Metatarsophalangeal Research Articles

Relationship Between Morphofunctional Alterations of the Foot and Its Functionality in Patients with Fibromyalgia Syndrome: A Case–Control Study

Objective: To evaluate the morphofunctional alterations in the foot and their association with functionality, considering aspects such as disability, pain, and limitations in daily activities in patients with fibromyalgia syndrome (FMS). Methods: A case–control study was conducted in patients with FMS (case group) and without FMS (control group), matched by age and sex. Foot posture was assessed using the foot posture index (FPI), along with the presence of hallux valgus (HV), trigger points, hyperkeratosis, and dorsiflexion of the first metatarsophalangeal joint and ankle. Foot functionality was evaluated using the foot function index (FFI) questionnaire. Results: A total of 100 women with FMS and 100 women without FMS, with a mean age of 61.97 ± 9.26 years, were recruited. HV (p < 0.001), hyperkeratosis (p < 0.001), pronated and supinated foot (p < 0.001), as well as limitations in dorsiflexion of the first metatarsophalangeal joint (p < 0.001) and the ankle with the knee flexed (p < 0.001) and extended (p < 0.001), along with the activity of the flexor hallucis brevis (p = 0.006), adductor hallucis (p = 0.006), and dorsal interosseous (p = 0.002) muscles, were significantly associated with the FFI, being higher in individuals with FMS, indicating greater impairment of foot functionality in these patients. Multivariate analysis revealed a statistical association between FMS and low educational level (OR = 2.57, 95% CI 1.05–5.72), the presence of another rheumatic disease (OR = 5.07, 95% CI 2.34–11), and the presence of any active trigger point (OR = 11.15, 95% CI 3.97–31.31). Conclusions: The study highlights the relationship between morphofunctional foot alterations, specifically the presence of active myofascial trigger points, and functionality in patients with FMS.

Effects of 4 weeks of foot exercise on subjective outcome and foot plantar pressure in elite adolescent dancers with hallux valgus: a pilot study

BackgroundDancers have a higher prevalence of hallux valgus (HV) than the general population. However, no reports specifically addressing treatment strategies for HV in dancers, or their effectiveness have been published. This study aimed to determine the effects of 4 weeks of foot exercises on subjective clinical outcomes, the HV angle, and change of foot plantar pressure during specific dance techniques.MethodsThirteen female elite adolescent dancesport athletes (age: 16.4 ± 3.3 years) completed the program. The HV angle was measured based on foot photographs. Clinical assessments were performed using the visual analog scale for first metatarsophalangeal (1st MTP) joint pain, and the Foot and Ankle Outcome Score. The changes in plantar pressure during two dance techniques (demi-pointe and plié) were measured. The plantar pressure was measured in six areas of the foot. All of these parameters were compared before and after the intervention by using chi-square tests and Student’s paired t-test (statistical significance: p < 0.05).ResultsThe HV angle was significantly reduced from 20.1° to 15.4° after the intervention. Participants reported an average subjective completion rate of 70.3% ± 14.6% over 3 weeks, exhibiting no significant differences despite an apparent trend toward improvement. Significant changes were noted in 1st MTP joint pain and subjective outcomes, and toe function significantly improved in the “paper” movement. The foot-exercise program changed plantar pressure distribution during the demi-pointe and plié techniques, with increased hallux pressure and decreased 2nd-5th MTP joint pressure.ConclusionsIn elite adolescent dancesport athletes, 4 weeks of foot-exercise rehabilitation reduced the HV angle and improved in subjective outcome and function during the two dance techniques. Coaches should consider utilizing foot-exercise training programs in a dancer training program for HV.

Distal sagittal forelimb conformation in young Walloon horses: Radiographic assessment and its relationship with osteochondral fragments.

