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Resumen: Introducción: el calzado ortopédico suele prescribirse en el postoperatorio de cirugía de hallux valgus para proteger la osteotomía y mantener la funcionalidad al paciente. En este sentido, la superioridad del zapato de suela rígida en comparación con el zapato de suela invertida sigue siendo controvertido. El objetivo de este estudio es comparar los resultados clínicos, funcionales y radiológicos entre el uso del zapato de suela rígida (ZSR) y el zapato de suela invertida (ZSI) después de la cirugía de hallux valgus. Material y métodos: un total de 57 pacientes intervenidos de hallux valgus fueron incluidos y analizados retrospectivamente. En un grupo se incluyeron 28 pacientes que usaron el ZSR, mientras que el segundo grupo incluyó a 29 pacientes que usaron el ZSI. El zapato ortopédico se usó durante seis semanas tras la cirugía. Se recogieron datos clínicos (dolor lumbar y articular de las extremidades inferiores, necesidad de muletas y problemas para subir y bajar escaleras), datos radiológicos (AIM, AHV), así como complicaciones postoperatorias (desplazamiento de osteotomía, fractura del primer metatarsiano o seudoartrosis). Resultados: el zapato de suela rígida mostró menor dificultad para subir y bajar escaleras (OR 3.8 (IC 95% 1.2-12.8), p 0.02), sólo para subir (OR 3.2 (IC 95% 1.1-10), p 0.03), así como una disminución de la necesidad de muletas (OR 1.7 (IC 95% 1.04-2.6), p < 0.03). El dolor de columna lumbar o articular de extremidades inferiores no mostró diferencias estadísticas. No se encontraron diferencias estadísticas en los datos epidemiológicos y radiológicos entre los grupos. Conclusiones: el zapato de suela parece aportar más comodidad a los pacientes sin aumentar las complicaciones radiológicas.
Abstract: Introduction: the orthopedic shoe is usually prescribed during postoperative care after hallux valgus surgery to protect the osteotomy and provide functional comfort to the patient. In this regard, the superiority of rigid sole shoe (RSS) compared to the reverse camber shoe (RCS) remains controversial. The aim of this study is to compare the clinical, functional and radiological outcomes from using the rigid sole shoe (RSS) vs. the reverse camber shoe (RCS) after hallux valgus surgery. Material and methods: fifty-seven hallux valgus surgery patients were included and analyzed retrospectively. The 1st group included 28 patients using the RSS and the 2nd group included 29 patients using the RCS. The orthopedic shoe was used for six weeks postoperatively. Clinical data (lumbar and lower limb pain, need of crutches and problems with going up and down stairs), radiological data (IMA, HVA) and postoperative complications (displacement of osteotomy, metatarsal fracture or non-union) were collected. Results: the RSS showed less difficulty going up and down stairs (OR 3.8 (CI 95% 1.2-12.8), p 0.02), only going upstairs (OR 3.2 (CI 95% 1.1-10), p 0.03), as well as a decreased need for crutches (OR 1.7 (CI 95% 1.04-2.6), p < 0.03). Lumbar spine or lower limb pain did not show any statistical differences. No statistical differences in the epidemiological and radiological data were found between the groups. Conclusions: the RSS seems to provide more comfort to the patients without worsening the radiological results.
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Objective: To summarize the technique and effectiveness of double metatarsal osteotomy for treating severe hallux valgus with increased distal metatarsal articular angle (DMAA). Methods: Between 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. Results: All 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). Conclusion: For 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.
