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PubMed2004

The effect of forefoot varus on postural stability.

STUDY DESIGN: Counterbalanced experimental design study comparing a group of subjects with greater than or equal to 70 of forefoot varus (MFV) to a group with less than 70 of forefoot varus (LFV). OBJECTIVES: To investigate the effect of forefoot varus on single-limb stance postural stability (PS). BACKGROUND: Impaired PS has been implicated as a potential risk factor for sustaining acute foot and ankle injuries. The identification of variables that deleteriously affect PS may be important in the prevention of future injuries. METHODS AND MEASURES: Postural stability of the MFV group (n = 20) and the LFV group (n = 12) was assessed during right and left single-limb stance and eyes-open and eyes-closed conditions. Standard deviations of the x-axis and y-axis ground reaction forces measured via a force platform were used to represent anteroposterior (AP) and mediolateral (ML) PS, respectively. The mean of 3 successful 5-second trials of each testing condition was calculated and used for subsequent data analysis using 3-way mixed-model ANOVAs with 1 between-subject and 2 within-subject factors. RESULTS: The AP PS scores of the MFV group were significantly greater than those of the LFV group (P < .05). ML PS scores, although higher in the MFV group, were not significantly different from those of the LFV group. Both groups had significantly greater AP and ML PS scores during the eyes-closed versus the eyes-open condition (P < .05). CONCLUSIONS: The results suggest that the presence of greater than or equal to 70 of forefoot varus may significantly impair AP PS. The decreased stability associated with increased forefoot varus may be due to decreased joint congruity and consequently an increased reliance on soft tissue structures for stability.

Adult↗

PubMed1988

Development of a quantitative method for the evaluation of varus-angular bone deformity in chickens.

A quantitative technique was developed to measure the degree of flexion (twisting) and torsion (angulation) of the tibiotarsus bone from chickens affected with varus-angular bone deformity (varus-ABD). A plexiglass device was constructed consisting of X, Y, and Z-axis planes. The Y-axis plane was used to position the tibia in a constant reference position. The distance in millimeters from the (0, 0, 0) coordinate to the (X', 0, 0) coordinate was used to measure medial tibial flexion (TF), and the distance from the (0, 0, 5 cm) coordinate to the (X', 0, 5 cm) coordinate was used to measure lateral TF. The X-axis plane was fitted with a protractor to measure the angle of the proximal head of the tibia as a measure of tibial torsion (TT). The Z-axis plane was used to measure tibial length. Tibias with mild varus-ABD had TF values of greater than 0 but less than or equal to 5 mm, whereas severe varus-ABD tibias had TF values of greater than 5 mm. The TT values ranged from 10 to 60 degrees, with the lower values associated with severe varus-ABD.

Animals↗

PubMedDate not supplied

Changes in plantar foot pressure with in-shoe varus or valgus wedging.

Varus and valgus wedging are commonly used by podiatric physicians in therapy with custom-made foot orthoses. This study aimed to provide scientific evidence of the effects on plantar foot pressure of applying in-shoe forefoot or rearfoot wedging. The plantar foot pressure distribution of 23 subjects walking on a treadmill was recorded using a pressure insole system for seven different wedging conditions, ranging from 3 degrees valgus to 6 degrees varus for the forefoot and from 4 degrees valgus to 8 degrees varus for the rearfoot. The results demonstrate that increasing varus wedging magnifies peak pressure and maximal loading rate at the medial forefoot and rearfoot, whereas increasing valgus wedging magnifies peak pressure and maximal loading rate at the lateral forefoot and rearfoot. As expected, the location of the center of pressure shifts medially with varus wedging and laterally with valgus wedging. However, these shifts are less significant than those in peak load and maximal loading rate. Timing variables such as interval from initial impact to peak load do not seem to be affected by forefoot or rearfoot wedging. Finally, rearfoot wedging does not significantly influence pressure variables of the forefoot; similarly, rearfoot pressure remains unaffected by forefoot wedging.

Adult↗

PubMed2001

Proximal tibial varus osteotomy. Indications, technique, and five to twenty-one-year results.