Osteochondral fragments within equine joints are commonly encountered and may predispose to lameness and limitation to sport purposes. Factors leading to this condition include genetic, nutritional and environmental conditions. However, few studies have evaluated the impact of conformation traits and their correlation with osteochondrosis. This study, based on the radiographic screenings of young horses born in Wallonia (266 individuals, 532 forelimbs), evaluated the correlation between foot, fetlock conformations of the front limb, height at the withers and presence of osteochondral fragments. Moreover, for all traits significantly associated with the presence of osteochondral fragments, a Receiver Operator Characteristic (ROC) curve, area under the curve and optimal cut-off value were calculated to predict the occurrence of fragments. Mean dorsal hoof wall angle was 52.36°, dorsal and palmar angle of the third phalanx were respectively 49.83° and 2.99°, and dorsal metacarpophalangeal angle 147.99°. Moreover, the prevalence of upright feet, defined as having an inclined profile of >2° steeper in relation to its contralateral counterpart, was 24%. Increased palmar angle of the distal phalanx was significantly correlated (P < 0.05) with presence of fragments located at the dorso-proximal margin of the proximal phalanx. The associated area under the curve was 0.623 (95% CI: 0528-0.717, P < 0.05) and the optimal cut-off value to predict fragment occurrence was 2.95° (sensitivity 77.3%; specificity 52.9%). Furthermore, the third metacarpal bone diameter of the left forelimb and height at the withers were significantly (P < 0.05) correlated with the presence of osteochondral fragments in general and within tarsocrural and metatarsophalangeal joints specifically. The area under the curve was 0.585 (95% CI: 0.513-0.656, P < 0.05) with an optimal cut-off value of 152.5 cm (sensitivity 85.1%; specificity 31.2%) for height at the withers to predict presence of osteochondral fragment; to predict the occurrence of osteochondral fragment in any joint on the basis of the third metacarpal bone diameter, the area under the curve was 0.595 (95% CI: 0.524-0.667, P <0.05) and the optimal cut-off value 34.9 mm (sensitivity 52.5%; specificity 64.9%). This study provides information about phenotypic traits associated with osteochondral fragments in horses. Although the diagnostic accuracy of these traits to detect osteochondral fragment was limited, the identification of more phenotypic characteristics could, in the future, make it possible to generate models for accurately identifying individuals at high risk of osteochondral fragments on the basis of their phenotype.

Progressive First Metatarsal Shortening Is Observed Following Dermal Allograft Interpositional Arthroplasty in Hallux Rigidus: Short Report.

The main goal of this study was to evaluate postoperative changes in the length of the first metatarsal (M1) and the proximal phalanx of the hallux (P1) after acellular dermal allograft interpositional arthroplasty (ADA-IPA). We hypothesized that there would be a shortening of the first ray at the first metatarsal, the proximal phalanx, or both. In this retrospective study, we assessed patients who underwent ADA-IPA between 2019 and 2022. On standing anteroposterior (AP) foot radiographs, we measured first metatarsal (M1), second metatarsal (M2), proximal phalanx (P1), and the entire hallux (HX) lengths. M1/M2 and P1/HX ratios were calculated. The first metatarsophalangeal joint space was calculated. All measurements were recorded preoperatively, at 6 weeks postoperatively, and at final follow-up. The pilot study included 11 patients. At final follow-up, we found shortening of M1 and P1 in comparison to the preoperative length, as evidenced by lower M1/M2 (82.6 ± 2.3 vs 75.4 ± 5.1; P = .001) and P1/HX ratios (53.4 ± 2.3 vs 48.9 ± 7.9; P = .001). Follow-up length was negatively correlated with M1/M2 (r = -0.76, P = .003). ADA-IPA might be associated with shortening of both first metatarsal and proximal phalanx, with the former showing progressive shortening.

Dual-energy computed tomography-based radiomics for differentiating patients with and without gout flares.

