Cannulated screws versus nitinol staple for tarsometatarsal fusion: A cadaveric biomechanical comparison model.

BACKGROUND: The objective of this study was to evaluate the biomechanical stability of a medially placed nitinol staple compared to two crossed-screws in the first TMT-1 joint fusion in a cadaveric cyclic loading model. METHODS: Seven matched pairs (N = 7) of lower limb cadaveric specimens were utilized. TMT-1 joints from each donor were fixed with a medially placed nitinol staple or dorsally placed two 3.5 mm partially threaded cannulated crossed-screws. Specimens were tested in a 4-point bending setting with increasing cyclic forces. RESULTS: The mean plantar gapping was not significantly different between the two groups at any loading stage below 200 N. Specimens fixed with a nitinol staple failed at a mean load of 305 ± 57 N. Conversely, those fixed with crossed-screws failed at 373 ± 86 N. (P = .09). CONCLUSION: There was no statistical difference between a medially placed nitinol staple and dorsally placed crossed-screws in failure loads and plantar gapping under cyclic loads at the TMT-1 joint, however, the staple fixation was much more variable. LEVEL OF EVIDENCE: Level V, basic science study, biomechanics.

Inconsistency in the Reporting Terminology of Adverse Events and Complications in Hallux Valgus Reconstruction: A Systematic Review.

Surgical complications are inevitable in any surgical subspecialty. Throughout the years, many classification systems have been developed to better understand and report such complications. The aim of this systematic review is to investigate the variability and frequency of reporting terms used to describe adverse events and complications in hallux valgus reconstruction. We hypothesized that the terms used would be highly inconsistent, which further promotes a need for a standardized terminology reporting system. Studies related to hallux valgus reconstruction outcomes that met our predetermined inclusion criteria were investigated to identify and report the related adverse terms and complications. Adverse terms and complications were grouped into 9 categories. Of the 142 studies included, 376 distinct terms that described adverse events or complications related to hallux valgus reconstruction were identified. Of these, 73.4% (276/376) were mentioned only once in their respective studies. Five of 376 terms were mentioned in at least 25% of the papers, and only 2 of 376 were mentioned in at least 50%. The most frequently reported adverse events were "Recurrence," mentioned in 77 of 142 studies (54%), followed by "Nonunion," mentioned in 76 of 142 studies (53%). The most reported category was "Bone/Joint" with 135 related terms, mentioned in 135 of 376 of the papers (95.1%). The terminology used in reporting adverse events and complications in surgical hallux valgus correction was highly inconsistent and variable. This represents yet another barrier in accurate reporting of these terms, and subsequently a difficult analysis of the outcomes related to hallux valgus reconstruction. To overcome these challenges, we suggest developing a standardized terminology reporting system.Levels of Evidence: Level III; systematic review of Level III studies and above.

Correction method for moderate and severe degrees of hallux valgus associated with transfer metatarsalgia.

BACKGROUND: Hallux valgus (HV) is a common foot deformity that manifests with increasing age, especially in women. The associated foot pain causes impaired gait and decreases quality of life. Moderate and severe HV is a deformity that is characterized by the involvement of lesser rays and requires complex surgical treatment. In this study, we attempted to develop a procedure for this condition. AIM: To analyse the treatment results of patients who underwent simultaneous surgical correction of all parts of a static forefoot deformity. METHODS: We conducted a prospective clinical trial between 2016 and 2021 in which 30 feet with moderate or severe HV associated with Tailor's bunion and metatarsalgia were surgically treated via a new method involving surgical correction of all associated problems. This method included a modified Lapidus procedure, M2M3 tarsometatarsal arthrodesis, intermetatarsal fusion of the M4 and M5 bases, and the use of an original external fixation apparatus to enhance correction power. Preoperative, postoperative, and final follow-up radiographic data and American Orthopaedic Foot and Ankle Society (AOFAS) scores were compared, and P values < 0.05 were considered to indicate statistical significance. RESULTS: The study included 28 females (93.3%) and 2 males feet (6.7%), 20 (66.7%) of whom had a moderate degree of HV and 10 (33.3%) of whom had severe deformity. M2 and M3 metatarsalgia was observed in 21 feet, and 9 feet experienced pain only at M2. The mean follow-up duration was 11 months. All patients had good correction of the HV angle [preoperative median, 36.5 degrees, interquartile range (IQR): 30-45; postoperative median, 10 degrees, IQR: 8.8-10; follow-up median, 11.5 degrees, IQR: 10-14; P < 0.01]. At follow-up, metatarsalgia was resolved in most patients (30 vs 5). There was a clinically negligible decrease in the corrected angles at the final follow-up, and the overall AOFAS score was significantly better (median, 65 points, IQR: 53.8-70; vs 80 points, IQR: 75-85; P < 0.01). CONCLUSION: The developed method showed good sustainability of correction power in a small sample of patients at the one-year follow-up. Randomized clinical trials with larger samples, as well as long-term outcome assessments, are needed in the future.

