scholarly journals Radiographic Analysis Between Two Commonly Used Measurements for Hallux Valgus Interphalangeus

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0027
Author(s):  
Caroline Lever ◽  
Graham Millward ◽  
Lyndon Mason ◽  
Andrew Molloy
Keyword(s):  
Hallux Valgus ◽  
Interobserver Agreement ◽  
Proximal Phalanx ◽  
Side Length ◽  
Single Measure ◽  
Post Surgery ◽  
Hallux Valgus Interphalangeus ◽  
Ap Weight ◽  
Akin Osteotomy ◽  
The Mean

Category: Bunion Introduction/Purpose: There is an increasing recognition of the contribution of hallux valgus interphalangeus (HVI) to the total deformity seen in hallux vallux valgus. The most commonly assessed radiological parameter is the hallux interphalangeus angle (HIA). Our aim in this study was to assess the reliability of the difference in medial and lateral proximal phalanx wall length (delta PP) in the assessment of hallux valgus interphalangeus in both the pre-operative and post-operative radiographs compared with the HIA. Methods: All patients undergoing scarf osteotomy for hallux valgus correction at our institution over a nine-month period were included. 40 feet in 36 patients were evaluated. Standard AP weight bearing radiographs preoperative and at 6 weeks post-surgery were evaluated by 2 independent observers. The standard PACS angular measurement tools were used for all measurements. The HIA and delta PP were measured along with hallux valgus angle (HVA) and intermetatarsal angle (IMA). Delta PP was calculated as the medial side length of the medial proximal phalanx minus the lateral side length of the proximal phalanx. SPSS 21 was used for statistical evaluation. Two-way random single measure intra-class correlation coefficient (ICC) was calculated to assess the interobserver agreement. Results: 33 female and 3 male patients were assessed. The mean age was 58 years (range 26-80 years). 18 patients underwent an Akin osteotomy. Pre-operative mean HVA 33 degrees, IMA 15 degrees, HIA 4 degrees and delta PP 1.64 mm. Post-operative mean HVA 17 degrees, IMA 9 degrees, HIA 7 degrees and delta PP 1.03 mm. In the sub group that underwent an Akin osteotomy the HIA increased from 5.2 degrees to 8.8 degrees in contrast to the delta PP that reduced from 2.04 to 0.26 mm. Pre-operatively the inter observer agreement using ICC was HVA 0.74, IMA 0.82, HIA 0.65 and Delta PP 0.70. Postoperatively the interobserver agreement was HVA 0.71, IMA 0.55, HIA 0.57 and Delta PP 0.64. Conclusion: The delta PP was more reliable than the HIA, with an improved interclass agreement on both pre and post- operative radiographs. The mean post-operative HIA increased, this was also present in the group where an akin osteotomy had been performed. In contrast the delta PP reduced. We feel pronation of the toe may alter the radiographic measures for HVI assessment and affect the validity of the HIA measurements, however the delta PP reliability was less affected. Pre-operative radiographs had greater interobserver agreement across all measures than postoperative radiographs, which may reflect difficulties in determining the bony landmarks for measurement following surgery.

Correction of Hallux Valgus Interphalangeus With an Osteotomy of the Distal End of the Proximal Phalanx (Distal Akin Osteotomy)

2016 ◽  
Vol 38 (2) ◽  
pp. 153-158 ◽  
Author(s):  
Robert Vander Griend
Keyword(s):  
Hallux Valgus ◽  
Proximal Phalanx ◽  
Case Series ◽  
Wedge Osteotomy ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Intraoperative Complication ◽  
Hallux Valgus Interphalangeus ◽  
Akin Osteotomy

Background: Operative correction of a symptomatic hallux valgus interphalangeus (HVI) deformity is often achieved with an osteotomy at the proximal end of the proximal phalanx (Akin osteotomy). However, the apex of the typical HVI deformity (center of rotation angle) is at the interphalangeal joint of the hallux. This study was done to evaluate the results of performing a medial closing wedge osteotomy at the distal end of the proximal phalanx. Methods: Thirty-three patients (33 feet) underwent an osteotomy at the distal end of the proximal phalanx for correction of HVI. All of the patients had other forefoot deformities which were corrected at the same time. Eight of these were revision procedures of prior forefoot operations. The length of follow-up was determined by the associated procedures with a minimum follow-up of 4 months. Results: The preoperative hallux valgus interphalangeus angle averaged 16 degrees of valgus (range 7-32 degrees) and was corrected to an average of 2 degrees of valgus (range 5 degrees valgus to 5 degrees varus). All of the patients were satisfied with the postoperative appearance and function of the first toe. Because of simultaneous correction of numerous other forefoot problems, it was not possible to specifically isolate or evaluate the effects and benefits of this osteotomy using outcomes measures. There was one intraoperative complication resulting in a fracture extending into the adjacent IP joint. Conclusions: Correction of an HVI deformity can be achieved with an osteotomy at the distal end of the proximal phalanx. This was a safe technique with few complications and with good results in terms of both correction and patient satisfaction. Level of Evidence: Level IV, retrospective case series.

