Treatment Of Moderate Hallux Valgus Research Articles

Republication of "Evidence Versus Practice: Operative Treatment Preferences in Hallux Valgus".

There is substantial variability in the operative treatment of hallux valgus despite the existence of high quality evidence to guide treatment decisions. The purpose of this study was to determine the current trends in the treatment of mild, moderate, and severe hallux valgus and if greater degrees of consensus correlate with the presence of higher-level evidence. Members of the American Orthopaedic Foot & Ankle Society completed a 14-item survey. A total of 131 (14%) of 922 members completed the survey. Three cases representing 3 stages of HV were presented, and respondents selected their preferred treatment. Preferred forms of proximal and distal metatarsal osteotomies, as well as mode of fixation for each, were inquired. In the treatment of mild hallux valgus without second metatarsalgia, 80% of those surveyed chose a distal metatarsal osteotomy, while, if second metatarsalgia was present, 56% chose a distal metatarsal osteotomy with a second metatarsal-shortening osteotomy. In the treatment of moderate hallux valgus, there was generally less consensus, while, in the treatment of severe hallux valgus, a majority of those surveyed chose a Lapidus procedure, with the addition of a second metatarsal-shortening osteotomy in the presence of second metatarsalgia. The most popular distal and proximal metatarsal osteotomies, respectively, were chevron osteotomy (80%) and opening wedge osteotomy (33%). The presence of Level I evidence did not significantly correlate with higher degrees of consensus. Despite the existence of high-quality evidence supporting the use of certain procedures in the treatment of HV, there exists an apparent lack of consensus among surgeons about the choice of surgical procedures. Moreover, higher-level evidence was not correlated with greater consensus in hallux valgus. Level II.

Percutaneous minimally invasive osteotomy with 8-shaped bandage and hallux valgus splint fixation for the treatment of moderate hallux valgus

To observe clinical effect of percutaneous minimally invasive osteotomy with 8-shaped bandage and hallux valgus splint fixation in treating moderate hallux valgus. Totally 23 patients with moderate hallux valgus were treated with percutaneous minimally invasive osteotomy with 8-shaped bandage and hallux valgus splint fixation from August 2019 to January 2021, and 1 patient was loss to follow-up, and finally 22 patients(30 feet) were included, 4 males (6 feet) and 18 females(24 feet), aged from 27 to 66 years old with an average of(50.59±11.95) years old. Hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsal span (the distance between the first and the fifth metatarsal bones), changed of soft tissue width, American Orthopaedic Foot and Ankle Society(AOFAS) score, and Visual Analogue Scale (VAS) were collected and compared before operation and 6 months after operation. Twenty-two patients were followed up from 5.7 to 6.4 months with an average of (6.13±0.85) months. The first metatarsal osteotomy of patients were obtained bone union, and deformity of the toes was corrected. Complications such as avascular necrosis of metatarsal head and transfer metatarsalgia were not occurred. Postoperative HVA, IMA, metatarsal span, soft tissue width, VAS, AOFAS score at 6 months were significantly improved compared with pre-operation (P<0.01). According to AOFAS score at 6 months after operation, 10 feet were excellent, 18 good and 2 poor. Two feet with poor were excellent after prolonged 8-shaped bandage and hallux valgus splint fixation time. Percutaneous minimally invasive osteotomy with 8-shaped bandage and hallux valgus splint fixation for the treatment of moderate hallux valgus could better correct deformity of hallux valgus, relieve foot symptoms, good recovery of postoperative function, and has a significant clinical efficacy.

