Treatment Of Severe Hallux Valgus Research Articles

Comparison of Radiographic and Clinical Outcomes between Distal and Proximal Minimally Invasive Chevron and Akin Osteotomy for Severe Hallux Valgus Deformity

Category: Midfoot/Forefoot; Midfoot/Forefoot Introduction/Purpose: The surgical treatment of severe hallux valgus (HV) deformity is challenging due to the difficulty in achieving sufficient reduction and the increased risk of complications such as recurrence, delayed or non-union. Minimally invasive surgery (MIS) has been increasingly used to treat HV deformity, with the third-generation minimally invasive Chevron and Akin osteotomies (MICA) technique being widely accepted. This retrospective cohort study aimed to compare the radiographic and clinical outcomes between the distal and proximal MICA techniques for severe hallux valgus deformity. It was hypothesized that the proximal MICA technique would provide better radiographic results due to the stronger deformity correction achieved by the proximal metatarsal osteotomy. Methods: Seventy-four feet with severe HV (defined as HVA [≥40 degrees] and/or IMA [≥20 degrees]) treated with distal MICA (40 feet) or proximal MICA (34 feet) were included in this study after at least one year of follow-up. Clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score, pain visual analog scale (VAS), patient satisfaction rating, and complications. Radiographic assessments included HV angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA). Results: There were no differences in the mean AOFAS score, pain VAS score, and patient satisfaction rate at the final follow-up between the two groups (all p > .05). The mean postoperative HVA, IMA, and DMAA significantly improved at the final follow-up in both groups (all p < .001). There was no significant difference in the improvement of radiographic values after surgery between the two groups (all p > 0.05). Although not statistically significant, there was a trend toward a higher recurrence and delayed or nonunion rate in the distal MICA group (7.5% vs. 2.9%, P =.218 and 10% vs. 2.9%, P =.072). Conclusion: Both types of minimally invasive techniques resulted in satisfactory outcomes in terms of significant improvement in clinical values, large deformity correction, and reasonable complication rates. However, the proximal MICA technique appears to provide more stable maintenance of deformity correction than the distal technique.

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.

Complications of First Tarsometatarsal Joint Arthrodesis

Category: Bunion Introduction/Purpose: Hallux valgus, a term introduced by Carl Hueter (1) to define static subluxation of the first metatarsophalangeal joint characterized by lateral deviation of the hallux and medial deviation of the first metatarsal, (1,2) is a disease for which different corrective surgical techniques can be used, depending on its severity. First tarsometatarsal joint (TMTJ) arthrodesis, also known as Lapidus, is one of the surgical procedures used in the treatment of severe hallux valgus, among other alterations (3-5). Despite the high satisfaction rate and high corrective power, this technique is not without complications. The main com- plications include delayed union, malunion, chronic edema, persistent pain, nonunion, joint stiffness, recurrent deformity, and varus deformity (6). However, there is little scientific evidence of these complications after first TMTJ arthrodesis. The purpose of this study was to report the complications of first TMTJ arthrodesis performed by orthopedic surgeons specializing in foot and ankle surgery. Methods: This study was approved by the institutional research ethics committee and registered at Plataforma Brasil. We evaluated 16 patients undergoing first TMTJ arthrodesis, who denied any comorbidities. The procedures were performed by 7 different orthopedic surgeons specializing in foot and ankle surgery with different levels of experience, ranging from 1 to 29 years of experience in the field. All patients underwent arthrodesis with plates and screws. The plate was placed on the plantar aspect of the first tarsometatarsal in 4 patients and on the anteromedial aspect in all other patients. The dorsomedial incision was used, centered on the first TMTJ, for the 12 cases in which the plate was positioned in the dorsomedial region, and the medial incision was used for the 4 cases in which the plate was positioned on the plantar aspect. Also, articular cartilage was resected using a chisel and microperforations. All 16 patients were followed up in an outpatient clinic at 1, 2, 4, 6, 12, and 24 weeks postoperatively. The follow-up visits included the evaluation of anteroposterior, lateral, and oblique radiographs of the foot, clinical alignment of the hallux, and patients' signs and symptoms. For all patients, postoperative care included immobilization in a non-weight-bearing cast for 4 weeks, initiation of physical therapy with range of motion gain at 4 weeks, and partial weight- bearing at 6 weeks Results: We evaluated 16 patients operated on over an 18-month period (from February 2017 to August 2018). We measured preoperative and postoperative hallux valgus and intermetatarsal angles (Table 1). Eight patients had either major or minor complications (Table 2). Three patients had recurrent deformity (1 with associated nonunion), 2 had delayed union, 2 had hardware loosening (Figure 1) - 1 with associated nonunion (Figure 2), and 1 had wound dehiscence. Conclusion: Based on our study, we can conclude that first TMTJ arthrodesis requires greater care in choosing the surgical technique for the treatment of hallux valgus. In addition, some points should be considered to avoid complications as much as possible, such as the use of implants to increase stability, instruments for better articular cartilage resection, and improvement in the correction of the pronation deformity of the hallux. The limitations of our study prevent us from drawing a robust conclusion and defining consistent parameters related to the main factors that may affect the various complications described in the study. Therefore, we believe that data are still scarce to provide a concrete basis, and further studies are needed to make substantiated conclusions.