Lapidus Arthrodesis for Correction of Hallux Valgus Deformity: A Systematic Review and Meta-Analysis.

BACKGROUND: The aim of this study was to evaluate and compare different fixation methods to achieve Tarsometatarsal joint I (TMT-1) arthrodesis in patients with hallux valgus regarding radiographic correction, complication profile, and clinical outcomes. METHODS: A systematic review and meta-analysis included primary literature results of evidence level 1 to 3 studies in German and English. Inclusion and exclusion criteria were established and applied, along with parameters suitable for comparison of data. RESULTS: 16 studies with a total of 1176 participants met the inclusion criteria for this analysis. Twelve evaluation criteria were compared among 3 fixation techniques; comprised of a screw-only, dorsomedial plating- and plantar plating cohort. There was no statistical difference in deformity correction (both intermetatarsal- and hallux valgus angle), or AOFAS score between the cohorts. The complication rate was 13% in the plantar-, 19.5% in the dorsomedial-, and 24.5% in the screw cohort. Nonunion was seen in 0.7% of participants in the plantar, 1.4% in the dorsomedial, and 5.3% in the screw group. The time until complete weightbearing correlated positively with the development of nonunion, with a coefficient of 0.376 (P = .009). Hardware removal was performed in 11.8% of patients in the dorsomedial cohort, 7.7% in the screw cohort, and 3.6% in the plantar cohort. CONCLUSION: Based on the results of meta-analysis of heterogeneous studies, plantar plating facilitated early weightbearing and patient mobilization compared to the other fixation methods, while carrying the lowest nonunion, hardware removal, and general complication risk. However, owing to the relatively small number of patients in the plantar plating group, more work is necessary to elucidate the benefits of plantar plating for a first tarsometatarsal joint arthrodesis. Development of complications appears to be largely dependent on the fixation model, rather than patient mobilization alone.Level of Evidence: 3.

Are sesamoids and proximal phalanx of metatarsus primus varus deformity of hallux valgus feet displaced? A radiological study.

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.

Combined Distal Metatarsal and Akin Osteotomies for Concomitant Metatarsophalangeal and Interphalangeal Hallux Valgus: Clinical and Radiological Outcomes.

Combined metatarsal and Akin-type proximal phalanx osteotomies represent a surgical solution for concomitant metatarso-phalangeal and inter-phalangeal hallux valgus. This retrospective observational study aimed to evaluate clinical and radiographic outcomes following combined distal linear metatarsal and Akin osteotomies. The study included 42 feet from 37 patients, with a mean follow-up of 27.1 (range 24-37) months. Mean surgical time was 16.54 ± 4.17 minutes. Pre- and postoperative clinical scores and radiological parameters were collected. Positive outcomes with a low recurrence and complications rates were reported. A statistically significant improvement in the Manchester-Oxford foot questionnaire, the EuroQol 5D-5L dimensions instrument, the visual analogue scale, the intermetatarsal angle, the hallux valgus angle, the distal metatarsal articular angle, and the interphalangeal angle correction was observed. Despite the results reported, further prospective studies are needed to identify the most suitable patients for this combined osteotomy approach.

Tension Side Fixation for Lapidus Arthrodesis: A Retrospective Analysis.

