Valgus Angle Research Articles

Pre- or co-activation of leg muscles is associated with risk of non-contact knee injury during a single-leg landing in badminton

Objectives: The present study evaluated if lower limb muscle pre- and co-activation was associated with the biomechanics of knee joint control during backward step single-leg landings following a badminton overhead stroke. Methods: Three-dimensional biomechanics data of the knee joint and electromyographic data of lower limb muscles were collected from 34 badminton players. Linear regression analysis of gluteus maximus, quadriceps, hamstrings, gastrocnemius pre-and muscle co-activation in relation to peak knee flexion angle, knee valgus angle and moment, peak extension moment, and tibial anterior shear force in participants 100 ms before initial touchdown were analyzed. Results: Increased quadriceps pre-activation predicts increased knee valgus angle (R2 = 0.48, P < 0.001). Greater Lateral Hamstring/Quadriceps co-contraction predicts increased peak knee extension moment (R2 = 0.39, P < 0.001). Greater lateral gastrocnemius/quadriceps co-contraction predicts an increased peak knee valgus moment (R2 = 0.20, P = 0.0073). No EMG pre-activity parameters were predictors (P > 0.05) for knee flexion angle and anterior tibial shear force. Conclusion: These findings suggested that pre-activation of the quadriceps or co-contraction ratio of the lateral hamstrings to the quadriceps or lateral gastrocnemius to the quadriceps would be positively associated with the risk of non-contact anterior cruciate ligament (ACL) injuries during a single-leg landing following a badminton backward step overhead stroke.

The Protective Role of the FIFA 11+ Training Program on the Valgus Loading of the Knee in Academy Soccer Players Across a Season.

Background: Improper neuromuscular control with excessive dynamic valgus loading of the knee has been identified as one of the main anterior cruciate ligament injury risk factors. This study aimed to analyze the impact of the FIFA 11+ training program on the valgus loading of the knee in academy soccer players over a competitive season. Methods: A prospective study was conducted on 85 players. The drop vertical jump test was carried out before the match and at the end of the same match at the beginning and at the end of the season over a period of 11 months. Results: An increase of the varus angle on the right limb was noted between the start and the end of the season at the beginning of the match (-4.7 ± 8.9 versus -6.9 ± 6, p = 0.003) and between the start and the end of the match in values measured at the beginning of the season (-4.7 ± 8.9 versus -7.7 ± 9, p < 0.001). An increase of the flexion angle of both limbs was noted between the start and the end of the season in values measured at the start of the match (left limb 76.8 ± 32.8 versus 98.6 ± 17.2, p < 0.001; right limb 76.4 ± 32.8 versus 96.1 ± 16.1, p < 0.001) and between the start and the end of the season in values measured at the end of the match (left limb 92.8 ± 19.1 versus 98.5 ± 16.3, p = 0.002; right limb 92.6 ± 19.2 versus 96.7 ± 14.5, p = 0.013). Conclusions: A decrease in dynamic valgus angle and an increase in knee flexion angle measured with the DVJ test were noted between the start and the end of the season, suggesting a protective role of the FIFA 11+ training program.

Hallux valgus interphalangeus is more common in juvenile-onset hallux valgus than in adult-onset hallux valgus

BackgroundThis study aimed to compare the prevalence of hallux valgus interphalangeus (HVI) in juvenile-onset hallux valgus and adult-onset hallux valgus and to analyze the correlation between the hallux interphalangeal angle (HIA) and other radiographic parameters in juvenile-onset hallux valgus.MethodsThis retrospective study included 640 feet and 320 patients with hallux valgus (160 juvenile-onset and 160 adult-onset cases). Eight radiographic parameters were measured: HIA, hallux valgus angle, intermetatarsal angle, talonavicular coverage angle, anteroposterior talocalcaneal angle, lateral talocalcaneal angle, lateral talo-first metatarsal angle, and calcaneal pitch. The two groups were compared based on the radiographic parameters, and the correlation between the HIA and other radiographic parameters in juvenile-onset valgus was analyzed.ResultsThe prevalence of HVI in juvenile-onset hallux valgus (63%) was higher than that in adult-onset hallux valgus (28%), and juvenile-onset hallux valgus demonstrated a greater HIA than that displayed by adult-onset hallux valgus (mean ± standard deviation, 12.9 ± 5.7 and 8.3 ± 5.2, respectively). In juvenile-onset valgus, the HIA was negatively correlated with the hallux valgus (r = -0.218, p < 0.001) and intermetatarsal angles (r = -0.143, p = 0.015) and positively correlated with the talonavicular coverage (r = 0.240, p < 0.001) and anteroposterior talocalcaneal angles (r = 0.127, p = 0.008).ConclusionsJuvenile-onset hallux valgus is associated with more HVI than that in adults. Moreover, forefoot abduction deformity is related to the progression of HVI. These findings highlight the need to consider concomitant HVI when juvenile-onset valgus is encountered.Level of evidenceLevel III, retrospective comparative study.