Clinical and radiological outcomes of the first metatarsophalangeal arthrodesis with Kirschner wires for the treatment of severe hallux valgus

Objective: To present the clinical and radiographic outcomes of metatarsophalangeal arthrodesis of the hallux with crossed Kirschner wires and cerclage for the treatment of severe hallux valgus. Methods: Twenty-nine feet of 21 consecutive patients who underwent metatarsophalangeal arthrodesis to correct severe hallux valgus between March 2011 and April 2018 were clinically and radiographically evaluated. Results: After an average follow-up period of 42 months, 17 feet (58.6%) generated a response of total satisfaction with the procedure and 12 (41.4%) a response of satisfied with reservations; none of the patients were dissatisfied. Pain assessed using the visual analog scale improved from a mean of 8 before the procedure to 1.2 at follow-up. The American Orthopaedic Foot and Ankle Society score improved from a mean of 26.5 points before the procedure to 78 points at follow-up. The hallux valgus angle improved from a mean of 38.5° in the preoperative period to 13.1° at follow-up, i.e., an improvement of 25.4°. The intermetatarsal angle improved from a mean of 18.8° in the preoperative period to 15° at follow-up. Consolidation of arthrodesis occurred in all cases, but reintervention was required to remove the hardware in 17 operated feet (58.6%). Conclusion: Metatarsophalangeal arthrodesis with crossed Kirschner wires and cerclage for the treatment of severe hallux valgus produced high rates of satisfaction, with substantial improvement in pain and functional parameters, consolidation in all cases and excellent radiological correction, but had the drawback high rate of reintervention for hardware removal. Level of Evidence IV; Therapeutic Study; Case Series.

Minimally invasive technique with intramedullary nail for treatment of severe hallux valgus

Objective: The purpose of the study was to evaluate early clinical and radiological results with a novel minimally invasive surgery (MIS) technique for Lapidus arthrodesis using intramedullary nail. Methods: Retrospective review of patients with hallux valgus surgery during an 18-month period. Patients with a procedure other than MIS Lapidus nail fixation were excluded. We describe surgical technique with a percutaneous joint preparation and fixation with an intramedullary nail through a MIS approach. Demographic variables, early complications and radiographic parameters were measured. Results: Ten feet in 8 patients with severe HV underwent a Lapidus procedure performed with a minimal invasive technique using intramedullary nail for fixation. No soft tissue complications and 1 patient required screw removal after bone healing. Mean HVA decreased from 31,4 degrees (range 17 to 47) SD (±9,3) to 10,3 degrees (range, -8,8 to 31,5) SD (±8,4), mean IMA decreased from 17,91 degrees (range, -17 to 20) SD (±0,9) to 5,46 degrees (range, –7,3 to 15.3) SD (±2,9) and mean DMAA decreased from 20,36 (range, 10-40) SD (±8,4) to 7,67 (range, -5 to 30) SD (±8,0). Conclusion: Intramedullary nail for Lapidus arthrodesis with minimally invasive technique showed satisfactory radiographic correction and minimal complications, but further follow up is needed to analyze clinical-radiographic results. Level of Evidence IV; Therapeutic Study; Case Series.

