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1.
Artigo em Inglês | MEDLINE | ID: mdl-38441963

RESUMO

BACKGROUND: A rounded lateral first metatarsal head shape is associated with higher rates of hallux abducto valgus recurrence following corrective surgery; however, the effect of the lateral first metatarsal head shape on the hallux abduction angle (HAA) has not yet been explored in a nonpathologic, pre-pointe ballet dancer population. The primary purpose of this study was to investigate the effect of the lateral first metatarsal head shape on the HAA when pre-pointe female dancers force their turnout. METHODS: Seventeen female, pre-pointe ballet students (mean age, 10.8 ± 0.95 years) participated in this study. Fluoroscopic images of each dancer's dominant foot were taken, and the lateral first metatarsal head shape was classified visually. Each dancer performed three consecutive stances of natural double-leg upright posture: both functional and forced turnout. HAAs were obtained by marking medial bony landmarks on paper and were compared to photographic measurements. RESULTS: No significant difference was found between the round and angular lateral first metatarsal head shape for the change in HAA from natural double-leg upright posture to forced turnout. Hallux abduction angle significantly increased by 4.6° (P < .001) in forced turnout compared to the natural double-leg upright posture for the photographic method, whereas the paper method demonstrated an increase of 2.6° (P = .007). No statistical differences were found between the paper and photographic methods in measuring the HAA for all stances. CONCLUSIONS: Our findings suggest no association between the HAA and lateral first metatarsal head shape; however, HAA does increase when a dancer assumes forced turnout. The paper method demonstrated similar reliability to the photographic method and shows the potential for future use as a clinical tool in assessing hallux abducto valgus.


Assuntos
Dança , Hallux Valgus , Ossos do Metatarso , Feminino , Humanos , Criança , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Projetos Piloto , Ossos do Metatarso/diagnóstico por imagem , Reprodutibilidade dos Testes
2.
Zhongguo Gu Shang ; 37(3): 258-64, 2024 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-38515412

RESUMO

OBJECTIVE: To explore clinical effect of the fifth metatarsal head excision and non-excision in rheumatoid arthritis (RA) forefoot deformity reconstruction. METHODS: Retrospective analysis was performed on 50 patients (76 feet) with moderate to severe forefoot deformity caused by RA treated from May 2015 to January 2019. According to degeneration of the fifth metatarsophalangeal joint,the fifth metatarsal head was retained or excised by wind-like forefoot reconstruction,and divided into the fifth metatarsal head preservation group (preservation group) and the fifth metatarsal head resection group (resection group). Twenty-four female patients in preservation group,aged from 47 to 81 years old with an average of (60.37±8.60) years old;the course of disease ranged from 13 to 22 years with an average of (19.00±3.06) years;body mass index (BMI) ranged from 21 to 28 kg·m-2 with an average of (23.53±2.47) kg·m-2;six patients (6 feet) with moderate hallux valgus deformity and 18 patients (30 feet) with severe hallux valgus deformity;treated with the first metatarsophalangeal joint fusion combined with the second th the fourth metatarsophalangeal joint arthroplasty and the fifth metatarsophalangeal joint cleanup. Twenty-six female patients in resection group were female,aged from 30 to 80 years old with an average of (58.53±13.70) years old;the course of disease ranged from 8 to 25 years with an average of (17.94±3.92) years;BMI raged from 20 to 28 kg·m-2 with an average of (24.60±2.03) kg·m-2;4 patients (4 feet) with moderate bunion valgus deformity and 22 patients (36 feet) with severe bunion valgus deformity;treated by the first metatarsophalangeal joint fusion combined with the second th the fifth metatarsophalangeal joint resection of the metatarsophalangeal head. Operation time and postoperative complications between two groups were observed,hallux valgus angle (HVA),intermetatarsal angles between the first and the second metatarsals (IMAFS),intermetatarsal angles between the first and fifth metatarsals (IMAFF),Japanese Society for Surgery of Foot (JSSF) score before surgery and at the latest follow-up were compared. RESULTS: Fifty patients were followed-up from 14 to 46(25.30±8.83) months in resection group and 12 to 48 with an average of (24.30±11.12) months in preservation group,while no significant difference between two groups (P>0.05). There were no significant difference in operation time and postoperative complications between two groups (P>0.05). JSSF scores,HVA,IMAFS and IMAFF in fesection group were improved from (45.09±3.35) points,(38.90±13.67) °,(12.88±1.72) °,(32.50±2.99) ° before operation to (81.60±3.27) points,(15.40±0.90),(9.06±2.27) °,(22.20±1.98) ° at the latest follow-up (P<0.05);preservation group were improved from (47.09±3.96) points,(43.30±12.65) °,(13.99±3.13) °,(33.20±6.14) ° to (83.10±3.66) points,(15.20±1.54) °,(8.99±1.02) °,(24.70±1.88) °,respectively. There were no significant difference in JSSF score,HVA,IMAFS and IMAFF between two groups before operation and the latest follow-up (P>0.05). At the latest follow-up,there were statistically significant differences in pain and deformity in JSSF scores between two groups (P<0.05). CONCLUSION: Both rheumatoid anterior foot reconstruction and anterior foot reconstruction fifth metatarsophalangeal joint debridement showed significant improvement in clinical efficacy and imaging results. Compared with rheumatoid prefoot reconstruction,the fifth metatarsophalangeal joint reconstruction for the treatment of moderate and severe deformity of rheumatoid prefoot showed better improvement in pain,but worse improvement in deformity. For the moderate to severe deformity of the forefoot caused by rheumatoid disease,patients with mild to moderate degenerative deformity of the articular surface of the fifth metatarsal phalanges may be considered for use.


