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Nakajima K. Arthroscopic Flexor Hallux Brevis and Plantar Capsule Release (Cochrane Procedure) for Hallux Rigidus: Case Presentation with Long-Term Follow-Up. J Clin Med 2025; 14:2785. [PMID: 40283614 PMCID: PMC12027970 DOI: 10.3390/jcm14082785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2025] [Revised: 04/14/2025] [Accepted: 04/16/2025] [Indexed: 04/29/2025] Open
Abstract
Background: In 1927, Cochrane observed persistent elastic resistance to hallux dorsiflexion after cheilectomy for hallux rigidus, attributing it to soft tissue tightness beneath the first metatarsophalangeal (MTP) joint. An innovative surgery was introduced using a plantar approach, dividing the plantar tissues. This procedure achieved complete pain resolution and high satisfaction in 12 patients. Despite addressing the etiology of hallux rigidus, this approach has not been adopted in current surgeries. This report presents a case treated with the arthroscopic Cochrane procedure with a long-term follow-up. Methods: A 73-year-old male with hallux rigidus presented with limited dorsiflexion, a painful bony prominence, and pain during walking at the first MTP joint, treated with the arthroscopic Cochrane procedure. Results: During surgery, hallux dorsiflexion did not improve after resecting all spurs in the MTP joint, but the dorsiflexion angle immediately improved from 55° to 85°after releasing the flexor hallucis brevis tendon, plantar capsule, and plantar portion of the lateral ligament. Improvements in both visual analog scale scores (70-0) and Japanese Society for Surgery of the Foot scores (57-88) were noted from preoperatively to 9 years and 6 months postoperatively. No postoperative cockup deformity was observed. Conclusions: The arthroscopic Cochrane procedure can yield favorable long-term outcomes without postoperative cockup deformity.
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Affiliation(s)
- Kenichiro Nakajima
- Center for Foot and Ankle Surgery, Department of Orthopedic Surgery, Yashio Central General Hospital, Saitama 340-0814, Japan
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2
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Kimura T, Kubota M, Kihara T, Suzuki N, Hattori A, Saito M. First ray mobility in hallux rigidus, hallux valgus, and normal feet based on weightbearing computed tomography and three-dimensional analysis: A case-control study. J Orthop Sci 2025; 30:320-324. [PMID: 38670826 DOI: 10.1016/j.jos.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 03/22/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Hallux valgus and hallux rigidus are disorders affecting the first ray and are associated with hypermobility of this structure. This study aimed to investigate the three-dimensional mobility of each joint of the first ray between feet with hallux valgus or hallux rigidus and healthy feet using weightbearing and nonweightbearing computed tomography (CT). METHODS This case-control study analyzed 17 feet of 11 healthy volunteers (control group), 16 feet of 16 patients with hallux valgus (HV group), and 16 feet of 11 patients with hallux rigidus (HR group). First, nonweightbearing foot CT imaging was performed in the supine position on a loading device with no load applied, with the legs extended and the ankle in the neutral position. Next, a load equivalent to body weight was applied for weightbearing CT imaging. Distal bone displacement relative to the proximal bone was quantified three-dimensionally under both conditions. RESULTS In the HV group, the talonavicular joint showed significantly greater eversion (P = 00.011) compared with the control group and significantly greater dorsiflexion (P = 00.027) and eversion (P < 00.01) compared with the HR group. In the medial cuneiform joint, the HV group showed significantly greater eversion (P < 00.01) and abduction (P = 00.011) than the control group. For the first tarsometatarsal joint, the HV group showed significantly greater dorsiflexion (P = 00.014), inversion (P = 00.028), and adduction (P < 00.01) than the control group, and greater inversion (P < 00.01) and adduction (P < 00.01) than the HR group. Dorsiflexion of the first tarsometatarsal joint was significantly greater in the HR group compared with the control group (P = 00.026). CONCLUSION Hypermobility of the first ray appears to be three-dimensional: in hallux valgus, it is centered at the first tarsometatarsal joint, while in hallux rigidus it is mainly in the sagittal plane at the first tarsometatarsal joint only. This difference may explain the different deformities ultimately observed in each condition.
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Affiliation(s)
- Tadashi Kimura
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan; Institute for High Dimensional Medical Imaging, The Jikei University School of Medicine, Tokyo, Japan.
| | - Makoto Kubota
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Takumi Kihara
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan; Institute for High Dimensional Medical Imaging, The Jikei University School of Medicine, Tokyo, Japan
| | - Naoki Suzuki
- Institute for High Dimensional Medical Imaging, The Jikei University School of Medicine, Tokyo, Japan
| | - Asaki Hattori
- Institute for High Dimensional Medical Imaging, The Jikei University School of Medicine, Tokyo, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Nakajima K. Joint-Preserving Surgeries for Hallux Rigidus Based on Etiology: A Review and Commentary. J Clin Med 2025; 14:1595. [PMID: 40095556 PMCID: PMC11899870 DOI: 10.3390/jcm14051595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2025] [Revised: 02/23/2025] [Accepted: 02/25/2025] [Indexed: 03/19/2025] Open
Abstract
In 1927, Cochrane noted that elastic resistance to dorsiflexion of the hallux was retained after the cheilectomy or dorsiflexion osteotomy of the metatarsal head and speculated that the shortening and tightness of the soft tissues below the first metatarsophalangeal joint would be the etiology of hallux rigidus. He devised a novel surgery in which the plantar tissues were divided using a plantar approach and reported good results in 12 patients with the disappearance of elastic resistance during dorsiflexion and with no recurrence. Although he identified the etiology of hallux rigidus and developed a revolutionary surgery that directly addressed the etiology, this approach has not yet been seen in current surgeries. Therefore, we hypothesized that current surgeries for hallux rigidus lack rationality regarding etiology and aimed to critically review joint-preserving surgeries based on etiology. First, we summarized the literature on proposed causes and explained how the condition progresses from shortened, tightened plantar soft tissues. We then reviewed joint-preserving surgeries in terms of etiology and treatment efficacy and finally mentioned the arthroscopic Cochrane procedure as a promising option.
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Affiliation(s)
- Kenichiro Nakajima
- Center for Foot and Ankle Surgery, Department of Orthopedic Surgery, Yashio Central General Hospital, Yashio 340-0814, Saitama, Japan
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Chong KAJM, Teo SJ, Toh RX, Buhary KSM, Li Z, Tay KS. High Preoperative Pain Score is a Predictor of Cheilectomy Failure in Hallux Rigidus. J Foot Ankle Surg 2025; 64:1-6. [PMID: 39154986 DOI: 10.1053/j.jfas.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 08/05/2024] [Accepted: 08/11/2024] [Indexed: 08/20/2024]
Abstract
Hallux rigidus (HR) is a prevalent arthritic condition in the foot. Cheilectomy is a common joint-preserving procedure for HR, involving the removal of prominent osteophytes to relieve impingement of the 1st MTPJ. This study aims to identify factors associated with the failure of cheilectomy in the treatment of HR. A retrospective review of a prospectively collected database from 2007 to 2021 identified all cheilectomy cases. The minimum follow-up was 2 years. Preoperative demographic data, patient-reported outcome measures (PROMs) and foot radiographs were collected. PROMs were reassessed in postoperative reviews, and cases were categorized as successes or failures. Failure was defined by meeting at least one of the following criteria at the latest review: 1) Visual analog pain score (VAS) more than or equal to 4, 2) undergoing subsequent revision procedures, or 3) reporting poor or terrible satisfaction with the surgery. The analysis involved 66 patients, with 19 failure and 47 success cases. Both groups showed similar age, BMI, and gender profiles. Preoperative radiographic parameters were comparable between groups. However, preoperative VAS was significantly higher in the failure group: 7.16 vs 5.23 (p = .0029). Logistic regression confirmed preoperative VAS as a predictor of nonresponse (p = .023). Receiver Operating Characteristic analysis established an optimal cut-off VAS score of 7.0. Patients with a preoperative VAS score of more than 7 had an odds ratio of 5.11 (p = .0055) for failure. A higher preoperative VAS score is significantly associated with cheilectomy failure in HR treatment, suggesting a cutoff score of 7.0.
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Affiliation(s)
| | - Shao Jin Teo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Rui Xiang Toh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Zongxian Li
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Kae Sian Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Murawski CD, Anderson RB. Managing Hallux Rigidus in the Elite Athlete. Foot Ankle Clin 2024; 29:455-469. [PMID: 39068021 DOI: 10.1016/j.fcl.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Hallux rigidus can present a difficult problem to both competitive and elite athletic populations. Once an appropriate diagnostic workup has been performed, nonoperative management strategies, including anti-inflammatory medications, injection therapies, shoewear modifications, and orthotic devices, represent the mainstay conservative management options. Surgical management can be considered where an athlete's athletic performance is limited. A joint-sparing cheilectomy can provide a predictable return to sport at the most elite levels. The addition of a proximal phalangeal osteotomy can be considered when necessary. Arthroplasty or arthrodesis techniques can be used for persistent symptoms or progressive disease, but with less predictable outcomes.
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Affiliation(s)
- Christopher D Murawski
- Foot & Ankle Institute, OrthoCarolina, 2001 Vail Avenue, Suite 200B, Charlotte, NC 28207, USA
| | - Robert B Anderson
- Foot & Ankle Institute, OrthoCarolina, 2001 Vail Avenue, Suite 200B, Charlotte, NC 28207, USA.
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6
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Williams BT, Hunt KJ. Hallux Rigidus: Anatomy and Pathology. Foot Ankle Clin 2024; 29:371-387. [PMID: 39068015 DOI: 10.1016/j.fcl.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Hallux rigidus is a common degenerative condition of the hallux metatarsophalangeal joint (MTPJ) characterized by pain, swelling, stiffness, and limited range of motion with characteristic corresponding clinical, physical examination, and radiographic findings. Many historical risks factors including trauma and family history and patient factors including hallux valgus interphalangeus and inflammatory arthropathies have a well-substantiated etiologic role in the disease process. The purpose of this section is to review the normal and pathologic anatomy and biomechanics of the hallux MTPJ while providing an overview of the current understanding and remain debate regarding the disease process.
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Affiliation(s)
- Brady T Williams
- Division of Foot and Ankle Surgery, Department of Orthopedic Surgery, University of Colorado, 12631 East 17th Avenue, Room 4508, Aurora, CO 80045, USA
| | - Kenneth J Hunt
- Division of Foot and Ankle Surgery, Department of Orthopedic Surgery, University of Colorado, 12631 East 17th Avenue, Room 4508, Aurora, CO 80045, USA.
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Jones MT, Braza S, Mallavarapu V, Behrens A, Jasper R, Stebral H, Carvalho KAMD, Barbachan Mansur NS, Dibbern K, de Cesar Netto C. Quantification of First Metatarsal Joint Surface Interactions in Hallux Rigidus Using Distance and Coverage Mapping: A Case-Control Study. Foot Ankle Int 2024; 45:1038-1046. [PMID: 39080928 DOI: 10.1177/10711007241258447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
BACKGROUND Weightbearing cone-beam computed tomography (WBCT) has proven useful for analysis of structural changes of the foot and ankle when compared to conventional radiographs. WBCT allows for extraction of distance and coverage mapping metrics, which may provide novel insight into hallux rigidus (HR). This study retrospectively assessed HR joint space using distance and coverage mapping in a case-control study. METHODS WBCT images of the foot and ankle for 20 symptomatic HR and 20 control patients were obtained. Three-dimensional models were created and analyzed using a custom semiautomatic measurement algorithm. Distance and coverage mapping metrics for the first metatarsophalangeal and metatarsosesamoid joints were extracted from the models and compared between cohorts. Relationships between these metrics and visual analog scale (VAS) scores, a patient-reported outcome of pain, were assessed in HR patients. RESULTS Overall first metatarsophalangeal joint space narrowing was noted in HR patients when compared to controls by an average of 11.8% (P = .02). However, no significant changes in the overall coverage of the joint were noted. Decreased joint space width and increased surface-to-surface coverage were only and particularly observed at the plantar medial quadrant of the first metatarsal head in HR patients relative to controls. VAS score was significantly but weakly correlated with dorsolateral quadrant coverage (R2 = 0.26, P = .03). CONCLUSION Distance and coverage mapping serve as a complementary option to current techniques of quantifying HR changes. These metrics can expand the scope of future work investigating joint articulation changes in HR.