scholarly journals Z-osteotomy in hallux valgus: clinical and radiological outcome after Scarf osteotomy

2009 ◽  
Vol 1 (1) ◽  
pp. 4 ◽  
Author(s):  
Marcus Jaeger ◽  
Michael Schmidt ◽  
Alexander Wild ◽  
Bernd Bittersohl ◽  
Susanne Courtois ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Mean Value ◽  
Surgical Approaches ◽  
Radiological Outcome ◽  
Scarf Osteotomy ◽  
Post Surgery ◽  
The Mean

Correction osteotomies of the first metatarsal are common surgical approaches in treating hallux valgus deformities whereas the Scarf osteotomy has gained popularity. The purpose of this study was to analyze short- and mid-term results in hallux valgus patients who underwent a Scarf osteotomy. The subjective and radiological outcome of 131 Scarf osteotomies (106 hallux valgus patients, mean age: 57.5 years, range: 22-90 years) were retrospectively analyzed. Mean follow-up was 22.4 months (range: 6 months-5 years). Surgical indications were: intermetatarsal angle (IMA) of 12-23°; increased proximal articular angle (PAA>8°), and range of motion of the metatarsophalangeal joint in flexion and extension >40°. Exclusion criteria were severe osteoporosis and/or osteoarthritis. The mean subjective range of motion (ROM) of the great toe post-surgery was 0.8±1.73 points (0: full ROM, 10: total stiffness). The mean subjective cosmetic result was 2.7±2.7 points (0: excellent, 10: poor). The overall post-operative patient satisfaction with the result was high (2.1±2.5 points (0: excellent, 10: poor). The mean hallux valgus angle improvement was 16.6° (pre-operative mean value: 37.5°) which was statistically significant (p<0.01). The IMA improved by an average of 5.96° from a pre-operative mean value of 15.4° (p<0.01). Neither osteonecrosis of the distal fragment nor peri-operative fractures were noted during the follow-up. In keeping with our follow-up results, the Scarf osteotomy approach shows potential in the therapy of hallux valgus. 筻

scholarly journals Treatment of Moderate Hallux Valgus by Percutaneous, Extra-articular Reverse-l Chevron (PERC) Osteotomy

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Julien Lucas ◽  
Olivier Laffenetre
Keyword(s):  
Hallux Valgus ◽  
Proximal Phalanx ◽  
Subjective Rating ◽  
Outpatient Basis ◽  
Range Of Movement ◽  
Aofas Score ◽  
First Metatarsophalangeal Joint ◽  
Chevron Osteotomy ◽  
The Mean

Category: Midfoot/Forefoot Introduction/Purpose: The purpose of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a Percutaneous Extra-articular Reverse-L Chevron (PERC) osteotomy. Methods: A total of 38 patients underwent 45 PERC procedures. A medial approach is used just proximal to the flare of the metatarsal head. The osteotomy is performed using a burr, the thickness of which is selected according to the planned correction and shortening. A second dorsolateral approach is then performed and the osteotomy is fixed using a self-drilling, self-tapping 3 mm diameter cannulated and headless compression screw. There were 35 women and three men. The mean age of the patients was 48 years (17 to 69). An additional percutaneous Akin osteotomy was performed in 37 feet and percutaneous lateral capsular release was performed in 22 feet. Clinical and radiological assessments included the type of forefoot, range of movement, the American Orthopedic Foot and Ankle (AOFAS) score, a subjective rating and radiological parameters. The mean follow-up was 59.1 months (45.9 to 75.2). No patients were lost to follow-up. Results: The mean AOFAS score increased from 62.5 (30 to 80) pre-operatively to 97.1 (75 to 100) post-operatively. A total of 37 patients (97%) were satisfied. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and the proximal articular set angle. The range of movement of the first metatarsophalangeal joint improved significantly. There was more improvement in the range of movement in patients who had fixation of the osteotomy of the proximal phalanx. Conclusion: Preliminary results of this percutaneous approach are promising. This technique is reliable and reproducible. The PERC osteotomy procedure is an effective approach for surgical management of moderate hallux valgus which combines the benefits of percutaneous surgery with the versatility of the chevron osteotomy. Its main asset is that it maintains an excellent range of movement; other advantages relate to the procedure being performed on an outpatient basis and the absence of tourniquet use.

