Early Outcomes and Complications of Surgically Treated Diabetic Hallucal Infection.

BACKGROUND: Severely infected diabetic ulcers of the big toe often necessitate surgical treatment. Depending on the wound stage and presence of osteomyelitis, conservative surgery and amputation are the main surgical treatments. Few articles reported the outcomes and complications of such procedures. This study is a preliminary comparative report on the early outcomes and complications of hallucal diabetic foot infection (DFI) treated with either conservative surgery or amputation. METHODS: This is a retrospective comparative study comprising a continuous series of patients admitted at our hospital. Initially, all diabetic foot ulcer (DFU) were infected and at advanced stage (Wagner Grade 3 or 4). All clinically suspected cases of osteomyelitis were confirmed by bone pathology and microbiology culture. The study included 37 patients diagnosed with DFI. Infection profile was as follows: 23 DFU with osteomyelitis (Wagner Grade 3 or 4) and 14 infected DFU (Wagner Grade 2). Twenty-four conservative procedures and 13 amputation surgeries were performed initially. The primary outcome was defined as the frequency of subsequent surgery (deep infection recurrence treated with surgery). Statistical analysis was used to look for significant difference between both groups. RESULTS: Ten patients (27%) required additional surgeries because of deep infection recurrence. Four recurrences (16.7%) were observed in the conservative group and 6 (46%) in the amputation group (P = 0.054). Amputation rate as a subsequent procedure was 8.3% for the conservative group and the reamputation rate for the amputation group was 23.1% (P = 0.2). CONCLUSIONS: The study findings would indicate that the more severe is the initial hallucal infection severity (higher Wagner grade), the higher is the frequency of early surgical complications mainly after an index amputation procedure. Our assessment tools of initial infection extent seem to be underperforming. A more aggressive treatment in the form of a more proximal cut with regard to magnetic resonance imaging bone infection signal could be considered to minimize the risk of subsequent surgeries and reamputations.

Prognostic Performance of the Maximal Systolic Acceleration at the Hallux in Healing of Foot Ulcers: A Retrospective Cohort Study.

BACKGROUND: The accurate prediction of foot ulcer healing remains a major challenge in clinical practice. To date, no reliable bedside tests are available. The primary aim of this study was to determine the prognostic performance of the maximal systolic acceleration (ACCmax) to predict ulcer healing. Secondary objectives comprised the investigation of the prognostic accuracy in patients prone to medial arterial calcification and to assess the potential risk of amputation. METHODS: A single-center retrospective cohort study was conducted. Patients aged ≥18 years who presented with a new-onset ulcer (i.e. Fontaine IV and neuropathic ulcers) on the foot and underwent an ACCmax measurement at the hallux were included. Ulcer healing was defined as an intact skin with epithelialization after 3 or 12 months of follow-up. Prognostic performance was calculated by using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR). RESULTS: In total, 136 patients with 143 wounds were included. Almost half of the patients were diagnosed with diabetes mellitus (47%), and wound infection was present in 42% of cases. After 3 months of follow-up, an NPV of 97.9%, PLR of 3.25, and NLR of 0.19 were found when applying an ACCmax threshold of 0.5 m/s2. When looking at 12 months, these numbers were 85.6%, 2.72, and 0.50, respectively. Subgroup analysis for patients with diabetes mellitus and chronic kidney disease showed comparable results. The risk of amputation increased significantly when a measurement below 1.0 m/s2 was present (odd ratio 5.3, P = 0.010). CONCLUSIONS: ACCmax measurements at the hallux can have additional prognostic value in patients with foot ulcers. An ACCmax below 1.0 m/s2 is associated with nonhealing of an ulcer and a higher risk of amputation, while higher ACCmax values are associated with limb salvage. Therefore, ACCmax could be used for grading ischemia in a wound classification system.

Great Toe Interphalangeal Fusion for Hallux Valgus Interphalangeus Deformity in Young Patients.

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.

