Impact of pain in other body regions on the foot-specific quality of life in patients with hallux valgus.

OBJECTIVES: The purpose of this study was to clarify the prevalence of pain outside the foot, and to determine the associations of pain outside the foot with foot-specific quality of life (QOL) in patients with hallux valgus. METHODS: Patients scheduled to undergo hallux valgus surgery were recruited. Patients answered whether they experienced disabling pain in 13 body regions other than the foot. Foot-specific QOLwas assessed using the Self-Administered Foot Evaluation questionnaire (SAFE-Q). Foot pain was quantified using the visual analogue scale (VAS). Patient characteristics, including age, sex, comorbidity, anxiety, and depression, were also surveyed. The association between pain elsewhere and the SAFE-Q and pain VAS scores were assessed using univariate and multivariate analyses. RESULTS: Of 102 patients, 55 (54%) experienced pain other than the foot. All SAFE-Q subscale scores were lower, and pain VAS was higher in patients with pain elsewhere than in patients without. In the multivariate analysis, an increase in the number of pain regions was independently associated with a decrease in SAFE-Q scores and an increase in pain VAS. CONCLUSION: More than half of the patients with hallux valgus experienced pain elsewhere. The presence of pain elsewhere was associated with poorer foot-specific QOL and severer foot pain.

Radiographic and Clinical Results of Minimally Invasive Chevron Akin Osteotomy for Moderate to Severe Hallux Valgus Deformities.

BACKGROUND: Few studies have reported results of minimally invasive chevron Akin osteotomy (MICA) for moderate to severe hallux valgus correction. This study aims to evaluate MICA for moderate to severe hallux valgus radiographically and clinically. METHODS: Forty feet were prospectively reviewed. Twenty-eight feet (70%) had a severe deformity (hallux valgus angle (HVA) ≥40° and/or first intermetatarsal angle (IMA) ≥18°). We measured HVA, IMA, lateral shape of the metatarsal head (round sign), tibial sesamoid position, first metatarsal shortening on anteroposterior weightbearing radiographs, and inclination angle of first metatarsal on lateral weightbearing radiographs. We evaluated the Japanese Society for Surgery of the Foot hallux scale and Self-Administered Foot Evaluation Questionnaire responses preoperatively and at the most recent follow-up. RESULTS: All measurements except shortening and inclination angle improved significantly. Both clinical scale and all subscores significantly improved. CONCLUSIONS: MICA improved moderate to severe hallux valgus both radiographically and clinically.Level of Evidence: Level IV: case series.

Percutaneous Bunionette Correction Without Fixation: Clinical Results and Radiographic Evaluations Including Rotation of Metatarsal Head and Sagittal Angle Change of Fifth Metatarsal.

Bunionette deformities have been treated as an analog of hallux valgus, and the surgical techniques are similar. Most commonly anteroposterior image is evaluated pre- and postoperatively. To our knowledge, only one study has evaluated changes on the lateral radiograph and no study has evaluated changes in rotation of the fifth metatarsal head postoperatively. In percutaneous bunionette correction using a burr for osteotomy, shortening of the fifth metatarsal and elevation of the metatarsal head are inevitable. Without fixation, there is also a possibility of rotational change to the metatarsal head. We measured parameters on anteroposterior and lateral weightbearing radiographs in 18 feet pre- and postoperatively. Rotation of the fifth metatarsal head was graded according to the medial tubercle location. We also evaluated angular change of the fifth metatarsal on weightbearing lateral radiographs. Percutaneous bunionette correction without fixation could achieve satisfactory clinical and radiographic results, with less complication, when compared with previously published outcomes of open and percutaneous surgery with fixation. In this surgical method, bunionette is corrected in 3 dimensions. To our knowledge, this is the first study to evaluate rotation of the metatarsal head and change in the sagittal angle of the fifth metatarsal after bunionette correction.

Removal of Painful Os Paracuneiforme: A Case Report.

Os paracuneiforme (OPC) is an extremely rare accessory bone located either medial to the medial cuneiform or to the naviculocuneiform joint. Although OPC often appears on the list of accessory ossicles, there are few reported cases regarding this bone. OPC can cause symptoms that require surgical intervention, but only 2 surgically treated cases have been published in the literature in English. Here, we report the case of a patient with painful OPC who was surgically treated. The patient showed no restriction in his daily living and recreational activities 6 months postoperatively. This is the first report showing not only preoperative and postoperative radiographs, but also preoperative CT images, photographs of intraoperative findings, and the resected ossicle. Level of Evidence: Level V.

Adult Flat Foot With Multiple Accessory Navicular Bones Treated Surgically: A Case Report and Review of the Literature.

