangeal Angle Research Articles

Intermetatarsal and Metatarsal-Phalangeal Angles Can Be Corrected by an Isolated Akin Osteotomy in Patients with Hallux Valgus Deformity

Introduction/Purpose: Akin osteotomy is a surgical technique commonly used in conjunction with osteotomies of the first metatarsal for correction of hallux valgus (HV) deformity. The main indication for an Akin osteotomy is the presence of hallux valgus interphalangeus (HVIF), defined as a HVIF angle >10º. Given that distal osteotomies can change the tendon vector forces, we hypothesize that in a patient with a mobile medial column, an isolated akin osteotomy could improve proximally some radiologic parameters of HV. The purpose of this study was to evaluate whether the isolated Akin osteotomy is able to correct proximally the intermetatarsal angle (IMA) and hallux valgus angle (HVA) in patients with HV deformity. Methods: Case series of consecutive patients with HV deformity treated with an isolated Akin osteotomy, were included in this study. The indications for this surgery were having a mild HV and overlapping of the hallux with the second toe as the main symptom. Patients with fractures, infections, prior surgeries in the forefoot, and concomitant metatarsal osteotomy or first tarsometatarsal fusion were excluded. Two independent evaluators measured the following parameters pre and post-operatively in anteroposterior(AP) feet x-rays: traditional and modified HVA (the latter defined as angle between the long axis of the 1st metatarsal and a line from the center of the base of the proximal phalanx and the tip of the distal phalanx), IMA, distal metatarsal articular angle (DMAA), and HVIF angle. Paired t-test was performed to compare the radiological parameters pre and post- surgery. The absolute intraclass correlation coefficient (ICC) was used to determine the interobserver agreement. P< 0.05 was considered significant. Results: Twenty AP feet x-rays of 12 females and 1 male with a mean age of 44.0 years (range 15 to 85) were included in the final analysis. The preoperative mean and standard deviation (SD) of traditional HVA, modified HVA, IMA, DMAA, and HVIF were 17.0º(7.5), 23.7º(6.5), 11.3º(1.6), 12.6(9.2), and 13.5º(6.0), respectively. The corresponding postoperative values were 9.8º(7.0), 14.4º(7.0), 9.5º(2.0), 11.2º(7.6), and 9.9º(4.9). There was a significant reduction in the traditional HVA (7.2º, p< 0.001), and modified HVA (9.3º, p< 0.001). Also, there was a significant decrease in the IMA (1.8º, p< 0.001), and HVIF (3.5º, p=0.001). Conversely, the DMAA did not change after the osteotomy. The interobserver agreement was moderate to excellent for all radiologic parameters. Conclusion: In this case series, an isolated Akin osteotomy significantly reduced the HVA and IMA. These results challenge the traditional knowledge that Akin only corrects the interphalangeal angle, and could help for a better biomechanical understanding of this deformity, including the effect in proximal correction of distal procedures. An isolated Akin osteotomy could be a plausible alternative for the correction of HV, especially for mild deformities.

Relationship Between Hallux Valgus Interphalangeal Deformity and the Recurrence of Ingrown Toenail in Children.

An abnormal hallux interphalangeal angle may be an important risk factor for the recurrence of ingrown toenails. Sixty pediatric patients who underwent surgery for an ingrown toenail were evaluated retrospectively in terms of recurrence. The patients were divided into two groups. Group 1 included 30 patients (22 boys and eight girls) with hallux valgus interphalangeal deformity. Group 2 included 30 patients (20 boys and ten girls) without toe deformity. The mean ± SD patient age was 12.8 ± 1.42 years and 12.5 ± 1.45 years in groups 1 and 2, respectively. There was no significant difference between the patient and control groups in terms of age and sex (P > .05). The mean ± SD follow-up time was 30.2 ± 13.46 months in group 1 and 31.3 ± 12.86 months in group 2 (P = .286). We observed recurrence in six patients (20%) in group 1 and in two patients (6.7%) in group 2. The recurrence of an ingrown toenail may be associated with an increased hallux interphalangeal angle in pediatric patients. Factors related to the hallux interphalangeal angle abnormality, which increases the risk of ingrown toenails, also increase the recurrence rate in these patients. Therefore, it is surmised that hallux valgus interphalangeal deformity should be evaluated before surgery, and patients and their families should be informed about the increased risk of recurrence.

Evaluation of Foot Deformities in Patients With Ingrown Nails.