There is a current lack of data pertaining to the potential link between gout flares and dual-energy computed tomography radiomic features. This study aimed to construct and validate a comprehensive dual-energy computed tomography-based radiomics model for differentiating patients with and without gout flares. The analysis included 200 patients, of whom 150 were confirmed to have experienced at least one flare in the past 12months; the remaining 50 patients did not experience flares. The radiomic features of the tophi at the bilateral first metatarsophalangeal joints were extracted and analyzed. Optimal radiomic features were selected using the least absolute shrinkage and selection operator method, and logistic regression analysis was used to screen clinical characteristics and establish a clinical model. The optimal radiomic features were then combined with the identified independent clinical variables to develop a comprehensive model. The performances of the radiomic, clinical, and comprehensive models were evaluated using receiver operating characteristic curve analysis, calibration curves, and decision curve analysis. Four radiomic features distinguished patients with at least one flare from those without flares and were used to establish the radiomic model. Disease duration and hypertension were independent factors that differentiated flare occurrences. The radiomic, clinical, and comprehensive models showed favorable discrimination, with areas under the receiver operating characteristic curves of 0.76 (95% CI, 0.69-0.83), 0.72(95% CI, 0.63-0.80), and 0.79(95% CI, 0.73-0.86), respectively. The calibration curves (P > 0.05) showed that the differentiated values of the comprehensive model agreed well with the actual values. Decision curve analysis demonstrated that the comprehensive model achieved higher net clinical benefits than the use of either the radiomic or clinical model alone. The results of this study suggest that a radiomics model can distinguish patients with and without gout flares. Our proposed clinical radiomics nomogram can increase the efficacy of differentiating flare occurrence, which may facilitate the clinical decision-making process.

Effect of Custom-Made Foot Orthotics on Multi-Segment Foot Kinematics and Kinetics in Individuals with Structural Hallux Limitus.

The first metatarsophalangeal joint (MTPJ) and the first ray are crucial in walking, particularly during propulsion. Limitation in this joint's sagittal plane motion, known as hallux limitus, can cause compensatory movements in other joints. Some studies assessed the impact of various foot orthoses designs on the foot biomechanics; however, a comprehensive understanding is lacking. This study compared the effects of two custom-made foot orthoses (CFOs) on the foot joint kinematics and kinetics in patients with structural hallux limitus (SHL). In this quasi-experimental study, 24 patients with hallux limitus were assessed in three conditions: (i) barefoot, (ii) shod with a cut-out custom foot orthosis (cut-out CFO), and (iii) shod with an anterior forefoot-stabilized element custom foot orthosis (AFSE CFO), fitted into a minimalist neoprene shoe. Multi-segment foot kinematics and kinetics were assessed during the stance phase of the gait. A decrease in ankle and midfoot inversion, as well as in ankle plantarflexion, was found in both orthotic conditions. Regarding the first MTPJ, a greater dorsiflexion was observed with the patient being barefoot compared to both of the conditions under study. From the current finding, it should be concluded that neither of the custom foot orthoses produced the predefined functional effects.

Zigzag tenotomy of the extensor hallucis longus through minimally invasive surgery in cadaveric specimens: description of a new technique

BackgroundLengthening of the extensor hallucis longus (EHL) is performed to address various forefoot pathologies. The retraction of this tendon is strongly associated with the Hallux Abductus Valgus (HAV) deformity. Minimally Invasive Surgery (MIS) lengthening of the EHL is carried out in combination with other surgical techniques for HAV bone realignment. It is performed without ischemia, using local anesthesia and sedation if required by the patient. One of the advantages of this technique is immediate ambulation with a postoperative shoe without the need for a cast. The objective of the research was to demonstrate the efficacy and safety of the minimally invasive technique for lengthening the tendon in patients with HAV.Materials and methodsThe procedures were performed on 11 fresh cryopreserved cadaveric feet. HAV surgery was performed through dorsomedial and dorsolateral portals for Reverdin-Isham, Akin and adductor tenotomy. In addition, EHL tendon elongation was performed using the Beaver 67 MIS scalpel through an incomplete zigzag tenotomy. The specimens used did not present any type of disease nor had they undergone previous surgeries that could affect the technique. First, the plantar flexion of the metatarsophalangeal joint was measured with a goniometer to establish the degrees of this joint before proceeding with the technique, the tenotomy was performed and remeasured and finally the osteotomy was performed. In addition, an anatomical dissection of cadaveric specimens was performed and various anatomical and surgical relationships were analyzed and measured.ResultsThe data indicate that, after performing zigzag tenotomy, there is an average improvement of 13.91 degrees in plantar flexion.ConclusionsThe study confirms the effectiveness and safety of elongating the extensor hallucis longus tendon of the hallux using minimally invasive surgery. The zigzag technique for tendon elongation may be considered a viable minimally invasive treatment option for addressing tendon hyperextension in patients with HAV.