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Objective: To evaluate the short-term effectiveness of Scarf osteotomy and Akin osteotomy combined with soft tissue procedures for hallux valgus associated with mild to moderate metatarsus adductus. Methods: The clinical data of 30 patients (48 feet) who were diagnosised hallux valgus associated with mild to moderate metatarsus adductus and treated by Scarf osteotomy and Akin osteotomy combined with soft tissue procedures between February 2013 and May 2015 were analyzed retrospectively. There were 2 males (2 feet) and 28 females (46 feet) with an average age of 29.4 years (range, 18-50 years). The disease duration was 3-12 years (mean, 6.1 years). The degree of metatarsal adductus was assessed by Sgarlato's measurement and Yu et al classification criteria, and the degree of metatarsal adductus was mild in 20 feet and moderate in 28 feet. Preoperative X-ray examination showed that the hallux valgus angle (HVA) was (39.4±5.6)°, the first-second intermetatarsal angle (1-2IMA) was (15.2±3.5)°, the metatarsus adductus angle (MAA) was (21.2±3.7)°. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 51.7±10.0, and visual analogue scale (VAS) score was 4.9±2.7 before operation. Postoperative complications and the union time of osteotomies were recorded. At last follow-up, the HVA, 1-2IMA, and MAA were measured on X-ray films, and the AOFAS scores and VAS scores were recorded, then compared them with preoperative ones. Roles - Maudsley score was used to investigate patients' satisfaction. Results: All the incisions healed by first intention. Thirty patients were followed up 24-27 months (mean, 26.4 months). Three patients (4 feet) occured metatarsalgia, and the pain relieved after treated by Custom-Made Orthotics. All the osteotomies were unoin, the healing time was 2-4 months (mean, 2.7 months). At last follow-up, the HVA and the 1-2IMA were (13.2±3.1)° and (5.1±2.3)°, respectively, showing significant differences when compared with preoperative ones ( t=14.606, P=0.000; t=22.356, P=0.000); the MAA was (21.0±3.4)° and there was no significant difference when compared with preoperative one ( t=0.789, P=0.434). The AOFAS and VAS scores were 91.8±7.5 and 1.1±1.0, respectively, showing signifiant differences when compared with preoperative ones ( t=13.787, P=0.000; t=14.781, P=0.000). Satisfaction survey showed that 28 patients were very satisfied and satisfied (93.3%), and 2 cases were not satisfied (6.7%). Conclusion: The short-term effectiveness of Scarf osteotomy and Akin osteotomy combined with soft tissue procedures for hallux valgus associated with mild to moderate metatarsus adductus is satisfactory, and no correction is required for metatarsal adductus.
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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 ( P0.05). 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.
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PURPOSE: The purpose of this study was to analyze the clinical results of medial horizontal suture fixation of Akin osteotomy in hallux valgus and present its advantages. MATERIALS AND METHODS: This study was based on 48 cases of 35 patients with Akin osteotomy, who underwent surgery of hallux valgus between December 2014 and July 2015, and with at least 12 months of follow-up. The mean age of patients was 46.9 years (range, 16~71 years). The mean follow-up duration was 15.9 months (range, 12~18 months). Clinical evaluations included pain visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS hallux metatarsophalangeal interphalangeal scale) score, and satisfaction score. Weightbearing anteroposterior radiographs were taken to measure the distal articular set angle (DASA) of the hallux. Radiographic bone union at 6 months follow-up was regarded as a success, while a loss of reduction and nonunion was regarded as a failure. RESULTS: The mean pre- and postoperative pain VAS scores were 4.27 and 1.67, respectively (p<0.05). The mean AOFAS score improved from 59.7 to 80.5 (p<0.05). The DASA was improved from 8.15 to –2.57 (p<0.05). There was no case of skin irritation, cortical breakage, inflammation from the knot, and infection. All patients showed union without fixation failure. CONCLUSION: The clinical and radiological evaluations in this study demonstrate reliable results without complication. The medial horizontal suture fixation of the Akin osteotomy was effective, and the advantage of this procedure was unnecessity of the material removal, preservation of the joint, and no skin irritation.