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Affiliation(s)
- Matthew Thomas Jones
- Department of Orthopedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Samuel Braza
- Department of Orthopedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Vineel Mallavarapu
- Department of Orthopedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Andrew Behrens
- Department of Orthopedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Ryan Jasper
- Department of Orthopedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Hannah Stebral
- Department of Orthopedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | | | - Kevin Dibbern
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA
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8
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Buldt AK, Gregory JS, Munteanu SE, Allan JJ, Tan JM, Auhl M, Landorf KB, Roddy E, Marshall M, Menz HB. Association of Bone Shape and Alignment Analyzed Using Statistical Shape Modeling With Severity of First Metatarsophalangeal Joint Osteoarthritis. Arthritis Care Res (Hoboken) 2024; 76:385-392. [PMID: 37728065 DOI: 10.1002/acr.25237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/22/2023] [Accepted: 09/14/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE We aimed to explore the relationship between bone shape and radiographic severity in individuals with first metatarsophalangeal joint osteoarthritis (first MTP joint OA). METHODS Weightbearing lateral and dorsoplantar radiographs were obtained for the symptomatic foot of 185 participants (105 females, aged 22 to 85 years) with clinically diagnosed first MTP joint OA. Participants were classified into none/mild, moderate, or severe categories using a standardized atlas. An 80-point model for lateral radiographs and 77-point model for dorsoplantar radiographs was used to define independent modes of variation using statistical shape modeling software. Odds ratios adjusted for confounders were calculated using ordinal regression to determine the association between radiographic severity and mode scores. RESULTS After assessment and grading of radiographs, 35 participants (18.9%) were included in the none/mild first MTP joint OA severity category, 69 (37.2%) in the moderate severity category, and 81 (43.7%) in the severe category. For lateral-view radiographs, 16 modes of variation were included, which collectively represented 83.2% of total shape variance. Of these, four modes were associated with radiographic severity. For dorsoplantar-view radiographs, 15 modes of variation were included, representing 82.6% of total shape variance. Of these, six modes were associated with radiographic severity. CONCLUSIONS Variations in the shape and alignment of the medial cuneiform, first metatarsal, and proximal and distal phalanx of the hallux are significantly associated with radiographic severity of first MTP joint OA. Prospective studies are required to determine whether bone shape characteristics are associated with the development and/or progression of this condition.
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Affiliation(s)
| | | | | | | | - Jade M Tan
- The University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Maria Auhl
- La Trobe University, Melbourne, Victoria, Australia
| | | | - Edward Roddy
- Keele University, Keele, Staffordshire, UK and Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire, UK
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9
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Morton’s Extension on Hallux Rigidus Pathology. PROSTHESIS 2023. [DOI: 10.3390/prosthesis5010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Study design, case-control study: Background, Morton’s extension (ME) is a kind of orthotic that has been used as a conservative treatment of painful hallux rigidus (HR) osteoarthritis, but only their effects on first metatarsophalangeal joint (MPJ) mobility and position in healthy subjects have been studied, but not on its applied pulled tension forces neither in subjects with HR. Objectives: This study sought to understand how ME’s orthotics with three different thicknesses could influence the kinematic first MPJ by measuring hallux dorsiflexion using Jack’s test and a digital algometer with a rigid strip anchored to the iron hook’s extremity and comparing subjects with healthy first MPJ mobility to those with HR. We aimed to clarify whether tension values were different between healthy and HR subjects. Methods: Fifty-eight subjects were selected, of whom thirty were included in the case group according to HR criteria and twenty-eight were included in the control group. A digital algometer (FPX®® 25, Wagner Instruments®®, Greenwich, CT, USA) was used to assess the pulled tension values (kgf) of the first MPJ during Jack’s test. Results: The pulled tension values were highly reliable (ICC > 0.963). There were no statistically significant differences between the pulled tension values for the different ME conditions in the case (p = 0.969) or control (p = 0.718) groups. However, as it’s expected, there were statistically significant differences comparing all pulled tension values between case and control group subjects (p < 0.001). Conclusions: Different ME’s thicknesses had no influence on the pulled effort applied during the dorsiflexion Jack’s test between the healthy and HR groups; therefore, it can be prescribed without joint-care danger. In addition, it is proven that there is greater resistance to performing Jack’s test in the HR group than in the healthy group, regardless of ME’s orthotics. Furthermore, it is shown that the digital algometer device is a valid tool to detect the first MPJ restriction and is more reliable than other tests.
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10
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Does metatarsus primus elevatus really exist in hallux rigidus? A weightbearing CT case-control study. Arch Orthop Trauma Surg 2023; 143:755-761. [PMID: 34505168 DOI: 10.1007/s00402-021-04168-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/01/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Elevated first metatarsal, Metatarsus primus elevatus (MPE), has been a topic of controversy. Recent studies have supported a significantly elevated first metatarsal in hallux rigidus on weight-bearing radiographs (WBR). However, conventional radiographs have limitations for accurate measurement. Our objective was to comparatively assess MPE and other variables which can affect the spatial relationship of the forefoot in the HR group compared to controls using weight-bearing CT (WBCT). METHODS In this single-center, retrospective, case-control study, 25 patients (30 feet) with symptomatic HR and 30 controls were selected. WBCT parameters were measured by two independent investigators. Inter-observer reliabilities were assessed using intra-class correlation coefficients (ICCs). MPE was evaluated by measuring the direct distance between 1st and 2nd metatarsals. Independent t tests were performed to compare the two groups. A threshold of MPE to diagnose HR was calculated using the Receiver Operating Characteristic (ROC) curve. RESULTS HR groups had increased hallux valgus angle (HVA) (8.52° in control vs 11.98° in HR) and MPE (2.92 vs 5.09 mm), decreased 1st metatarsal declination angle (21.09° vs 19.07°) 1st/2nd metatarsal declination ratio (87.45 vs 79.71) indicating elevated first metatarsal compared to controls. Dorsal translation of the first metatarsal at the first tarsometatarsal joint was observed in 21 (70%) patients of the HR group when defined as a step-off or discontinuation of the curvature along the first TMT joint. The threshold of MPE for diagnosis of HR was 4.19 mm with 77% sensitivity and 77% specificity. CONCLUSION Our results confirmed a significantly elevated first metatarsal in the HR group compared to controls on WBCT. A MPE greater than 4.19 mm was found to be diagnostic for symptomatic HR. Significant number of patients in the HR group (70%) had dorsal translation of the first metatarsal at the first TMT joint which can contribute to increased MPE. CLINICAL RELEVANCE The present study demonstrated significantly increased MPE in HR on WBCT and MPE greater than 4.19 mm on WBCT can be used as a diagnostic threshold for HR.
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Vieira Cardoso D, Veljkovic A, Wing K, Penner M, Gagne O, Younger A. Cohort Comparison of Radiographic Correction and Complications Between Minimal Invasive and Open Lapidus Procedures for Hallux Valgus. Foot Ankle Int 2022; 43:1277-1284. [PMID: 35880322 PMCID: PMC9527364 DOI: 10.1177/10711007221112088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Lapidus procedure corrects hallux valgus first ray deformity. First tarsometatarsal (TMT) fusion in patients with hallux valgus deformity using minimally invasive surgery (MIS) is a new technique, but comparative outcomes between MIS and open techniques have not been reported. This study compares the early radiographic results and complications of the MIS with the open procedure in a single-surgeon practice. METHODS 47 MIS patients were compared with 44 open patients. Radiographic measures compared preoperatively and postoperatively were the intermetatarsal angle (IMA), hallux valgus angle (HVA), foot width (FW), distal metatarsal articular angle (DMAA), sesamoid station (SS), metatarsus adductus angle (MAA), first metatarsal to second metatarsal length, and elevation of the first metatarsal. Early complications were recorded, as well as repeat surgeries. RESULTS The mean follow-up was 82 (range, 31-182) months for the open group and 29 (range, 14-47) months for the MIS group. In both techniques, postoperative measures (IMA, HVA, DMAA, FW, and sesamoid station) were significantly improved from preoperative measures. When comparing postoperative measures between both groups, the IMA was significantly lower in the open group (4.8 ± 3.6 degrees vs 6.4 ± 3.2 degrees, P < .05). Differential between pre- and postoperative measures for both techniques were compared, and the open group was associated with more correction than the MIS group for IMA (12.4 ± 5.3 degrees vs 9.4 ± 4.4 degrees, P = .004) and HVA (25.5 ± 8.3 degrees vs 20 ± 9.9 degrees, P = .005). Wound complication and nonunion rates trended higher in the open group (4 vs 0) (P = .051). CONCLUSION Both techniques resulted in good to excellent correction. However, the open technique was associated with lower postoperative IMA values and more correction power for IMA and HVA, than the MIS.
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Affiliation(s)
- Diogo Vieira Cardoso
- Division of Orthopaedics and Trauma
Surgery, Geneva University Hospitals, Geneva, Switzerland,Diogo Vieira Cardoso, MD, Department of
Orthopaedics Geneva University Hospitals Rue Gabrielle-Perret-Gentil 4, Geneva,
1205, Switzerland.
| | - Andrea Veljkovic
- Division of Orthopaedics and Trauma
Surgery, British Columbia University, Vancouver, Canada
| | - Kevin Wing
- Division of Orthopaedics and Trauma
Surgery, British Columbia University, Vancouver, Canada
| | - Murray Penner
- Division of Orthopaedics and Trauma
Surgery, British Columbia University, Vancouver, Canada
| | - Oliver Gagne
- Division of Orthopaedics and Trauma
Surgery, British Columbia University, Vancouver, Canada
| | - Alastair Younger
- Division of Orthopaedics and Trauma
Surgery, British Columbia University, Vancouver, Canada
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12
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Anwander H, Alkhatatba M, Lerch T, Schmaranzer F, Krause FG. Evaluation of Radiographic Features Including Metatarsus Primus Elevatus in Hallux Rigidus. J Foot Ankle Surg 2022; 61:831-835. [PMID: 34974984 DOI: 10.1053/j.jfas.2021.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/24/2021] [Accepted: 11/29/2021] [Indexed: 02/03/2023]
Abstract
The etiology of hallux rigidus remains a controversial issue in foot and ankle surgery, i.e., the relationship between metatarsus primus elevatus (MPE) and hallux rigidus. The purpose of this study was to evaluate several radiographic parameters including first metatarsal elevation in patients with hallux rigidus compared to a matched control group. A retrospective case control study was performed including 50 feet, 25 feet with and 25 feet without hallux rigidus. In the patients with hallux rigidus, the first metatarsal was more elevated than in the control group (8.3 ± 1.7 mm vs 3.0 ± 2.0 mm, p < .001) and in 60% of patients with hallux rigidus MPE was diagnosed, compared to zero patients in the control group (p < .001). The lateral 1 to 2 intermetatarsal angle was higher in patients with hallux rigidus (3.6 ± 2.5 vs -0.7 ± 2.8; p < .001). The first metatarsal declination angle was not different between the 2 groups. Intraclass correlation coefficient between 2 observers for measuring the first metatarsal elevation was 0.929 (p < .001). In the current study, increased elevation of the first metatarsal, a higher incidence of MPE and increased lateral 1 to 2 intermetatarsal angle were found in patients with hallux rigidus compared to the control group. These findings support the theory of an association between MPE and hallux rigidus. Further high reliability of first metatarsal elevation measurement was found in our study.
