scholarly journals Hallux valgus

2011 ◽  
Vol 58 (3) ◽  
pp. 107-111 ◽  
Author(s):  
Zoran Bascarevic ◽  
Zoran Vukasinovic ◽  
Violeta Bascarevic ◽  
Vladan Stevanovic ◽  
Dusko Spasovski ◽  
...  

Hallux valgus is a complex deformity of the forefoot. Beside the lateral deviation of the first metatarsophalangeal joint angle exceeding 15-20 degrees and intermetatarsalvarus exceeding 8-9 degrees, it is also characterized by extensive changes of the soft tissue arch, sesamoid mechanism and metatarsocuneiform joint. It occurs almost exclusively in humans wearing shoes. Although in some measure it can be treated non-operatively, by corrective separators and inserts, operative treatment is predominant. There are numerous operative procedures aimed at the correction of the deformity and inducing normal biomechanics of the forefoot. There are seven conceptually different procedures starting from simple bunionectomy, through various soft tissue procedures, metatarsal and phalangeal osteotomies, to resection arthroplasty and metatarsophalangeal arthrodesis. All have clear indications, and none of them has advantages over the others. In accordance with the etiopathogenesis of the disease prevention is easy; wearing comfortable shoes.

1997 ◽  
Vol 18 (3) ◽  
pp. 119-127 ◽  
Author(s):  
Hans-Jörg Trnka ◽  
Alexander Zembsch ◽  
Hermann Wiesauer ◽  
Marc Hungerford ◽  
Martin Salzer ◽  
...  

The Austin osteotomy is a widely accepted method for correction of mild and moderate hallux valgus. In view of publications by Kitaoka et al. in 1991 and by Mann and colleagues, a more radical lateral soft tissue procedure was added to the originally described procedure. From September 1992 to January 1994, 85 patients underwent an Austin osteotomy combined with a lateral soft tissue procedure to correct their hallux valgus deformities. Seventy-nine patients (94 feet) were available for follow-up. The average patient age at the time of the operation was 47.1 years, and the average follow-up was 16.2 months. The average preoperative intermetatarsal angle was 13.9°, and the average hallux valgus angle was 29.7°. After surgery, the feet were corrected to an average intermetatarsal angle of 5.8° and an average hallux valgus angle of 11.9°. Sesamoid position was corrected from 2.1 before surgery to 0.5 after surgery. The results were also graded according to the Hallux Metatarsophalangeal Interphalangeal Score, and the functional and cosmetic outcomes were graded by the patient. Dissection of the plantar transverse ligament and release of the lateral capsule repositioned the tibial sesamoid and restored the biomechanics around the first metatarsophalangeal joint. There was no increased incidence of avascular necrosis of the first metatarsal head compared with the original technique.


Biology ◽  
2022 ◽  
Vol 11 (1) ◽  
pp. 127
Author(s):  
Qiaolin Zhang ◽  
Yan Zhang ◽  
Jialu Huang ◽  
Ee Chon Teo ◽  
Yaodong Gu

Background: The stress of foot bone can effectively evaluate the functional damage caused by foot deformity and the results of operation. In this study, the finite element method was used to investigate the degree of displacement of distal chevron osteotomy on metatarsal stress and metatarsophalangeal joint load; Methods: Four finite element models of displacement were established by using the CT images of a patient with moderate hallux valgus (hallux valgus angle and intermetatarsal angle were 26.74° and 14.09°, respectively), and the validity of the model was verified. Each finite element model consisted of bones and various cartilage structures, ligaments, and plantar fascia, as well as encapsulated soft tissue. Except for soft tissue, the material properties of other parts were isotropic linear elastic material, and the encapsulated soft tissue was set as nonlinear hyperelastic material. The mesh was tetrahedral mesh. Link elements were used in ligament and plantar fascia. A ground reaction force with a half-body weight was applied at the bottom of the floor to simulate the ground reaction when standing. The upper surfaces of the encapsulated soft tissue, distal tibia, and distal fibula were fixed. The stress distribution of metatarsals and the stress of cartilage of the first metatarsophalangeal joint were compared and analyzed; Results: Compared with the hallux valgus without osteotomy, the stress of the first metatarsals and second metatarsals of 2–4 mm decreased, and the stress of the interarticular cartilage of the first metatarsophalangeal joint with 4 mm was reduced. In the case of 6 mm, the stress value between the first metatarsal and the first metatarsophalangeal joint increased, and 4 mm was the most suitable distance; Conclusions: Compared with the hallux valgus without osteotomy, the stress of the first metatarsals and second metatarsals of 2–4 mm decreased, and the stress of the interarticular cartilage of the first metatarsophalangeal joint with 4 mm was reduced. In the case of 6 mm, the stress value between the first metatarsal and the first metatarsophalangeal joint increased, and 4 mm was the most suitable distance. For the degree of displacement of the distal chevron osteotomy, the postoperative stability and the stress distribution of metatarsal bone should be considered. Factors such as hallux valgus angle, intermetatarsal angle, patient’s age, body weight, and metatarsal width should be considered comprehensively. The factors affecting osteotomy need to be further explored. The degree of displacement of osteotomy can be evaluated by FE method before the operation, and the most suitable distance can be obtained.