Moderate to severe hallux valgus deformity often requires a Lapidus procedure (first-tarsometatarsal arthrodesis). Traditional methods include a dorsal approach with dorsal or medial fixation. However, studies demonstrate plantar/tension-side fixation, provides superior load to failure and fixation strength. This could improve outcomes, address comorbidities, and accelerate postoperative protocols; however, a paucity exists for patient outcomes in the literature regarding tension-side-fixation. The purpose of this study is to report the outcomes for tension-side Lapidus fixation. A retrospective analysis was performed of 81 patients who underwent tension-side-fixation Lapidus. Data collection consisted of: time to weight-bear, time to return to regular shoegear, hardware removal rate, revision rate, recurrence rate, relative metatarsal shortening, and nonunion rates. Mean patient age was 44 years old (range: 16-82). There were 65 females, and 16 males. The average time to weightbearing was 10.4 days. Time to return to regular shoegear was a mean of 6 weeks (ranging 2-10 weeks). Hardware removal rate was 1.2%. The recurrence rate was 8.6% (7 of 81 patients) and 5 of those 7 patients experienced recurrence before frontal-plane-correction was adopted by the surgeon. The revision rate was 0% and despite 8.6% recurrence, no patients were dissatisfied or requested a revisional procedure. The first-metatarsal shortening was a mean of 0.42 mm. The complications were as follows: 7% superficial dehiscence, 1.2% superficial wound infection, 0% deep infection, and 1.2% asymptomatic nonunion. This study suggests tension-side-fixation for Lapidus arthrodesis may allow for safe early return to weightbearing, early return to regular shoegear, low hardware removal rate, low revision rate, low metatarsal shortening, and low nonunion rate.

Immediate Weightbearing Following First Metatarsal Phalangeal Joint Arthrodesis With 2 Nickel Titanium Alloy Staples.

The use of staples has been shown to be a reasonable fixation technique to achieve stability of a first MTPJ arthrodesis. Although it has been shown to be a weaker construct than crossed screws or plate and screw combinations, their ease of insertion, low profile, and stability make them a desirable choice for first MTPJ arthrodesis fixation. However, because of this relative weakness, the question remains whether immediate weightbearing when using staples is advisable. The aim of this study is to determine whether the use of 2 nickel-titanium alloy (NITINOL) staples, placed at 90 degrees to one another is a stable enough construct to support full, immediate weightbearing following first MTPJ arthrodesis. We performed a retrospective chart review of patients undergoing first MTPJ arthrodesis by a single surgeon utilizing 2 NITINOL staples placed at 90 degrees to one another. Patients were allowed to be fully weightbearing immediately postoperatively. Forty-seven of 50 (94%) patients achieved complete radiologic consolidation of fusion at 12 weeks, with only 3 requiring revision surgery for nonunion. All of the patients requiring revision surgery for nonunion, had preoperative diagnosis of hallux abducto valgus. We concluded that the use of 2 NITINOL staples placed at 90 degrees to one another is a viable option for first MTPJ arthrodesis, and immediate weightbearing does not increase rate of nonunion or incidence of revision surgery when compared to other fixation techniques.

Retrospective Comparison of Preoperative and Postoperative Foot Width in Minimally Invasive Hallux Valgus Surgery.

Minimally invasive surgery (MIS) has gained popularity for hallux valgus correction in the adult population. The advantage of reproducibility of this procedure can aid in lower operating room costs, quicker recovery, and fewer complications. The purpose of this retrospective study was to compare preoperative versus postoperative foot widths in patients that underwent MIS hallux valgus correction. The average preoperative foot width was 101.1 ± 5.67 mm and postoperatively the foot width measured at 12-month follow-up was 95.9 ± 4.92 mm, which was statistically significant (p < .001). Overall, there was a 5.03 ± 3.71% reduction in foot width, with a statistically significant linear relationship between preoperative foot width and percent change in width following the procedure (R = -0.46; p = .003). Based on our results, we can conclude that MIS bunion surgery can effectively narrow the foot postoperatively, particularly in patients with a wider forefoot, adding cosmetic benefit to the procedure.

Hallux Valgus Bunion Splint: Surgical Dressing Technique.

BACKGROUND: Hallux valgus is a common condition with a complex etiology resulting in numerous treatment options. Recurrence of the deformity can occur following correction. Surgical technique and possibly also postoperative care play a role in reducing recurrence rates. This article highlights a postoperative surgical dressing technique which allows for semirigid support during the immediate postoperative period. METHODS: A wooden tongue depressor placed along the medial border of the hallux comprises the primary support for the dressing. The rigidity of the tongue depressor allows for the hallux to be drawn toward the depressor, encouraging neutral alignment of the hallux. Dressings are removed 2 weeks postoperatively, with new dressings applied in similar fashion and maintained in place until 6 weeks postoperatively. RESULTS: Based upon our observations, our surgical dressing technique provides sufficient support following hallux valgus correction surgery while being straightforward to replicate without the need for frequent dressing changes. The dressing materials are of negligible cost and are typically readily available. No associated wound complications have been observed. CONCLUSIONS: We present an easily replicable and affordable option for postoperative hallux valgus correction surgical dressings. LEVELS OF EVIDENCE: Level V: Expert Opinion.

