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

Background Previous studies have determined the videos on YouTube® have misleading information in medicine, however the assessment of the information for hallux valgus surgery is lacking. Methods YouTube® was analyzed using two keywords as ‘hallux valgus surgery’ and ‘bunion surgery’. Once redundancies were eliminated, each video was evaluated for the characteristic as following: duration, number of views, likes and dislikes, days since upload, view and like ratios and video power index (VPI). The quality of the information was evaluated using DISCERN, JAMA and Hallux Valgus Score (HVS). Results A total of 49 videos included. Fair or poor results for DISCERN and HVS (90% and 69% of videos, respectively) were found. No difference was found between video source and quality scores. Number of likes and VPI negatively correlated with all scores (p Conclusions YouTube® had poor quality of information for hallux valgus surgery.

The relationship between managing patient expectations and postoperative functional outcomes has been studied widely in other areas of orthopedics, but there is a paucity of information in the foot and ankle literature. The primary objective of the study was to identify the most common patient "expectations" from hallux valgus surgery and establish over what time period postsurgery they would meet those goals. A prospective study of 45 consecutive patients was performed at a single center. This included adult patients (18 years old) that underwent a scarf osteotomy for primary hallux valgus correction. Patients were followed up for 6 months and completed pre- and postoperative Manchester-Oxford Foot Questionnaire and Visual Analogue Scale scores. A separate "expectations" questionnaire was designed and completed assessing the patient's preoperative rehabilitation expectations compared to the actual time taken to achieve those goals. These included 5 domains: pain improvement, return to walking unaided, return to normal foot sensation, return to normal footwear, and return to driving. The postoperative functional scores demonstrated statistically significant improvement postsurgery (p.001). It also highlighted the overall time frame over which the above expectations were met. On average, patients achieved satisfactory pain improvements 1.4 weeks earlier than expected (p.001) along with trends toward an earlier return to driving function of patient expectation (p.05). Patients can thus be reliably informed that their pain symptoms are likely to settle within one month of surgery. This should allow patients to prepare for their rehabilitation more informed, thus facilitating earlier weightbearing and return to function.

Background Pes planus is associated with hallux valgus development. This study evaluated the impact of pes planus on clinical outcomes following hallux valgus surgery. Methods 191 patients underwent Scarf osteotomy for hallux valgus. Pes planus angles including talonavicular coverage angle, lateral talus-first metatarsal angle (Meary’s angle) and lateral talocalcaneal angle were measured. The cohort was stratified into control (0°–4.0°), mild (4.1°–14.9°), moderate (15.0°–30.0°) and severe (> 30.0°) pes planus groups according to Meary’s angle. Clinical outcomes were compared at baseline, 6 months and 24 months. Results There were 78 controls, 95 mild and 18 moderate cases of pes planus. Meary’s angle was independently associated with preoperative hallux valgus angle. Pes planus angles were not associated with pain, AOFAS, SF-36 physical or mental scores. All three groups had similar clinical outcomes and patient satisfaction. Conclusion Compared to patients with neutral foot arches, those with pes planus presented with more severe hallux valgus deformity but had similar clinical outcomes following surgical correction.

The prevalence of hallux valgus increases with age. However, few studies have compared the effectiveness of surgical correction among different age groups. The authors present a retrospective evaluation of the influence of age on clinical outcomes. Patients who underwent corrective surgery for hallux valgus at an academic hospital were stratified into 2 age groups: ≥70 years old (Group 1) and70 years old (Group 2). Following propensity score matching there were 106 patients: 53 patients in each group. Clinical outcomes, quality of life, and satisfaction questionnaires were collected preoperatively and at 6 months and 24 months postoperatively. There were no differences between both patient groups in preoperative biodata and clinical parameters. However, elderly patients had significantly poorer Physical Component Summary scores postoperatively at both 6 months (p = .001) and 24 months (p.001), and significantly poorer American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal- Interphalangeal Scale at 24 months (p = .026). There was no difference between the 2 groups in patient satisfaction rates at 24 months postoperatively (70% vs 85%, p.05). Elderly patients display significant improvements in their clinical scores 24 months postoperatively with no significant difference between satisfaction rates with their younger counterparts. Elderly patients can stand to benefit from hallux valgus surgery.

Multiple fixation techniques for first metatarsophalangeal joint arthrodesis have been described with an average fusion rate of 93.5%. This retrospective cohort study assesses the association between crossed screws (vs dorsal plating) and medical comorbidities and the outcome radiographic union. Bivariate tests of association and multivariable logistic regression were employed to assess differences across fixation type and outcomes. We identified 305 patients who underwent a first metatarsophalangeal joint arthrodesis during the study period. Crossed screw fixation was used in 158 (51.8%) patients while dorsal plating (tubular or anatomic locking plate) was used in 147 (48.2%) patients. Dorsal plating was utilized more often in patients with rheumatoid arthritis (p = .019) and history of smoking (p = .044). At 12 weeks post-operatively there were no significant differences in fusion rates between the two groups (crossed screw group = 95.3% vs dorsal plate group (referent) = 93.5%, Adjusted odds ratio (AOR) 1.39, 95% confidence interval [CI] 0.45-4.26). Not smoking was associated with a greater odds of fusion at 12 weeks (96.2% for nonsmokers vs 75.0% for smokers (referent), AOR 0.07, 95% CI 0.02-0.28). Lower body mass index was associated with a greater odds of fusion at 12 weeks (AOR 0.90, 95% CI 0.82-0.99). Surgeons allowed weightbearing earlier with dorsal plate fixation (2 weeks (interquartile range [IQR] 2.6) versus 5 weeks (IQR 2.6) for crossed screw fixation, p = .001). Patients with multiple medical comorbidities were more likely to require revision surgery than patients having 0-1 comorbidities (p.05). Crossed screws can provide an inexpensive yet effective option for first metatarsophalangeal joint arthrodesis.

Arthrodesis of the first metatarsal phalangeal joint (MTPJ) is a widely utilized surgical procedure for a wide array of metatarsal pathologies. This study aims to explore the functional limitations following first MTPJ arthrodesis, overall satisfaction and patient's abilities to achieve activities of daily living (ADL). This prospective cohort study assessed functional limitations as well as footwear and lifestyle restrictions using several questionnaires. One hundred and three participants who had a first MTPJ arthrodesis under the care of a single surgeon were recruited. Pre- and postoperative patient-reported outcome measures were recorded. The American Orthopaedic Foot and Ankle Score (AOFAS) and the Manchester-Oxford Foot Questionnaire were also used to further examine functional status. Hallux valgus angle (HVA) and intermetatarsal angle (IMA) were compared using preoperative and postoperative weightbearing radiographs and successful fusion was recorded. Complications were documented and are discussed in detail. The duration of follow-up was more than 12 months. There was one nonunion in the cohort while 2 patients experienced delay to fusion. Approximately 97% of patients were very satisfied with the procedure and their ability to achieve ADLs post operatively. A further 82.5% of patients were able to return to wearing nonadaptive footwear. The mean reduction in HVA and IMA was 21.78° and 6.84°, respectively. This study demonstrates the safe and successful use of a compression screw/locking plate construct for arthrodesis of the first MTPJ. Furthermore, the study provides clear evidence of high levels of functionality after the procedure with statistically significant differences (p value.05) in all 4 facets of the AOFAS questionnaire as well as several notable differences in activity levels and footwear restrictions pre and postoperatively.