Special Issue No. – 10, June, 2020 Journal &gt; Special Issue &gt; Special Issue No. – 10, June, 2020 &gt; Page 5 “Quantative Methods in Modern Science” organized by Academic Paper Ltd, Russia MORPHOLOGICAL AND ANATOMICAL FEATURES OF THE GENUS GAGEA SALISB., GROWING IN THE EAST KAZAKHSTAN REGION Authors: Zhamal T. Igissinova,Almash A. Kitapbayeva,Anargul S. Sharipkhanova,Alexander L. Vorobyev,Svetlana F. Kolosova,Zhanat

Special Issue No. – 10, June, 2020 Journal &gt; Special Issue &gt; Special Issue No. – 10, June, 2020 &gt; Page 5 “Quantative Methods in Modern Science” organized by Academic Paper Ltd, Russia MORPHOLOGICAL AND ANATOMICAL FEATURES OF THE GENUS GAGEA SALISB., GROWING IN THE EAST KAZAKHSTAN REGION Authors: Zhamal T. Igissinova,Almash A. Kitapbayeva,Anargul S. Sharipkhanova,Alexander L. Vorobyev,Svetlana F. Kolosova,Zhanat

A new minimally extended distal Chevron osteotomy (MEDCO) with percutaneous soft tissue release (PSTR) for treatment of moderate hallux valgus

PurposeSurgical treatment of moderate hallux valgus (HV) onwards by Chevron osteotomy and all variants described to date including the recent extended distal Chevron osteotomy (EDCO), yields improvable outcome but with recurrence rate. A new modification of this technique is needed to achieve better results. Methods34 consecutive female patients suffering from moderate HV underwent a new minimally extended distal Chevron osteotomy (MEDCO) with percutaneous soft tissue release (PSTR). Outcome was assessed using pre-post operative VAS-Pain, AOFAS Hallux Score and radiological measurements. Mean age was 53.7 years, follow-up 2.7 years and satisfaction score 8. ResultsVAS improved from 7 to 1 (p < 0.001) and AOFAS score from 64 to 90.7 (p < 0.001). Comparing postoperative HV and intermetatarsal (IM) angles of previous studies (either employing a Chevron osteotomy alone or a double Chevron-Akin) with our results, an improvement from 15.6/14.8 to 9.1 and 8.2 /8.8 to 5.6 respectively (p < 0.05) was achieved. Complication and recurrence rates were both 5.8%, lower than the documented rates of other techniques. ConclusionThe modified technique in the present study was found to be a more effective and reliable method of correcting hallux valgus when compared to other previous procedures. It provides a higher level of satisfaction and excellent outcomes with low complication and recurrence rates. Furthermore, the percutaneous lateral incision improved the cosmetic results by avoiding formation of a dorsal first web space scar. Medial incision is also shorter than the one used for EDCO. Level of evidenceLevel IV, case series.

Evidence Versus Practice: Operative Treatment Preferences in Hallux Valgus

Background: There is substantial variability in the operative treatment of hallux valgus despite the existence of high quality evidence to guide treatment decisions. The purpose of this study was to determine the current trends in the treatment of mild, moderate, and severe hallux valgus and if greater degrees of consensus correlate with the presence of higher-level evidence. Methods: Members of the American Orthopaedic Foot &amp; Ankle Society completed a 14-item survey. A total of 131 (14%) of 922 members completed the survey. Three cases representing 3 stages of HV were presented, and respondents selected their preferred treatment. Preferred forms of proximal and distal metatarsal osteotomies, as well as mode of fixation for each, were inquired. Results: In the treatment of mild hallux valgus without second metatarsalgia, 80% of those surveyed chose a distal metatarsal osteotomy, while, if second metatarsalgia was present, 56% chose a distal metatarsal osteotomy with a second metatarsal-shortening osteotomy. In the treatment of moderate hallux valgus, there was generally less consensus, while, in the treatment of severe hallux valgus, a majority of those surveyed chose a Lapidus procedure, with the addition of a second metatarsal-shortening osteotomy in the presence of second metatarsalgia. The most popular distal and proximal metatarsal osteotomies, respectively, were chevron osteotomy (80%) and opening wedge osteotomy (33%). The presence of Level I evidence did not significantly correlate with higher degrees of consensus. Conclusion: Despite the existence of high-quality evidence supporting the use of certain procedures in the treatment of HV, there exists an apparent lack of consensus among surgeons about the choice of surgical procedures. Moreover, higher-level evidence was not correlated with greater consensus in hallux valgus. Level of Evidence: Level II.