Assuntos
Artrite Reumatoide , Joanete , Hallux Valgus , Ossos do Metatarso , Articulação Metatarsofalângica , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto , Masculino , Ossos do Metatarso/cirurgia , Hallux Valgus/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Artrodese , Complicações Pós-Operatórias , Artrite Reumatoide/cirurgia , Artrite Reumatoide/complicações , Joanete/complicações , Articulação Metatarsofalângica/cirurgia , Dor/complicações
3.
BMC Musculoskelet Disord ; 25(1): 111, 2024 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-38317173

RESUMO

BACKGROUND: Hallux Valgus (HV) deformity is associated with misalignment in the sagittal plane that affects the first toe. However, the repercussions of the first toe hyperextension in HV have been scarcely considered. The purpose of this study was to provide evidence of the association between first-toe hyperextension and the risk of first toenail onycholysis in HV. METHODS: A total of 248 HV from 129 females were included. The extension of 1st MTP joint was measured while the patient was in the neutral position of the hallux using a two-branch goniometer. The classification of the HV severity stage was determined by the Manchester visual scale, and the height of the first toe in the standing position was measured using a digital meter. An interview and clinical examination were performed to collect information on the presence of onycholysis of the first toe. RESULTS: Of the 248 HV studied, 100 (40.3%) had onycholysis. A neutral extension > 30 degrees was noted in 110 (44.3%) HV. The incidence of onycholysis was higher in HV type C than in type B (p = 0.044). The probability of suffering onycholysis in the right foot was 2.3 times greater when the neutral position was higher than 30 degrees (OR = 2.3; p = 0.004). However, this was not observed in the left foot (p = 0.171). Onycholysis was more frequent in HV with more than 2 cm height of the first toe (p < 0.001). For both feet, the probability of suffering onycholysis was greater for each unit increase in hallux height (right foot OR = 9.0402, p = 0.005; left foot OR = 7.6633, p = 0.010). CONCLUSIONS: The incidence of onycholysis appears to be significantly associated with HV showing more than 30º extension, and more than 2 cm height of the first toe. Height and hyperextension of the first toe together with first toenail pathology should be mandatory in the evaluation of HV.


Assuntos
Joanete , Hallux Valgus , Hallux , Articulação Metatarsofalângica , Onicólise , Humanos , Feminino , Hallux Valgus/epidemiologia , Estudos Transversais , Prevalência , Onicólise/patologia , Articulação Metatarsofalângica/patologia
4.
J Orthop Surg (Hong Kong) ; 32(1): 10225536241233474, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38369475

RESUMO

BACKGROUND: The hallux valgus deformity is made up of misaligned first metatarsal, hallux, and sesamoids. Their angular deformities are well-studied, but not their positional displacements. A few available reports claimed the proximal end of the proximal phalanx and sesamoids were not shifted medially along with the first metatarsal head. However, the general observation is otherwise. This study revisits the issue. METHODS: A radiological study of 189 feet with and without the hallux valgus deformity was carried out to analyze the first metatarsal, hallux, and sesamoid positional changes in relation to the second metatarsal and among themselves. A total of 194 X-ray images with all relevant measurements that formed the raw database for this study were submitted for online viewing and reference. RESULTS: There was a statistically significant change in the first metatarsal, hallux, and sesamoid positions of feet with hallux valgus deformity compared to normal feet. All have migrated medially but to different degrees. It was contrary to the past findings of no change in sesamoid and hallux positions. CONCLUSIONS: We agree with past findings that the metatarsus primus varus deformity is directly related to the failed medial metatarsosesamoid ligament. We also believe in the failure of the deep 1-2 transverse metatarsal ligament responsible for the sesamoid migration.


