Midfoot width changes after first metatarsal osteotomy in hallux valgus surgery: A biomechanical effect?

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.

Does Hallux Valgus Exhibit a Deformity Inherent to the First Metatarsal Bone?

Hallux valgus is a common condition, and it still poses some challenges. The identification of factors associated with the development of the deformity is of paramount importance in obtaining a full correction of the disorder. Hallux pronation is one of the frequently found components, especially in larger deformities, but the cause and exact location of this condition are not fully understood. The aim of the present study was to investigate whether there is a rotational deformity inherent to the first metatarsal bone. A case-control study was conducted on patients with and without hallux valgus who were subjected to computed tomography with multiplanar reconstruction. Statistical analysis was performed by means of a mixed model adjusted for foot and gender to compare metatarsal rotation between cases and controls. Correlations between numerical quantitative measurements were investigated by means of Pearson's correlation coefficient obtained in a linear mixed model. A total of 82 feet (tests) were analyzed in the hallux valgus group and 64 feet (tests) in the control group (N = 146). The hallux valgus group was significantly different from the control group (p< .001). Mean metatarsal bone rotation was 15.36° (range 1.65° to 32.52°) in the hallux valgus group and 3.45° (range -7.40° to 15.56°) in the control group. The difference between the means was 11.9° (confidence interval 9.2° to 14.6°). In conclusion, patients with hallux valgus exhibited increased exclusive bone rotation of the first metatarsal toward pronation compared with the population without this condition.

Ankle Arthroscopy as an Adjunctive Method for Diagnosis of Nonunion After Tibiotalar Arthrodesis.

The definition of consolidation after ankle arthrodesis can be challenging in some situations. Computed tomography has increased diagnostic accuracy; however, there are still no clear criteria for nonunion. In this context, arthroscopy with direct visualization of the arthrodesis may provide crucial data to inform the choice of treatment. The present report illustrates a case in which arthroscopy prompted a change in treatment strategy. More extensive surgery, with the potential for greater morbidity due to revision arthrodesis, could be avoided.

Comparison between Simple Radiographic and Computed Tomographic Three-Dimensional Reconstruction for Evaluation of the Distal Metatarsal Articular Angle.

The hallux valgus is a pathologic condition in the forefoot that often causes pain and functional limitations. Assessing all deformity components, such as the distal metatarsal articular angle (DMAA) is essential to hallux valgus treatment. Nevertheless, interobserver agreement of DMAA is poor on plain radiographs. The present study compared computed tomographic (CT) 3-dimensional (3D) reconstruction with plain radiographic measurements for measuring the DMAA. We included 43 consecutive patients (77 feet), diagnosed with hallux valgus at the orthopedic outpatient clinic at Hospital de Clínicas de Porto Alegre (Porto Alegre, Brazil) from April 2014 to June 2015 in our prospective study. The DMAAs were measured by 2 observers using CT 3D reconstruction. The results were compared between observers and with the plain radiographic measurements using the concordance correlation coefficient and the Bland-Altman plot to determine the agreement between the 2 methods. The interobserver agreement of the CT 3D measurements was high (concordance correlation coefficient 0.90; p < .001). Significant agreement was found between the plain radiographic and CT measurements (concordance correlation coefficient 0.667; p < .001). The Bland-Altman plot showed that the difference between the plain radiographic and CT measurements increased when greater DMAA values were associated with the presence of metatarsal rotation. The interobserver agreement of DMAA measurements was greater on CT 3D reconstruction than on plain radiography. The poor interobserver agreement of the radiographic DMAA might have resulted from metatarsal rotation.

Leptospirose / Leptospirosis

A leptospirose é uma doença muito prevalente em nosso meio. Possui curso autolimitado e, em geral, de bom prognóstico. Entretanto, existem formas mais graves e essas têm sido observadas com maior freqüência(13). O emprego da terapêutica antimicrobiana parece ser útil em formas graves, entretanto, tal benefício tem sido questionado