Analysis of hallux valgus angles automatically extracted from 3D foot scans taken in North America, Europe, and Asia.

The forefoot is the foot part most affected by ill-fitting shoes. Footwear fitting considers the measurements of length, width, and arch length. Toe shape has not yet been used in sizing feet and fitting shoes. This study aims to investigate the variation in toe shape, as measured by the hallux valgus angle. An automatic and reproducible hallux valgus angle measuring method using 3D foot scans with no palpation markers is proposed and applied to about half a million samples collected across North America, Europe, and Asia. The measuring method is robust and can detect the medial contour along the proximal phalanx even in extreme cases. The hallux valgus angle has a normal distribution with long tails on both sides in the general population. Large dispersions of HVA values were observed for both genders and in all three geographical regions. Practitioner summary: The hallux valgus angle has a broad distribution in the general population. Females have larger hallux valgus angles than males, and people from Asia have larger hallux valgus angles than people from North America and Europe. Shoe toe boxes should be designed to fit the actual shapes of shoppers' toes. The proposed method for measuring HVA opens a new opportunity to study the causal relationship between shoe wearing habits and HVA on a large scale.

Relationship between medial partite hallux sesamoid and hallux valgus in the general population.

BACKGROUND: An association between the medial partite hallux sesamoid (MPHS) and hallux valgus (HV) has been suggested; however, a causal relationship has not been confirmed. This study aimed to determine their causal relationship using a cross-sectional radiographic survey of a large-scale population cohort covering a wide age group. PATIENTS AND METHODS: The fifth survey of the Research on Osteoarthritis/Osteoporosis against Disability study involved 1997 participants aged 21-95 years who had undergone anteroposterior radiography of bilateral feet. The presence of MPHS, its morphology, and radiographic parameters related to the HV were assessed using radiographs. Changes in the prevalence of MPHS with age were assessed using trend tests. The relationship between the MPHS and HV was assessed based on sex and age. RESULTS: MPHS was found in 508 out of 3994 feet (12.7 %), with a significant difference in prevalence between men and women (10.0 % vs. 13.7 %, p < 0.001). Trend analysis demonstrated a significant decrease in MPHS occurrence with age in both sexes. HV angle was significantly higher in feet with MPHS than in those without (Men: 17.8 ± 7.0° vs. 14.0 ± 5.9°, p < 0.0001; Women: 19.6 ± 7.7° vs. 17.7 ± 7.9°, p < 0.0001). The prevalence of HV angle ≥ 20° was also significantly higher in feet with MPHS than in those without (Men: 33.3 % vs. 14.6 %, p < 0.0001; Women: 46.5 % vs. 34.6 %, p < 0.0001). This association between MPHS and HV was noticeable in younger adults and became less prominent with age. CONCLUSIONS: MPHS is associated with HV. The weakening of this relationship and the decreased prevalence of MPHS with age suggest that MPHS is not caused by HV, but is one of the causes of HV, especially in younger adults.

The chevron bunionectomy for moderate to severe hallux valgus deformity: Effects of procedural factors on hallux valgus correction.

BACKGROUND: Effects of procedural factors on chevron bunionectomy outcomes were studied. METHODS: Included were 109 feet with distal chevron osteotomy and preoperative intermetatarsal angle (IMA) greater than 15 degrees. IMA and hallux valgus angles (HVA), release type, fixation, second-digit procedures, and risk factors were evaluated. RESULTS: Eighty-three percent (91/109 feet) had satisfactory outcomes; nine had moderate pain. From preoperative, IMA improved 7.2 and HVA 20.5 degrees. Risk factors or second-digit procedures had no effect. Lateral release improved IMA (p < 0.01), with no difference between open lateral and transarticular release; 86% percent (64/74) were satisfied with open lateral release compared with 83% (19/23) and 66% (8/12) with no release and transarticular release, respectively. Fixation did not affect outcomes. CONCLUSION: Chevron bunionectomy corrected IMA and HVA to normal with few complications. Lateral release increased IMA correction. Transarticular release had lower satisfaction than open lateral release or no release. LEVEL OF EVIDENCE: Level III, retrospective.