Treatment of juvenile hallux valgus can be challenging. Initial treatment with conservative measures is appropriate until exhausted. Surgical treatment should be delayed until after skeletal maturity when possible. Before any intervention, a thorough understanding of the whole patient and any underlying systemic contributors to their hallux valgus, in addition to the radiographic foot parameters, is imperative. Careful and individualized surgical planning should be done to optimize results and decrease the risk for recurrence.

Plantar callosities under lesser metatarsals are often accompanied by the hallux valgus, and the cause of callosity is thought to be associated with the foot deformity, such as the metatarsal length discrepancy, the abnormal metatarsal head height, cavus, flat foot, and rheumatoid conditions. However, it is unclear which variable is most involved in the cause of callosity in hallux valgus deformity. To clarify the factors associated with the callosity with hallux valgus deformity, we conducted multiple image assessments based on weightbearing radiography and computed tomography. A retrospective review was performed based on the collection of clinical records from all patients with hallux valgus treated from 2010 to 2019 in our institution. We measured the hallux valgus angle, intermetatarsal angles, calcaneal pitch angles, talo-first metatarsal angles, metatarsal length, metatarsal head height, first metatarsal pronation angles, and sesamoid position with weightbearing radiography and computed tomography. We analyzed the relation between callosity formation and imaging assessments using univariate and multivariate logistic regression models. Fifty feet were retrospectively evaluated, and multiple logistic analyses by the stepwise method revealed that the first metatarsal-lateral-sesamoid distance was the only radiographical variable associated with callosity formation among all the tested variables (p .001). As the grade of the callosity became more severe, the lateral shift of the lateral sesamoid increased. The position of the sesamoid bone appears to have a critical role in the assessment and choice of treatment protocols and further research needs to be conducted on the relationship with the position of sesamoid bone to elucidate the mechanism of callus formation.

Objective: To establish a possible relationship between the Giacomini vein and osteoarticular pathology of the lower extremities in chronic venous diseases (CVD).Materials and methods. In 115 examined patients (out of 321), we identified the Giacomini vein (92 women, 23 men). The average age of men was 44.82 ± 1.62 years; women – 45.36 ± 3.31 years. All patients were divided into 3 groups by anatomical randomization. The first group was without pathology, the second group of patients had only CVD, and the third group included patients with CVD and osteoarticular pathology. The criteria for inclusion in the groups were: the presence of Giacomini vein in patients, chronic venous disease and osteoarticular pathology on one or both lower extremities. Exclusion criteria: age of patients less than 18 years, the presence of CVD C5-C6 according to the CEAP classification, post-traumatic changes in the osteoarticular system, post-thrombotic transformation of the veins of the lower extremities. Using triplex angioscanning, the anatomical features of the structure of the venous system of the lower extremities were assessed. The study of the condition of the foot was carried out using the Friedland method.Results. Group I with an absolute norm of the venous and osteoarticular systems included 30 people (26 %). The second group consisted of 45 patients (39.22 %) with CVD C0-C4 according to CEAP, and the third group consisted of 40 patients (34.78 %) who, in addition to venous, osteoarticular pathology. Chronic venous diseases in patients of groups II and III were distributed as follows: C0 – 25.6 %; C1 – 16.4 %; C2 – 49.4 %; C3 – 4.3 %; C4 – 4.3 % on the CEAP scale. Among the osteoarticular pathology, the most numerous group consisted of changes in the configuration of the foot, non-traumatic deformities – 32 (27.81 %) cases. To confirm the relationship between venous and osteoarticular pathology, we used the Pearson criterion. We found a significant correlation in the presence of nontraumatic deformities of the foot in the group of patients with CVD (Pearson's criterion 0.749642; p < 0.22). A strong correlation was established between the age of patients and changes in the venous and osteoarticular systems of the lower extremities (Pearson's criterion 0.7677696; p < 0.22), which confirms the relationship between the development of nontraumatic changes in the foot and CVD in patients with Giacomini vein with age.Conclusion. It was found that the presence of an altered Giacomini vein leads to an aggravation of venous stasis in the lower extremities, which in turn increases the likelihood of developing venous pathology. Chronic diseases of the veins of the lower extremities contribute to dystrophic changes in soft tissues, most pronounced in the distal part of the extremity and, as a consequence, predispose to the development of osteoarticular pathology.

Background and purpose - Tourniquet is widely used in orthopedic surgery to reduce intraoperative bleeding and improve visualization. We evaluated the effect of tourniquet application on peri- and postoperative cefuroxime concentrations in subcutaneous tissue, skeletal muscle, calcaneal cancellous bone, and plasma. The primary endpoint was the time for which the free cefuroxime concentration was maintained above the clinical breakpoint minimal inhibitory concentration (T > MIC) for Staphylococcus aureus (4 mu g/mL). Patients and methods - 10 patients scheduled for hallux valgus or hallux rigidus surgery were included. Microdialysis catheters were placed for sampling of cefuroxime concentrations bilaterally in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone. A tourniquet was applied on the thigh of the leg scheduled for surgery (tourniquet duration time [range]: 65 minutes [58-77]). Cefuroxime (1.5 g) was administered intravenously 15 minutes prior to tourniquet inflation, followed by a second dose 6 hours later. Dialysates and venous blood samples were collected for 12 hours. Results - A cefuroxime concentration of 4 mu g/mL was reached within 23 minutes in all compartments and patients. For cefuroxime the T > MIC (4 mu g/mL) ranged between 4.8 and 5.4 hours across compartments, with similar results for the tourniquet and non-tourniquet leg. Comparable T > MIC and penetration ratios were found for the first and second dosing intervals. Interpretation - Administration of cefuroxime (1.5 g) 15 minutes prior to tourniquet inflation is safe in order to achieve tissue concentrations above 4 mu g/mL throughout surgery. A tourniquet application time of approximately 1 hour did not affect the cefuroxime tissue penetration in the following dosing interval.

Objective: According to the data in September 2020, 63.2% of the world population uses the internet. Internet is one of the most important sources for fast and easy access to information. Youtube is the second most popular social media network platform. Our aim in this descriptive study was to evaluate the accuracy and quality of the information in hallux valgus videos shared on YouTube. Methods: The keywords "hallux valgus" and "bunyon" were searched on Youtube respectively. The videos were evaluated by two independent reviewers according to VPI, Discern, GQS, JAMA and HVS scoring systems. Results: As a result of search a total of 64 videos were evaluated. The view count varies between 56438 and 14799537, with a mean of 665114.48 ± 1837230.87. The videos had a total run time varies between 47 and 3731 seconds, with a mean of 457.67 ± 538.93 seconds. The average; VPI score was 1336,77±8212,91; Discern score was 1,55±0,58; GQS score was 2,17±0,83; JAMA score was 1,39±0,48 and HVS score was 4,72±4,83. Conclusion: Information on the diagnosis and treatment of hallux valgus on Youtube is of low quality and its content is of unknown source and accuracy.

This study examined the clinical and radiographic outcomes of modified Mitchell’s osteotomy using three-point fixation with a full-thread headless screw. This technique was described to resolve the problem of excessive shortening and overshifting of the metatarsal. A total of 33 feet of 26 patients underwent modified Mitchell’s osteotomy with three-point fixation for hallux valgus. Clinical and radiographic outcomes were assessed preoperatively and at specific time points of follow-up by using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale, hallux valgus angle (HVA), and intermetatarsal angle (IMA). The global AOFAS scale score (0–100) significantly improved from 50.7 ± 9.9 preoperatively to 84.4 ± 8.7 at the final follow-up. The HVA significantly improved from 30.2 $$^\circ$$ ± 6.0 $$^\circ$$ to 9.0 $$^\circ$$ ± 5.0 $$^\circ$$ , and the IMA significantly improved from 14.2 $$^\circ$$ ± 2.6 $$^\circ$$ to 5.1 $$^\circ$$ ± 2.0 $$^\circ$$ . None of the patients experienced nonunion and transfer metatarsalgia. Complications were observed in two feet, and one foot had recurrence of hallux valgus. Modified Mitchell’s osteotomy using three-point fixation with a full-thread headless screw is a reliable alternative treatment for hallux valgus, even in patients with severe deformities.