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Affiliation(s)
- Helen Anwander
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mohammad Alkhatatba
- Department of Special Surgery, Jordan University of Science and Technology, Irbid, Jordan
| | - Till Lerch
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian G Krause
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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13
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Xu Y, Guo CJ, Li XC, Xu XY. Radiographic and clinical outcomes of minimally invasive surgery versus open osteotomies for the correction of hallux valgus. INTERNATIONAL ORTHOPAEDICS 2022; 46:1767-1774. [PMID: 35513549 DOI: 10.1007/s00264-022-05419-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Hallux valgus is a common disease which causes pain and dysfunction of the foot. Although numerous methods of procedures have been introduced, a single procedure cannot correct all deformities of hallux valgus. The study aims to evaluate the radiographic and clinical effectiveness of a new minimally invasive surgery (MIS) versus open Chevron-Akin procedures. METHODS This was a retrospective comparative study. Data were collected from May 2018 to January 2020. A total of 27 patients (31 feet) undergoing MIS for hallux valgus were included in this study. The average age of patients underwent MIS was 59.9 years. The mean follow-up was 25.1 months. Open osteotomies were performed in 30 patients (31 feet) during the same period. The mean age of these patients at the time of surgery was 59.1 years. The mean follow-up was 26.1 months. Pre-operative and post-operative radiographic outcome measures included HVA, IMA, DMAA, the Sgarlato's angle and the length of the first metatarsal, and distance between the dorsal cortex of first and second metatarsal necks. The AOFAS and VAS were used to assess foot function. RESULTS The preoperative HVA in MIS group and open group were 34.8° and 33.1° respectively. The post-operative HVA were 20.4° and 13.7°. The pre-operative IMA in MIS group and open group were 13.0° and 12.1°. The post-operative IMA were 11.4° and 5.5° respectively. The pre-operative DMAA were 14.8° and 15.1° respectively. The post-operative DMAA were 6.3° and 8.7°. The AOFAS increased from 44.0 to 90.2 in MIS group and from 47.6 to 89.5 in open group. The VAS decreased from 7.3 to 1.3 in MIS group and from 7.1 to 1.2 in open group. CONCLUSION Although open osteotomies were superior than MIS in HVA and IMA, MIS showed advantages in correcting DMAA. MIS provided equivalent functional outcomes compared to open surgery.
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Affiliation(s)
- Yang Xu
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Chang-Jun Guo
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Xing-Chen Li
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Xiang-Yang Xu
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
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Balesar VV, Koster LA, Kaptein BL, Keizer SB. Five-Year Prospective Roentgen Stereophotogrammetric and Clinical Outcomes of the BioPro MTP-1 Hemiarthroplasty. Foot Ankle Int 2022; 43:637-645. [PMID: 34962173 DOI: 10.1177/10711007211061366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mixed results for functional outcomes and long-term fixation have been reported for first metatarsophalangeal arthroplasty. This prospective study was designed to evaluate the migration of the BioPro metatarsophalangeal-1 (MTP-1) joint hemiprosthesis with Roentgen stereophotogrammetric analysis (RSA). Migration patterns of the prosthesis, prosthesis-induced erosion of the metatarsal bone, and clinical outcomes were evaluated sequentially to 5 years postoperation (PO). METHODS Eleven female patients received the BioPro-1 hemiprosthesis. Prosthesis translation and metatarsal erosion were measured with RSA at immediately PO, 6 weeks, and 3, 6, 12, 36, and 60 months postoperatively. Clinical assessment was done by patient questionnaires. RESULTS RSA data of 9 patients were available for analysis. Median (range) number of markers used in RSA analysis, condition number, and mean error of markers around the prosthesis were 4 (3-7), 320 (208-862), and 0.13 (0.02-0.28), respectively. Progressive subsidence was seen up to 3 years PO (mean 2.1 mm, SE 0.32). Progressive metatarsal erosion was found from 1 year PO (mean 0.49 mm, SE 0.15). Pain, function, and quality scores improved after surgery and did not deteriorate at later follow-up moments. CONCLUSION Model-based RSA of the BioPro-1 prosthesis shows nonstabilizing medial and distal translation and metatarsal erosion. Despite the measured migration and erosion, clinical outcomes improved and remained similar up to 5 years postoperation. LEVEL OF EVIDENCE Level II, prospective analysis of MTP-1 hemiprosthesis.
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Affiliation(s)
| | | | - Bart L Kaptein
- Leiden Universitair Medisch Centrum, Leiden, the Netherlands
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15
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Chambers LAR, Gibboney LMD, Song KY. The Cotton Osteotomy as an Adjunct Procedure in Hallux Valgus and Hallux Limitus Surgery. J Am Podiatr Med Assoc 2022; 112:20-115. [PMID: 35900918 DOI: 10.7547/20-115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Cotton osteotomy, as described in 1936 by Frederic Cotton, consisted of a medial cuneiform opening base wedge osteotomy. This Cotton osteotomy served to restore the "triangle of support" of the foot. In his address to the New England Surgical Society, he described this osteotomy as being multipurpose; it can be used for plantarflexion in hallux valgus surgery and has use in hallux rigidus conditions. Since its inception, the procedure has become a popular adjunct to aid in the restoration of the medial column deformity present in pes planus. Recently, there has been renewed interest in the use of the procedure to aid in the correction of deformities involving metatarsus primus elevatus, specifically, hallux valgus and hallux limitus. The advantage of the use of this procedure as opposed to others is that it allows for the preservation and/or restoration of first ray length and the preservation of motion at the medial column. In retrospective review, the authors evaluated seven cases with a 1-year follow-up. In this series of cases, the Cotton osteotomy was performed as an adjunct to common hallux valgus procedures or hallux limitus corrections. Radiographic review was also performed evaluating for initial evidence of radiographic bone-graft healing and patient weightbearing. Although not without its own limitations, the Cotton osteotomy offers several advantages with minimal complications, proving to be a valuable underused resource in the foot and ankle surgeon's toolkit.
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Affiliation(s)
| | | | - Kayla Y Song
- ‡Jerry L. Pettis Memorial Veterans Hospital, Loma Linda, CA
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16
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Boffeli TJ, Collier RC, Thompson JC, Luer SA. Cheilectomy Combined With First Tarsometatarsal Joint Arthrodesis for Surgical Treatment of Midstage Hallux Rigidus Complicated by Medial Column Insufficiency: Prospective Evaluation of Outcomes. J Foot Ankle Surg 2021; 59:829-834. [PMID: 32057622 DOI: 10.1053/j.jfas.2019.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 04/11/2019] [Accepted: 04/15/2019] [Indexed: 02/03/2023]
Abstract
The role of metatarsus primus elevatus and first ray hypermobility is under scrutiny with regard to the pathoanatomy of hallux rigidus. Regardless of the underlying biomechanical cause, there is a subset of patients with hallux limitus present with concomitant insufficiency of the medial column identified on clinical exam and lateral imaging as dorsal divergence of the first compared with the second metatarsal. While cheilectomy and decompression metatarsal osteotomy are commonly used to mitigate retrograde forces at the first metatarsophalangeal joint (MPJ) level, traditional hallux limitus procedures do not address more proximal deformity of the medial column. Although the authors prefer to treat this complex condition with cheilectomy combined with tarsometatarsal joint arthrodesis, there is a paucity of literature on this approach. A prospective cohort study of consecutive patients was therefore performed to assess outcomes. Ten patients (3 males, 7 females) and 11 feet (8 right and 3 left) met the inclusion criteria. Mean follow-up was 21.9 months (range 12 to 52). Average age was 50.4 years (range 28 to 61). The average preoperative ACFAS score of 49.6 (range 29 to 61) improved to 78 (range 51 to 92) at 10 weeks postoperatively and 85.4 (range 60 to 100) at 1 year postoperatively. By 1 year postsurgery, 9 of 10 patients (90%) described their satisfaction level as very satisfied, and 1 (10%) was somewhat satisfied.
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Affiliation(s)
- Troy J Boffeli
- Director, Foot & Ankle Surgery Residency Program, Regions Hospital/HealthPartners Institute for Education & Research, St. Paul, MN.
| | - Rachel C Collier
- Attending, Foot & Ankle Surgery Residency Program, Regions Hospital/HealthPartners Institute for Education & Research, St. Paul, MN
| | - Jonathan C Thompson
- Foot & Ankle Surgeon, Orthopedic Center, Mayo Clinic Health System, Eau Claire, WI
| | - Samantha A Luer
- Chief Resident, Foot & Ankle Surgery, Regions Hospital/HealthPartners Institute for Education and Research, St. Paul, MN
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17
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Khlopas H, Fallat LM. Correction of Hallux Abducto Valgus Deformity Using Closing Base Wedge Osteotomy: A Study of 101 Patients. J Foot Ankle Surg 2021; 59:979-983. [PMID: 32622674 DOI: 10.1053/j.jfas.2020.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/10/2019] [Accepted: 04/02/2020] [Indexed: 02/03/2023]
Abstract
Hallux abducto valgus is a functionally disabling deformity with lateral deviation of the hallux and medial prominence of the first metatarsal head. Various surgical techniques have been used in the treatment of this deformity. In this retrospective review, we assess the outcomes of proximal closing base wedge osteotomy (CBWO). A single-surgeon database was reviewed for patients who underwent proximal CBWO between January 1, 2012, and December 31, 2017. A total of 101 patients were identified with a mean age of 49 years (range 13 to 80) and mean body mass index of 29 kg/m2 (range 19 to 53). The medical records were reviewed for smoking status, time to heal, rates of nonunion, shortening of the first metatarsal, intermetatarsal angle, hallux valgus angle, elevatus, mean loss of correction, complication rates, and pain scores. Pre- and postoperative variables were compared using Student's t test for continuous variables. The mean pre- and postoperative intermetatarsal angles were 15.46° (range 10° to 21°) and 3.77° (range 0° to 10°; p < .05). The mean pre- and postoperative hallux abductus valgus angles were 34.57° (range 12° to 60°) and 9.24° (range, 0° to 30°;p < .05). The mean metatarsal length shortening was 3.72 mm, and the mean postoperative elevatus was 2.73 mm. We have demonstrated excellent outcomes of CBWO with correction of intermetatarsal and hallux valgus angles. This procedure allows for superior reduction of moderate to severe intermetatarsal angles in rigid first rays. The mean postoperative elevatus of 2.73 did not result in any adverse sequelae.
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Affiliation(s)
- Hannah Khlopas
- Chief Resident, Postgraduate Year 3, Beaumont Health Wayne Podiatric Foot and Ankle Surgical Residency, Beaumont Health Wayne, Wayne, MI.
| | - Lawrence M Fallat
- Director, Beaumont Health Wayne Podiatric Foot and Ankle Surgical Residency, Beaumont Health Wayne, Wayne, MI
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Lee JY, Tay KS, Rikhraj IS. Distal oblique osteotomy versus cheilectomy for moderate-advanced hallux rigidus: A 2-year propensity-score-matched study. Foot Ankle Surg 2021; 27:443-449. [PMID: 32631778 DOI: 10.1016/j.fas.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/10/2020] [Accepted: 06/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The surgical treatment of moderate-advanced hallux rigidus is controversial. Cheilectomy is widely used but has recurrence rates of up to 30%. Dorsal oblique metatarsal osteotomy (DOO) has also shown good results, however, there is no study comparing outcomes of the DOO against cheilectomy. METHODS This was a retrospective propensity score matched study based on registry data from a single tertiary institution. Between 2007 and 2017, all patients who had undergone dorsal cheilectomy or DOO for hallux rigidus were included. Patients with previous foot surgery, revision surgeries, and concomitant surgical procedures were excluded. Clinical outcomes, complication rates, revision rates and patient satisfaction were assessed at 2 years postoperatively. RESULTS There were 44 patients (34 cheilectomy, 10 DOO). After propensity score matching, 17 cheilectomy and all 10 DOO cases were selected for comparison. Patients in both groups had a significant improvement in visual analogue pain scores (VAS) and AOFAS 1st toe scores 2-years post-operatively (P<0.001) with high levels of post-operative satisfaction (85.1%). Overall there were no statistically significant differences in post-operative scores, improvement in scores, complication rates, revision rates, and levels of patient satisfaction between groups. CONCLUSIONS Both the DOO and cheilectomy give similarly good outcomes for moderate-advanced hallux rigidus. Further studies are needed to elucidate differences in indications for each procedure.