Forefoot inflammation in recent-onset ACPA-positive and ACPA-negative RA: clinically similar, but different in underlying inflamed tissues

ObjectivesAlthough joint swelling is traditionally interpreted as synovitis, recent imaging studies showed that there is also inflammation of tenosynovium and intermetatarsal bursae in the forefoot. We aimed to increase our...

Return to activities in younger individuals (

Arthrodesis is a common procedure in the treatment of forefoot conditions affecting the first metatarsophalangeal (MTP) joint. Although this procedure has been shown to significantly improve individuals’ activities of daily living and effectively relieve pain, there is a lack of research specifically investigating younger patients below 60 yrs of age wishing to return to sports. Our aim is to evaluate their ability to return to sports after 1st MTP joint arthrodesis. A retrospective analysis of clinical records of 159 patient that had undergone first MTP arthrodesis performed by a single surgeon was undertaken to determine pre- and postoperative sf-FAOS and sporting activity scores. The Tobit constant censoring limit model was used to analyze change in sf-FAOS scores. After the application of inclusion and exclusion criteria, 58 patients (median age 54 years, range 30 – 59) were included in the final cohort with a mean follow up of 5.3 years (range 2.0 to 9.44, SD 2.10). There was a significant improvement in the mean pain score (p<0.001), as well as an improvement in the mean function score (p<0.001). The number of hours spent in sporting activities per week were significantly higher (p<0.001) post-surgery (5.29 hours, SD 5.0) in comparison to preoperative levels (4.26 hours, SD 3.1). There was no significant change in the intensity of sporting activities (p=0.176). First MTP joint arthrodesis remains a good treatment option for younger individuals wishing to achieve a satisfactory return to sports. Level of evidenceLevel 4

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

Prediction of angular correction following first metatarsal-phalangeal joint arthrodesis.

The literature has established that the first metatarsal-phalangeal joint arthrodesis procedure will provide some correction of the first intermetatarsal and hallux valgus angles. But while this has previously primarily been investigated as a simple association (i.e. comparison of pre-operative to post-operative values), the objective of this investigation was to consider angular change as a continuous variable and to specifically correlate it with pre-operative values. Radiographs from 100 consecutive first metatarsal-phalangeal joint arthrodeses meeting selection criteria were evaluated. A negative Pearson correlation coefficient was observed between the pre-operative first intermetatarsal angle and intraoperative change in the first intermetatarsal angle (Pearson -0.547; p<0.001). In other words, with progressively increased levels of pre-operative intermetatarsal angle deformity, one should expect greater intermetatarsal angle correction. The relationship is described by the equation Y = 2.82 – 0.38X indicating that for every one degree of pre-operative intermetatarsal deformity over approximately 7 degrees, 0.38 degrees of post-operative correction might be expected. A negative Pearson correlation was observed between the pre-operative hallux valgus angle and the intraoperative change in the first hallux valgus angle (Pearson -0.806; p<0.001). In other words, with progressively increased levels of pre-operative hallux valgus angle deformity, one should expect greater hallux valgus correction. The relationship is described by the equation Y = 5.5 – 0.63X indicating that for every one degree of pre-operative hallux valgus angle deformity over approximately 9 degrees, 0.63 degrees of hallux valgus angle post-operative correction might be expected. Results of this investigation demonstrate a statistical correlation between pre-operative radiographic deformity and intermetatarsal angle and hallux valgus angle post-operative correction, and might provide foot and ankle surgeons with a degree pre-operative prediction of expected angular correction following the procedure. Level of Evidence3