Comparison of the effects of orthoses on hallux valgus angle and plantar pressure in individuals with hallux valgus.

Hallux valgus (HV) is a condition characterized by the lateral deviation of the first phalanx and medial deviation of the first metatarsal, leading to subluxation of the first metatarsophalangeal joint. Various orthotic applications are employed in the treatment of HV deformity. This study aimed to compare the effects of a toe separator (TS) and dynamic orthosis (DO) on hallux valgus angle (HVA), plantar pressure (PP), and quality of life (QoL). Thirty individuals aged between 18 and 65 years who had mild to moderate HV deformity were included in our study. Participants were randomized into TS and DO groups. Pretest and post-test evaluations at 4 weeks included goniometric measurement for HVA, PP measurement using the Sensor Medica device, QoL assessment using the American Orthopaedic Foot & Ankle Society-Hallux MTP-IP Scale and Manchester-Oxford Foot Questionnaire, and numerical evaluation scale for orthosis satisfaction. No statistically significant changes were observed in HVA measurements (p > 0.05). In the DO group, significant differences were observed in PP assessment for right rearfoot loading (p = 0.048) and total average pressure measurement of the right foot (p = 0.025). QoL assessments were observed significant differences in the DO group compared with the TS group (p < 0.05). After a 4-week period of wearing the TS and DO orthoses, no change in HVA was observed. In the DO group, a more balanced load distribution between the right and left foot (50.2% left, 49.8% right) and a more pronounced effect in reducing deformity-related pain and improving QoL by increasing functionality were noted.

Results of Modified Minimally Invasive Hallux Valgus Surgery, Factors for the First Metatarsal Shortening, and Patients' Satisfaction.

Background: Hallux valgus is a prevalent foot deformity conventionally treated with open surgical techniques, which carry risk of complications due to extensive soft tissue dissection. Minimally invasive surgeries (MISs) as alternatives offer comparable outcomes, reduced pain, and faster recovery; however, their challenges include the risk of shortening of the first metatarsal. This study aimed to assess the efficacy of our modified MIS hallux valgus correction technique and investigate the factors that affect first metatarsal shortening. Methods: Twenty-nine feet treated with modified MIS hallux valgus surgery between 2017 and 2022 were included with an average follow-up of 29 months. Clinical outcomes were evaluated with the Manchester-Oxford Foot Questionnaire (MOXFQ), Foot Function Index (FFI), and visual analog scale for pain. Radiographic evaluations included the intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), first metatarsal length, and sesamoid grade. Results: Functional and radiographic outcomes were significantly improved (p < 0.0001 and p < 0.001, respectively). Significant correlations between patient satisfaction and the MOXFQ, FFI, and VAS scores were found, with no significant correlations between patient satisfaction and radiographic outcomes. Non-purchasing of the lateral cortex of the proximal osteotomy site was identified to increase risk of first metatarsal shortening (odds ratio [OR] = 22.09, p = 0.0064). Conclusions: Our modified MIS for hallux valgus correction showed favorable radiographic and functional outcomes. Proximal lateral cortex purchasing should be targeted to reduce postoperative shortening of the first metatarsal.

Outcomes of Simultaneous Correction of Adult Hallux Valgus and Flexible Pes Planus Deformities.

There is a high correlation between hallux valgus and pes planus deformity. We sought to evaluate the outcomes of simultaneous Scarf osteotomy and extraosseous talotarsal stabilization (EOTTS) for correcting adult hallux valgus with flexible pes planus deformity. This retrospective study enrolled patients who had hallux valgus deformity with flexible pes planus and underwent combined Scarf osteotomy and EOTTS from January 2018 to October 2021. The hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary's angle, calcaneal pitch, and lateral talocalcaneal angles were assessed preoperatively and at 1-year follow-up. Clinical outcomes were evaluated using the visual analog scale (VAS) score for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, and the Maryland foot score (MFS). Complications were recorded. This study included 25 patients, 19 women and 6 men, with a mean age of 44.3 years. The mean follow-up period was 14.6 months. The mean HVA, IMA, Meary's angle, calcaneal pitch, and lateral talocalcaneal angles improved significantly at 1-year follow-up (P<.001). The mean VAS score decreased from 5.8 to 1.0, whereas the mean AOFAS forefoot score and MFS increased from 52.3 to 88.9 and 61.2 to 89.3, respectively, at 1-year follow-up (P<.001). Two patients had arthroereisis implant removal as a consequence of sinus tarsi pain. No other complications were seen during the follow-up. Management of hallux valgus with flexible pes planus deformity with combined Scarf osteotomy and EOTTS can achieve satisfactory clinical and radiologic results with low complication and recurrence rates. [Orthopedics. 202x;4x(x):xx-xx.].