Radiological Analysis of the Syndesmosis Concept in Metatarsus Primus Varus and Hallux Valgus Deformities Recurrence Prevention.

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.

What Do Patients Report Regarding Their Real-World Function Following Concurrent Arthrodesis of the First Tarsometatarsal and First Metatarsophalangeal Joints.

First metatarsal phalangeal joint and the first Tarsometatarsal arthrodesis have both been used for deformity correction and treatment of pain and arthritis. Concomitant arthrodesis of the first metatarsophalangeal and first tarsometatarsal joints (Double First Ray Arthrodesis) has rarely been described. We surveyed 29 patients who underwent double first-ray arthrodesis for primary or revision correction of hallux valgus. A custom questionnaire was used to assess their activities of daily living and sports activity at a mean follow-up of 19.6 months (median 18.4 months). Secondary endpoints were return to activity, deformity correction, and arthrodesis healing rate. The primary outcomes showed an excellent return to activities of daily living with 96.6% of patients capable of walking as much as they liked after surgery at a normal pace. About 96.6% reported they felt that their surgery was successful, they had no pain, and the loss of motion at the joint fusion sites did not affect their ability to perform daily activities. Protected walking in a fracture boot was initiated at a mean (SD) of 9.8 (9.9) days. Return to an athletic shoe occurred at a mean (SD) of 44.2 (11.7) days. Full unrestricted activity was at a mean (SD) of 105.2 (19.3) days with 65% of the patient group reporting that their recovery was easier than expected. There was 1 nonunion and no other complications. This data set supports the hypothesis that patients undergoing double first-ray arthrodesis can return to activities of daily living and sports with and low complication rate.

The Triplanar Hallux Abducto Valgus Classification System: Is it Valid?

Historically, 2-dimensional radiographic study techniques have been used to classify deformity and guide treatment of hallux valgus deformities in the transverse plane. Recently, a triplanar hallux abducto valgus classification system was proposed. The key elements of this classification system are the pathologic alignments in 3 anatomic planes. The triplanar hallux abducto valgus classification system is intended to clarify the deformity and apply a triplanar anatomic algorithm for treatment. To our knowledge, this classification system has not been validated. Our objective was to assess reliability of the triplanar hallux valgus classification system. Patients with hallux abducto valgus were identified from a foot and ankle registry. Digital radiographs were assembled in a digital slide presentation. The eligibility criteria required complete radiographic studies and represented varying degrees of hallux abducto valgus. The reviewers included 3 board-certified, fellowship-trained orthopedic foot and ankle surgeons. Each reviewer independently classified the hallux abducto valgus deformity for a total of 75 observations. After an 8-week washout period, the order of the hallux abducto valgus cases was randomized in the digital slide presentation and redistributed to the reviewers. The average kappa value from 3 readers was 0.241 with 95% CI (0.093-0.374), indicating a fair agreement. The inter-reader agreement was 0.046 with 95% CI (-0.041 to 0.112), showing poor agreement between readers. Our results indicate the triplanar hallux abducto valgus is not a reliable classification system. While this is the first known triplanar hallux abducto valgus classification system, it lacks prognostic value and reliability.

Arthrodesis of the first metatarsophalangeal joint for severe hallux valgus in adolescents with cerebral palsy: A retrospective comparison study of three surgical techniques.