Ingrown nail is a condition caused by the perforation of the periungual soft tissues on nail folds by the sides of nail plaque, causing inflammation and severe pain. Recently, the role of foot anatomical disorders in ingrown nail development has been emphasized. The main objective of this study aimed to determine whether foot deformities played significant roles in ingrown nail development with objective radiological parameters. The study included 64 patients diagnosed with clinical ingrown nail and 71 patients as controls without any ingrown nail history. In both groups, we evaluated the bilateral foot radiographs of patients with ingrown nails for hallux valgus angle (HVA), interphalangeal angle (IPA), and intermetatarsal angle (IMA) associated with hallux valgus, and the calcaneal pitch angle (CPA), talohorizontal angle (THA), and talometatarsal angle (TMA) related to pes planus. No significant difference was found in terms of hallux valgus radiological measurements of HVA, IPA and IMA as well as pes planus radiological measurements of CPA and TMA values, when compared to controls. THA was statistically significantly higher in the control group (P = 0.025). There was a moderate strength positive relationship between ingrown nail stage and measured TMA for pes planus diagnosis (rho = 0.326; P = 0.04), yet there are no significant correlations between ingrown nail stage and other angles. Therefore, we do not recommend foot anatomy correction in the prevention and treatment of ingrown nails, unless there is an accompanying foot deformity; however, pes planus is a foot deformity that can accompany patients with severely ingrown nails.

Combined Distal Metatarsal and Akin Osteotomies for Concomitant Metatarsophalangeal and Interphalangeal Hallux Valgus: Clinical and Radiological Outcomes

Combined metatarsal and Akin-type proximal phalanx osteotomies represent a surgical solution for concomitant metatarso-phalangeal and inter-phalangeal hallux valgus. This retrospective observational study aimed to evaluate clinical and radiographic outcomes following combined distal linear metatarsal and Akin osteotomies. The study included 42 feet from 37 patients, with a mean follow-up of 27.1 (range 24-37) months. Mean surgical time was 16.54 ± 4.17 minutes. Pre- and postoperative clinical scores and radiological parameters were collected. Positive outcomes with a low recurrence and complications rates were reported. A statistically significant improvement in the Manchester–Oxford foot questionnaire, the EuroQol 5D-5L dimensions instrument, the visual analogue scale, the intermetatarsal angle, the hallux valgus angle, the distal metatarsal articular angle, and the interphalangeal angle correction was observed. Despite the results reported, further prospective studies are needed to identify the most suitable patients for this combined osteotomy approach.

The use of an Intra-medullary fusion system in hammer toe surgery; mid-term follow-up

Objective: To assess the efficacy of a new hammer-toe locking fusion system. Method: The retrospective study was conducted at Kutahya Evliya Çelebi Education and Research Hospital, and comprised data from March 2014 to January 2017 of patients of either gender with hammer toe deformity. The American Orthopaedic Foot and Ankle Society and visual analogue scale scoring systems were used. Radiological evaluation was also used to determine the lateral interphalangeal angle measurements. All patients were subjected to hammer toe surgery using new two-block interlocking fusion system, and were followed up for about 2 years. SPSS 25.0 for windows was used for analysis. Results: According to gender, 13(65%) of patients were female and 7(35%) of patients were male. The overall mean age was 51.5±16.31 years (range: 20-72 years). Of all the surgeries, 9(45%) were performed on the right foot, and 11(55%) on the left foot. The follow-ups ranged 21-32 months. Compared to baselines values, American Orthopaedic Foot and Ankle Society scale and visual analogue scale scores significantly improved post intervention (p<0.05). Conclusion: Significantly favourable outcomes were noted, indicating the efficacy of the fusion process. Key Words: Toes, Hammer, Interphalangeal, Lesser toe, Arthrodesis.

Arthrodesis of the first metatarsophalangeal joint for severe hallux valgus in adolescents with cerebral palsy: A retrospective comparison study of three surgical techniques.