Hallux Valgus: The Influence of Intersesamoid Crista's Osteoarthritis on Frontal Plane Pronation.

A frontal plane metatarsal rotational (pronation) has been documented in a high percentage of hallux valgus patients. Pathoanatomical concepts leading to pronation are still debated. Nevertheless, there is no consensus on how to measure this component of the deformity. The aim of the present study was to find potential associations between sesamoid's crista osteoarthritis and the frontal plane deformity in HV cases. Our study showed a moderate correlation between the crista's OA and the intermetatarsal angle (IMA), the hallux valgus angle (HVA) and the alpha angle. In severe hallux vulgus deformed specimens, with an eroded intersesamoid crista, frontal plane pronation was not as prevalent nor severe as in those without osteoarthritic degeneration. Severe hallux valgus cases with a completely eroded crista, showed lower pronation, and higher IMA, when compared to specimens with a preserved anatomy. This brings to light the intersesamoid crista's unique function in retaining the IMA. Understanding the role the frontal plane plays in hallux valgus' biomechanics and in its radiographic appearance is vital to change the current paradigm.

Long-Term Outcomes of Hallux Amputations at Various Anatomic Levels.

Hallux amputations have long been performed for the definitive treatment of hallux osteomyelitis resulting from ulcerations. These amputations have been performed at various levels of the hallux. The aim of this study is to assess the long-term outcomes in patients with hallux amputations performed at these various levels and to determine whether there is an ideal anatomic level that would limit post-operative complications and need for revisional surgery. An Institutional Review Board (IRB)-approved retrospective chart review of 148 feet with hallux amputations performed at various levels from July 1, 2013 to July 16, 2020 at an academic medical center was conducted. A 2-year minimum follow up was required for inclusion in the study. Incidence of re-ulceration, need for further amputation, healing of index procedure, and revascularization status were evaluated. Statistical analysis utilizing chi square analysis was performed to calculate p-values where <.05 was statistically significant. In this retrospective study with a minimum of 2-year follow-up, there was a tendency for amputations performed at the level of the head of the proximal phalanx (21%) to have a lower rate of reulceration (24%) followed by amputations performed at the level of the metatarsophalangeal joint and interphalangeal joints (36%). However, neither proved to be statistically significant.

Hallux Dorsal Curvature of the Distal Phalanx and Its Possible Implications for the Dorsal Osteophyte.

Background and Objective: The dorsal osteophyte on the distal phalanx of the first toe (hallux) is a reactive bony protrusion that may be associated with pathologies such as onychocryptosis or pincer nail. This study aims to describe and analyze the correlation between three novel measurements-dorsal osteophyte height (HDO), distal phalangeal hyperextension (DPHA), and distal phalangeal curvature (DCDP)-and to evaluate the impact of minimally invasive surgery on the dorsal osteophyte using fluoroscopic data. Materials and Methods: A total of 125 fluoroscopic images were analyzed. Baseline measurements for the variables were compared between groups. The key variables included distal phalanx curvature, distal phalanx hyperextension, and dorsal osteophyte height. Results: The analysis revealed statistically significant differences in the main group effect for distal phalanx curvature (F [2, 122] = 7.54, p < 0.001), distal phalanx hyperextension (F [2, 122] = 28.90, p < 0.001), and dorsal osteophyte height (F [2, 122] = 13.64, p < 0.001). Significant correlations were found between distal phalanx curvature and distal phalanx hyperextension, as well as between distal phalanx hyperextension and dorsal osteophyte height. However, no significant correlation was observed between distal phalanx curvature and dorsal osteophyte height. Conclusions: The findings suggest that minimally invasive dorsal osteophyte surgery effectively restores the distal phalanx to normal conditions, as indicated by the variables studied.

[Case report: Great toe dorsal defect reconstruction by cross-toe flap]. / Cas clinique : reconstruction d'une perte de substance de la face dorsale de l'hallux par lambeau cross-toe.