The presence of metatarsus adductus (MTA) adds complexity to the diagnosis and treatment of hallux valgus (HV). Identification and careful analysis of these combined deformities is of paramount importance. The inability to completely correct HV and an increased incidence of recurrence has been established when MTA deformity is present. We present an option for correction of the combined deformities with multiplanar angular correction arthrodesis of the first, second, and third tarsometatarsal (TMT) joints.

Successful deformity correction utilizing first metatarsophalangeal (MTP) fusion for hallux valgus with concomitant degenerative changes of the first MTP joint is well documented. Currently, there is limited discussion in the literature focusing on triplanar correction of the first MTP arthrodesis. Presented is a novel approach for triplane correction and fusion of the first MTP joint utilizing a biplanar locked plating system.

Background We reviewed the rates of and reasons for hallux valgus (HV) recurrence and the rates of avascular necrosis following Scarf osteotomy. Methods We searched the Cochrane Library, PubMed, and Embase databases for studies reporting operative management of HV using Scarf osteotomy. The primary endpoints were reasons for and rates of HV recurrence. The secondary endpoint was the rate of avascular necrosis. Results We included 15 studies with 946 operations for HV. Seven studies reported no recurrence, six reported recurrence rates of 3.6–11.3%, one reported a recurrence rate of 30%, and one reported a recurrence rate of 78%. Thirteen studies (678 feet) reported other complications from Scarf osteotomy without avascular necrosis. Conclusions Although HV recurrence is not uncommon following Scarf osteotomy, patient-related factors, surgical competence, and longer follow-up are more likely to be associated with recurrence. Avascular necrosis is an infrequent complication in HV patients treated using Scarf osteotomy.

Hallux varus is a classical complication of hallux valgus surgery with a medium rate of 6%. Methods of treatment are MTP1 fusion or conservative joint operations. Hallux varus results from imbalance between excessive medial capsule retraction or tensioning and excessive lateral laxity or soft-tissue release but also and mainly from an over displacement of the first metatarsal which reduces the intermetatarsal angle and thus leads to medial displacement of the great toe. A majority are well tolerated, but few need to be re-operated upon. Factors guiding choice are mainly range of motion and reducibility of the first metatarsophalangeal joint and tendon balance. Joint sparing could be decided for a mobile and well balancesd MTP1 with two options, soft-tissue repairing such as tendon and ligament transfer and reverse osteotomies. The choice depends mainly on the radiological features as an unduly closed intermetarsal angle which leads to a reverse scarf or chevron osteotomy whatever previous surgery was or was not with an osteotomy. Conservative treatment is tricky, and MTP1 fusion is still a reliable procedure which can be used widely.

The effectiveness of minimally invasive surgery (MIS)-distal chevron metatarsal osteotomy (DCMO) for the correction of moderate-to-severe hallux valgus deformity is unclear. This study aimed to compare the radiographic and clinical outcomes of our novel MIS-proximal chevron metatarsal osteotomy (PCMO) with those of MIS-DCMO performed during the same timeframe. We prospectively compared the outcomes of patients who underwent MIS-PCMO (n = 20 patients; 22 cases) with those of patients who underwent MIS-DCMO (n = 23 patients; 26 cases) for moderate-to-severe hallux valgus deformity (hallux valgus angle [HVA] ≥ 30° and first-to-second intermetatarsal angle [IMA] ≥ 13°) between June 2017 and January 2019. The minimum follow-up duration for study inclusion was two years. The HVA, IMA, distal metatarsal articular angle (DMAA), relative length of the second metatarsal, medial sesamoid position, and Meary’s angle to evaluate the degree of deformity correction and its maintenance were measured pre-operatively and at the final follow-up. Compared with MIS-DCMO, MIS-PCMO resulted in significantly greater correction of the HVA (P

Background Obesity and its relationship with higher rate of complications in orthopedic surgeries have been reported. There is no evidence of the relation between obesity and percutaneous foot surgery. Our objective was to evaluate obesity as a risk factor for complications and reoperations in percutaneous surgery of the hallux valgus. Methods A total 532 feet were retrospectively reviewed in which a percutaneous hallux valgus correction was performed. Complications and surgical reoperations were recorded. Patients were divided into 2 groups: BMI less and greater than 30 kg/m2. Results There were no differences in the rate of complications or reoperations. The total complication rate was 8%. Obesity as an isolated risk factor, presented aOR = 1.14 (95%CI 0.54–2.4, p = .714). The overall rate of reoperations was 9%. Obesity presented an aOR = 0.64 (95%CI 0.27–1.49, p = .31). Conclusion Obesity has not been associated with a higher rate of complications and reoperations in percutaneous hallux valgus surgery. It is a safe procedure and BMI should not influence in the prognosis. Level of evidence: Level III, retrospective comparative study.

Hallux valgus is a common forefoot deformity that affects function of foot and quality of life (QoL). This study aims to identify factors associated with clinically important improvements in QoL after hallux valgus corrective surgery.A retrospective analysis on 591 cases of hallux valgus corrective surgery performed between 2007 and 2013 was conducted. Patients' preoperative and 2-year postoperative Physical Component Score (PCS) and Mental Component Score (MCS) were compared to identify the presence of clinically significant improvements in patient-reported QoL. A multiple logistic regression model was developed through a stepwise variable-selection model building approach. Age, BMI, preoperative patient reported outcome score, PCS, MCS, pain score, gender, side of surgery, type of surgery, and presence of lesser toe deformities or metatarsalgia were considered.Median PCS significantly improved from 49 to 53 (p0.001), and median MCS remained at 56 (p = 0.724). Age, preoperative MCS and PCS were independent predictors for significant improvements of PCS at 2-year postoperatively.Three groups of patients were more likely to have significant QoL improvements after hallux valgus corrective surgery. These were the younger patients, those with better preoperative mental health or those with poorer preoperative physical health.III.

Background: In this study, our aim was to determine the effect of cosmetic improvement on patient satisfaction and functional scores in hallux valgus (HV) surgery. Methods: Preoperative foot photographs of 105 patients who had undergone chevron osteotomy for HV between 2016 and 2018 were taken. The patients were divided into 2 groups. Twenty-four months after surgery, the preoperative foot photographs were shown to patients in group 1 (n = 52) but not to patients in group 2 (n = 53). The groups were then compared using the visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP), and the 36-Item Short Form Health Survey (SF-36) scores. Both groups were evaluated radiologically with preoperative and postoperative hallux valgus angles and intermetatarsal angles. Results: There was no difference between the 2 groups in terms of radiologic parameters either pre- or postoperatively, or AOFAS Hallux MTP-IP scores postoperatively. However, for group 1, the VAS was lower (0.4±0.8 vs 1.8±1.6, P = .003) and both the SF-36 physical functioning (88.3±18.1 vs 79.1±23.2, P = .017) and SF-36 mental health scores were higher (78.8±19 vs 69.2±16.3, P = .022). Conclusion: Visualizing improvement in the cosmetic appearance of the foot appears associated with patients’ perception of subjective pain and functional improvement. We recommend that preoperative foot photographs be taken and recorded. Level of Evidence: Level III, case-control study.

