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.

SCARF OSTEOTOMY FOR HALLUX VALGUS CORRECTION: RADIOLOGICAL AND CLINICAL ANALYSIS.

Objectives: This article aims to radiographically and clinically evaluate the results of the surgical correction of hallux valgus using the scarf technique. The pre- and postsurgical hallux valgus angles - metatarsophalangeal angle (MP), intermetatarsal angle (IM), and degree of dislocation of the sesamoids - were retrospectively evaluated, as well as their clinical parameters. Methods: 70 pre- and postoperative radiographs of patients undergoing surgical correction of hallux valgus by the scarf osteotomy technique were retrospectively evaluated. The American Orthopedic Foot And Ankle Society Score (AOFAS) was used for pre- and postoperative clinical evaluation. Results: There was a statistically significant improvement in the MP, IM, and sesamoid position, in addition to the clinical improvement verified by the AOFAS. Conclusion: Scarf osteotomy improves the MP and IM angles and correct the position of the sesamoid, as well as improve the AOFAS. Level of Evidence IV, Retrospective Comparative Study.

Objetivos: Analisar radiograficamente e clinicamente os resultados da correção cirúrgica do hálux valgo pela técnica de Scarf, assim como os ângulos pré e pós-cirúrgico do hálux valgo - ângulo metatarsofalângico (MTF) e ângulo intermetatarsal (IM) -, grau de luxação dos sesamoides e parâmetros clínicos. Métodos: Foram avaliadas retrospectivamente 70 radiografias com carga pré e pós-operatórias dos pacientes submetidos à correção cirúrgica do hálux valgo pela técnica de osteotomia de Scarf. Para avaliação clínica pré e pós-operatória foi utilizado a escala da American Orthopaedic Foot And Ankle Society (AOFAS). Resultados: Foi observado melhora estatisticamente significativa dos ângulos MTF e IM e posição dos sesamoides, além de melhora clínica verificada pela escala AOFAS. Conclusão: A osteotomia de Scarf é capaz de melhorar os ângulos MTF e IM e corrigir a posição dos sesamoides, acompanhado da melhora da escala AOFAS. Nível de Evidência IV, Estudo Retrospectivo Comparativo.

The Effect of Hallux Valgus Surgery on the Transverse Plane Hallux Proximal Phalanx Position.

The objective of this investigation was to evaluate the apparent movement of the hallux proximal phalanx in the transverse plane relative to the second metatarsal following hallux valgus surgery. Pre- and postoperative radiographs of a consecutive series of 45 feet undergoing hallux valgus surgery were analyzed. Significant improvements were observed in the first intermetatarsal angle (12.4 vs 7.5 degrees; p < .001), hallux valgus angle (24.3 vs 13.4 degrees; p < .001), tibial sesamoid position (4.6 vs 2.7; p < .001), and second metatarsal-hallux proximal phalanx angle (80.1 vs 84.6 degrees; p < .001). No difference was observed in the distance between the second metatarsal bisection and the medial aspect of the tibial sesamoid (31.7 vs 31.5 mm; p = .756) nor between the second metatarsal bisection and medial aspect of the hallux proximal phalanx base (34.6 vs 34.2 mm; p = .592). Significant differences were observed between the second metatarsal bisection and the central aspect of hallux proximal phalanx base (26.5 vs 23.9 mm; p < .001) and between the second metatarsal bisection and the lateral aspect of the hallux proximal phalanx base (19.3 vs 15.4 mm; p < .001). A statistically significant difference was observed in the change of distance between the second metatarsal bisection and the medial, central, and lateral aspects of the hallux proximal phalanx base (-0.4 vs -2.6 vs -3.9 mm; p = .002). These results indicate that the hallux proximal phalanx does not translocate in the transverse plane following hallux valgus surgery, but instead pivots about the medial aspect of the joint.

Technique Tip: Medial prominence bone spur resection in the third-generation percutaneous Chevron-Akin Osteotomy Technique (PECA) for hallux valgus correction.