scholarly journals Distal Linear Metatarsal Osteotomy Combined with Akin Osteotomy for Hallux Valgus with Hallux Valgus Interphalangeus

2019 ◽  
Vol 13 (1) ◽  
pp. 34-41
Author(s):  
Kazuki Kanazawa ◽  
Ichiro Yoshimura ◽  
Tomonobu Hagio ◽  
Takuaki Yamamoto
Keyword(s):  
Hallux Valgus ◽  
Metatarsal Head ◽  
Clinical Results ◽  
Osteotomy Site ◽  
Metatarsal Osteotomy ◽  
Intermetatarsal Angle ◽  
Hallux Valgus Interphalangeus ◽  
Valgus Angle ◽  
Akin Osteotomy

Background: Minimally invasive distal linear metatarsal osteotomy is commonly performed to correct mild-to-moderate hallux valgus. The technique is easy to perform, fast, and has a low complication rate with satisfactory clinical results. However, it has so far not been applied to hallux valgus with concomitant hallux valgus interphalangeus deformity. Objective: We aimed to investigate the short-term clinical results of distal linear metatarsal osteotomy combined with Akin osteotomy in hallux valgus with concomitant hallux valgus interphalangeus deformity. Methods: We retrospectively reviewed 10 patients (10 feet) who underwent surgery for hallux valgus with hallux valgus interphalangeus between 2012 and 2016. Akin osteotomy was performed and fixated with a screw/K-wire, followed by distal linear metatarsal osteotomy and K-wire fixation. Clinical evaluations pre- and postoperatively used the Japan Society for Surgery of the Foot (JSSF) scale and the Visual Analog Scale (VAS). Radiography pre-and postoperatively assessed the hallux valgus, hallux valgus interphalangeus, and the intermetatarsal angle. Results: The mean follow-up period was 20.2 months. Both the JSSF and VAS score improved significantly, from 64.5 to 90.0 and from 5.5 to 1.1, respectively. In all patients, bone healing was complete within four months with no osteonecrosis of the metatarsal head or malunion at the osteotomy site. The hallux valgus angle improved from 31.5° to 7.7°, the hallux valgus interphalangeus angle from 17.2° to 5.8°, and the intermetatarsal angle from 11.7° to 5.5°. Conclusion: Distal linear metatarsal osteotomy combined with Akin osteotomy safely and effectively corrects mild-to-moderate hallux valgus with hallux valgus interphalangeus deformity.

scholarly journals Akin osteotomy as an adjunct to hallux MTPJ fusion

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Devendra Damany ◽  
Ramesh Dalwai
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Proximal Phalanx ◽  
Plaster Cast ◽  
Lateral Border ◽  
Valgus Angle ◽  
Akin Osteotomy ◽  
Screw Position ◽  
Second Toe ◽  
Metaphyseal Region

Category: Midfoot/Forefoot, Hallux MTP fusion Introduction/Purpose: It is not uncommon to note residual valgus at the hallux interphalangeal joint when performing a hallux MTPJ fusion. On occasion, despite optimum positioning of hallux MTPJ for fusion, we found that in some cases the hallux was still abutting the second toe. We noted that these cases had either a high hallux interphalangeus valgus angle or the proximal phalanx had a shorter, concave lateral border due to eccentric wear. These two variables were difficult to correct despite optimum positioning of the hallux MTPJ. Consequently the hallux abuts the second toe causing irritation. We have used Akin osteotomy as an adjunct to hallux MTPJ fusion to address this intraoperative problem Methods: Between 2013 to 2016 this technique was utilised in 16 patients in whom residual hallux valgus interphalangeus was noted once the hallux MTPJ was stabilised in the appropriate position. We used two 4.0 mm AO cannulated partially threaded screws inserted in a crossed configuration for MTPJ fusion and a 8 mm x 90 degree varisation staple for the Akin osteotomy. The Akin osteotomy was performed in the mid to distal diaphyseal region of the proximal phalanx to avoid the screw position. Postoperatively, patients were given a toe spica plaster cast and were advised to walk in a heel weight bearing wedge shoe for six weeks. Results: Despite the osteotomy not being in the metaphyseal region, we have not encountered any immediate post-operative complications. We accept that this technique may not be suitable when using plates and screws for fusion but would be suitable for use with screws or staples. We have not encountered any postoperative complications. All hallux MTPJ joints have fused and Akin osteotomies have healed uneventfully Conclusion: This technique has not been reported before. Akin osteotomy is commonly used as an adjunct to corrective hallux valgus surgery. It is a relatively quick and reproducible technique with minimal incidence of complications. We suggest that this technique be considered when carrying out a hallux MTPJ fusion, although may not be required in all cases.