The purpose of this study was to evaluate the radiographic and clinical outcomes of patients with hallux valgus (HV) with concomitant metatarsus adductus (MA) treated with distal chevron metatarsal osteotomy (DCMO), without any procedure for the second or third metatarsal.A multicentre retrospective study involving four hospitals was conducted. A total of 45 feet from 38 patients who had received DCMO for HV with MA with at least one year post-operative follow-up were analysed. HV angle (HVâ), inter-metatarsal angle (IMâ), MA angle (MAâ), and the lateral sesamoid grade were measured. Foot function index (FFI) and visual analogue scale (VAS) were recorded. Patients were divided into mild (18° ≤ MAâ 20°) and moderate (20° ≤ MAâ) MA groups, and results were compared.The mean HVâ and IMâ improved significantly from 35.1° and 14.4° pre-operatively to 10.6° and 7.1° one year post-operatively (p 0.001). There were no differences in pre-operative HVâ, IMâ, or the sesamoid grade, and also no difference in post-operative HVâ or the sesamoid grade between mild and moderate MA groups. Only the mean post-operative IMâ showed a difference between the two groups (8.3° vs. 6.3°; p = 0.019). All clauses of FFI and VAS improved significantly (p 0.001). When the extent of improvement was compared between the two groups, there were no significant differences in any category (p 0.05). The total rate of recurrence (HVâ ≥ 20°) was 11.1% (5/45), and although the moderate group (4/29, 13.8%) had a higher proportion than the mild group (1/16, 6.3%), this was not statistically significant (p = 0.641).DCMO for patients with HV with MA had satisfactory radiographic and clinical outcomes with minimal recurrence. Except in cases of severe combined deformity, we recommend performing DCMO alone without any additional procedure or manipulation of the other metatarsals as a viable treatment option.

Hallux valgus is a disease that can be treated with many different surgical procedures. In our study, we aimed to compare patients with and without dorsal neutralization plate after distal metatarsal osteotomy and fixation with compression screws. The files of 59 patients with 89 feet operated with the diagnosis of moderate degree hallux valgus have been examined retrospectively. Hallux valgus angles, AOFAS, VAS and satisfaction scores, time to return to work of both groups were compared. The cases in which only screw fixation was performed were mobilized with the hallux valgus apparatus for 6 weeks postoperatively, while the cases in which dorsal neutralization plate was performed were immediately mobilized full weightbearing without using an additional apparatus. Patients with a minimum follow-up of 2 years were included in the study. There was no statistically significant difference between the two groups in terms of being bilateral (p = 0.457), mean age (p = 0.105) and gender data (p = 0.105). There was no significant difference in the preop and postop second year hallux valgus angles, AOFAS, VAS and satisfaction scores of the patients. There was a significant difference in the time to return to work (p

Objective This study aimed to compare the percutaneous oblique osteotomy (POO) and the open chevron osteotomy technique for correction of hallux valgus deformity at a 2‐year follow‐up. Methods This is a retrospective study of consecutive patients undergoing operative correction of hallux valgus using one of two techniques (POO vs open chevron osteotomy) from 2014 to 2018. Forty eight feet (41 patients) that underwent the POO was compared with 64 feet (58 patients) that underwent open chevron osteotomy. The hallux valgus angle (HVA), intermetatarsal angle (IMA) and American Orthopedic Foot & Ankle Society Hallux Metatarsophalangeal‐Interphalangeal scores (AOFAS‐HMI) were assessed preoperatively and postoperatively at the 1, 2‐year follow‐up. The Manchester–Oxford Foot Questionnaire (MOXFQ) were assessed preoperatively and postoperatively at the 2‐year follow‐up. The VAS score was collected preoperatively and on 2 weeks,1 year and 2‐year follow‐up. Results Both groups achieved significant correction of the hallux deformity. The HVA in the POO group during the follow‐up period were 12.5 ± 2.22 and 17.9 ± 9.31, respectively, and in the open chevron group were 14.1 ± 6.78 and 14.8 ± 7.83, respectively. The IMA in the POO group during the follow‐up period were 7.61 ± 1.63 and 6.94 ± 1.53, respectively, and in the open chevron group were 6.89 ± 3.06 and 6.97 ± 2.95, respectively. Postoperative MOXFQ scores in all domains were significantly improved in both groups, however there was no significant difference in the improvement of any domain between POO and open groups at a 2‐year follow‐up. The AOFAS HMI scores in the POO group during the follow‐up period were 86.5 ± 10.7 and 85.2 ± 13.8, respectively, and in the open chevron group were 88.2 ± 10.8 and 79.5 ± 23.7, respectively. The VAS scores in the POO group during the follow‐up period were 2.00 ± 0.98, 2.00 ± 0.99 and 1.55 ± 1.11, respectively, and in the open chevron group were 5.51 ± 1.45, 2.56 ± 2.88 and 2.56 ± 2.88 respectively. The 1‐year and 2‐year follow‐up outcomes between POO and open groups showed no significant difference regarding AOFAS HMI scores and VAS scores, however the POO group showed statistically significant improvement of VAS scores in the postoperative 2 weeks (P, We compare a percutaneous oblique osteotomy (POO) technique and the open chevron technique for correction of hallux valgus deformity at a 2‐year follow‐up. This POO technique is reliable and shows a comparable outcome to the open chevron technique. However, the POO technique had significantly less pain in the first 2 weeks following surgery.

Background First metatarsophalangeal joint (MTPJ) fusion is the most effective technique for the treatment of MTPJ primary arthritis, severe hallux valgus and failure of primary corrective surgery of these conditions. It can be achieved through different techniques. We evaluated the outcomes in a cohort of patients treated with dorsal plate arthrodesis. Materials and methods We treated 30 feet for 28 patients; the mean follow-up was 35 months. For each foot, we collected radiological and clinical assessment, with the visual analogue scale (VAS) for pain and the Manchester and Oxford Foot questionnaire (MOFQ). The technique consisted in a cup and cone arthrodesis with the application of a low profile dorsal plate. Patients were allowed for immediate weight bearing. Results Consolidation was achieved in all cases; in 29 cases, radiographic union was recorded within 6 months from surgery, in one case after 9 months. Comparison between the preoperative and postoperative of VAS and MOXFQ values showed a statistically significant difference (p Conclusions Even if there is still a debate regarding the best system for MTPJ fusion, we believe cup and cone fusion with dorsal plating is an effective method. Moreover, the stability of the osteosynthesis obtained allows for immediate post-operative weight bearing, making patients able to return soon to their normal life. Trial registration We present a retrospective study; all patients enrolled were retrospectively registered.

Background Hallux valgus (HV) is an important risk factor for falls (in older people); however, the detailed relationship is less understood. We aimed to evaluate postural stability in bilateral HV patients. Methods Two groups of 20 female patients—an HV group and a C (i.e., non-HV) group—participated in this study. Evaluations were made using the Timed Up and Go (TUG) test, the Berg Balance Scale (BBS), the Falls Efficacy Scale (FES), track length (LNG), velocity (VEL), enveloped area (ENV), and root mean square area (RMS). Results TUG and FES scores were significantly higher and BBS scores were lower in the HV group than in the C group. LNG was significantly longer, VEL was higher, and ENV and RMS were wider in the HV group than in the C group. Conclusions The HV group exhibited impaired walking mobility, balance, and postural stability.

Background: Despite advancements in operative techniques and the extraordinary number of procedures described for correcting hallux valgus (HV), there is still uncertainty as to why some patients thrive postoperatively whereas others do not. This study aimed to investigate whether the postoperative outcome of HV surgery could be predicted from patient demographics or functional impairment at the time of referral. Methods: The prospectively collected data, from 92 patients, were analyzed to determine whether patient demographics significantly influenced outcome 52 weeks after surgery. Potential relationships between socioeconomic deprivation and the outcome, as well as between preoperative functional impairment and postoperative improvement, were examined. The Manchester Oxford Foot Questionnaire (MOXFQ) and Scottish Index of Multiple Deprivation (SIMD) were used in this evaluation. Results: None of the demographics studied were found to be statistically significant determinants of outcome. Preoperative MOXFQ scores for patients from the most deprived areas were significantly worse at the time of referral. Patients living in the least deprived postcodes experienced the lowest improvement in MOXFQ scores. Patients from the most deprived SIMD quintile achieved significantly higher improvement in MOXFQ–walking and standing compared to those from the least deprived quintile. A strong positive correlation was found between the preoperative MOXFQ scores and the improvement in the scores postoperatively. Conclusion: In this patient cohort, demographics could not be used to predict the postoperative outcome at week 52. Socioeconomic disparities seem to influence the timing of patients seeking surgery. Lower preoperative MOXFQ scores strongly correlate with a lesser degree of postoperative improvement. Level of Evidence: Level III, retrospective study with prospective arm.

Hallux valgus is a complex deformity with a variety of techniques described for correction. A biplanar plating system for triplanar correction system has been developed to address both the translation and rotational component of the hallux valgus deformity and allow an accelerated weightbearing protocol. The purpose of this study was to determine the correction and complications using radiographic parameters and patient reported outcomes. We sought to determine prognostic factors for successful correction, including age, gender, and preoperative deformity. From the medical records, we collected preoperative data. Patient-reported outcomes were obtained using AOFAS Hallux Metatarsophalangeal-Interphalangeal score, FAAM, and SF-12 scores preoperatively and postoperatively. Imaging was reviewed at preoperative and postoperative visits to determine hallux valgus angle, intermetatarsal angle, and tibial sesamoid position. Fifty-seven procedures, in 55 patients, were performed. There were 7 complications and mean follow-up time was 45.7 weeks (+ 28.3 weeks). Age over 62.5 years were associated with an increased risk of complications (p = .018). Males had an increased rate of complications (71%) compared with females. Radiographic parameters were significantly improved from preoperative values at alltime points (p.05). Only the AOFAS Hallux Metatarsophalangeal-Interphalangeal score was statistically significant at 3, 6 and 12 months. We sought to determine the effectiveness of biplanar plating and triplanar correction procedure with early weightbearing. Over a 12 month follow-up period, our results showed significant improvement in deformity and maintained correction. AOFAS Hallux Metatarsophalangeal-Interphalangeal scores significantly improved from the preoperative to the postoperative state. Our results show a nonunion rate of 5.2%, which is comparable to prior studies.

Arthrodesis of the first tarsometatarsal joint (TMT1) reduces pathologic angles at the anatomic center of rotation of angulation and presents a substantial correction potential in 3 planes in the treatment of hallux abductovalgus. The optimal fixation method remains unclear since prevailing dorsomedial locking plates and/or compression screws depict elevated implant-associated complications. Medical records of 49 patients that underwent 53 TMT1 arthrodeses in hallux abductovalgus interventions were included. Median average visual analog scale scores decreased (p < .001) from 6.8 (range 4-10) to 2.7 (range 0-10), first intermetatarsal angles were reduced (p < .001) from 17.39° (range 12°-28°) to 7.16° (range 3°-12°), standing lateral first metatarsal angles improved (p < .001) from 21.66° (range 12°-29°) to 23.94° (range 14°-31°) and tibial sesamoid positions were plantarized (p < .001) from 6.02° (range 4°-7°) to 2.79° (range 1°-6°). Plantar plating allowed immediate weightbearing with transition to normal shoe gear at 6 weeks. Complications occurred in 6 (11.34%) feet including 1 (1.89%) nonunion, 1 (1.89%) delayed union, 1 (1.89%) hallux varus, 1 (1.89%) incomplete recurrence, 1 (1.89%) minor dehiscence, and 1 (1.89%) hardware irritation. Plantar locking plates combined with a dorsal compression screw presented a favorable tension-side implant location that closed the fusion site under load. This facilitated substantial reductions in complications, pathologic angles, and pain.

Hallux valgus (HV) is a very common deformity among foot disorders, therefore attracting strong interest from foot and ankle surgeons. We investigated publication trends on HV in the literature. The analysis was conducted through an electronic search of the Web of Science database for publications between 1999 and 2019, studying the data of origin through bibliometrics. The following search string was utilized: TI = (hallux valgus* OR hallux abductovalgus*) with filters for the English language and documents in article format. The “Bibliometrix” package of R software was used for the bibliometric analysis, and the VOSviewer was used to create graphs. A total of 789 articles were found in the electronic search, with 2,723 cited articles. The most common Web of Science category was Orthopedics (83.0%), and Coughlin M.J. was the main researcher in this field with the largest number of publications (17). The United States led in terms of the number of published articles (26.7%). An increase in the number of publications over time was noted, with 2016 being the year with the highest number of articles (78). The journal with the most articles was Foot and Ankle International, with 35.2% of the publications. The number of published studies on HV has increased rapidly since 2012. The United States ranks first in related research worldwide. The journal with the most articles was Foot and Ankle International.

The purpose of the present study was to analyze the difference in frontal plane rotation of the entire first ray in patients with and without hallux valgus using standing weightbearing computed tomography (CT). Ten feet of 10 patients with hallux valgus and 36 feet of 36 patients without hallux valgus were examined. Standing weightbearing CT scans and radiographs were taken for all subjects. Frontal plane measurements of the sesamoid apparatus, first metatarsal head, first metatarsal base, and medial cuneiform were performed. Frontal plane rotation of the first tarsometatarsal joint and intrinsic first metatarsal torsion was calculated. An independent 2 sample t test was used to compare means of outcomes of interest across control and treatment groups. Statistical significance was set at an alpha level of 0.05. There was a significant increase in pronation of the sesamoid apparatus (23.49° vs 6.60°) and first metatarsal head (17.79° vs 9.81°) in patients with hallux valgus. There was a significant increase in first metatarsal torsion toward pronation in patients with hallux valgus (22.28° vs 13.52°). No significant difference was detected in the rotation at the first tarsometatarsal joint or the frontal plane orientations of the first metatarsal base and medial cuneiform. By examining the frontal plane position of the entire first ray during weightbearing using standing CT in patients with and without hallux valgus, we determined the level at which pronation originates to be within the first metatarsal bone rather than the first tarsometatarsal joint.

Lately there has been a growing interest in the use of percutaneous surgery for the correction of hallux valgus (HV). The purpose of the present study was to systematically review the published data about this topic and establish the efficacy and safety, stressing the complication rates found on this percutaneous technique. A systematic review of the literature available in PubMed was performed. The radiological and clinical outcomes were evaluated as well as complication rates. A total of 16 studies were included and 1157 procedures reported for percutaneous HV on 1246 patients. The mean angle correction of HV deformity improved postoperatively. Reported complications vary among the studies. The highest complication rate was joint stiffness in 18.47% of cases, followed by HV recurrence and shortening of M1, both in 15.2%, material intolerance in 10.1%, osteoarthritic changes in 9.1%, infection in 7.6%, and transfer metatarsalgia in 5.4%. There is a lack of randomized control trials and insufficient comparative case control studies to assess whether one technique is more effective than another or if the percutaneous surgery is recommended rather than open surgery with respect to complications.