Hallux anatomy: much ado about shoes-an attempt to prove that constrictive V-shaped toe-box shoes deform the hallux.

PURPOSE: A question still remains as to whether constrictive toe-box shoes (TBS) cause disability only due to pain on pressure points or if they can cause permanent changes in the hallux anatomy. The aim of this study is to compare the hallux morphology in 3 groups classified according to their use of constrictive or open TBS. METHODS: 424 patients were classified into 3 groups: group A used open TBS daily; group B used constrictive TBS daily; group C used both open and constrictive TBS. Hallux's angles, presence of exostoses and shape of the distal phalanx (DP) were analyzed on dorsoplantar weight-bearing radiographs and compared amongst groups. RESULTS: The intermetatarsal (IMA), metatarsophalangeal (MTPA), DASA, PASA, interphalangeal (IPA), obliquity (AP1), asymmetry (AP2) and joint deviation (JDA) angles for group A were 10°, 8°, 5°, 4°, 9°, 3°, 5°, 3°; for group B were 9°, 19°, 5°, 6°, 12°, 2°, 8°, 2°; and for group C were 10°, 10°, 4°, 4°, 12°, 3°, 8°, 1°. Only the differences in the MTPA, IPA and AP2 were statistically significant (p < 0.05). The prevalence of exostoses on the tibial side of the DP was 22, 36, and 29% in groups A, B and C, respectively (p < 0.05). We found similar distributions of the different DP shapes in the three groups. CONCLUSIONS: Our results suggest that the use of constrictive TBS, even if used only occasionally, could change hallux anatomy from a young age increasing MTPA, IPA and AP2. Moreover, we have found that DP exostoses are present as a "normal variation" in patients who wear an open TBS, but their prevalence is higher in those wearing constrictive toe-box shoes. This could be due to a reactive bone formation secondary to the friction caused by the inner border of the shoe. LEVEL OF CLINICAL EVIDENCE: 3.

Hallux valgus with second metatarsalgia: Is second metatarsal Weil osteotomy necessary?

BACKGROUND: The role of concomitant Weil osteotomy to address second toe metatarsalgia during hallux valgus correction is unclear. We aimed to critically analyse outcomes of an additional Weil osteotomy versus isolated Scarf osteotomy.in the management of hallux valgus and second metatarsalgia. METHODS: Patients with second toe metatarsalgia who underwent first metatarsal Scarf osteotomy for hallux valgus were enrolled retrospectively. Demographics, radiographic measurements and functional outcomes were assessed at baseline, 6-months and 2-years postoperatively. Between-group significance was established with Fisher exact test, Chi-square or Mann-Whitney U test. Within-group changes from baseline were assessed with paired t-test and Wilcoxon signed-rank test. RESULTS: 48 feet (34 isolated Scarf, 14 concomitant Weil osteotomy) were included. Both cohorts demonstrated significant improvements across all measures of functional outcome. However, patients with additional Weil osteotomy reported poorer short-term outcomes. CONCLUSION: Superiority of additional Weil osteotomy versus isolated Scarf osteotomy in addressing second toe metatarsalgia or improving functional outcomes was not demonstrated.

Independent muscle of extensor hallucis capsularis: a cadaveric case report.

Extensor hallucis capsularis (EHC) is an accessory tendon located medially to extensor halluces longus (EHL) tendon. Most EHC is known to originate as a tendinous slip of the EHL tendon, although it may be splitted from the tibialis anterior (TA) tendon or the extensor halluces brevis (EHB) tendon. During routine dissection of a 49-year-old male cadaver, independent muscle bellies of EHC were discovered bilaterally. The EHL muscle arose from the middle anteromedial aspect of fibula, lateral to the origin of TA muscle and medial to extensor digitorum longus (EDL) muscle. An additional muscle bellies were separated from EHL muscle at the point of 6 cm away from EHL origin in the right leg, and 3 cm away in the left. They coursed downward as EHC to reach the first metatarsophalangeal joint capsule. This muscle, unlike the variations identified to date, is considered to extend to EHC, and the name "extensor hallucis capsularis muscle" is offered. This kind of variation may be important for investigating the development of deformity at the first metatarsophalangeal joint, such as hallux valgus.

