Comparison of Proximal and Modified Distal Chevron Osteotomy for the Treatment of Moderate to Severe Hallux Valgus Deformity / 대한족부족관절학회지

PURPOSE: The purpose of our study is the comparison of radiological and clinical outcomes between modified distal chevron osteotomy and proximal metatarsal osteotomy for the patients who had moderate to severe hallux valgus deformity. MATERIALS AND METHODS: In this retrospective study, we included 54 patients (65 feets) who underwent the operation of moderate to severe hallux valgus in our hospital from May 2007 to August 2010. Our study compares two groups. For Group 1, a modified distal chevron osteotmy and a distal soft tissue procedure were done and for Group 2, a proximal metatarsal osteotmy and a distal soft tissue procedure were done. The group 1 were 29 feets; the group 2 were 36 feets, and the average follow up was 9 months. RESULTS: The radiological results show that the hallux valgus angle and the first-second intermetatarsal angle were significantly decreased in two groups. In each parameter, the correction of the hallux valgus angle was 19.1degrees (Group 1) and 24.3degrees (Group 2), the correction of the first-second intermetatarsal angle was 9.6degrees (Group 1) and 10.3degrees (Group 2). Shortening of the first metatarsal length was 0.87 mm (Group 1) and 0.77 mm (Group 2). There are no significant clinical results (American Orthopaedic Foot and Ankle Society score, AOFAS score) in two groups. CONCLUSION: It is thought that a modified distal chevron osteotomy and a distal soft tissue procedure are a considerable operative treatment of moderate to severe hallux valgus deformity because of the similar cilinical results, more simple operative techniques, and less complications than a proximal metatarsal osteotomy.

Operative Treatment of Hallux Valgus Deformity in Male Patients / 대한족부족관절학회지

PURPOSE: We evaluated the result of operative treatment of the hallux valgus in male patients. MATERAILS AND METHODS: Total 11 cases (10 patients) of the hallux valgus deformity that treated with operation were evaluated. Following Mann's radiological classification system, there was 1 cases of mild, 8 cases of moderate, and 2 cases of severe. Preoperative, postoperative, postoperative 3 months and postoperative 6 months follow up standing radiographs were used as radiologic evaluation. And we evaluated radiological outcomes by hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), proximal phalangeal articular angle (PPAA) and clinical outcomes by hallux-metatarsophalangeal scale of American Orthopaedic Foot and Ankle Society (AOFAS) score. RESULT: Radiologically, the mean preoperative HVA 37degrees and IMA 13.7degrees were improved postoperatively as HVA 11.9degrees and IMA 4.7degrees, and the mean preoperative DMMA 29.4degrees and PPAA 8.6degrees were improved postoperatively DMMA 13.9degrees and PPAA 7degrees. But, postoperative 6 months follow up HVA, IMA, DMMA and PPAA was increased at 14.2degrees, 6.3degrees, 16.1degrees and 8.3degrees. Average AOFAS score were improved from 61.2 points to 75.2 points. CONCULSION: In our study, operative treatment of hallux valgus in male patients with proximal metatarsal osteotomy and distal soft tissue procedure showed good results but it was necessary to pay attention to increase aspect of follow up radiologic measurements.

Comparison of Proximal Metatarsal Osteotomy andDistal Chevron Osteotomy for Correction of Hallux Valgus / 대한족부족관절학회지