Modified Proximal Scarf Osteotomy for Hallux Valgus.

BackgroundWe developed a modified proximal scarf osteotomy technique for moderate to severe hallux valgus in an attempt to obtain better correction of the deformity. In addition, we compared the clinical and radiographic results of this modified technique with those of the classic scarf osteotomy reported in other studies.MethodsBetween December 2004 and July 2009, 44 cases of modified proximal scarf osteotomy was performed in 35 patients with moderate hallux valgus. The American Orthopedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, range of motion of the first metatarsophalangeal joint, and radiographic results were evaluated.ResultsThe mean hallux valgus angle and the mean first intermetatarsal angle improved from an average of 32.2° and 14.3°, respectively, to an average of 12.5° and 8.6°, respectively. The distal metatarsal articular angle improved from an average of 18.7° to 12.4°. The preoperative mean AOFAS and VAS scores were 47 points and 7 points, respectively, which improved to 86 points and 1 point, respectively, at the final follow-up. Limited range of motion occurred in two cases postoperatively. The height of the first metatarsal-cuneiform joint, which was an average of 15.9 mm preoperatively, did not change. The first metatarsal-talus angle increased from an average of 4.1° to 7.1°.ConclusionsThe modified proximal scarf osteotomy for the treatment of moderate hallux valgus showed similar results with the classic scarf osteotomy with regard to changes in the first intermetatarsal angle and postoperative satisfaction. Therefore, we suggest the modified proximal scarf osteotomy be considered as well as other proximal osteotomy in the treatment of moderate to severe hallux valgus.

Osteotomía en tejadillo (“Chevron”) con técnica MIS (“Minimally invasive surgery”) del primer metatarsiano. [Chevron osteotomy with minimally invasive surgery (MIS) of the first metatarsal.

&lt;p&gt;&lt;strong&gt;Objetivo&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;/strong&gt;El objetivo del presente estudio, fue analizar los resultados radiológicos de una osteotomía en tejadillo (“Chevron”) con técnica MIS (&lt;em&gt;Minimally invasive surgery&lt;/em&gt;) del primer metatarsiano en una población uniforme de pacientes (hallux valgus moderado).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material y Métodos&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;/strong&gt;Entre octubre del año 2013 y noviembre del año 2014, se realizó el tratamiento quirúrgico del hallux valgus mediante una osteotomía en tejadillo (“Chevron”) con técnica MIS del primer metatarsiano en 24 pies correspondientes a 21 pacientes. Todos los pacientes presentaban diagnóstico de hallux valgus moderado.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Resultados&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;/strong&gt;El ángulo intermetatarsiano entre primero y segundo metatarsiano preoperatorio promedio fue de 12,46° (Rango: 11 a 15°; Desvío estándar o DE 1,03). En el postoperatorio se obtuvo el siguiente valor promedio: 8,13° (Rango: 5 a 10°; DE 1,16). La corrección angular fue de 4,33° promedio. El ángulo de hallux valgus preoperatorio promedio fue de 33,96° (Rango: 20 a 40°; DE 4,93). En el postoperatorio, el ángulo metatarsofalángico fue de 8,16° promedio, con rango entre 3° y 15° y con un DE 2,86. La mejoría promedio del ángulo MTF fue de 25,86°.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discusión&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;/strong&gt;La corrección radiológica obtenida mediante la técnica mínimamente invasiva de la osteotomía en “tejadillo” confirma un seguro y efectivo procedimiento para el tratamiento del hallux valgus moderado, con correcciones angulares satisfactorias a mediano plazo. El mencionado procedimiento remeda de manera fidedigna la técnica quirúrgica abierta con todas sus virtudes conocidas y no fue encontrado estudio equivalente en la bibliografía.&lt;/p&gt;