Objective: To evaluate the postoperative results of patients who underwent surgical treatment of hallux valgus with a modified Reverdin-Isham (RI) technique and to compare the achieved correction with that reported by studies using the original technique. Methods: This is a retrospective study with patients with mild to moderate hallux valgus who underwent surgery from June 2010 to July 2019. All patients were operated using the modified RI technique. Data were collected through the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire, in addition to pre and postoperative radiographic studies of the intermetatarsal angle (IMA), the hallux valgus angle (HVA), and the distal metatarsal articular angle (DMAA). Results: The mean postoperative follow-up was 30.1 months, and the mean age of patients was 56.4 years. The median AOFAS score in the postoperative period was increased by 56 points. The mean HVA was reduced in 16.5°, the mean IMA was reduced in 4.3°, and the mean DMAA was reduced in 10°. There were no cases of displacement or deviation of the first metatarsal head during the postoperative follow-up. Conclusion: The modified RI technique provided considerable stability to the osteotomy, in addition to a significant correction of the measured angles and an improvement in AOFAS scores, demonstrating itself as an effective technique for correcting mild to moderate hallux valgus. Level of Evidence IV, Therapeutic Studies, Case Series.

Acute great toe (Hallux) pain is a common complaint encountered by the primary care physician. Pathological conditions can vary from acute trauma to acute exacerbation of underlying chronic conditions. Delay in treatment or misdiagnosis can lead to debilitating loss of function and long-lasting pain. This review endeavors to discuss the pertinent history, physical exam findings, radiographic evidence, conservative treatment options, and surgical management for the musculoskeletal causes of acute and acute on chronic great toe pain in the adult population. The acute pathologies discussed in this review are hallux fractures and dislocations, turf toe, sand toe, and sesamoid disorders. The chronic pathologies discussed include hallux rigidus, hallux valgus, and chronic sesamoiditis.

In the literature, first metatarsophalangeal joint arthrodesis with lesser metatarsal head resection seems to be a reliable procedure in rheumatoid foot deformity. Maybe this procedure could be proposed in nonrheumatoid severe forefoot deformity (hallux valgus angle >40° and lesser metatarsophalangeal dislocation). The aim of this study was to compare radiological and clinical outcomes between lesser metatarsal head resection and lesser metatarsal head osteotomy in nonrheumatoid patients. Thirty-nine patients (56 feet) suffering from well-defined nonrheumatoid severe forefoot deformity were retrospectively enrolled in our institution between 2009 and 2015. Metatarsal head resection and metatarsal head osteotomy represented 13 patients (20 feet) and 26 patients (36 feet), respectively. In this observational study, a rheumatoid population (21 patients) was included as the control. The clinical outcome measures consisted of American Orthopaedic Foot and Ankle Society score, Foot and Ankle Ability Measurement, and Short Form-36. The radiological outcomes were: intermetatarsal angle, hallux valgus angle, and metatarsophalangeal alignment. Mean follow-up was 24 months. Satisfaction rate was, respectively, 92% for resection, 91% for osteotomy procedure, and 80% for surgery in rheumatoid patients. Short Form-36 global score was, respectively, 80.7 (52.5-96.4), 76 (57.7-93), and 68.3 (22.6-86). No functional outcome difference was found between resection and osteotomy procedures, except that the metatarsal head resection group had poorer results in sports activities than the osteotomy group. Complications were similar between osteotomy and resection (p > .05). The radiological outcomes were improved significantly from preoperative to postoperative. First metatarsophalangeal joint arthrodesis with lesser metatarsal head resection in nonrheumatoid severe forefoot deformity might be a good therapeutic option.

The modified Lapidus bunionectomy is a useful and highly powerful procedure for correcting hallux abducto valgus. Traditionally reserved for “severe” deformities, this procedure has seen a recent resurgence in the podiatric community for its unique ability to achieve tri-planar correction of this challenging deformity. Although this procedure has been extensively studied in both biomechanical labs and the clinical arenas, no clear consensus has been achieved regarding optimal fixation for this thought-provoking procedure. The current study examined the differences in strength between commercially available 5-hole locking plates with interfragmentary compression vs a crossed-screw with a third “transfixation” screw construct in a controlled setting. Ten fresh-frozen cadaveric match pair limbs (20 total limbs) were used to complete this study. Ten limbs were randomly assigned to a 3-screw construct. The other 10 contralateral limbs were assigned to a commercially available 5-hole locking plate (5 stainless steel and 5 titanium alloy) with an interfragmentary lag screw construct. The first rays were then isolated and potted into a 4-point bending device. The specimens were loaded to failure in a servohydraulic load frame at a controlled rate. Failure was defined as catastrophic or 3 mm of plantar gapping at the arthrodesis site. The mean maximal load to failure was 310.9 ± 109.4 N for the 3-screw construct. The mean maximal load to failure for the locking plate constructs was 264.1 ± 100.9 N. This difference was not statistically significant (p = .328). These results suggest that a 3-screw construct for Lapidus arthrodesis is as strong as commercially available locking plate constructs.

There has been much debate regarding the aetiology and pathogenesis of hallux valgus and it appears to be multifactorial with contracture or tightness of the Achilles tendon and more specifically the gastrocnemius being implicated as an intrinsic factor. The purpose of this study was to look at the association of gastrocnemius tightness, genu valgum and hallux valgus. A prospective case-control study with 25 patients in each group was carried out over a 12-month period. The case group observed adult patients who were referred primarily because of symptomatic hallux valgus and were assessed for the following: hallux valgus stage; presence or absence of isolated gastrocnemius tightness; presence or absence of genu valgum. The control group excluded those with pre-existing hallux valgus, genu valgum and rheumatoid arthritis and were assessed for isolated gastrocnemius tightness. There was a statistically significant association between the presence of genu valgum and hallux valgus when comparing both groups with a p < .001. There was also a statistically significant association between the Silfverskiold test and the presence of hallux valgus, as well as the Silfverskiold test and the presence of genu valgum with a p < .001. This study is the first to describe the association of gastrocnemius tightness, genu valgum and hallux valgus. Further studies are required to assess this relationship but knowledge and awareness of it can be applied by clinicians when considering the most appropriate management options with patients.

Hallux rigidus can be treated with a proximal hemiarthroplasty (HemiCAP®) to preserve the motion in the first metatarsophalangeal joint and reduce pain. This study examines the functionality, and survival rates of HemiCAP® implants, with or without a dorsal flange. One hundred and five patients were treated with a HemiCAP® (N = 116 HemiCAPs®) between 2006 and 2014. Revision rates, arthrosis score, hallux valgus (HV), intermetatarsal (IM), distal metaphyseal articular angle (DMAA), visual analog scale (VAS) (1-10 points), American Orthopaedic Foot and Ankle Score (AOFAS) MTP-IP (AOFAS 0-100 points), SF-12, range of motion (ROM), and radiographs were analyzed pre- and postoperatively. Statistics: Kaplan-Meier survival analysis, Cox-regression, and paired t tests. At 2, 4, and 6 years, the implant survival was 87%, 83%, and 81%, respectively. All revised due to pain. Dorsal flange, gender, arthrosis, HV, IM, and DMAA did not influence the results. At the mean 5-year follow-up (n = 47) median (range) dorsal ROM was 45° (10°-75°), AOFAS was mean 87.2 ± 10.8, VAS was 2 ± 1.6, and SEFAS was 42 ± 6 points. The dorsal flange made no significant difference for ROM or patient-reported outcome measures compared to the HemiCAP® with no dorsal flange. Twenty-three patients with preoperative data were re-examined, and preoperative dorsal ROM mean difference (confidence interval [CI]) increased 20.7° (13.9°-27.4°), VAS decreased with a mean difference (CI) of -4.7 (-5.8 to 3.5), and AOFAS increased with a mean difference (CI) 26.2 (20.2-32.2) (for all p.001). The 6-year survival rate of the HemiCAP® implant was 81%. The design change to dorsal flange was not evident clinically. Unrevised patients had significantly less pain, greater ROM, and better foot and ankle function than preoperatively.