Multiple accessory navicular bones is an extremely rare condition. To the best of our knowledge, only 8 cases in 2 imaging studies have been published. We report a case of a patient with flat foot with 2 accessory navicular bones. This patient needed to be treated surgically, and the surgery was successful, with short-term follow-up. We believe this is the first case of multiple accessory navicular bones to be treated surgically in English literature. The incidence of multiple accessory navicular bones might be higher. There is a risk to remaining ossicles without resection or fixation during surgery; therefore, we strongly recommend using not only radiographs, but also 3-dimensional computed tomography scans or magnetic resonance imaging scans to confirm the type of accessory navicular bone, at least before surgery, for both painful accessory navicular bone and flat foot with accessory navicular bone.

Chronic extensor hallucis longus tendon rupture treated with double-bundle autograft of extensor hallucis capsularis: A case report.

The extensor hallucis capsularis is an accessory extensor tendon with varied occurrence. Here, we present the case of a 40-year-old man with chronic extensor hallucis longus tendon rupture treated using extensor hallucis capsularis tendon as a double-bundle autograft. He had dropped a knife proximal to the right hallux metatarsophalangeal joint 4 months ago. Computed tomography revealed the presence of extensor hallucis capsularis, with its width and thickness, and the point of divergence from the extensor hallucis longus tendon. Because direct suturing was considered difficult and the extensor hallucis capsularis tendon was sufficiently wide and long, double-bundle autograft transplantation of extensor hallucis capsularis was performed. At 1-year follow-up examination, the patient retained almost full function of his hallux. To the best of our knowledge, this is the first case to use this technique. Using the extensor hallucis capsularis tendon for grafting should be carefully considered because the variable width and length may limit the graft strength. Level of evidence: IV.

Accessory anterolateral talar facet impingement with tibialis spastic varus foot.

In recent years, some authors have reported accessory anterolateral talar facet impingement with flatfoot including peroneal spastic flatfoot. Conversely, to our knowledge, no case report has been published about accessory anterolateral talar facet impingement with tibialis spastic varus foot. We report the first case in a 22-year-old man with intellectual disability, bilateral cleft hands and type 1 diabetes mellitus. Since spraining his left ankle over a year earlier, he experienced left sinus tarsi pain while standing and walking. Physical examination revealed that his left foot was in the varus position with spasm of the anterior tibial muscle, tenderness in the sinus tarsi and lateral hindfoot pain upon attempted passive hindfoot eversion. He could not stand on his left toes. His pain decreased after lying down and receiving a massage on his anterolateral lower leg at night. Radiographs and computed tomography scans revealed the absence of tarsal coalition and the presence of accessory anterolateral talar facet in both feet. Magnetic resonance imaging demonstrated abutting bone marrow edema between the talus and calcaneus around the accessory anterolateral talar facet. We diagnosed the patient with accessory anterolateral talar facet impingement and tibialis spastic varus foot. After conservative treatment failed, resection of accessory anterolateral talar facet achieved good results with short-term follow-up.

Hypertrophy of the abductor hallucis muscle: A case report and review of the literature.

OBJECTIVES: Muscle hypertrophy is a relatively rare condition that may cause nerve entrapment syndromes. We report the case of a 14-year-old girl with unilateral hypertrophy of the abductor hallucis muscle with entrapment of the medial plantar nerve and review the literature. METHODS: Computed tomography and magnetic resonance imaging revealed unilateral hypertrophy of the abductor hallucis muscle. RESULTS: Two injections of steroid and lidocaine at the point of tenderness resulted in resolution of the pain. CONCLUSIONS: We report a rare case of hypertrophy of the abductor hallucis muscle considered with entrapment of the medial plantar nerve. Treatment of this condition should be selected according to the pathological condition of each patient.

Severe Hallux Valgus With Coalition of the Hallux Sesamoids Treated With Modified Lapidus Procedure: A Case Report.

Coalition of the hallux sesamoids is an extremely rare condition. To our knowledge, only 1 case report has been published. We report a case of severe hallux valgus deformities with coalitions of the hallux sesamoids. The coalitions themselves were asymptomatic; however, this severe hallux valgus deformity needed to be surgically treated. The hallux sesamoids in both feet appeared to be fused and heart shaped on anteroposterior radiographs and dumbbell shaped on axial radiographs. It is known that postoperative incomplete reduction of the medial sesamoids can be a risk factor for the recurrence of hallux valgus. The computed tomography scan demonstrated a groove in the bottom of the center of the heart-shaped sesamoid. The flexor hallucis longus tendon was located in the groove. Therefore, a modified Lapidus procedure was performed considering the medial half of the heart-shaped sesamoid as the medial sesamoid. Although delayed union occurred, successful correction of the deformity was achieved. LEVELS OF EVIDENCE: Level IV.

Effectiveness of Percutaneous Proximal Closing Wedge Osteotomy With Akin Osteotomy to Correct Severe Hallux Valgus Determined by Radiographic Parameters.