Reconstruction of hallux soft-tissue defects is essential for the locomotor function. Some regional flaps are available and have to be preferred in case of small defect. Here, we present the case of a patient treated by a cross-toe flap in order to cover an exposed hallux proximal interphalangeal joint, after an open fracture. The functional outcome of this reliable and easy flap was very satisfying, with quick wound healing and resumption walk.

The reconstruction of fingertip injury by mini hallux toenail flap pedicled with the hallux transverse artery and toe pulp vein transplantation technique based on the equivalent design theory.

INTRODUCTION: How to reconstruct the damaged fingertip is a clinical problem. Our team propose the theory of equivalent design and use the mini toenail flap pedicled with the hallux transverse artery and toe pulp vein transplantation technique to reconstruct Allen's type II fingertip injury. Thus, we perform the retrospective study to evaluate the effects of this technique on fingertip injury. MATERIALS AND METHODS: A retrospective analysis was performed on 56 patients admitted to our hospital from January 2015 to January 2020 who used equivalently designed miniature hallux toenail flaps for the plastic repair of fingertip damage. We recorded the size of the miniature hallux toenail flap, operation time, intraoperative blood loss, and complications and calculated the survival rate of the transplanted miniature hallux toenail flap. During routine follow-up after surgery, we recorded nail growth time and observed finger appearance. At the last time of follow-up, we recorded Semmes-Weinstein evaluating tactile sensation and Two-point discrimination testing (TPD). The efficacy was evaluated by Zook score evaluation. RESULTS: The size of the mini hallux toenail flap was 0.71 cm × 1.22 cm to 0.88 cm × 1.71 cm. The operation time was (3.54 ± 0.58) hours, the intraoperative blood loss was (20.66 ± 4.87) ml, and the survival rate of mini hallux toenail flaps was 100%. The postoperative follow-up time was (30.82 ± 11.21) months, and the total nail growth time was (9.68 ± 2.11) months. The average tactile sensation evaluated by the Semmes-Weinstein test was (0.32 ± 0.14) g, and the average TPD was (7.33 ± 1.02) mm. According to Zook score, the curative effect of fifty-six cases were all excellent or good with 100% excellent and good rate, and all patients had beautiful appearances and good function of damaged fingertips. CONCLUSIONS: Based on the equivalent design theory, the mini hallux toenail flap pedicled with the hallux transverse artery and toe pulp vein transplantation technique is an effective method to reconstruct Allen's type II fingertip injury with a beautiful appearance and good function. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Correlation Analysis Between Clinical Hypermobility Measurement and Radiographic Parameters of the Hallux Valgus Deformity.

The finding of "hypermobility" has conventionally been considered as a dichotomous categorical variable in both clinical practice and in the literature. In other words, it is defined as being either "present" or "absent" in patients with hallux valgus. Yet it might be far more likely that this represents a continuous variable described by a bell-shaped distribution. Therefore the objective of this investigation was to consider hypermobility as a continuous variable, and to compare the sagittal plane first ray motion to radiographic parameters commonly used in the evaluation of the hallux valgus deformity by means of correlation analyses. The radiographs and measurements of 86 feet were included and measurement of sagittal plane first ray motion was performed with the validated Klaue device. No statistically significant correlation was observed between the total first ray motion with the first intermetatarsal angle (Pearson correlation coefficient 0.106; p = .333), hallux valgus angle (Pearson correlation coefficient -0.106; p = .330), nor sesamoid position (Pearson correlation coefficient 0.155; p = .157). The results of this investigation uniquely consider measurement of hypermobility as a continuous variable, and find no correlation between first ray sagittal plane motion and radiographic parameters associated with the hallux valgus deformity. These results might indicate that although the concept of hypermobility has traditionally been coupled with presentation of the hallux valgus deformity, this might simply represent the result of a historical confirmation bias.

Radiographic Assessment of Relationship Between Medial Cuneiform Obliquity and Hallux Valgus.

The research results are inconsistent that assessing whether the increased obliquity of the distal articular surface of the medial cuneiform leads to an increase in hallux valgus angle. Thus, this study investigated the relationship between distal medial cuneiform obliquity and hallux valgus by measuring various angles in weightbearing anteroposterior radiographs of the foot. In total, 679 feet of 538 patients with the radiographs were included in the study. We measured radiographic parameters including hallux valgus angle, first to second intermetatarsal angle, metatarsus adductus angle, first metatarsus cuneiform angle, distal medial cuneiform angle, and first proximal metatarsal articular angle. The surface morphology (flat or curved) of the first tarsometatarsal joint was also recorded. Our results analysis revealed a weak negative correlation between distal medial cuneiform angle and both hallux valgus angle and first to second intermetatarsal angle, contrary to our assumption. So we believe that distal medial cuneiform angle was relatively constant and it cannot be used as a characteristic angle for quantifying hallux valgus. First metatarsus cuneiform angle was a characteristic indicator of hallux valgus and was positively correlated with its severity (p < .000), indicating that it can be used to measure the size of hallux valgus. It can also be used as a reference factor for the first metatarsal osteotomy in clinical bunion orthopedics. First tarsometatarsal joint morphology was unrelated to hallux valgus, whereas metatarsus adductus angle, and first proximal metatarsal articular angle should be considered in hallux valgus.

Radiological and Anatomical Evaluation of First Metatarsal Pronation in Hallux Valgus Deformity: A Comparison Between Three Different Methods.

A frontal plane metatarsal rotational (pronation) has been documented in a high percentage of hallux valgus patients. Pathoanatomical concepts leading to pronation are still debated. Nevertheless, there is no consensus on how to measure this component of the deformity. The aim of the present study was to compare three commonly used radiographic methods to measure the frontal plane deformity in hallux valgus deformity, such as 1. Round sign of the lateral edge of the first metatarsal head on anterior-posterior radiograph, 2. Non-weightbearing CT-scan and 3. Bernard's axial projection of the first metatarsal head. Afterwards, feet were dissected, and a direct measurement of the pronation was done. Our data showed that alpha angle measurements made through the Bernard's axial projection were closer with those obtained during the dissection compared to those made through the CT-scan. The main finding of our study is that osteoarthritic changes at the metatarso-sesamoid joint play an important role in severe hallux valgus cases. The proposed radiographic methods allow surgeons to verify whether rotation can be corrected during Hallux Valgus procedures and to determine which procedure may be the best for each patient.

What Do Patients Report Regarding Their Real-World Function Following Triplane Metatarsophalangeal Joint Arthrodesis for Hallux Valgus?

First metatarsal phalangeal (MTP) joint arthrodesis has been employed for decades for pain related to arthritis and other associated abnormalities. Despite the commonality of the procedure there continues to be questions regarding functional expectations following the procedure especially when employed for correction of hallux valgus deformity. We surveyed 60 patients who had a tri plane MTP joint arthrodesis at mean 28.4 months (median 27.8) regarding their activities of daily living and sports activity through a direct conversation. Secondary endpoints assessed were return to activity, deformity correction and arthrodesis healing rate based on chart review and weightbearing radiographs. The primary outcomes showed robust return to all activities of daily living with 96.7% able to walk without restrictions and or pain, 98.3% were able to walk at a normal pace and 95% responded that loss of motion of their big toe did not affect their daily function. Regarding return to sports all patients that participated in sports before surgery resumed participation after with a trend toward increased sports activity. Early return to walking in a fracture boot was noted in this cohort at mean 4.1 days, return to athletic shoe at mean 6.3 weeks and full unrestricted activity at mean 13.3 weeks with no non-unions identified on radiographic or clinical exam. Deformity correction of the typical components of hallux valgus deformity was similar to previously published studies. This data set supports the hypothesis that patients undergoing first MTP joint arthrodesis can expect rapid and full return to activities of daily living and sports with a low complication rate.