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Affiliation(s)
- Jia Ying Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Rd, Singapore 169608, Singapore.
| | - Kae Sian Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Rd, Singapore 169608, Singapore.
| | - Inderjeet Singh Rikhraj
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Rd, Singapore 169608, Singapore.
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19
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Verdu Roman C, Martinez Gimenez E, Bustamante Suarez de Puga D, Mas Martinez J, Morales Santias M, Sanz-Reig J. Hallux valgus with and without metatarsalgia in women: a matched-cohort study of plantar pressure measurements. Indian J Orthop 2021; 55:436-444. [PMID: 34306558 PMCID: PMC8275713 DOI: 10.1007/s43465-021-00416-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 05/03/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Few previous studies focused on plantar loading patterns in HV patients with metatarsalgia. Are there any differences in plantar pressure measurements in women with HV with and without metatarsalgia? METHODS A prospective matched-cohort study was designed to analyze plantar pressure measurements in women with HV with and without metatarsalgia from January 2017 to December 2019. The inclusion criteria were age over 18 years old, women, diagnosis of HV with metatarsalgia. Control group had the same inclusion criteria, except metatarsalgia. Patient-reported outcomes scores included American Orthopedic Foot and Ankle Society Score (AOFAS), and Visual Analog Scale (VAS). Radiographic data were obtained according to the guidelines of the AOFAS Committee on Angular Measurements. Plantar pressure measurements were performed using a platform. RESULTS Forty-seven patients met the inclusion criteria. An age-, BMI-, and hallux valgus angle-matched cohort of 47 patients were also selected. There were no statistically significant differences in demographic data and radiographic assessment. HV with metatarsalgia group showed greater values in peak and mean force, peak and mean pressure, and pressure-time integral under toes and metatarsal heads. These differences reached statistically significant in mean force (p = 0.009) and peak force (p = 0.003) under T1; mean pressure (p = 0.01) and peak pressure (p = 0.04) under T1; and mean force (p = 0.003) under MH1. The binary logistic regression analysis showed mean force under T1 as the most associated plantar pressure measurement with the presence of metatarsalgia. C-statistic was 0.66. Mean force > 35 N had a 70% of sensitivity and a 57% of specificity as a cut-off value for the presence of metatarsalgia. CONCLUSION HV patients with metatarsalgia had greater values in plantar pressure measurements. Mean force under T1 could be used as a plantar pressure measurement to predict metatarsalgia.
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Affiliation(s)
- Carmen Verdu Roman
- Foot and Ankle Unit, Department of Orthopaedic Surgery, Clinica HLA Vistahermosa, Av de Denia 76. 03016. Alicante, Spain
| | - Enrique Martinez Gimenez
- Foot and Ankle Unit, Department of Orthopaedic Surgery, Clinica HLA Vistahermosa, Av de Denia 76. 03016. Alicante, Spain
| | | | - Jesus Mas Martinez
- Foot and Ankle Unit, Department of Orthopaedic Surgery, Clinica HLA Vistahermosa, Av de Denia 76. 03016. Alicante, Spain
| | - Manuel Morales Santias
- Foot and Ankle Unit, Department of Orthopaedic Surgery, Clinica HLA Vistahermosa, Av de Denia 76. 03016. Alicante, Spain
| | - Javier Sanz-Reig
- Foot and Ankle Unit, Department of Orthopaedic Surgery, Clinica HLA Vistahermosa, Av de Denia 76. 03016. Alicante, Spain
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20
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Radiographic measurements have limited effect in dynamic plantar pressures in hallux valgus patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:19-26. [PMID: 33661373 DOI: 10.1007/s00590-021-02906-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Radiographic measurements are the gold standard in the management for preoperative surgical planning of hallux valgus deformity. Plantar pressure technology is a tool that is not commonly used to evaluate and manage hallux valgus patients, and few studies have reported the correlation of plantar pressure measurements and radiography. METHODS A prospective cohort study was designed to analyze plantar pressure measurements and radiographic variables. The inclusion criteria were age over 18 years old, and diagnosis of hallux valgus requesting surgical correction because of discomfort, pain or difficulty with shoe wear. Plantar pressure measurements were performed using a platform. Radiographic data were obtained according to the guidelines of the AOFAS Committee on Angular Measurements. RESULTS A total of 114 patients met the inclusion criteria. Mean age of the patients was 50 years, and 94 patients (82.5%) were women. We found significant correlations between dynamic plantar pressure measurements and HVA, DMAA, and MDA. Mean pressure under third metatarsal head was the most associated plantar pressure measurement with hallux valgus angle and metatarsal declination angle. However, this association showed signs of weakness. CONCLUSION Hallux valgus angle and metatarsal declination angle had a minimal influence on plantar-loading parameters. Pressure values did not discriminate the magnitude of HV deformity. Others factors responsible for the observed plantar pressures pattern should be addressed.
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21
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Távara Vidalón P, Lafuente Sotillos G, Munuera-Martínez PV. Movimiento del primer dedo en sujetos con hallux limitus vs. sujetos con pies normales. REVISTA ESPAÑOLA DE PODOLOGÍA 2021. [DOI: 10.20986/revesppod.2021.1621/2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Sansone V, Maiorano E, Melato M, Martinelli N, Pascale V. Novel treatment for hallux rigidus using a temporary metal interpositional device. Foot Ankle Surg 2020; 26:630-636. [PMID: 31439504 DOI: 10.1016/j.fas.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this prospective study is to evaluate the results of a consecutive series of patients suffering from grade II-III hallux rigidus who underwent a mobility preserving surgical technique consisting of resection arthroplasty with implantation of a temporary metal spacer. METHODS Thirty consecutive patients, 18 female and 12 male with a diagnosis of a grade II-III hallux rigidus, not responding to conservative treatment, underwent a minimal resection arthroplasty followed by the implantation of a temporary metal interpositional device by the same surgeon. All spacers were removed after 6 months through a minimal incision under regional anaesthesia. Patients were clinically and radiographically evaluated at 3, 6, 12 months, and 5 years after spacer removal. RESULTS The clinical AOFAS scores improved already at first follow-up and continued to improve over time with a statistically significant change until the first year. At 3, 6, and 12 months follow-ups, the number of patients with severely limited ROM (i.e. under 30°, that means grade II-III according to Coughlin and Shaurnas classification) significantly decreased. There were only two minor complications, so defined as both of which resolved spontaneously and did not affect the procedure's effectiveness. CONCLUSIONS We observed good to excellent results with the use of this mobility preserving surgical technique for the treatment of symptomatic grades II and III hallux rigidus. The never before published procedure is easy to perform and inexpensive. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Valerio Sansone
- University of Milan, Via Festa del Perdono, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Emanuele Maiorano
- University of Milan, Via Festa del Perdono, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Marco Melato
- Department of Orthopaedic, Hospital SS. Antonio and Biagio and Cesare Arrigo Alessandria, Italy
| | - Nicoló Martinelli
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy.
| | - Valerio Pascale
- University of Milan, Via Festa del Perdono, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
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23
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Kido M, Ikoma K, Sotozono Y, Ikeda R, Imai K, Maki M, Ohashi S, Kubo T. The influence of hallux valgus and flatfoot deformity on metatarsus primus elevatus: A radiographic study. J Orthop Sci 2020; 25:291-296. [PMID: 31010610 DOI: 10.1016/j.jos.2019.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/22/2019] [Accepted: 03/27/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Metatarsus primus elevatus (MPE), a dorsal elevation of the first metatarsal in relation to the lesser metatarsals on lateral-view radiographs, is an indicator of hallux rigidus. The angle between the articular surfaces of the base of the first metatarsal and the anterior part of the medial cuneiform (M1C1A) reflects the sagittal instability of the first tarsometatarsal (TMT) joint. MPE may also indicate instability of the first metatarsal. The purpose of this study was to identify the influence of hallux valgus (HV) and flatfoot (FF) deformities on measurements obtained from first metatarsal-related radiographic images. METHODS Standing radiographic images of 134 feet were investigated. In dorsoplantar-view radiographs, HV and intermetatarsal angles were evaluated. The position of the medial sesamoid was classified with a grading system (Hardy score). In lateral-view radiographs, MPE, M1C1A, and Meary's angle were measured. The subjects were divided into 4 groups: the normal group (G1), HV(-)FF(-); the HV group (G2), HV(+)FF(-); the FF group (G3), HV(-)FF(+); and the dual group (G4), HV(+)FF(+). The radiographic parameters were compared among the groups. RESULTS MPE in the HV patients (G2 and G4) was less than that in the non-HV participants (G1 and G3). MPE in G4 was less than that in G3. The odds ratios of the Hardy score were higher in G2, G3 and G4 than in G1. The ratios were higher in the FF patients (G3 and G4) than in the non-FF participants (G1 and G2) and were higher in G4 than in G2. CONCLUSIONS FF affects sesamoid dislocation, and the combination of HV and FF further increases sesamoid dislocation. Combined with M1C1A and the Hardy score, MPE may be a useful indicator of three-dimensional instability of the first TMT joint. First TMT joint-related operations may be considered for severe HV treatment in G4 patients.
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Affiliation(s)
- Masamitsu Kido
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Kazuya Ikoma
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan.
| | - Yasutaka Sotozono
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Ryosuke Ikeda
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Kan Imai
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Masahiro Maki
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Suzuyo Ohashi
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
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Jones MT, Sanders AE, DaCunha RJ, Cody EA, Sofka CM, Nguyen J, Deland JT, Ellis SJ. Assessment of Various Measurement Methods to Assess First Metatarsal Elevation in Hallux Rigidus. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419875686. [PMID: 35097341 PMCID: PMC8696814 DOI: 10.1177/2473011419875686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: While metatarsus primus elevatus (MPE) has been implicated in the development of hallux rigidus, previous studies have presented conflicting findings regarding the relationship between MPE and arthritis. This may be due to the variety of definitions for MPE and the radiographic measurement techniques that are used to assess it. Additionally, previous studies have only assessed elevation of the first metatarsal with respect to the floor or the second metatarsal, and not with respect to the proximal phalanx. The aim of this study was to examine the reliability of new radiographic measurements that consider the elevation of the first metatarsal in relation to the proximal phalanx, rather than in relation to the second metatarsal as previously described, to assess for MPE. In addition, we aimed to determine whether the elevation of the first metatarsal was significantly different in patients with hallux rigidus than in a control population. Methods: A retrospective chart review was conducted from prospectively collected registry data at the investigators’ institution to identify patients with hallux rigidus (n = 65). A size-matched control cohort of patients without evidence for first metatarsophalangeal (MTP) joint arthritis was identified (n = 65). Patients with a previous history of foot surgery, rheumatoid arthritis, or hallux valgus were excluded. Five blinded raters of varying levels of training, including 2 research assistants, 1 senior orthopedic resident, 1 foot and ankle fellowship-trained orthopedic surgeon, and 1 attending musculoskeletal fellowship-trained radiologist, evaluated 7 radiographic measurements for their reliability in assessing for MPE in hallux rigidus and control groups. Four of the 7 were newly designed measurements that include the relationship of the first MTP joint. Inter- and intrarater reliability were calculated using intraclass correlation coefficients (ICCs) and categorized by Landis and Koch reliability thresholds. The measurements between the hallux rigidus and control populations were compared using an independent t test. Results: Six of the 7 radiographic measurements were found to have substantial to almost perfect interrater reliability (ICC, 0.800-0.953) between all levels of training, except for the proximal phalanx–first metatarsal angle, which showed moderate reliability (ICC, 0.527). Substantial to almost perfect intrarater reliability (ICC, 0.710-0.982) was demonstrated by the measurements performed by research assistants. All 7 of the measurements taken by the musculoskeletal fellowship-trained radiologist demonstrated significant differences in first metatarsal elevation between the hallux rigidus and control populations, with the hallux rigidus group showing increased elevation (P < .001-.019). Conclusion: This study confirmed the reliability of 7 radiographic measurements used to assess for MPE, including 3 previously established and 4 newly described measurements. Observers across all levels of training were able to demonstrate reliable measurements. In addition, the measurements were used to show that patients with hallux rigidus were more likely to have MPE compared with patients without radiographic evidence for first MTP arthritis. These measurements could be used in future work to examine how the presence of MPE relates to the etiology and progression of hallux rigidus, and how it affects the results of operative treatment. Level of Evidence: Level III, retrospective comparative study.