BACKGROUND: Although high tibial osteotomy has been proved effective for the treatment of painful osteoarthritis of the medial compartment of the knee, the role of proximal tibial varus osteotomy for the treatment of painful osteoarthritis of the lateral compartment still remains controversial. METHODS: From 1974 to 1993, we performed proximal tibial varus osteotomy for the treatment of osteoarthritis of the lateral compartment of the knee in thirty-six consecutive patients. The procedure consisted of a proximal lateral opening-wedge varus osteotomy of the tibia with use of corticocancellous bone grafts from the iliac crest. The valgus deformity was posttraumatic in twenty-three patients, followed a lateral meniscectomy in five, was due to overcorrection of a varus deformity in four, and was idiopathic in four. The preoperative valgus deformity averaged 11.6 degrees (range, 4 degrees to 22 degrees ). RESULTS: At a mean of eleven years (range, five to twenty-one years) after the operation, the clinical results for thirty-four of the thirty-six patients were analyzed. None of the patients had severe progression of the osteoarthritis after the osteotomy, and none had a meaningful loss in the range of motion of the knee joint. A superficial wound infection developed in one patient, and another patient had thrombophlebitis. Three patients (9%) had a transient palsy of the peroneal nerve. According to the system of Insall et al., the mean knee score was 84 points (range, 54 to 99 points). According to the knee score described by Lysholm and Gillquist, the subjective result was excellent in nine patients (26%), good in twenty-one (62%), fair in three (9%), and poor in one (3%). CONCLUSIONS: We concluded that when the indications outlined in this study are followed and our opening-wedge technique is used, a proximal lateral opening-wedge varus osteotomy of the tibia is a good alternative for the treatment of isolated osteoarthritis of the lateral compartment of the knee. High accuracy in preoperative planning, based on a slight overcorrection, is important to prevent failure.

Adolescent↗

PubMed1986

The results and morbidity of varus osteotomy for Perthes' disease.

The results of varus proximal femoral osteotomy in 55 hips in 52 patients were analyzed by Harrison's radiologic autoassessment method. Excluding operations upon Catterall Grade 1 hips, 75.6% were either therapeutic successes or unchanged; 24.4% were therapeutic failures. These results are compared with and shown to be similar to those of patients treated conservatively by the Birmingham splint. In ten children with Catterall Grade 1 disease, seven were unchanged but three were therapeutic failures. Improved end results occurred in hips with greater surgical varus than those in which the end result worsened, but the statistical significance was questionable. The bone remodelling in response to surgical varus was unpredictable, but the greater the surgical varus the less the correction of the neck shaft angle at follow-up evaluation. Chronologic age cannot be used to predict such bone remodelling as may be impaired by the disease process. An analysis of the incidence and significance of leg shortening, limping, and abductor lurch is presented and some observations made on trochanteric overgrowth and the effect of surgery on the rate of femoral head reconstitution. New attempts to achieve containment of the hip by high-femoral osteotomy may determine the effects of a combination of varus and selective rotation osteotomy using ultrasound scans to measure femoral torsion before operation.

Child↗

PubMed1985

Cubitus varus deformity following supracondylar fracture of the humerus. A method for measuring rotational deformity.

Cubitus varus following supracondylar fracture of the humerus in children consists of varus, hyperextension, and internal rotation deformities of the distal bone fragment of the humerus. There has been no simple clinical method of measuring internal rotation deformity. The authors report here on a method of accurately measuring the internal rotation of the shoulder in a position with the elbow at 90 degrees flexion on the back and the shoulder held at the maximum extension. When a patient with developing cubitus varus attempts to rotate his shoulder internally, there is an apparent increase in the degree of internal rotation at the shoulder of the fractured side. The mean value of the angle formed between the horizontal plane of the back and the mid-line of the forearm was approximately 0 degrees in 217 normal children, whereas an increase of 35 degrees was seen in seven children with cubitus varus. When this angle was corrected successfully, the angle after surgical correction became approximately 0 degrees. In the treatment of cubitus varus deformity, it is necessary to simultaneously correct three-dimensional deformities.

Child↗

PubMed1978

Results of treatment of supracondylar fractures of the humerus in children with special reference to the cause and prevention of cubitus varus.

Report and analysis of the results of treatment of 56 children who exhibited a typical supracondylar fracture of the humerus necessitating reposition and treatment by clinical methods. The functional results were good on the whole and they were not clearly dependent on the nature of the treatment. The treatment consisting in manual reposition followed by application of a plaster cast was followed in about 50% of the cases by disfiguring cubitus varus. The causes of this phenomenon are discussed. The typical endorotation of the distal fracture fragment in regard to the proximal fragment plays an important part in causing cubitus varus. Cubitus varus may be prevented by wire traction through the olecranon, even if the rotation displacement persists. For this reason, this treatment is recommended. If the rotation displacement persists in the course of the traction treatment, it is advisable to use Baumann's method of demonstrating and correcting a possible varus tilting during the course of the traction treatment. If development of cubitus varus is still suspected, surgical reposition and fixation are possible, a safe method which gives good results. The surgical treatment should achieve an anatomically correct position of the fragments.

Adolescent↗

PubMed1996

Varus migration of PCA stems.

Forty-seven patients with cementless, porous-coated anatomic hip replacements were evaluated after a minimum 2-year follow up with specific attention to varus migration of the stem. A cadaver study was done to define a relationship between projected size of the lesser trochanter seen radiographically, rotation of the femur, and stem position. Seven (15%) of the stems migrated into varus with the distal tip moving laterally. Thigh pain occurred in patients with varus migration and those with no change in stem position. A lower percent canal fill was seen on the lateral radiograph (P < .001) and larger average width of radiodense lines in zone 1 superolateral, and zone 6, midstem medial (P < .005) in the patients with varus migration. Poor distal stability associated with a lower percent canal fill at the stem tip seen on the lateral radiograph may result in varus migration.

Biomechanical Phenomena↗

PubMed1994

Idiopathic adult hallux varus.

Adult hallux varus is an uncommon clinical entity usually caused by an inflammatory arthropathy or overcorrection during bunion reconstruction. We present five cases of unexplained spontaneous hallux varus. Clinically, all patients initially were found to have flexible deformities, and no evidence of underlying inflammatory disease or history of trauma. Symptoms were easily relieved with shoe wear modifications. Two of the patients developed more rigid deformities and subsequent medial callusing of the first toe and varus deformities of the lesser toes. These two patients eventually required surgical intervention. A Keller arthroplasty was performed on the first metatarsophalangeal joint and valgus proximal phalangeal osteotomies were done on the lateral toes when indicated. The outcome for these patients was good. Possible etiologic mechanisms are discussed. It is postulated that in these cases, the abductor hallucis tendon inserts more medially on the phalanx and overpowers the adductor. This produces a medially directed moment and, with time, a varus deformity.

Female↗

PubMed1986

Dynamic post-surgical hallux varus after lateral sesamoidectomy: treatment and prevention.

Hallux varus and clawing are occasionally seen after a McBride procedure, due to the severance of the flexor hallucis brevis, when the lateral sesamoid is removed. The present study includes six patients, (involving ten feet), who developed hallux varus and great toe clawing after McBride procedures were performed by various orthopedic surgeons. Treatment utilized partial proximal phalangeal resection, with and without silicone single-stem implants, extensor hallucis longus tendon transfer to the great toe metatarsal, and interphalangeal joint arthrodesis, or tenodesis of the great toe to correct clawing. One patient eventually required a great toe metatarsophalangeal joint fusion. This reconstructive surgery is generally effective by correcting capsular malalignment, the "bowstringing" tendency of the extensor hallucis longus, and great toe clawing that develops simultaneously with hallux varus. Lateral sesamoidectomy is risky, and believed unnecessary as adductor hallucis tenotomy is effective in relieving hallux valgus. Although, it can occur with excessive excision of the medial emminence and distal advancement of the abductor hallucis. The author is unaware of hallux varus developing after adductor hallucis tenotomies.

Adult↗

PubMed2000

The association between varus-valgus alignment and patellofemoral osteoarthritis.

OBJECTIVE: Little is known about risk factors for patellofemoral (PF) osteoarthritis (OA). The lateral vector at the PF joint increases the likelihood of lateral PF versus medial PF pathology. Both valgus and varus malalignments affect forces at the PF joint and may predispose to PF OA. We examined whether lateral PF OA is more common than medial PF OA, whether valgus malalignment is more frequent in lateral PF OA than in medial PF OA, and whether knees with PF OA are more often valgus than knees with isolated tibiofemoral (TF) OA. METHODS: In 292 knee OA patients, we obtained semiflexed, fluoroscopy-confirmed radiographs of the TF joint and weight-bearing, 30 degrees flexion, axial views of the PF joint. Varus-valgus alignment (the angle formed by the intersection of the mechanical axes of the femur and tibia) was measured on a full-limb radiograph. RESULTS: Lateral PF OA was more common than medial PF OA (P<0.0001). Forty-three of 75 knees with lateral PF OA had valgus malalignment compared with only 5 of 21 patients with medial PF OA (P = 0.0066). Conversely, varus malalignment was more likely in the medial PF OA group. Knees with isolated PF OA were more likely to have valgus malalignment than those with isolated TF OA (P = 0.0002), as were knees with mixed PF-TF OA (P = 0.0006). CONCLUSION: Varus-valgus alignment may influence the risk of PF OA and, in particular, which compartment is affected.