Incidence of Nonunion Following First Metatarsophalangeal Joint Arthrodesis for Hallux Valgus Deformity: A Retrospective Analysis of Four Different Constructs.

Arthrodesis of the great toe joint is a valuable procedure for hallux valgus deformities. The primary aim of this study was to determine nonunion rates of a first metatarsophalangeal joint (MTPJ) arthrodesis for bunion deformity. This was a retrospective review of 166 consecutive limbs that underwent a first metatarsal phalangeal joint arthrodesis at Wake Forest Baptist Medical Center (WFBMC). Procedures were performed using 4 different constructs for the arthrodesis. Incidence of nonunion, intermetatarsal correction, infection, and recurrence were measured. Overall, 20 patients (12%) experienced nonunion following a first metatarsophalangeal joint arthrodesis. Eighty-seven patients (86%) of plate and screw patients achieved union while 14 (78%) of crossing screw patients achieved union. The minimum time of follow-up was 3 months and the maximum time was 15.4 months. The mean change in intermetatarsal and hallux valgus angle correction was 3.4° and 20.3°, with no statistical difference based on hardware construct or being diabetic. First metatarsophalangeal joint arthrodesis is a viable option for hallux valgus. However, the results of the present study suggest that there is a lower fusion rate of the first MTPJ using crossing screws for bunion deformities.

A Neglected Extensor Hallucis Longus Tendon Rupture Caused by Arthritic Adhesion.

Extensor hallucis longus tendon injury is relatively rare and is principally caused by a laceration when a sharp object is dropped on the instep. Primary suturing is possible if the injury is acute, but if the tear is chronic, tendon contracture causes the space between the edges of the tear to widen, disrupting the end-to-end connection. In particular, a claw toe or checkrein foot deformity may develop over time due to adhesion of the lower leg tendons near the fracture site or scar. We report on a 44-year-old man who visited our outpatient clinic complaining of pain in the right foot and a hindered ability to extend his great toe. He had enjoyed playing soccer during his schooldays; since that time, the extension of that toe had become somewhat difficult. T2-weighted sagittal magnetic resonance imaging revealed that the continuity of the extensor hallucis longus tendon had been lost at the distal phalangeal base attachment site, and that the region of the proximal tendon was retracted to level of the middle shaft of the proximal phalanx. The findings allowed us to diagnose extensor hallucis longus tendon rupture accompanying osteoarthritic changes in the joint and soft tissues. We performed surgical tenorrhaphy and adhesiolysis. This is a rare case of extensor hallucis longus tendon rupture caused by minor trauma. Arthritis that developed at a young age caused the adhesions. If patients with foot and ankle arthritis show tendon adhesion at the arthritic site, tendon rupture can develop even after minor trauma or intense stretching.

Surgical management of osteochondral lesions of the first metatarsal head: A systematic review.

BACKGROUND: Treating osteochondral lesions of the first metatarsal head can help reducing pain and preventing end-stage arthritic cartilage degeneration and hallux rigidus. Several surgical techniques have been described, but no clear indications are reported. This systematic review aims to offer an overview of the current surgical treatments for focal osteochondral lesions of the first metatarsal head. METHODS: The selected articles were examined to extract data about population, surgical technique, and clinical outcomes. RESULTS: Eleven articles were included. Mean age at surgery was 38,2 years. Osteochondral autograft was the most used technique. After surgery, an improvement was achieved in AOFAS, VAS, and hallux dorsiflexion but not in plantarflexion. CONCLUSION: There is limited evidence and knowledge regarding the surgical management of the first metatarsal head osteochondral lesions. Various surgical techniques have been proposed, drawn from other districts. Good clinical results have been reported. Further high-level comparative studies are necessary to design an evidence-based treatment algorithm.

First metatarsophalangeal arthrodesis outcomes for hallux rigidus versus hallux valgus.