Morphology of the first metatarsal head as a risk factor for hallux valgus interphalangeus.

BACKGROUND: The aetiology of hallux valgus interphalangeus (HVI) is not well understood. First metatarsophalangeal joint stability, influenced by first metatarsal head shape, may be linked to HVI. We hypothesised that first metatarsal head shape is a risk factor for HVI. No published article could be found in the literature investigating this hypothesis. METHODS: 127 standardised foot radiographs were analysed retrospectively. The hallux valgus angle (HVA) and interphalangeus angle (IPA) were measured. The first metatarsal head shape was divided into chevron, round and flat groups. Statistical analysis was then performed to investigate the relationship between first metatarsal head shape and the occurrence of HVI. RESULTS: There was no statistically significant relationship between first metatarsal head shape and the occurrence of HVI. There was however a negative relationship between HVA and HVI. CONCLUSIONS: The morphology of the first metatarsal head does not seem to be a risk factor for HVI. A known negative relationship between HVA and IPA is reinforced. LEVEL OF EVIDENCE: Level III, retrospective cohort.

Appearance of hindfoot valgus deformity and recurrence of hallux valgus in the very early period after hallux valgus surgery in a poorly controlled rheumatoid arthritis case: A case report.

Control of rheumatoid arthritis (RA) disease activity is an important factor related to the development of hallux valgus (HV) deformity. Furthermore, if valgus hindfoot remains and/or appears after HV surgery, the affected foot is at risk of recurrence of HV deformity. We experienced a case suggesting the possibility that hindfoot valgus deformity appeared after HV surgery because of poor control of RA disease activity, and the HV deformity recurred in the very early period after surgery.

Symptomatic hallux valgus and dorsal bunion in adolescents with cerebral palsy: clinical and biomechanical factors.

AIM: The prevalence of severely symptomatic deformities of the first metatarsophalangeal (MTP) joint in adolescents with cerebral palsy (CP) requiring arthrodesis is unknown. Recent literature regarding these deformities is limited. We studied the presentation of severe, symptomatic deformities of the first ray in a large population of children and adolescents with CP and their association with gross motor function, CP subtype, and other musculoskeletal deformities. METHOD: We identified 41 patients with CP and a symptomatic deformity of the first MTP joint, managed by arthrodesis, from a large population based database over a 21-year period. Information recorded included demographics, CP subtype, Gross Motor Function Classification System (GMFCS), clinical presentation, and radiological features. RESULTS: Adolescents with spastic diplegia, at GMFCS levels II and III, were the most common group to develop symptomatic hallux valgus. In contrast, non-ambulant adolescents, at GMFCS levels IV and V, with dystonia or mixed tone, more commonly had dorsal bunions. INTERPRETATION: The type of first MTP joint deformity in patients with CP may be predicted by the type and distribution of movement disorder, and by GMFCS level. Specific patterns of associated musculoskeletal deformities may contribute to the development of these disorders and may provide a guide to surgical management. WHAT THIS PAPER ADDS: The prevalence of severe bunions requiring fusion surgery was 2%. The two types of bunion were hallux valgus and dorsal bunion. The type of bunion can be identified on both clinical and radiological grounds. The cerebral palsy subtype is predictive of the type of bunion.

Reverse-Shoe Wearing Method for Treating Toe-In Gait in Children Can Lead to Hallux Valgus.