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Affiliation(s)
- Mackenzie T. Jones
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Austin E. Sanders
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Rachael J. DaCunha
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Elizabeth A. Cody
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Carolyn M. Sofka
- Department of Radiology, Hospital for Special Surgery, New York, NY, USA
| | | | - Jonathan T. Deland
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Scott J. Ellis
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
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Stith A, Dang D, Griffin M, Flint W, Hirose C, Coughlin M. Rigid Internal Fixation of Proximal Crescentic Metatarsal Osteotomy in Hallux Valgus Correction. Foot Ankle Int 2019; 40:778-789. [PMID: 30994364 DOI: 10.1177/1071100719842800] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate outcomes utilizing a low-profile titanium plate and screw construct for rigid fixation of first ray proximal crescentic osteotomies in the treatment of hallux valgus. METHODS Forty-eight patients (53 feet) with mild to severe hallux valgus were prospectively enrolled and completed 12-month follow-up. All were treated with a proximal crescentic osteotomy, fixed with a low-profile titanium plate, distal soft tissue correction, with or without an Akin osteotomy. Recorded outcomes included change in first ray dorsiflexion angles, need for hardware removal, radiographic and clinical evaluation, pain, and American Orthopaedic Foot & Ankle Society (AOFAS) scores. RESULTS All patients achieved radiographic union of their osteotomy. An Akin osteotomy was performed in 83% of patients. Seventeen feet (32%) had hardware removed. First ray dorsiflexion angles increased from a mean of 1.6 degrees preoperatively to 5.0 degrees postoperatively (P < .001). Dorsal malunion, defined as change in dorsiflexion angle greater than 1 standard deviation above the mean, occurred in 7 feet. The mean hallux valgus angle improved from 29 to 9 degrees (P < .001). The mean 1-2 intermetatarsal angle decreased from 14 to 6 degrees (P < .001). The first metatarsophalangeal joint range of motion decreased from 77 to 59 degrees (P < .001). The mean visual analog scale score improved from 4 to 0.7 (P < .0001). The mean AOFAS score improved from 55 to 89 points (P < .001). CONCLUSION Proximal crescentic metatarsal osteotomy, fixed with a low-profile titanium plate and screw construct, with distal soft tissue repair, and Akin osteotomy as indicated, was a safe and reliable method for operative treatment of hallux valgus. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Andrew Stith
- 1 Saint Alphonsus Medical Group, Coughlin Foot & Ankle Clinic, Boise, ID, USA
| | - Debbie Dang
- 1 Saint Alphonsus Medical Group, Coughlin Foot & Ankle Clinic, Boise, ID, USA
| | | | - Wesley Flint
- 1 Saint Alphonsus Medical Group, Coughlin Foot & Ankle Clinic, Boise, ID, USA
| | - Christopher Hirose
- 1 Saint Alphonsus Medical Group, Coughlin Foot & Ankle Clinic, Boise, ID, USA
| | - Michael Coughlin
- 1 Saint Alphonsus Medical Group, Coughlin Foot & Ankle Clinic, Boise, ID, USA
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Ohara K, Tanaka Y, Taniguchi A, Kurokawa H, Kumai T, Yamada H. Is metatarsus primus elevatus truly observed in hallux rigidus? Radiographic study using mapping methods. J Orthop Sci 2019; 24:312-319. [PMID: 30279135 DOI: 10.1016/j.jos.2018.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/27/2018] [Accepted: 09/02/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hallux rigidus and metatarsus primus elevatus (MPE) are associated, but their causal relationship remains unknown. Several surgical approaches for treating hallux rigidus are available. We evaluated morphological characteristics of hallux rigidus with different grades to determine the optimal surgical approach. The amount of degenerative change in the metatarsophalangeal joint on the preoperative roentgenograms was graded on a scale of 1-3. We analyzed the morphology of hallux rigidus using X-ray image mapping developed by our team. METHODS This study involved weight-bearing, dorsoplantar, and lateral foot X-rays of 36 feet from 26 patients underwent surgery for hallux rigidus (Group R) at our institution, and 26 normal feet (Group N). A two-dimensional coordinate system was used to analyze the sharps of these feet by converting each dot on the radiographs into X and Y coordinates. Diagrams of the feet from each group were drawn for comparison. Feet with grades 2 (Group R2) and 3 (Group R3) hallux rigidus and normal feet were compared by Kruskal-Wallis test. RESULTS Mapping revealed that the tip of distal phalanges of the second, and third toes in Group R medially shifted (P < 0.05) in dorsoplantar image of the feet, and that the medial point, a part of the talus, navicular, cuneiform, and first metatarsal bone in Group R, shifted lower (P < 0.05) in lateral feet images of the feet. Multiple comparisons revealed a significant navicular bone depression in grade 3 hallux rigidus compared with normal feet. A significant difference was observed between Group N and R3 but not between Group R2 and N or R3. CONCLUSIONS X-ray morphological analysis of the foot revealed MPE in Group R. Elevation gradually increased as hallux rigidus grade worsened. Therefore, osteotomy combined with cheilectomy, whereby the first metatarsal bone can be tilted toward the plantar side, are useful for treating a higher-grade hallux rigidus. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Kuniji Ohara
- Takagi Hospital, Department of Orthopaedic Surgery, Nagoya, Aichi, 4670806, Japan; Nara Medical University, Department of Orthopaedic Surgery, Kashihara, Nara, 6348522, Japan.
| | - Yasuhito Tanaka
- Nara Medical University, Department of Orthopaedic Surgery, Kashihara, Nara, 6348522, Japan
| | - Akira Taniguchi
- Nara Medical University, Department of Orthopaedic Surgery, Kashihara, Nara, 6348522, Japan
| | - Hiroaki Kurokawa
- Nara Medical University, Department of Orthopaedic Surgery, Kashihara, Nara, 6348522, Japan
| | - Tsukasa Kumai
- Nara Medical University, Department of Orthopaedic Surgery, Kashihara, Nara, 6348522, Japan
| | - Harumoto Yamada
- Fujita Health University, Department of Orthopaedic Surgery, Toyoake, Aichi, 4701192, Japan
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Sanchez PJ, Grady JF, Lenz RC, Park SJ, Ruff JG. Metatarsus Primus Elevatus Resolution After First Metatarsophalangeal Joint Arthroplasty. J Am Podiatr Med Assoc 2018; 108:200-204. [PMID: 29932752 DOI: 10.7547/16-176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hallux limitus (HL) is the second-most common pathology associated with the first metatarsophalangeal joint. A common etiology believed to be associated with HL is metatarsus primus elevatus (MPE), although causation has been unsubstantiated by evidence. Historically, correction of MPE is surgically addressed with an osteotomy. However, some believe MPE is a secondary manifestation of HL due to retrograde pressure and lack of dorsiflexion at the first metatarsophalangeal joint. This study sought to determine whether MPE resolves spontaneously after first metatarsophalangeal joint arthroplasty and reinstitution of normal joint dorsiflexion. METHODS Twenty-seven weightbearing lateral radiographs from patients with HL were reviewed before and after nonimplant first metatarsophalangeal joint arthroplasty. Radiographs were taken preoperatively and at postoperative visits 1 (mean, 2 weeks) and 2 (mean, 10 weeks). Measurements included first to second metatarsal elevation, Seiberg Index, first to fifth metatarsal distance, sagittal plane first to second metatarsal angle, Meary's angle, metatarsal declination angle, and hallux equinus angle. RESULTS Statistically significant improvement was seen at both postoperative visits in all of the previously mentioned measurements except first to fifth metatarsal distance, which was reduced but was not statistically significant. CONCLUSIONS Metatarsus primus elevatus was reduced significantly after first metatarsophalangeal joint arthroplasty. Resolution occurred rapidly and was maintained at the final postoperative visit. This could be due to MPE being a manifestation of HL and not a cause. Based on the results of this study, osteotomies may be unnecessary to surgically address MPE because it can spontaneously correct after reinstitution of first metatarsophalangeal joint motion.
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Affiliation(s)
| | | | - Robin C. Lenz
- Department of Podiatry, Jesse Brown VA Medical Center, Chicago, IL. Dr. Lenz is now with the Ocean County Foot and Ankle Surgical Associates, PC, Toms River, NJ. Dr. Park is now with the San Francisco Foot and Ankle Center, San Francisco, CA. Dr. Ruff is now with OSF Medical Group, Peoria, IL
| | - Sarah J. Park
- Department of Podiatry, Jesse Brown VA Medical Center, Chicago, IL. Dr. Lenz is now with the Ocean County Foot and Ankle Surgical Associates, PC, Toms River, NJ. Dr. Park is now with the San Francisco Foot and Ankle Center, San Francisco, CA. Dr. Ruff is now with OSF Medical Group, Peoria, IL
| | - Jake G. Ruff
- Department of Podiatry, Jesse Brown VA Medical Center, Chicago, IL. Dr. Lenz is now with the Ocean County Foot and Ankle Surgical Associates, PC, Toms River, NJ. Dr. Park is now with the San Francisco Foot and Ankle Center, San Francisco, CA. Dr. Ruff is now with OSF Medical Group, Peoria, IL
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Minimally invasive distal linear metatarsal osteotomy combined with selective release of lateral soft tissue for severe hallux valgus. J Orthop Sci 2018; 23:557-564. [PMID: 29573864 DOI: 10.1016/j.jos.2018.02.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 02/06/2018] [Accepted: 02/22/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Minimally invasive techniques for hallux valgus have been widely used to treat mild to moderate hallux valgus deformities. The purpose of this study was to evaluate the clinical and radiographic outcomes of distal linear metatarsal osteotomy (DLMO), which is one of the minimally invasive techniques, for severe hallux valgus. METHODS 95 patients (141 feet) with severe hallux valgus underwent DLMOs. Lateral soft tissue release (LSTR) was performed at the same time for the cases selected by an original manual test. The satisfaction level, the Japanese Society of Surgery of the Foot (JSSF) hallux scale score, and weight-bearing radiographs of the foot were assessed preoperatively and after more than 24 months. In addition, the clinical and radiographic outcomes were compared among three groups divided by the kind of LSTR: no LSTR; manual correction; and open release through skin incision. RESULTS Although the first metatarsal bone was significantly shortened, dorsiflexed, and elevated on postoperative radiographs, the rate of satisfaction was 87.2% (123/141), and the mean JSSF hallux scale score improved significantly from 60.4 (44-73) to 90.4 (65-100). The mean hallux valgus and intermetatarsal angles also improved significantly from 45.5° (40.0-60.0°) to 10.3° (-28.0-40.9°) and from 19.9° (14.0-28.7°) to 8.3° (-1.6-18.5°), respectively. Delayed union (18 feet), metatarsalgia (16 feet), recurrence (22 feet), and hallux varus (22 feet) were observed, and they were more obvious in DLMO combined with open release through a skin incision. CONCLUSIONS DLMO combined selectively with LSTR is an effective procedure for correcting severe hallux valgus. However, the indication for open release with DLMO should be considered carefully.