Sesamoid Bone Reduction in Hallux Valgus: Comparing Radiological Outcomes of Hallux Valgus Following Distal Chevron Osteotomy and Modified McBride Procedure.

Background: Hallux valgus is a common forefoot disorder with hundreds of proposed management techniques. Distal chevron osteotomy with a modified McBride procedure has been traditionally recommended for mild hallux valgus because of its simple and less invasive nature with fewer complications, faster recovery, and reliable outcomes. In recent years, the indications for this procedure have expanded to include hallux valgus with severe deformities. This study aims to compare the radiographic outcomes of the surgical treatment for moderate versus severe hallux valgus patients from the perspective of sesamoid bone reduction. Materials and Methods: A retrospective review of medical records identified 99 feet from 94 patients that were treated with distal chevron osteotomy with a modified McBride procedure. These feet were divided by the preoperative hallux valgus angle and intermetatarsal angle into the moderate and severe groups. Results: Postoperative radiographic parameters significantly improved in both groups after treatment, indicating adequate deformity correction. Improvement in the sesamoid position was better in the moderate group compared to that in the severe group. The recurrence rate in the severe group was higher than that in the moderate group without statistical significance. Conclusions: Based on the radiographic results of the postoperative position following sesamoid reduction, the distal chevron osteotomy with a modified McBride procedure is effective for treating moderate hallux valgus deformities. However, this treatment strategy may be associated with a higher recurrence rate in cases of severe hallux valgus deformity. A complete reduction in the sesamoids should be emphasized during the management of severe hallux valgus deformity.

Evaluation of hallux valgus treatment: is classical angular correction approach relevant?

Hallux valgus correction is mostly done by metatarsal procedures, and widely accepted strategy is to decide which surgical method should be used is based on radiological severity using intermetatarsal (IMA) and hallux valgus (HVA) angles (classical angular correction approach-CACA). The aim of the study is to compare the postoperative improvement in radiographic parameters and morphologic appearance of the foot between patients operated with and without adhering to CACA strategy based on classical severity classification using angle measurements. A retrospective comparative study between two groups (conforming and not conforming to proposed algorithm) was performed. Of 122 feet of 119 patients underwent metatarsal procedures for hallux valgus between October 2022 and November 2023, 92 feet of 92 patients were enrolled in the study (age 43.86 ± 16.1years, 15.2% male). Patients were classified into two groups as conforming and non-conforming to CACA algorithm based on IMA and HVA angles (mild: IMA ≤ 13°, HVA ≤ 30°; moderate: 13° < IMA < 20°, 30° < HVA < 40°; severe: IMA ≥ 20°, HVA ≥ 40°). Algorithm proposed distal osteotomies for mild cases, shaft osteotomies for moderate cases and proximal osteotomies or tarsometatarsal arthrodeses for severe cases. HVA and IMA corrections after surgery, bony foot width, soft tissue foot width, medial eminence bony distance and medial soft tissue distance alterations, American Orthopaedic Foot and Ankle Society Metatarsophalangeal-Interphalangeal Scale (AOFAS-MTP-IP) scores and improvement of foot appearance according to Manchester scale in postoperative first year follow-up were compared between groups. 58 procedures (group 1) conformed CACA, while 34 (group 2) did not. There was no statistically significant difference in terms of IMA (3.81° ± 4.01°, 2.72° ± 2.25°, p = 0.423), HVA (12.78° ± 7.81°, 10.31° ± 5.4°, p = 0.106) bony forefoot width (4.41 ± 6.66mm, 1.65 ± 6.67mm, p = 0.059), soft tissue forefoot width (1.21 ± 6.61mm, 2.41 ± 7.45mm, p = 0.423), medial eminence width (5.72 ± 3.17mm, 6.07 ± 3mm, p = 0.609) alterations and AOFAS-MTP-IP scores (82.17 ± 5.26, 83.06 ± 5.18, p = 0.435) between groups. Medial soft tissue width increased in both groups (2.74 ± 2.53mm, 1.48 ± 1.67mm, p = 0.011). Manchester stages were improved in 45 feet in group 1 (77.6%) and 19 feet in group 2 (55.9%) (p = 0.029). The CACA strategy of treating more severe deformities with more proximal procedures and milder deformities with distal osteotomies did not significantly impact postoperative radiologic parameters. Nonetheless, following CACA strategy is likely to improve the morphologic appearance of the foot. III, comparative study.