BACKGROUND The aim of this study was to compare the effect of 2 methods for treating toe-in gait in children (reverse-shoe wearing and orthopedic insoles) and to determine whether reverse-shoe wearing results in hallux valgus. MATERIAL AND METHODS Between July 2012 and July 2014, 337 children diagnosed with toe-in gait over 2 years were recruited. For 139 children, parents selected use of reverse-shoe wearing treatment (RS group) and for 198 children, parents selected orthopedic insoles treatment (OI group). There were 98 children in the RS group and 167 in the OI group who completed the 12-month therapy and follow-up. We excluded 28 children who failed to complete the study, and 44 children who ceased treatment within the first month were selected as controls. Patients were assessed for up to 24 months after the cessation of treatment. Foot progression angle (FPA) and presence and degree of hallux valgus angle (HVA) were recorded. RESULTS FPA was significantly reduced after 6 months in both RS and OI groups (P<0.05). FPA returned to almost normal after 12 months of treatment, with no significant difference between the 2 groups. There were 29 cases (51 feet) of hallux valgus in the RS group after 12-month treatment; the HVA had significantly declined by 2 years after treatment with normal shoe wearing but did not return to normal. CONCLUSIONS Corrective treatment should be used with children diagnosed with toe-in gait over 2 years showing no remission. Both reverse-shoe wearing and orthopedic insoles show similar levels of treatment success, but reverse-shoe wearing has a significant adverse effect of hallux valgus.

Hallux valgus deformity after total ankle arthroplasty for rheumatoid arthritis: A case report.

Hallux valgus (HV) deformity is associated with hindfoot valgus deformity. We experienced a case that suggests the possibility that valgus correction for varus hindfoot with bony ankylosis of the subtalar joint by total ankle arthroplasty may have caused a forefoot HV deformity, despite adequate valgus correction.

Effects of wearing shoes on the feet: Radiographic comparison of middle-aged partially shod Maasai women's feet and regularly shod Maasai and Korean women's feet.

BACKGROUND: Maasai tribe members walk long distances daily either barefoot or wearing traditional shoes made from recycled car tires, without any foot ailments. To figure out the characteristic of their feet, we designed a radiographic comparative study of middle-aged partially shod Maasai women's feet and regularly shod Maasai and Korean women's feet. METHODS: Weight bearing radiographs of bilateral foot and ankle joints from 20 healthy middle-aged bush-living partially shod (PS) Maasai women were obtained. Same number of radiographs from 20 urban-living regularly shod (RS) Maasai and 20 Korean women were obtained and compared. The hallux valgus angle, the first to second intermetatarsal angle, talonavicular coverage angle, talo-first metatarsal angle, Meary angle, naviculo-cuboidal overlap, and the medial cuneiform height were measured to establish the degree of pes plano-valgus and hallux valgus deformity. RESULTS: On comparing PS and RS Maasai groups radiographically, the talonavicular coverage angle, talo-first metatarsal angle, and naviculo-cuboidal overlap were significantly greater in the PS Maasai group, whereas hallux valgus angle, the first and second intermetatarsal angle, Meary angle, and the medial cuneiform height were greater in the RS Maasai and Korean group. CONCLUSIONS: Regularly wearing shoes would protect the feet from pes plano-valgus deformity, despite potentially contributing to hallux valgus deformity.

[Hallux valgus : Etiology, diagnosis, and therapeutic principles]. / Hallux valgus : Ätiologie, diagnostische und therapeutische Prinzipien.

Hallux valgus-the most common forefoot deformity-can cause both pain and decreased mobility. The development and progress of the hallux valgus is a multifactorial process. Different intrinsic and extrinsic causes are responsible. Various conservative and operative treatment options exist and have to been chosen regarding the stage of the disease. Conservative orthopedic measures may prevent a deterioration of hallux valgus only at an early stage of the disease. Concerning operative techniques, more than 150 different surgical procedures are described in the literature, which can be reduced to some common procedures. These are dependent on the manifestation of the bunion as well as on associated foot and ankle pathologies. Patients should be informed that postoperative follow-up treatment until complete recovery is time-consuming.

Surgical Reconstruction of Metatarsal Type Preaxial Polydactyly Using an Amalgamating Osteotomy.