Purpose: We compared the outcomes of arthrodesis of the first metatarsophalangeal joint for severe hallux valgus in 31 adolescents with cerebral palsy, using three different methods of fixation: K-wires, non-locking plates, and locking plates. Methods: Clinical outcomes included time to weight-bearing, fusion rates and surgical complications. Radiographic assessment included comparing pre- and post-operative hallux valgus angles, intermetatarsal angles, interphalangeal angles, and lateral metatarsophalangeal angles. Patient-reported outcomes included pre- and post-operative visual analogue scales addressing bunion pain and concerns, difficulties with wearing shoes and braces, and difficulties with foot hygiene. Results: Of the 31 adolescents (16 male), 10 patients had K-wire fixation, 11 had a non-locking dorsal plate, and 10 had fixation with a dorsal locking plate. Mean age at surgery was 16 years (12-18 years) and mean follow-up was 4 years (2.7-6.5 years). Patients with K-wire fixation had delayed weight-bearing and had more complications than those managed by dorsal plating. There were significant improvements in radiographic parameters (except interphalangeal angle) and in patient-reported outcomes, in all groups (p < 0.001). However, radiographic and clinical outcomes were better in the dorsal plating groups compared to the K-wire group. Conclusion: Arthrodesis of the first metatarsophalangeal joint gave good correction of deformity with improvements in symptoms and radiographic parameters in adolescents with cerebral palsy. We recommend dorsal plating that allowed early weight-bearing and had fewer complications with better clinical and radiographic outcomes, than K-wire fixation. Level of evidence: IV: Retrospective case series.

Radiographic and Patient-Reported Outcomes of a Low-Cost Modified Lapidus Bunion Correction Technique.

Background: The modified Lapidus (ML) is a powerful procedure for correction of hallux valgus (HV) with emerging techniques. Studies considering patient-reported outcomes, radiographic measures, complications, and implant costs are currently limited. Methods: Retrospective cohort with prospectively collected Patient Reported Outcome Information System Physical Function (PROMIS-PF) Computerized Adaptive Test (CAT) scores, radiographic parameters (intermetatarsal angle, IMA; hallux valgus angle, HVA; and tibial sesamoid position, TSP), complications, and total operative time and implant costs were reviewed from 2014 to 2019. Results: Seventy-three feet (68 patients) underwent bunion correction by ML with lag-screw fixation. Median age was 55.8 years (IQR 45.6, 53.9), 4 of 73 (5.5%) were male, 11 of 73 (15.1%) were smokers, and 15 of 73 (20.6%) were diabetic (median HbA1c 6.4% [IQR 6.0, 7.4], none insulin dependent, 5 of 15 with neuropathy). Complications included 6 of 73 (8.2%) wound issues resolved with topical or oral treatment, 9 of 73 (12.3%) painful or broken hardware requiring hardware removal. Two of 73 (2.7%) had persistent pain despite union. One of 73 (1.4%) was overcorrected and required first MTP arthrodesis. Of 3 nonunions (2.7%), 1 resolved with corrected hypothyroidism, 1 was asymptomatic and required no treatment, 1 had a hallux valgus recurrence and sought revision surgery elsewhere. Preoperative radiographic angles were HVA 35 degrees, IMA 14 degrees which improved at final postoperative follow up to HVA 10 degrees, IMA 6 degrees. Tibial sesamoid position improved from 6.05 ± 1.00 to 2.22 ± 1.38. Thirty-two patients had preoperative and 42 had 1-year postoperative outcomes. PROMIS-PF (51% collection rate) was 43 (IQR 37,52) preoperatively, 37 (31, 39) at 6 weeks, 46 (42, 51) at 3 months, and 49 (41, 53) at >360 days postoperatively. The drop in PROMIS-PF between preoperative and 6 weeks and the rise from 6 weeks to 3 months were statistically significant. Pre- and postoperative PROMIS-PF scores were not significantly different. Implant cost averaged US$146. Discussion/Conclusion: We report low complication rates and costs with high patient postoperative functional and radiographic outcomes. PROMIS-PF decreased acutely postoperatively but recovered and maintained high levels by 3 months postoperatively. Level of Evidence: Level IV, case series.

A Systematic Review and Meta-Analysis of the Prevalence of Hallux Valgus in the General Population.

The objective of this systematic review was to determine the prevalence of hallux valgus (HV) in the general population by conducting a review and meta-analysis of existing studies. Published articles on the incidence of HV were systematically searched and evaluated on reputable medical databases such as PubMed. The keywords "the prevalence of hallux valgus and/or bunions"were used to create the search syntax on the various databases. Data were gathered on prevalence, population under study, and methodology. A total of 11 articles that met the search criteria were identified and included in this review for a total of 10,886 participants across the studies. The pooled prevalence of HV across the studies was3.75 (95% confidence interval = 0.388-0.517). Therefore, the prevalence varied widely across the studies reviewed. Prevalence was observed to be high among females and increased with risk factors such as body mass index, which were identified as significant across the studies. This review was limited by insufficient data and the lack of a standard HV diagnosis method. Therefore, a standard HV diagnosis tool is recommended.

