Evaluación radiológica pre y posoperatoria de la osteotomía de Austin y uso de AutoCAD® / Preoperative and Postoperative Radiological Evaluation of Austin Osteotomy and Use of Autocad®

Introducción: Se han descrito más de 300 técnicas quirúrgicas para la corrección del hallux valgus. Una de ellas es la técnica de Austin, la cual constituye una osteotomía capital en V con una angulación de 60º utilizada en el tratamiento quirúrgico del hallux valgus leve-moderado. Objetivos: Analizar el grado de corrección que tiene la osteotomía de Austin sobre diferentes parámetros radiológicos y describir la frecuencia con la que se utilizan técnicas complementarias sobre la falange proximal. Métodos: Se realizó un estudio descriptivo, transversal, observacional y retrospectivo. Se seleccionó una muestra de 29 pies intervenidos mediante la técnica de Austin, a los que se les realizaron varias mediciones sobre sus radiografías pre y posoperatorias con AutoCAD®. Resultados: Se obtuvieron diferencias estadísticamente significativas en todos los parámetros evaluados. Conclusiones: Esta técnica corrige significativamente todos los parámetros analizados. Se demuestra que el uso de técnicas quirúrgicas complementarias sobre la falange proximal es bastante frecuente al realizar esta osteotomía(AU)

Introduction: More than 300 surgical techniques have been described for the correction of hallux valgus. One of them is the Austin technique, which constitutes a capital V osteotomy with an angulation of 60º used in the surgical treatment of mild-moderate hallux valgus. Objectives: To analyze the degree of correction that Austin osteotomy has on different radiological parameters and to describe the frequency with which complementary techniques are used on the proximal phalanx. Methods: A descriptive, cross-sectional, observational and retrospective study was carried out in a sample of 29 feet operated on using the Austin technique. Several measurements were made on their pre- and postoperative radiographs with AutoCAD®. Results: Statistically significant differences were obtained in all the parameters evaluated. Conclusions: This technique significantly corrects all the parameters analyzed. It is shown that the use of complementary surgical techniques on the proximal phalanx is quite frequent when performing this osteotomy(AU)

New application of endobutton suspension plate in hallux valgus deformity / 中国组织工程研究

BACKGROUND: Hallux valgus is a complex deformity. There is no gold standard for the treatment of hallux valgus. Osteotomy is highly recommended at present, but there are many complications. Whether we can correct hallux valgus without osteotomy Is a new attempt In our group. OBJECTIVE: To explore the efficacy of an Endobutton suspension plate treatment for hallux valgus deformity. METHODS: From April 2013 to August 2018 at Department of Orthopedics, Changzhou Tumor Hospital Affiliated to Soochow University, 26 cases of hallux valgus were treated with Endobutton suspension plate, without osteotomy. All patients signed the Informed consents and the study was approved by the hospital ethics committee. The hallux valgus angle and angle between metatarsal 1 and 2 were detected preoperatively and postoperatively. The American Orthopaedic Foot & Ankle Society score was detected at 12 months postoperatively. RESULTS AND CONCLUSION: (1) All patients were followed up from 8 to 38 months. (2) The hallux valgus angle (28.95±4.12)° and angle between metatarsal 1 and 2 (15.82±1.81)° preoperatively were significantly decreased to (14.15±3.60)° and (7.88±0.90)° postoperatively (both P < 0.01). (3) The American Orthopaedic Foot & Ankle Society score at 12 months after surgery (89.15±7.81) was significantly higher than that at baseline (62.08±7.10) (P < 0.01). (4) In summary, Endobutton suspension fixation between metatarsal 1 and 2 for treating hallux valgus is a viable treatment option.

Surgical Outcomes of Internal Fixation Using Multiple Screws in Femoral Neck Fractures with Valgus Impaction: When Should We Consider Hip Arthroplasty? A Retrospective, Multicenter Study / 대한고관절학회지

PURPOSE: We analyzed the surgical outcomes at two institutions after internal fixation using multiple screws in femoral neck fractures with valgus impaction to determine independent predictors and their cut-off values for nonunion and reoperation. MATERIALS AND METHODS: Between January 2006 and December 2016, 104 femoral neck fractures with valgus impaction that underwent internal fixation using multiple screws from two institutions were enrolled. The multiple logistic regression model and receiver operating characteristics analysis were used to determine the independent predictors and cut-off values for nonunion and reoperation. RESULTS: There were 20 reoperations (19.2%) due to 11 nonunions (10.6%) and nine cases of femoral head osteonecrosis (8.7%). Multiple logistic regression analysis revealed that independent predictors of nonunion and reoperation were age and posterior tilt angle (P<0.05). The cut-off value for age and the posterior tilt angle for reoperation were 72.5 years and 12.2°, respectively. The patients with a posterior tilt angle of greater than 13° had poorer radiological and clinical outcomes compared with those with a posterior tilt angle of less than 13°, even though they did achieve bone union. CONCLUSION: Primary hip arthroplasty should be considered in patients older than 73 years of age with a posterior tilt angle greater than 13°.