Subject(s)
Humans , Ankle , Follow-Up Studies , Foot , Hallux Valgus , Hallux , Inflammation , Joints , Osteotomy , Pain, Postoperative , Skin , Sutures , Weight-BearingABSTRACT
Objective To study the clinical efficacy of Akin combined Scarf osteotomies for moderate and severe hal?lux valgus. Methods Thirty-nine (58 feet) patients received Akin combined Scarf osteotomies, in which 12 patients (16 feet) with moderate hallux valgus received the single scarf osteotomy. Hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position and American orthopedic foot and ankle society score (AOFAS) were measured and compared before and after operation respectively. Results All operations were successfully completed patients were followed up for 8-22 months. The mean operation time was (55.0±6.8) min. The amount of intraoperative bleeding was 3-20 mL with an aver?age of (11.0±5.4) mL. All patients were healed except for a delayed union of Akin on a severe hallux valgus patient. Two cas?es (2 feet) were found inflammation in surgical incision. Two cases (2 feet) were found numbness in dorsal medial side of hal?lux, which was considered nerve damage and improved in 3-5 months. There was no recurrence of hallux valgus in the peri?od of following up. After surgery, HVA (14.1°±5.3°), IMA (7.7°±3.8°) and tibial sesamoid position (2.58±0.61) were signifi?cantly decreased compared with those before operation (39.6° ± 6.8° , 18.7° ± 5.4° and 4.87 ± 0.59, P<0.05). AOFAS score (84.4±8.7) was significantly higher after surgery than that before surgery (37.3±9.5, P<0.05). Conclusion Akin combined Scarf osteotomies can achieve a excellent therapeutic effect for moderate and severe hallux valgus with very few complica?tions and recurrence, which is worth for clinical application.
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The Akin osteotomy is a complimentary procedure in hallux valgus surgery. Surgical techniques may vary depending on the operators or fixation devices. Suture fixation, for which a removal procedure is not necessary, can often be recommended. However, there is a risk of failure due to the thin cortex of the phalanx. We describe a new technique using Ethibond suture fixation in Akin osteotomy, which can lower the risk of phalangeal cortical failure and articular cartilage irritation. First, the Akin osteotomy was performed on the proximal phalanx 5 to 6 mm distal to the first metatarsophalangeal joint. Then bone holes were drilled from dorsum to plantar parallel to osteotomy with the Kirschner wire. The final procedure involved passing the Ethibond sutures connected to a straight needle through the holes and tying it. This fixation method offers an effective and easy technique for performance of Akin osteotomy.
Subject(s)
Cartilage, Articular , Hallux Valgus , Metatarsophalangeal Joint , Needles , Osteotomy , SuturesABSTRACT
PURPOSE: When medial protrusion in the base of proximal phalanx is severe from removing metatarsal bunion during the hallux valgus surgery, it could lead to skin irritation and medial pain after the surgery. The purpose of this paper was to report our clinical and radiographic results with transarticular fixation of Akin osteotomy for the treatment of patients with hallux valgus after resection of the medial protrusion of base of the proximal phalanx. MATERIALS AND METHODS: Our study is subject to 34 cases of 30 patients who went through proximal phalanx medial corticectomy among patients undergone both hallux valgus surgery and Akin osteotomy at our institution from March 2006 to March 2012. In all cases, we used absorbable suture material through the articular surface for Akin osteotomy after resection of the medial protrusion in proximal phalanx. Radiographs were reviewed to assess the union and displacement of osteotomy site at the time of postoperative 6 months. The clinical results were assessed by using AOFAS score and complication such as skin irritation and pain. RESULTS: AOFAS score was improved from average 44 points(36-58), before operation and average 87 points(74-96), 12 months after operation. In two cases, partial union was suspected in radiological perspective, however, complete union on the osteotomy site was observed in all cases, 12 months after the operation. No patients was dissatisfied with pain, joint discomfort, skin irritation and inflammation from the knot. CONCLUSION: When medial protrusion in the base of proximal phalanx is severe from removing metatarsal bunion during the hallux valgus surgery, We have good results by transarticular fixation of Akin osteotomy using absorbable suture material.
