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Objective To analyze changes in neuromuscular control during sit-to-stand (STS) in older adults with hallux valgus ( HV) through muscle synergy, and thus to explore the effect of falls in older adults with HV. Methods Four groups of subjects were included in this study, 13 young controls (YC); 12 young HV group ( HVY) ; 14 healthy elderly controls (EC ); and 15 elderly HV group ( HVE ). All subjects completed the STS maneuver in an armless chair, and EMG data were integrated using non-negative matrix factorization to compare muscle synergies in the YC, HVY, EC, and HVE groups; plantar pressures (COP), ground reaction forces (GRF), and fall scores (FES-I) were collected. Results Compared with YC group, HVY, EC, and HVE groups had lower relative activation amplitude of abductor hallucis and lateral gastrocnemius in STS preparation phase ; meanwhile, EC and HVE groups needed more muscle activation to maintain stability of trunk and foot-ankle joints in STS stabilization phase; and HVE group needed more co-contractions of thigh muscles to maintain stability of the knee joint. The COP, FES-I of HVE group was higher than that of the other groups (P < 0.05 ). Conclusion In STS, healthy older adults and older adults with HV required more muscle activation to maintain trunk and ankle stability ; older adults with HV required more co-contraction of the thigh muscles to maintain knee stability; in addition to this, older adults with HV were more prone to falls. [ABSTRACT FROM AUTHOR]

BACKGROUND: Finite element model construction and biomechanical analysis make it possible to explore the formation of hallux valgus and the recovery of related structures and functions. OBJECTIVE: To establish a finite element model of moderate hallux valgus foot in the neutral position with load to analyze the changes of the angle of the first metatarsophalangeal joint and the stress distribution of the corresponding bones under the action of external forces of different parts and sizes. METHODS: One female volunteer with moderate hallux valgus was selected, and CT image data were collected. The computer 3D imaging technology was used to conduct 3D finite element modeling to verify the validity of the model, and standardize the measurement method of the angle of the first metatarsophalangeal joint and the angle between the first and second metatarsal. Variables were controlled and the force was changed in turn to observe the changes of the above two angles, and analyze the stress distribution of the first metatarsal and proximal phalanx. RESULTS AND CONCLUSION: (1) An effective finite element model of moderate hallux valgus foot was established, which showed that a large stress concentration appeared in the first metatarsal. The distribution trend was from the medial middle and lateral middle of the bone body, gradually decreasing towards the dorsal and basal sides of the bone. (2) The feasibility of the method for determining the axis reference point of the first metatarsal, the second metatarsal and the proximal phalanx of the great toe was verified in finite element analysis. (3) The horizontal force acting on the lateral middle area of the distal phalanx of the first great toe has a direct effect on the change of the first metatarsophalangeal angle, but it has no linear effect. The regional force acting on the medial capsule of the metatarsophalangeal joint mainly affects the size of the first-second metatarsophalangeal angle. The horizontal force acting on the medial surface of the proximal metatarsal has little effect on the two angles. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although the elastic fixation between the first and second metatarsal bones can achieve satisfactory clinical effects in the treatment of hallux valgus, the reported risk of complications of stress fracture of the second metatarsal bone is higher. In the previous study of the research group, good clinical results were obtained using this elastic fixation in the treatment of hallux valgus. OBJECTIVE: To further verify the safety and reliability of the technique by establishing a finite element model of hallux valgus surgery for the fixation of the first and second metatarsal bones, and perform mechanical loading analysis. METHODS: Based on the CT image of a female hallux valgus patient as modeling data, relevant operations were carried out to establish a three-dimensional model of hallux valgus using the software Mimics 19.0, Geomagic Studio, Hypermesh 12.0, and ANSYS 19.0. The hallux valgus model was divided into three kinds of surgical models according to surgical sites: from the base of the distal segment of the first metatarsal to the base of the distal segment of the second metatarsal (group A), the middle segment (group B), and the proximal base (group C) of the second metatarsal. The three groups of surgical models were subjected to horizontal mechanical loading to gradually reduce the intermetatarsal angle for mechanical test analysis. To simulate the stress mode of the human body when standing, the vertical loading mechanics were gradually performed on the upper segment of the tibia and fibula, and the mechanics and deformation of the whole foot and the first and second metatarsal bones were observed. RESULTS AND CONCLUSION: (1) In terms of stress, when the horizontal force applied to the angle between the first and second metatarsal bones was 50, 100, 200, and 300 N, the maximum stress at the overall action point of the metatarsal bones occurred in group B. The maximum stress of the first metatarsal occurred in the model of group A. The maximum stress of the second metatarsal occurred in the model of group C. The minimum stress of the second metatarsal occurred in the B model. (2) In terms of deformation, the lateral displacement of the first metatarsal was the largest in model A, followed by group B, the smallest in group C. The difference between the models in each group was small for vertical application. (3) The results showed that models of group A and group B had better orthopedic ability and were less likely to cause stress fracture of the second metatarsal. This study provides mechanical data for the clinical implementation of the first and second metatarsal elastic fixation to correct hallux valgus surgery without osteotomy. [ABSTRACT FROM AUTHOR]

Objective: To explore early effectiveness of modified minimally invasive Chevron-Akin (MICA) osteotomy in the treatment of moderate to severe hallux valgus., Methods: A clinical data of 49 patients (61 feet) with moderate to severe hallux valgus, who met the selection criteria between December 2019 and October 2022, was retrospectively analyzed. There were 7 males (8 feet) and 42 females (53 feet) with an average age of 38.0 years (range, 15-59 years), including 37 of unilateral foot and 12 of bilateral feet. There were 41 feet of moderate hallux valgus [hallux valgus angle (HVA) 20°-40°] and 10 feet of severe hallux valgus (HVA>40°). All patients underwent modified MICA osteotomy. A transverse osteotomy on the distal end of the first metatarsal bone was performed to replaced the traditional Chevron osteotomy, and three Kirschner wires were used to assist in three-dimensional correction. The other treatments were the same as traditional MICA osteotomy. The HVA, inter metatarsal angle (IMA), Hardy score of the sesamoid, and American Orthopaedic Foot and Ankle Society (AOFAS) score of 61 feet before operation and at last follow-up were recorded, and the results were compared between the various severity of hallux valgus., Results: All patients were followed up 6-24 months with an average of 12.0 months. After operation, the redness and swelling around the incision occurred in 1 foot; limited mobility of the metatarsophalangeal joint occurred in 2 feet; mild numbness of the skin occurred in 5 feet; mild inversion of the great toe occurred in 2 feet. No complication such as tendon injury was found. X-ray films showed no abnormal healing, nonunion, or necrosis of the metatarsal head after osteotomy. The healing time of osteotomy ranged from 3 to 4 months, with an average of 3.2 months. At last follow-up, the HVA, IMA, Hardy score of sesamoid, and AOFAS scores all significantly improved when compared with preoperative levels ( P <0.05). The AOFAS scores were excellent in 45 feet, good in 15 feet, and fair in 1 foot, with an excellent and good rate of 98.4%. The above indicators for moderate or severe hallux valgus patients were significantly improved when compared with preoperative levels ( P <0.05). The changes between pre- and post-operation in HVA, IMA, and Hardy scores of severe hallux valgus were all greater than those of moderate hallux valgus, with significant difference in HVA change between groups ( P <0.05), while there was no significant difference in the other two changes ( P >0.05)., Conclusion: Modified MICA osteotomy can achieve good orthopedic effects and early functional improvement in the treatment of moderate to severe hallux valgus.

BACKGROUND: At present, the osteotomy is the mainstream surgical method, and there are many complications. Elastic fixation between the first and second metatarsals is a new surgical method for hallux valgus. OBJECTIVE: Using the method of finite element analysis, the treatment of hallux valgus with fixation between the first and second metatarsals was studied, which provided theoretical data for clinical treatment. METHODS: CT data of a female patient with hallux valgus in Changzhou Tumor Hospital Affiliated to Soochow University were collected to establish a finite element model of hallux valgus. Three surgical sites were divided into group A (from the base of the distal first metatarsal to the base of the distal second metatarsal); group B (from the base of the distal first metatarsal to the middle segment of the second metatarsal); group C (from the base of the distal segment of the first metatarsal to the base of the proximal segment of the second metatarsal). The first metatarsal and the second metatarsal were fixed respectively to correct the hallux valgus angle to 9 degrees in the three groups to analyze stress and deformation after fixation. The protocol was conducted in accordance with relevant ethical requirements of Changzhou Tumor Hospital (approval No. 2019-SY-031; date: 2019). Patients and their family signed the informed consent. RESULTS AND CONCLUSION: (1) After implementing the surgical plan at the three groups of surgical sites, in group A, the total foot stress was 202.43 MPa, and the deformation was 1.71 mm; the first metatarsal stress was 37.38 MPa, and the deformation was 1.71 mm; the second metatarsal stress was 1.16 MPa, and the deformation was 0.005 mm. In group B, the stress of the whole foot was 220.58 MPa, and the deformation was 1.47 mm; the first metatarsal stress was 29.26 MPa, and the deformation was 1.47 mm; the second metatarsal stress was 0.94 MPa, and the deformation was 0.004 5 mm. In group C, the total foot stress was 141.94 MPa, and the deformation was 1.07 mm; the first metatarsal stress was 23.62 MPa, and the deformation was 1.07 mm; the second metatarsal stress was 1.43 MPa, and the deformation was 0.003 2 mm. (2) The results showed that the surgical site from the base of the distal first metatarsal to the base of the distal second metatarsal or the middle segment of the second metatarsal had higher deformation ability, which was more conducive to the correction of hallux valgus angle. [ABSTRACT FROM AUTHOR]