We compared the outcomes of arthrodesis of the first metatarsophalangeal joint for severe hallux valgus in 31 adolescents with cerebral palsy, using three different methods of fixation: K-wires, non-locking plates, and locking plates. Clinical outcomes included time to weight-bearing, fusion rates and surgical complications. Radiographic assessment included comparing pre- and post-operative hallux valgus angles, intermetatarsal angles, interphalangeal angles, and lateral metatarsophalangeal angles. Patient-reported outcomes included pre- and post-operative visual analogue scales addressing bunion pain and concerns, difficulties with wearing shoes and braces, and difficulties with foot hygiene. Of the 31 adolescents (16 male), 10 patients had K-wire fixation, 11 had a non-locking dorsal plate, and 10 had fixation with a dorsal locking plate. Mean age at surgery was 16 years (12-18 years) and mean follow-up was 4 years (2.7-6.5 years). Patients with K-wire fixation had delayed weight-bearing and had more complications than those managed by dorsal plating. There were significant improvements in radiographic parameters (except interphalangeal angle) and in patient-reported outcomes, in all groups (p < 0.001). However, radiographic and clinical outcomes were better in the dorsal plating groups compared to the K-wire group. Arthrodesis of the first metatarsophalangeal joint gave good correction of deformity with improvements in symptoms and radiographic parameters in adolescents with cerebral palsy. We recommend dorsal plating that allowed early weight-bearing and had fewer complications with better clinical and radiographic outcomes, than K-wire fixation. IV: Retrospective case series.

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

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

Ulcer occurrence on adjacent toes and hallux valgus deformity after amputation of the second toe in diabetic patients

BackgroundAmputation of the second toe is associated with destabilization of the first toe. Possible consequences are hallux valgus deformity and subsequent pressure ulcers on the lateral side of the first or on the medial side of the third toe. The aim of this study was to investigate the incidence and possible influencing factors of interdigital ulcer development and hallux valgus deformity after second toe amputation.MethodsTwenty-four cases of amputation of the second toe between 2004 and 2020 (mean age 68 ± 12 years; 79% males) were included with a mean follow-up of 36 ± 15 months. Ulcer development on the first, third, or fourth toe after amputation, the body mass index (BMI) and the amputation level (toe exarticulation versus transmetatarsal amputation) were recorded. Pre- and postoperative foot radiographs were evaluated for the shape of the first metatarsal head (round, flat, chevron-type), the hallux valgus angle, the first–second intermetatarsal angle, the distal metatarsal articular angle and the hallux valgus interphalangeal angle by two orthopedic surgeons for interobserver reliability.ResultsAfter amputation of the second toe, the interdigital ulcer rate on the adjacent toes was 50% and the postoperative hallux valgus rate was 71%. Neither the presence of hallux valgus deformity itself (r = .19, p = .37), nor the BMI (r = .09, p = .68), the shape of the first metatarsal head (r = − .09, p = .67), or the amputation level (r = .09, p = .69) was significantly correlated with ulcer development. The interobserver reliability of radiographic measurements was high, oscillating between 0.978 (p = .01) and 0.999 (p = .01).ConclusionsThe interdigital ulcer rate on the first or third toe after second toe amputation was 50% and hallux valgus development was high. To date, evidence on influencing factors is lacking and this study could not identify parameters such as the BMI, the shape of the first metatarsal head or the amputation level as risk factors for the development of either hallux valgus deformity or ulcer occurrence after second toe amputation.Trial Registration: BASEC-Nr. 2019-01791

Metatarsophalangeal and interphalangeal joint angle measurements on weight-bearing CT images

BackgroundThe aim of this study was to present and evaluate methods of measuring toe joint angels using joint-surface based and inertial axes approaches. MethodsNine scans of one frozen human cadaveric foot were obtained using weight-bearing CT. Two observers independently segmented bones in the forefoot and measured metatarsalphalangeal joint (MTPJ) angles, proximal and distal interphalangeal joint (PIPJ and DIPJ) angles and interphalangeal angles of the hallux (IPJ) using 1) inertial axes, representing the long anatomical axes, of the bones and 2) axes determined using centroids of articular joint surfaces. ResultsThe standard deviations (SD) of the IPJ/PIPJ and DIPJ angles were lower using joint-surface based axes (between 1.5˚ and 4.1˚) than when the inertial axes method was used (between 3.3˚ and 16.4˚), for MTPJ the SD’s were similar for both methods (between 0.5˚ and 2.6˚). For the IPJ/PIPJ and DIPJ angles, the width of the 95% CI and the range were also lower using the joint-surface axes method (95% CI: 2.0˚–4.1˚ vs 3.2˚–16.3˚; range: 3.1˚–7.4˚ vs 3.8˚–35.8˚). Intra-class correlation coefficients (ICC) representing inter- and intra-rater reliability were good to excellent regarding the MTPJ and IPJ/PIPJ angles in both techniques (between 0.85 and 0.99). For DIPJ angles, ICC’s were good for the inertial axes method (0.78 and 0.79) and moderate for the joint-surface axes method (0.60 and 0.70). ConclusionThe joint-surface axes method enables reliable and reproducible measurements of MTPJ, IPJ/PIPJ and DIPJ angles. For PIPJ and DIPJ angles this method is preferable over the use of inertial axes.