BACKGROUND: Polydactyly of the foot is a relatively common condition. Approximately 15% of cases are preaxial, with one third of these cases involving duplication of the metatarsal [metatarsal type preaxial polydactyly (MTPP)].Surgical reconstruction of polydactyly is indicated to improve shoe tolerance. Reconstruction of MTPP has traditionally involved resection of the hypoplastic lateral ray in addition to soft tissue reconstruction to correct hallux varus. Poor postoperative results have frequently been reported, primarily due to residual hallux varus. We present a novel surgical technique for the treatment of children with MTPP presenting with a cosmetic lateral hallux, involving an amalgamating osteotomy that permits retention of the stable medial metatarsotarsal joint while avoiding the complication of residual hallux varus. METHODS: This was a retrospective case series describing the surgical technique of an amalgamating osteotomy in the treatment of patients with MTPP and a cosmetic lateral hallux. The surgical technique involves corresponding metatarsal osteotomies of the medial and lateral halluces, with amalgamation of the metatarsals and ablation of the residual medial hallux, without the need for extensive soft tissue reconstruction. Clinical and radiologic outcomes were evaluated at a minimum of 2 years postoperatively in 2 patients who underwent this technique. RESULTS: Two children, 1 female and 1 male, underwent an amalgamating osteotomy at the age of 31 and 18 months, respectively. At latest follow-up, 7.3 and 2.8 years after osteotomy, respectively, both patients displayed an excellent functional result according to the Phelps and Grogan clinical outcome scale. Plain radiographs in both cases demonstrated a well-aligned first ray with no growth abnormality and no hallux varus. CONCLUSIONS: We have presented a novel surgical technique for the reconstruction of MTPP presenting with a cosmetic lateral hallux, involving an amalgamating osteotomy without extensive soft tissue reconstruction. This simple technique maintains the stable medial metatarsotarsal joint, permits ongoing longitudinal metatarsal growth, and avoids the complication of hallux varus. LEVEL OF EVIDENCE: Level IV-case series.

Radiologic Patterning of Hallux Deformity in Rheumatoid Arthritis and Its Relationship to Flatfoot.

Hallux deformities other than hallux valgus, especially those in the sagittal plane, have not yet been elucidated in the feet of patients with rheumatoid arthritis. The objectives of the present study were to classify rheumatoid arthritis hallux deformity in both the horizontal and the sagittal planes and investigate its relationship with flatfoot. Using a cross-sectional study design, we assessed patients with rheumatoid arthritis (527 feet in 274 patients) using radiographs and classified the deformity patterns of the great toes using cluster analysis. Of the 274 patients, the range of motion in the metatarsophalangeal joint was clinically investigated in 44 (16.1%) patients. The great toes could be divided into 5 clusters according to the characteristic configuration as follows: cluster I (normal type), cluster II (hallux valgus type), cluster III (boutonniere type), cluster IV (boutonniere with hallux valgus type), and cluster V (swan-neck type). Radiographic measurements revealed the characteristic deformities of each cluster, including splayed foot for cluster II; flat foot, metatarsal primus elevatus, and plantar displacement of the proximal phalanx for cluster III; and a mixture of these characteristics for cluster IV. Plantar displacement of the proximal phalanx, which was a specific characteristic of the boutonniere deformity, correlated significantly with the decreased dorsiflexion in the metatarsophalangeal joint. Our classification method revealed the relationship of hallux deformity in the sagittal plane to flatfoot and also demonstrated the usefulness of measuring basal phalanx displacement in predicting the range of motion of the metatarsophalangeal joint.

Effects of ballet training of children in Turkey on foot anthropometric measurements and medial longitudinal arc development.

OBJECTIVE: To investigate the effects of ballet training on foot structure and the formation of the medial longitudinal arc in childhood, and the association of body mass index with structural change secondary to ballet training. METHODS: This study was conducted at Öykü Ballet and Dance School and Trakya University, Edirne, Turkey, from September 2007 to November 2008, and comprised girl students who were taking ballet classes, and a group of those who were not taking such who acted as the controls. Static footprints of both feet of all participants were taken with an ink paedogram. Parameters evaluated from footprints included foot length, metatarsal width, heel width and medial longitudinal arch. The relationship between the parameters, the ballet starting age, training duration and body mass index was investigated. RESULTS: Of the 67 participants, there were 36(53.7%) in the experimental group and 31(48.3%) in the control group. The difference between age, height, weight and body mass index between the two groups was insignificant (p>0.05). The average ballet starting age was 6.47±1.55 years and duration was 4.36±2.002 years. Positive correlations were found between body mass index and foot length, metatarsal width, heel width, medial longitudinal arch contact width and halluxvalgus angle; between ballet starting age and metatarsal width, heel width; between duration of training and foot length, metatarsal width and hallux valgus angle (p?0.05 each). CONCLUSIONS: Evidence supporting the education in children on foot anthropometric measurements and medial longitudinal arc development could not be found.