Influence of medial longitudinal arch flexibility on lower limb joint coupling coordination and gait impulse

BackgroundA causal link exists between structural differences in the foot and alterations in the lower limb biomechanics, which might predispose an individual to develop characteristic musculoskeletal disorders. Research questionThis study aimed to determine how the foot structural characteristics, as represented by the medial longitudinal arch flexibility, affect lower limb joint coupling coordination and anterior-posterior ground reaction impulses (GRIs) during walking and running. MethodsFollowing the calculation of arch height flexibility, a total of fifty-four physically active males were grouped and completed gait experiments to collect kinematic and kinetic data synchronously. Inter-joint coordination and variability were calculated from the angle-angle plots of knee-hip, ankle-knee, and metatarsophalangeal (MTP)-ankle couplings based on an optimized vector coding technique. ResultsOur results indicate that coupling coordination of interest and its variability, as well as anterior-posterior GRIs, could potentially be influenced due to differences in arch height flexibility. Notably, the individuals with stiff arches exhibited significantly greater coordination variabilities during the early stance for both ankle-knee and MTP-ankle coordination yet significantly smaller for MTP-ankle coordination variabilities during the mid-stance phase. Furthermore, combining the statistical parametric mapping analysis results, the flexible arches experienced a greater proportion of GRIs in the anterior-posterior direction. SignificanceIn conclusion, these observations demonstrated that variations in arch flexibility led to differences in lower limb joint coordination variabilities and GRIs during gait. This fresh insight into inter-joint coordinative function may be useful for enhancing foot motion strategies based on arch structural characteristics.

Systemic Inflammation In Asymptomatic Hyperuricemia With Sonographic Crystal Deposits, Including A Comparison With Normouricemia And Gout.

To describe the inflammatory profile of asymptomatic hyperuricemia (AH) with ultrasound evidence of monosodium urate (MSU) crystals (AH-MSUpos), vs AH without deposits (AH-MSUneg), intercritical gout, and normouricemia. Based on serum urate levels, musculoskeletal ultrasound, and history of flares, we divided 122 participants into four groups: normouricemia, AH-MSUneg, AH-MSUpos, and intercritical gout. We tested four ultrasound definitions for MSU deposition in AH: grade 2-3 (G2-3) double contour and/or tophi, G1-3 double contour and/or tophi, G1-3 Stewart scheme (double contour sign in knee cartilage and/or first metatarsophalangeal joint and/or tophi in first metatarsophalangeal joint), and G2-3 Stewart scheme. Serum acute phase reactants, cytokines, pyroptosis derivates, and neutrophil-related proteins were measured and compared between groups. A linear regression model was fitted to correlate crystal and inflammatory burden (measured by ultrasound) with inflammatory markers in hyperuricemics. Rates of MSU deposition in AH ranged from 26.0% to 68.8%, depending on the definition used. Levels of CRP, leukocytes, IL-1RA, IL-6, sIL-6R, IL-18, TNF-α, TGF-β, and galectin-3 were higher in hyperuricemics vs normouricemics. Sex, obesity, and comorbidity scores influenced some comparisons. We saw no differences comparing AH-MSUpos vs AH-MSUneg groups, except for higher calprotectin using G1-3 sonographic definitions and higher CRP and TGF-β when restricted to women and obese participants. Hyperuricemia is associated with substantial inflammation and some degree of active pyroptosis. Four different ultrasound definitions for AH with MSU deposits yielded similar findings, although we noted some differences in calprotectin, CRP, and TGF-β. Sex, obesity, and comorbidities influenced some inflammatory responses.

