TITLE

Hallux Valgus and First Ray Mobility

AUTHOR(S)
Coughlin, Michael J.; Smith, Berth W.
PUB. DATE
October 2008
SOURCE
Journal of Bone & Joint Surgery, American Volume;Oct2008 Supplement 2, Vol. 90-A, p153
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
BACKGROUND: There have been few prospective studies that have documented the outcome of surgical treatment of hallux valgus deformities. The purpose of this investigation was to evaluate the effect of operative treatment of hallux valgus with use of a proximal crescentic osteotomy and distal soft-tissue repair on the first metatarsophalangeal joint. METHODS: All adult patients in whom moderate or severe subluxated hallux valgus deformities had been treated with surgical repair between September 1999 and May 2002 were initially enrolled in the study. Those who had a hallux valgus deformity treated with a proximal crescentic osteotomy and distal soft-tissue reconstruction (and optional Akin phalangeal osteotomy) were then invited to return for a follow-up evaluation at a minimum of two years after surgery. Out-comes were assessed by a comparison of preoperative and postoperative pain and American Orthopaedic Foot and Ankle Society scores; objective measurements included ankle range of motion, Harris mat imprints, mobility of the first ray (assessed with use of a validated calibrated device), and radiographic angular measurements. RESULTS: Of the 108 patients (127 feet), five patients (five feet) were unavailable for follow-up, leaving 103 patients (122 feet) with a diagnosis of moderate or severe primary hallux valgus who returned for the final evaluation. The mean duration of follow-up after the surgical repair was twenty-seven months. The mean pain score improved from 6.5 points preoperatively to 1.1 points following surgery. The mean American Orthopaedic Foot and Ankle Society score improved from 57 points preoperatively to 91 points postoperatively. One hundred and fourteen feet (93%) were rated as having good or excellent results following surgery. Twenty-three feet demonstrated increased mobility of the first ray prior to surgery, and only two feet did so following the bunion surgery. The mean hallux valgus angle diminished from 30° preoperatively to 10° postoperatively, and the mean first-second intermetatarsal angle decreased from 14.5° preoperatively to 5.4° postoperatively. Plantar gapping at the first metatarsocuneiform joint was observed in the preoperative weight-bearing lateral radiographs of twenty-eight (23%) of 122 feet, and it had resolved in one-third (nine) of them after hallux valgus correction. Complications included recurrence in six feet. First ray mobility was not associated with plantar gapping. There was a correlation between preoperative mobility of the first ray and the preoperative hallux valgus (r = 0.178) and the first-second intermetatarsat angles (r = 0.181). No correlation was detected between restricted ankle dorsiflexion and the magnitude of the preoperative hallux valgus deformity, the postoperative hallux valgus deformity, or the magnitude of hallux valgus correction. CONCLUSIONS: A proximal crescentic osteotomy of the first metatarsal combined with distal soft-tissue realignment should be considered in the surgical management of moderate and severe subluxated hallux valgus deformities. First ray mobility was routinely reduced to a normal level without the need for an arthrodesis of the metatarsocuneiform joint. Plantar gapping is not a reliable radiographic indication of hypermobility of the first ray in the sagittal plane.LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
ACCESSION #
34787380

 

Related Articles

  • PERSPECTIVE. Miller, Stuart D. // Orthopedics Today;Jul2011, Vol. 31 Issue 7, p52 

    The author presents his views on a study by Sandro Giannini and colleagues which demonstrated the benefits of simple, effective, rapid, inexpensive (SERI) distal metatarsal osteotomy technique for patients with hallux valgus.

  • Rehabilitation After Hallux Valgus Surgery: Importance of Physical Therapy to Restore Weight Bearing of the First Ray During the Stance Phase.  // Physical Therapy;Sep2009, Vol. 89 Issue 9, p934 

    Background. Operative treatment of people with hallux valgus can yield favorable clinical and radiographic results, However, plantar pressure analysis has demonstrated that physiologic gait patterns are not restored after hallux valgus surgery. Objective. The purpose of this study was to...

  • Treating hallux abducto valgus conservatively through foot mobilisation techniques and exercise therapy. A Case Study. Jedynak, Ted // Podiatry Now;Oct2009, Vol. 12 Issue 10, p12 

    The article presents a case study of a 53 year-old woman with an inflamed metatarsophalangeal joint (MTPJ) and pain which had worsened over the previous six months prior to seeking treatment. Diagnostic tests and physical evaluation were performed showing significant joint movement limitations...

  • Long-term results of the retrocapital metatarsal percutaneous osteotomy for hallux valgus. Faour-Martín, Omar; Martín-Ferrero, Miguel; Valverde García, Jóse; Vega-Castrillo, Aurelio; Red-Gallego, María // International Orthopaedics;Sep2013, Vol. 37 Issue 9, p1799 

    Purpose: The current trend in hallux valgus surgery is directed toward percutaneous procedures. However, no evidence that any of these methods of treatment are superior to the others has been described, excepting studies in the long term. The aim of this study was to analyse a series of patients...

  • Hallux valgus u pacientu s revmatoidn� artritidou -- soucasn� mo�nosti operacn� terapie. Popelka, S.; Vavr�k, P.; Hrom�dka, R.; Bart�k, V.; Bek, J.; Sosna, A. // Czech Rheumatology / Ceska Revmatologie;Aug2011, Vol. 19 Issue 3, p119 

    The aim of the publication is to present different surgical methods that we use for correction of valgus deformity of the big toe. Valgus deformity is the most common deformity of the big toe in patients with rheumatoid arthritis. It causes difficulty walking and problems while wearing shoes....

  • Problem feet in children. Fixsen, J. A. // Journal of the Royal Society of Medicine;Jan1998, Vol. 91 Issue 1, p18 

    This article presents information on several abnormalities associated with children's feet, and offers suggestions for their treatment. Flat foot abnormality is frequently found in families and is generally associated with familial joint laxity. A range of exercises, orthoses and special...

  • Clinical outcomes after Chevron procedure are better than pedobarographic results. Prejbeanu, Radu; Vermesan, Dinu; Haragus, Horia; Vermesan, Simona; Ioan Stoia, Dan // Key Engineering Materials;2014, Vol. 601, p177 

    The distal Chevron or Austin procedure, is arguably the most prominent of the distal metatarsal osteotomies. Recent studies in the literature have shown a trend in recommending this osteotomy or one if it's modifications for even severe hallux valgus deformities. Therefore we aimed to compare...

  • Minimally invasive hallux valgus surgery: a critical review of the evidence. Trnka, Hans-Joerg; Krenn, Sabine; Schuh, Reinhard // International Orthopaedics;Sep2013, Vol. 37 Issue 9, p1731 

    This systematic review aims to illustrate the published results of 'minimally invasive' procedures for correction of hallux valgus. Based on former systematic reviews on that topic, the literature search was organised by two independent investigators. MEDLINE was systematically searched for...

  • A minimally invasive technique for surgical treatment of hallux valgus: simple, effective, rapid, inexpensive (SERI). Giannini, Sandro; Faldini, Cesare; Nanni, Matteo; Martino, Alberto; Luciani, Deianira; Vannini, Francesca // International Orthopaedics;Sep2013, Vol. 37 Issue 9, p1805 

    Purpose: Several bony and soft tissue procedures have been described for the treatment of hallux valgus, and currently mini-invasive surgical techniques are preferred in order to reduce surgical trauma, complications, time of surgery and to allow an earlier recovery. The aim of this study is to...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics