ObjectiveTo summarize the technique and effectiveness of double metatarsal osteotomy for treating severe hallux valgus with increased distal metatarsal articular angle (DMAA).MethodsBetween 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.ResultsAll 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).ConclusionFor 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 compare the difference in forefoot width between minimally invasive extra-articular osteotomy via small incision and traditional Chevron osteotomy in the treatment of hallux valgus. Methods A retrospective analysis was conducted on the clinical data of 45 patients with hallux valgus between April 2019 and July 2022. Among them, 22 cases underwent minimally invasive extra-articular osteotomy via small incision (minimally invasive group), and 23 cases underwent traditional Chevron osteotomy (traditional group). There was no significant difference in the baseline data between the two groups (P>0.05), including gender, age, affected side, Mann classification of hallux valgus, disease duration, and preoperative intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), bony forefoot width, soft tissue forefoot width, osteophyte width, and American Orthopaedic Foot and Ankle Society (AOFAS) score. The osteotomy healing time and the occurrence of complications in the two groups were recorded. The differences between pre- and post-operation (changes) in various imaging indicators and AOFAS scores in the two groups were calculated. And the bony forefoot width and soft tissue forefoot width at 1, 6, and 12 months after operation were also recorded and compared between the two groups. Results One case of skin injury occurred during operation in the minimally invasive group, while 3 cases of poor wound healing occurred after operation in the traditional group. None of the patients experienced infections, nerve injuries, or other complications. All patients were followed up 12-31 months (mean, 22.5 months). The osteotomy healed in the two groups and no significant difference in healing time between the two groups was found (P>0.05). The IMA, HVA, DMAA, osteophyte width, and AOFAS score at 12 months after operation significantly improved compared to those before operation (P<0.05). There was no significant difference between the two groups in the changes of IMA, HVA, and osteophyte width (P>0.05). However, the differences in the changes of AOFAS score and DMAA were significant (P<0.05). There was no significant difference between the two groups in bony and soft tissue forefoot widths at different time points after operation (P>0.05). However, there were significant differences in the two groups between the pre- and post-operation (P<0.05). Conclusion The minimally invasive extra-articular osteotomy via small incision for hallux valgus, despite not removing the medial osteophyte of the first metatarsal, can still effectively improve the forefoot width and osteophyte width. While correcting the IMA and HVA, it can more effectively restore the DMAA, resulting in better AOFAS scores.
ObjectiveTo explore the effectiveness and advantage of three-dimensional (3D) printed navigation templates assisted Ludloff osteotomy in treatment of moderate and severe hallux valgus.MethodsBetween April 2013 and February 2015, 28 patients (28 feet) with moderate and severe hallux valgus who underwent Ludloff osteotomy were randomly divided into 2 groups (n=14). In group A, the patients were treated with Ludloff osteotomy assissted with a 3D printed navigation template. In group B, the patients were treated with traditional Ludloff osteotomy. There was no significant difference in gender, age, affected side, and clinical classification between 2 groups (P>0.05). The operation time and intraoperative blood loss were recorded. The ankle function of the foot at preoperation, immediate after operation, and last follow-up were assessed by the American Orthopedic Foot and Ankle Society (AOFAS) score. Besides, the X-ray film were taken to assess the hallux valgus angle (HVA), intermetatarsal angle (IMA), and the first metatarsal length shortening.ResultsAll patients were followed up 18-40 months (mean, 26.4 months). The operation time and intraoperative blood loss in group A were significantly less than those in group B (P<0.05). The HVA, IMA, and AOFAS scores in groups A and B at immediate after operaton and last follow-up were sinificantly improved when compared with preoperative values (P<0.05); but no significant difference was found between at immediate after operation and at last follow-up (P>0.05). No significant difference was found in HVA and IMA between group A and group B at difference time points (P>0.05). There were significant differences in AOFAS score and the first metatarsal length shortening at immediate after operation and at last follow-up between 2 groups (P<0.05). Except 1 case of metastatic metatarsalgia in group B, there was no other operative complications in both groups.Conclusion3D printed navigation template assisted Ludloff osteotomy can provide accurate preoperative planning and intraoperative osteotomy. It is an ideal method for moderate and severe hallux valgus.
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.