UNFORESEEN BARRIER IN GOUT TREATMENT: A CASE OF COEXISTING LYME DISEASE

Refractory gout and Lyme disease are distinct conditions that, when coexisting, pose significant diagnostic and therapeutic challenges, particularly in regions endemic for Lyme disease. This case report presents a 49-year-old male with a three-year history of gout, presenting with acute arthritis of the first metatarsophalangeal joint, unresponsive to standard urate-lowering therapy. Despite treatment with colchicine and prednisone, the patient’s symptoms persisted, and inflammatory markers remained elevated. Imaging revealed findings consistent with gouty arthritis, but due to the atypical treatment response, further testing was conducted. Serological analysis confirmed infection with Borrelia burgdorferi, establishing the diagnosis of concurrent Lyme disease. The addition of doxycycline to the treatment regimen resulted in significant clinical improvement within days. This case highlights the importance of considering Lyme disease in patients with refractory gout in areas endemic for Lyme disease. While rare cases of Lyme disease mimicking gout have been reported, this is among the first documented instances of their coexistence. Early recognition and appropriate antibiotic treatment are critical in preventing complications and ensuring optimal management of both conditions.

Subclinical carotid atherosclerosis in gouty patients: relation to musculoskeletal ultrasonographic findings and serum sclerostin level

Objectives. To detect subclinical carotid atherosclerosis in gout patients and its relation to musculoskeletal ultrasound (MSK US) manifestations and serum sclerostin (SCL) levels. Patients and methods. Thirty Egyptian gouty patients were classified into two groups: Group A included 15 patients with diagnostic MSK US manifestations of gout (double contour sign), and Group B included 15 patients without MSK US findings. MSK US was done for both knees and the first MTP joints. Carotid duplex ultrasonography was done to evaluate carotid intima-media-thickness (CIMT) and serum SCL level was measured in all patients by ELISA technique. Results. Gouty patients with MSK US findings had a significantly higher increase in serum SCL levels than those without MSK US findings (p &lt;0.01). Group A patients had a significantly greater CIMT than patients of group B (p &lt;0.01). Serum uric acid and SCL levels were found to be significantly positively correlated. The ROC curve revealed that the optimal SCL cutoff value for detecting positive MSK US findings in gout patients was &gt;25.05 ng/ml. At this level, there was a significant difference between the patients with a CIMT &gt;0.9 mm and the patients with a CIMT ≤0.9 mm (p &lt;0.05). Conclusions. Patients with MSK US manifestations of gout are more liable to have subclinical carotid atherosclerosis than patients without these manifestations. SCL at a certain level &gt;25.05 ng/ml in gout patients might predispose patients to radiographic findings of MSK US of gout and subclinical atherosclerosis.

Local and non-local effects (on the posterior chain) of four weeks of foot exercises: a randomized controlled trial

This study investigated the local, remote, and contralateral effects of a four-week intrinsic foot muscle exercise intervention in recreationally active participants on foot parameters, flexibility, and performance of the posterior chain (PC). Twenty-eight healthy participants (12f, 16m) were randomly assigned to a control group or performed 2 × 6 min of foot exercises twice daily unilaterally at least five days/week for four weeks. At baseline (M1), after the intervention (M2), and after a four-week wash-out period (M3), we assessed bilateral Foot Posture Index-6, medial longitudinal arch mobility, single-leg stance balance, range of motion (ROM) (first metatarsophalangeal joint and ankle), and flexibility and performance of the PC. The FPI-6 score changes over time differed significantly between groups for both legs, improving by 26% in the trained- (p < .001) and 11% in the untrained leg (p = .02) in the intervention group from M1 to M2. Improvements were maintained at M3 for the trained leg (p = .02). Ankle range of motion and balance of the trained leg improved from M1 to M2, yet only became significant at M3 (ROM: p = .02; balance: p = .007). The other parameters did not change significantly. A four-week foot exercise intervention might have local but no remote effects in healthy young adults.German Clinical Trial Register (DRKS00027923) (24/08/2022).