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Mermerkaya MU, Alkan E, Ayvaz M. Evaluation of Metatarsal Head Resurfacing Hemiarthroplasty in the Surgical Treatment of Hallux Rigidus: A Retrospective Study and Mid- to Long-Term Follow-up. Foot Ankle Spec 2018; 11:22-31. [PMID: 29232993 DOI: 10.1177/1938640017695864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the mid- to long-term outcomes of metatarsal head resurfacing hemiarthroplasty in the surgical treatment of advanced-stage hallux rigidus. METHODS We performed a retrospective review of 57 consecutive patients (25 [43.9%] males, 32 [56.1%] females; mean age, 61.0 ± 6.4 years) who underwent first metatarsal head resurfacing hemiarthroplasty (HemiCAP) for hallux rigidus between August 2007 and September 2010. Sixty-five implantations were performed in 57 patients; 8 patients underwent bilateral procedures. All patients were clinically rated prior to surgery and at the final follow-up visit using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale and first metatarsophalangeal joint range of motion (MTPJ ROM). RESULTS The median follow-up duration was 81 (range = 8-98) months. The median preoperative AOFAS score was 34 (range = 22-59) points, which had increased to 83 (range = 26-97) points at the final follow-up visit (P < .001). The median preoperative first MTPJ ROM was 25° (range = 15° to 40°), which had increased to 75° (range = 30° to 85°) at the final follow-up visit (P < .001). CONCLUSIONS First MTPJ hemiarthroplasty is an effective treatment method that recovers toe function and first MTPJ ROM, and provides good mid- to long-term functional outcomes. LEVELS OF EVIDENCE Level IV: Retrospective case series.
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Affiliation(s)
- Musa Uğur Mermerkaya
- Department of Orthopaedics and Traumatology, Medical School, Bozok University, Yozgat, Turkey (MUM).,Department of Orthopaedics and Traumatology, Yalvaç State Hospital, Isparta, Turkey (EA).,Department of Orthopaedics and Traumatology, Medical School, Hacettepe University, Ankara, Turkey (MA)
| | - Erkan Alkan
- Department of Orthopaedics and Traumatology, Medical School, Bozok University, Yozgat, Turkey (MUM).,Department of Orthopaedics and Traumatology, Yalvaç State Hospital, Isparta, Turkey (EA).,Department of Orthopaedics and Traumatology, Medical School, Hacettepe University, Ankara, Turkey (MA)
| | - Mehmet Ayvaz
- Department of Orthopaedics and Traumatology, Medical School, Bozok University, Yozgat, Turkey (MUM).,Department of Orthopaedics and Traumatology, Yalvaç State Hospital, Isparta, Turkey (EA).,Department of Orthopaedics and Traumatology, Medical School, Hacettepe University, Ankara, Turkey (MA)
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Cheung ZB, Myerson MS, Tracey J, Vulcano E. Weightbearing CT Scan Assessment of Foot Alignment in Patients With Hallux Rigidus. Foot Ankle Int 2018; 39:67-74. [PMID: 28971698 DOI: 10.1177/1071100717732549] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND An association between hallux rigidus and metatarsus primus elevatus (MPE) has been suggested, although there remains no general consensus about the nature of this relationship. Past studies were limited due to inaccuracies of assessing MPE on 2-dimensional radiographs. The aims of this study were to (1) assess and compare foot alignment in patients with and without hallux rigidus using 3-dimensional (3D) reconstructions from weightbearing computed tomography (CT) and (2) assess intraobserver and interobserver reliability of these measurements. METHODS A prospective study was performed in 50 consecutive patients with symptomatic hallux rigidus and 50 control patients who underwent a weightbearing CT. Two investigators measured first and second metatarsal declination angles, first and second metatarsal lengths, first to second intermetatarsal angle (IMA), hallux valgus angle (HVA), and foot width on 3D CT reconstructions. Measurements were repeated after 1 month. Student t tests were performed to compare hallux rigidus and control groups. Intraclass and interclass correlation coefficients were calculated to evaluate reliability. RESULTS The first to second metatarsal declination ratio was less in patients with hallux rigidus (mean, 0.81) than controls (mean, 0.92; P < .001). Patients with Coughlin and Shurnas grade 3 and 4 hallux rigidus had greater first metatarsal declination than patients with grade 1 and 2 hallux rigidus. Last, IMA was higher (mean, 13 degrees) but HVA was lower (mean, 11 degrees) in patients with hallux rigidus than controls (IMA mean, 12 degrees; HVA mean, 15 degrees; P = .04). Intraobserver (ICC1,1 ≥ 0.93) and interobserver (ICC3,1 ≥ 0.85) reliability were good to excellent for all measured parameters. CONCLUSIONS Patients with hallux rigidus had MPE. Patients with grade 3 and 4 hallux rigidus had more MPE than patients with grade 1 and 2 hallux rigidus. There was no clear correlation between hallux rigidus and bunions. Finally, weightbearing CT proved to be a reliable method of assessing all measured parameters. LEVEL OF EVIDENCE II, prospective comparative series.
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Affiliation(s)
- Zoe B Cheung
- 1 Department of Orthopaedic Surgery, Mount Sinai West, New York, NY, USA
| | - Mark S Myerson
- 2 The Institute for Foot & Ankle Reconstruction at Mercy, Baltimore, MD, USA
| | - Joseph Tracey
- 3 The Medical University of South Carolina, Charleston, SC, USA
| | - Ettore Vulcano
- 4 Department of Orthopaedic Surgery, Mount Sinai West, New York, NY, USA
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Naraghi R, Bremner A, Slack-Smith L, Bryant A. Radiographic Analysis of Feet With and Without Morton's Neuroma. Foot Ankle Int 2017; 38:310-317. [PMID: 27837053 DOI: 10.1177/1071100716674998] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this research was to investigate the association of various structural measurements of the forefoot with Morton's neuroma (MN). METHODS Weightbearing anteroposterior and lateral foot radiographs of subjects attending the University of Western Australia (UWA) Podiatry Clinic and the first author's private practice were included in this study. A single assessor measured the following angles: lateral intermetatarsal angle (LIMA), intermetatarsal angle (IMA), hallux valgus angle (HVA), digital divergence between the second and third digits (DD23), digital divergence between the third and fourth digits (DD34) and relative metatarsal lengths of the first to fifth metatarsals (Met1-5), and the effect of MN size as measured by ultrasonograph on digital divergence. Intratester reliability of all radiographic measurements was assessed on all radiographic measurements. The study included 101 subjects, of whom 69 were diagnosed with MN and 32 were control subjects without MN. The mean (± standard deviation) age of MN subjects was 52 (±15) years and for control subjects, 48 (±12) years. RESULTS When comparing all feet, there were no significant differences in the LIMA, HVA, IMA, digital divergence angles and the relative metatarsal distances between subjects with MN and control subjects. No relationship between MN size and digital divergence was found in either foot, or in either neuroma location. CONCLUSION We were unable to demonstrate any relationship in this study between radiographic metatarsal length and angular measurements in a symptomatic MN group compared to a control group. In addition, we did not find any correlation between the size of MN as measured from ultrasonographic images and radiographic evidence of digital divergence. LEVEL OF EVIDENCE Level III, case control study.
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Affiliation(s)
- Reza Naraghi
- 1 Podiatric Medicine Unit M422, School of Surgery, University of Western Australia, Crawley, Western Australia, Australia
| | - Alexandra Bremner
- 2 School of Population Health M431, University of Western Australia, Crawley, Western Australia, Australia
| | - Linda Slack-Smith
- 3 School of Dentistry M512, University of Western Australia, Crawley, Western Australia, Australia
| | - Alan Bryant
- 1 Podiatric Medicine Unit M422, School of Surgery, University of Western Australia, Crawley, Western Australia, Australia
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Mermerkaya MU, Adli H. A comparison between metatarsal head-resurfacing hemiarthroplasty and total metatarsophalangeal joint arthroplasty as surgical treatments for hallux rigidus: a retrospective study with short- to midterm follow-up. Clin Interv Aging 2016; 11:1805-1813. [PMID: 28008240 PMCID: PMC5167455 DOI: 10.2147/cia.s110865] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose We evaluated the short- to midterm outcomes of metatarsal head-resurfacing hemiarthroplasty and total metatarsophalangeal joint arthroplasty (total joint replacement [TJR]) as surgical treatments for advanced-stage hallux rigidus (HR). Patients and methods From 2012 to 2014, all data from patients who underwent surgery for the treatment of grades 2–3 HR were retrospectively reviewed, and 45 patients were included in this study. Of these patients, 26 underwent metatarsal head-resurfacing hemiarthroplasty (Group I) and 19 underwent TJR (Group II). All patients were clinically graded prior to surgery and at their final follow-up visits using the American Orthopedic Foot and Ankle Society’s (AOFAS) hallux metatarsophalangeal–interphalangeal scale, a visual analog scale (VAS), and the “first metatarsophalangeal joint range of motion” (MTPJ ROM) score. Results Metatarsal head resurfacing was performed on 26 patients. Two patients underwent bilateral procedures, yielding a total of 28 cases in Group I. TJR was performed on 19 patients in Group II. Of the 26 Group I patients, 12 (46.2%) were male and 14 (53.8%) were female, with a mean age of 56.3±4.5 years (range: 47–63 years); the mean follow-up duration was 29.9±5.2 months. Of the 19 Group II patients, eight (42.1%) were male and eleven (57.9%) were female, with a mean age of 57.1±5.8 years (range: 45–66 years); the mean follow-up duration was 27.1±7.5 months. Significant improvements were evident in the AOFAS scores, and the VAS scores decreased, in both groups. No significant difference was evident between groups I and II. Conclusion After failure of conservative treatment in patients with moderate-to-severe HR, both MTPJ hemiarthroplasty and TJR were associated with effective recovery of toe function and MTPJ ROM, as well as good short- to midterm functional outcomes.
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Affiliation(s)
| | - Houman Adli
- Department of Orthopaedics and Traumatology, Yozgat State Hospital, Yozgat, Turkey
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Circi E, Tuzuner T, Sukur E, Baris A, Kanay E. Metatarsal head resurfacing arthroplasty in the treatment of hallux rigidus: is it reliable treatment option? Musculoskelet Surg 2016; 100:139-144. [PMID: 27255589 DOI: 10.1007/s12306-016-0410-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 05/26/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND This study looks at the failure and complications arising secondary to resurfacing and hemi-arthroplasty done at the metatarsal head in patients with hallux rigidus. Our report includes a review of the relevant literature to verify the validity of our techniques. MATERIALS AND METHODS We performed metatarsal head resurfacing with hemi-arthroplasty using the HemiCap(®), on 12 patients with hallux rigidus between the dates of March 2010 and October 2013. The mean follow-up period was 22.3 months (range 12-54). All patients were clinically and radiologically evaluated according to the American Orthopedics Foot and Ankle Society (AOFAS) functional scale and the Coughlin and Shurnas classification. RESULTS The recorded mean AOFAS score showed an increase from the preoperative score of 49.2 ± 13.1 to a postoperative follow-up score of 80.8 ± 13.1 (p < 0.001). Pain scores also showed an improvement from 16.5 ± 7.1 points preoperatively to 32.5 ± 6.9 points during the postoperative follow-up (p < 0.001). The mean function score improved from 17.7 ± 7.6 points preoperatively to 33.2 ± 7.6 points during the final postoperative follow-up (p < 0.001). Furthermore, the mean range of motion improved from 16.3 ± 4.8° preoperatively to 45.4 ± 13.2° postoperatively (p < 0.001). Three patients (25 %) reported pain at rest. Surgical revision was done on these patients who have significant pain that limited their range of motion. CONCLUSION Favorable outcomes were achieved by performing minimal bone resection which also helps maintain metatarso-phalangeal joint function through metatarsal head resurfacing arthroplasty. We expect the failure rates to decrease with the advancements of surgical techniques. Selecting the appropriate patient populous in the application of the technique is crucial in attaining successful clinical results.