BACKGROUND: This study compared radiographic and functional patient outcomes of 1st MTP arthrodesis between hallux rigidus (HR) and hallux valgus (HV) cohorts. METHODS: A retrospective review was conducted at an academic medical center on patients who underwent 1st MTP arthrodesis during 2009-2021. In total, 136 patients (148 feet: HR=57, HV=47, combined=44) met the inclusion criteria of minimum three-month follow-up (mean=1.25 years, range=0.25-6.14 years). Data collection included patient-reported outcome measures (PROMs), radiographic markers, and complication and reoperation rates. RESULTS: PROMs improved overall, with HV patients significantly improving the least. The HR group had a significantly smaller improvement in HV angle (HR=-3.6, HV=-17, Combined=-15 p < .001), intermetatarsal angle (H=-0.16, HV=-2.8, Combined=-2.6 p < .001), and 1st-5th metatarsal width (HR=-0.98, HV=-4.6, Combined=-4.6, p < .001). Complication and reoperation rates did not differ by group. CONCLUSION: Outcomes of 1st MTP arthrodesis does not appear to differ between diagnostic indications of hallux rigidus, hallux valgus, or both. LEVEL OF EVIDENCE: Level III, Retrospective cohort study.

Coverage of Big Toe Defects After Wraparound Flap Transfer With a Second-Toe Medial-Side Adjacent Toe Flap.

PURPOSE: In finger reconstruction, big-toe wraparound flap (WAF) transfer provides excellent results. However, difficulty in healing and impaired function at the donor site are common. We aimed to explore an ideal method to address these complications. METHODS: This retrospective study involved 22 patients who were treated with big toe WAF transfer for finger reconstruction between 2016 and 2020. Patients were categorized into cohorts by donor site repair method: second-toe medial-side adjacent toe flap and skin graft (cohort 1) and skin graft alone (cohort 2). Functional outcomes, aesthetic appearance, and complications at the donor site were compared. Functional outcomes were assessed according to the American Orthopaedic Foot and Ankle Society (AOFAS) for hallux metatarsophalangeal-interphalangeal score, Foot Function Index-Verbal Rating Scales (FFI-5 pt), and visual analog scale for pain. Aesthetic appearance was evaluated according to the adjusted question 28 in the Michigan Hand Outcome Questionnaire. RESULTS: The mean pain scores in AOFAS and FFI-5 pt were 38.00 ± 4.22 and 3.75 ± 2.37, and 32.50 ± 4.52 and 6.60 ± 2.14 in cohorts 1 and 2, respectively, which showed no significant differences. The method in cohort 1 can reduce the level of pain. This was further confirmed by visual analog scale scores of 3.40 ± 0.84 and 6.42 ± 7.93 in cohorts 1 and 2, respectively. The mean functional scores in AOFAS and FFI-5 pt were 38.40 ± 2.37 and 1.25 ± 1.62, and 37.92 ± 2.15 and 1.56 ± 2.11 in cohorts 1 and 2, respectively, which showed no significant differences. Eight patients developed complications: 1 patient (1/10 [10%]) in cohort 1 developed a superficial infection, and in cohort 2, 7 patients (7/12, 58.30%) developed complications, including 2 short-term complications with partial necrosis and 1 delayed healing. Long-term complications included the following: scar discomfort (2 cases), pain discomfort (1 case), and skin ulceration due to repeated wear and tear (1 case). Cohort 2 had significantly more complications than cohort 1. CONCLUSIONS: Second-toe medial-side adjacent toe flap combined with skin graft had better aesthetic appearance, less complications, and less pain compared with skin graft alone. Hence, it can be a reliable technique for repairing the donor site after big-toe WAF transfer.

Multivariate Analysis of Hallux Valgus Radiographic Parameters.