Republication of "Treatment of Hallux Valgus Deformity Using a Suture Button Device: A Preliminary Report".

Background: Hallux valgus (HV) is commonly treated with proximal or distal first metatarsal osteotomy. Despite good correction, these procedures have inherent risks such as malunion, nonunion, metatarsal shortening, loss of fixation, and avascular necrosis. Suture button fixation has been used for HV treatment. It avoids the risks of corrective osteotomies while maintaining reduction of the intermetatarsal angle (IMA). The goal of this study was to assess the radiographic and functional outcomes of patients undergoing HV correction with a distal soft tissue procedure and proximal suture button fixation. Methods: The authors retrospectively reviewed the charts and radiographs of 22 patients who had undergone HV correction using a distal soft tissue correction and proximal fixation with a miniature suture button device (Mini TightRope; Arthrex, Inc, Naples, FL). Mean follow-up was 27.7 months. The IMA, hallux valgus angle (HVA), and sesamoid station were measured on radiographs obtained preoperatively as well as in the immediate postoperative period and at final follow-up. Preoperative and postoperative Short Form-36 (SF-36) and Foot and Ankle Ability Measure (FAAM) scores were collected. Postoperative complications, and any additional operative procedures performed were also recorded. Results: The mean preoperative IMA and HVA were 16.9 and 32.6 degrees, respectively. The mean immediate postoperative IMA was 5.2 degrees (P < .0001) and the mean HVA was 9.8 degrees (P < .0001). At final follow-up, the mean IMA was 8.2 degrees (P < .0001) and the mean HVA was 16.7 degrees (P < .0001). The average change in HVA from preoperative to final follow-up was 16.0 degrees and the average change in IMA from preoperative to final follow-up was 8.6 degrees (P < .0001). Sesamoid station assessment at the 2-week follow-up showed that 22 patients (100%) were in the normal position group; at final follow-up, 17 patients (77%) had normal position and 5 patients (23%) had displaced position. Although there were no clinically symptomatic recurrences, asymptomatic radiographic recurrence was noted in 5 patients (23%) who had a final HVA >20 degrees. All components of the FAAM and the SF-36 showed improvement from preoperative to final follow-up, although these changes were not statistically significant. Three patients experienced complications, including an intraoperative second metatarsal fracture, a postoperative second metatarsal stress fracture, and a postoperative deep vein thrombosis. Conclusion: The use of a distal soft tissue procedure in conjunction with proximal suture button fixation is a safe and effective procedure for treating symptomatic HV deformity. Our results show that this technique can correct the IMA, HVA, and sesamoid station without the need for osteotomy. Level of evidence: Level IV.

Finite Element Parametric Design of Hallux Valgus Orthosis Based on Orthogonal Analysis.

OBJECTIVE: To design appropriate orthosis for hallux valgus, a difficult foot condition that affects a quarter of the body's bones, we need to clarify the numerical biomechanical features, which have not been established in previous biomechanical studies. Therefore, we constructed a finite element model of the bunion foot to investigate the orthopaedic force compensation mechanism. METHODS: A patient with moderate hallux valgus was recruited. CT imaging data in DICOM format were extracted for three-dimensional foot model reconstruction. In conjunction with the need for rapid design of bunion orthosis, a metatarsal force application sizing method based on an orthogonal test design was investigated. The orthogonal test design was used to obtain the hallux valgus angle (HVA) and the inter metatarsal angle (IMA) data for different force combinations. Based on the extreme difference analysis and analysis of variance of the test results, the influence of different force combinations on the bunion angle was quickly determined. RESULTS: The results showed that the stress concentration occurred mainly in the first metatarsal bone. The distribution trend was in the medial and lateral middle of the bone and gradually decreased to the dorsal base of the bone body. The greatest stress occurs in the cartilage between the phalanges and metatarsals. In 25 groups of simulation experiments, HVA was reduced from 27.7° to 13°, and IMA was reduced from 12.5° to 7.3°. CONCLUSION: Applying detailed orthopaedic force collocation to the first metatarsal column can effectively restore the mechanics and kinematics of hallux valgus, and provide a reference for the treatment of bunion valgus and the design of orthopaedic devices.