RESUMEN
In the nineteenth century, the prevalent understanding of the hallux valgus was that it was purely an enlargement of the soft tissue, first metatarsal head, or both, most commonly caused by ill-fitting footwear. Thus, treatment had varying results, with controversy over whether to remove the overlying bursa alone or in combination with an exostectomy of the medial head. Since 1871, when the surgical technique was first described, many surgical treatments for the correction of hallux valgus have been proposed. A number of these techniques have come into fashion, and others have fallen into oblivion. Progress in biomechanical knowledge, and improvements in materials and supports have allowed new techniques to be developed over the years. We have developed techniques that sacrifice the metatarsophalangeal joint (arthrodesis, arthroplasties), as well as conservative procedures, and one can distinguish those which only involve the soft tissues from those that are linked with a first ray osteotomy.
Asunto(s)
Tratamiento Conservador , Hallux Valgus/cirugía , Procedimientos Ortopédicos , Fenómenos Biomecánicos , Tratamiento Conservador/historia , Tratamiento Conservador/métodos , Hallux Valgus/historia , Hallux Valgus/fisiopatología , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Procedimientos Ortopédicos/historia , Procedimientos Ortopédicos/métodosRESUMEN
A fifteenth-century Florentine altarpiece painted by the Pollaiuolo brothers, Antonio (1433-1498) and Piero (1443-1496), shows three saints with evident deformities of the hands and feet. The pathologies concerned are tentatively identified, and various rationales for their presence in the painting are discussed. Of particular importance is the location of the altarpiece in a chapel which houses the tomb of the Cardinal of Portugal, Prince James of Lusitania (1433-1459). It is argued that both the artistic style of the day and the religious symbolism of the Cardinal's funeral chapel contributed to the artists' decision to portray the saints with deformities. An unnatural curvature of the fifth finger was apparently considered elegant in fifteenth-century paintings, and the depiction of bare feet with hallux valgus gave them a shape which approximated and could have been caused by fashionable pointed shoes. But in addition, deformities in religious art could be symbolic of suffering and martyrdom, a theme which the Cardinal's chapel emphasised in a number of ways. It is suggested therefore that the Pollaiuolo altarpiece reconciles these two disparate factors, portraying genuine deformities in a way that was artistically stylish and symbolically meaningful.
Asunto(s)
Hallux Valgus/historia , Deformidades de la Mano/historia , Medicina en las Artes , Pinturas/historia , Santos , Historia del Siglo XV , ItaliaRESUMEN
Hallux valgus is the most common orthopedic problem of the adult foot. The etiology can be congenital, associated with the occurrence of metatarsus primus varus, or acquired, which is closely related to wearing ill-fitting shoes. Hallux valgus occurs almost exclusively in shod societies and, therefore, is a very uncommon finding in archaeological remains. We present a partial first ray of the left foot belonging to a dismembered Egyptian mummy recovered in the necropolis of Sharuna (Middle Egypt) and dated to the end of the Old Kingdom (circa 2100 BC). The mummification process led to a metatarsophalangeal joint in connection by means of soft tissues. The alignment of this joint could be diagnosed as a hallux valgus. Further examination showed a metatarsophalangeal angle of 28°. After a comprehensive literature search and noting that all of the previous cases were described by indirect factors, such as mounting the joint in dry bones, we can state with certainty that the piece we present herein is the oldest case of mummified hallux valgus.
Asunto(s)
Pie/patología , Hallux Valgus/diagnóstico , Articulación Metatarsofalángica/anomalías , Adulto , Egipto , Pie/diagnóstico por imagen , Hallux Valgus/historia , Historia Antigua , Humanos , Masculino , MomiasRESUMEN
The Scarf osteotomy has proven to be a versatile and powerful procedure to correct various degrees of hallux valgus deformity. Through modifications of bone-cut lengths and in combination with a phalangeal osteotomy, most hallux valgus deformities can be addressed. In cases of extreme hypermobility of the first ray or arthrosis of the first metatarsocuneiform joint, the Lapidus operation may be more appropriate. Hallux valgus rigidus or hallux valgus with severe rheumatoid joint disease usually requires alternative procedures. The results of the Scarf osteotomy compare favorably with the results reported for other popular bunion surgeries. When choosing a procedure, the clinician should consider that the Scarf osteotomy allows the patient to ambulate postoperatively without a cast or the use of crutches, to return to bathing and a closed athletic shoe in one week, and to have bilateral surgery, which maintains cost-effectiveness and returns the patient to his or her desired lifestyle more quickly. It has been said that surgery is both a science and an art. The author often believes that bunion surgery is more art than science, hence the success of so many procedures in one surgeon's hands and the failure in another's hands. The Scarf bunionectomy is a technically demanding procedure that has a large learning curve. Once mastered, however, the Scarf bunionectomy can provide a predictable and satisfying outcome for both patient and foot surgeon.