The third-generation percutaneous chevron and Akin osteotomy (PECA) technique for surgical management of hallux valgus has shown improvement in clinical and radiographic outcomes. During this procedure, lateral translation and fixation of the first metatarsal head results in the formation of a bony prominence on the medial side of the distal aspect of the first metatarsal which can cause pain and discomfort to the patient. We describe two techniques to address this bony prominence; either i) excision osteotomy and removal of the fragment or ii) a dorsal closing wedge osteotomy retaining the bony fragment. LEVEL OF EVIDENCE: Level V, expert opinion.

Scarf osteotomy for hallux valgus correction: radiological and clinical analysis / Osteotomia de scarf para correção do hálux valgo:análise radiológica e clínica

ABSTRACT Objectives: This article aims to radiographically and clinically evaluate the results of the surgical correction of hallux valgus using the scarf technique. The pre- and postsurgical hallux valgus angles - metatarsophalangeal angle (MP), intermetatarsal angle (IM), and degree of dislocation of the sesamoids - were retrospectively evaluated, as well as their clinical parameters. Methods: 70 pre- and postoperative radiographs of patients undergoing surgical correction of hallux valgus by the scarf osteotomy technique were retrospectively evaluated. The American Orthopedic Foot And Ankle Society Score (AOFAS) was used for pre- and postoperative clinical evaluation. Results: There was a statistically significant improvement in the MP, IM, and sesamoid position, in addition to the clinical improvement verified by the AOFAS. Conclusion: Scarf osteotomy improves the MP and IM angles and correct the position of the sesamoid, as well as improve the AOFAS. Level of Evidence IV, Retrospective Comparative Study.

RESUMO Objetivos: Analisar radiograficamente e clinicamente os resultados da correção cirúrgica do hálux valgo pela técnica de Scarf, assim como os ângulos pré e pós-cirúrgico do hálux valgo - ângulo metatarsofalângico (MTF) e ângulo intermetatarsal (IM) -, grau de luxação dos sesamoides e parâmetros clínicos. Métodos: Foram avaliadas retrospectivamente 70 radiografias com carga pré e pós-operatórias dos pacientes submetidos à correção cirúrgica do hálux valgo pela técnica de osteotomia de Scarf. Para avaliação clínica pré e pós-operatória foi utilizado a escala da American Orthopaedic Foot And Ankle Society (AOFAS). Resultados: Foi observado melhora estatisticamente significativa dos ângulos MTF e IM e posição dos sesamoides, além de melhora clínica verificada pela escala AOFAS. Conclusão: A osteotomia de Scarf é capaz de melhorar os ângulos MTF e IM e corrigir a posição dos sesamoides, acompanhado da melhora da escala AOFAS. Nível de Evidência IV, Estudo Retrospectivo Comparativo.

Validity and Reliability of a New Radiological Method to Estimate Medial Column Internal Rotation in Hallux Valgus Using Foot Weight-Bearing X-Ray.

BACKGROUND: Medial column internal rotation in hallux valgus (HV) can be measured using weight-bearing computed tomography (WBCT). Anteroposterior weight-bearing foot radiographs' (WBXR) ability to estimate medial column internal rotation in HV was evaluated comparing these measurements with those obtained from WBCT. METHODS: Three observers evaluated WBCT and WBXR of 33 HV feet twice. Medial column internal rotation was measured with WBCT and classified into 3 levels according to WBXR findings. Intra- and interobserver reliability were obtained for WBXR and WBCT, in addition to WBXR-WBCT correlation. RESULTS: WBXR and WBCT intraobserver agreement was substantial and near perfect, respectively (κ 0.79 and 0.84). Their interobserver agreement was excellent (intraclass correlation 0.85 and 0.9, respectively). The WBXR-WBCT correlation was substantial (κ 0.68). WBXR diagnostic accuracy to predict the WBCT results was 85%. CONCLUSIONS: The proposed method for medial column internal rotation measurement using WBXR is reliable and has a substantial agreement with WBCT measurements. LEVELS OF EVIDENCE: Level III.