Rigid iatrogenic hallux varus: a decades’ worth experience with arthrodesis of the metatarsophalangeal joint

PurposeArthrodesis of the first ray metatarsophalangeal joint (MPJ) is the gold standard in iatrogenic hallux varus (IHV) in the presence of stiffness and osteoarthritis. The purpose of this study is to collect clinical and radiographic results and complications of MPJ arthrodesis in rigid iatrogenic HV.MethodsA retrospective evaluation of rigid iatrogenic HV undergoing arthrodesis with a minimum follow-up (FU) of two years was performed. The clinical parameters assessed were visual analog scale (VAS), the AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale score and the satisfaction scale. The radiological parameters evaluated the first to second metatarsal angle (IMA) and the angle of hallux valgus (HVA). Complications were also analysed.ResultA total of 18 patients (19 procedures) with a mean FU of 5.5 ± 2.5 years were included. The mean VAS improved from 7.3 ± 1.6 to 1.3 ± 1.2 (p < 0.05) at the last FU. Similarly, the AOFAS Hallux Metatarsophalangeal-Interphalangeal scale score significantly improved to 82 ± 9.2 (p < 0.05). Radiological evaluation demonstrated a 1–2 IMA improvement from 4.4 ± 2.2° preoperatively to 8.9 ± 2.4° at 3 months post-operatively. Similarly, there was a significant (p < 0.05) improvement of the HVA from − 22.7 ± 4.1° to 13.1 ± 4.1° at three months post-operative (p < 0.05). No signification loss of correction was noted at the last follow-up (p > 0.05). In one case, a delayed fusion at the arthrodesis site required surgical revision to promote fusion. No patient experienced pain with stress from the first MTP joint arthrodesis site or identified the arthrodesis site as a source of pain. No patient required implant removal. Re-operation and revision rates were 5.3%. The overall complications rate was 15.8%.ConclusionsMPJ fusion effectively corrects Iatrogenic Hallux Varus in cases of rigid and fixed deformities in the medium- to long-term follow-up, with lasting improvements in AOFAS and VAS scores. The procedure is characterised by a non-negligible risk of complications, reoperations and revisions.Level of evidenceLevel IV, case series.

Effects of Pathological Characteristics on Functional Scores and Surgical Satisfaction in Patients after Hallux Valgus Surgery.

Few studies have explored the relationship between the pathological characteristics of hallux valgus and surgical outcomes. The aim of our study was to report the influence of pathological characteristics such as the tibial sesamoid position (TSP) and first metatarsal pronation on postoperative functional scores and patient satisfaction with hallux valgus surgery. From June 2017 to December 2022, a retrospective analysis was conducted on patients who underwent hallux valgus surgery at our hospital. Anteroposterior (AP) x-ray parameters (hallux valgus angle [HVA], intermetatarsal angle [IMA], distal metatarsal articular angle [DMAA], TSP, first metatarsal pronation, and first metatarsophalangeal joint dislocation) (preoperative weight-bearing, immediate postoperative non-weight-bearing, and early postoperative weight-bearing), visual analog scale (VAS) scores, American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores, SAFE-Q self-administered foot evaluation questionnaire (excluding the Sports Activity subscale), complications, and patient satisfaction were used to describe the outcomes. Correlation analysis and multiple linear regression models were used to identify factors influencing postoperative functional scores and patient satisfaction after hallux valgus surgery. Eighty-one patients (92 feet) whose early radiographic parameters and latest follow-up scores improved significantly (p < 0.01) were included in the present study. The overall complication rate was 27.2%, with recurrence being the most common complication (20.7%). Functional scores and patient satisfaction were associated with age; preoperative, immediate postoperative, and early postoperative HVA; and immediate postoperative IMA (p < 0.05), but not with TSP, first metatarsal pronation, DMAA, callosities, toe deformities, or first metatarsophalangeal joint dislocation (p > 0.05). The R2 values of the multiple linear regression models predicting postoperative functional scores and patient satisfaction ranged from 0.042 to 0.351. TSP and first metatarsal pronation were unrelated to postoperative functional scores or patient satisfaction. This finding enhances surgeons' understanding of the functional prognosis of hallux valgus surgery, particularly aiding in explaining the condition and assessing surgical outcomes.

Synthetic cartilage implant vs. first metatarsophalangeal arthrodesis for the treatment of hallux rigidus.