BACKGROUND: Through the combination of traditional X-ray technology, digital software and anatomy, the visually obtained images of the human foot bones are easy to observe and measure the changes in the bones of the foot. At present, relevant domestic and foreign researches focus on pathological conditions of foot and plantar pressure distribution, and there are few studies on the changes of foot bones under weight-bearing conditions. OBJECTIVE: To explore the changes in the foot bones in the standing state. METHODS: Totally 100 healthy young male students were selected. Special software developed by Criminal Investigation Police University of China for footprint measurement was used to measure the characteristics of the foot bones in the X-ray. Data of the human foot bones in normal and weight-bearing states were recorded RESULTS AND CONCLUSION: (1) Compared with the normal standing state, the weight-bearing state had a significant increase in the foot bone length, width, and the difference in the length of the second and fifth metatarsal bones (P < 0.01). (2) Compared with the normal standing state, the weight-bearing state had no significant effect on the hallux abduction angle, the little toe varus angle, and the length difference between the first and second metatarsals (P > 0.05), with stability. It can be used in medical foot bone and joint measurement research and forensic examination and identification. (3) The change of hallux valgus angle before and after loading was used to distinguish mild hallux valgus patients from healthy people. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of small incision external articular minimally invasive osteotomy and traditional Chevron osteotomy in the treatment of hallux valgus., Methods: A retrospective analysis was conducted on the clinical data of 58 patients (58 feet) with hallux valgus who were admitted between April 2019 and June 2022 and met the selection criteria. Among them, 28 cases were treated with small incision external articular minimally invasive osteotomy (minimally invasive group), and 30 cases were treated with traditional Chevron osteotomy (traditional group). There was no significant difference in baseline data such as age, gender, disease duration, Mann classification, and preoperative inter metatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), forefoot width, tibial sesamoid position (TSP) score, American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, visual analogue scale (VAS) score, psychological score (SF-12 MCS score) and physiological score (SF-12 PCS score) of short-form 12 health survey scale, and range of motion (ROM) of metatarsophalangeal joint between the two groups ( P >0.05). The incision length, operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, weight-bearing walking time, fracture healing time, and incidence of complications were recorded and compared between the two groups; as well as the changes of imaging indexes at last follow-up, and the clinical function score and ROM of metatarsophalangeal joint before operation, at 6 weeks after operation, and at last follow-up., Results: All patients were followed up 11-31 months, with an average of 22 months. The incision length and intraoperative blood loss in the minimally invasive group were significantly less than those in the traditional group ( P <0.05), and the intraoperative fluoroscopy frequency and operation time in the minimally invasive group were significantly more than those in the traditional group ( P <0.05); but no significant difference was found in weight-bearing walking time and fracture healing time between the two groups ( P >0.05). There was 1 case of skin injury in the minimally invasive group and 3 cases of poor incision healing in the traditional group; all patients had good healing at the osteotomy site, and no complication such as infection, nerve injury, or metatarsal head necrosis occurred. At last follow-up, the imaging indexes of the two groups significantly improved when compared with those before operation ( P <0.05). The changes of DMAA and TSP score in the minimally invasive group were significantly better than those in the traditional group ( P <0.05), and there was no significant difference in the changes of IMA, HVA, and forefoot width between the two groups ( P >0.05). The clinical scores and ROM of metatarsophalangeal joint significantly improved in the two groups at 6 weeks after operation and at last follow-up when compared with preoperative ones ( P <0.05), and the indicators in the minimally invasive group were significantly better than those in the traditional group ( P <0.05)., Conclusion: Compared with traditional Chevron osteotomy, small incision external articular minimally invasive osteotomy can effectively improve HVA, IMA, and forefoot width, correct foot deformities, and has less trauma. It can better correct the first metatarsal pronation deformity and restore the anatomical position of the sesamoid bone, resulting in better effectiveness.

To explore the curative effect of reverse transfer of abductor hallucis tendon for insertion reconstruction in the synthetic therapy for hallux valgus deformity. Methods A total of 65 patients (104 feet) with hallux valgus deformity from January 2014 to January 2019 were analyzed retrospectively. All patients underwent reverse transfer of abductor hallucis tendon for insertion reconstruction. The adductor hallucis tendon was loosened and resected at joint capsule attachment medial to proximal segment base of hallux. The increased synovium and hypertrophic osteophyte of the first metatarsal head were resected simultaneously. The medial joint capsule was contracted sutured. The plaster fixation of hallux under full extension was maintained for 6 weeks. All patients were followed up for 6 to 60 months, with an average of 24 months. The curative effect was assessed through hallux valgus angle (HVA), shape of hallux, bunion, metatarsal pain, joint range of motion and disappearance of callus by forefoot scoring system of American Orthopaedic of Foot and Ankle Society (AOFAS). Results All incisions were healing by first intention without infections. The symptoms of bunion and metatarsalgia disappeared in all patients. The plantar callus disappeared in 52 patients and improved in 13 patients. The shape of foot was good and walk was normal. No obvious complications occurred. The preoperative AOFAS score was (52.35±7.43) and postoperative score was (82.46±7.71). The difference was statistically significant (t=8.99, P<0.01). The HVA was (36.37毅±2.64毅) before operation and (12.32毅± 2.48毅) after operation (P<0.01). Conclusion The reverse transfer of abductor hallucis tendon for insertion reconstruction combined with adductor hallucis tendon loosen and resection was easy to operate with less injury and fast recovery, which provide an alternative choice for the treatment of hallux valgus deformity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Scarf osteotomy is an osteotomy of the metatarsal shaft, and the orthopedic force is strong, and the effect of osteotomy is significant, but the orthopedic often fluctuates greatly due to the change of the vetex line of the osteotomy and the angle of the osteotomy, causing undercorrection or overcorrection. Three-dimensional reconstruction software has unique advantages in three-dimensional model reconstruction, osteotomy simulation and index measurement. Therefore, it is necessary to quantify the influence of the osteotomy angle of the Scarf osteotomy line on the strength of orthopedic. OBJECTIVE: To analyze the influence of the inclination angle of the transverse osteotomy line on the strength of hallux valgus correction during Scarf osteotomy using 3-matic software. METHODS: From May 2018 to September 2020, 14 patients diagnosed with hallux valgus were admitted to the Department of Foot and Ankle Surgery, Wuxi Ninth Hospital, Soochow University, with 21 feet, aged 22 to 76 years old. With the aid of a simulated weight-bearing stent, the simulated weight-bearing CT images of the feet of patients with hallux valgus were obtained. Three-dimensional bone model was constructed in Mimics software, imported in 3-matic software to simulate Scarf osteotomy of the first metatarsal, adjust the different osteotomy angles of the transverse osteotomy line to simulate osteotomy. The relevant indexes of postoperative hallux valgus were measured, and compared with the measurement results of the same individual and the same index. The changing trend of each measured value was analyzed. RESULTS AND CONCLUSION: (1) The inclination angle of the transverse osteotomy line of Scarf osteotomy has significant differences with the hallux valgus angle change rate, first-second intermetatarsal angle change rate, lateral intermetatarsal angle change rate and metatarsal head height change rate (P < 0.05). (2) At the same time, the change rate of lateral intermetatarsal angle and metatarsal head height increased significantly when the inclination angle of the osteotomy line was in the range of 20°-25°, and the change rate of hallux valgus angle and intermetatarsal angle was significantly increased in the range of 15°-20°. (3) It is concluded that using computer-assisted technology for preoperative simulation planning to provide a personalized and precise method for the correction of hallux valgus deformity, which is beneficial to reduce the incidence of surgical complications such as metastatic metatarsalgia, and increase the intensity of osteotomy orthopedic and the safety of osteotomy, improve patient satisfaction, reduce the learning curve of surgeons, and provide guidance and theoretical basis for clinical surgical treatment of hallux valgus. [ABSTRACT FROM AUTHOR]

BACKGROUND: Surgical treatment of hallux valgus includes bone surgery and soft tissue balance surgery. At present, many surgical plans are made based on the experience of the surgeon. There are many surgical methods for hallux valgus, and the pathological changes are complex and diverse. No surgery can perfectly solve all the problems of hallux valgus, and the surgical effect is not accurate, and the learning curve is also long. OBJECTIVE: To explore the application of digital technology in the treatment of hallux valgus. METHODS: Databases of PubMed, Wanfang, and CNKI were searched. The key words were “hallux valgus; digital technology; biomechanics; finite element; digital orthopedics; osteotomy” in Chinese and English. Retrieval time was from January 2000 to May 2020. Among 571 articles in English and 350 articles in Chinese, 42 articles were selected according to the inclusion criteria for review. RESULTS AND CONCLUSION: (1) When clinical treatment of hallux valgus is performed, the software is used to reconstruct the three-dimensional simulation model, to simulate the operation under different working conditions, and to analyze the orthopedic effect. This has a clear guiding significance for preoperative planning and is helpful to reduce the incidence of postoperative complication of hallux valgus and optimize the orthopedic effect. (2) The use of computer software for three-dimensional modeling and finite element plantar stress analysis has obvious advantages for the study of biomechanical mechanisms and the evaluation of postoperative clinical efficacy. (3) The clinical application of three-dimensional printed hallux valgus osteotomy guide plate and bone model can enable the patients with hallux valgus to get more accurate and personalized treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: The anatomical structure of the foot and ankle is complex. There are many extensor and flexor tendons passing through the foot and ankle, which is adjacent to many blood vessels and nerves. The foot and ankle play an important role in human walking, jumping and squatting. As the ankle joint itself is the most distal load-bearing joint of the limb, it is difficult to achieve satisfactory therapeutic effect by traditional methods to treat complex periankle fractures (such as severe comminuted trimalleolar fractures and Pilon fractures), or various severe ankle deformities (such as talipes equinovarus, hallux valgus, and flatfoot). Fortunately, in recent years, 3D printing technology has significantly improved the success rate and patient satisfaction of the above diseases. OBJECTIVE: To summarize the current situation of 3D printing technology in the treatment of ankle fracture and deformity. METHODS: The computer was used to search CNKI, PubMed database. Chinese search terms were “3D printing technology, ankle surgery, ankle fracture, ankle deformity, orthopedics”. The English search terms were “3D printing, foot and ankle surgery, ankle fracture, foot and ankle deformity, orthopedic surgery”. The retrieval period was from January 2000 to February 2020. A total of 105 articles were retrieved. According to the inclusion and exclusion criteria, 55 articles were finally included for review. RESULTS AND CONCLUSION: (1) Through the simulation operation of foot and ankle surgery on 3D physical model, the operator’s proficiency in the operation can be improved. Simultaneously, according to the needs of the operation, individual surgical instruments can be made to improve the success rate of the operation. (2) Compared with the traditional foot orthosis, 3D printing technology can make foot orthosis more suitable for human body structure. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical efficacy of distal Chevron osteotomy of the first metatarsal combined with modified McBride procedure in the treatment of mild to moderate hallux valgus. Methods From October 2015 to June 2019, 15 patients (17 feet) with mild to moderate hallux valgus were treated by distal Chevron osteotomy of the first metatarsal combined with modified McBride procedure. Those who had the metatarsalgia under the second, third and fourth metatarsal head with the formation of corpus callosum underwent Weil osteotomy. The weight-bearing radiography of the foot was taken before and after surgery, the hallux valgus angle (HVA) and the angle between the 1st and 2nd metatarsal bones (intermetatarsal angle, IMA) were measured, the sesamoid position and joint matching situation were observed, the ankle function was evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scoring system. Results The follow-up ranged from 3 to 23 months, with an average of 13 months. The preoperative HVA ranged from 16.7°to 37.8°, with an average of 31.2°; IMA was from 11.3°to 15.7°, with an average of 14.7 °; AOFAS forefoot score was from 40 to 65, with an average of 52 points. At the last follow-up, HVA ranged from 5.7°to 17.6°, with an average of 11.5°; IMA ranged from 7.4°to 13.2°, with an average of 12.1°; AOFAS forefoot score was from 82 to 95, with an average of 87. Conclusion The postoperative imaging angle are significantly improved and satisfaction is high in the mild to moderate hallux valgus patients under went distal Chevron osteotomy of the first metatarsal combined with modified McBride procedure. The clinical efficacy of the correction for mild to moderate hallux valgus deformity is satisfactory. [ABSTRACT FROM AUTHOR]