Asunto(s)
Hallux Valgus/cirugía , Huesos Metatarsianos/cirugía , Osteotomía/métodos , Tornillos Óseos , Hallux Valgus/historia , Historia del Siglo XX , Humanos , Osteotomía/efectos adversos , Osteotomía/historia , Cuidados PosoperatoriosRESUMEN
This paper discusses the normal adult values of the fibular deviation of the distal phalanx of the great toe. Occurrence of this deviation at birth is a normal finding and an increase can be expected during periods of active growth within the foot. This developmental increase is dependent upon transverse plane stability at the metatarsophalangeal joint. Preoperative procedures and postoperative reviews are discussed.
Asunto(s)
Hallux Valgus/historia , Femenino , Hallux Valgus/diagnóstico por imagen , Hallux Valgus/cirugía , Historia del Siglo XX , Humanos , Masculino , Osteotomía/historia , Radiografía , Articulación del Dedo del Pie/diagnóstico por imagen , Articulación del Dedo del Pie/cirugíaRESUMEN
OBJECTIVES: To estimate the prevalence of hallux valgus in a historical population in France, to identify associated skeletal abnormalities, and to look for an influence of footwear changes through time. METHODS: We studied the 605 first metatarsals found in the necropolis of the Notre-Dame-du-Bourg cathedral in Digne in the Alpes-de-Hautes-Provence region of southern France. The necropolis contains remains from the 5th to the 17th century. RESULTS: Hallux valgus was identified only in individuals older than 30years at death, and its prevalence increased significantly with age. Exostosis at the medial and dorsal aspects of the head of the first metatarsal were common in advanced forms. The prevalence was comparable in males and females in the Middle Ages but was significantly higher in males in the 16th and 17th centuries, whereas in contemporary populations females are selectively affected. CONCLUSIONS: The increase in the prevalence of hallux valgus over time suggests an influence of changes in footwear. The heeled shoes and boots made of stiff leather that men wore in premodern times probably promoted the development of hallux valgus. However, the prevalence of hallux valgus in women in western industrialized countries today is even higher than that in our historical population of older premodern individuals, suggesting an extremely deleterious effect of contemporary female footwear.
Asunto(s)
Hallux Valgus/historia , Huesos Metatarsianos/patología , Zapatos/historia , Adulto , Distribución por Edad , Causalidad , Femenino , Francia/epidemiología , Hallux Valgus/epidemiología , Hallux Valgus/patología , Historia del Siglo XV , Historia del Siglo XVI , Historia del Siglo XVII , Historia Medieval , Humanos , Masculino , Persona de Mediana Edad , Paleopatología , Prevalencia , Distribución por SexoRESUMEN
Hallux valgus is the abnormal lateral deviation of the great toe. The principal cause is biomechanical, specifically the habitual use of footwear which constricts the toes. In this study, descriptions of the anatomical changes of hallux valgus from published cadaveric and clinical studies were used to generate criteria for identifying the condition in ancient skeletal remains. The value of systematic scoring of hallux valgus in paleopathology is illustrated using two British skeletal series, one dating from the earlier and one from the later Medieval period. It was found that hallux valgus was restricted to later Medieval burials. This appears consistent with archaeological and historical evidence for a rise in popularity, during the late Medieval period (at least among the richer social classes), of narrow, pointed shoes which would have constricted the toes.
Asunto(s)
Deformidades Adquiridas del Pie/historia , Hallux Valgus/historia , Fenómenos Biomecánicos , Inglaterra , Deformidades Adquiridas del Pie/patología , Hallux Valgus/patología , Historia Medieval , Humanos , Prácticas Mortuorias , Paleopatología , Zapatos/efectos adversos , Zapatos/historiaRESUMEN
A historical review of osteotomies of the proximal phalanx has been presented. The techniques have remained relatively unchanged since their introduction by O. F. Akin in 1925. This article describes a minimal incision osteotomy technique using a medial approach to the hallux and wedge-shaped burs. The results suggest that the procedure produces good clinical results and is highly accepted by the patient. The procedure is compatible with a hospital or outpatient surgical facility. The procedure is recommended to those surgeons who are well-trained in ambulatory foot surgery. A statistical survey of the end-results is not available at the present time.
Asunto(s)
Hallux Valgus/cirugía , Osteotomía/métodos , Procedimientos Quirúrgicos Ambulatorios , Hallux/anatomía & histología , Hallux Valgus/historia , Historia del Siglo XX , Humanos , Osteotomía/historia , Cuidados Posoperatorios , Cuidados Preoperatorios , Estados UnidosRESUMEN
Long-term results of 484 cases of Silastic total first joint replacement are presented. The history, discussion of other total first implants, and a descriptive surgical technique with a discussion of complications are also presented. The authors propose a new, universal grading system for assessment of results following bunion surgery.