Aged↗

PubMed2004

Varus-valgus alignment in the progression of patellofemoral osteoarthritis.

OBJECTIVE: To test the hypotheses that lateral patellofemoral (PF) osteoarthritis (OA) progression is more common than medial PF OA progression, that varus alignment increases the likelihood of medial PF OA progression, and that valgus alignment increases the likelihood of lateral PF OA progression. METHODS: Patients with knee OA were recruited from the community. Inclusion criteria were definite osteophyte presence (i.e., Kellgren/Lawrence radiographic grade >/=2) in 1 or both knees and at least some difficulty with knee-requiring activity. Varus-valgus alignment (the angle formed by the intersection of the mechanical axes of the femur and tibia) was measured on a full-limb radiograph at baseline. To assess PF OA progression, weight-bearing skyline views of the PF compartment were obtained at baseline and at 18-month followup. Knees with the highest grade of PF narrowing at baseline were excluded from analysis. Logistic regression and generalized estimating equations were used; odds ratios (ORs) were adjusted for age, sex, and body mass index. RESULTS: Lateral PF OA progression, which occurred in 120 (30%) of 397 knees, was more common than was medial PF OA progression, which occurred in 60 knees (15%). Varus (versus nonvarus) alignment increased the odds of PF OA progression isolated to the medial PF compartment (adjusted OR 1.85, 95% confidence interval [95% CI] 1.00-3.44). Valgus alignment increased the odds of PF OA progression isolated to the lateral compartment (adjusted OR 1.64, 95% CI 1.01-2.66). CONCLUSION: Lateral PF OA progression was more common than medial progression, and varus-valgus alignment influenced the likelihood of PF OA progression in a compartment-specific manner. Interventions that address the stress imposed by alignment on the PF compartments may delay PF OA progression and should be developed.

Aged↗

PubMed1997

Muscle activation at the human knee during isometric flexion-extension and varus-valgus loads.

We examined the role of muscles in counteracting static loads in the transverse plane at the knee to determine if (a) knee muscles are activated to counteract isometric varus or valgus loads, (b) muscle activity during varus and valgus loads changes with the angle of knee flexion, and (c) the direction of a muscle's activation can be predicted by its moment arm orientations. For seven subjects, muscle activity was recorded during isometric tasks using surface and intramuscular electrodes from 10 muscles that span the knee. A six-degree-of-freedom load cell was rigidly attached to each subject's lower leg just above the ankle, and the subjects were instructed to push against the load cell so as to produce moments in the flexion-extension-varus-valgus plane at the knee. Moments in this plane were all of equal magnitude and varied in direction the full 360 degrees in 20 degrees increments. Most muscles were not activated to stabilize the knee against varus-valgus loads, but the sartorius, gracilis, and tensor fasciae latae showed substantial electromyographic activation in these directions. The load directions where muscles were principally active were observed to be dependent on joint angle for some muscles. In particular, the principal directions of activation for these three muscles changed as the angle of knee flexion changed. Similarly, a muscle's moment arm orientation was a good predictor of direction of activation for some muscles and a poor one for others. These results suggest that different muscles may play different roles in providing joint stability and that these roles are complex functions of muscle moment arm orientations, joint angles, external load directions, and possibly other undetermined parameters.

Adult↗

PubMed2000

Cubitus varus: problem and solution.

A lateral closing wedge osteotomy was performed in 39 children with cubitus varus deformity resulting from a supracondylar fracture. All had a deformity of 15 degrees or more, with 5 having more than 30 degrees of varus. The osteotomy was fixed by three different methods. In 8 cases the osteotomy was fixed with 2 parallel Kirschner wies (group K). A modified French technique (group TBW) was used in 25 cases and held with a figure-of-8 wire loop tightened over the screw heads. In the last 6 cases the osteotomy was fixed with an external fixator (group EF). The only poor result (i.e. loss of carrying angle of more than 10 degrees and loss of flexion and extension of 20 degrees or more) was in group K due to pin tract infection and loosening of the K-wires. In the TBW group 5 patients lost some degree of correction, and none became infected. In the EF group no patient suffered pin tract infection or loss of correction. Based on our experience and results, we feel that the best age at which to correct cubitus varus deformity was 6-11 years and that the external fixator is a safe, effective and reliable method to fix the osteotomy. We propose this method of fixation as a good alternative method to the modified French technique, especially in cases of severe cubitus varus deformity, where removal of a large wedge can produce a big step at the osteotomy site, increasing the possibility of disengagement of the stainless steel wire from the screw head. In addition, minor postoperative modifications of correction, if required, can also be performed. It also avoids a second operation for implant removal.