1989 ◽  
Vol 79 (3) ◽  
pp. 132-138
Author(s):  
JA Wenig ◽  
DJ McCarthy

The two-stage capsular closure modification of the V-Y capsulorrhaphy in hallux abducto valgus surgery is a technique for restoring the soft tissue anatomical relationships of the first metatarsophalangeal joint in a bunion deformity. The first stage of the V-Y capsulorrhaphy corrects the plantar and lateral deviation of the abductor hallucis tendon. The second stage of the V-Y capsulorrhaphy closure allows for the correction of abductus and valgus rotation of the hallux. Inasmuch as each element of the soft tissue deformity in hallux abducto valgus deformity is corrected individually, greater precision can be applied to each constituent of the hallux abducto valgus deformity.


Foot & Ankle ◽  
1988 ◽  
Vol 9 (2) ◽  
pp. 75-80 ◽  
Author(s):  
Scott R. McGarvey ◽  
Kenneth A. Johnson

We reviewed the results of the Keller arthroplasty in combination with resection arthroplasty of the forefoot in patients with rheumatoid arthritis. Of the 29 patients (49 feet) in the series, 20 had involvement of both feet and nine had involvement of a single foot. The average age of the patients was 55.4 years, and the average follow-up period was 4.9 years. All feet had resection of the lesser metatarsal heads, resection of the base of the proximal phalanges of the lesser toe, and a Keller arthroplasty of the first metatarsophalangeal joint. The results were satisfactory in 16 feet, satisfactory with some reservations in 21 feet, satisfactory with major reservations in seven feet, and unsatisfactory in five feet. For 40 of the 49 feet (82%), the patients stated that they would repeat the procedure, knowing the results achieved. The major causes of patient reservations and lack of satisfaction were return of the hallux valgus deformity and pain (53%), forefoot instability (27%), and continuing metatarsalgia (20%). Resection arthroplasty of the lesser metatarsophalangeal joints of the forefoot in rheumatoid disease is a satisfactory procedure. When used in combination with Keller resection arthroplasty of the first metatarsophalangeal joint, however, an increased number of unsatisfactory results occur, attributable to returning pain and deformity of that joint.


2020 ◽  
Vol 14 (2) ◽  
pp. 132-137
Author(s):  
Enzo Sperone ◽  
Martín Rofrano ◽  
Andrés Bigatti ◽  
Matías Iglesias ◽  
Iván Torterola ◽  
...  

Objective: To assess the involvement of the hallux interphalangeal (IP) joint after first metatarsophalangeal joint (MTPJ) arthrodesis and propose a treatment consisting of MTPJ resection arthroplasty associated with phalangeal osteotomy or IP joint arthrodesis. Methods: We retrospectively analyzed 9 patients treated with MTPJ resection arthroplasty associated with phalangeal osteotomy or hallux IP joint arthrodesis from November 2006 to January 2017. Results: The main causes of MTPJ arthrodesis that subsequently evolved to IP involvement were severe hallux valgus and sequelae or complications of previous hallux valgus operations. Additionally, the reasons leading to rescue surgery were pain, deformity, and/or discomfort. Conclusion: This therapeutic modality is able to relieve symptoms by a simple procedure, with acceptable functional and estheticresults. Level of Evidence IV; Therapeutic Studies; Case Series.


1998 ◽  
Vol 19 (3) ◽  
pp. 127-131 ◽  
Author(s):  
Harold B. Kitaoka ◽  
Gary L. Patzer

We reviewed the results of 15 patients (16 feet) in whom a hallux valgus procedure had failed. Salvage was by proximal crescentic first metatarsal osteotomy with distal soft-tissue reconstruction. Results based on a clinical scale considering the level of pain, activity limitations, support requirement, footwear limitations, and alignment were good in 11, fair in two, and poor in three. Patients were satisfied with the results in 10 feet, satisfied with reservations in four feet, and dissatisfied in two feet. Complications were: transfer metatarsalgia in three, hallux varus in one, and osteotomy nonunion in one. One of the patients required reoperation to bone graft a proximal osteotomy. Metatarsal osteotomy was helpful in the salvage treatment of recurrent, symptomatic hallux valgus when the first metatarsophalangeal joint was functional and painless.