Assuntos
Hallux Valgus , Hallux Varus , Hallux , Ossos do Metatarso , Humanos , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/etiologia , Hallux Valgus/cirurgia , , Radiografia , Ossos do Metatarso/diagnóstico por imagem
5.
Foot Ankle Int ; 45(3): 261-271, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38327241

RESUMO

BACKGROUND: With the advent of effective disease-modifying medications, the surgical treatment of forefoot deformities in patients with rheumatoid arthritis (RA) has evolved from joint-sacrificing to joint-preserving surgery. However, it is unclear whether joint-preserving surgery is effective for the full range of metatarsophalangeal joint involvement. Hence, this study investigated the postoperative outcomes of joint-preserving surgery for rheumatoid forefoot deformities with a wide range of joint destruction. METHODS: This retrospective observational study included 68 feet from 68 patients with RA who underwent joint-preserving surgery for forefoot deformities between 2014 and 2020. The Larsen grade classification was used to assess the first metatarsophalangeal joint destruction and classify patients into 4 groups as follows: 0 and 1 (n = 14), 2 (n = 21), 3 (n = 19), and 4 and 5 (n = 14). The Self-Administered Foot and Ankle Evaluation Questionnaire (SAFE-Q) score, hallux valgus angle (HVA), and intermetatarsal angle (IMA) were determined before surgery and at the last follow-up visit. RESULTS: The median observation duration was 40 (range, 24-78) months. SAFE-Q scores of all groups significantly improved in all subscales at the last observation, with no significant differences among the study groups. Radiographic evaluations of all groups revealed significant improvements in HVA and IMA after surgery, with no significant differences among the groups. CONCLUSION: In patients using the surgical approaches described in this study, joint-preserving surgery for rheumatoid forefoot deformities led to satisfactory clinical and radiographic improvements, regardless of the severity of joint destruction. LEVEL OF EVIDENCE: Level III, case-control study.


Assuntos
Artrite Reumatoide , Joanete , Hallux Valgus , Articulação Metatarsofalângica , Humanos , Resultado do Tratamento , Estudos de Casos e Controles , , Artrite Reumatoide/cirurgia , Antepé Humano/cirurgia , Antepé Humano/anormalidades , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Estudos Retrospectivos , Articulação Metatarsofalângica/cirurgia
6.
Foot (Edinb) ; 58: 102070, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38382165

RESUMO

Hallux valgus is a challenging pathology characterized by a valgus deformity in the metatarsophalangeal area of the first ray. The aim of this study was to analyze the influence of first metatarsal osteotomy on the relationship between midfoot bones in patients with hallux valgus. The sample consisted of patients from the orthopedics and traumatology outpatient clinic who underwent surgical treatment for hallux valgus. Preoperative and postoperative X-rays were compared regarding the width of the midfoot and the tarsometatarsal joint. The sample consisted of 17 women, with 22 feet assessed in each group. The distance from the medial cuneiform to the cuboid, the distance from the intermediate cuneiform to the cuboid, the distance between the first and fifth metatarsals, and the distance between the second and fifth metatarsals reduced significantly between pre- and postoperative assessments. Hallux valgus correction through osteotomy of the first metatarsal leads to a structural change in the midfoot. Further studies should determine whether these changes persist over time.


Assuntos
Hallux Valgus , Ossos do Metatarso , Articulação Metatarsofalângica , Humanos , Feminino , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Osteotomia , , Articulação Metatarsofalângica/cirurgia , Resultado do Tratamento
7.
PLoS One ; 19(2): e0297504, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38349907

RESUMO

Hallux Valgus foot deformity affects gait performance. Common treatment options include distal oblique metatarsal osteotomy and chevron osteotomy. Nonetheless, the current process of selecting the appropriate osteotomy method poses potential biases and risks, due to its reliance on subjective human judgment and interpretation. The inherent variability among clinicians, the potential influence of individual clinical experiences, or inherent measurement limitations may contribute to inconsistent evaluations. To address this, incorporating objective tools like neural networks, renowned for effective classification and decision-making support, holds promise in identifying optimal surgical approaches. The objective of this cross-sectional study was twofold. Firstly, it aimed to investigate the feasibility of classifying patients based on the type of surgery. Secondly, it sought to explore the development of a decision-making tool to assist orthopedists in selecting the optimal surgical approach. To achieve this, gait parameters of twenty-three women with moderate to severe Hallux Valgus were analyzed. These patients underwent either distal oblique metatarsal osteotomy or chevron osteotomy. The parameters exhibiting differences in preoperative and postoperative values were identified through various statistical tests such as normalization, Shapiro-Wilk, non-parametric Wilcoxon, Student t, and paired difference tests. Two artificial neural networks were constructed for patient classification based on the type of surgery and to simulate an optimal surgery type considering postoperative walking speed. The results of the analysis demonstrated a strong correlation between surgery type and postoperative gait parameters, with the first neural network achieving a remarkable 100% accuracy in classification. Additionally, cases were identified where there was a mismatch with the surgeon's decision. Our findings highlight the potential of artificial neural networks as a complementary tool for surgeons in making informed decisions. Addressing the study's limitations, future research may investigate a wider range of orthopedic procedures, examine additional gait parameters and use more diverse and extensive datasets to enhance statistical robustness.