scholarly journals Improvement of Valgus Deviation of the Lesser Toes of Moderate to Severe Hallux Valgus After Proximal Chevron Metatarsal Osteotomy and Akin Osteotomy

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0027
Author(s):  
Hong-Geun Jung ◽  
Hwa Jun Kang ◽  
Juan Agustin Coruna
Keyword(s):  
Hallux Valgus ◽  
Metatarsal Osteotomy ◽  
Metatarsal Angle ◽  
Valgus Angle ◽  
Significant Difference ◽  
Akin Osteotomy ◽  
The Mean ◽  
Severe Hallux Valgus ◽  
Mtp Joints

Category: Lesser Toes Introduction/Purpose: The valgus deviation of lesser toes is often found in the hallux valgus patients. It has been known that valgus deviation of lesser toes remain unchanged even after correction of hallux valgus. The purpose of this study was to determine whether valgus deviation of lesser toes can be corrected after proximal chevron metatarsal osteotomy (PCMO) and Akin osteotomy for the hallux valgus patients, and to evaluate the factors affecting the degree of correction. Methods: The study is based on 116 feet (89 patients) of moderate to severe hallux valgus that underwent proximal chevron metatarsal osteotomy with Akin ostetomy. Hallux valgus angle (HVA), inter-metatarsal angle (IMA), valgus angle of 2nd, 3 rd, 4th metatarso-phalangeal joint were assessed preoperatively and postoperative 6 month, 1 year and yearly. VAS pain cores, American Orthopedic Foot and Ankle Society metatarsophalangeal-interphalangeal (AOFAS MTP-IP) scale and patient satisfaction were evaluated preoperatively and at subsequent follow-up. Results: The average follow-up was 30.6 months (range,12-99). The mean HVA and IMA reduced from 34.4° to 8.7° and 15.9° to 5.3° respectively at the final follow-up. Patients with more severe HVA showed higher degree of valgus deviation of lesser toes than those with lesser HVA. The valgus angle of 2nd,3 rd,4th MTP joints reduced from 8.9°, 6.7°, 2.4° preoperatively to 5.6°, 4.9°, 1.3° respectively at the final follow-up (p<0.05). The more HVA corrected, the more valgus deviation of lesser toe was found corrected. There was no significant difference in the degree of lesser toe correction angle according to follow up period after postoperative 1 year. The mean VAS and AOFAS scores significantly improved from 6.0, 60.9 to 1.2, 92.0 at the final follow-up, respectively (P<0.05). Conclusion: Unlike the previous reports, the current study showed significant reduction of the valgus angle of 2nd, 3 rd, 4th MTP joints after PCMO and Akin osteotomy for the moderate to severe HV without additional corrective lesser toe surgery.

Distal akin osteotomy for hallux valgus interphalangeus

2017 ◽  
Vol 23 ◽  
pp. 88
Author(s):  
E. Sartorelli ◽  
T. Giacalone ◽  
C. Bonifacino ◽  
M. Hosseinzadeh ◽  
A. Bianchi ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Hallux Valgus Interphalangeus ◽  
Akin Osteotomy

Hallux Varus Interphalangeus Following Osteochondral Fracture of the Proximal Phalanx: A Case Report

2020 ◽  
Vol 110 (5) ◽  
Author(s):  
Calvin J. Rushing ◽  
Tarak Amin ◽  
Alberto Herrada ◽  
Steven M. Spinner
Keyword(s):  
Case Report ◽  
Hallux Valgus ◽  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
First Metatarsophalangeal Joint ◽  
Osteochondral Fracture ◽  
Medial Head ◽  
Hallux Varus ◽  
Hallux Valgus Interphalangeus ◽  
Joint Fusion

Hallux valgus interphalangeus deformity has been previously reported in the literature following trauma and first metatarsophalangeal joint fusion. However, to the best of our knowledge, hallux varus interphalangeus deformity has not been previously reported. We present the case of a 26-year-old skeletally mature woman who sustained an acute, open hallux varus interphalangeus injury following an osteochondral fracture of the medial head of the proximal phalanx.