BACKGROUND: The foot is an important part of the human motor system. Foot diseases and injuries have become a troubling problem. Orthopedic insoles can effectively treat and prevent foot diseases and injuries and reduce the risk of injuries. It has become the main method of physical correction. OBJECTIVE: To clarify the design principles of orthopedic insoles, to classify orthopedic insoles according to the production methods, to sort out the rehabilitation function of orthopedic insoles to human joint-related diseases, children’s hemiplegia, and sports injuries, to explore the current research status and shortcomings of orthopedic insoles, and to make suggestions for future research and development. METHODS: A search of CNKI, WanFang, Baichain, Baidu Library, and PubMed was performed for relevant literature published from 2005 to 2019. Search terms were “Orthopedic insoles,” “valgus hallux, flat feet, high arch, plantar fasciitis,” “knee varus, knee valgus, knee osteoarthritis,” “scoliosis,” “foot and ankle injury,” “gait,” and “abnormal gaits” in Chinese and “Orthopedic insoles, Corrective effect, Motion pattern characteristics” in English. Included articles were screened, summarized and analyzed. RESULTS AND CONCLUSION: The design principles of the insoles include four aspects: adjusting the force bearing point of the vola and dispersing plantar pressure; supporting the arch of the foot, improving cushioning ability; improving the force line of the lower limb, providing a stable support; improving proprioception and foot comfort. Orthopedic insoles can be divided into three types: prefabricated, semi-customized and customized. Orthopedic insoles can play an effective prevention and rehabilitation function in ankle, knee, spinal deformity, hemiplegia-type cerebral palsy in children, and sports injuries. Orthopedic insoles have certain limitations in clinical application and in therapeutic effects. In the development and evaluation of orthopedic insoles, the changes in foot shape and shoe shape during human movement should be considered to reflect the concept of “foot-shoe integration.” Different shapes, materials, and hardness of orthopedic insoles can be used to conduct more in-depth research on the effects of orthopedic insoles to prevent and treat injuries and improve exercise capacity. [ABSTRACT FROM AUTHOR]

BACKGROUND: The clinical effect of minimally invasive treatment of hallux valgus is significant. The osteotomy end is stabilized only by external fixation of the bandage. There is currently no research on the stability of the osteotomy end. OBJECTIVE: To study the effect of minimally invasive treatment of the “8” bandage external fixation on the stress and displacement of the osteotomy end in the balanced standing condition after hallux valgus. METHODS: In the minimally invasive treatment of the “8” bandage external fixation finite element model after the hallux valgus operation, three vertical axes (X-axis, Y-axis, Z-axis) were established with the first tibial osteotomy as the center. The X-axis and Y-axis were parallel to the horizontal plane of the foot, pointing to the medial and anterior sides of the foot respectively. The Y axis was perpendicular to the horizontal plane of the foot, pointing upwards. The four nodes defining the distal osteotomy surface were A1 on the upper side, B1 on the outer side, and C1 on the outer side, and D1 on the inner lower side. The proximal end osteotomy surface corresponded to four nodes as A2, B2, C2 and D2. The displacement was positive when it coincided with the direction of the coordinate axis, and negative when it was opposite. Through the finite element analysis, the direction and magnitude of the stress and displacement of the distal and proximal nodes of the osteotomy surface in the balanced standing condition were obtained. RESULTS AND CONCLUSION: (1) The finite element model of the “8” bandage after minimally invasive treatment of hallux valgus was used in a balanced standing condition. The maximum stress at the osteotomy end was at the dorsal side of the osteotomy surface (B2), which was 0.632 MPa. (2) The first principal stress at the osteotomy surface was at Z-axis. The direction was opposite to the Z-axis, and was the same as the total stress, which was a compressive stress. The shear force was the largest on the XY plane, and the maximum stress was at the dorsal inner side (A2) of the proximal osteotomy surface, which was 0.058 MPa. (3) The major displacements of the distal and proximal ends of the first patella osteotomy were on the X-axis, and the displacements were on the medial condyle (D1) of the osteotomy surface, i.e., -1.002 mm and medial condyle (A2), and 0.621 mm, respectively. (4) The results confirm that the external fixation of “8” bandage can maintain the stability of the osteotomy end after minimally invasive treatment of hallux valgus, and is conducive to the healing of the osteotomy end. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical application of absorbable screws and metal screw in the treatment of patients with moderate to severe hallux valgus. Methods: From January 2016 to January 2018, 28 patients with moderate to severe hallux valgus admitted to our hospital were enrolled in the study. They were divided into 2 groups according to the random number table method. The control group and the observation group were treated with metal screws or absorbable screws. Patients with hallux valgus. Absorbing screws treat hallux valgus. Perioperative indicators were compared between the two groups, the hallux valgus angle (HVA) before and after surgery, the angle between the first and second metatarsal, the American Society of Orthopedic Foot and Foot Function (AOFAS), and complications. Results: There was no significant difference in operation time, intraoperative blood loss, and hospital stay between the two groups (P>0.05). The HVA, IMA and AOFAS were better than those before operation (P<0.05). There was no significant difference in HVA, IMA and AOFAS between the two groups(P>0.05). The excellent and good rate of treatment in the control group was 88.46%, and the excellent and good rate in the observation group was 92.31%. There was no significant difference in the excellent and good rate between the two groups (P>0.05). The incidence of delayed healing or non-union, hallux valgus recurrence or postoperative loss correction in the observation group was lower than that in the control group(P<0.05). Incision infection and tibia lateral displacement occurred in the two groups. There was no significant difference in the incidence of metastatic pain and hallux valgus (P>0.05). Conclusion: After the hallux valgus osteotomy, it can be fixed by absorbable screws, the treatment effect is remarkable, and the safety is high, which is worthy of being widely used in clinical practice. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hallux valgus is a complex deformity. There is no gold standard for the treatment of hallux valgus. Osteotomy is highly recommended at present, but there are many complications. Whether we can correct hallux valgus without osteotomy is a new attempt in our group. OBJECTIVE: To explore the efficacy of an Endobutton suspension plate treatment for hallux valgus deformity. METHODS: From April 2013 to August 2018 at Department of Orthopedics, Changzhou Tumor Hospital Affiliated to Soochow University, 26 cases of hallux valgus were treated with Endobutton suspension plate, without osteotomy. All patients signed the informed consents and the study was approved by the hospital ethics committee. The hallux valgus angle and angle between metatarsal 1 and 2 were detected preoperatively and postoperatively. The American Orthopaedic Foot & Ankle Society score was detected at 12 months postoperatively. RESULTS AND CONCLUSION: (1) All patients were followed up from 8 to 38 months. (2) The hallux valgus angle (28.95±4.12)° and angle between metatarsal 1 and 2 (15.82±1.81 )° preoperatively were significantly decreased to (14.15±3.60)° and (7 .88±0.90)° postoperatively (both P < 0.01 ). (3) The American Orthopaedic Foot & Ankle Society score at 12 months after surgery (89.15±7.81) was significantly higher than that at baseline {62.08± 7.1 0) (P < 0.01 ). (4) In summary, Endobutton suspension fiXation between metatarsal 1 and 2 for treating hallux valgus is a viable treatment option. [ABSTRACT FROM AUTHOR]