Assuntos
Hallux Valgus , Ossos do Metatarso , Cirurgiões Ortopédicos , Humanos , Feminino , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Estudos Transversais , Osteotomia/métodos , Marcha , Ossos do Metatarso/cirurgia , Resultado do Tratamento , Estudos Retrospectivos
8.
Foot (Edinb) ; 58: 102069, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38325170

RESUMO

BACKGROUND: Hallux valgus (HV) is a common foot pathology. Severe HV in the presence of Tarsometatarsal joint (TMTJ) instability is often managed with arthrodesis of the 1st TMTJ. There are concerns regarding non-union and malunion (particularly the early loss of inter-metatarsal angle correction before complete arthrodesis). We report our medium-term results of a small series of patients that underwent an evolved surgical technique utilising orthogonal staples and a transverse suture button fixation to address biomechanical concerns with traditional Lapidus arthrodesis. METHODS: A retrospective study of a consecutive series of patients who underwent this surgical technique between February 2017 and May 2022. Clinical outcomes were validated through Patient-reported outcomes measures (PROMS); EuroQol-5 Dimension (EQ-5D) and Manchester-Oxford Foot Questionnaires (MOXFQ). Radiographic parameters (hallux valgus (HVA), intermetatarsal (IMA), distal metatarsal articular angle (DMAA)) were assessed. Union of the arthrodesis and complications were recorded. RESULTS: During the study period, 9 feet underwent the procedure. Radiographic data was available for all nine and PROMS data for seven (77.8%). Significant improvement occurred in all radiographic deformity parameters at mean 6-month follow-up. Mean ± standard deviation correction calculated preoperatively as HVA 40.2°, IMA 19.3° and DMAA 15.8°, corrected to HVA 15.4°, IMA 5.8° and DMAA 5.9° postoperatively. (HVA; P < 0.001, IMA; P < 0.001, DMAA; P < 0.001) Clinical PROMs at mean follow-up of 2 years were MOXFQ 34.4 ± 25.2, EQ-5D-5 L 0.819 ± 0.150 and VAS pain 13.6 ± 13.6. There were no cases of non-union, Tibialis anterior tendon irritation or hallux varus. Complications included first MTPJ stiffness in one case and CRPS and dorsiflexion malunion of the first ray in another patient. CONCLUSION: This preliminary study of the procedure used in this series confirm this is a safe surgical technique to address severe HV with a low rate of non-union and significant radiographic improvements. A larger patient dataset is needed to evaluate this procedure robustly.


Assuntos
Hallux Valgus , Instabilidade Articular , Ossos do Metatarso , Humanos , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Osteotomia/métodos , Radiografia , Artrodese/métodos , Ossos do Metatarso/cirurgia
9.
Eur Rev Med Pharmacol Sci ; 28(1): 90-97, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38235861

RESUMO

OBJECTIVE: In the treatment of mild and moderate hallux valgus (HV) cases, the Lindgren distal osteotomy (LDO) technique has been one of the most frequently preferred methods, and screw fixation has been the most preferred material for surgery. However, considering the implant removal operations due to the reaction to the material,  the risk of unsteadiness, retarded union, and malunion has limited the amount of safe application of lateralization of the distal fragment in distal osteotomy surgery and has yielded the researchers for a better alternative. This study compared the results of the LDO cases using headless cannulated screws and intramedullary plate fixation materials. PATIENTS AND METHODS: The retrospective study included 31 files of patients operated for HV between January 1, 2018, and December 31, 2022, in Adana City Training and Research Hospital Orthopedics Clinic, Adana, Turkey. In the radiological evaluation, the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the length of the first metatarsal (ML), and the distal metatarsal articular angle (DMAA) recorded preoperatively and postoperatively were analyzed. The functional results of the operations were evaluated by using the Visual Analog Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS), and EuroQol (EQ-5D) scores. RESULTS: Postop HVA, IMA, MU, and DMMA values were significantly higher in patients in Group 1 than in patients in Group 2 (p<0.001; p=0.004; p=0.004; p=0.049; p<0.001, respectively). The change in Delta (∆) HVA and EQ-5D values was significantly higher in patients in Group 2 compared to patients in Group 1 (p=0.020; p=0.016, respectively). CONCLUSIONS: The easily available and low-cost locking plates produced for mini-fractures may safely be used in distal osteotomy surgery of mild and moderate HV successfully combined with screws if intramedullary-placed, allowing accurate lateralization and improving overall outcome.


Assuntos
Hallux Valgus , Humanos , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Parafusos Ósseos , Osteotomia/métodos
10.
BMC Musculoskelet Disord ; 25(1): 61, 2024 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-38216881

RESUMO

BACKGROUND: Traditional Scarf osteotomy (TSO) is an effective procedure with a good record in moderate to severe hallux valgus (MSHV) surgery. In order to overcome shortcomings of TSO, Modified Rotary Scarf osteotomy (MRSO) was introduced in this study, which aimed to compare the clinical and radiological outcome in the patients treated with MRSO or TSO. METHODS: Of 175 patients (247 feet) with MSHV, 100 patients (138 feet) treated with MRSO and 75 patients (109 feet) treated with TSO were evaluated according to relevant indicators in twenty-four months follow-up. Pre-surgical and post-surgical HVA, IMA, DMAA, MTP-1 ROM, sesamoid grade and AOFAS (American Orthopaedic Foot and Ankle Society) scores and postsurgical complications were evaluated. RESULTS: Both groups manifested similar baseline characters. The mean follow-up was of 25.9 (range, 22-37) months. Significantly lower IMA, lower Sesamoid grade and higher DMAA at six months, twelve months and twenty-four months post-surgically had been showed in MRSO group compared to TSO group. There was no significant difference in HVA, MTP-1 ROM and AOFAS data at each follow-up time point post-surgically between the two groups. No major complications occurred in either group. CONCLUSION: MRSO showed comparable results to TSO, and improved IMA and sesamoid grade to a greater extent, with a lower probability of throughing effect. Although DMAA could be increased by MRSO, MRSO could still be a reproducible, non-dangerous and efficacious alternative procedure for treating HV patients which do not have severe DMAA.


