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)

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.

Characteristics of Severe Hallux Valgus Deformity with Moderate Intermetatarsal Angle / 대한족부족관절학회지

PURPOSE: The purpose of this study is to evaluate the characteristics of hallux valgus with severe hallux valgus angle (HVA) and moderate intermetatarsal angle (IMA) after proximal chevron osteotomy. MATERIALS AND METHODS: Between January 2008 and December 2010, 41 patients (48 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic severe hallux valgus deformity (HVA > or =40degrees). Patients were divided into two groups, group M (IMA or =18degrees). Mean age of patients was 55.7 years (34~70 years) in group M and 60.0 years (44~78 years) in group S. Mean duration of follow-up was 20.4 months (12~41 months) in group M and 18.5 months (12~35 months) in group S. Radiographic parameters, including HVA, IMA, sesamoid position, metatarsus adductus angle (MAA), and distal metatarsal articular angle (DMAA), were compared between groups. Clinical results were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS). Recurrence rate at the last follow-up was compared between group M and group S. RESULTS: Preoperative HVA and grade of sesamoid position did not differ between the groups. However, immediate postoperative HVA and grade of sesamoid position were significantly larger in group M. Preoperative MAA and DMAA were significantly larger in group M. No significant difference in AOFAS score and VAS was observed between the groups at the last follow-up. Ten of the 27 feet (37.0%) in group M and two of the 21 feet (9.5%) in group S showed hallux valgus recurrence at the last follow-up. Group M showed a significantly higher recurrence rate than group S. CONCLUSION: Recurrence rate for severe hallux valgus with moderate IMA is higher than that of severe hallux valgus with severe IMA.

The 4th-5th Intermetatarsal Angle and the 5th Metatarsophalangeal Angle of Young Men in Korea / 대한족부족관절학회지

PURPOSE: The purpose of this study is to find out the normal angles of forefoot for diagnosis of bunionette deformity in Korea. This would be helpful as it would provide a basic angular measurement of bunionette deformity that indicates the need for operation. MATERIALS AND METHODS:Within a period of four months from January 2007 to April 2007. We have established 300 males and 600 feet without trauma history of foot. The source to image distance is 40 inches and erect weight bearing radiographs are obtained in anteroposterior and lateral projections. The significant angular measurements that define a bunionette deformity are the fourth-fifth intermetatarsal angle, the fifth metatarsophalangeal angle RESULTS:The mean age was 21 years(19-22 years) old. The mean 4th-5th intermetatarsal angle was 9.4+/-4.7 degrees , the mean 5th metatarsophalangeal angle was 7.9+/-9.2 degrees . CONCLUSION: We can consider over the 14.1 degrees on the 4th-5th intermetatarsal angle and over 17.1 degrees on the 5th metatarsophalangeal angle as an operational indication.

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.