A question still remains as to whether constrictive toe-box shoes (TBS) cause disability only due to pain on pressure points or if they can cause permanent changes in the hallux anatomy. The aim of this study is to compare the hallux morphology in 3 groups classified according to their use of constrictive or open TBS. 424 patients were classified into 3 groups: group A used open TBS daily; group B used constrictive TBS daily; group C used both open and constrictive TBS. Hallux’s angles, presence of exostoses and shape of the distal phalanx (DP) were analyzed on dorsoplantar weight-bearing radiographs and compared amongst groups. The intermetatarsal (IMA), metatarsophalangeal (MTPA), DASA, PASA, interphalangeal (IPA), obliquity (AP1), asymmetry (AP2) and joint deviation (JDA) angles for group A were 10°, 8°, 5°, 4°, 9°, 3°, 5°, 3°; for group B were 9°, 19°, 5°, 6°, 12°, 2°, 8°, 2°; and for group C were 10°, 10°, 4°, 4°, 12°, 3°, 8°, 1°. Only the differences in the MTPA, IPA and AP2 were statistically significant (p

Background Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a frequently performed surgical procedure. Many patients have bilateral hallux MTPJ pathology requiring bilateral arthrodesis. There are concerns that bilateral simultaneous hallux surgery, under one anaesthetic, results in the patient being severely incapacitated in the early post-operative period. We hypothesize that bilateral simultaneous hallux MTPJ fusions does not compromise outcomes or the patients’ post-operative comfort and rehabilitation and is cost and time effective. Methods In this retrospective study, 16 patients who underwent bilateral simultaneous first MTPJ arthrodesis were compared to 16 patients who had unilateral MTPJ arthrodesis with regards to outcome, tolerance, cost and time effectiveness. Outcome measures were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux score and the Self-Reported Foot and Ankle questionnaire (SEFAS). Results There was a significant improvement in the AOFAS scores post surgery in the bilateral group and according to the SEFAS grading, 14 patients (87.5%) had good or excellent outcome scores with 13 (81.25%) of these patients having excellent scores. This was comparable to the outcome scores in the unilateral group. Two patients developed non-unions bilaterally compared to one in the unilateral group. There is also a notable general cost saving and less time off work when bilateral fusions are done at the same setting. Conclusion Bilateral simultaneous hallux MTPJ arthrodesis is an effective, convenient and cost effective option for patients requiring MTPJ fusions for bilateral hallux pathology. Level of evidence Level 4

BACKGROUND Rheumatoid arthritis (RA) is an autoimmune disorder and a chronic inflammatory disease that can damage joints throughout the body. As dramatic improvements in medical treatment have contributed to reduced progression of joint destruction, surgical methods for the treatment of RA-related forefoot deformities have gradually changed from joint-sacrificing to joint-preserving. The aim of this study was to assess the long-term outcomes, including patient-reported outcomes, of joint-preserving surgery for forefoot deformities associated with RA. METHODS This retrospective study included 105 feet in 89 patients with RA who were treated during the period of January 2012 to May 2015 and had a minimum of 5 years of follow-up (mean, 6.0 ± 0.9 years). The patient-reported outcome measure used was the Self-Administered Foot Evaluation Questionnaire (SAFE-Q), which was completed preoperatively and at the latest follow-up (n = 53 feet). The hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the position of the medial sesamoid were measured preoperatively, at 3 months postoperatively, and at the latest follow-up. Cases of delayed wound-healing, hallux valgus recurrence, nonunion at the osteotomy sites, and reoperation were recorded. Kaplan-Meier survival curves were used to determine the estimated survivorship, with reoperation as the end point. RESULTS Scores of all 5 subscales of the SAFE-Q demonstrated significant improvement at the latest follow-up. The average HVA and IMA decreased significantly 3 months postoperatively, and these measurements remained significantly lower than the preoperative values (p < 0.01). The position of the medial sesamoid at the latest follow-up improved significantly (p < 0.01). Delayed wound-healing was found at the site of surgery in 21 (20.0%) of the 105 feet. Recurrence of hallux valgus was observed in 11 (10.5%) of the feet. There was no case of nonunion at any osteotomy site. Eleven (10.5%) of the feet required reoperation. The estimated survivorship of the studied joint-preserving surgery at 7 years, with reoperation as the end point, was 89.5%. CONCLUSIONS Satisfactory long-term patient-reported and radiographic outcomes after joint-preserving surgery for forefoot deformities associated with RA can be achieved. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Background: The prevalence of hallux valgus increases with age. However, no studies have compared the effectiveness of surgical correction among different age groups. This study investigated the influence of age on clinical and radiological outcomes following hallux valgus surgery. Methods: Patients who underwent correction for hallux valgus at an academic hospital were stratified into 3 age groups: younger (Results: The preoperative hallux valgus angle was significantly greater in older patients ( P < .001). The older group had 3 perioperative complications ( P = .144) and showed a trend toward a longer hospital stay ( P = .083). There was no difference in visual analog scale, American Orthopaedic Foot & Ankle Society score, or SF-36 among the groups at 6 months or 2 years. Using multiple regression, age was not associated with any outcome score. The satisfaction rates were 82%, 78%, and 83% in the young, middle-aged, and older groups, respectively ( P = .698). There was no difference in the number of reoperations at a mean follow-up of 9.2 ± 2.2 years ( P = .778), and no patients underwent reoperation for recurrent hallux valgus. The risk of recurrence was 5 times higher in older patients compared with younger patients (OR, 5.15; 95% CI, 1.10-24.03; P = .037). Conclusion: Age did not influence the perioperative, functional, or subjective outcomes following hallux valgus surgery. However, older patients should be counseled on the higher risk of recurrence following surgical correction. Level of Evidence: Therapeutic, level III, retrospective comparative series.

This article describes the percutaneous technique of a minimally invasive basal closing wedge osteotomy for correction of hallux valgus.This procedure allows correction of severe deformity with a minimally invasive approach.No specific contraindication; a fusion would be preferred for an arthritic tarsometatarsal or metatarsophalangeal joint.The surgical technique is based on the use of burrs specifically adapted for foot surgery. A basal closing wedge osteotomy is performed and fixed percutaneously. Each step is controlled under fluoroscopy.A postoperative heel shoe is prescribed for 6 weeks with crutches. The foot is elevated during the first 2 weeks. Impact is forbidden for 3 months.The authors report good and excellent results with an average correction of the hallux valgus angle of 26° and an intermetatarsal angle of 8.2°.ZIEL: Im vorliegenden Beitrag wird die perkutane Technik einer miminal-invasiven basalen Closing-Wedge-Osteotomie zur Korrektur eines Hallux valgus beschrieben.Dieses Verfahren ermöglicht die Korrektur schwerer Deformitäten mithilfe eines miminal-invasiven Ansatzes.Spezifische Kontraindikationen bestehen nicht, bei arthritischen tarsometatarsalen oder metatarsophalangealen Gelenken würde eine Fusion bevorzugt.Die chirurgische Technik basiert auf der Verwendung von Bohrern, die speziell auf die Fußchirurgie ausgerichtet sind. Eine basale Closing-Wedge-Osteotomie wird perkutan durchgeführt und fixiert. Jeder Schritt wird unter Durchleuchtung kontrolliert.Ein postoperativ zu tragender Verbandsschuh und Gehstützen werden für 6 Wochen verordnet. Der Fuß wird in den ersten 2 Wochen hochgelagert. Belastung ist 3 Monate lang verboten.Die Autoren berichten über gute und ausgezeichnete Ergebnisse bei einem durchschnittlichen Korrekturwinkel von 26° für den Hallux valgus und einem Intermetatarsalwinkel von 8,2°.