PURPOSE: The purpose of this study is comparison of radiological and clinical outcomes between proximal metatarsal osteotomy and distal chevron osteotomy for the correction of hallux valgus. MATERIALS AND METHODS: In this retrospective study, we included subjects who underwent the correction of hallux valgus in our institution between March 2001 and August 2006, with a minimum follow-up of 12 months. The group of proximal metatarsal osteotomy was 23 patients (34 feet); the group of distal chevron osteotomy was 20 patients (26 feet). The group of proximal metatarsal osteotomy was composed of 26 severe cases (76.5%) and 8 moderate cases (23.5%); the group of distal chevron osteotomy was composed of 13 severe cases (50.0%) and 13 moderate cases (50.0%). RESULTS: Compared to preoperative values, the hallux valgus angle, the first-second intermetatarsal angle and the distance of first-fifth metatarsal head were significantly decreased in two groups (p<0.05). In each parameter, the hallux valgus angle was decreased 66.3% (proximal metatarsal osteotomy) versus 49.6% (distal chevron osteotomy), which were significant (p=0.037). The first-second intermetatarsal angle and the distance of first-fifth metatarsal head were not significant. Mayo clinic forefoot scoring system (FFSS) score was significantly improved in two groups (p<0.05). The ratio of improvement was not significant (p=0.762). In severe group, hallux valgus angle and the first-second intermetatarsal angle was significantly decreased in proximal metatarsal osteotomy group compared to distal chevron osteotomy group (p<0.05), but the difference of the distance of first-fifth metatarsal head and FFSS score was not significant in both groups. In moderate group, the difference of all parameters was not significant in both groups. CONCLUSION: Although both proximal metatarsal osteotomy and distal chevron osteotomy showed satisfactory result in FFSS, proximal metatarsal osteotomy was more proper operative technique than distal chevron osteotomy in severe group, because of superiority of correction in radiological parameters.

Operative Treatment for Hallux Valgus with Proximal Metatarsal Osteotomy in Patients over 55 Years Old / 대한족부족관절학회지

PURPOSE: The purpose of our report was to evaluate the result of operative treatment of hallux valgus in old age patients. MATERIALS AND METHODS: We studied about the clinical & radiologic results of the 31 patients over 55 years old, who had operative treatment of hallux valgus. Clinical evaluation, such as pain, activity limitation, footwear requirement, 1st metatarsophalangeal joint motion, and callosity, was done using AOFAS scale and preoperative and postoperative radiologic parameters, such as hallux valgus angle, intermetatarsal angle, tibial sesamoid position, 1st metatarsal shortening, were evaluated by conventional methods. RESULTS: Objectively, according to AOFAS, the score improved from average of 57.8 to 71.5 postoperatively. The range of motion of first metatarsophalangeal joint was decreased from average of 60.7 to 56.8 degrees. Radiologically, the hallux valgus angle improved from average of 35 to 6.5 degrees and the first intermetatarsal angle improved from average of 14.2 to 4.4 degrees. The position of sesamoid was collected from an average of grade 3.6 to grade 2.2. CONCLUSION: The combination of proximal metatarsal osteotomy, distal soft tissue procedure and Akin osteotomy may yield rather satisfactory clinacal result in severe elderly hallux valgus patients with massive degenerative change and poor soft tissue condition.

Correction of Sesamoid after Proximal Metatarsal Osteotomy and Distal Soft Tissue Procedure in Hallux Valgus / 대한족부족관절학회지

PURPOSE: A retrospective review of the radiographs of the proximal metatarsal osteotomy and distal soft tissue procedure for hallux valgus, evaluating the correction of the tibial sesamoid, was undertaken. We evaluated the correlation between the reduction of the tibial sesamoid and the clinical outcomes. MATERIALS AND METHODS: 17 patients (23 cases) with moderate to severe hallux valgus deformity underwent the proximal metatarsal osteotomy and distal soft tissue procedure. The preoperative and last follow-up radiographs were reviewed according to the tibial sesamoid grade classification recommended by the Research Committee of the American Orthopedic Foot and Ankle Society (AOFAS). We divided them into two groups according to the reduction of the tibial sesamoid. We anaylyzed the clinical outcomes in each group according to Mayo Clinic Forefoot Scoring System (FFSS). RESULTS: In all of the patients, the preoperative tibial sesamoid position were grade 2 or greater. At the last follow-up, 52% (n=12) were grade 1 or less (Group I) and 48% (n=11) were grade 2 or greater (Group II). In group I, the forefoot score was improved from preoperative mean value of 32.0 points to final follow-up value of 66.3 points. In group II, the forefoot score was improved from preoperative mean value of 31.7 points to final follow-up value of 65.9 points. There was no statistical significance between postoperative, average scores in group I and II (p>0.05). CONCLUSION: The position of the tibial sesamoid was corrected insufficiently in almost half of all cases. In view of clinical outcomes, there was no significant difference between the corrected group and the other group.