Assuntos
Joanete , Hallux Valgus , Ossos do Metatarso , Humanos , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Osteotomia/efeitos adversos , Osteotomia/métodos , Ossos do Metatarso/cirurgia
11.
Medicine (Baltimore) ; 103(3): e36912, 2024 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-38241574

RESUMO

Hallux valgus (HV) is often accompanied by metatarsalgia. This study compared the radiological and clinical outcomes of new triplanar chevron osteotomy (TCO) and chevron osteotomy (CO) in the treatment of HV, especially for patients with plantar callosities and metatarsalgia. In this retrospective analysis, 90 patients (45 patients per group) with mild to moderate HV and plantar callosities were treated with TCO and CO from July 2020 to January 2022. In both procedures, the apex was located in the center of the head of the first metatarsal bone, and the CO was oriented towards the fourth MTPJ at a 60° angle. Plantar-oblique chevron osteotomy was defined as chevron osteotomy and a 20° plantar tilt; TCO was defined as plantar-oblique chevron osteotomy-based metatarsal osteotomy with a 10° tilt towards the metatarsal head. Primary outcome measures included preoperative and postoperative hallux valgus angle, 1 to 2 intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), first metatarsal length (FML), and second metatarsal head height X-ray images; clinical measurements, including visual analogue scale and American Orthopaedic Foot & Ankle Society (AOFAS) scores; changes in callosity grade and area; and changes in the number of people with metatarsalgia. Secondary outcomes included complications, recurrence rates, and cosmetic appearance. The hallux valgus angle, IMA, and DMAA were significantly lower after surgery (P  < .001) in all patients. In the TCO group, the mean FML and second metatarsal head height increased significantly postoperatively (P < .001). The AOFAS and visual analogue scale scores improved postoperatively in both groups (P < .001). All patients experienced satisfactory pain relief and acceptable cosmesis. The plantar callosity areas were smaller postoperatively in both the TCO and CO groups, but the change in the area (Δarea) in the TCO group significantly differed from that in the CO group (P < .001). The number of postoperative patients with metatarsalgia and the plantar callosity grade were both significantly lower in the TCO group than in the CO group after osteotomy (P < .05). TCO prevents dorsal shift of the metatarsal head and preserves and even increases FML, thereby preventing future metatarsalgia in patients. Therefore, compared with CO, TCO has better orthopedic outcomes and is an effective method for treating mild to moderate HV and preventing transfer metatarsalgia.


Assuntos
Calosidades , Doenças do Pé , Hallux Valgus , Ossos do Metatarso , Metatarsalgia , Articulação Metatarsofalângica , Humanos , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Resultado do Tratamento , Estudos Retrospectivos , Fluormetolona , Metatarsalgia/cirurgia , Osteotomia/métodos , Ossos do Metatarso/cirurgia
12.
Foot Ankle Int ; 45(3): 252-260, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38281125

RESUMO

BACKGROUND: Flatfoot deformity is believed to play a role in hallux valgus development and recurrence. While symptomatic flatfoot deformity can be treated with separate procedures at the time of hallux valgus correction, the question remains whether the patient undergoing correction of a symptomatic hallux valgus deformity should have their asymptomatic flatfoot concurrently addressed. We aimed to investigate whether the presence of asymptomatic flatfoot influences patient-reported and radiographic outcomes of the minimally invasive chevron and Akin bunionectomy. METHODS: A total of 104 patients were included in this study. Forty-two asymptomatic patients met the radiographic criteria for flatfoot while 62 had a normal arch. Patient-reported outcomes were evaluated and compared between the two groups using validated PROMIS measures preoperatively and at a minimum one-year postoperatively. Radiographic outcomes including hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary's angle, calcaneal pitch (CP), and talonavicular coverage angle (TNCA) were measured and compared preoperatively and minimum six-months postoperatively. RESULTS: Both groups demonstrated similar preoperative and postoperative PROMIS scores with significant improvements in physical function, pain interference, pain intensity, and global physical health. Preoperatively, HVA was similar between both groups, however the flatfoot group showed a greater IMA, Meary's angle, TNCA, and lower CP. Postoperatively, HVA and IMA were similar between groups, although patients in the flatfoot group retained a significantly greater Meary's angle, TNCA, and lower CP. Both groups showed significant improvements in HVA, IMA, and TNCA. CONCLUSION: Our study indicates that the minimally invasive chevron and Akin bunionectomy leads to improved clinical and radiographic hallux valgus outcomes without adversely impacting radiographic flatfoot parameters. Therefore, the MIS bunionectomy may be an effective option for hallux valgus correction in patients with mild, asymptomatic flatfoot. LEVEL OF EVIDENCE: Level III, retrospective cohort.