The medial branch of the medial dorsal cutaneous nerve is frequently encountered in medial column surgery. Postoperative sensory nerve symptoms can lead to dissatisfaction and suboptimal outcome. The purpose of this case series is to correlate intraoperative nerve location on direct viewing with preoperative nerve localization to assess the accuracy of a specific nerve palpation technique. Hundred consecutive patients undergoing elective Lapidus fusion were prospectively evaluated. Preoperative nerve localization and intraoperative comparison was performed along with assessment of nerve position in relation to the cuneiform and first tarsometatarsal joint. Preoperative nerve identification correlated with intraoperative findings in 99 of 100 consecutive cases. In 1 of 100 cases, the palpated nerve was proximal to the zone of dissection and was not visualized. The medial branch of the medial dorsal cutaneous nerve crossed the dorsal Lapidus incision at the medial cuneiform or first metatarsal base level in 95 of 100 cases; at the mid metatarsal level in 2 of 100 cases; and proximal to the medial cuneiform in 3 of 100 cases.

Hallux Valgus Surgery success depends not only on the operative technique, but also on the care of the foot during the postoperative period. Orthopedic shoes have been developed to decrease the weight load on the first ray, an excess of which might lead to a loss of fixation or pseudoarthrosis. The goal of this study was to determine how the load distribution changed as the forced applied to the foot increased, with and without an orthopedic shoe. Also, we compared to different shoe models.Pressure sensors were placed under the first metatarsal head and the heel of twenty specimens of fresh cadaveric adult feet. Two orthopedic shoes were chosen, a double padded (MS) and a reverse camber shoe (RCS). 10 kg loads were progressively applied, up to 60 kg. We first compared three instances: no shoe, MS and RCS. A secondary analysis comparing barefoot versus shoes was performed. A mean comparison was performed (ANOVA/T-student).The mean pressure of the heed and the first metatarsal showed that there were significant differences between groups (P.005). The secondary analysis (no shoe vs orthopedic shoes) showed that the pressure without shoe was significantly higher than with any orthopedic shoe (P.005). There were no statistically significant differences between models of shoes (P = .402).After a surgical procedure for hallux valgus fixation, postoperative shoes should be indicated to decrease the pressure on the first metatarsal head and heel in order to avoid an overload of the postoperative area.Cadaveric study. Level V.

Background Endolog is an intra-medullary titanium device used for a minimally-invasive hallux valgus correction. The aim of this study was to evaluate clinical and radiographic outcomes of this device. Methods A retrospective study with a prospective data collection was conducted. Patients underwent to Endolog procedures from September 2009 to April 2017 were enrolled. Mild HV deformity (HVA ≤ 19° and IMA ≤ 13°) or associated procedure to Endolog technique were excluded. The radiological (HVA, IMA and PASA) and clinical (AOFAS score) pre and post-operative data were compared through Wilcoxon Signed-Rank test. Results 194 feet (144 moderate and 50 severe HV) underwent HV correction respecting study’s criteria. AOFAS scores significantly improved from 31.0 ± 12.7 points preoperatively to 88.5 ± 8.0 at 24 months. Even all radiographic measurements significantly improved during 2 years’ follow-up. Only 6 patients experienced complications: 4 cases of HV recurrence and 2 cases of intolerance device-related pain. Conclusions Endolog technique proved to be a valid option in the moderate-to-severe hallux valgus treatment, comparable to other surgical techniques described in literature.

With the development of recent technology, radiographs can be saved digitally, and angular measurements can be processed using various software packages. We developed an innovative computer-aided design method with Materialize Interactive Medical Image Control System software to measure hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the distal metatarsal articular angle (DMAA) and assessed its concordance with traditional X-ray imaging methods. All measurements were carried out on 42 feet from 26 adult patients diagnosed with hallux valgus who were prospectively selected from July 2016 to April 2018. Standing X-ray radiograph and weightbearing computed tomography scans were conducted on all patients, and HVA, IMA, and DMAA were generated using both a traditional X-ray method and our innovative method. Two different observers assessed measurements for each patient. Finally, statistical analyses were conducted to assess the reliability of the measurements. Both X-ray imaging and our innovative method had strong interobserver and test-retest reliability. The ICC of X-ray imaging was 0.945, p.001, and the ICC of the innovative method was 0.915, p.001. There was no statistical difference between the 2 methods for HVA and IMA measurements (p.05); however, a difference was detected for DMAA (p.05). Bland-Altman analyses demonstrated a high degree of agreement between the 2 methods for HVA and IMA, but a significant difference for DMAA. From the results, we concluded that our innovative computer-aided design method is a feasible, reliable way to quantitatively assess HVA, IMA, and DMAA, and it is likely more accurate for measuring DMAA.

Background There is an absence of high quality research validating instruments that measure foot and ankle related quality of life among hallux valgus (bunion) patients’ perspectives. The Foot and Ankle Outcome Scale is a patient-reported outcome instrument, that when administered to patients with symptomatic hallux valgus, provides a patient-centric perspective of their foot function. The aim of this study is to assess the psychometric properties of the instrument’s five subscales among preoperative bunion surgery patients. Methods The Foot and Ankle Outcome Scale instrument measures Pain, Symptoms, Activities of Daily Living, Sport and Recreational Activities and Foot/Ankle Related Quality of Life. Preoperative data is collected from a sample of patients scheduled for surgical treatment of their condition in Vancouver, Canada. Classical and item response theory methods are used to report on reliability, validity and differential item functioning among subgroups. Results This study included 249 surveys, representing an overall response rate of 44.1% among 564 eligible patients. The instrument demonstrated high reliability for all subscales, though 18 items across subscales, exhibited poor discrimination between item levels. Four items score differently according to patients’ sex and one item scored differently by age. Conclusions The instrument measures five domains of health important to bunion patients. These findings suggest that the current instrument can be used with an understanding of its limitations, including redundant questions and sex-based differences. Future research should revise a number of items. The results highlight the importance of the psychometric analyses of instruments in specific patient populations.

Background Crossover second toe is often presented in moderate to severe hallux valgus. However, its clinical impact on the postoperative outcome of hallux valgus is still unknown. Methods Thirty-five patients who had moderate to severe hallux valgus with crossover second toe were matched with 35 controls who did not have crossover second toe, according to preoperative hallux valgus angle and first-second intermetatarsal angle. Radiological parameters, Foot Function Index (FFI), and Visual Analog Scale (VAS) were assessed as postoperative outcomes at 3, 6, and 12 months after surgery. Results At 3 months, the FFI in the crossover second toe group was lower than in the control group (p = 0.001), while other outcomes were similar. On the other hand, there were no significant differences between the groups at 6 and 12 months, in terms of radiological parameters, FFI, and VAS. Conclusions Patients who had moderate to severe hallux valgus with crossover second toe were at risk for slow functional recovery after surgical treatment in the short term, but, in the long-term, there was no difference in overall postoperative outcomes in patients with and without crossover second toe. Level of Evidence Level III, retrospective comparative study.