[11. Hallux valgus. b). 10-year results after Hohmann's operation in hallux valgus].
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Adolescent↗
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Results for “HALLUX VALGUS”
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[11. Hallux valgus. a). 10-year results of Lelièvre's operation for hallux valgus (author's transl)].
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Follow-Up Studies↗
Radiographic validation of the Manchester scale for the classification of hallux valgus deformity.
OBJECTIVES: Hallux valgus is a common orthopaedic condition affecting elderly people. Grading the severity of the condition commonly involves obtaining measurements from radiographs, which may not be feasible or necessary in some clinical or research settings. Recently, a non-invasive clinical assessment tool (the Manchester scale), consisting of four standardized photographs, has been developed; however, its validity has not yet been determined. Therefore, the objective of this study was to determine the validity of this tool by correlating Manchester scale scores with hallux valgus measurements obtained from radiographs. METHODS: Weight-bearing dorsoplantar foot radiographs were obtained from 95 subjects (31 men and 64 women) aged 62-94 yr (mean 78.6, s.d. 6.5), and measurements of the hallux abductus angle, intermetatarsal angle and hallux interphalangeal adbuctus angle were performed. These measurements were then correlated with the Manchester scale scores (none, mild, moderate or severe). RESULTS: The Manchester scale score was highly correlated with hallux abductus angle (Spearman's rho = 0.73, P<0.01) and moderately associated with intermetatarsal angle (rho = 0.49, P<0.01) measurements obtained from radiographs. Analysis of variance revealed significant differences in mean hallux abductus angles [F3 = 119.99, P<0.001] and intermetatarsal angles [F3 =29.56, P<0.001] between the four Manchester scale categories. CONCLUSIONS: These findings indicate that the Manchester scale provides a valid representation of the degree of hallux valgus deformity determined from radiographic measurement of hallux abductus angle and intermetatarsal angle. We therefore recommend the use of this instrument as a simple, non-invasive screening tool for clinical and research purposes.
Aged↗
Evaluation and operative procedures for hallux valgus deformity.
The hallux valgus deformity, or bunion deformity, is a common problem. Evaluation of the deformity for surgical intervention requires a knowledge of the basic pathomechanics of the medial displacement of the head out of the sesamoid complex with the associated deformity of the large toe and incompetency of the metatarsal cuneiform joint. The foot's relation to the leg and the body must be evaluated as well as the general condition of the patient, the age of the patient, and the expectations of the patient in regard to footwear and level of activity desired postoperatively. X-rays of the feet must be made in a consistent manner. The deformity should be classified as to the degree of severity. Operative procedures are grouped into the distal soft tissue procedures, metatarsal osteotomies, miscellaneous procedures, arthroplasty operations, and combinations of procedures. Indications and complications are presented. The procedures are discussed to provide an overview of surgical methods of treatment available for the hallux valgus deformity.
Hallux↗
[Hallux valgus: practical summary].
Hallux valgus arises from static and dynamic unbalance of the forefoot. Possibilities of conservative treatment are limited. This paper recalls the essentials of physiopathology and exposes briefly to the non-operators the most current amongst 150 operative techniques described. While becoming more complex, the surgery of hallux valgus has proven to gain efficiency. Surgical indication, based on biomechanics, should be very careful, which gives a greater interest to this discipline.
Biomechanical Phenomena↗
[Hallux valgus: which treatment].
Hallux valgus deformity is characterized by lateral deviation of the proximal phalanx on the metatarsal head. Variable severity of the deviation causes prominence of the medial eminence, giving rise to a painful bunion deformity. Many patients will find permanent or temporary relief with non surgical measures. For those who failed conservative treatment, surgery may cure their symptoms. However unsatisfactory outcomes following hallux valgus surgery is not rare. Therefore a clear understanding of the pathology and of the patient's expectations must anticipate any treatment strategy in order to optimise patient's outcome. Cosmetic considerations should never be an indication for surgery.
Bone Nails↗
Oblique displacement osteotomy according to Crawford adams for hallux valgus.
Correction of hallux valgus by oblique displacement osteotomy ad modum Crawford Adams was carried out in 54 cases, of which all but 3 were examined clinically and radiologically 1 year or more after the operation. The median age was 32 years. Seventy-eight per cent were satisfied with the operation, and 64 per cent were totally free of pain. A feeling of stiffness in the first metatarso-phalangeal joint and/or intermittent pain during walking was found in 22 per cent of the patients, all of whom were dissatisfied with the operation. Adams' osteotomy was found to give a satisfactory correction of the deformity of hallux valgus, but the length of the first metatarsal bone could not be maintained.