Does the use of high-heeled shoes lead to fore-foot pathology? A controlled cohort study comprising 197 women.

BACKGROUND: High-heeled shoes have been suggested as a main explanation for the female dominance in foot pain and deformities. Aim of study was to test this hypothesis scientifically. METHODS: Women 40-66 years were included in two groups. 95 women who had worn high-heeled shoes at work for at least 5 years were compared to 102 women who had never worn high-heeled shoes at work. The investigations were weight bearing radiographs of foot and ankle, the SEFAS questionnaire and the AOFAS Clinical Rating System. Evaluators were blinded to the group-affiliation. RESULTS: Radiographs showed no statistically significant differences between the two groups concerning deformities or joint disease. Foot function measured by SEFAS and AOFAS total score, were similar in the two groups. The high-heeled group had more pain and more callosities. CONCLUSION: For women aged 40-66 years wearing of high-heeled shoes had not caused foot deformation, but more foot pain and callosities.

Does the subtalar joint compensate for ankle malalignment in end-stage ankle arthritis?

BACKGROUND: Patients with ankle arthritis often present with concomitant hindfoot deformity, which may involve the tibiotalar and subtalar joints. However, the possible compensatory mechanisms of these two mechanically linked joints are not well known. QUESTIONS/PURPOSES: In this study we sought to (1) compare ankle and hindfoot alignment of our study cohort with end-stage ankle arthritis with that of a control group; (2) explore the frequency of compensated malalignment between the tibiotalar and subtalar joints in our study cohort; and (3) assess the intraobserver and interobserver reliability of classification methods of hindfoot alignment used in this study. METHODS: Between March 2006 and September 2013, we performed 419 ankle arthrodesis and ankle replacements (380 patients). In this study, we evaluated radiographs for 233 (56%) ankles (226 patients) which met the following inclusion criteria: (1) no prior subtalar arthrodesis; (2) no previously failed total ankle replacement or ankle arthrodesis; (3) with complete conventional radiographs (all three ankle views were required: mortise, lateral, and hindfoot alignment view). Ankle and hindfoot alignment was assessed by measurement of the medial distal tibial angle, tibial talar surface angle, talar tilting angle, tibiocalcaneal axis angle, and moment arm of calcaneus. The obtained values were compared with those observed in the control group of 60 ankles from 60 people. Only those without obvious degenerative changes of the tibiotalar and subtalar joints and without previous surgeries of the ankle or hindfoot were included in the control group. Demographic data for the patients with arthritis and the control group were comparable (sex, p=0.321; age, p=0.087). The frequency of compensated malalignment between the tibiotalar and subtalar joints, defined as tibiocalcaneal angle or moment arm of the calcaneus being greater or smaller than the same 95% CI statistical cutoffs from the control group, was tallied. All ankle radiographs were independently measured by two observers to determine the interobserver reliability. One of the observers evaluated all images twice to determine the intraobserver reliability. RESULTS: There were differences in medial distal tibial surface angle (86.6°±7.3° [95% CI, 66.3°-123.7°) versus 89.1°±2.9° [95% CI, 83.0°-96.3°], p<0.001), tibiotalar surface angle (84.9°±14.4° [95% CI, 45.3°-122.7°] versus 89.1°±2.9° [95% CI, 83.0°-96.3°], p<0.001), talar tilting angle (-1.7°±12.5° [95% CI, -41.3°-30.3°) versus 0.0°±0.0° [95% CI, 0.0°-0.0°], p=0.003), and tibiocalcaneal axis angle (-7.2°±13.1° [95% CI, -57°-33°) versus -2.7°±5.2° [95% CI, -13.3°-9.0°], p<0.001) between patients with ankle arthritis and the control group. Using the classification system based on the tibiocalcaneal angle, there were 62 (53%) and 22 (39%) compensated ankles in the varus and valgus groups, respectively. Using the classification system based on the moment arm of the calcaneus, there were 68 (58%) and 20 (35%) compensated ankles in the varus and valgus groups, respectively. For all conditions or methods of measurement, patients with no or mild degenerative change of the subtalar joint have a greater likelihood of compensating coronal plane deformity of the ankle with arthritis (p<0.001-p=0.032). The interobserver and intraobserver reliability for all radiographic measurements was good to excellent (the correlation coefficients range from 0.820 to 0.943). CONCLUSIONS: Substantial ankle malalignment, mostly varus deformity, is common in ankles with end-stage osteoarthritis. The subtalar joint often compensates for the malaligned ankle in static weightbearing. LEVEL OF EVIDENCE: Level III, diagnostic study.