The Effect of Second Toe Valgus on Correction Loss of Hallux Valgus Angle in Surgical Treatment / 대한족부족관절학회지

PURPOSE: The purpose of this study is to determine the correlation between the correction loss of hallux valgus angle and the severity of valgus angle of the second toe. MATERIALS AND METHODS: We selected 312 cases from 268 surgical patients with hallux valgus deformity receiving distal chevron osteotomy. For a radiological evaluation, we analyzed the changes in the hallux valgus angles, first to second intermetatarsal angles, and valgus angle of the second toe post index operations. All patients were women; the mean age was 46 years. The mean follow-up period was 17 months. RESULTS: The mean hallux valgus angle was 33.6° preoperatively (range, 25.7°~44.8°), 13.1° (range, 8.4°~16.4°) after 4 weeks of postoperative period, and 17.1° (range, 9.4°~28.5°) at their final follow-up. The mean valgus angle of the second toe was 8.4° preoperatively (range, 2.0°~25.8°) and 8.3° (range, 1.7°~24.9°) at the final follow-up. Preoperatively, there was a positive correlation between the valgus angle of the second toe and hallux valgus angle (r=0.747, p=0.001). The correction loss of hallux valgus angle had a significant correlation with the severity of valgus angle of the second toe (r=0.802, p=0.001). CONCLUSION: The existence of the second toe valgus deformity may present itself as a cause of correction loss of hallux valgus angle. The preoperative measurement of the second toe valgus angle may be a good predictor of correction loss; therefore, thorough preoperative warning on the possibility of correction loss should be conducted to maximize patient satisfaction after the procedure.

Point-Connecting Measurements of the Hallux Valgus Deformity: A New Measurement and Its Clinical Application

PURPOSE: The aim of this study was to investigate new point-connecting measurements for the hallux valgus angle (HVA) and the first intermetatarsal angle (IMA), which can reflect the degree of subluxation of the first metatarsophalangeal joint (MTPJ). Also, this study attempted to compare the validity of midline measurements and the new point-connecting measurements for the determination of HVA and IMA values. MATERIALS AND METHODS: Sixty feet of hallux valgus patients who underwent surgery between 2007 and 2011 were classified in terms of the severity of HVA, congruency of the first MTPJ, and type of chevron metatarsal osteotomy. On weight-bearing dorsal-plantar radiographs, HVA and IMA values were measured and compared preoperatively and postoperatively using both the conventional and new methods. RESULTS: Compared with midline measurements, point-connecting measurements showed higher inter- and intra-observer reliability for preoperative HVA/IMA and similar or higher inter- and intra-observer reliability for postoperative HVA/IMA. Patients who underwent distal chevron metatarsal osteotomy (DCMO) had higher intraclass correlation coefficient for inter- and intra-observer reliability for pre- and post-operative HVA and IMA measured by the point-connecting method compared with the midline method. All differences in the preoperative HVAs and IMAs determined by both the midline method and point-connecting methods were significant between the deviated group and subluxated groups (p=0.001). CONCLUSION: The point-connecting method for measuring HVA and IMA in the subluxated first MTPJ may better reflect the severity of a HV deformity with higher reliability than the midline method, and is more useful in patients with DCMO than in patients with proximal chevron metatarsal osteotomy.

The Computerized Measurement for the Radiological Severity of Hallux Valgus / 대한족부족관절학회지

PURPOSE: To study the reliability of intra- and interobserver reliability in angular measurement of hallux valgus deformity by assessing hallux valgus angle (HVA) and the 1st to 2nd intermetatarsal angle (1-2 IMA) through using computerized system. MATERIALS AND METHODS:20 cases of moderate to severe hallux valgus patients were included in this study. With the standing anteroposterior view of foot, the HVA and 1-2 IMA were calculated by computerized measurement system of Infinity cooperation, called phi-view, with its software tools. Using the statistical software program, SPSS (version 12th), we interpreted the results which were measured by two independent observers. RESULTS:In the intraobserver measurement, the HVA of observer A showed reliability (32.5 degrees +/-6.9 and 33.1 degrees +/-6.8)(p005). In the results of observer B, HVAs were measured as 35.7 degrees +/-7.6 and 36.2 degrees +/-7.7, and were not reliable (p>005). 1-2 IMA in observer B was not reliable as well (17.0 degrees +/-0.8 and 20.8 degrees +/-1.5)(p>005). In the interobservers' measurements, the first and the second results of HVA were 3.2 degrees +/-3.6 and 3.1 degrees +/-3.1, reliable within the 95% confidence interval (p005). CONCLUSION: In the angular measurement of the hallux valgus by computerized system, the HVA and 1-2 IMA showed less error range in the interobserver's results, compared with the previous studies about the manual measurement. However, our results failed to show the statistical reliability of intra- and interobserver's measuring. Therefore, even the computerized angular measurements in the severity of hallux valgus require development of the measuring methods and software tools.