Results of the Application of the Original Method of Surgical Treatment of Patients with Severe Hallux Valgus

Background. Traditional methods of surgical treatment of severe Hallux valgus (HV) lead to a large number of complications and poor results. In order to avoid complications and improve the quality of treatment, an original technique of double osteotomy of the first metatarsal bone has been proposed. The aim of the study was to conduct a comparative assessment of the results of applying the original technique in the treatment of patients with severe Hallux valgus. Materials and methods. A retrospective analysis of the treatment of 95 patients operated on at the Seversk Clinical Hospital for severe Hallux valgus in the period from 2008 to 2016 was performed. The study group included 60 patients who underwent surgery according to the original method. In a comparison group of 35 people, Logroshino's surgery was performed. Clinical, radiological, surgical and statistical research methods were used. Results. The final assessment of the results 1 year after the operation showed an unacceptably high number of Hallux valgus relapses, complications, and unsatisfactory results in the comparison group. The use of original approachesfor osteotomy of the first metatarsal bone in patients of the study group allowed to significantly improve treatment results and achieve good results in 85 % of cases. Conclusion. The proposed surgical technique is effective and shows statistically significantly better results 1 year after surgery. Application of the original technique will improve the results of surgical correction of the severe degree of Hallux valgus, which consists in reducing the number of complications and improving functional indicators.

TL 18241 - Preliminary results of the correction of metatarsus adductus associated with severe hallux valgus

Objective: To evaluate the preliminary results of angular corrections from a series of cases of surgical treatment of severe hallux valgus associated with metatarsal adduction. Methods: Data were retrospectively collected from the medical records and pre- and postoperative radiographs of patients undergoing Lapidus arthrodesis combined with lateral rotation osteotomy at the bases of the second and third metatarsals. The following angle measurements were performed before and after surgery: hallux valgus angle, intermetatarsal angle, and the degree of adduction of metatarsal bones (measured using Sgarlato’s and Engel’s angles). The mean follow-up period was 18 months (16-24 months). Results: The mean hallux valgus correction angle was 31° (19-53°), and the mean intermetatarsal correction angle was 5.771° (2-9°). Regarding forefoot adduction, the mean correction angle measured was 15.57° (12-21°) when the Sgarlato technique was used and 15.71° (10-22°) when the Engel technique was used. All measured angles decreased significantly in the postoperative evaluation. Conclusion: Rotational osteotomy at the bases of the second and third metatarsals was effective for correcting metatarsal adduction, allowing the alignment of the first metatarsal and therefore the correction of the deformity.

PO 18197 - PROMO technique for hallux valgus treatment

Introduction: Hallux valgus (HV) deformity is a prevalent condition that affects several aspects of the foot, causing pain, imbalance, immobility and increased risk of falls. Various osteotomies have been described for HV treatment, and osteotomy is the best option currently available among hundreds of surgical techniques, although no osteotomy is considered better than any other. The incidence of complications is associated with the degree of deformity, which may be defined according to the HV angle, the intermetatarsal angle and the degree of sesamoid subluxation. When the deformity is diagnosed as severe, the risk of recurrence is higher. Wagner et al. (2017) focused on controlling these complex cases and described a technique called Proximal ROtational Metatarsal Osteotomy (PROMO), inspired by the rotational osteotomy for Blount’s disease. Objective: To present the outcomes of 10 cases of severe HV (16 feet) treated using the PROMO technique. Methods: The pre- and postoperative data of 16 consecutive patients treated at a private hospital in São Paulo, SP, were collected. All patients were treated using the PROMO technique described by Wagner et al., and radiographs were taken to measure the parameters and collect records. A calculator programed in Microsoft Excel®, together with a cell phone application, were used to calculate the target angle correction power and osteotomy angle according to a process is described in this study. Results: There was satisfactory improvement in the American Orthopedic Foot and Ankle Society (AOFAS) score and subjective pain in all cases, in addition to a clear resolution of the deformity on physical examination and on radiographs. The union time; complications, such as symptomatic or asymptomatic pseudarthrosis; and angle correction power are also described in the present study. Conclusion: The PROMO technique is a safe and interesting option for the treatment of severe HV that has low rates of complications and a high angle correction power.

Preliminary results of the correction of metatarsus adductus associated with severe hallux valgus