Progression and risk factors of hallux valgus angle in elite adolescent dancers: a cohort study

IntroductionTo the best of our knowledge, no previous studies have linked the progression of hallux valgus (HV) with plantar pressure distribution. Therefore, this study aimed to determine the progression of HV angle in elite adolescent dancers and evaluate the risk factors associated with foot plantar pressure during demi-pointe movement.MethodsFor this cohort study, 40 adolescent dancesport dancers (age: 14.5 ± 1.3 years; height: 168.3 ± 8.3 cm; weight: 52.4 ± 8.1 kg) were recruited from a dancesport specialty school. All participants reported no foot or lower limb injuries or symptoms in the past year and were not undergoing any rehabilitation or medication treatment. The HV angle was measured by photography (HVAp). The HVAp survey included baseline and follow-up assessments after 1 year. Foot plantar pressures (kPa) were obtained using the F-Scan measurement system (Tekscan, Tokyo, Japan), and the data were divided into two categories based on the foot location (type 1: hallux, toe, and metatarsophalangeal [MTP] joint area and type 2: medial, middle, and lateral areas). Data were analyzed using the Pearson’s chi-square test and multiple logistic regression.ResultsThe HVAp measurement demonstrated excellent reliability. A significant increase of 2.1° ± 3.5° in the HV angle of elite adolescent dancers was found at the 1-year follow-up assessment relative to that at baseline. There were significant correlations between the HVAp variation values and the hallux (r = − 0.480, P = 0.002), toe (r = − 0.313, P = 0.049), and MTP joint area (r = 0.446, P = 0.004) plantar pressure percentages in the type 1 category and medial area (r = − 0.331, P = 0.037) and middle area (r = 0.386, P = 0.014) pressure percentages in the type 2 category. Based on the multivariate logistic regression analysis, the HVAp variation values were associated with foot plantar pressure in the hallux (odds ratio [OR]: − 0.12, 95% confidence interval [CI]: − 0.191 to − 0.048, P = 0.002) and middle areas (OR: 0.09, 95% CI: 0.019 – 0.161, and P = 0.014) from the two categories, respectively.ConclusionThis study demonstrated significant progression of the HV angle in elite adolescent dancers over 1 year, which was significantly associated with increased foot plantar pressure in the middle area and decreased plantar pressure in the hallux area. These findings highlight the importance of monitoring and addressing foot plantar pressure in adolescent dancers.

Comparative analysis of triplanar Chevron osteotomy (TCO) and Chevron osteotomy (CO) for treating mild to moderate hallux valgus via computer simulation and 3D printing: An observational study.

Hallux valgus (HV) deformity, which is characterized by lateral deviation and pronation of the metatarsophalangeal joint, demonstrates complex 3-dimensional challenges, thus prompting the development of various surgical approaches, including traditional Chevron osteotomy (CO) and novel triplanar Chevron osteotomy (TCO). The objective of this study is to determine TCO at various tilt angles by employing 3D printing for ex vivo osteotomy angle simulations and computer modeling to correct deformities across 3 planes, thus aiming to enhance surgical outcomes by preserving or even increasing the length of the first metatarsal and thereby overcoming the limitations of CO. In this study, we collected and analyzed non-weight-bearing CT data from 55 patients (61 feet) with mild-to-moderate hallux valgus, plantar callosities and metatarsalgia from June 2019 to June 2020. The study utilized Mimics software for 3D digital reconstructions and simulation osteotomy of both TCO and CO. For both procedures, the apex was centered at the first metatarsal head, with CO specifically oriented towards the fourth metatarsal head at a 60° angle. The plantar-oblique Chevron osteotomy (POCO) was defined by a 15° plantar tilt, whereas TCO involved a further 9° tilt towards the metatarsal head. The key metrics that were measured included the hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and first metatarsal length (FML). Our study aged between 30 and 71 years, with an average age of 47.37 years. Postoperative assessments using Mimics software showed significant improvements in reducing the HVA, IMA, and DMAA after CO and TCO. However, when comparing both techniques, their corrective capacities were roughly equivalent, with no significant differences observed in these metrics. Notably, compared with CO, TCO significantly increased the FML (P < .001), thus suggesting that TCO has greater potential to effectively prevent transfer metatarsalgia. This study underscores the ability of TCO to significantly extend the first metatarsal, with precise adjustments to its distal tilt to tailor deformity corrections. In computational simulation experiments, TCO offers a superior alternative to CO for treating hallux valgus by addressing 3-dimensional deformities and preserving or even increasing FML, thereby preventing transfer metatarsalgia.