BACKGROUND: Bandage internal fixation (defined as the interphalangeal insertion of “8”-shaped bandage for elastic external fixation) produces a suitable mechanical environment for bone healing after minimally invasive treatment of hallux valgus. Stress stimulation is essential for bone healing after osteotomy, but the mechanism is still unclear. OBJECTIVE: To study the regulatory mechanism of mechanical stress on fibroblasts-derived exosomes. METHODS: The medial bone tissue of the first metatarsal bone obtained in the surgery for hallux valgus was taken as a specimen. The fibroblasts were passaged in vitro via direct tissue adherent culture. The loading system provided a cell strain simulating external fixation using “8”-shaped bandage for the pressure-loading culture of hallux valgus fibroblasts, and then exosomes were extracted. Size distribution, morphology and markers of exosomes were detected by electron microscopy, nanoparticle tracking analysis and western blot assay. The study protocol was approved by the Ethics Committee of Wangjing Hospital of China Academy of Chinese Medical Sciences with approval No. 2013-03-21 on March 21, 2013. RESULTS AND CONCLUSION: Static stretching (15%) could promote the secretion of exosomes from fibroblasts. The expression of CD9 and CD81 was detected in the fibroblasts-derived exosomes of the control group and the experimental group. Range of exosome particle size distribution was consistent in the two groups of exosomes, and 15% static stretching increased the concentration of exosomes. This indicates that 15% static stretching helps fibroblasts secrete growth factors, which in turn contribute to osteoblast osteogenesis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hallux valgus is one of the common foot deformities, and seriously affects the quality of life of patients. The traditional surgical treatment adopts large incision and direct vision orthopedic surgery. The patient suffers great pain and recovery is slow. With the progress and development of minimally invasive technology, minimally invasive treatment of hallu valgus with traditional Chinese medicine and western medicine is widely used, and it has the advantages of small incision, quick recovery and early walking. OBJECTIVE: To measure the pressure around osteotomy of hallux valgus with 8-shaped bandage external fixation in walking, standing, active and passive functional exercise. METHODS: SPI FREE FORM single point pressure measurement system with 32 channels was used to measure the pressure of the osteotomy of hallux valgus of the patients in walking, standing, active plantar flexion, active back extension, passive plantar flexion and passive dorsiflexion with 8-shaped bandage external fixation in a 24-year-old patient at 4 weeks after treatment. RESULTS AND CONCLUSION: By analyzing the pressure around osteotomy of hallux valgus with 8-shaped bandage external fixation in walking, standing, active and passive functional exercise, the middle of toe web always kept great pressure; and all but in standing, the dorsal pressure of the metatarsal head was greater than that of the metatarsal head. Besides, the lateral pressure of the toe web was greater than the medial pressure of the metatarsal head except in passive plantar flexion. These results verify that after minimally invasive osteotomy in hallux valgus, 8-shaped bandage external fixation can maintain the distal osteotomy of hallux plantar flexion displacement and neutral position, and effectively maintain the stability of the osteotomy, which is beneficial to fracture healing. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hallux valgus is a common orthopedic disease, and its causes are complex and treatment is varied. The mechanical analysis of hallux valgus is an issue of concern. The finite element analysis makes it predictable to treat hallux valgus. OBJECTIVE: To explore the clinical application of finite element analysis in biomechanical study of hallux valgus. METHODS: The first author searched CNKI and PubMed databases from January 1980 to March 2017 using the key words of “finite element, hallux valgus” in English and Chinese, respectively. The repetitive, irrelevant and low-quality articles were excluded. Finally 33 eligible articles were included in accordance with the inclusion criteria, and the critical issues of finite element analysis applied in hallux valgus were reviewed. RESULTS AND CONCLUSION: (1) There are many researches concerning finite element of hallux valgus, which mostly require physicians to work with engineers. These methods are already very mature, but most of the model and material properties of the data come from foreign researches. (2) The finite element analysis is important and reliable for the etiology of hallux valgus, preoperative planning and prognosis. (3) The finite element model of the hallux valgus is only used on static analysis and gait cycle analysis, the modeling details and definition of material properties still need to be improved. [ABSTRACT FROM AUTHOR]

BACKGROUND: Operative correction of hallux valgus is one of the most procedures in foot and ankle department, but postoperative plaster slab immobilization often brings great inconvenience and pain. Off-loading forefoot shoes can theoretically help them to do activities off bed early, and prevent loading on the forefoot during walking. But its advantages and disadvantages compared with plaster slab are still unknown. OBJECTIVE: To compare the clinical effects of over-the-toe plaster slab and off-loading forefoot shoes after hallux valgus correction. METHODS: Patients with hallux valgus undergoing distal Chevron osteotomy or Scarf osteotomy in the Huashan Hospital of Fudan University between May 2012 and October 2013 were retrospectively reviewed. Group A patients had a below-knee and over-the-toe plaster slab while Group B had an off-loading forefoot shoe applied after surgery. Radiological assessment was done at 6 weeks postoperatively. Immobilization was removed once bone union was indicated. Clinical scales and subjective satisfaction investigation were performed at final follow-up, and complications during follow-up were noted. All values between groups were analyzed statistically. RESULTS AND CONCLUSION: Totally 125 patients (157 feet) were completely followed up, including 83 patients (95 feet) in Group A and 42 patients (62 feet) in Group B. There was no significant difference in demographics, pre-and-post operative radiological assessments, clinical scale, union time or general satisfaction rates between two groups. However, Group B patients had less chance to suffer metatarsophalangeal joint or inter-phalangeal joint stiffness, restricted ankle motion and supra-ankle pains of operated side in comparison with Group A (P < 0.05), and were more willing to accept the same treatment if they could choose again (P < 0.05). Compared with the plaster slab, the application of off-loading shoes not only maintains correction level, but also reduces such complications as stiffness or restricted motion of the joint, limb pains and so on, which makes patients more likely to accept, and should be given priority to in the rehabilitation following hallux valgus correction. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of SCARF or reverse SCARF osteotomy operation of Hallux Valgus on the stage of knee osteoarthritis patients in the lesion side. Methods Retrospective analysis was used to recruit the 45 patients who were diagnosed as moderate or severe Hallux Valgus accompanying Knee osteoarthritis on the lesion side and had complete data. We divided the 22 cases who received the SCARF （or reverse SCARF） osteotomy operation into operation group and divided the 23 cases who received the no-operation treatments into no-operation group. T test was used to compare the difference of Hallux Valgus common malformation angles between of two groups before and after the resident treatment. χ² test was used to compare the difference between two groups on stages of knee osteoarthritis before and after the resident treatment. Results Follow-up for 2-3 yearsr: (1) Compared with the no-operation group，the amelioration of Hallux Valgus common malformation angles measured of operation patient group， the difference had statistical significance (P ＜0.01). (2) Compared with the no-operation group the accelerating speed of knee osteoarthritis in the lesion side of operation patient group was delayed， the relation of staging before and after the treatment had significant difference (P ＜0.01) . (3) Compared with the operation group， the accelerating speed of knee osteoarthritis in the lesion side of operation patient group was increased without the relation of staging before and after the treatment and had no significant difference (P＞0.05). (4) After the treatment，the constitution rate difference of Knee Osteoarthritis between the two groups had statistical significance (P＜0.01) . Conclusion For the patients who suffered from Hallux Valgus and Knee Osteoarthritis in the lesion side， active applying the SCARF or reverse SCARF osteotomy operation of Hallux Valgus may not only cure the local symptoms of Hallux Valgus but also delay the pathological accelerating speed of Knee Osteoarthritis in the lesion side. [ABSTRACT FROM AUTHOR]

Objective: To observe clinical effect of percutaneous minimally invasive osteotomy with 8-shaped bandage and hallux valgus splint fixation in treating moderate hallux valgus., Methods: Totally 23 patients with moderate hallux valgus were treated with percutaneous minimally invasive osteotomy with 8-shaped bandage and hallux valgus splint fixation from August 2019 to January 2021, and 1 patient was loss to follow-up, and finally 22 patients(30 feet) were included, 4 males (6 feet) and 18 females(24 feet), aged from 27 to 66 years old with an average of(50.59±11.95) years old. Hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsal span (the distance between the first and the fifth metatarsal bones), changed of soft tissue width, American Orthopaedic Foot and Ankle Society(AOFAS) score, and Visual Analogue Scale (VAS) were collected and compared before operation and 6 months after operation., Results: Twenty-two patients were followed up from 5.7 to 6.4 months with an average of (6.13±0.85) months. The first metatarsal osteotomy of patients were obtained bone union, and deformity of the toes was corrected. Complications such as avascular necrosis of metatarsal head and transfer metatarsalgia were not occurred. Postoperative HVA, IMA, metatarsal span, soft tissue width, VAS, AOFAS score at 6 months were significantly improved compared with pre-operation ( P <0.01). According to AOFAS score at 6 months after operation, 10 feet were excellent, 18 good and 2 poor. Two feet with poor were excellent after prolonged 8-shaped bandage and hallux valgus splint fixation time., Conclusion: Percutaneous minimally invasive osteotomy with 8-shaped bandage and hallux valgus splint fixation for the treatment of moderate hallux valgus could better correct deformity of hallux valgus, relieve foot symptoms, good recovery of postoperative function, and has a significant clinical efficacy.

Objective To study the clinical efficacy of Akin combined Scarf osteotomies for moderate and severe hal⁃ lux valgus. Methods Thirty-nine (58 feet) patients received Akin combined Scarf osteotomies, in which 12 patients (16 feet) with moderate hallux valgus received the single scarf osteotomy. Hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position and American orthopedic foot and ankle society score (AOFAS) were measured and compared before and after operation respectively. Results All operations were successfully completed patients were followed up for 8- 22 months. The mean operation time was (55.0±6.8) min. The amount of intraoperative bleeding was 3-20 mL with an aver⁃ age of (11.0±5.4) mL. All patients were healed except for a delayed union of Akin on a severe hallux valgus patient. Two cas⁃ es (2 feet) were found inflammation in surgical incision. Two cases (2 feet) were found numbness in dorsal medial side of hal⁃ lux, which was considered nerve damage and improved in 3-5 months. There was no recurrence of hallux valgus in the peri⁃ od of following up. After surgery, HVA (14.1°±5.3°), IMA (7.7°±3.8°) and tibial sesamoid position (2.58±0.61) were signifi⁃ cantly decreased compared with those before operation (39.6°±6.8°, 18.7°±5.4° and 4.87±0.59, P＜0.05). AOFAS score (84.4±8.7) was significantly higher after surgery than that before surgery (37.3±9.5, P＜0.05). Conclusion Akin combined Scarf osteotomies can achieve a excellent therapeutic effect for moderate and severe hallux valgus with very few complica⁃ tions and recurrence, which is worth for clinical application. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical efficacy of modified McBride orthomorphia with small incision in the treatment of Hallusx Valgus. Methods: 104 patients who were admitted in our hospital from 2010 to 2014 and diagnosed as Hallusx Valgus were cured by modified mcBride orthomorphia. The clinical efficacy was evaluated by visual analogue scale (VAS), the changes of hallus valgus angle(HVA) and intermetatarsal angle(IMA) and Ankle Society score(AOFAS) at reoperation, 3 weeks after surgery and 6 weeks after surgery. Results: All the patients were followed up at least 6 months after the operation and the excellent rate was 96.2%. The postoperative VAS score, hallus valgus angle and Ankle Society score at 3 weeks after surgery were obviously improved compared with those preoperation (P<0.05). Only three patients had recurrence at 6 months after surgery, 6 patients had mild pain of foot and 1 case had delayed healing of incision. Conclusions: Modified McBride orthomorphia with small incision could effectivly correct the foot hallux valgus deformity and relieve the pain due to this disease. [ABSTRACT FROM AUTHOR]