ObjectiveTo explore the effectiveness of the procedure of reconstructing the transverse arch of the forefoot by anastomosing adductor hallucis and abductor hallucis tendons in correcting hallux valgus. MethodsA retrospective analysis was made on the clinical data from 28 patients (40 feet) with hallux valgus treated with the procedure of reconstructing the transverse arch of the forefoot by anastomosing adductor hallucis and abductor hallucis tendons between January 2010 and January 2014. There were 3 males (6 feet) and 25 females (34 feet), with an average age of 51.7 years (range, 20-71 years). The unilateral foot was involved in 16 cases and bilateral feet in 12 cases. The mean disease duration was 8.9 years (range, 1-30 years). All the cases had pain of the first metacarpophalangeal joint; 22 feet had collapsed transverse arch of the forefoot combined with plantar callus, and 8 feet had collapsed transverse arch of the forefoot combined with hammer toe deformity. American Orthopaedic Foot and Ankle Society (AOFAS) score was 59.07±8.49. Preoperative X-ray showed that the hallux valgus angle (HVA) was (33.68±8.10)°, and the intermetatarsal angle (IMA) was (15.60±4.07)°. According to classification of the hallux valgus by Mann, 9 feet were rated as mild, 23 feet as moderate, and 8 feet as severe. ResultsSuperficial infection of incision occurred in 1 case (1 foot) after surgery, and healing by first intention was obtained in the others. Two cases (3 feet) had numbness in the toes. All of 28 cases were followed up from 6 months to 4 years (1.8 years on average). Based on the AOFAS score, the results were excellent in 24 feet, good in 9 feet, fair in 4 feet, and poor in 3 feet, and the excellent and good rate was 82.5%. At last follow-up, the HVA, IMA, and AOFAS score were (15.10±5.28)°, (9.05±2.42)°, and 86.03±7.45 respectively, showing significant differences compared with preoperative ones (P=0.00). The collapsed transverse arch of the forefoot was recovered to some extent, plantar callus disappeared (14 feet), or decreased (8 feet). Recurrence of hallux valgus deformity was observed in 2 cases (3 feet) at 2 and 3 months after surgery respectively, and no hallux varus was found. ConclusionThis procedure not only can effectively reduce the increased hallux valgus angle, and narrow the angle between the 1st and 2nd metatarsal, but also can relocate the sesamoid system, reconstruct the transverse arch of the forefoot, and effectively restore the physiological anatomy structure and biological function of the forefoot.
Objective To explore an effective micro-traumatechnic with small incision for hallux valgus. Methods From August 2002 to June 2004, 136 cases (263 feet) with hallux valgus were treated with micro-trauma technic with small incision and postoperative external elastic fixation. Of all the cases, 7 were males and 129 werefemales. Their ages ranged from 19 to 84 years. According to Coughlin classification, there were 24 gentle cases, 63 medium cases, and 49 severe cases. All the feet were with some degree of pain and flatfoot. Symptom, sign and theresults of X-ray were evaluated. Results Wound healed at stage Ⅰ.All cases were followed up for 8 to 26 months, 19 months on average. Hallux valgus of the 263 feet were completely healed, feet pain disappeared, and no nonunion or osteonecrosis was observed. Xray examination indicated that 105 feet’s hallux valgus angle was less than 12°, inter metatarsal angle less than 9°, and remedy subluxation of the tibial sesamoid less than 50%. Evaluation on the result indicated that there were 84 cases of excellent result, 48 cases of good result, 3 cases of fair result, and 1 case of poor result. The rate of excellent and good was 97%. Conclusion With less injury, less pain, complete restoration, and fewer possibility of relapse, microtrauma technic with small incision is effective in treating hallux valgus.