Incidence of Hallux Valgus Interphalangeus in the Normal and Hallux Valgus Feet and its Correlations with Hallux Valgus Angle and Intermetatarsal Angle / 대한족부족관절학회지

PURPOSE: In order to achieve successful outcome for the hallux valgus surgery, it is mandatory to consider the possible associated hallux valgus interphalangeus, and therefore the hallux interphalangeal angle (HIA) other than hallux valgus angle (HVA) and intermetatarsal angle (IMA) has been well appreciated. The purpose of this study is to evaluate the incidence of hallux interphalangeal angle in the normal and hallux valgus feet and also the statistical correlations of HIA with HVA and IMA in the 2 groups. MATERIALS AND METHODS: The study is base on the standing foot AP radiographs of the 100 normal feet (HVA25 degrees and IMA>12 degrees). We measured the hallux valgus angle, intermetatarsal angle and hallux interphalangeal angle, where we defined the hallux valgus interphalangeus when the HIA was more than 10 degrees. We evaluated the incidence of the hallux valgus interphalangeus in the normal and hallux valgus groups and the correlations of the HIA with HVA and IMA. RESULTS: In normal feet group, hallux valgus interphalangeus comprised 82%, while there were only 20% of HVI in hallux valgus group. Among 200 total feet, there was negative correlations between the HVA and HIA as well as IMA and HIA statistically (p<0.01). CONCLUSION: There was lower incidence of hallux valgus interphalangeus in the hallux valgus group compared to the normal feet group.

Radiographic Changes in Forefoot Geometry with Weightbearing: Hallux Valgus Angle, Intermetatarsal Angle, and Medial Sesamoid / 대한족부족관절학회지

PURPOSE: To determine the radiographic changes in forefoot geometry with weight-bearing. MATERIALS AND METHODS: The forefoot radiographs of 100 normal Korean adults, 50 male and 50 female volunteers, were evaluated both in nonweight-bearing and weight-bearing. The mean age was 27 years with range of 21-39 years. Those with normal feet were selected from volunteers having no history of foot problems or other musculoskeletal diseases. RESULTS: The changes of measured angle between phalanges and metatarsals with weight-bearing were as follows; Hallux valgus angle was noted to increase in 20% of the feet, decrease in 59%, and remained unchange in 21%. Intermetatarsal angle 1~2 was noted to increase in 76% of the feet, decrease in 3%, and remained unchange in 21%. Intermetatarsal angle 1~5 was noted to increase in 95% and remained unchange in 5%. Shift in medial sesamoid on weight-bearing was also not consistent. Lateral shift was noted in 27%, no shift in 66%, medial shift in 7%. CONCLUSION: The generalized concept that the angles between bones and shift of medial sesamoid in the forefoot will change consistently with weightbearing was not found.

Radiographic Changes in Forefoot Geometry with Weightbearing: Hallux Valgus Angle, Intermetatarsal Angle, and Medial Sesamoid / 대한족부족관절학회지

PURPOSE: To determine the radiographic changes in forefoot geometry with weight-bearing. MATERIALS AND METHODS: The forefoot radiographs of 100 normal Korean adults, 50 male and 50 female volunteers, were evaluated both in nonweight-bearing and weight-bearing. The mean age was 27 years with range of 21-39 years. Those with normal feet were selected from volunteers having no history of foot problems or other musculoskeletal diseases. RESULTS: The changes of measured angle between phalanges and metatarsals with weight-bearing were as follows; Hallux valgus angle was noted to increase in 20% of the feet, decrease in 59%, and remained unchange in 21%. Intermetatarsal angle 1~2 was noted to increase in 76% of the feet, decrease in 3%, and remained unchange in 21%. Intermetatarsal angle 1~5 was noted to increase in 95% and remained unchange in 5%. Shift in medial sesamoid on weight-bearing was also not consistent. Lateral shift was noted in 27%, no shift in 66%, medial shift in 7%. CONCLUSION: The generalized concept that the angles between bones and shift of medial sesamoid in the forefoot will change consistently with weightbearing was not found.

Evaluation of Foot Deformity according to the Occupational Condition in the Labor of the Industry

OBJECTIVE: The purpose of this study was to evaluate the correlation between each variable on occupational condition and foot deformity by Harris mat footprint. METHOD: Subjects were 227 labors having no neurologic or musculoskeletal problems. They were evaluated by clinical history and Harris mat footprint. Three optional parameters of footprints were medial arch angle, metatatarsal arch grade, and hallux valgus angle. RESULTS: 1) Hallux valgus angles were significantly increased in group of female, above 39 years old, labor, and duration of duty more than 6 years. 2) Medial arch angles were significantly decreased in female, above 39 years old, obese person, and labor. 3) Metatarsal arch grades were significantly increased in group of female, above 39 years old, and more than 20 numbers of conveyance, less than 6 years of duration of duty. Foot pain was not related to medial arch angle, metatatarsal arch grade, and hallux valgus angle, respectively. CONCLUSION: These results suggest that deformity of foot were related to female, above 39 years old, obese person, position of duty, duration of duty, and standing time. So these peoples maybe helpful for weaning proper modified shoes.