Objective: Although hallux valgus is a common diagnosis and there are different well-described techniques for its correction, the presence of this deformity associated with a diagnosis of metatarsus adductus is relatively uncommon, and there is no consensus regarding surgical treatment. The objective of this study was to evaluate the preliminary radiographic results of angular corrections obtained in a series of cases of the surgical treatment of severe hallux valgus associated with adduction of the metatarsal bones, following the technique proposed herein. Methods: Retrospective data were collected from the medical records and pre- and postoperative radiographs of patients subjected to Lapidus arthrodesis combined with lateral rotation osteotomy at the bases of the second and third metatarsals. The following angular measurements were performed before and after surgery: hallux valgus angle, intermetatarsal angle, and the degree of adduction of metatarsal bones (measured by Sgarlato’s and Engel’s angles). The mean follow-up period was 18 months (16-24 months). Results: The mean hallux valgus correction angle was 31° (19-53°), and the mean intermetatarsal correction angle was 5.771° (2-9°). Regarding the forefoot adduction, the mean correction angle measured by the Sgarlato technique was 15.57° (12-21°) and by the Engel technique was 15.71° (10-22°). All of the measured angles decreased significantly in the postoperative assessment. Conclusion: Lapidus arthrodesis combined with rotational osteotomy at the bases of the second and third metatarsals proved to be effective for correcting the adduction of the metatarsals, allowing for the alignment of the first metatarsal and consequent correction of the deformity. Level of Evidence IV; Therapeutic Studies; Case Series.

Minimally invasive double-level osteotomy of the first metatarsus for treatment of severe hallux valgus

Background Surgery for the treatment of severe hallux valgus (HV) is commenced to correct the forefoot deformity, provide metatarsalgia relief, and provide a stable biomechanically functional foot. Many surgeons advocate moving from open surgery to minimally invasive techniques, replacing large incisions with smaller ones through which the surgeon can work. Minimally invasive techniques have been successfully used for mild to moderate HV deformities; however, controversy exists for their use in cases with more severe involvement. The aim of this prospective study was to assess the clinical and radiological outcomes of a minimally invasive technique for management of severe HV deformity. Patients and methods Between March 2015 and August 2017, a total of 24 feet in 18 active patients, comprising 11 female and seven male patients, with six patients having bilateral involvement, met our selection criteria for symptomatic severe HV deformity and were treated with a minimally invasive double-level metatarsal osteotomy technique. The surgery is done through simple transverse osteotomy, with lateral translation, of the first metatarsus both proximally and distally combined with selective distal soft-tissue dissection. The average age of patients was 37.7 years. Clinically, the American Orthopedic Foot and Ankle Society score and the subjective patient's satisfaction were evaluated. Radiologically, HV angle, distal metatarsal articular angle, and intermetatarsal angle and joint congruity were measured preoperatively, postoperatively, and at the end of the follow-up period. All data were statistically analyzed. Results The mean follow-up period was 22.7 months (range, 18–30 months). Union was achieved in all osteotomies in a mean of 6.67±0.45 weeks. Each radiological and clinical parameter showed a statistically significant improvement (P<0.001), with negligible first-ray shortening (P=0.547) and a few complications. At the end of follow-up period, no patient was dissatisfied. Conclusion Minimally invasive double-level first metatarsal osteotomy technique with selective distal soft-tissue dissection provides a simple, effective procedure, and reproducible alternative for treatment of severe HV deformity.

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 & 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.

An evaluation of scarf osteotomy in the treatment of severe hallux valgus

An evaluation of scarf osteotomy in the treatment of severe hallux valgus

Percutaneous Triple and Double Osteotomies for the Treatment of Hallux Valgus.

Percutaneous surgery to correct deformities of the forefoot presents the advantages of using a minimal incision, which involves less soft tissue damage and less risk of wound complications. For severe deformities, percutaneous techniques have not been proven as effective. We propose a technique for the treatment of severe hallux valgus. In a sample of 52 feet operated on 48 patients, we performed a double percutaneous osteotomy (closure proximal osteotomy and a distal Akin) or triple when a Reverdin-Isham osteotomy was added. We measured preoperatively the American Orthopaedic Foot & Ankle Society (AOFAS) score at the 1-year and 2-year follow-up, as well as the values of hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular ankle (DMAA), and shortening and elevation of the first metatarsal. The presence of metatarsalgia was recorded before and after the surgery. HVA, IMA, and DMAA improved from 39.3 ± 7.1, 17.0 ± 2.0, and 16 ± 8.7 to 11.2 ± 6.2, 8.4 ± 3.4, and 8.3 ± 6.2, respectively. In 5 cases (10%), there was an elevation of the distal metatarsal bone, but only in 2 cases did a transfer metatarsalgia develop. There were no significant correlations between the amount of shortening and the presence of postoperative metatarsalgia. Scores on the AOFAS scale improved from 47.6 ± 5.6 to 89.7 ± 10.1 points. The results are comparable to those reported with other more established techniques. Transfer metatarsalgia did not correlate with lifting or shortening of the metatarsal. We indicate the percutaneous technique for IMA above 15 degrees and increased DMAA or congruent joints. Level IV, retrospective case series.