2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0050
Author(s):  
Li Yi ◽  
Liang Xiaojun ◽  
Zhao Hong-Mou

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: At present, there is a wide range of surgical methods for the treatment of hallux valgus with an increased distal metatarsal articular angle, there are not many reports on the effectiveness of this method that triple osteotomy and lateral soft tissue release. To study the clinical effect of triple osteotomy and lateral soft tissue release in treatment of hallux valgus with an increased distal metatarsal articular angle. Methods: A retrospective analysis of the clinical data of 23 patients (35 feet) with an increased distal metatarsal articular angle and undergoing triple osteotomy and lateral soft tissue release between January 2010 and December 2014 in Xi’an Hong Hui Hospital was conducted including 7 male (12 feet) and 16 female (23 feet). Their average age was (45.7+-15.2) years (range: 21˜66 years). The hallux valgus angle (HVA), the intermetatarsal angle (1-2 IMA) and the distal metatarsal articular angle (DMAA) in weightbearing dorsoplantar radiographs of the foot before operation and at final follow-up visit were compared. The preoperative and the final follow-up clinical functional outcomes were evaluated by the American Orthopaedic Foot & Ankle Society Hallux metatarsophalangeal-interphalangeal (AOFAS-MTP-IP) scale and a visual analogue scale (VAS). Results: The average follow-up time was (19.1+-7.3) months (range: 10˜32 months). There are no such severe complications as nonunion, avascular necrosis. The pain of first metatarsophalangeal joint was apparent release after operation 6 months. The incomplete range of motion in the first metatarsophalangeal joint occured at three patient (4 feet), but the symptoms disappeared after functional exercise. The HVA, IMA and DMAA were significantly improved from preoperative (47.6+-6.4)°, (18.6+-2.1)° and (34.7+-7.2)° to the latest follow-up (16.7+-4.3)°, (8.2+-2.2)°and (9.0+-4.5)°(P<0.01). The preoperative AOFAS score was 56.6+-3.9 points, which was significantly different from 89.2+-2.1 points (P<0.01). The postoperative VAS score has declined from 6.0+-0.8 points to 0.8+-0.7 points with statistically significant differences (P<0.01). According AOFAS score, 22 feet got an excellent result, 6 good and 5 fair. The function was good and excellent in 84.8%. Conclusion: Triple osteotomy and lateral soft tissue release in treatment of hallux valgus with an increased distal metatarsal articular angle which can gain good result in respect of functional and radiological outcomes. It is important to correct the distal metatarsal articular angle and functional training of the first metatarsophalangeal joint after operation.


Author(s):  
Ruslan Khairutdinov ◽  
Timur Minasov ◽  
Ekaterina Yakupova ◽  
Elvina Mukhametzyanova

Hallux valgus is characterized by the appearance and growth of a painful “lump” in the region of the first metatarsophalangeal joint, the development of forefoot corns, and inability to choose the right shoes, which leads to a significant decrease in the quality of life of these patients. Corrective osteotomies that preserve the metatarsophalangeal joint, for example Austin (Chevron) osteotomy, are usually used for hallux valgus deformity of the I, II degrees. Radiography with the study of the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA) is a research method that shows the true correlation between bone structures. The correlation between the radiological and functional indicators of osteotomy allows us to determine possible recommendations for indications for surgical treatment of Hallux valgus. Correlation shows that the largest correction of hallux valgus in older patients occurs due to a small adjustment of the angle of DMMA and HVA. IMA had the best correction after Austin osteotomy among patients of a younger age, then the HVA, and the DMMA had minimum correction according to the AOFAS rating scale (Kitaoka). The revealed correlations allow us to determine the correct tactics for the treatment of hallux valgus by identifying the benefits of Austin osteotomy.


2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110085
Author(s):  
Christopher Traynor ◽  
James Jastifer

Background: Instability of the first-tarsometatarsal (TMT) joint has been proposed as a cause of hallux valgus. Although there is literature demonstrating how first-TMT arthrodesis affects hallux valgus, there is little published on how correction of hallux valgus affects the first-TMT joint alignment. The purpose of this study was to determine if correction of hallux valgus impacts the first-TMT alignment and congruency. Improvement in alignment would provide evidence that hallux valgus contributes to first-TMT instability. Our hypothesis was that correcting hallux valgus angle (HVA) would have no effect on the first-TMT alignment and congruency. Methods: Radiographs of patients who underwent first-MTP joint arthrodesis for hallux valgus were retrospectively reviewed. The HVA, 1-2 intermetatarsal angle (IMA), first metatarsal–medial cuneiform angle (1MCA), medial cuneiform–first metatarsal angle (MC1A), relative cuneiform slope (RCS), and distal medial cuneiform angle (DMCA) were measured and recorded for all patients preoperatively and postoperatively. Results: Of the 76 feet that met inclusion criteria, radiographic improvements were noted in HVA (23.6 degrees, P < .0001), 1-2 IMA (6.2 degrees, P < .0001), 1MCA (6.4 degrees, P < .0001), MC1A (6.5 degrees, P < .0001), and RCS (3.3 degrees, P = .001) comparing preoperative and postoperative radiographs. There was no difference noted with DMCA measurements (0.5 degrees, P = .53). Conclusion: Our findings indicate that the radiographic alignment and subluxation of the first-TMT joint will reduce with isolated treatment of the first-MTP joint. Evidence suggests that change in the HVA can affect radiographic alignment and subluxation of the first-TMT joint. Level of Evidence: Level IV, retrospective case series.


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