Assessment of tibialis anterior tendon insertion variations in relation to hallux valgus utilizing magnetic resonance imaging

BackgroundHallux valgus is a deformity characterized by lateral deviation of the big toe and medial deviation of the first metatarsal, causing difficulty in walking and requiring various treatments. Despite its multifactorial etiology, the role of the tibialis anterior tendon in hallux valgus and its variations in the morphology of tibialis anterior tendon distal insertion sites have not been fully explored. This study aimed to evaluate the effect of such variations on hallux valgus using magnetic resonance imaging.MethodsThis was a retrospective study and included 115 individuals aged 18 years and older who underwent foot radiographs and MRI. The participants were divided into a hallux valgus group of 53 patients and a control group of 62 people based on radiographic measurements. Tibialis anterior tendon distal attachment was classified into five types according to the attachment morphology. Statistical analyses were performed to evaluate the relationship between the tibialis anterior tendon types and hallux valgus severity.ResultsAmong the participants, patients who underwent foot radiography and MRI due to any medical indication 70.4% were female, with a mean age of 43.83 ± 15.25 years. In terms of tibialis anterior tendon distal attachment, the most common type was Type 5 (40.9%), followed by Type 2 (34.8%). Type 4 was not observed in any case. In all participants, the mean hallux valgus angle was 20.63 ± 8.42o, and the mean intermetatarsal angle was 9.69 ± 2.68o. Tibialis anterior tendon distal attachment Type 5 was significantly associated with an increased hallux valgus angle but not with the intermetatarsal angle. We found a significant relationship between the diameter of the tibialis anterior tendon and hallux valgus angle.ConclusionsThis study revealed a significant association between hallux valgus and Type 5 tibialis anterior tendon distal attachment, suggesting that tibialis anterior tendon morphology influences hallux valgus severity. The findings underscore the importance of considering variations in tibialis anterior tendon distal attachment sites in the etiopathogenesis and treatment planning of hallux valgus.

Association Between Postoperative Medial-Middle Intercuneiform Joint Widening and Recurrence Rates in Hallux Valgus Treated With Modified Lapidus Procedure.

Although an association between intercuneiform (C1-C2) joint instability and the recurrence of hallux valgus (HV) deformity after the modified Lapidus procedure has been suggested, there is currently no radiographic evidence to support it. This study aims to investigate radiographic changes in the C1-C2 joint after the modified Lapidus procedure for HV correction, using weightbearing computed tomography (WBCT). This retrospective cohort study included 52 feet (50 patients) with HV who underwent modified Lapidus procedure and had preoperative and postoperative WBCT. Patients who had an additional transfixation screw between the first and second ray were excluded. The preoperative and average 6.5 months postoperative C1-C2 distance, C1-C2 angle, and C1-ground angle were measured on coronal multiplanar reconstructed WBCT images. Radiographic parameters between the recurrence group (n = 9) and nonrecurrence group (n = 43) were compared. Recurrence of HV deformity was characterized by a postoperative hallux valgus angle (HVA) greater than 20 degrees. Nine of 52 patients (17.3%) had recurrence of their HV deformity. The recurrence group had greater changes in the C1-C2 distance; the median widening in the recurrence group was 0.7 mm (IQR, 0.6-0.8), whereas the nonrecurrence group was 0.3 mm (IQR, 0.1-0.4, P < .001). Regression analysis showed that increase in the C1-C2 distance were significantly associated with recurrence (odds ratio, 1.79; 95% CI, 1.18-3.77; P = .0015). Although no preoperative imaging parameters were associated with a change in the C1-C2 distance, increasing postoperative sesamoid position (r = 0.32, P = .022) and HVA (r = 0.28, P = .046) were correlated with a greater change in the C1-C2 joint gapping. Our study results suggest a possible association between early postoperative widening of the C1-C2 joint and the recurrence of the HV deformity following a modified Lapidus procedure. This raises, but does not answer, the question as to whether the routine stabilization of intercuneiform joint directly or indirectly may help reduce the rate of hallux valgus recurrence when performing the modified Lapidus procedure.

Midfoot and Forefoot Disorders in Adolescents and Adults with X-Linked Hypophosphatemia.