Operative Treatment for Hallux Valgus with Proximal Metatarsal Osteotomy in Patients over 55 Years Old / 대한족부족관절학회지

PURPOSE: The purpose of our report was to evaluate the result of operative treatment of hallux valgus in old age patients. MATERIALS AND METHODS: We studied about the clinical & radiologic results of the 31 patients over 55 years old, who had operative treatment of hallux valgus. Clinical evaluation, such as pain, activity limitation, footwear requirement, 1st metatarsophalangeal joint motion, and callosity, was done using AOFAS scale and preoperative and postoperative radiologic parameters, such as hallux valgus angle, intermetatarsal angle, tibial sesamoid position, 1st metatarsal shortening, were evaluated by conventional methods. RESULTS: Objectively, according to AOFAS, the score improved from average of 57.8 to 71.5 postoperatively. The range of motion of first metatarsophalangeal joint was decreased from average of 60.7 to 56.8 degrees. Radiologically, the hallux valgus angle improved from average of 35 to 6.5 degrees and the first intermetatarsal angle improved from average of 14.2 to 4.4 degrees. The position of sesamoid was collected from an average of grade 3.6 to grade 2.2. CONCLUSION: The combination of proximal metatarsal osteotomy, distal soft tissue procedure and Akin osteotomy may yield rather satisfactory clinacal result in severe elderly hallux valgus patients with massive degenerative change and poor soft tissue condition.

Correction of Sesamoid after Proximal Metatarsal Osteotomy and Distal Soft Tissue Procedure in Hallux Valgus / 대한족부족관절학회지

PURPOSE: A retrospective review of the radiographs of the proximal metatarsal osteotomy and distal soft tissue procedure for hallux valgus, evaluating the correction of the tibial sesamoid, was undertaken. We evaluated the correlation between the reduction of the tibial sesamoid and the clinical outcomes. MATERIALS AND METHODS: 17 patients (23 cases) with moderate to severe hallux valgus deformity underwent the proximal metatarsal osteotomy and distal soft tissue procedure. The preoperative and last follow-up radiographs were reviewed according to the tibial sesamoid grade classification recommended by the Research Committee of the American Orthopedic Foot and Ankle Society (AOFAS). We divided them into two groups according to the reduction of the tibial sesamoid. We anaylyzed the clinical outcomes in each group according to Mayo Clinic Forefoot Scoring System (FFSS). RESULTS: In all of the patients, the preoperative tibial sesamoid position were grade 2 or greater. At the last follow-up, 52% (n=12) were grade 1 or less (Group I) and 48% (n=11) were grade 2 or greater (Group II). In group I, the forefoot score was improved from preoperative mean value of 32.0 points to final follow-up value of 66.3 points. In group II, the forefoot score was improved from preoperative mean value of 31.7 points to final follow-up value of 65.9 points. There was no statistical significance between postoperative, average scores in group I and II (p>0.05). CONCLUSION: The position of the tibial sesamoid was corrected insufficiently in almost half of all cases. In view of clinical outcomes, there was no significant difference between the corrected group and the other group.