Proximal Opening Wedge Osteotomy Provides Satisfactory Midterm Results With a Low Complication Rate

Hallux valgus is one of the most common foot deformities. Proximal opening wedge osteotomy is used for the treatment of moderate and severe hallux valgus with metatarsus primus varus. However, hypermobility of the first tarsometatarsal joint can compromise the results of the operation, and a paucity of midterm results are available regarding proximal open wedge osteotomy surgery. The aim of the present study was to assess the midterm results of proximal open wedge osteotomy in a consecutive series of patients with severe hallux valgus. Thirty-one consecutive adult patients (35 feet) with severe hallux valgus underwent proximal open wedge osteotomy. Twenty patients (35.5%) and 23 feet (34.3%) were available for the final follow-up examination. The mean follow-up duration was 5.8 (range 4.6 to 7.0) years. The radiologic measurements and American Orthopaedic Foot and Ankle Society hallux-metatarsophalangeal-interphalangeal scores were recorded pre- and postoperatively, and subjective questionnaires were completed and foot scan analyses performed at the end of the follow-up period. The mean hallux valgus angle decreased from 38° to 23°, and the mean intermetatarsal angle correction decreased from 17° to 10°. The mean improvement in the American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal score increased from 52 to 84. Two feet (5.7%) required repeat surgery because of recurrent hallux valgus. No nonunions were identified. Proximal open wedge osteotomy provided satisfactory midterm results in the treatment of severe hallux valgus, with a low complication rate. The potential instability of the first tarsometatarsal joint does not seem to jeopardize the midterm results of the operation.

Does arthrodesis of the first metatarsophalangeal joint correct the intermetatarsal M1M2 angle? Analysis of a continuous series of 208 arthrodeses fixed with plates

IntroductionFirst-ray metatarsophalangeal arthrodesis is a classic surgical procedure in the treatment of severe hallux valgus, hallux rigidus, revision surgery, and inflammatory arthritis. The objective of this study was to verify if metatarsophalangeal plate arthrodesis could correct the M1M2 intermetatarsal angle. Material and methodsThis prospective and continuous series (June 2007 to March 2011) included 208 patients (48% severe and/or arthritic hallux valgus, 18% hallux rigidus, 16% rheumatoid forefoot, 13% surgical revision of the first ray, 5% hallux varus), with a mean age of 62.4±9.9 years (range, 19–87 years). All the patients were operated on by a senior surgeon with the same technique: spherical avivement of the joint surfaces using reamers, osteosynthesis with an anatomic plate (Fyxis-Biotech™) in Ti.6Al.4V alloy prebent to 5° with a phalangeal arm to receive an oblique metatarsophalangeal screw in compression, in addition to four 2.7-mm nonlocking dorsal screws. The full-scale preoperative and intraoperative angle measurements were taken on AP and lateral X-rays of the weightbearing foot, as related to the etiology and the severity of the preoperative metatarsus varus (M1M2<15°, M1M2 15–19°, M1M2≥20°). The statistical analysis was done using the StatView software. ResultsThe mean follow-up was 18.6±12.4 months (range, 2–76 months). Nearly all of the arthrodesis patients (97%) achieved bone union, and 5% of the plates were removed. The M1P1angle decreased from 33.8±19.7° (range, −45° to –67°) preoperatively to 13.3±5.3° (range, 0–32°) at the last follow-up, and the M1M2angle from 14.2±5.4°(range, 0–26°) to 6.5±2.3° (range, 0–12°). The preoperative M1M2angle was <15° in 97 patients, 15–19° for 78 patients, and ≥20° for the 33 others; at the last follow-up it was 5.8±2.1° (range, 0–10°), 6.7±2.2° (0–10°), and 8.1±2.4° (3–12°), respectively. No correction of the metatarsus varus was demonstrated in relation to etiology. The M1M2angle was >10° in only two patients (one case of rheumatoid arthritis and one case of severe hallux valgus): 0.9%. DiscussionThese results show that isolated metatarsophalangeal arthrodesis of the first ray can correct metatarsus varus even in substantial deformations in any etiology. Level of proofLevel II cohort study.