Adolescent↗
K-wire transfixation or distraction following the Keller-Brandes arthroplasty in Hallux rigidus and Hallux valgus?
A total of 118 feet with Hallux valgus and Hallux rigidus treated by the Keller-Brandes method were re-examined clinically and radiologically after 9.1 years (range: 1.7-24.3). Correction of the Hallux valgus angle was obtained from an average of 40 degrees to 23 degrees in the Hallux valgus group. Improvement in the postoperative range of motion was observed when the aftertreatment consisted of Kirschner-wire distraction instead of an axial Kirschner-wire transfixation. The patients who underwent Keller-Brandes surgery for Hallux valgus had less pain when the aftertreatment was carried out using an axial Kirschner wire, while those operated on for Hallux rigidus had less pain when the aftertreatment consisted of distraction. The percentage of satisfied or very satisfied patients with the cosmetic results of the Keller-Brandes arthroplasty was more than 66.7%. Patients with Hallux valgus and postoperative aftertreatment with Kirschner wire transfixation were the most satisfied patients, while patients with Hallux rigidus were very satisfied with the postoperative distraction. Our good results are comparable to those in other studies and confirm the success of the Keller-Brandes resection arthroplasty in Hallux valgus with osteoarthritis of the first metatarsophalangeal joint in older patients whose demand for movement is less, and in Hallux rigidus in less active older patients.
Arthralgia↗
[Congenital hallux valgus].
Congenital hallux varus is a rare deformity. The authors discuss 3 clinical cases observed and define the specific features of the anomaly. The clinical and radiographic pictures are described, emphasising essential aspects and possible variations, including the rare occurrence of congenital varus of a single interphalangeal joint. Differential diagnosis is discussed and surgical indications determined.
Child, Preschool↗
Interventions for treating hallux valgus (abductovalgus) and bunions.
BACKGROUND: Hallux valgus is classified as an abnormal deviation of the great toe (hallux) towards the midline of the foot. OBJECTIVES: To identify and evaluate the evidence from randomised trials of interventions used to correct hallux valgus. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register (2003/1), the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2003), MEDLINE (January 1966 to March 2003) and EMBASE (1980 to January 2003). No language restrictions were applied. Hand searching of specific foot journals was also undertaken. Date of the most recent search: 31st March 2003. SELECTION CRITERIA: Randomised or quasi-randomised trials of both conservative and surgical treatments of hallux valgus. Excluded were studies comparing areas of surgery not specific to the control of the deformity such as use of anaesthetics or tourniquet placement. DATA COLLECTION AND ANALYSIS: Methodological quality of trials which met the inclusion criteria was independently assessed by two reviewers. Data extraction was undertaken by two reviewers. The trials were grouped according to the interventions being compared, but the dissimilarity in the comparisons prevented pooling of results. MAIN RESULTS: The methodological quality of the 21 included trials was generally poor and trial sizes were small. Three trials involving 332 participants evaluated conservative treatments versus no treatment. There was no evidence of a difference in outcomes between treatment and no treatment. One good quality trial involving 140 participants compared surgery to conservative treatment. Evidence was shown of an improvement in all outcomes in patients receiving chevron osteotomy compared with those receiving orthoses. The same trial also compared surgery to no treatment in 140 participants. Evidence was shown of an improvement in all outcomes in patients receiving chevron osteotomy compared with those receiving no treatment. Two trials involving 133 people with hallux valgus compared Keller's arthroplasty with other surgical techniques. In general, there was no advantage or disadvantage using Keller's over the other techniques. When the distal osteotomy was compared to Keller's arthroplasty, the osteotomy showed evidence of improving the intermetatarsal angle and preserving joint range of motion. The arthroplasty was found to have less of an impact on walking ability compared to the arthrodesis. Six trials involving 309 participants compared chevron (and chevron-type) osteotomy with other techniques. The chevron osteotomy offered no advantages in these trials. For some outcomes, other techniques gave better results. Two of these trials (94 participants) compared a type of proximal osteotomy to a proximal chevron osteotomy and found no evidence of a difference in outcomes between techniques. Three trials involving 157 participants compared outcomes between original operations and surgeon's adaptations. There was no advantage found for any of the adaptations. Three trials involving 71 people with hallux valgus compared new methods of fixation to traditional methods. There was no evidence that the new methods of fixation were detrimental to the outcome of the patients. Four trials involving 162 participants evaluated methods of post-operative rehabilitation. The use of continuous passive motion appeared to give an improved range of motion and earlier recovery following surgery. Early