Proximal Metatarsal Wedge Osteotomy with Single Screw Fixation in Treatment of Hallux Valgus / 대한족부족관절학회지

PURPOSE: We conducted this study to examine the clinical results of the proximal metatarsal wedge osteotomy using a single screw fixation and the distal soft tissue procedure in patients with moderate to severe hallux valgus deformity. MATERIALS AND METHODS: Between February 2002 and February 2004, we performed these procedures on 12 patients (15 cases). The 6 cases of all patients had mild to moderate instability in the first MTC (metatarsocuneiform) joint. We estimated the clinical outcomes, the radiological findings and complications. RESULTS: AOFAS score was improved from preoperative 41.5 points to 87.7 points lastly on average. The mean correction angle of HVA and IMA was 23.8 degrees and 6.6 degrees, respectively. The mean position of tibial sesamoid was 2.67 before surgery and 0.87 after surgery. The mean shortening of the first metatarsal bone was 3.07 mm after surgery. There was no pain and complications on the first MTC joint except the breakage of screw in one case and instability of the first MTC joint was improved postoperatively. CONCLUSION: We obtained good clinical and radiographic outcomes in our series. So, proximal metatarsal wedge osteotomy using a single screw fixation and distal soft tissue procedure seems one of the good surgical treatments for moderate hallux valgus deformity.

Correlation of Correction Angle with Pain at First Metatarsophalangeal Joint in the Treatment of Hallux Valgus / 대한정형외과학회잡지

PURPOSE: We evaluated the correlation between correction angle and pain of the first metatarsophalangeal joint in the treatment of hallux valgus. MATERIALS AND METHODS: The 28 cases (20 patients) with moderate to severe hallux valgus deformity and pain of the first metatarsophalangeal joint who underwent the distal soft tissue procedure and proximal metatarsal closing wedge osteotomy, were divided into two groups, Group I: no pain of the first metatarsophalangeal joint after surgery, and Group II: with persisting pain. We analyzed the correc-tion angle and pain of the first metatarsophalangeal joint in each group, preoperatively and at the last follow-up. All of the patients were women and their mean age was 58 years old. The average follow-up time was 18 months. RESULTS: At the last follow-up, the 21 feet (75%) were free of pain of the first metatarsophalangeal joint. In 7 feet (25%) pain persisted. In group I, sufficient deformity correction was obtained, but in group II, the deformity was corrected insufficiently. A high correlation was observed between correction angle and pain relief. CONCLUSION: A high correlation was obtained between correction angle and pain of the first metatarsophalangeal joint in the treatment of hallux valgus deformity. Therefore, in view of the patient's expectation of pain relief, meticulous attention should be paid to the correction of hallux valgus deformity.

Treatment of Hallux Valgus with a Proximal Metatarsal Osteotomy and Distal Soft: Tissue Procedure / 대한정형외과학회잡지

The deformity of hallux valgus is associated with three hasic prohlems: a prominent rnedial eminence, contracted soft-tissue structures on the lateral side of the great toe, and an altered intermetatarsal angle between the first and second metatarsal. We retrospectively have reviewed the results for thirty-one patients(47 feet) in whom a hallux vaigus deformity had heen conected with the release of the distal soft tissues, excision of the medial eminence, plication of the medial part of the capsule, and proximal crescentic osteotomy of the first metatarsal. The patients were followed for an average of twenty months(range, twelve to twenty-eight months). There were nine cases with mild defoimity, twenty-nine cases with moderate deformity, nine cases with severe deformity. The preoperative hallux valgus angle averaged 38.1 degrees, and the immediate postoperative angle averaged 6.7 degrees. The preoperative intermetatarsal angle averaged 17.1 degrees, and the immediate postoperative angle, 7.6 degrees. At the latest follow-up, the hallux valgus angle averaged 19.3 degrees, the intermetatarsal angle averaged 9.9 degrees. We found that the more the deformity, the lesser the congruency. 74.5% of the patients were satisfied with the result of the procedure. They stated that, eiven the same circumstances, they would have the operation again. The most common complication was recurrence of the nallux valgus, which occurred in nine feet(five patients). The other complications included pain under a fibular sesamoid in one foot, severe hypoesthesia on the medial aspect ot the big toe in one foot, and superficial wound infection in one foot.