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Humans , Arthralgia , Displacement, Psychological , Hallux , Hallux Valgus , Inflammation , Metatarsal Bones , Osteotomy , Skin , SuturesABSTRACT
PURPOSE: The Akin osteotomy which is a closing wedge osteotomy of the proximal phalanx widely used for the correction of hallux valgus has several methods of fixation. we tried to report the effects of the fixation using an absorbable suture material during the Akin osteotomy for the hallux valgus. MATERIALS AND METHODS: This study was based on 448 cases of 346 patients who were able for follow-up more than 12 months among the patients who had an Akin osteotomy together with the surgery of hallux valgus between March of 2006 and May of 2010. Absorbable suture material had been used in all cases. Radiologically displacement and union of osteotomy site were observed after the surgery, and clinically postoperative complication such as skin irritation, pain and satisfaction were investigated. RESULTS: Radiologically all cases had showed complete union and no case had the loss of an correction due to loss of fixation. Also, any case had no skin irritation due to a knot. Three cases had a medial cortical breakage due to a strong knot, and the initial one case among them had additionally fixed the osteotomy site for four weeks using K-wire, and the remaining two cases had fixed a suture on an articular surface without any fixation of an additional wire. If a medial cortical bone was lost by carrying out an ostectomy due to proximal protrusion of proximal phalanx, three cases could show union through the fixation of suture on an articular surface. CONCLUSION: This study considers that the fixation of the osteotomy site using an absorbable suture material in an Akin osteotomy was effective method and the advantage of this procedure was unnecessity of the material removal and no skin irritation.
Subject(s)
Humans , Displacement, Psychological , Follow-Up Studies , Hallux , Hallux Valgus , Imidazoles , Lifting , Nitro Compounds , Osteotomy , Postoperative Complications , Skin , SuturesABSTRACT
PURPOSE: This study analyzed the clinical and radiographic outcome of the severe hallux valgus corrected with proximal reverse chevron metatarsal osteotomy and Akin osteotomy. MATERIALS AND METHODS: The study was based on 18 feet (15 patients) of severe hallux valgus (hallux valgus angle> or =40degrees or intermetatarsal angle> or =18degrees) treated with proximal reverse chevron metatarsal osteotomy and followed for more than 1 year. Akin osteotmy was added in 72% of the patients. Clinically preoperative and postoperative AOFAS Hallux Metatarsophalangeal - interphalangeal score, VAS pain score and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, hallux valgus interphalangeal angle, the intermetatarsal angle and sesamoid position before and after the operation were analyzed. RESULTS: AOFAS Hallux Metatarsophalangeal - interphalangeal score improved from 54.5 (25-78) to 87.7 (70-100) and VAS pain score decreased from 6.0 (3-8) to postoperative 1.2 (0-5). Ninety-six percents of the patients were satisfied with results. Radiologically hallux valgus angle was decreased from 43.3degrees(31-58degrees) preoperatively to 6.8degrees (-8-27degrees) postoperatively. The intermetatarsal angle was decreased from 18.4degrees(11-24degrees) preoperatively to 5.3degrees (1-12degrees) postoperatively. The sesamoid subluxation was improved from 2.8+/-0.4 preoperatively to 0.4+/-0.6 postoperatively. CONCLUSION: Proximal reverse chevron metatarsal osteotomy and lateral soft tissue release with additional Akin osteotomy is good treatment option for severe hallux valgus.