weightbearing or the use of a crepe bandage were not found to be detrimental to final outcome. REVIEWER'S CONCLUSIONS: Only a few studies had considered conservative treatments. The evidence from these suggested that orthoses and night splints did not appear to be any more beneficial in improving outcomes than no treatment. Surgery (chevron osteotomy) was shown to be beneficial compared to orthoses or no treatment, but when compared to other osteotomies, no technique was shown to be superior to any other. Only one trial had compared an osteotomy to an arthroplasty. There was limited evidence to suggest that the osteotomy gat the osteotomy gave the better outcomes. It was notable that the numbers of participants in some trials remaining dissatisfied at follow-up were consistently high (25 to 33%), even when the hallux valgus angle and pain had improved. A few of the more recent trials used assessment scores that combine several aspects of the patients outcomes. These scoring systems are useful to the clinician when comparing techniques but are of dubious relevance to the patient if they do not address their main concern and such scoring systems are frequently unvalidated. Only one study simply asked the patient if they were better than before the treatment. Final outcomes were most frequently measured at one year, with a few trials maintaining follow-up for 3 years. Such time-scales are minimal given that the patients will be on their feet for at least another 20-30 years after treatment. Future research should include patient-focused outcomes, standardised assessment criteria and longer surveillance periods, more usefully in the region of 5-10 years.
Hallux Valgus↗
The Lapidus procedure as salvage after failed surgical treatment of hallux valgus. Surgical technique.
BACKGROUND: Recurrent hallux valgus is a relatively common, yet challenging, condition for both the patient and the surgeon. The literature on the treatment of recurrent hallux valgus is sparse. The purpose of this study was to evaluate prospectively the functional outcome and patient satisfaction following the Lapidus procedure for the treatment of recurrent hallux valgus deformity. METHODS: Twenty-four patients with a total of twenty-six symptomatic recurrences of hallux valgus after previous procedures for treatment of the deformity were included in the study. Exclusion criteria included prior fusion procedures on the foot or ankle, a previous Keller or Mayo procedure, insulin dependent diabetes, peripheral vascular disease, or peripheral neuropathy. A visual analog pain scale and the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale were administered preoperatively, at six months postoperatively, and yearly thereafter. Weight-bearing radiographs were also made preoperatively; at six weeks, three months, six months, and one year postoperatively; and yearly thereafter. Patient satisfaction was assessed at the latest follow-up evaluation. RESULTS: At twenty-four months, the mean score according to the American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale had increased from 47.6 to 87.9 points, the mean score according to the visual analog pain scale had improved from 6.2 to 1.4, the mean hallux valgus angle had improved from 37.1 degrees to 17.1 degrees, and the mean intermetatarsal angle had improved from 18 degrees to 8.6 degrees. The patients were very satisfied after 77% of the twenty-six procedures, satisfied after 4%, and somewhat satisfied after 19%; no patient was dissatisfied. There were no cases of hallux varus. Complications included three nonunions, all of which occurred in smokers, and two superficial wound infections. CONCLUSIONS: In appropriately selected patients, the Lapidus procedure is a reliable and effective operation after failed surgical treatment of hallux valgus.
Hallux Valgus↗
Muscle imbalance in hallux valgus: an electromyographic study.
OBJECTIVE: Hallux valgus is a very common foot deformity in modern societies. Muscle imbalance in abductor and adductor muscles was cited as a major factor in the production of hallux valgus. Our aim in this study was to evaluate the role of certain muscles in this deformity. DESIGN: Twenty hallux valgus patients and 20 healthy volunteers participated in the study. After thorough physical, neurologic, and radiographic investigations, we performed an electromyographic study to observe the relationship of hallux valgus deformity with the muscles coordinating first metatarsophalangeal joint movements. Voluntary extension, flexion, abduction, and adduction at the hallux with maximum resistance were performed. Firing rates and amplitudes of motor unit potentials of four muscles: musculus abductor hallucis, musculus adductor hallucis, musculus extensor hallucis longus, and musculus flexor hallucis brevis were recorded. Statistical analysis, including Spearman's correlation analysis and Mann-Whitney U tests were performed with SPSS 8.0 for Windows. RESULTS: We observed that in the hallux valgus group, abduction activity of musculus abductor hallucis was markedly decreased when compared with adduction of musculus adductor hallucis. Motor unit potential amplitude of abductor activity recorded from musculus abductor hallucis was slightly more than half of the activity in flexion. CONCLUSION: Muscle imbalance in abductor and adductor muscles is apparent in hallux valgus deformity, and this imbalance may be the reason or the result of joint deformity.