A Radiographic Analysis of Hallux Valgus Interphalangeus and Biplanar Proximal Phalanx Closing Wedge “MoAkin” Osteotomy in Hallux Rigidus Treated with a Synthetic Cartilage Implant

Category: Midfoot/Forefoot Introduction/Purpose: 'MoAkin' biplanar proximal phalanx closing wedge osteotomy with dorsal cheilectomy has been described as an effective procedure for treatment of hallux rigidus with hallux valgus interphalangeus (HVI). Its role as an adjunct procedure to first metatarsophalangeal joint hemiarthroplasty using a synthetic cartilage implant has not been well described. The purpose of this radiographic analysis was to examine radiographic changes associated with the MoAkin osteotomy performed in patients who underwent first MTPJ hemiarthroplasty using the Cartiva implant. Methods: A retrospective study of all patients with hallux rigidus and HVI treated with a synthetic cartilage implant and MoAkin osteotomy between 2009 and 2020 was conducted. Radiographs were performed preoperatively and at six- and/or twelve-month postoperatively, and evaluated using standardized measurement techniques. Hallux valgus angle (HVA), interphalangeal angle (IPA), and intermetatarsal angle (IMA) were measured. Results: Fifty-four patients were included in the study (37 male; 17 female). Mean preoperative HVA, IPA, and IMA were 11.7+- 4.2 degrees, 15.8+-4.6 degrees, and 8.2+-2.4 degrees, respectively. Mean six-month postoperative HVA, IMA, IPA were 7.7+-4.2 degrees, 15.7+-5.7 degrees, and 8.2 +- 3.0 degrees. Mean twelve-month postoperative HVA, IMA, IPA were 8.0+-4.5 degrees, 15.2+-6.1 degrees, and 8.1+-2.9 degrees. No statistical differences were found between the six-month and twelve-month radiographic analysis (p&gt;=0.59). There was a statistically significant reduction in the hallux valgus angle at six and twelve-month follow up compared to the preoperative angles (p&lt;0.001, d=0.73-1.16). No statistically significant differences were noted in terms of IPA and IMA (p&gt;=0.31). Conclusion: MoAkin osteotomy improves the hallux valgus angle in patients with hallux rigidus and HVI undergoing first MTPJ hemiarthroplasty with the Cartiva implant. Further studies are warranted to evaluate the impact of these radiographic findings on patient-reported outcomes and other clinical outcomes.

Hallux Valgus Angular Measurements using WBCT Semiautomatic and Manual Assessments

Category: Bunion; Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Radiographic measurements are an essential tool to determine the appropriate surgical treatment and outcome for Hallux Valgus (HV). WBCT already demonstrates significant advances that include the ability to perform traditional measurements for HV in the 3D setting reliably, as well as a more complete and accurate evaluation of the deformity. In addition, new software with an advanced semi-automated segmentation system obtains semi-automatic 3D measurements of WBCT scan data sets, minimizing the errors in reading angular measurements. The objective was (1) to assess the reliability of WBCT computer-assisted semi-automatic imaging measurements in HV, (2) to compare semi-automatic with manual measurements in the setting of an HV, and (3) to compare semi-automatic measurements between HV and control group. Methods: In this retrospective IRB (ID# 201904825) approved study, we assessed patients with hallux valgus deformity. The sample size calculation was based on the hallux valgus angle (HVA). Thus, to obtain the 0.8 power, including 26 feet with HV in this study, was necessary. Our control group consisted of 19 feet from 19 patients without HV. Raw multiplanar data was evaluated using software CubeVue. In the axial plane, hallux valgus angle (HVA), intermetatarsal angle (IMA), and interphalangeal angle (IPA) were measured. The semiautomatic 3D measurements were performed using the Bonelogic Software. Inter-rater reliabilities were performed using ICC. Agreement between methods was tested using the Bland-Altman plots. The difference between Pathologic and Control cases using semi-automatic measurements was assessed with the Wilcoxon signed-rank test. Alpha risk was set to 5% (α = 0.05). P&lt;= 0.05 was considered significant. Results: Intraobserver and Interobserver agreement and consistency for Manual and Semi-automatic WBCT measurements assessed by ICC demonstrated excellent reliability in both cases. However, when comparing Manual and Semi-automatic measurements for HVA, IMA, and IPA, Semi-automatic measurements showed the highest values. Agreement between manual (M) and semi-automatic (SA) methods was tested for HVA, IMA and IPA using the Bland-Altman plots. The results indicated a high correlation between the parameters calculated from the manual and semi-automatic measurements, and a strong agreement between the readers and the software. Comparison between pathological group with HV and control (standard) group without HV using semi-automatic measurements was capable of differentiating pathological (HV) from non-pathological conditions for the HVA and IMA angles (p &lt; 0,05). Conclusion: Semi-automatic measurements are reproducible and comparable to measurements performed manually. The software differentiated pathological from non-pathological conditions when subjected to semi-automatic measurements. The development of advanced semi-automatic segmentation software with minimal user intervention is essential for the establishment of big data and can be integrated into clinical practice, facilitating decision-making.