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Affiliation(s)
- E Circi
- Department of Orthopedics and Traumatology, Istanbul Education and Research Hospital, Istanbul, Turkey.
| | - T Tuzuner
- Department of Orthopedics and Traumatology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - E Sukur
- Department of Orthopedics and Traumatology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - A Baris
- Department of Orthopedics and Traumatology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - E Kanay
- Department of Orthopedics and Traumatology, Istanbul Education and Research Hospital, Istanbul, Turkey
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Knox AF, Bryant AR. Radiographic Measurements of the Affected and Unaffected Feet in Patients with Unilateral Hallux Limitus A Case-Control Pilot Study. J Am Podiatr Med Assoc 2016; 106:172-81. [PMID: 27269972 DOI: 10.7547/14-137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Controversy exists regarding the structural and functional causes of hallux limitus, including metatarsus primus elevatus, a long first metatarsal, first-ray hypermobility, the shape of the first metatarsal head, and the presence of hallux interphalangeus. Some articles have reported on the radiographic evaluation of these measurements in feet affected by hallux limitus, but no study has directly compared the affected and unaffected feet in patients with unilateral hallux limitus. This case-control pilot study aimed to establish whether any such differences exist. METHODS Dorsoplantar and lateral weightbearing radiographs of both feet in 30 patients with unilateral hallux limitus were assessed for grade of disease, lateral intermetatarsal angle, metatarsal protrusion distance, plantar gapping at the first metatarsocuneiform joint, metatarsal head shape, and hallux abductus interphalangeus angle. Data analysis was performed using a statistical software program. RESULTS Mean radiographic measurements for affected and unaffected feet demonstrated that metatarsus primus elevatus, a short first metatarsal, first-ray hypermobility, a flat metatarsal head shape, and hallux interphalangeus were prevalent in both feet. There was no statistically significant difference between feet for any of the radiographic parameters measured (Mann-Whitney U tests, independent-samples t tests, and Pearson χ(2) tests: P > .05). CONCLUSIONS No significant differences exist in the presence of the structural risk factors examined between affected and unaffected feet in patients with unilateral hallux limitus. The influence of other intrinsic factors, including footedness and family history, should be investigated further.
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Affiliation(s)
- Andrew F. Knox
- Podiatric Medicine Unit, School of Surgery, The University of Western Australia, Crawley, Western Australia, Australia. Dr. Knox is now with Perth Podiatric Surgery, Cottesloe, Western Australia, Australia
| | - Alan R. Bryant
- Podiatric Medicine Unit, School of Surgery, The University of Western Australia, Crawley, Western Australia, Australia. Dr. Knox is now with Perth Podiatric Surgery, Cottesloe, Western Australia, Australia
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Becerro de Bengoa Vallejo R, Sanchez Gómez R, Losa Iglesias ME. Clinical improvement in functional hallux limitus using a cut-out orthosis. Prosthet Orthot Int 2016; 40:215-23. [PMID: 25261491 DOI: 10.1177/0309364614550262] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 08/01/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Functional hallux limitus (FHL) has been implicated in the development of metatarsophalangeal joint osteoarthritis. OBJECTIVES To determine whether cut-out orthosis treatment increases plantarflexion of the first metatarsal by increasing its declination angle. STUDY DESIGN Cross-sectional study. METHODS A total of 46 female volunteers with an average age of 25.66 ± 5.70 years (range: 19-42 years) and FHL participated in the study. We assessed the degrees of movement of the first metatarsal and proximal phalanx bones at the first metatarsophalangeal joint without and while wearing the cut-out orthosis using the 3Space Fastrak® via sensors. RESULTS The movement of the plantarflexión declination angle of the first metatarsal bone was higher using the orthosis 29.84° ± 5.98° versus without orthosis 27.69° ± 5.91° (p < 0.031°). Use of sandals may have minimized the magnitude of movement changes associated with orthosis versus non-orthosis use. CONCLUSION The cut-out orthosis demonstrated a beneficial effect on non-fixed first metatarsophalangeal and metatarsal cuneiform joints affected by FHL, significantly increasing the declination of the metatarsal angle. Furthermore, use of the cut-out orthosis significantly reduced adduction movement of the first metatarsal bone in the transverse plane. CLINICAL RELEVANCE The cut-out orthosis demonstrated a beneficial effect on non-fixed first metatarsophalangeal and metatarsal cuneiform joints affected by FHL, significantly increasing the declination of the metatarsal angle. Furthermore, use of the cut-out orthosis significantly reduced adduction movement of the first metatarsal bone in the transverse plane.
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36
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Abstract
Hallux rigidus is a painful condition of the great toe characterized by restriction of the metatarsophalangeal joint arc of motion and progressive osteophyte formation. Precise cause of hallux rigidus remains under debate. Anatomic variations and historical, clinical, and radiographic findings have been implicated in the development and progression of hallux rigidus. Radiologic findings associated with hallux rigidus include metatarsal head osteochondral defects, altered metatarsal head morphology, and an elevated hallux interphalangeus angle measure. Associated historical findings include a positive family history and history of trauma to the joint. An understanding of relevant anatomy and pathophysiology is essential during the approach to hallux rigidus treatment.
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Abstract
Hallux rigidus, the most common degenerative disorder of the foot, is accountable for abnormality of gait and restriction of activity levels and daily function. This article describes and reviews the available literature on nonoperative modalities available in the treatment of hallux rigidus, including manipulation and intra-articular injections, shoe modifications and orthotics, physical therapy, and experimental therapies.
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Affiliation(s)
- Remesh Kunnasegaran
- Department of Orthopaedics, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Gowreeson Thevendran
- Department of Orthopaedics, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
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Evaluation of first metatarsal head declination through a modified distal osteotomy in hallux rigidus surgery. A cadaveric model. Foot Ankle Surg 2015; 21:187-92. [PMID: 26235858 DOI: 10.1016/j.fas.2014.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/10/2014] [Accepted: 11/13/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND First metatarsal osteotomies have been described for treatment of hallux rigidus. Most of these techniques result in declination of the first metatarsal head through shortening of the metatarsal and transfer metatarsalgia may result. Our objective was to evaluate the declination effect of a distal metatarsal osteotomy when different angulations and lateral translations are applied. MATERIALS AND METHODS A cadaveric study was conducted performing a modified distal oblique osteotomy, which produces head declination while limiting shortening. Several transverse inclination angles (0-10-20-30-40°) were used. Thereafter, plantar translation of the metatarsal head was registered at different lateral displacements (1, 3, 5mm). RESULTS Twenty-two specimens were included. Three feet were operated on with a 0° of angulation in the transverse plane, 6 with 10°, 5 with 20°, 5 with 30°, and 3 with 40°. Head declination significantly increased with higher angulation and with greater lateral translations (p<0.001), but the interrelationship between these two variables did not achieve statistical significance (p=0.597). In regards to angulation, significant differences in head declination were found between 0° (0.1-0.7 mm), 10°-20° (0.5-1.2mm) and 30°-40° (1.3-2.4mm). The metatarsal sesamoid joint was compromised when the osteotomy was performed at a 40° inclination angle. CONCLUSIONS Metatarsal head declination is determined by the inclination angle of the oblique limb of the osteotomy and lateral displacement of the metatarsal head. Our results suggest that the effect of lateral displacement is an independent factor from angulation. The latter may impact surgery planning and may improve clinical outcome by selecting a safer inclination angle when lateral displacement of the metatarsal head is being considered. LEVEL OF EVIDENCE Level II-A, systematic review with homogeneity of cohort studies.
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Abstract
Advanced stages of hallux rigidus are usually treated with various arthroplasties or arthrodesis. Recent results with resurfacing of the metatarsal head have shown promising results and outcomes similar or superior to those of arthrodesis. In this article, the authors show their preoperative decision making, surgical techniques, postoperative management, results, and a comparative literature review to identify metatarsal head resurfacing as an acceptable technique for the treatment of advanced hallux rigidus in active patients. Key points in this article are adequate soft tissue release, immediate rigid fixation of the components, and appropriate alignment of the components.
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Affiliation(s)
- Alex J Kline
- University of Pittsburgh Medical Center, Three Rivers Orthopaedic Associates, 200 Delafield Road, Suite 1040, Pittsburgh, PA 15215, USA
| | - Carl T Hasselman
- University of Pittsburgh Medical Center, Three Rivers Orthopaedic Associates, 200 Delafield Road, Suite 1040, Pittsburgh, PA 15215, USA.
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40
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Perez-Aznar A, Lizaur-Utrilla A, Lopez-Prats FA, Gil-Guillen V. Dorsal wedge phalangeal osteotomy for grade II-III hallux rigidus in active adult patients. Foot Ankle Int 2015; 36:188-96. [PMID: 25288332 DOI: 10.1177/1071100714552481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate prospectively the results of the dorsal wedge phalangeal osteotomy for treating moderate hallux rigidus. METHODS The prospective study included 42 consecutive feet in 40 active patients, with an average age of 55.1 (range, 41-65) years. Clinical evaluation included American Orthopaedic Foot and Ankle Society (AOFAS) score, pain visual analog scale, range of motion, and subjective patient satisfaction. Radiographic evaluation was performed, including linear and angular measurements. The average follow-up was 2.7 (range, 2-3.8) years. RESULTS The preoperative and postoperative mean AOFAS scores were 51.7 and 88.8, respectively (P = .001), and for pain VAS were 7.6 and 1.9, respectively (P = .001). Good and excellent results at final follow-up were seen in 34 feet. All patients returned to their previous activities. Satisfaction with surgery was good or excellent in 39 patients. The average passive metatarsophalangeal (MTP) dorsiflexion improved from 20.3 to 55.7 degrees (P = .001). The average MTP joint space improved from 2.2 to 2.3 degrees (P = .001). The radiographic measurements were unchanged, except anatomic angles related to phalangeal dorsiflexion. The average width of the bone wedge was 3.5 (range, 2.2-5.0) mm, and significant correlation was found with final AOFAS score (P = .006) and pain VAS (P = .001). There were 2 revisions for screw irritation. CONCLUSION Phalangeal osteotomy was a reliable and reproducible treatment for moderate hallux rigidus in active patients, with substantial improvement in AOFAS score and MTP dorsiflexion and decreased pain. LEVEL OF EVIDENCE Level IV, prospective case series.
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Affiliation(s)
- Adolfo Perez-Aznar
- Foot Unit, Orthopaedic Surgery Department, Elda University Hospital, Alicante, Spain
| | | | - Fernando A Lopez-Prats
- Orthopaedic Surgery Department, Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain
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41
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Abstract
Functional hallux rigidus is a clinical condition in which the mobility of the first metatarsophalangeal joint is normal under non-weight-bearing conditions, but its dorsiflexion is blocked when first metatarsal is made to support weight. In mechanical terms, functional hallux rigidus implies a pattern of interfacial contact through rolling, whereas in a normal joint contact by gliding is established. Patients with functional hallux rigidus should only be operated on if the pain or disability makes it necessary. Gastrocnemius release is a beneficial procedure in most patients.