Adult↗
Interventions for treating hallux valgus (abductovalgus) and bunions.
BACKGROUND: Hallux valgus is classified as an abnormal deviation of the great toe (hallux) towards the midline of the foot. OBJECTIVES: To identify and evaluate the evidence from randomised trials of interventions used to correct hallux valgus. SEARCH STRATEGY: Medline (1966-October 1998), Embase (1980-1998), Cinahl (1982-1998), Amed (1993-1998), the Cochrane Controlled Trials Register, the Cochrane Musculoskeletal Injuries Trials Register and bibliographies of identified trials were searched. Hand searching of podiatry journals was undertaken. Date of the most recent search: October 1998. SELECTION CRITERIA: Randomised or quasi-randomised trials of both conservative and surgical treatments of hallux valgus. Excluded were studies comparing areas of surgery not specific to the control of the deformity such as use of anaesthetics or tourniquet placement. DATA COLLECTION AND ANALYSIS: Methodological quality of trials which met the inclusion criteria was independently assessed by two reviewers. Data extraction was undertaken by one reviewer and confirmed by another. The trials were grouped according to the interventions being compared, but the dissimilarity in the comparisons prevented pooling of results. MAIN RESULTS: The methodological quality of the 12 included trials was poor and trial sizes were small. Two trials involving 150 patients evaluated conservative treatments. There was no difference in outcomes between treatment and no treatment. Two trials involving 133 patients compared Keller's arthroplasty with other surgical techniques. In general, there was no advantage in using Keller's over the other techniques, particularly in terms of range of motion and intermetatarsal angle. Three trials involving 205 patients compared chevron (and chevron-type) osteotomy with other techniques. The chevron osteotomy offered no advantages in these trials. For some outcomes, other techniques gave better results. Three trials involving 157 patients compared outcomes between original operations and surgeon's adaptations. There was no advantage found for any of the adaptations. Two trials involving 95 patients evaluated methods of post-operative rehabilitation. The use of continuous passive motion appeared to give an improved range of motion and earlier recovery following surgery; early weightbearing was not found to be detrimental to final outcome. REVIEWER'S CONCLUSIONS: There is insufficient evidence from randomised trials to determine which methods of either conservative, operative or post-operative treatment are the most appropriate for the hallux valgus. It is notable that the numbers of patients remaining dissatisfied at follow-up were consistently high (25 to 33%), even when the hallux valgus angle and pain had improved. Assessment of future research should focus on evaluating basic intervention types in eligible patients with similar degrees of deformity. Future research should include patient-focused outcomes, standardised assessment criteria and longer surveillance periods.
Hallux Valgus↗
A radiographic study of the relationship between metatarsus adductus and hallux valgus.
The relationship between metatarsus adductus and hallux valgus was evaluated on 100 dorsoplantar weight-bearing radiographs. The metatarsus adductus angle varied positively with the degree of hallux valgus. By using measures of correlation, a significant linear association was found for women (r =.53, P <.001) and men (r =.48, P <.001). The relationship was strongest in women when all cases of abnormal metatarsus adductus (>24 degrees ) were associated with abnormal degrees of hallux valgus (>15 degrees ). This relationship was different in men in that abnormal metatarsus adductus angles were not always associated with abnormal hallux valgus angles. With male and female data combined, the prevalence of metatarsus adductus was 55% in subjects with hallux valgus deformity compared with 19% in subjects without hallux valgus. A Chi(2) test showed this to be a significant difference in the distribution of the data (P =.002). The data of this study suggests that there may be a clinical association between metatarsus adductus and hallux valgus. The need to further evaluate the role of metatarsus adductus angle in hallux valgus surgery is emphasized.
Adult↗
Associated deformities and hypermobility in hallux valgus: an investigation with weightbearing radiographs.