Fact or fiction? Iatrogenic hallux abducto valgus secondary to tibial sesamoidectomy.

First ray function and hallux misalignment after isolated tibial sesamoidectomy have been topics of debate. Although sesamoidectomy has been proved to be effective in the relief of sesamoid pain, many foot and ankle surgeons remain hesitant to perform the procedure fearing a possible joint perturbation. To our knowledge, the present study is the first to evaluate both laboratory and clinical evidence of the association between isolated tibial sesamoidectomy and hallux abducto valgus deformity. The bench study consisted of 10 cadaveric limbs that were dissected and prepared for testing. Controlled valgus loads were applied before and after tibial sesamoidectomy. No significant difference was found in the joint position after sesamoidectomy in both the rectus (p = .36) and the dorsiflexed (p = .062) positions. The clinical evaluation consisted of a retrospective cohort of 5 females; all of whom underwent isolated tibial sesamoidectomy. The pre- and postoperative radiographs and self-reported pain scores (visual analog scale) were compared. None of the patients developed a postoperative hallux abducto valgus deformity. Neither the hallux abductus angle (p = .180) nor the intermetatarsal angle 1-2 (p = .180) changed significantly in the postoperative setting. The visual analog scale pain scores changed from a mean of 6.8 to 1, a significant difference (p = .042). Based on our observations and clinical experience, we believe that isolated tibial sesamoidectomy does not have a significant effect on the position of the first metatarsophalangeal joint when meticulous surgical technique is used to excise the sesamoid. Isolated tibial sesamoidectomy can provide substantial pain relief and appears to be a safe treatment for a variety of conditions affecting the tibial sesamoid.

Surgical Treatment Guidelines for Digital Deformity Associated With Intrinsic Muscle Spasticity (Intrinsic Plus Foot) in Adults With Cerebral Palsy.

Intrinsic plus foot deformity has primarily been associated with cerebral palsy and involves spastic contracture of the intrinsic musculature with resultant toe deformities. Digital deformity is caused by a dynamic imbalance between the intrinsic muscles in the foot and extrinsic muscles in the lower leg. Spastic contracture of the toes frequently involves curling under of the lesser digits or contracture of the hallux into valgus or plantarflexion deformity. Patients often present with associated pressure ulcers, deformed toenails, shoe or brace fitting challenges, and pain with ambulation or transfers. Four different patterns of intrinsic plus foot deformity have been observed by the authors that likely relate to the different patterns of muscle involvement. Case examples are provided of the 4 patterns of intrinsic plus foot deformity observed, including global intrinsic plus lesser toe deformity, isolated intrinsic plus lesser toe deformity, intrinsic plus hallux valgus deformity, and intrinsic plus hallux flexus deformity. These case examples are presented to demonstrate each type of deformity and our approach for surgical management according to the contracture pattern. The surgical approach has typically involved tenotomy, capsulotomy, or isolated joint fusion. The main goals of surgical treatment are to relieve pain and reduce pressure points through digital realignment in an effort to decrease the risk of pressure sores and allow more effective bracing to ultimately improve the patient's mobility.