Objective To observe the clinical effect of arthrodesis in treating severe hallux rigidus. Methods Totally 30 patients (30 feet) with severe hallux rigidus treated by arthrodesis from January in 2010 to January in 2013 were retrospectively analyzed. AOFAS and VAS scoring system were employed to evaluate the clinical curative effect including acquiring the fusion rate, the time to fusion and the incidence rate of hallux valgus. Forefoot-plantar pressure values before and after operation were measured by Plantar pressure measurement system. Results The mean follow-up time was 18 months. AO-FAS score was raised from (48.2±7.6) to (72.8±6.2) after operation (P<0.01). VAS score was also increased from (1.7±0.7) to (8.3±1.1) after operation (P<0.01). The average healing time of knitting was 12.1 weeks. None was non-union and developed to hallux valgus. The forefoot-plantar pressure returned to normal postoperatively from abnormal laterally distribution. Conclusion The surgical strategy of arthrodesis is proved to be effective in treating severe hallux rigidus, in terms of capability of relief from pain, recovery of forefoot-plantar pressure distribution, low incidence of complication. [ABSTRACT FROM AUTHOR]

Objective: To explore clinical effect of Scarf osteotomy combined with soft tissue balance in treating severe hallux valgus., Methods: Totally 38 patients(50 feet) with severe hallux valux who underwent Scarf osteotomy combined with soft tissue balance surgery from June 2019 to June 2021 were retrospectively analyzed, aged from 29 to 64 years old with an average of(54.7±6.8) years old; 26 feet on the left side and 24 feet on the right side;the courses of disease ranged from 5 to 23 years with an average of (12.4±3.9) years. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were compared before and after operation, and postoperative complications was observed. American orthopedic foot ankle society(AOFAS) score before operation and final follow-up was used to evaluate recovery of forefoot function, and visual analogue scale (VAS) was used to evaluate pain relief., Results: Thirty-eight patients (50 feet) were followed up from 15 to 23 months with an average of (18.3±3.2) months. Preoperative HVA, IMA and DMAA were (44.61±3.92)°, (18.74±2.51)°, (12.85±2.11)°, and improved to (13.45±2.13)°, (7.83±1.36)°, (7.03±1.39)°at final follow-up, which had statistical differneces( P <0.05). No delayed union or nonunion of osteotomy end, fracture or loosening of internal fixation, hallux varus occurred. VAS and AOFAS score improved from (6.81±2.14), (43.6±8.4)points before operation to (1.97±0.78), (87.6±5.2) points at final follow-up, which had statistical difference( P <0.01). According to AOFAS at final follow-up, 20 feet got excellent result, 28 feet good and 2 feet moderate., Conclusion: Scarf osteotomy combined with soft tissue balance release for severe hallux valgus has good stability and corrective effect, but learning curve and postoperative complications should be paid attention.

Objective: To explore clinical effect of rotational Scarf osteotomy in treating hallux valgus (HV) with rotation of the first metatarsal bone., Methods: From January 2018 to October 2019, 35 patients (40 feet) with HV and rotation deformity of the first metatarsal were treated with rotational Scarf osteotomy, including 5 males and 30 females;aged from 25 to 76 years old with an average of (40.32±5.43) years old. Hallux valgus angle(HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), the first metatarsal length (FML) were observed and compared, American Orthopedic Foot and Ankle Society(AOFAS) of hallux metatarsophalangeal interphalangeal joint score and visual analogue scale (VAS) were used to evaluate functional evaluation., Results: Thirty-five patients(40 feet) were followed up from 12 to 36 months with an average of (14.35±3.62) months. HVA, IMA and DMAA were corrected from (36.32±4.51) °, (14.21±3.22) ° and (28.35±4.32) ° before operation to (14.32±5.71) °, (5.83±3.97) ° and (7.32±2.14) ° after operation respectively ( P <0.05). There was no satistical difference in FML before and after operation ( P >0.05). AOFAS score and VAS improved from (57.00±4.31) and (6.00±1.21) before operation to (90.31±3.28) and (1.42±0.83) after operation, respectively, and had significant difference( P <0.05);according to AOFAS score, 23 feet got excellent results, 15 feet good and 2 feet fair., Conclusion: Rotational Scarf osteotomy with strong correction and high dimension could effectively correct HV combined with rotation deformity of the first metatarsal bone, improve function of the forefoot, and obtain good clinical results.

Objective: To explore clinical effect of the first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy in treating hallux valgus with severe metatarsal adduction., Methods: From March 2017 to August 2021, 37 patients ( 69 feet ) with severe plantar adductor hallux valgus were treated with the first metatarsophalangeal joint fusion combined with rotational Weil osteotomy were retrospectively analyzed, including 8 males(11 feet) and 29 females (58 feet), aged from 67 to 83 years old with an average of (70.03±2.87) years old;3 cases on the left side, 2 cases on the right side and 32 cases on both sides. Visual analogue scale(VAS) was used to evaluate degree of pain relief before operation, 6 weeks after operation and at the final follow-up. American Orthopaedic Foot and Ankle Surgery (AOFAS) forefoot score was used to evaluate function of the affected foot before operation and final follow-up. Hallux valgus angle(HVA) and intermetatarsal angle(IMA) were measured before operation and at the final follow-up., Results: Thirty-seven patients(69 feet) were followed up from 12 to 48 months with an average of(22.8±0.6) months. Bone healing was achieved at the first metatarsophalangeal joint from 7 to 10 weeks with an average of (8.00±1.21) weeks after operation, without delay and nonunion. HVA was increased from (44.30±2.84)° before operation to (15.20±2.13) °at the final follow-up, and had statistical difference( t =65.781, P <0.05);while no difference in IMA before and after operation( P >0.05). VAS was decreased from (6.73±1.48) points to (2.78±0.71) points at 6 months after operation( t =3.279, P <0.05), and had difference compared with the latest follow-up(1.16±1.12)( t =4.859, P <0.05). AOFAS forefoot score increased from (52.14±5.78) preoperatively to (86.70±4.86) at the fonal follow-up, and 25 feet got excellent results, 40 feet good and 4 feet fair., Conclusion: The first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy in treating severe plantar adduction hallux valgus could significantly relieve pain and appearance of forefoot, stabilize the first sequence, and significantly improve walking function.

Objective: To compare clinical efficacy of scarf osteotomy and double metatarsal osteotomy(DMO) in treating moderate to severe hallux valgus., Methods: Fifty patients (81 feet) with moderate to severe hallux valgus deformity were treated from January 2017 to December 2019, and were divided into Scarf osteotomy (SO) group or DMO group according to different osteotomy methods. There were 26 patients (44 feet) in SO group, including 1 male and 25 females, aged from 48 to 65 years old with an average of (55.5±4.67) years old;18 patients (30 feet) with moderate and 8 patients (14 feet) with severe. There were 24 patients(37 feet) in DMO group, including 1 male and 23 females, aged from 45 to 62 years old with an average of (52.1±6.8) years old;there were 14 patients (24 feet) with moderate and 10 patients (13 feet) with severe. Hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and relative length of the first metatarsal(RLFM) on weight-bearing anteroposterior radiographs before and after operation were compared. American Orthopaedic Foot and Ankle Society (AOFAS) hallux, metatarsal, and interphalangeal joint scores was used for evaluate clinical effects. Weight bearing time and complications were observed., Results: Fivty patients were followed up. The follow-up time in SO group ranged from 12 to 36 months with an average of(20.50±6.22) months and from 16 to 28 months with an avaerge of(19.80±2.44) months in DMO group while there was no significant difference between two groups( P >0.05). All incision healed at stage I, and osteotomy healed at (20.31±3.17) months after operation. One patient occurred hallux adduction deformity, without transferred metatarsalgia;2 patients occurred metastatic metatarsalgia in DMO group. There were no significant difference in HVA, IMA, DMAA, and AOFAS scores between two groups( P >0.05) before and after operation. There was no significant difference in RLFM between two groups( P >0.05), while had significant difference in RLFM between two groups at final follow-up ( P <0.05). Partial weight-bearing time and full weight-bearing time in SO group were significantly earlier than those in DMO group ( P <0.05)., Conclusion: Both of Scarf osteotomy and the first metatarsal biplane osteotomy could effectively treat moderate to severe hallux valgus deformity, with similar imaging and clinical evaluation. However, the relative length of the first metatarsal bone in SO group was longer than that in DMO group after operation, and the time of weight bearing in Scarf osteotomy is earlier than that of double metatarsal osteotomy of the first metatarsal.

Objective: To evaluate clnical effect of minimally invasive osteotomy with absorbable screws in treating hallux valgus deformity., Methods: Clnical data of 31 patients with hallux valgus deformity were retrospective analyzed from January 2019 to December 2020, and divided into absorbable screws group (17 patients) and titanium cannulated screw group (14 patients). In absorbable screws group, there were 1 male and 16 females aged from 32 to 72 years old with an average of (54.53±12.12) years old;6 patients on the left side, 5 on bilateral and 6 on the right side;1 patient was mild, 11 moderate and 5 severe;treated with minimally invasive osteotomy and fixation of absorbable screws. In titanium cannulated screw group, there were 2 males and 12 females aged from 18 to 71 years old with an average of (47.57±15.68) years old;4 patients on the left side, 4 on bilateral and 6 on the right side;1 patient was mild, 9 moderate and 4severe;treated with minimally invasive osteotomy and fixation of titanium cannulated screw. Complications between two groups were observed, changes of hallux valgus angle (HVA)and intermetatarsal angle (IMA)were detected and compared before and after operation at 12 months, American Orthopedic Foot and Ankle Society(AOFAS) and visual analogue scale(VAS) before and after operation at 12 months were also compared., Results: All 31 patients were followed up from 13 to 20 months with an average of (16.61±2.47) months. Patients in absorbable screws group were followed up from 14 to 20 months with an average of (16.88±2.80) months, while patients in titanium cannulated screw group were followed up from 13 to 19 months with an average of (16.29±2.05) months;there was no difference between two groups( P >0.05). One patient in absorbable screws group occurred numbness around incision, 3 patients in titanium cannulated screw group occurred complications, including numbness around incision in 1 patient, skin irritation due to internal fixation in 1 patient, and recurrence in 1 case;there was no statistic difference between two groups ( χ 2 =1.651, P =0.199). There were no statistic difference in HVA and IMA between two groups before and after operation at 12 months( P >0.05). There were no statistic difference between two groups in AOFAS and VAS before and after operation at 12 months( P >0.05)., Conclusion: Compare with mainstream fixation with titanium hollow screw after minmally invasive osteotomy, fixation with absorbable screw could achieve comparable clinical outcome on the basis of images and function evaluation.