Assuntos
Joanete , Pé Chato , Hallux Valgus , Humanos , Estudos Retrospectivos , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Pé Chato/diagnóstico por imagem , Pé Chato/cirurgia , Osteotomia/métodos , Radiografia , Resultado do Tratamento
13.
Foot Ankle Surg ; 30(3): 258-262, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38185597

RESUMO

BACKGROUND: Minimally invasive surgical (MIS) osteotomies are increasing as a surgical option for treating midfoot and forefoot conditions. This study aimed to evaluate the impact of each burr pass on the degree of correction, gap size, and alignment in MIS Akin and first metatarsal dorsiflexion osteotomies (DFO). METHODS: MIS Akin and first metatarsal DFO were performed on ten cadaveric specimens. Fluoroscopic measurements included the metatarsal dorsiflexion angle (MDA), dorsal cortical length (MDCL), first phalangeal medial cortical length (PCML) and proximal to distal phalangeal articular angle (PDPAA). RESULTS: The average decrease in PCML with each burr pass was as follows: 1.53, 1.33, 1.27, 1.23 and 1.13 mm at the 1st to 5th pass, respectively. The MDCL sequentially decreased by 1.80, 1.59, 1.35, 0.75, and 0.60 mm. The MDA consistently decreased, and the PDPAA incrementally became more valgus oriented. CONCLUSION: On average, a first metatarsal dorsal wedge resection of 4.7 mm and first phalangeal medial wedge resection of 2.9 mm was achieved after 3 and 2 burr passes, respectively. This data may aid surgeons determine the optimal number of burr passes required to achieve the desired patient-specific surgical correction.


Assuntos
Hallux Valgus , Lamina Tipo A/deficiência , Ossos do Metatarso , Distrofias Musculares , Humanos , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Hallux Valgus/cirurgia , Osteotomia , , Resultado do Tratamento
14.
J Foot Ankle Surg ; 63(1): 64-73, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37690498

RESUMO

Radiographic measurements are frequently used to classify deformity and determine treatment options. Correlation coefficients can be used to determine inter- and intrarater reliability. Reliability is a required feature of any measurement if the measurement is to provide valid information. We calculated correlation coefficients for standard radiographic measurements used to categorize foot deformities: this was done for 52 sets of radiographs assessed by 5 raters. We aimed for generalizability, and kept rater instructions to match what was originally published for each measurement of interest with schematic illustration. Overall, our results mostly showed a lack of inter-rater reliability (correlation coefficients <0.4), and strong intrarater reliability (correlation coefficients >0.6), for 12 forefoot and 12 rearfoot radiographic measurements that are commonly used. The results of this investigation bring into question the routine use of radiographic measurements to categorize deformity, select treatments, and measure surgical outcomes, between surgeons, because the validity of these measurements appears to be threatened by weak inter-rater reliability. In order for these measurements to be considered useful, it may be necessary for surgeons to more rigorously define and practice making standard radiographic measurements.


Assuntos
Deformidades do Pé , Hallux Valgus , Humanos , Hallux Valgus/cirurgia , Reprodutibilidade dos Testes , Pé/diagnóstico por imagem , Deformidades do Pé/diagnóstico por imagem , Deformidades do Pé/cirurgia , Radiografia
15.
Foot Ankle Int ; 45(2): 141-149, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-38063154

RESUMO

BACKGROUND: There is little available information regarding the difference in outcomes between severe hallux valgus (S-HV), defined as 40 degrees ≤ hallux valgus angle (HVA) < 50 degrees, and what we consider to be "super-severe HV" (SS-HV), defined as >50 degrees, following a proximal metatarsal osteotomy. We aimed to retrospectively compare the outcomes of a proximal metatarsal osteotomy in S- and SS-HV. METHODS: The series consisted of 57 female patients (57 feet) treated with a proximal supination osteotomy for symptomatic S- and SS-HV (33 and 24 feet, respectively). The outcome measures included radiographic parameters and for 45 patients included the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) score, and a visual analog scale pain score (VAS-PS) preoperatively and at a minimum follow-up of 12 months with a median of 26 months. No significant differences were found in age, body mass index, and the duration of follow-up between patients with S-HV and SS-HV (P > .10 for all comparisons) with the numbers available. RESULTS: Preoperative HVA in patients with S- and SS-HV was significantly improved at the final follow-up (P < .0001 for both comparisons). No significant differences in postoperative HVA and IMA were observed between patients with S- and SS-HV (P = .51 and .50, respectively). All 5 preoperative subscale scores of SAFE-Q in patients with S- and SS-HV significantly improved postoperatively (P < .01 for all comparisons). Preoperative VAS-PS in patients with S- and SS-HV significantly improved postoperatively (P < .0001 and <.009, respectively). There were no significant differences in preoperative and postoperative scores of all the SAFE-Q subscales and VAS-PS between patients with S-HV and SS-HV (P > .10 for all) with the numbers available. CONCLUSION: We found for this patient group that a proximal supination osteotomy can achieve a large correction for SS-HV as well as S-HV and significantly improve radiologic and clinical outcomes in SS-HV. The outcomes between patients with S- and SS-HV were not different in this series. LEVEL OF EVIDENCE: Level III, retrospective comparative study.