Hallux valgus en el adulto: conceptos actuales y revisión del tema / Hallux valgus in the adult: current concepts and review

El hallux valgus, o juanete, es la desviación en valgo del primer ortejo con una desviación en varo del primer metatarsiano. El 90% de los pacientes son mujeres, siendo las limitaciones más frecuentes el dolor medial sobre la prominencia ósea, el dolor plantar bajo la cabeza de los metatarsianos y la aparición de ortejos en garra. El antecedente genético y el uso de calzados en punta son los factores asociados más importantes en el origen de este cuadro. La decisión de tratamiento está relacionada exclusivamente con la limitación que esta deformidad produce en el/la paciente. Es frecuente que pacientes que no acostumbran usar calzado ajustado nunca tengan síntomas, aunque tengan un hallux valgus grave. Por el contrario, personas que por su trabajo deben usar calzado formal/ajustado, pueden tener un juanete doloroso incluso con deformidades leves. Formas no quirúrgicas de tratamiento no corrigen el juanete. Las únicas maneras de aliviar los síntomas son utilizando zapatos anchos y/o plantillas en caso de metatarsalgia. La corrección quirúrgica se realiza mediante osteotomías, realineando la estructura ósea. Existen múltiples técnicas, las que se utilizan dependiendo de la severidad del cuadro y de la experiencia del cirujano. La cirugía tiene resultados satisfactorios en aproximadamente el 85% de los casos con alivio del dolor y de la deformidad como objetivos. El riesgo de complicaciones es del 15% aproximadamente, siendo las principales la recidiva de la deformidad, la presencia de osteosíntesis sintomática e infección superficial. El riesgo de recidiva aumenta en casos de deformidades graves, siendo la gran mayoría de las recidivas leves en magnitud y no siempre requieren cirugía.

Hallux valgus, or bunion, is a deformity of the big toe and a first metatarsal varus deviation. Most (90%) of patients are women, with bunion pain, metatarsalgia, and claw toes, being the most frequent complaints. The genetic background and use of pointed shoes are the most important factors responsible for this condition. The treatment decision is taken depending on the complaints due to this deformity. Patients that do not usually wear tight pointed shoes never have symptoms even in severe hallux valgus. On the other hand, people that wear formal or tight footwear at work, it can be very painful even with very mild bunion deformities. Non-surgical treatment does not correct the bunion. The only way to relieve symptoms is using wide shoes, and / or insoles in cases of metatarsalgia. Surgical correction is performed by osteotomy. There are multiple techniques, which are used depending on the severity of the deformity and the experience of the surgeon. Successful outcomes are obtained in 85% of patients. The complications risk is about 15%, with recurrence, the presence of osteosynthesis, and superficial infections, accounting for most of them. The recurrence risk increases if the deformity is severe, but most recurrences are mild and do not always require surgery.

The Mechanical Axis of the First Ray: A Radiographic Assessment in Hallux Abducto Valgus Evaluation.

The present report describes a new method of hallux abducto valgus deformity correction planning using the mechanical axis of the medial column (mechanical axis planning). This method of radiographic evaluation identifies an ideal position for the first metatarsal after correction and is useful regardless of the surgical procedure chosen. We retrospectively reviewed 200 radiographs to identify a "normal" value for the mechanical axis angle. We reviewed 100 radiographs of patients with hallux abducto valgus deformity (deformity group) and 100 radiographs of patients without hallux abducto valgus deformity (control group). The deformity group revealed an M1-M2 anatomic axis angle of 13.5° ± 2.83° and an M1-M2 mechanical axis angle of 11.58° ± 1°. The control group revealed an M1-M2 anatomic axis angle of 7.5° ± 1.76° and an M1-M2 mechanical axis angle of 11.19° ± 0.9°. The differences in the M1-M2 anatomic axis angle and M1-M2 mechanical axis angle were statistically significant between the control and deformity groups. We sought to provide a reliable method for planning hallux abducto valgus deformity correction by aligning the mechanical axis of the medial column and the mechanical axis of the first ray to the "normal" value of 11° to reduce the deformity.