The Use of Advanced Semi-Automated Bone Segmentation in Hallux Rigidus

Category: Midfoot/Forefoot Introduction/Purpose: Weight-Bearing Computed Tomography (WBCT) measurements represent a reliable tool for radiographic analysis of the first ray, including multiplanar assessment in the axial, sagittal, and coronal planes. WBCT can allow for more reliable studies of pathologies, such as Hallux Rigidus (HR), which permits several anatomical points to be evaluated for a correct clinical-radiographic diagnosis. In addition, new software with an advanced semi-automated segmentation system obtains semi-automatic 3D measurements of WBCT scan data sets, minimizing the errors in reading angular measurements. The study`s objective was (1) to assess the reliability of WBCT computer-assisted semi-automatic imaging measurements in HR, (2) to compare semi-automatic to manual measurements in the setting of HR, and (3) to compare semi-automatic measurements between a pathologic (HR) group and a control standard group. Methods: This was a retrospective, IRB approved study of patients with Hallux Rigidus deformity. The sample size calculation was based on the Metatarsus Primus Elevatus (MPE). A control group consisting of 20 feet without HR and a pathologic group consisting of 20 feet with HR was necessary for this study. All WBCT manual and semiautomatic 3D measurements were performed using the following parameters: (1) first Metatarsal-Proximal Phalanx Angle (1stMPP) (sagittal plane), (2) Hallux Valgus Angle (HVA), (3) first to second Intermetatarsal Angle (IMA), (4) Hallux Interphalangeal Angle (IPA), (5) first Metatarsal Lengths (1stML), (6) second Metatarsal Length (2ndML), (7) first Metatarsal Declination Angle (1stMD), (8) second Metatarsal Declination Angles (2ndMD), and (9) MPE. The semiautomatic 3D measurements were performed using the Bonelogic Software. The differences between pathologic and control cases were assessed with a Wilcoxon test and P&lt;= 0.05 was considered significant. Results: Interobserver and intraobserver agreement and consistency for manual versus semi-automatic WBCT measurements assessed by ICC demonstrated excellent reliability. Manual and semi-automatic measurements were performed in individuals with HR. According to the Pearson's coefficient, there was a strong positive linear correlation between both methods for the following parameters evaluated: HVA, (ρ = 0.96); IMA, (ρ = 0.86); IPA, (ρ = 0.89); 1stML, (ρ = 0.96); 2ndML, (ρ = 0.91); 1stMD, (ρ = 0.86); 2ndMD, (ρ = 0.95) and, MPE, (ρ = 0.87). Agreement between the manual and semi-automatic methods was tested using a Bland- Altman plot and expressed excellent agreement between the methods. Comparison between the pathological group with HR and the control (standard) group allowed for the differentiating of the pathological (HR) from the non-pathological conditions for MPE (p &lt; 0.05). Conclusion: Semiautomatic measurements are reproducible and comparable to measurements performed manually, showing excellent interobserver and intraobserver agreement and consistency. The software used differentiated pathological from non- pathological conditions only when submitted to semi-automatic MPE measurements. The development of advanced semi-automatic segmentation software with minimal user intervention is an essential step toward the establishment of big data and can be integrated into clinical practice, facilitating decision making.

The Use of Advanced Semiautomated Bone Segmentation in Hallux Rigidus.

Weightbearing computed tomography (WBCT) measurements allow evaluation of several anatomical points for a correct clinical-radiographic diagnosis of pathologies, such as hallux rigidus (HR). In addition, a new semiautomatic segmentation software obtains automated 3D measurements from WBCT scan data sets, minimizing errors in reading angular measurements. The study's objective was (1) to evaluate the reliability of WBCT semiautomatic imaging measures in HR, (2) to evaluate correlation and agreement between manual and semiautomatic measures in the setting of HR, and (3) to compare semiautomatic measurements between pathologic (HR) and standard control groups. A retrospective study of HR patients was performed including 20 feet with HR. WBCT manual and semiautomatic 3D measurements were performed using the following parameters: (1) first metatarsal-proximal phalanx angle (1stMPP), (2) hallux valgus angle (HVA), (3) first to second intermetatarsal angle (IMA), (4) hallux interphalangeal angle (IPA), (5) first metatarsal length (1stML), (6) second metatarsal length (2ndML), (7) first metatarsal declination angle (1stMD), (8) second metatarsal declination angles (2ndMD), and (9) metatarsus primus elevatus (MPE). The differences between pathologic and control cases were assessed with a Wilcoxon test. Interobserver and intraobserver agreement for manual vs semiautomatic WBCT measurements demonstrated excellent reliability. According to the Pearson coefficient, there was a strong positive linear correlation between both methods for the following parameters evaluated: HVA (ρ = 0.96), IMA (ρ = 0.86), IPA (ρ = 0.89), 1stML (ρ = 0.96), 2ndML (ρ = 0.91), 1stMD (ρ = 0.86), 2ndMD (ρ = 0.95), and MPE (ρ = 0.87). Comparison between the pathologic group with HR and the control (standard) group allowed for the differentiating of the pathologic (HR) from the non-pathologic conditions for MPE (p < 0.05). Semiautomatic measurements are reproducible and comparable to measurements performed manually, showing excellent interobserver and intraobserver agreement. The software used differentiated pathologic from nonpathologic conditions when submitted to semiautomatic MPE measurements. Level III, retrospective comparative study.

Hallux Valgus Interphalangeus Measurement: Comparison of the Two Radiographic Methods

Category: Midfoot/Forefoot Introduction/Purpose: To determine the reliability of Delta PP (difference in medial and lateral proximal phalanx wall length) compared to HIA (hallux interphalangeal angle) in the assessment of HVI (hallux valgus interphalangeus) in both pre and postoperative radiographs. Methods: This was a retrospective observational study of 186 feet with hallux valgus. The number of cases required to adequately power the study was 128. Preoperative and postoperative hallux alignment were evaluated by two different radiological parameters, Delta PP and HIA. Inter-observer variability was assessed independently by two authors and compared using a intraclass correlation coefficient. Results: The intra-class correlation coefficient was more than 0.8 for all parameters, thus both HIA and Delta PP measurement provide reliable and reproducible data. Mean HIA significantly increased following surgical correction of hallux valgus. In comparison, the mean Delta PP decreased after correction. This postoperative increase in HIA indicates that pre-operative HIA underestimates the magnitude of HVI and therefore is an inaccurate tool for measuring HVI's contribution to the TVDH (total valgus deformity of the hallux) and to preoperative planning. However, the Delta PP was a greater determinant of the phalanx deformity's contribution to the TVDH. Conclusion: The outcome of our study shows that both HIA and Delta PP are reproducible when assessing the hallux valgus interphalangeus deformity, however, Delta PP quantifies the amount of correction obtained more precisely. The additional benefit of measuring the Delta PP is that it allows for accurate planning in determining the dimensions of the medial based wedge of the Akin osteotomy that needs to be resected.

Evaluation of the relationship between hallux valgus and foot measurements in radiographic images of adult female.