Оптимізація хірурґічного лікування важкої форми вальґусного відхилення першого пальця стопи модифікованим методом остеосинтезу

Оптимізація хірурґічного лікування важкої форми вальґусного відхилення першого пальця стопи модифікованим методом остеосинтезу

Clinical study on three osteotomy in the treatment of severe hallux valgus

Objective To explore the application value of three osteotomy in the treatment of severe hallux valgus.Methods 25 patiens with severe hallux valgus who were treated were selected.The results of surgical treatment and postoperative complications were retrospectively analyzed,and preoperative and postoperative AOFAS score,HVA and IMA were comparatively analyzed.Results AOFAS hallux valgus feet with reference to evaluation standard,35 foot excellent prognosis was 94.3％.Postoperative AOFAS score(88.7±5.2) compared to the preoperative (41.7±8.4) was significantly higher(P＜0.05),while the postoperative HVA values(10.2 ±2.1)° and IMA value (7.4±1.3)° compared to preoperative(55.7±14.2)° and IMA values(22.7±4.8) ° were significantly lower(P＜0.05).35 feet,the inside of the front foot after the numbness in 8 feet,metatarsophalangeal joints slightly limited by 3 feet,while the remainder were serious complication.Conclusion Three osteotomy for severe hallux valgus had acute efficacy and fewer complications,which is worth dirtical application. Key words: Hallux valgus; Osteotomy

Surgical Treatment of Severe Hallux Valgus: The State of Practice among Academic Foot and Ankle Surgeons

The purpose of this study was to evaluate the operative procedures used for treatment of severe hallux valgus by academic foot and ankle surgeons practicing in the United States. A patient with severe hallux valgus deformity was developed as a hypothetical case: a 50-year-old woman with a severe deformity (intermetatarsal angle = 20 degrees; hallux valgus angle = 42 degrees). The patient was symptomatic with pain, did not improve with conservative measures, and wanted the deformity corrected. This case was sent to academic foot and ankle surgeons in a survey to determine their preferred operative treatment for this case. The overall response rate was 84% (128 of 153). To be included in the study group each surgeon had to have 1) foot and ankle patients comprising 50% or more of his clinical practice and 2) direct responsibility for teaching orthopaedic residents. One hundred and five respondents met the inclusion criteria and formed the study group; however, three surveys with invalid responses were deleted. Fifty-two percent (54 of 102) of the respondents chose a metatarsal osteotomy, 26% (26 of 102) a first metatarsophalangeal (MTP) joint arthrodesis, and 24% (24 of 102) a Lapidus procedure. Two respondents chose both an arthrodesis and a metatarsal osteotomy. Among the 54 respondents who chose metatarsal osteotomies, 24 used a Ludloff, 16 a proximal crescentic, eight a proximal chevron, two a scarf, two a distal chevron, and two other. In addition, secondary procedures to enhance the correction included a Weil osteotomy in 46% (47 of 102) and an Akin osteotomy in 30% (31 of 102). There was a wide variation in the type of procedure used to correct this severe hallux valgus deformity; approximately 50% of the respondents chose a metatarsal osteotomy, 25% chose a first MTP joint arthrodesis, and 25% a Lapidus procedure.

The rotation Scarf and Akin osteotomy for the correction of severe hallux valgus

Background: The Scarf osteotomy is a mid shaft osteotomy of the first metatarsal. Like other distal and mid-shaft osteotomies there is probably a limit to the amount of intermetatarsal (IM) angle correction that can be achieved, restricting the indications for the Scarf to moderate hallux valgus only. We have modified the Scarf osteotomy to allow rotation of the metatarsal and combined it with a closing wedge osteotomy of the hallux for the correction of severe hallux valgus. Objectives: The following prospective study seeks to provide evidence of the effectiveness of the rotation Scarf and Akin procedure for the treatment of severe hallux valgus with high intermetatarsal angles or metatarsus adductus. Method: Thirty-five patients (50 feet) underwent a rotation Scarf and Akin osteotomy and were reviewed at an average of 28 months postoperatively. Using pre- and post-operative weightbearing X-rays, the intermetatarsal angle, hallux valgus angle, distal metatarsal articular angle (DMAA), metatarsal length, and tibial sesamoid position were measured. The AOFAS clinical rating scale was used preoperatively and at final review and a visual analogue scale was used to measure patient satisfaction. Results: Preoperatively, the mean intermetatarsal angle was 16 and 5° postoperatively. Preoperatively the mean hallux valgus angle was 39 and 15° postoperatively. DMAA was reduced by an average of 10° and the tibial sesamoid position improved by an average of two positions. The AOFAS clinical rating scale improved by an average of 46 points and 92% of patients were completely satisfied with their result. Conclusion: The rotation Scarf and Akin osteotomy is a safe and effective procedure for the treatment of severe hallux valgus with high intermetatarsal angles or metatarsus adductus.