Subject(s)
Humans , Congenital Abnormalities , Foot , Hallux , Hallux Valgus , Metatarsal Bones , OsteotomyABSTRACT
PURPOSE: This study analyzed the clinical and radiographic outcome of the severe hallux valgus corrected with proximal reverse chevron metatarsal osteotomy and Akin osteotomy. MATERIALS AND METHODS: The study was based on 18 feet (15 patients) of severe hallux valgus (hallux valgus angle> or =40degrees or intermetatarsal angle> or =18degrees) treated with proximal reverse chevron metatarsal osteotomy and followed for more than 1 year. Akin osteotmy was added in 72% of the patients. Clinically preoperative and postoperative AOFAS Hallux Metatarsophalangeal - interphalangeal score, VAS pain score and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, hallux valgus interphalangeal angle, the intermetatarsal angle and sesamoid position before and after the operation were analyzed. RESULTS: AOFAS Hallux Metatarsophalangeal - interphalangeal score improved from 54.5 (25-78) to 87.7 (70-100) and VAS pain score decreased from 6.0 (3-8) to postoperative 1.2 (0-5). Ninety-six percents of the patients were satisfied with results. Radiologically hallux valgus angle was decreased from 43.3degrees(31-58degrees) preoperatively to 6.8degrees (-8-27degrees) postoperatively. The intermetatarsal angle was decreased from 18.4degrees(11-24degrees) preoperatively to 5.3degrees (1-12degrees) postoperatively. The sesamoid subluxation was improved from 2.8+/-0.4 preoperatively to 0.4+/-0.6 postoperatively. CONCLUSION: Proximal reverse chevron metatarsal osteotomy and lateral soft tissue release with additional Akin osteotomy is good treatment option for severe hallux valgus.
Subject(s)
Humans , Congenital Abnormalities , Foot , Hallux , Hallux Valgus , Metatarsal Bones , OsteotomyABSTRACT
PURPOSE: We tried to understand the effects of the derotational closing wedge Akin osteotomy during the operation for the hallux valgus with pronation of great toe. MATERIALS AND METHODS: Eighty five patients who had undergone Akin osteotomy among the eighty seven patients who had been treated with Scarf osteotomy with hallux valgus were included in this study. Derotational supination was added on the medial closing wedge Akin osteotomy at the base of proximal phalanx and it was secured with K-wire, headless screw or staple. We measured and analyzed pre- and post-operative hallux primus valgus angle and hallux pronational rotatory angle. RESULTS: The hallux primus valgus angle improved an average of 14+/-2.98 degrees to -1+/-1.68 degrees with the hallux pronational rotatory angle respectively from 24.8+/-7.64 degrees to 4.7+/-4.22 degrees. CONCLUSIONS: After the metatarsal osteotomy for the treatment of the hallux valgus with the pronation of great toe, derotational closing wedge Akin osteotomy can give us a belief that it can correct the hallux primus valgus angle and hallux pronational rotatory angle also and it can be a helpful method for minimizing the recurrence rate of the hallux valgus deformity.
Subject(s)
Humans , Hallux , Hallux Valgus , Metatarsal Bones , Osteotomy , Pronation , Recurrence , Supination , ToesABSTRACT
PURPOSE: The purpose of this study was to document the results of fixation with ethibond suture in akin osteotomy and its advantages. MATERIALS AND METHODS: From May 2001 to January 2004, Akin osteotomy was performed in 218 patients. We reviewed 110 patients (114 feet) who were possible radiographic evaluation more than 6 months after operation. 110 feet had hallux valgus and 4 feet had hallux valgus interphalangeus. 105 patients were female and 5 were male. The average age was 43.8 years old (18 to 68 years old). The average follow up was 9 months (6 to 23 months). After performing the Akin osteotomy at 7 mm from the proximal articular surface of the proximal phalanx, one hole is made on either side of the osteotomy site with a K-wire. The passer was passed through the both holes and the ethibond was passed. And then, the ethibond was tied tightly. 2 sutures in 66 feet and 1 suture in 48 feet were made. Radiographic bone union at 6 months follow up was regarded as success and loss of the reduction, nonunion was regarded as failed. RESULTS: In the radiographic evaluation, bony union were made at 6 months follow up in all feet. There was no difference between 2 sutures and 1 suture, and the knots were removed in 3 feet because of skin irritation. CONCLUSION: The fixation of the osteotomy site using suture material was an effective method in Akin osteotomy. The advantage of this procedure was unnecessity of the material removal.