In the present study, we aimed to determine the relationship of HV angle with angles and measurements obtained from lateral and anteroposterior (AP) radiological images of the foot in individuals with HV. The present study had a retrospective design, and the participants consisted of 66 female patients between the ages of 19 and 64 who applied to Orthopedics and Traumatology and were diagnosed with Hallux valgus. Metatarsus adductus angle, metatarsus primus adductus angle, hallux valgus angle, hallux interphalangeal angle, metatarsal break angle, first metatarsal protrusion distance, metatarsal width, talocalcaneal angle, AP Meary's angle were measured on AP view and calcaneal inclination angle, talar declination angle, lateral talocalcaneal angle, first metatarsal declination angle, fifth metatarsal declination angle, navicular height, lateral Meary's angle, tibiotalar angle were measured on a lateral radiograph. The IBM SPSS 21.0. program was used for statistical analysis, and the level of significance was taken as p < 0.05. There were statistically significant differences between the right and left feet in MPA and AMA measurements. The results showed that HV angle (HVA) had a weak relationship with MAA and MW, as well as a moderately positive relationship with MPA. However, it had a moderately negative relationship with AMA and a weak negative relationship with HIPA. We believe that in addition to the HVA angle, MPA and AMA angles should be considered in the diagnosis of HV, especially as the HVA angle is moderately positively correlated with the MPA angle and moderately negatively correlated with the AMA angle.

Minimally Invasive Chevron-Akin for Correction of Moderate and Severe Hallux Valgus Deformities: Clinical and Radiologic Outcomes With a Minimum 2-Year Follow-up.

The minimally invasive chevron-Akin (MICA) technique has already demonstrated efficacy compared with other known surgical treatments for mild to moderate hallux valgus (HV). MICA combines percutaneous osteotomies with the benefits of modern, rigid internal fixation. The aim of study was to evaluate the radiographic parameters, clinical improvement, and potential complications in moderate to severe HV cases, operated using the MICA technique. Retrospective study including 70 feet with HV operated using the MICA technique. The AOFAS hallux MTP-IP score and radiographics for HV evaluation were applied preoperatively, and after 6 months, 1 year, and 2 years of follow-up. The following radiographic parameters were measured: metatarsophalangeal hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), interphalangeal angle (IPA), and intermetatarsal angle (IMA). The average preoperative VAS pain score was 8.2 ± 1.5, which improved to 1.2 ± 2.2 at 24 months. The mean preoperative IMA was 14.8 ± 3.6 degrees compared with a mean of 7.5 ± 2.1 degrees (P < .01) at 24 months. The preoperative HVA value averaged 30.4 ± 9.8 degrees and at 6 months postoperatively 11.1 ± 6.8 degrees (P < .01), which remained stable until measured at 24 months. The mean preoperative DMAA was 16.3 ± 8.6 degrees and at the 6-month follow-up was 7.8 ± 5.4 degrees (P < .01). The mean preoperative IPA was 7.63 ± 4.4 degrees compared with a mean of 6.28 ± 3.5 degrees (P > .05) at 24 months. Complications included painful hardware (14.28%), neuropathic pain (2.85%), and loss of correction (4.28%). In this retrospective review from a single center, we found the MICA technique to be an effective procedure for correcting moderate to severe HV, with a low rate of recurrence and an acceptable rate of complications. Patients undergoing the surgical procedure in our series showed a significant reduction in radiographic parameters and a significant improvement in clinical scores, maintaining these results over time. Level IV, retrospective study.

Identification of radiographic characteristics associated with pain in hallux valgus patients: A preliminary machine learning study.

ObjectiveTo investigate the association between the structural deformity and foot pain in hallux valgus (HV) patients using a multi-variate pattern analysis (MVPA) approach.MethodsPlain radiographic metrics were calculated from 36 painful and 36 pain-free HV feet. In analysis 1, univariate analyses were performed to investigate the clinical and radiographic differences between painful and pain-free HV. In analysis 2, we investigated the pattern differences for radiographic metrics between these two groups using a MVPA approach utilizing a support vector machine. In analysis 3, sequential backward selection and exhaustive search were performed as a feature-selection procedure to identify an optimal feature subtype. In analysis 4, hierarchical clustering analysis was used to identify the optimal radiographic HV subtype associated with pain in HV.ResultsWe found that: (1) relative to feet with pain-free HV, the painful ones exhibited a higher hallux valgus angle, i.e., the magnitude of distal metatarsal and phalangeal deviation; (2) painful HV could be accurately differentiated from pain-free HV via MVPA. Using sequential backward selection and exhaustive search, a 5-feature subset was identified with optimal performance for classifying HV as either painful or pain-free; and (3) by applying hierarchical clustering analysis, a radiographic subtype with an 80% pain incidence was identified.ConclusionThe pain in HV is multifactorial and associated with a radiographic pattern measured by various angles on plain radiographs. The combination of hallux valgus angle, inter-phalangeal angle, distal metatarsal articular angle, metatarsal cuneiform angle and metatarsal protrusion distance showed the optimal classification performance between painful and pain-free HV.