Objective: To explore short-term results of minimally invasive Chevron osteotomy with lateral soft tissue release in treating mild to moderate hallux valgus., Methods: Sixty patients (80 feet) with mild to moderate hallux valgus treated with minimally invasive Chevron osteotomy with lateral soft tissue release from January 2019 to December 2021 were retrospectively analyzed. Among them, there were 5 males (6 feet) and 62 females (74 feet), aged from 20 to 60 years old with an average of (47.2±9.7) years old;54 patients (64 feet) with mild hallux valgus, and 13 patients(16 feet) with moderate hallux valgus. Hallux valugs angle(HVA), Ⅰ-Ⅱ intermetatarsal anlge(Ⅰ-Ⅱ IMA), distal metatarsal articular angle(DMAA)and sesamoid Hardy score were compared before and after operation, and American Orthopaedic Foot and Ankle Society's Hallux Metatarsophalangeal- Interphalangeal (AOFAS Hallux MTP-IP) scale was used to evaluate clinical effects., Results: Sixty-seven patients (80 feet) were followed-up from 6 to 23 months with an average of (13.7±6.5) months. Preopertive HVA, Ⅰ-Ⅱ IMA, DMAA, sesamoid Hardy score and AOFAS Hallux MTP-IP were (27.5±7.0)°, (17.4±4.1)°, (11.4±3.8)°, (4.9±2.6) and (58.2±9.1), respectively;while at the final follow up were(8.3±4.8)°, (6.9±3.0)°, (3.9±2.4)°, (2.7±1.1) and(91.3±2.2);and there were statistical differences between pre-operation and the latest follow-up( P <0.05). There were differences in preopertaive imaging indexes and AOFAS Hallux MTP-IP between 64 mild and 16 moderate hallux valgus feet( P <0.05);while no difference in above indexes at the final follow-up( P >0.05);from the view of degree of improvement, HVA, Ⅰ-Ⅱ IMA, sesamoid Hardy score and AOFAS Hallux MTP-IP in moderate hallux valgus were better than that of in mild hallux valgus( P <0.05). Four patients occurred redness and swelling around incision on the osteotomy site, and cured by local dressing change and oral antibiotics., Conclusion: Minimally invasive Chevron osteotomy combined with lateral soft tissue release has advantages of correction and functional improvement for mild to moderate hallux valgus.

Objective: To compare minimally invasive and traditional Chevron osteotomy in treating patients with mild to moderate hallux valgus., Methods: Clinical data of 36 patients (36 feet) with mild to moderate hallux valgus from January 2019 to February 2021 were retrospectively analyzed, and divided into minimally invasive osteotomy(minimally invasive group) and traditional Chevron osteotomy(traditional group). There were 16 patients in minimally invasive group, including 1 male and 15 females, aged from 36 to 60 years old with an average of(49.0±9.5) years old;9 were mild and 7 were moderate according to Mann classification;treated with minimally invasive osteotomy with hollow screw fixation. There were 20 patients(20 feet) in traditional group, including 2 males and 18 females, aged from 38 to 65 years old with an average of(50.0±9.2) years old;11 were mild and 9 were moderate according to Mann classification;treated with traditional Chevron osteotomy. Hallux valgus angle (HVA), intermetatarsal angle (IMA) before and after operation at 12 months bewteen two groups were observed and compared, and American Orthopedic Foot and Ankle Society (AOFAS) forefoot score and visual analogue scale (VAS) before and after operation at 6 weeks and 12 months between two groups were compared., Results: Thirty-six patiens were followed up from 14 to 30 months with an average of (21.00±5.77) months. All incisions were healed well at stageⅠwithout infection. There were no significant differences in HVA, IMA, AOFAS forefoot scores and VAS before and after operation at 12 months between two groups( P >0.05). However, AOFAS forefoot scores and VAS of minimally invasive group was significantly better than that of traditionl group at 6 weeks after operation ( P <0.05). Postoperative HVA, IMA, AOFAS forefoot scores and VAS at 12 months bewteen two groups were improved better than that of preoperation( P <0.05)., Conclusion: Compared with traditional Chevron osteotomy, minimally invasive osteotomy has less trauma and quicker recovery. Both of them has similar clinical effects, and could receive satisfactory clinical effects, while treatment of minimally invasive osteotomy should pain attention to learning curve.

Objective: To explore early efficacy of minimally invasive Chevron Akin(MICA) osteotomy for the treatment of mild to moderate hallux valgus., Methods: From June 2019 to April 2021, a total of 26 patients (29 feet) with mild to moderate hallux valgus, including 1 male and 25 females aged from 19 to 78 years old with an average of(38.3±19.5) years old, were treated with MICA. Preoperative and postoperative hallux valgus angle(HVA), intermetatarsal angle(IMA) and shortening of the first metatarsal were observed and compared. American Orthopedic Foot and Ankle Society (AOFAS) forefoot scoring system and visual analogue scale (VAS) were applied to evaluate clinical outcome at the final follow-up, and complications were also recorded., Results: All patients obtained followed up from 12 to 33 months with an average of(19.6±5.1) months. HVA and IMA was improved from (32.3±6.6)° and (11.7±3.2)° pre-operatively to (13.0±5.3)° and (6.1±3.2)° post-operatively, respectively, which had a significant difference ( P <0.01). The average shortening of the first metatarsal was (2.7±1.1) mm. AOFAS and VAS was improved from (55.7±7.4) and (6.5±1.5) preoperatively and to (88.5±7.9) and (0.7±0.4) respectively at the final follow-up, which also had a significant difference( P <0.01). According to AOFAS score, 15 feet achieved an excellent result, 11 good and 3 moderate., Conclusion: MICA osteotomy is a safe and reliable surgical technique for mild to moderate hallux valgus with advantages of minimally invasive, rapid recovery, low complication rate and an effect improvement of hallux valgus deformity.

Recurrence of hallux valgus is one of the most common and difficult complications after surgery. Due to the lack of understanding of 3D deformity of hallux valgus and risk factors for recurrence, the overall recurrence rate is still high, and the choice of treatment is still controversial. Improper operation and severe deformity are known risk factors for recurrence, while the role of unstable of the first plantar train and combined flat foot deformity in the recurrence has been paid more attention by scholars at home and abroad. In addition to the first metatarsophalangeal fusion, modified Lapidus osteotomy and proximal metatarsal osteotomy have been proven to be reliable revision procedures. The purpose of this study is to summarize risk factors for recurrence of hallux valgus after surgery, and to explore the choice of revision surgery after recurrence, in order to provide guidance for prevention and management of recurrence of hallux valgus.

The expert consensus of the third-generation minimally invasive technical specification for hallux valgus was developed by Foot and Ankle Committee of Orthopaedic Branch of Chinese Medical Doctor Association, Foot and Ankle Committee of Sports Medicine Branch of Chinese Medical Doctor Association, and Foot and Ankle Expert Committee of Orthopedic Branch of Chinese Association of Integrative Medicine. The consensus was drawn from evidence-based medicine and experts' clinical experience to provide an academic guidance of the third-generation minimally invasive technical specification of hallux valgus for the orthopedic surgeons, including definition, indications, osteotomy techniques, post-operative rehabilitation and prognosis.

Objective: To analyze the biomechanical changes of hallux valus after Swanson prosthesis-arthroplasty of the 1st metatarsophalangeal joint combined with osteotomy and bone grafting of the 1st metatarsal bone by three-dimensional finite element analysis, so as to provide data basis for studying the changes of foot morphology and physiological function after hallux valus correction surgery., Methods: A 65-year-old female patient with severe hallux valus admitted in January 2013 was selected as the research object. The CT data of the right foot was obtained, and the three-dimensional finite element models before and after Swanson prosthesis-arthroplasty of the 1st metatarsophalangeal joint combined with osteotomy and bone grafting of the 1st metatarsal bone were established by Mimics10.01, Geomagic Studio, and ANSYS12.0 software. ANSYS 12.0 software was used for nonlinear static stress analysis, and the hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the von Mises stress distributions of the forefoot plantar surface and the 1st to 5th metatarsal bones were observed before and after operation., Results: The HVA and IMA were 56.3° and 16.3° before operation and 9.2° and 9.8° after operation, respectively. Before operation, the stress on the forefoot was the largest in the 4th metatarsal head zone and the smallest in the 1st metatarsal head zone; the stress on the medial side of the forefoot was significantly smaller than that on the lateral side, and the center of forefoot pressure was located on the lateral side. After operation, the stress on the forefoot was the largest in the 1st metatarsal head zone and the smallest in the 5th metatarsal head zone; the stress on the lateral side of the forefoot was significantly smaller than that on the medial side, and the center of forefoot pressure was located on the medial side. Before operation, the stress of the 5th metatarsal bone was the largest, and the 1st metatarsal bone was the smallest. After operation, the stress of the 1st metatarsal bone was the largest, and the 4th metatarsal bone was the smallest., Conclusion: Swanson prosthesis-arthroplasty of the 1st metatarsophalangeal joint combined with osteotomy and bone grafting of the 1st metatarsal bone can effectively correct hallux valgus and make HVA, IMA, and plantar pressure distribution close to normal. However, postoperative stresses of the 1st to 5th metatarsal bones elevate, which may lead to associated complications.

Objective: To investigate the relationship between hallux valgus and the indicators associated with medial cuneiform obliquity measured on feet weight-bearing anteroposterior X-ray films., Methods: Based on the feet weight-bearing anteroposterior X-ray films taken between January 2018 and February 2021 and met the criteria, the hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsus adductus angle (MAA), metatarsus cuneiform angle (MCA), distal medial cuneiform angle (DMCA), and proximal metatarsal articular angle (PMAA) were measured and the morphology of the first tarsometatarsal (TMT) were recorded. According to the HVA, the X-ray films were divided into normal group (HVA<15°) and hallux valgus group (HVA≥15°). The gender, age, sides, IMA, MAA, MCA, DMCA, PMAA, and the morphology of TMT were compared between groups. The influencing factors of HVA and IMA were analyzed by multivariate linear regression analysis., Results: X-ray films of 534 patients (679 feet) met the selection criteria and were included in the study. There were 220 males and 314 females, with an average age of 36 years (mean, 18-82 years). There were 154 cases (168 feet) in the normal group and 403 cases (511 feet) in the hallux valgus group. There were significant differences in gender and age between groups ( P <0.05), and no significant difference in the side ( P >0.05). The IMA, MAA, and MCA in the hallux valgus group were significantly bigger than those in the normal group ( P <0.05); the difference in DMCA between the two groups was not significant ( P >0.05). The TMT morphology of the two groups was mainly curved, and the difference in morphology classification was not significant ( P >0.05). PMAA measurement showed that there were 3 kinds of metatarsal shapes: adductive metatarsal, neutral metatarsal, and abductive metatarsal, the difference in metatarsal shapes between groups was not significant ( P >0.05). The PMAA of abductive metatarsal was significantly bigger in normal group than in hallux valgus group ( P <0.05), there was no significant difference in PMAA of adductive metatarsal between groups ( P >0.05). Multivariate linear regression analysis showed that age, MCA, and DMCA were the influencing factors of HVA ( P <0.05), and age, MAA, MCA, and DMCA were the influencing factors of IMA ( P <0.05)., Conclusion: The medial cuneiform obliquity is relatively constant and the DMCA can not be used as the characteristic angle to quantify hallux valgus. The morphology of TMT has no relationship with hallux valgus, while MAA, MCA, and PMAA are all factors to be considered, and MCA can be used as the characteristic angle to quantify hallux valgus.