Adolescent↗

PubMed1979

Varus deformity in supracondylar fractures of the humerus in children.

Eighty cases of supracondylar fracture of the humerus at the elbow in children have been analysed. The post-reduction radiograph of the fracture was classified depending on the residual deformity present and related to the loss of carrying angle and cubitus varus deformity at the time of follow-up. Fifty-four percent of the displaced fractures showed a loss of carrying angle greater than 5 degrees, and of these 23 per cent developed cubitus varus deformity. Eighty-five per cent of those cases with a loss of carrying angle greater than 10 degrees showed either residual tilt or medial rotation on the post-reduction radiograph. All cases in which there was residual medial tilt after manipulation and 40 per cent of those with medial rotation on the post-reduction radiograph developed cubitus varus. In our series, there was no evidence of epiphyseal injury causing the deformity and in none of the cases was the deformity progressive. It is suggested that, in order to reduce the incidence of varus deformity in suprocondylar fractures, open reduction and internal fixation is indicated in those fractures in which tilt or medial rotation cannot be reduced by conservative means.

Adolescent↗

PubMed2005

Wear patterns on tibial plateau from varus osteoarthritic knees.

BACKGROUND: The knowledge of cartilage wear patterns at the medial tibial plateau is important to understand the main causes of arthritis in varus knees. The most important factors influencing knee arthritis in fact seem to be the severity of the degenerative changes determined by the lower limb mechanical axis and the abnormal knee joint kinematics which frequently results from dysfunction of the anterior cruciate ligament. METHODS: We studied the wear patterns of cartilage damage in 70 medial tibial plateaus resected at operation during total knee arthroplasty indicated for varus osteoarthritic knee. Anterior cruciate ligament and medial meniscus integrity was assessed intra-operatively. Calibrated digital images were used to measure the wear patterns with a standard software tool. The medial compartment of the tibial plateau was divided into six zones, and the amount of cartilage and bone destruction in each zone was classified into two grades. FINDINGS: The wear pattern was found to be highly dependent upon knee varus deformity (Mann Whitney P<0.001) and anterior cruciate ligament integrity (Friedman P<0.0005). Anterior cruciate ligament was found intact in 35.7% of the cases. Wear patterns on intact anterior cruciate ligament knees occurred in the central to medial aspect of the tibial plateau. Anterior cruciate ligament deficient knees had significantly larger wear patterns anteriorly and posteriorly in the most medial region of the medial plateau. INTERPRETATION: These observations suggest altered joint mechanics exist in anterior cruciate ligament deficient varus knees, which would worsen cartilage degeneration and osteoarthritis progression.

Adult↗

PubMedDate not supplied

Role of the coronoid process in varus osteoarticular stability of the elbow.

The role of the coronoid process in varus osteoarticular stability of the elbow was investigated in 10 cadaveric elbows. Testing was performed at multiple flexion angles after incremental removal of the coronoid. At each flexion angle, removal of more than 50% of the coronoid produced a statistically significant decrease in the load resisting varus displacement compared with all lesser resection levels (P < .003). There was a trend for decreasing load after removal of 50% of the coronoid. The mean decrease in load across all flexion angles was 10.1%, 50.4%, and 75.4% after removal of 50%, 75%, and 100% of the coronoid, respectively. Resistance to varus displacement tended to decrease more as a percent of control at lower flexion angles than at higher flexion angles after removal of more than 50% of the coronoid. The coronoid process was found to be a key varus stabilizer in the elbow and may contribute more to elbow stability in extension than in flexion.

Aged↗

PubMedDate not supplied

Three-dimensional corrective osteotomy for cubitus varus in adults.

In 23 adult patients, cubitus varus deformity was corrected by 3-dimensional osteotomy. During surgery, not only varus but internal rotation, flexion-extension deformity of the elbow, and lateral protrusion of the distal fragment were simultaneously addressed. The mean age of the patients was 26 years. Three showed tardy ulnar nerve palsy. The follow-up period after osteotomy averaged 1 year 10 months. The humeral-elbow-wrist angle improved from a mean 26 degrees of varus preoperatively to a mean of 3 degrees of valgus postoperatively. The mean internal rotation angle improved from 25 degrees to 5 degrees. As there was no recurrence of the deformity, this method of 3-dimensional corrective osteotomy for the treatment of cubitus varus in skeletally mature adults is recommended.

Adolescent↗