Objectives: X-linked hypophosphatemia (XLH, OMIM 307800) is a rare genetic disorder that affects phosphate metabolism. While lower limb deformity represents a hallmark symptom of patients with XLH, the effect on the foot has not been investigated. This study aimed to characterise foot pathologies and assess related outcome scores in adolescents and adults with XLH. Methods: Patients aged ≥ 16 years with genetically verified XLH were included in this study. Physical examination was performed, and foot scores as well as foot X-rays were assessed. Radiographic analysis included the assessment of osteoarthritis, enthesopathies, and alignment abnormalities. Results: Twenty-six participants (51 limbs) with a mean age of 33.9 ± 15.4 years were eligible for the study. Patients with XLH presented with flatfoot deformity (reduced Meary angles > -4° in 84.3%), elevated first and fifth metatarsal angles > 30° (IM 1-5, 53.5%) and hallux valgus angles > 15° (36.0%). Moderate-to-severe joint space narrowing was observed in the talonavicular (49%) and cuneonavicular joints (41.2%). The American Orthopedic Foot and Ankle Society (AOFAS) score was associated with mildly reduced midfoot function. Conclusions: A high rate of bony deformity, joint degeneration, and decreased foot scores indicated the impact of forefoot and midfoot disorders in patients with XLH.

Comparison of plate and compression screw in the treatment of hallux rigidus with arthrodesis: a retrospective study

Objectives: Although numerous surgical techniques and fixation methods have been described for the treatment of hallux rigidus (HR) with arthrodesis, consensus on the gold standard treatment has not been reached. The aim of this study is to retrospectively compare the clinical and radiological outcomes of compression screw fixation and plate fixation in the treatment of HR with arthrodesis. Methods: Patients who underwent arthrodesis surgery due to HR between January 2021 and December 2023 at a single center were retrospectively reviewed. Patients who met the inclusion criteria were divided into two groups: those who underwent arthrodesis with plate fixation (PLATE) and those who underwent arthrodesis with compression screw fixation (SCREW). Demographic data including age, gender, affected side, operative time, hallux valgus angle (HVA), dorsiflexion angle, AOFAS scores, and implant irritation data were compared among patients with at least 3 months of follow-up. Results: It was observed that all patients included in the study had successful bone union without any complications. There were no significant differences between the two groups in terms of age, gender, affected side, preoperative HVA, and preoperative AOFAS scores (P=0.970, P=0.426, P=0.694, P=0.216, and P=0.905, respectively). The mean operation time and postoperative AOFAS score were lower in the PLATE group compared to the SCREW group (P=0.006 and P=0.004, respectively). However, in the SCREW group, the dorsiflexion angle and the rate of implant irritation were lower compared to the PLATE group (P=0.016 and P=0.01, respectively). Conclusions: In the surgical treatment of HR, both plate fixation arthrodesis and compression screw arthrodesis are reliable surgical techniques. While plate fixation arthrodesis is a faster and more practical method, arthrodesis with a compression screw results in fewer complaints related to the implant and provides a more functional recovery.

Center of Pressure in Relation to Foot Morphology and Knee Symptoms in Older Women With Medial Knee Joint Deformity: A Cross-sectional Study

ObjectiveTo examine the correlations amongst center of pressure (COP) trajectories, foot morphology, and knee symptoms in older women with medial knee deformity. DesignThis was a cross-sectional study. SettingParticipants were recruited from 2 local orthopedic clinics. ParticipantsFemale patients with medial knee deformity (Kellgren–Lawrence grade ≥1) aged 60 years or older (N=84). InterventionsNot applicable. Main Outcome MeasuresCOP trajectories during comfortable gait were obtained using a plantar pressure distribution platform. As foot morphology metrics, hallux valgus angle, navicular/foot ratio, and leg-heel alignment were measured. The knee society scoring system was used to evaluate knee symptom severity. We used statistical parametric mapping for COP trajectory analysis to reduce the bias caused by data extraction. Multiple linear regression in statistical parametric mapping was used to determine the correlations amongst foot morphology, knee symptom severity, and COP trajectories. ResultsThere was a correlation between higher navicular/foot ratio and medial shift on COP at initial contact (0%∼3.0% stance phase, P<.05) and at toe-off (95.3%∼100% stance phase, P=.04). Also, higher navicular/foot ratio was associated with lateral shift of COP during single leg stance phase (8.3%∼80.1% stance phase, P<.01). We also found a significant correlation between lateral shift of COP during loading response phase (6.8%∼19.0% stance phase) and knee symptom severity (P=.03). ConclusionsOur results indicated that patients with severe knee symptoms may benefit from intervention to modify the foot arch and to medially shift the COP, which may be capable of relieving knee symptoms. Although our results do not directly show pain reduction, a medial COP shift could indeed reduce pain in cases where knee adduction moment is responsible for pain. These findings may contribute to the further development of conservative intervention, which focus on foot morphology of patients with knee osteoarthritis.