This investigation aimed to better understand the complex relationship of common radiographic measurements performed during the perioperative evaluation of the hallux valgus deformity while accounting for interactions and potential interdependence. Several analyses utilizing the first intermetatarsal angle, hallux valgus angle, tibial sesamoid position, Engel's angle, subject age and subject gender were performed with varying independent and dependent variables. The hallux valgus angle (p < .001), tibial sesamoid position (p < .001), and Engel's angle (p < .001) were found to be independently associated with the first intermetatarsal angle. The first intermetatarsal angle (p < .001), tibial sesamoid position (p < .001), and Engel's angle (p < .001) were found to be independently associated with the hallux valgus angle. This suggests that there is significant interdependence of these variables during a preoperative radiographic examination. However, only the change in tibial sesamoid position (p < .001) was found to be independently associated with the change in the first intermetatarsal angle following surgical correction, while no studied variables were found to be independently associated with the change in hallux valgus angle following surgical correction. This suggests that correction of the intermetatarsal angle and tibial sesamoid position might not always reliably predict correction of the hallux valgus angle following surgical intervention. It might also suggest that additional procedures beyond metatarsal osteotomies are required to reliably correct the hallux valgus angle in some deformities. It is hoped that this investigation adds to the body of knowledge with respect to the perioperative radiographic evaluation of the hallux valgus deformity.

Arthroscopic Sesamoidectomy for Hallux Sesamoid Disorders.

In this retrospective case series, we aimed to study arthroscopic sesamoidectomy, including surgical methods, clinical outcomes, and complications. We retrospectively reviewed the medical records of patients with hallux sesamoid disorders who underwent arthroscopic sesamoidectomy from July 2015 to July 2017. The visual analog scale for rating pain, Japanese Society for Surgery of the Foot scale scores, number of days taken to return to normal daily living, number of months taken to return to playing sports, and complications were analyzed. The mean follow-up duration was 3.2 years. Among 14 patients, there were 8 females and 6 males (median age: 39 years). The mean visual analog scale score improved from 75.4 to 14.3 mm; the mean Japanese Society for Surgery of the Foot score improved from 55.2 to 88.0 points. The mean time to return to activities of daily living was 5.3 days. Among the 5 patients who played sports, 3 and 2 patients resumed playing sports at 3 and 12 postoperative months, respectively. Complications included wound pain (n = 4), discomfort in severe weather (n = 4), numbness (n = 3), pain in the sole other than in the ball of the foot (n = 2), pain during hallux dorsiflexion (n = 2), residual sesamoid discomfort (n = 1), swelling (n = 1), toe-in gait (n = 1), and metatarsal head bone marrow edema (n = 1). Despite good clinical outcomes of arthroscopic sesamoidectomy, patients should be made aware of the many potential complications of this procedure prior to surgery.

Concentrated Bone Marrow Aspirate Injection for Hallux Sesamoid Disorders.

Concentrated bone marrow aspirate (CBMA) offers an alternative to sesamoid resection in end stage sesamoid pathology. CBMA potentiates the anti-inflammatory effect, stimulates local tissue regeneration and osteogenesis, when injected into bone. The purpose of this study is to evaluate the functional outcomes in a cohort of athletes following CBMA injection for the treatment of hallux sesamoid disorders. A retrospective case series of consecutive patients treated with CBMA injection for hallux sesamoid disorders were identified. Radiographs, Foot and Ankle Outcome Scores (FAOS), and Visual Analogue Scale (VAS) score were collected pre- and postinjections. Descriptive statistics were presented as the mean and standard deviation for continuous variables and frequency as percentages for categorical variables. Fifteen consecutive patients with were included with a mean follow-up time of 20.1 (range 12-34) months. Significant improvement in all scoring subscales of the FAOS and VAS score was noted preinjection compared to final follow-up postinjection (p < .001). Eight of 11 patients that were involved in sports prior to the CBMA injection returned to play, with 7 successfully returning to preinjury level status. Three patients required further treatment (20%). The case series suggests that CBMA injection is a safe and effective treatment option for hallux sesamoid disorders with a high rate of return to play.