This study evaluated the outcome of the Cartiva synthetic cartilage implant (SCI) in the treatment of hallux rigidus. In the present retrospective matched case-control study, we compared 18 patients with Cartiva SCI (mean follow-up: 17.7 months) to 18 patients with metatarsophalangeal joint arthrodesis (mean follow-up: 20 months) using multiple function measures, along with four specified visual analog subscales for pain. Pre- and postoperative radiographs were compared, and radiographic abnormalities were documented. We observed no significant differences in function measures between groups. While both groups experienced significant pain reduction, the arthrodesis group reported significantly lower exertion pain than the Cartiva SCI group (p = 0.004). Radiographic abnormalities, including implant site enlargement (6/18, 33.3%), erosive changes of the metatarsal bone (11/18, 61.1%) or articular surfaces (10/18, 55.6%), and bright sclerotic margins (12/18, 66.7%), occurred in the Cartiva SCI group. The present study showed good functional results and a high satisfaction rate after MTP joint arthrodesis, which is considered the gold standard surgical treatment for higher grade hallux rigidus. While the Cartiva SCI group did not show significant differences from the arthrodesis in most aspects of function and clinical scores, the arthrodesis group tended to have better results in terms of satisfaction, residual pain, and revision rate. Even after the short follow-up period, there were some remarkable radiographic findings in the Cartiva SCI group, the long-term effects of which are not yet evident, but which may lead to implant loss. Cartiva SCI has advantages for patients who prioritize postoperative mobility, but the potential risks should be considered in the patient's informed consent. Therefore, the present study highlights the importance of MTP joint arthrodesis for the treatment of hallux rigidus. Level IV - Retrospective matched case-control study.

Early effectiveness of modified minimally invasive Chevron-Akin osteotomy for moderate to severe hallux valgus

To explore early effectiveness of modified minimally invasive Chevron-Akin (MICA) osteotomy in the treatment of moderate to severe hallux valgus. A clinical data of 49 patients (61 feet) with moderate to severe hallux valgus, who met the selection criteria between December 2019 and October 2022, was retrospectively analyzed. There were 7 males (8 feet) and 42 females (53 feet) with an average age of 38.0 years (range, 15-59 years), including 37 of unilateral foot and 12 of bilateral feet. There were 41 feet of moderate hallux valgus [hallux valgus angle (HVA) 20°-40°] and 10 feet of severe hallux valgus (HVA>40°). All patients underwent modified MICA osteotomy. A transverse osteotomy on the distal end of the first metatarsal bone was performed to replaced the traditional Chevron osteotomy, and three Kirschner wires were used to assist in three-dimensional correction. The other treatments were the same as traditional MICA osteotomy. The HVA, inter metatarsal angle (IMA), Hardy score of the sesamoid, and American Orthopaedic Foot and Ankle Society (AOFAS) score of 61 feet before operation and at last follow-up were recorded, and the results were compared between the various severity of hallux valgus. All patients were followed up 6-24 months with an average of 12.0 months. After operation, the redness and swelling around the incision occurred in 1 foot; limited mobility of the metatarsophalangeal joint occurred in 2 feet; mild numbness of the skin occurred in 5 feet; mild inversion of the great toe occurred in 2 feet. No complication such as tendon injury was found. X-ray films showed no abnormal healing, nonunion, or necrosis of the metatarsal head after osteotomy. The healing time of osteotomy ranged from 3 to 4 months, with an average of 3.2 months. At last follow-up, the HVA, IMA, Hardy score of sesamoid, and AOFAS scores all significantly improved when compared with preoperative levels ( P<0.05). The AOFAS scores were excellent in 45 feet, good in 15 feet, and fair in 1 foot, with an excellent and good rate of 98.4%. The above indicators for moderate or severe hallux valgus patients were significantly improved when compared with preoperative levels ( P<0.05). The changes between pre- and post-operation in HVA, IMA, and Hardy scores of severe hallux valgus were all greater than those of moderate hallux valgus, with significant difference in HVA change between groups ( P<0.05), while there was no significant difference in the other two changes ( P>0.05). Modified MICA osteotomy can achieve good orthopedic effects and early functional improvement in the treatment of moderate to severe hallux valgus.