Limb dominance influences landing mechanics and neuromuscular control during drop vertical jump in patients with ACL reconstruction.

The purpose of this study was to compare the interlimb biomechanical differences in patients who had undergone anterior cruciate ligament reconstruction (ACLR) in either dominant (ACLR-D) or nondominant (ACLR-ND) limbs and healthy controls (CON) during drop vertical jump (DVJ) task. To investigate whether the dominant or nondominant limb influences the risk of re-injury in ACLR patients. Thirty-three ACLR patients were divided into ACLR-D and ACLR-ND groups according to whether the surgical limb was dominant or nondominant. Seventeen healthy individuals were selected as the CON group. Three-dimensional kinematic data, ground reaction force (GRF) data, and surface electromyographic (EMG) data from the bilateral lower limbs of all participants were collected during the DVJ task. Two-way repeated-measures ANOVAs (limb × group) were performed on the variables of interest to examine the main effects of limb (dominant vs. nondominant) and group (ACLR-D, ACLR-ND, and CON), as well as the interaction between limb and group. The nonsurgical limbs of ACLR group had significantly greater knee valgus angles, knee extension and valgus moments, peak posterior GRF (PPGRF), and peak vertical GRF (PVGRF) compared to the surgical limbs. The nonsurgical limbs of ACLR-ND patients demonstrated significantly greater knee extension and valgus moments, greater PPGRF and PVGRF, and reduced muscle activity in the vastus medialis and vastus lateralis compared to the CON group. The ACLR patients had reduced muscle activity in the quadriceps of the surgical limb and the hamstrings of the bilateral limbs compared to controls. The nonsurgical limbs of ACLR patients may suffer an increased risk of ACL injury due to altered landing mechanics and neuromuscular control strategies compared to the surgical limbs. Additionally, limb dominance influences movement patterns and neuromuscular control during DVJ task, the nonsurgical limbs of the ACLR-ND might be at higher risk of ACL injury compared to the ACLR-D group.

Comparison of third-generation minimally invasive surgery, split-drill osteotomy, and triplanar chevron osteotomy for treating mild to moderate hallux valgus with metatarsalgia in middle-aged women: An observational study.

This retrospective study compared the clinical efficacy of third-generation minimally invasive surgery (3rd-MIS) split-drill osteotomy with soft tissue release to that of triplanar chevron osteotomy (TCO) for treating mild to moderate hallux valgus (HV) with metatarsalgia in middle-aged women. This study compared the efficacy of 3rd-MIS using split-drill osteotomy to that of TCO in treating mild to moderate HV with metatarsalgia in 52 middle-aged women from March 2022 to June 2023. Retrospectively analyzing a total of 52 patients (26 patients per group), we employed 2 distinct surgical methods across 2 groups in this study: the TCO group received a traditional TCO accompanied by soft tissue release, whereas the MIS group underwent a split-drill osteotomy with soft tissue release. The study compared the operation time, onset of weight-bearing, osteotomy healing, blood loss, pre- and postsurgery X-ray measurements, metatarsalgia, and foot function scores. In the TCO group, complications included peri-incisional numbness, elevation of the first metatarsal head with metatarsalgia, and bone hyperplasia with stiffness at the MTPJ in one patient each. In the MIS group, bunions were successfully corrected without significant complications like bone nonunion or avascular necrosis of the metatarsal head, and the metatarsal length was preserved. Significant differences in operation time, weight-bearing onset, healing, and blood loss were detected between groups (P < .05). Preoperatively, there were no significant differences in hallux valgus angle, 1-2 intermetatarsal angle, or distal metatarsal articular angle among the groups (P > .05). Nonetheless, notable postoperative differences were observed (P < .05). Foot function and pain scores, assessed by the American Orthopaedic Foot & Ankle Society and the Visual Analogue Scale, showed significant improvements in both groups following surgery. Both surgical techniques effectively corrected the HV angle without significant changes in the first metatarsal length. The MIS group experienced significantly less pain on the second day postsurgery, as indicated by lower Visual Analogue Scale scores (P < .05). Both techniques were similarly effective in treating metatarsalgia. 3rd-MIS split-drill osteotomy with soft tissue release offers several advantages over TCO techniques for treating mild to moderate HV with metatarsalgia in middle-aged women, such as reduced trauma, quicker healing, smaller scars, and less pain after surgery.