Objective: To investigate the method and clinical effect of modified Chevron osteotomy of the distal end of the first metatarsal in the treatment of moderate and severe hallux valgus., Methods: From January 2015 to January 2019, 28 patients(30 feet) with moderate and severe hallux valgus were treated with modified Chevron osteotomy combined with lateral soft tissue release of the first metatarsophalangeal joint, including 2 males (2 feet) and 26 females (28 feet). The age ranged from 35 to 74 (57.3±9.3) years;10 feet on the left, 16 feet on the right, 2 cases on both sides(4 feet);the course of disease was 3 to 12 (9.32±3.89) years. The changes of hallux valgus angle(HVA), intermetatarsal angle(IMA) between the first and second metatarsals and distal metatarsal articular angle(DMAA) of the first metatarsal were measured and compared before and 6 months after operation. The American Orthopaedic Foot and Ankle Society(AOFAS) thumb joint scoring system was used to evaluate the curative effect., Results: All 28 patients were followed up for 8 to 16 (11.28±3.42) months. The incision healed well in all patients, and there were no complications such as incision infection and metatarsal head necrosis. The healing time of osteotomy site was 6 to 10(7.12±1.34) weeks. Preoperative HVA, IMA, DMAA and AOFAS were (36.06±6.02) °, (21.78±4.16) °, (8.21±2.65) ° and (52.90±10.97) respectively, at six months after operation, they were (8.87±2.46) °, (11.66±2.84) °, (3.65±1.00) ° and (87.45±10.55) respectively, there was significant difference between preoperative and 6 months after operation( P <0.05). At 6 months after operation, AOFAS score was excellent in 20 feet, good in 7 feet and poor in 3 feet. Among the 3 patients with poor scores, 2 were excellent after revision, and 1 was significantly improved after using custom insoles., Conclusion: Modified Chevron can effectively correct HVA, IMA and DMAA and improve functional recovery. The modified Chevron osteotomy increases the moving distance and the contact of the osteotomy surface. It can be fixed with multiple screws, has strong correction ability, and can exercise early. It is one of the optional methods for the treatment of moderate and severe hallux valgus.

Objective: To evaluate the clinical efficacy of local infiltration anesthesia of ropivacaine combined with compound betamethasone for postoperative analgesia in patients with hallux valgus., Methods: From September 2019 to December 2020, 48 patients with hallux valgus were treated surgically. According to different postoperative analgesia methods, the patients were divided into combined local infiltration group and intravenous analgesia pump group. There were 24 cases, in the combined local infiltration group including 2 males and 22 females;the age ranged from 21 to 78 years old, with an average of (58.3±7.7) years old;soft tissue release and chevron osteotomy were performed in 15 cases and metatarsophalangeal joint fusion in 9 cases;immediately after operation, 20 ml of ropivacaine combined with compound betamethasone mixed diluent was used for local infiltration anesthesia once. There were 24 patients in intravenous analgesia pump group, including 3 males and 21 females;the age ranged from 23 to 81 years old, with an average of(56.8±8.3) years old;soft tissue release and Chevron osteotomy were performed in 17 cases and metatarsophalangeal joint fusion in 7 cases;immediately after operation, intravenous analgesia pump was used for analgesia. The basic flow was 2 ml / h;the self control dose was 0.5 ml;and the locking time was 15 min. Visual analogue scale (VAS) was recorded at 12, 24, 48 and 72 hours after operation;and the VAS was recorded at 24 hours after operation. The occurrence of adverse drug reactions at 0 to 12 hours, 12 to 24 hours and 24 to 48 hours after operation were recorded;and the healing of incision was recorded., Results: All patients were followed up, and the duration ranged from 14 to 17 days, with a mean of (14.60±0.92) days. There was significantdifference in VAS at 12, 24 and 48 hours between the combined local infiltration group and the intravenous analgesia pump group( P <0.05). There was no significant difference in VAS between the two groups 72 hours after operation ( P >0.05). There was no significant difference in the number of adverse drug reactions between the two groups at 0 to 12 hours after operation ( P >0.05);there was significant difference in the number of adverse drug reactions 12 to 24 hours after operation ( P <0.05). No adverse drug reactions occurred in both groups 24 to 48 hours after operation. There was no significant difference in the grade of knife edge healing between the two groups after suture removal ( P >0.05)., Conclusion: Compared with intravenous analgesia pump group, ropivacaine combined with compound betamethasone can significantly reduce postoperative wound pain without increasing adverse drug reactions, and does not increase wound infection.

Objective: To explore clinical effects of minimally invasive osteotomy and manual reduction in treating hallux valgus., Methods: From January 2018 to May 2019, 31 patients (42 feet) with hallux valgus were treated with minimally invasive osteotomy and manual reduction, including 3 males and 28 females aged from 18 to 76 years old with an average of (50.1± 4.9) years old. Preoperative and postoperative hallux valgus (HVA), intermetatarsal angles(IMA), length difference between 1 and 2 metatarsals were recorded and compared, and American Orthopedic Foot and Ankle Society (AOFAS)score were observed and measured., Results: Thirty-one patients (42 feet) were followed up from 14 to 18 months with an average of (15.1± 1.2) months. HVA, IM before operation were (38.5±5.4)°, (13.0± 1.1)°, and improved to (14.3±4.7)°and (9.1±1.5)°after operation respectively( P <0.05). Preopertaive length difference between 1 and 2 metatarsals was 2-4(-0.59±1.80) mm, and 0 to -6(-3.53±1.60) mm after operation, the average shortening of the first metatarsal was 2.94 mm. There were significant difference between preoperative and postoperative. Preoperative AOFAS score was 57.8±9.7, increased to 92.1±9.3 at the final follow-up, there was significant differences ( P <0.05). According to standard of AOFAS score, 32 feet obtain excellent results, 16 good and 3 moderate., Conclusion: Minimally invasive osteotomy and manual reduction in treating hallux valgus have advantages of shorter operation time, less length of incision, and could correct hallux valgus deformity, improve front feet and receive good clinical effect in further.

Objective: To evaluate the clinical effect of Z-shaped rotating osteotomy of metatarsal diaphysis in patients with moderate and severe hallux valgus with metatarsophalangeal joint incongruency. Methods: We selected 36 patients (38 feet) with moderate and severe hallux valgus with metatarsophalangeal joint incongruency who underwent Z-shaped rotating osteotomy of metatarsal diaphysis in the First Affiliated Hospital of Army Medical University of Chinese PLA from September 2010 to January 2019. There were 2 males and 34 females with an average age of (49±18) years (18-77 years). Hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), congruency index, length of first metatarsal, and functional scores were evaluated before and 6 weeks after surgery and at the last follow-up. The data were compared by one-way ANONA or t test. Results: The congruency index was significantly improved from 0.75±0.11 before surgery to 0.95±0.07 at the last follow-up ( t= 11.728, P< 0.01). HVA and IMA improved significantly at 6 weeks after surgery, however, HVA at the last follow-up showed an increased trend compared with that at 6 weeks after the operation, while no significant improvement in IMA. Although DMAA increased slightly 6 weeks after surgery when compared with that before surgery, there was no significant difference in it between the last follow-up and the 6 weeks after surgery, and no significant difference in the length of the first metatarsal at different time points ( F= 0.991, P> 0.05). In terms of functional scores, American Orthopaedic Foot & Ankle Society (AOFAS) score increased from 50±9 before surgery to 80±17 at the last follow-up, while visual analogue scale (VAS) decreased from 5.8±1.1 to 2.7±1.5, Manchester-Oxford Foot Questionnaire (MOXFQ) score decreased from 70±13 to 25±19 ( t= 12.024, 13.439, 16.880, all P< 0.05). Conclusions: The treatment of moderate and severe hallux valgus with metatarsophalangeal joint incongruency by Z-shaped rotating osteotomy of metatarsal diaphysis can significantly increase the congruency index of metatarsophalangeal joint and improve the metatarsophalangeal joint matching relations. It will not significantly increase the DMAA. A certain degree of radiographic recurrence occurs during a longtime follow-up, but it doesn't influence the symptoms and function.

Objective: To investigate the clinical outcomes and effects of distal oblique osteotomy and the Youngswick osteotomy in the treatment of grade Ⅲ and Ⅳ hallux rigidus. Methods: Totally 29 patients (33 feet) suffered from grade Ⅲ and Ⅳ hallux rigidus who received the distal first metatarsal osteotomy in Ningbo NO.6 Hospital from May 2013 to December 2018 were analyzed retrospectively. Among them, there were 10 males and 19 females. The average age was (56±6) years. Seventeen cases (18 feet) underwent distal oblique osteotomy of the first metatarsal, 12 cases (15 feet) underwent the Youngswick osteotomy. The overall clinical evaluations were investigated before the operation and at the final follow-up, included the visual analogue scale (VAS) of the pain, American Orthopedic Foot & Ankle Society (AOFAS) scores, the motionrange of the first metatarsophalangeal joint and the first metatarsophalangeal joint space. The data before and after operation were compared by paired t test and non-parametric rank sum test. Results: The operation time were (1.1±0.2) hours and (1.3±0.1) hours, and the intraoperative bleeding was 35 (25, 36) ml and 35 (30, 40) ml in the distal oblique osteotomy and Youngswick osteotomy respectively. All patients were followed up for 12 to 46 months. No nonunion or delayed union occurred in all patients. All patients did not need to be operated again, and no complications such as transferring metatarsalgia, infection and osteonecrosis occurred. In the two groups, the pain VAS score decreased significantly ( Z= -3.8, -3.5, both P< 0.01), the first metatarsophalangeal joint dorsal extension activity increased ( Z= -3.7, -3.4, both P< 0.01), the AOFAS score increased ( t= 28.0, 15.4, both P< 0.05) and the first metatarsophalangeal joint space also improved significantly ( t= 17.7, 14.6, P< 0.05) after the operation. There was no significant difference in VAS score, the first metatarsophalangeal joint activity and Horton index between the two groups( Z= -1.3, -0.3, -0.4, all P> 0.05), and there was no statistical difference inAOFAS score ( t= 0.1, P> 0.05). But compared with it in the first distal oblique metatarsal osteotomy, the joint space with the Youngswick osteotomy after the operation was larger ((2.4±0.3) mm vs (2.1±0.4) mm, t= 2.2, P= 0.04). Conclusions: The oblique metatarsal osteotomy and Youngswick osteotomy can effectively relieve the pain of the hallux rigidus, increase the dorsal extension activity and joint space of the first metatarsophalangeal joint, sink the first metatarsal head, and improve the living conditions of the patients. The results of the distal metatarsal osteotomy and the Youngswick osteotomy in the treatment of stage Ⅲ and Ⅳ patients with rigid are similar, which can delay the progress of the disease.