Objective To evaluate the effectiveness of Scarf osteotomy combined with Akin osteotomy in the treatment of moderate to severe hallux valgus with absorbable screws or metal screws fixation by clinical and radiological data. Methods Between March 2014 and May 2016, the Scarf osteotomy combined with Akin osteotomy was used to treat 62 patients (83 feet) with moderate to severe hallux valgus. Twenty-five patients (35 feet) were fixed by absorbable screws (group A) and 37 patients (48 feet) were fixed by metal screws (group B). The difference in gender, age, affected side, etiology, severity, disease duration, preoperative hallux valgus angle (HVA) and first-second intermetatarsal angle (1-2IMA) measured in weight-bearing anteroposterior X-ray film, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and visual analogue scale (VAS) scores between 2 groups (P>0.05). The complications and healing time of 2 groups were recorded and compared. At last follow-up, the AOFAS and VAS scores, and HVA, 1-2IMA measured by weight-bearing anteroposterior X-ray film were used to evaluate the effectiveness. Results All incisions healed by first intention and no incision-related complication occurred in the two groups after operation. Both groups were followed up, the follow-up time in group A was 12-36 months (mean, 24.4 months) and in group B was 14-38 months (mean, 25.7 months). In group A, 1 foot was complicated with hallux varus, 2 feet had mild stiffness, 1 foot appeared metastatic metatarsal pain, and in group B was 2, 3, 2 feet, respectively. There was no recurrence of hallux valgus in both groups. The difference in the incidence of complications between the two groups after the first operation was not significant (χ2=0.275, P=0.843). The removal rate of internal fixator in group B was 89.2% (33 cases) during the second operation, among which 3 cases had screw slip and 1 case had screw fracture. And 10.8% (4 cases) refused the second removal operation due to their age. Postoperative X-ray films showed that both groups had good healing at the osteotomy site, and there was no significant difference in healing time between the two groups (t=1.633, P=0.285). At last follow-up, the AOFAS score, VAS score, HVA, and 1-2IMA were significantly improved in the two groups when compared with preoperative ones (P<0.05); but no significant difference was found between the two groups (P>0.05). Conclusion The effectiveness of Scarf osteotomy combined with Akin osteotomy in the treatment of moderate to severe hallux valgus is significant, with few complications. Compared with being fixed by metal screws, being fixed by absorbable screws has the same effectiveness, but can avoid the risk of second operation to remove the internal fixator.
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.
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. ResultsThe 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.
ObjectiveTo investigate the effectiveness of Youngswick-Akin osteotomy in the treatment of moderate hallux valgus combined with mild to moderate hallux rigidus. Methods The clinical data of 43 patients with moderate hallux valgus combined with mild to moderate hallux rigidus who were admitted between August 2019 and August 2022 and met the selection criteria were retrospectively analyzed. There were 8 males and 35 females. The age ranged from 28 to 77 years, with an average age of 59.0 years. The disease duration ranged from 10 to 35 months, with an average of 20 months. The degree of hallux rigidus included 2 cases of Ⅰ degree, 29 cases of Ⅱ degree, 12 cases of Ⅲ degree. The preoperative hallux valgus angle ranged from 25° to 40°, with an average of 32°. All patients were treated with Youngswick-Akin osteotomy. The first metatarsophalangeal joint space was compared before operation and at 6 months after operation. The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were used to evaluate the functional recovery and pain relief of the patients before operation and at 6 and 24 months after operation. According to the severity of hallux rigidus, the patients were divided into mild group (Ⅰ, Ⅱ degree) and moderate group (Ⅲ degree) to compare the prognosis, including the changes of AOFAS score, VAS score, and the first metatarsophalangeal joint space before and after operation. Results The operation time was 60-75 minutes (mean, 65 minutes). The intraoperative blood loss was 10-30 mL (mean, 20 mL). Two cases had superficial infection of the incision margin after operation, and healed well after incision dressing change and antibiotic treatment. The incisions of the other patients healed by first intention, and no medial cutaneous nerve injury of the great toe occurred. All patients were followed up 24-31 months, with an average of 25.8 months. The patient’s hallux valgus deformity was corrected without recurrence; no complication such as osteomyelitis and hallux varus occurred. The AOFAS score, VAS score, and the first metatarsophalangeal joint space after operation significantly improved when compared with those before operation, the AOFAS score and VAS score at 24 months after operation further improved when compared with those at 6 months after operation, and the differences were significant (P<0.05). The change of VAS score in patients with moderate hallux stiffness was significantly better than that in moderate group (P<0.05); but there was no significant difference in the changes of AOFAS score and the first metatarsophalangeal joint space between the two groups (P>0.05).ConclusionYoungswick-Akin osteotomy for moderate valgus deformity with mild to moderate hallux rigidus can achieve good functional recovery, pain relief, and joint space improvement.