Differences in Foot Morphology across Age Groups for Women Active in Sport

Introduction: Foot morphology in the general population has been shown to change with age, and active older adults have reported a need for wide-fitting footwear. Methods: This study recruited 374 women active in racket sports and team sports in the UK who had their feet scanned while 50% weight bearing. Participants were grouped into 10-year age bands ranging from 18–29 years to 70–79 years. Data analysis was performed on the widths, heights, and circumferences of participants’ right feet normalised to foot length, as well as an assessment of hallux valgus angle and deformity. Results: The 18–29-year group had significantly smaller measures of foot width, ball of foot circumference and short heel circumference (p < 0.05, η2 = 0.042, η2 = 0.056) compared to the older groups. The foot dorsum height and circumference at 50% foot length were significantly less in the oldest age groups compared to the middle age groups (p = 0.0001, η2 = 0.055 and p = 0.0007, η2 = 0.044, respectively). There was some evidence of increased hallux valgus deformity with age. Conclusion: Designers and manufacturers of athletic footwear should be aware of the changes in foot morphology with age in order to provide more inclusive footwear.

Recurrence rates with long-term follow-up after hallux valgus surgical treatment using shaft metatarsal osteotomies: a systematic review and meta-analysis.

Recurrence of hallux valgus (HV) following corrective surgery is a frequent concern. A recent systematic review estimated recurrence of HV in only 4.9%, which may be an underestimation, as most included studies had short- to mid-term follow-up. The purpose of this systematic review and meta-analysis was to synthesize and critically appraise the literature on the long-term outcomes of shaft osteotomies of the first metatarsal (M1) to treat HV without inflammatory disease or degenerative arthritis, and to assess the long-term HV recurrence rates of studies with a minimum follow-up of 5 years. This systematic review conforms to the PRISMA guidelines. The authors conducted a search using PubMed, Embase®, and Cochrane Central Register of Controlled Trials databases. Studies that report outcomes of shaft osteotomies of the M1 for non-inflammatory and non-degenerative HV having a minimum follow-up of 5 years were included. We found five eligible studies comprising six datasets, all assessed Scarf osteotomies with a mean follow-up that ranged from 8 to 14 years. The HV recurrence rate was 40%, considering the threshold of >15° hallux valgus angle (HVA), 30% having >20°, and 2% having >25°. At a minimum follow-up of 8 years following shaft osteotomies of M1, the HVA was 15.9°, the intermetatarsal angle (IMA) was 7.7°, and the DMAA was 8.3°. Furthermore, the recurrence rates considering the various thresholds of HVA were: 40% having >15°, 20% having >20°, and 2% having >25°. Meta-analysis, Level IV.

Changes in Foot Width in Minimally Invasive Bunionectomy

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Hallux Valgus (HV) is a common foot condition often requiring surgical intervention. Minimally invasive bunionectomy (MISB) has gained popularity for HV correction. While previous research has focused on distal foot width changes following surgery, this study introduces a novel midshaft measurement to assess proximal transverse midfoot width. The study aims to provide a comprehensive evaluation of foot width changes post-MISB. Methods: A retrospective review of prospectively collected data was conducted for 44 patients who underwent MISB for HV via an institutional outcome registry. Demographic data, surgical details, radiographs, and foot width measurements were collected. Changes in hallux valgus angle (HVA) and intermetatarsal angle (IMA) were also measured. The novel midshaft bony and soft tissue foot width measurements were included. Two independent observers conducted all preoperative and postoperative measurements. Results: Intraclass correlation coefficients (ICCs) demonstrated high interobserver reliability (all ICCs &gt;0.70) for all measurements. MISB resulted in a consistent reduction in distal foot width, both bony (8.17%) and soft tissue (5.24%)(p &lt; 0.001). These reductions correlated with changes in HVA and IMA, suggesting the extent of deformity correction influenced distal foot width (all r &gt; 0.375, p &lt; 0.05). However, the study revealed that proximal foot width, as measured by midshaft bony width, increased (5.27%) in the majority of cases (p &lt; 0.001). Changes in midshaft foot width showed no correlation with HVA or IMA alterations. Conclusion: MISB for HV leads to an increase in midshaft foot width due to the unique mechanics of the procedure. Simultaneously, there is a decrease in distal foot width, which correlates with the extent of deformity correction. This results in a more uniform foot width. These findings may influence patient satisfaction, comfort, and shoe wear capabilities post-surgery. Further research should assess patient perception and comfort regarding these foot width changes after MISB.