scholarly journals Management of Juvenile Hallux Valgus Deformity: the role of combined Hemiepiphysiodesis

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Ming-Hung Chiang ◽  
Ting-Ming Wang ◽  
Ken N. Kuo ◽  
Shier-Chieg Huang ◽  
Kuan-Wen Wu
Keyword(s):  
Hallux Valgus ◽  
Skeletal Maturity ◽  
Proximal Phalanx ◽  
Case Series ◽  
Large Degree ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Hallux Valgus Deformity ◽  
The Mean

Abstract Background This study aimed to investigate the efficacy of percutaneous hemiepiphysiodesis for gradual correction of symptomatic juvenile hallux valgus (HV) deformity. Methods Between 2012 to 2014, 24 patients with symptomatic juvenile HV were treated by combined percutaneous medial drilling hemiepiphysiodesis of the first proximal phalanx and lateral transphyseal screw hemiepiphysiodesis of the first metatarsal at our institution. Twenty-one of 24 patients fulfilled inclusion criteria had a complete radiological and clinical follow-up of at least 2 years. Preoperative and postoperative radiographs of the feet were reviewed for measurements of hallux valgus angle (HVA), intermetatarsal angle (IMA), proximal metatarsal articular angle (PMAA), proximal phalangeal articular angle (PPAA), and metatarsal length ratio (MTLR). Clinical outcomes were assessed using the AOFAS hallux metatarsophalangeal-interphalangeal score. Results The study included 21 consecutive patients (37 ft) for analysis. The mean age at surgery was 12.0 years (SD = 1.3) and mean follow-up after surgery was 35.1 months (SD = 6.0). With the data available, the HV deformity improved in terms of the reduction of HVA by a mean of 4.7 degrees (P < .001) and the reduction of IMA by 2.2 degrees (P < .001). The PMAA and PPAA also improved significantly in the anteroposterior plane; however, the PMAA difference was insignificant in lateral plane as expected. The mean difference in the MTLR was 0.00 (P = .216) which was indicative of no length discrepancy between first and second metatarsals. The AOFAS score increased from 68.7 to 85.2 (P < .001). In correlation analysis, time to physeal closure was significantly correlated with the final HVA change (r = −.611, P = .003). Conclusion Although combined hemiepiphysiodesis does not create a large degree of correction as osteotomy, yet it did improve HV deformity with adequate growth remaining in our series. It is a procedure that can be of benefit to patients with symptomatic juvenile HV from this minimal operative approach before skeletal maturity. Level of evidence Level IV, retrospective case series.

scholarly journals Intra-articular fracture of proximal phalanx of great toe accompanied by valgus deformity associated with sports activities

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901769032
Author(s):  
Sungsoo Kim ◽  
Myoungjin Lee ◽  
Sangyun Seok
Keyword(s):  
Hallux Valgus ◽  
Proximal Phalanx ◽  
Valgus Deformity ◽  
Lateral Side ◽  
Great Toe ◽  
Fracture Group ◽  
Articular Fracture ◽  
Medial Side ◽  
Hallux Valgus Interphalangeus ◽  
Sports Activities

Background: We analyzed clinical and radiologic examination of intra-articular fracture of the proximal phalanx of great toe accompanied by valgus deformity associated with sports activities. Therefore, we assessed valgus deformity of great toe at fracture side and contralateral side by simple radiograph in order to confirm the causal relation of fracture and deformity. Methods: A retrospective study was conducted on 23 cases, between January 2000 and August 2014, which showed an intra-articular fracture of proximal phalanx which was diagnosed after visiting our hospital for valgus deformity of great toe as a chief complaint. All patients were involved in sports activities for over 2 years. The site of fracture was the lateral side of the proximal phalanx head in 16 cases and the medial side of the proximal phalanx base in 7 cases. In order to assess the valgus deformity of great toe, hallux valgus angle (HVA) and hallux valgus interphalangeal angle (HVIPA) were measured on the weight-bearing foot radiograph. Results: The average HVA of the fracture group on the lateral side of the proximal phalanx head was 10.5° and HVIPA was 17.8°, while the average HVA of the fracture group on the medial side of the proximal phalanx base was 18.1° and HVIPA was 10.7°. Among the 16 cases with a fracture on the lateral side of the head, 13 cases showed hallux valgus interphalangeus (81.3%), while all 7 cases of fracture on the medial side of the base showed hallux valgus (100%). Conclusion: Hallux valgus was mostly found on the fracture of the medial side of the proximal phalanx base, while hallux valgus interphalangeus was mostly found on the fracture of the lateral side of the proximal phalanx head.

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