Assuntos
Joanete , Hallux Valgus , Ossos do Metatarso , Humanos , Feminino , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Supinação , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Osteotomia
16.
Foot Ankle Int ; 45(1): 52-59, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-38047491

RESUMO

BACKGROUND: Intraoperative fracture of the lateral cortex is common during Akin osteotomy. In a recent study, lateral cortex fracture did not impede healing or result in loss of correction in a combined cohort of open and percutaneous osteotomies stabilized by K-wire fixation. We hypothesize that undesired lateral cortex fracture will not affect radiographic correction and patient-reported outcomes in a percutaneous cohort stabilized by permanent, rigid screw fixation. METHODS: Consecutive patients with hallux valgus who underwent first metatarsal osteotomy and percutaneous Akin osteotomy stabilized by permanent, rigid screw fixation between May 2020 and January 2022 were retrospectively reviewed. Patients were stratified based on fractured lateral cortex (FC) or its absence (nonfractured cortex [NFC]). Visual analog scale (VAS) and Foot Function Index (FFI) were used to assess pain and patient-reported outcomes at 1-year follow-up. Patients were polled for satisfaction at 1-year follow-up by yes/no survey. RESULTS: Ninety-eight patients (89% female) were reviewed (98 feet; 43 NFC, 55 FC). Mean age was 48.3 years (range, 18-83 years). Mean preoperative VAS score was 7.5 and 7.7 in NFC and FC groups, which significantly decreased to 0.6 (P < .01) and 0.6 (P < .01), respectively. Mean total FFI was 53.9 and 54.2 and decreased to 17.9 (P < .01) and 17.2 (P < .01) in the NFC group and FC group, respectively. Overall, 97.8% of the NFC group and 96.4% of the FC group reported satisfaction.Mean HVA improved from 27.2 (16-42) degrees to 10.7 degrees (4-12) postoperatively in the NFC group. And in the FC group, HVA improved from 29.3 (19-39) degrees to 7.1 (4-12) degrees postoperatively. Postoperative HVA was significantly lower in the FC group (P < .05). CONCLUSION: In an exclusively percutaneous surgical cohort with correction maintained by rigid screw fixation, fracture of the lateral cortex is associated with improved postoperative radiologic alignment without detriment to patient-reported outcomes. LEVEL OF EVIDENCE: Level III, retrospective cohort study.


Assuntos
Hallux Valgus , Ossos do Metatarso , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Radiografia , Parafusos Ósseos , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Ossos do Metatarso/cirurgia , Osteotomia
17.
J Foot Ankle Surg ; 63(2): 262-266, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38056554

RESUMO

Hallux valgus (HV) is a common deformity of the foot. Its postoperative recurrence is not uncommon and is closely related to the recurrence of its underlying metatarsus primus varus (MPV) deformity. The syndesmosis procedure uses 1 to 2 intermetatarsal cerclage sutures to realign the first metatarsal and then induces a biological bonding between the 2 metatarsals to prevent the MPV deformity from recurring. This radiological study aimed to assess its effectiveness in long-term MPV and HV deformities recurrence prevention. Ninety-two feet of 51 consecutive patients had syndesmosis procedures that were prospectively followed up for more than 1 y and up to 14 y, averaging 100.5 (SD 45.2) months. Patients underwent X-ray examinations regularly at fixed intervals of their feet. We used Hardy's methods in measuring the intermetatarsal angle (IMA), hallux valgus angle (HVA), and medial sesamoid position from standing foot X-rays. More than 450 relevant X-ray and photo images were submitted as Supplementary Material for online viewing and reference. There was a significant final correction of IMA from 14.30° (SD 2.70) to 6.70° (SD 1.75) (p < .0001). There was no significant increase in IMA after the sixth postoperative month to their final follow-up endpoints, regardless of their lengths. There was a significant final correction of HVA from 31.95° (SD 7.45) to 19.1° (SD 7.45) (p < .0001). This study reconfirmed past findings that the MPV deformity could be corrected without osteotomies. Creating a syndesmosis-like intermetatarsal bonding was effective for long-term MPV recurrence prevention. Three feet had postoperative stress fracture of the second metatarsal. However, the HV deformity correction was less satisfactory, and the reasons were explained.