Proximal to distal phalangeal articular angle of the first proximal phalanx: Reliability and correlation with round sign

BackgroundTo reduce the rate of correction loss in hallux valgus surgery, a proximal to distal phalangeal articular angle (PDPAA) of the proximal phalanx of the greater toe of> 8° is considered an indication for a combined Akin and Chevron osteotomy. The PDPAA is measured between the articular surfaces of the proximal phalanx of the greater toe. Viewed from a sagittal perspective, the joint surfaces are not perpendicular aligned to the phalanx axis. Therefore, the PDPAA might be confounded by pronation. This study aims to, first, evaluate the intra- and interobserver reliability of the PDPAA and, second, to analyze the correlation to first ray pronation. MethodsIn a consecutive series of 59 feet who underwent hallux valgus (HV) surgery, PDPAA, round sign and other angles were measured on weight-bearing radiographs pre- and postoperatively. After power analysis, the intraclass correlation coefficient (ICC) was used to calculate the intra- and interobserver reliability. The correlation of PDPAA with the round sign as well as angles defining the HV and the Hallux valgus interphalangeus (HVI) were evaluated. ResultsThe PDPAA showed an excellent intra- and interobserver reliability (ICC 0.92 and 0.89, p < 0.05). The round sign did not correlate significantly with the PDPAA (p = 0.51). However, the PDPAA showed a moderate correlation with the interphalangeal angle (r = 0.51, p < 0.05) and fair inversely with the intermetatarsal angle (r = −0.45, p < 0.05). ConclusionFirst, measurement of PDPAA is reliable. Second, PDPAA is not associated with first ray pronation, but a false low PDPAA is geometrically possible. A high PDPAA correlates with a relevant HVI and inversely correlates with the HV like the HVI. Hence, first ray pronation should be treated first and a remaining PDPAA of> 8° after intraoperatively reevaluation separately.

Contribution Ratio of Metatarsal Osteotomy and First Tarsometatarsal Joint Reduction in Moderate to Severe Hallux Valgus Correction.

Hallux valgus is a common foot and ankle disease, for which numerous surgical procedures were introduced. So, understanding the mechanism of deformity reduction is important to select the proper method. Intermetatarsal angle (IMA) determines the severity of hallux valgus, which is influenced by the translated metatarsal head and the reduction of the first tarsometatarsal joint. We hypothesized that both of the mechanisms simultaneously contribute to the correction of IMA. Hallux valgus (70 feet) operated with a Scarf osteotomy with the Akin procedure were reviewed. Hallux valgus angle (HVA), IMA (mechanical and anatomical), hallux valgus interphalangeal angle (HVIP), distal metatarsal articular angle (DMAA), and sesamoid position were checked. The ratio of contributions to the IMA changes were calculated and compared. When the individual contributions by metatarsal head translation and first tarsometatarsal joint reduction were compared, metatarsal head translation contributed by 82%, whereas first tarsometatarsal joint reduction contributed by 18%. Both were responsible for mechanical IMA correction. However, IMA change by metatarsal head translation was a major correction mechanism compared to anatomical IMA change by first tarsometatarsal joint reduction.

Reliability of intraoperative radiographic visual assessment of the hallux interphalangeal angle after hallux valgus correction

Objective: The aim of this study was to evaluate the reliability and reproducibility of visual estimation of the hallux interphalangeal angle (IPA). As a secondary aim we assessed for change in the IPA before and after hallux valgus (HV) correction. Methods: A total of 50 surgically treated HV deformities were included in the study. Two surgeons visually estimated the IPA on intraoperative fluoroscopy after correcting HV. The fellow then measured the IPA formally on a printout of the fluoroscopic image. Pre-and intraoperative HVI angles were compared to assess for change after HV correction. Results: The researchers found the interobserver reliability of radiographic visual assessment of the IPA to be 78% and intraobserver reliability to be 76% and 80% for surgeon 1 and 2, respectively. It was found that the preoperative IPA is on average 5.5 degrees less than IPA after HV correction. Conclusion: Radiographic visual assessment of the IPA of the hallux was found to be reliable intraoperatively, thus aiding in the amount of correction required by Akin osteotomy. HVI can be masked by hallux pronation in HV deformity and should be assessed intraoperatively after HV correction. Level of Evidence II; Therapeutic Studies; Prospective Comparative Study.