BACKGROUND: Hallux valgus has been reported to recur after surgical correction in patients subsequently diagnosed with hypermobility of the first ray, pronation of the foot, and pes planovalgus. An objective means of assessing the foot for these deformities preoperatively may avert a poor outcome. This investigation evaluated the efficacy of full-length weightbearing radiographs to recognize associated deformities in patients with hallux valgus before surgery. METHODS: This study compared five parameters from anteroposterior and four parameters from lateral weightbearing pedal radiographs of patients with moderate to severe hallux valgus to a control group to identify differences in the alignment of the midfoot and the first metatarsal-medial cuneiform joint. An examination for clinical evidence of hypermobility was also performed on both groups. RESULTS: The hallux valgus group demonstrated increased abduction and dorsiflexion of the midfoot. The mean talonavicular coverage angle and lateral talo-first metatarsal angle of this group was greater than the mean values for the controls. Radiographic evaluation also revealed differences in the alignment of the first metatarsal-medial cuneiform joint in the sagittal plane. The hallux valgus group possessed a mean of 2 mm of dorsal translation and 2 degrees of dorsiflexion at this joint compared to the controls. CONCLUSIONS: Weightbearing radiographs permit the recognition of associated malalignments of the foot in patients with hallux valgus. The comparisons performed in this study identified deformities consistent with pes planovalgus and hypermobility of the first ray in patients with moderate to severe hallux valgus. The results of our study support a recommendation for a thorough evaluation of full-length, biplanar weightbearing radiographs via the measurement of midfoot and first ray alignment for concomitant deformities of the foot in patients with hallux valgus.
Adolescent↗
Surgical correction of hallux valgus.
Surgical treatment of hallux valgus was carried out by a procedure which comprises lengthening of extensor tendons, interposition of a capsular flap, and attachment of the periosteocapsular cover with distributed tension in addition to the routine excision of a sufficiently large portion of the first phalanx and metatarsal head. Impairment of function and persistent pain were considered more important in the indication for operation of hallux valgus than the cosmetic demands. Of 142 patients operated upon, 117 patients displayed a satisfactory result applying morphologic and functional criteria.
Female↗
Salvage of complications of hallux valgus surgery.
Complications following hallux valgus surgery can occur and are a frequent source of patient dissatisfaction. The treatment of these complications begins with careful preoperative planning to ensure that the chosen procedure is appropriate for the specific patient. When complications occur, treatment must also be individualized to address the symptoms of the patient. This article presented an overview of the more common complications that are seen following hallux valgus surgery. Nonsurgical and surgical options for treatment were outlined to assist in the management of these complications.
Foot Deformities, Acquired↗
The Ludloff osteotomy for correction of hallux valgus.
OBJECTIVE: Correction of a symptomatic hallux valgus deformity. INDICATIONS: A hallux valgus deformity in which the intermetatarsal angle I-II exceeds 15 degrees and the shaft of the first metatarsal is broad enough to allow a rotational osteotomy. CONTRAINDICATIONS: Hypermobility of the first ray. Severe osteoporosis. Degenerative arthritis of the first metatarsophalangeal joint. SURGICAL TECHNIQUE: Longitudinal incision over the first intermetatarsal space. Division of the metatarsosesamoid ligament together with the tendon of the adductor hallucis muscle. Opening of the lateral articular capsule of the first metatarsophalangeal joint allowing a tension-free realignment of the head of the first metatarsal with the sesamoids. Medial longitudinal incision along the first metatarsal starting over the medial cuneiform bone and ending at the proximal phalanx of the great toe. Oblique osteotomy of the proximal two thirds of the first metatarsal in a proximal dorsal to distal plantar direction and lateral rotation of the distal fragment around a proximally placed 3-mm AO screw. Additional fixation with one BOLD screw. Trimming of the protruding bone and of bunion. Medial metatarsophalangeal capsulorraphy. RESULTS: Between September 1998 and October 1999, 76 feet underwent a Ludloff osteotomy. Patients were followed up clinically and radiographically for 36 months (24-56 months). The mean hallux valgus angle was reduced from 37 degrees to 14 degrees and the mean intermetatarsal angle I-II from 18 degrees to 9 degrees. Using a four-point scale 81% of the patients were satisfied or very satisfied with the result of the operation. 95% of them felt no or very mild pain.
Adult↗