Assuntos
Joanete , Hallux Valgus , Hallux Varus , Ossos do Metatarso , Metatarso Varo , Humanos , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Resultado do Tratamento , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Osteotomia/métodos , Estudos Retrospectivos
18.
Foot Ankle Surg ; 30(2): 155-160, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37957060

RESUMO

BACKGROUND: We aimed to investigate whether foot function and physical performance differ between women with and without bilateral painful hallux valgus (HV). METHODS: Forty-four women with bilateral painful HV and forty-three controls were included. The Foot Function Index, American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joints Scale, and Manchester-Oxford Foot Questionnaire were used. The time while walking 10 m-walkway at maximum speed and ascending and descending ten stairs as fast as possible also single-limb stance time were measured. RESULTS: All self-reported and performance-based measures showed that women with HV had poorer foot function and physical performance than controls (p < 0.05). Women with mild HV had better self-reported foot function than those with moderate HV or severe HV (p < 0.05), but physical performance did not differ (p > 0.05). CONCLUSIONS: Women with bilateral painful HV exhibited poorer self-reported foot function and performance-based physical function than those without HV. LEVELS OF EVIDENCE: Level III.


Assuntos
Hallux Valgus , Hallux , Humanos , Feminino , Hallux Valgus/cirurgia , Extremidade Inferior , Caminhada , Dor , Desempenho Físico Funcional
19.
J Pediatr Orthop ; 44(3): 179-183, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-37997383

RESUMO

OBJECTIVES: The purposes of this study were to examine indications, radiographic outcomes, and clinical complications for primary arthrodesis of the great toe interphalangeal (IP) joint in young patients. BACKGROUND: Hallux valgus interphalangeus deformity of the great toe is uncommon in the pediatric population and often requires fusion of the IP joint. METHODS: A retrospective review of patients, ages 8 to 19 years, who underwent operative fusion of the great toe IP joint, and had >1 year radiographic follow-up was performed. Medical records and radiographs were reviewed to determine indications for surgery, concomitant procedures, success of fusion, complications, and need for revision procedures or elective hardware removal. Differences between pre and postradiographic outcomes for the hallux valgus angle, IP angle, and intermetatarsal angle were analyzed. RESULTS: Twenty-seven patients (31 feet) were included in the analyses. The average age at fusion surgery was 14.9 years (SD ± 2.3) with a mean follow-up visit of 35.2 months. The most common indications for fusion of the great toe IP joint were pain and deformity. Kirschner wire fixation was utilized in 7 cases, with the remaining 24 cases fixed with a single retrograde cannulated screw. Fifty-five concomitant toe and foot procedures were performed in 21 feet (68%) to address additional foot and toe deformity. Successful fusion occurred in 30 of 31 toes after the primary fusion. Patient satisfaction with the toe position and diminished pain were high (94.1%). Significant improvement was noted in the measure of the IP angle ( P < 0.001), with minimal clinical change in the hallux valgus angle ( P = 0.24) or the intermetatarsal angle ( P = 0.03). CONCLUSIONS: Hallux valgus interphalangeus of the great toe was successfully managed with the fusion of the IP joint. Single screw fixation or the use of Kirschner wires led to similar outcomes. Hardware-related issues with the use of screws were the most common adverse outcome. Patients should be made aware of the possible need for hardware removal after fusion utilizing screw fixation. LEVEL OF EVIDENCE: Level IV-a retrospective case series.


Assuntos
Hallux Valgus , Hallux , Articulação Metatarsofalângica , Humanos , Criança , Adolescente , Hallux/cirurgia , Hallux Valgus/complicações , Hallux Valgus/cirurgia , Estudos Retrospectivos , Artrodese , Dor , Resultado do Tratamento , Articulação Metatarsofalângica/cirurgia
20.
J Foot Ankle Surg ; 63(2): 226-232, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37984694

RESUMO

Hallux valgus (HV) is a common condition in which the first ray is deformed, leading to pain and altered joint mechanics. A variety of radiographic measurements are used to evaluate HV. Little is known about measurements used in the assessment of HV on lateral radiographs compared to anteroposterior (AP) radiographs. The primary aim of this study was to correlate lateral measurements with AP measurements pre and postoperatively. The secondary aim was to correlate lateral measurements with patient-reported outcome measures (PROMs) pre and postoperatively. One hundred eighty-three patients were initially enrolled in the study. Two fellowship-trained musculoskeletal radiologists independently performed all measurements. On AP radiographs, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured. On lateral radiographs, sagittal IMA, Meary's angle, and sagittal first ray length were measured. Measurements were recorded at baseline and 6, 12, and 24 months postoperatively. Intraclass correlation coefficients (ICCs) were used for inter-reader analysis. ICCs were moderate to very strong among readers. There were significant but weak correlations between lateral measurements and AP measurements. For at least 1 timepoint, IMA correlated with sagittal IMA, sagittal first ray length, and Meary's angle. HVA only correlated with sagittal first ray length. These correlations were all weak in magnitude. There were a few significant but weak correlations between the measurements in the study and PROMs. This study showed that sagittal IMA, sagittal first ray length, and Meary's angle are not predictive of AP measurements or patient outcomes and are not useful in preoperative assessment of HV.


Assuntos
Joanete , Hallux Valgus , Ossos do Metatarso , Humanos , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Estudos Prospectivos , , Medidas de Resultados Relatados pelo Paciente , Estudos Retrospectivos , Ossos do Metatarso/cirurgia
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