Surgical Treatment of Moderate Hallux Valgus: A Comparison of Distal Chevron Metatarsal Osteotomy With and Without Lateral Soft-Tissue Release

The purpose of the study was to determine whether lateral soft-tissue release (LSTR) has a beneficial or detrimental effect on the outcome of distal Chevron first metatarsal osteotomy (DCMO) in the treatment of moderate hallux valgus (HV). We compared the effect of different surgical treatments in 2 groups of patients: group I (23 patients, 25 feet, average age of 55 [from 43 to 77] years) was subjected to DCMO only, whereas group II (18 patients, 23 feet, average age of 59 [from 52 to 70] years]) was subjected to DCMO with LSTR. The American Orthopaedic Foot and Ankle Society's Hallux Metatarsophalangeal-Interphalangeal scale survey was conducted postoperatively, followed by the brief survey on postoperative patient satisfaction. The patient follow-up period was from 18 to 24 months after surgical treatment, on average. After surgical intervention, both groups of patients presented with an improved HV angle, but there was no significant difference between the groups. However, group II showed significant improvements in medial sesamoid bone position and patient satisfaction scores as compared with group I. Our midterm follow-up of surgical treatments for moderate HV deformity suggests that both procedures provide good postoperative results. However, according to our results, DCMO with LSTR provides better results than procedures without LSTR. Therapeutic, Level III: Retrospective comparative study.

Treatment of moderate Hallux valgus with a mini TightRope ® system: A modified technique

Objective To evaluate the clinical and radiological results in the treatment of moderate Hallux valgus with a minimally invasive system: Mini Tightrope ® (MTR). Material and methods We selected 32 patients, 36 feet (4 bilateral), with moderate Hallux valgus according to the criteria of Mann and Coughlin, and performed the Mini Tightrope ® modified technique. The American Orthopaedic Foot and Ankle Society (AOFAS) scale, the measurement of intermetatarsal angle (IMA) and metatarsophalangeal (MTT-F), sesamoid position, first toe mobility and the level of satisfaction, were assessed in these patients. Results A mean score of 88.0 points was obtained on the AOFAS scale (47.7 preoperative) after 24 months. In the last visit the radiographic correction of the IMA and the AH was 4.8° and 10.0° on average, respectively. There were 6 complications during follow-up (16%), 2 of which led to the patient being reoperated. Discussion and conclusions The Mini Tightrope ® is a reproducible technique that allows the treatment of moderate Hallux valgus. It achieves the same correction as osteotomies but preserving and avoiding the complications arising from those, being similar to less invasive percutaneous techniques. However, it is not without complications, some of them specific to this technique, which need to be determined.

Tratamiento del Hallux valgus moderado con sistema mini TightRope ®: técnica modificada

Objective To evaluate the clinical and radiological results in the treatment of moderate Hallux valgus with a minimally invasive system: Mini Tightrope ® (MTR). Material and methods We selected 32 patients, 36 feet (4 bilateral), with moderate Hallux valgus according to the criteria of Mann and Coughlin, and performed the Mini Tightrope ® modified technique. The American Orthopaedic Foot and Ankle Society (AOFAS) scale, the measurement of intermetatarsal angle (IMA) and metatarsophalangeal (MTT-F), sesamoid position, first toe mobility and the level of satisfaction, were assessed in these patients. Results A mean score of 88.0 points was obtained on the AOFAS scale (47.7 preoperative) after 24 months. In the last visit the radiographic correction of the IMA and the AH was 4.8° and 10.0° on average, respectively. There were 6 complications during follow-up (16%), 2 of which led to the patient being reoperated. Discussion and conclusions The Mini Tightrope ® is a reproducible technique that allows the treatment of moderate Hallux valgus. It achieves the same correction as osteotomies but preserving and avoiding the complications arising from those, being similar to less invasive percutaneous techniques. However, it is not without complications, some of them specific to this technique, which need to be determined.