Objective: To evaluate the short-term effectiveness of the first ray tri-plane osteotomy and other metatarsal basal osteotomy in treatment of hallux valgus with moderate and severe metatarsus adductus., Methods: Between February 2012 and September 2016, 10 patients (12 feet) of hallux valgus with moderate and severe metatarsus adductus were admitted and treated with the first ray tri-plane osteotomy and other metatarsal basal osteotomy and lateral soft tissue release. There were 1 male (2 feet) and 9 females (10 feet) with an average age of 34.5 years (range, 21-55 years). The disease duration ranged from 3 to 10 years (mean, 5.8 years). The degree of metatarsal adductus was moderate in 4 feet and severe in 8 feet according to modified Sgarlato measurement method. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 46.4±9.3. The metatarsus adductus angle (MAA) was (25.41±3.66)°, hallux valgus angle (HVA) was (41.42±9.67)°, and the first-second intermetatarsal angle (1-2IMA) was (10.72±2.26)°., Results: All incisions healed by first intention. All patients were followed up 18-24 months, with an average of 21.4 months. One patient (1 foot) had metastatic metatarsalgia after operation, but the symptoms disappeared after symptomatic treatment. X-ray re-examination showed that all osteotomies healed, and the healing time was 2.4-3.2 months, with an average of 2.8 months. At last follow-up, MAA was (8.42±0.71)°, HVA was (13.29±1.03)°, 1-2IMA was (4.41±0.48)°, and AOFAS score was 89.8±5.9. There were significant differences in clinical and radiographic indexes between pre- and post-operation ( P <0.05)., Conclusion: The first ray tri-plane osteotomy combined with other metatarsal basal osteotomy has a significant short-term effectiveness in the treatment of hallux valgus with moderate and severe metatarsus adductus.

Objective: To summarize the technique and effectiveness of double metatarsal osteotomy for treating severe hallux valgus with increased distal metatarsal articular angle (DMAA)., Methods: Between June 2014 and December 2017, 64 patients (94 feet) of severe hallux valgus with an increased DMAA were treated with the double metatarsal osteotomy (distal metatarsal Reverdin osteotomy+proximal metatarsal open wedge osteotomy) combined with Akin osteotomy and soft tissue surgery to correct the deformity. There were 10 males (15 feet) and 54 females (79 feet) with an average age of 44.5 years (range, 26-66 years), including 34 of unilateral foot and 30 of bilateral feet. The Maryland metatarsophalangeal joint score of the American Orthopaedic Foot and Ankle Society (AOFAS) was 54.3±7.4 and the visual analogue scale (VAS) score was 6.0±2.0. The pre- and post-operative AOFAS score, VAS score, DMAA, hallux valgus angle (HVA), first-second intermetatarsal angle (1-2IMA), and the first metatarsal length (FML) were recorded and compared., Results: All incisions healed by first intention. All patients were followed up 12-15 months, with an average of 13.2 months. The complications occurred in 4 feet, including 1 foot of hallux stiffness, 1 foot of numbness at the edge of the wound, 1 foot of metastatic metatarsalgia, and 1 foot of metatarsal bone necrosis. At 1 year after operation, the Maryland metatarsal joint score of AOFAS was 89.2±7.4, showing significant difference compared with preoperative score ( t =18.427, P =0.000); and the effectiveness was rated as excellent in 78 feet, good in 12 feet, poor in 3 feet, and bad in 1 foot, with an excellent and good rate of 95.7%. The VAS score was 1.5±2.0, showing significant difference compared with the preoperative score ( t =10.238, P =0.000). The X-ray films showed that the osteotomies achieved bony healing at 3 months after operation. There were significant differences ( P <0.05) in HVA, 1-2IMA, and DMAA between preoperation and 6 months and 1 year after operation; but no significant difference was found in FML between preoperation and 1 year after operation ( t =0.136, P =0.863)., Conclusion: For the patients with severe hallux valgus with increased DMAA, the double metatarsal osteotomy can significantly relieve the clinical symptoms and improve the imaging parameters with less postoperative complications.

Objective: To evaluate efficacy of radiographic and clinical of Chevron osteotomy versus Scarf osteotomy for hallux valgus at moderate and severe degree., Methods: Randomized controlled trial (RCT) about Chevron and Scarf osteotomy for hallux valgus, in PubMed, Embase, Cochrane Library, CBM, CNKI, Wanfang Data were searched by computer from establishing database to June 2018. According to inclusion and exclusion criteria, two researchers independently screened the literatures, evaluated risk of bias and extracted related observation index, RevMan 5.3.5 software was used to perform Meta-analysis. Postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), AOFAS score, complications and patients' satisfaction degree between Chevron and Scarf osteotomy., Results: Six RCT literatures were included, involving 507 patients, 92.5% patients were at moderate and severe degree, and 261 patients were performed by Chevron osteotomy and 246 patients were performed by Scarf osteotomy. Meta analysis results showed that Chevron osteotomy was better than Scarf osteotomy in correcting HVA [MD=-1.95, 95%CI(-2.64, -1.27), P <0.000 01]. While there were no statistical differences in IMA [MD=-0.42, 95%CI(-1.04, 0.21), P =0.19], DMAA[MD=0.78, 95%CI(-0.72, 2.29), P =0.31], AOFAS score [MD=2.47, 95%CI(-2.38, 7.33), P =0.32], complications [RR=1.09, 95%CI(0.54, 2.20), P =0.82], and patients' satisfaction degree [RR=1.00, 95%CI(0.96, 1.05), P =0.92]., Conclusions: Chevron osteotomy, which has advantages in simple operation, shorten metatarsal bone, less trauma, was better in correcting HVA of hallux valgus at moderate and severe degree, and had similar effects in IMA, DMAA, AOFAS score, complications and patients' satisfactory degree., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2019 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: To explore distal Chevron osteotomy of the first metatarsal and soft-tissue release for the treatment of mild and moderate hallux valgus., Methods: From June 2015 to June 2017, 32 patients(40 feet) with mild and moderate hallux valgus were treated with distal Chevron osteotomy with soft tissue release. including 3 males(3 feet) and 29 females (37 feet), aged from 22 to 80 years old with an average of 57.57 years old. The courses of disease ranged from 2 to 32 years with an average of 14 years. Among them, 9 feet were mild, 31 feet were moderate. Patients were combined with bunion, pain around the first metatarsal joint, and pain increased during weight-bearing walking before opertaion. AP and lateral X-rays on weight-bearing were performed, hallux valgus angle(HVA) and intermetatarsal angle(IMA) between the first and the second metatarsal were examined before and after operation. AOFAS score was applied to evaluate clinical effects., Results: All patients were followed up from 12 to 24 months with an average of 15.2 months.Fracture wounds were healed well without infection and metatarsal head necrosis occurred. Preoperative HVA (32.08±5.59)° and IMA (11.63±2.24)° decreased to (10.31±4.36)° and (5.02°±2.34)°after operation at 12 months, and had statistical difference before and after operation ( P <0.05). AOFAS score increased from 56.75±6.42 before operation to 88.80±3.99 after operation at 12 months( P <0.05)., Conclusions: Distal Chevron osteotomy of the first metatarsal and soft-tissue release for the treatment of mild and moderate hallux valgus could obtain good effects and provide more options for hallux valgus treatment., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2019 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: To investigate the clinical effect of Lapidus operation combined with bone setting manipulation of traditional Chinese medicine in treating hallux valgus in elderly patients., Methods: From March 2013 to October 2017, 53 elderly patients (87 feet) with hallux valgus were treated with Lapidus operation combined with bone-setting manipulation of traditional Chinese medicine, including 12 males (18 feet) and 41 females (69 feet), ranging in age from 65 to 92 years old, with an average of (76.3±4.8) years old. Visual analogue scale(VAS) was used to evaluate the degree of relief of foot pain before and 26 months after operation. American Orthopaedic Foot and Ankle Society(AOFAS) was used to evaluate the function of foot pain. The changes of hallux valgus angle(HVA angle), interphalangeal angle (IMA angle) and metatarsal wedge angle(MCA angle) were compared on X-ray films., Results: All the patients were followed up, and the duration ranged from 12 to 42 months, with an average of(26.0±2.7) months. In all patients, the first metatarsal joint reached bone fusion within 6 to 8 months, with an average of 4.7 months. The preoperative VAS score was 8.06±1.44, which was significantly different from 2.14±1.98 at 26 months( P <0.05). The preoperative AOFAS score was 53.90±7.89, which was significantly different from 92.80±2.78 at 26 months( P <0.05). The HVA, IMA and MCA were significantly improved from preoperative(38.60±2.72)°, (21.90±1.91)° and(20.90±2.20)° to the latest follow-up(17.80±1.94)°, (9.70±2.56)° and(11.70±0.48)°( P <0.05). According AOFAS score, 74 feet got an excellent result, 11 good and 2 fair., Conclusions: Lapidus operation combined with bone-setting manipulation of traditional Chinese medicine on the treatment of hallux valgus foot in elderly patients has satisfactory clinical effects, shortens the time of osteotomy and fixation, protects the soft tissue around the osteotomy end and promotes the bone fusion on the most satisfactory position., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.)