Some authors reported the results from percutaneous distal metatarsal osteotomy for hallux valgus recently. On the other hand, there are few reports of percutaneous proximal metatarsal osteotomy. The purpose of the present study was to evaluate the radiographic results of percutaneous proximal closing wedge osteotomy with Akin osteotomy for correction of severe hallux valgus and increasing longitudinal arch height. Consecutive 17 feet (mean age = 70.8 years) were investigated. The mean follow-up was 22 months. Excision of medial eminence, distal soft tissue release, and Akin osteotomy were all performed percutaneously and concurrently. Weight-bearing anteroposterior and lateral radiographs of the feet were acquired preoperatively and at final follow-up. On the anteroposterior radiographs, hallux valgus angle, intermetatarsal angle, and first metatarsal shortening were measured. On the lateral radiographs, talometatarsal angle, calcaneal pitch angle, and first metatarsal dorsiflexion were measured. The average improvements in hallux valgus angle and intermetatarsal angle were 27.6° and 9.9°, respectively. The average first metatarsal shortening was 2.7 mm. The first metatarsal dorsiflexion improved by 2.2°; however, other parameters did not improve significantly. In conclusion, percutaneous proximal closing wedge osteotomy with Akin osteotomy corrects severe hallux valgus; however, the procedure does not increase the medial longitudinal arch. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case series.

An Isolated Chronic Osteochondral Fracture of the Third Metatarsal Head Treated With Bioabsorbable Pins: A Case Report.

An osteochondral fracture of the metatarsal head is generally the result of direct trauma and is associated with additional proximal fractures of the medially adjacent metatarsals. An isolated osteochondral fracture of the metatarsal head is extremely rare, with only 10 published case reports. Open reduction and internal fixation was performed in 6 of 10 cases and in 2 of 4 chronic cases, each with different implants previously. The mechanism of injury was considered to be shear force in 5 of the reported cases. It is difficult to achieve and maintain reduction in these cases, and the best method for treatment of this type of fracture is unclear. We report a case of an isolated chronic osteochondral fracture of the third metatarsal head in a 14-year-old boy. The boy reported pain in his third metatarsophalangeal joint on dismounting from a bicycle 2 months prior to presentation. He could play soccer at first; however, the pain worsened after running long distances. Therefore, he was referred to our department. Magnetic resonance imaging revealed an osteochondral fracture of the metatarsal head without Freiberg's disease. We achieved a good result 12 months postoperatively by using open reduction and internal fixation with 2 bioabsorbable thread pins. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case study.

Tibialis Spastic Varus Foot With Calcaneonavicular Coalition: A Case Report and Review of the Literature.

UNLABELLED: Peroneal spastic flat foot is a well-known condition usually occurring with tarsal coalition. Conversely, tibialis spastic varus foot is a rare condition, which can be difficult to diagnose. Moreover, tibialis spastic varus foot with calcaneonavicular coalition is extremely rare, with only a few published case reports. Resection of the calcaneonavicular bar is performed in the majority of patients. We report a case of tibialis spastic varus foot with calcaneonavicular coalition in an 11-year-old boy with intellectual disability. His family noticed his right varus foot deformity 1.5 years earlier. There was no obvious history of trauma. The deformity gradually worsened with running. Because conservative treatment failed, resection of the coalition was performed that facilitated a good outcome. In this article, we report our experience of tibialis spastic varus foot with calcaneonavicular coalition and review the English literature of this condition. LEVEL OF EVIDENCE: Therapeutic, Level IV: Case report.

Valgus toe deformity of fourth proximal phalanx due to osteochondroma treated with closing wedge osteotomy.

Osteochondroma is the most common benign tumor of all benign and primary bone tumors. It rarely occurs in the proximal phalanx of the lesser toe. The treatment of osteochondroma usually consists of simple resection. However, if other deformities remain, added procedures may be considered. We report a case of a valgus toe deformity of the fourth proximal phalanx due to osteochondroma. The patient was a 21-year-old man who noticed a valgus deformity of his fourth toe over 10 years earlier. He began to experience pain in his fifth toe because of crossover of the fourth toe when wearing formal shoes. Although resection of osteochondroma was performed, the valgus deformity was not sufficiently corrected. Therefore, closing wedge osteotomy of the proximal phalanx was performed at the same time. A good outcome was achieved for this patient.

Checkrein deformity due to extensor hallucis longus hypotrophy treated with extensor digitorum longus tendon transfer.

Checkrein deformity is a relatively rare condition caused by hypotrophy or adhesion of a tendon after a lower leg injury. The occurrence of this condition due to the dysfunction of the extensor hallucis longus (EHL) is extremely rare. Only a few related case reports have been published, and Z-lengthening of the EHL tendon was performed for almost all patients. We report a case of checkrein deformity due to EHL hypotrophy. The patient was involved in a traffic accident 7 years ago. He sustained left tibial and fibular closed diaphyseal fractures and underwent minimally invasive plate osteosynthesis. He continued to have left great toe symptoms characterized by dorsiflexion of the great toe during ankle plantarflexion. The EHL had become an insufficient power source because of considerable hypotrophy. Therefore, a tendon transfer using the extensor digitorum longus to the second toe was performed as a primary treatment.