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Affiliation(s)
- Ernesto Maceira
- Foot and Ankle Unit, Department of Orthopaedic Surgery, Hospital Universitario Quirón Madrid, Calle Diego de Velázquez 1, Pozuelo de Alarcón, Madrid 28223, Spain.
| | - Manuel Monteagudo
- Foot and Ankle Unit, Department of Orthopaedic Surgery, Hospital Universitario Quirón Madrid, Calle Diego de Velázquez 1, Pozuelo de Alarcón, Madrid 28223, Spain
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Rao S, Bell K. Reliability and relevance of radiographic measures of metatarsus primus elevatus and arch alignment in individuals with midfoot arthritis and controls. J Am Podiatr Med Assoc 2014; 103:347-54. [PMID: 24072361 DOI: 10.7547/1030347] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Low arch alignment and metatarsus primus elevatus (MPE) have been postulated to increase dorsal compressive stresses in the joints of the medial column of the foot and to contribute to the development of degenerative changes. The primary purposes of this study were (1) to examine the relationship between radiographic measures of arch alignment and MPE and (2) to assess arch alignment and MPE in individuals with midfoot arthritis and in asymptomatic controls. The secondary aim was to examine the reliability of radiographic measures of arch alignment and MPE. METHODS Radiographic measures of arch height and MPE were quantified on 28 individuals with midfoot arthritis and 22 individuals in a control group. Reliability was assessed using the intraclass correlation coefficient (ICC). The Pearson product moment correlation (r) was used to assess the relationship between arch alignment and MPE. Between-group differences were assessed using a two-sample t test (α = 0.05). RESULTS Good to excellent reliability was noted for measures of arch height (ICC[2,3] = 0.919-0.994) as well as MPE (ICC[2,3] = 0.891-0.882). A modest positive association was noted between normalized cortical elevation and normalized navicular height (r = 0.274, P = .030) and calcaneal inclination angle (r = 0.263, P = .035). Individuals with midfoot arthritis demonstrated lower arch alignment, reflected in a significantly higher calcaneal-first metatarsal angle (P = .002), lower calcaneal inclination angle (P = .004), and lower normalized navicular height (P < .001) compared with controls. No evidence was found to support between-group differences in lateral intermetatarsal angle (P = .495) and normalized cortical elevation (P = .146). CONCLUSIONS These findings provide objective data establishing the reliability of measures of MPE and arch alignment and their potential clinical significance.
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Affiliation(s)
- Smita Rao
- Department of Physical Therapy, New York University, New York, NY
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Klos K, Simons P. Lapidus arthrodesis plus osteochondral autograft transplantation in the management of hallux rigidus with an elevated first ray. Foot Ankle Spec 2014; 7:135-9. [PMID: 24379451 DOI: 10.1177/1938640013516856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The range of joint-sparing treatments for advanced hallux rigidus is still very limited. The authors describe an osteochondral autograft transplantation technique combined with Lapidus arthrodesis as a novel method of obtaining a relatively symptom-free first metatarsophalangeal joint function in patients with hallux rigidus and first-ray elevation.
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Affiliation(s)
- Kajetan Klos
- Department of Foot and Ankle Surgery, Katholisches Klinikum Mainz, Germany (KK, PS)
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Kuni B, Wolf SI, Zeifang F, Thomsen M. Foot kinematics in walking on a level surface and on stairs in patients with hallux rigidus before and after cheilectomy. J Foot Ankle Res 2014; 7:13. [PMID: 24524773 PMCID: PMC3925775 DOI: 10.1186/1757-1146-7-13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 02/10/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Walking down stairs is a clinically relevant daily activity for older persons. The aim of this pilot study was to investigate the impact of cheilectomy on walking on level ground and on stairs. METHODS 3D motion analysis of foot kinematics was performed in eight patients with hallux rigidus and 11 healthy control participants with a 12-camera system, using the Heidelberg foot measurement method before and one year after surgery. The clinical results were documented using the AOFAS Scale. RESULTS The range of motion of the first metatarsophalangeal joint did not improve after the operation under any gait condition. Preoperatively, hallux dorsi-/plantarflexion in level walking was 11.9° lower in patients than in controls (p = 0.006), postoperatively 14.5° lower (p = 0.004). Comparing walking conditions in patients, hallux dorsi-/plantarflexion was significantly higher in level walking than in climbing stairs (difference up stairs - level: -8.1°, p = 0.018).The AOFAS Scale improved significantly from 56.9 ± 19.9 points (mean ± SD), preoperatively, to 75.9 ± 13.9 points, postoperatively (p = 0.027). CONCLUSIONS Cheilectomy is appropriate for reducing symptoms of hallux rigidus. However, neither a positive influence on the range of motion in walking on level ground and on stairs nor a functional improvement was observed in this group of patients. TRIAL REGISTRATION NCT01804491.
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Affiliation(s)
- Benita Kuni
- Clinic for Orthopedics and Trauma Surgery, Department of Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr, 200a, 69118 Heidelberg, Germany.
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Polzer H, Polzer S, Brumann M, Mutschler W, Regauer M. Hallux rigidus: Joint preserving alternatives to arthrodesis - a review of the literature. World J Orthop 2014; 5:6-13. [PMID: 24649409 PMCID: PMC3952696 DOI: 10.5312/wjo.v5.i1.6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 10/29/2013] [Accepted: 11/16/2013] [Indexed: 02/06/2023] Open
Abstract
Hallux rigidus describes the osteoarthritis of the first metatarsophalangeal joint. It was first mentioned in 1887. Since then a multitude of terms have been introduced referring to the same disease. The main complaints are pain especially during movement and a limited range of motion. Radiographically the typical signs of osteoarthritis can be observed starting at the dorsal portion of the joint. Numerous classifications make the comparison of the different studies difficult. If non-operative treatment fails to resolve the symptoms operative treatment is indicated. The most studied procedure with reproducible results is the arthrodesis. Nevertheless, many patients refuse this treatment option, favouring a procedure preserving motion. Different motion preserving and joint sacrificing operations such as arthroplasty are available. In this review we focus on motion and joint preserving procedures. Numerous joint preserving osteotomies have been described. Most of them try to relocate the viable plantar cartilage more dorsally, to decompress the joint and to increase dorsiflexion of the first metatarsal bone. Multiple studies are available investigating these procedures. Most of them suffer from low quality, short follow up and small patient numbers. Consequently the grade of recommendation is low. Nonetheless, joint preserving procedures are appealing because if they fail to relief the symptoms an arthrodesis or arthroplasty can still be performed thereafter.
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46
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Abstract
Hallux rigidus is a term describing degenerative joint disease (DJD) to the first metatarsal phalangeal joint (MTPJ). It is the most common DJD encountered in the foot and is the second most common pathology of the great toe behind hallux valgus. The goal of a cheilectomy is to relieve pain and increase MTPJ motion. Critical evaluation of the cheilectomy must include longevity of desired results. The primary goal of this study was to determine how long a cheilectomy can be expected to last before an arthrodesis or joint destructive procedure is performed, if ever. We examined 189 cheilectomies with a mean radiographic follow-up of 235 days and mean chart review follow-up of 1184 days (3.2 years). Analysis showed 5 repeat cheilectomies, 1 interpositional arthroplasty, and only 2 arthrodeses subsequently performed. This retrospective study provides intermediate term evidence that cheilectomy is an appropriate procedure for stages 1, 2, and 3 first MTPJ DJD with reliable, lasting results.
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47
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Abstract
BACKGROUND Advanced stages of first metatarsophalangeal (MTP) arthritis have traditionally been treated with various arthroplasties or arthrodesis. Studies suggest the outcomes of arthrodesis are superior to those of metallic joint replacement; however, complications and suboptimal outcomes in active patients still remain with arthrodesis of the first MTP joint. This study reports results of patients with advanced MTP arthritis who underwent metallic resurfacing of the metatarsal side of the MTP joint. METHODS From 2005 to 2006, 26 patients (30 implants) with stage II or III hallux rigidus underwent resurfacing with the HemiCAP® implant and consented to participate in a study comparing pre- and postoperative radiographs, range of motion (ROM), American Orthopedic Foot and Ankle Society, and Short Form 36 Health Survey (SF-36) scores. Average age of these patients was 51 years. Patients were assessed at a mean of 27 months with outcome measures and contacted at 60 months to assess current symptoms and satisfaction. RESULTS Assessment at 27 months demonstrated statistically significant improvements in ROM, AOFAS, and SF-36 scores (P < .05) when compared to baseline. Mean preoperative AOFAS scores improved from 51.5 to 94.1. Mean active ROM improved from 19.7 to 47.9 degrees. Mean passive ROM improved from 28.0 to 66.3 degrees. Mean RAND SF-36 physical component score improved significantly from 66.7 to 90.6. Average time for return to work was 7 days. At 60 months, all patients reported excellent satisfaction with their current state and would repeat the procedure. Implant survivorship was 87% at 5 years. Of the 30 implants, 4 were revised at 3 years. CONCLUSION The results at 5 years were very promising. Preservation of joint motion, alleviation of pain, and functional improvement data were very encouraging. Because minimal joint resection was performed, conversion to arthrodesis or other salvage procedures would be relatively simple if further intervention became necessary. LEVEL OF EVIDENCE Level IV, prospective case series.
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Affiliation(s)
- Alex J Kline
- University of Pittsburgh, Pittsburgh, PA 15215, USA
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48
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Abstract
Hallux rigidus is a complex disorder, and numerous surgical procedures have been described for its management. Although the optimal technique has yet to be defined, it is important to individualize the degree of arthritis as well as other clinical features (metatarsal index, pain characteristics, and so forth) of each patient to achieve optimal results. The authors firmly believe that for patients with only dorsal pain, a cheilectomy is the ideal choice because good and reliable results can be achieved. When pain is also present around the joint or is combined, which is the most common scenario, their main choice now is to perform a decompressive osteotomy. The biomechanics of the joint are more adequately restored, soft tissues are relaxed, and remodeling of the contracted tissues is allowed. More investigation has still to be performed to elucidate the origin of this abnormality.
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Affiliation(s)
- A Migues
- Institute of Orthopaedics Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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49
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Abstract
Since its introduction by Morton in the early 20th century, first metatarsal instability has been debated as a contributing cause of many foot ailments. Given our evolutionary origins, some instability at the first ray seems inevitable. It makes sense that hypermobility could be the pathology leading to the development of various forefoot disorders. The problem is that it has been difficult to prove. Only in the last decade have there been any devices with which to quantify mobility, and each of the devices measures slightly different variables. However, each of these devices has been shown to be consistent and reliable. Excessive mobility of the first ray probably cannot be considered the only "suspect." With disorders such as hallux valgus and metatarsalgia, environment and footwear may play just as important a role as hypermobility. There are some conclusions, though, that can be safely drawn at this point. * We should define the measures of first ray mobility. One recent study has suggested the terms metatarsal elevation and metatarsal translation to describe two different aspects of the problem. * Simple clinical tools may be as useful as more cumbersome research tools for assessing first ray instability. * First ray mobility on average is increased in patients with hallux valgus. * First ray mobility is increased in some patients with transfer metatarsalgia. * Although some studies show increased elevation or mobility of the first ray in hallux rigidus, other studies do not. The burden is on the current generation of foot and ankle practitioners to resolve the debate of its predecessors. By first defining the measures of instability and then applying them to large populations, the role of hypermobility may be better defined. Then we can debate how best to "fix" the problem!
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Affiliation(s)
- Corinne Van Beek
- Columbia University, Orthopaedic Surgery, 622 W 168th St, PH Ilth Floor, New York, NY 10032, USA
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50
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Usuelli F, Palmucci M, Montrasio UA, Malerba F. Radiographic considerations of hallux valgus versus hallux rigidus. Foot Ankle Int 2011; 32:782-8. [PMID: 22049864 DOI: 10.3113/fai.2011.0782] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Metatarsus primus elevatus (MPE) has long been suggested as a primary causative factor in the pathogenesis of hallux rigidus (HR). The purpose of this investigation was to more clearly define this relationship by comparison of first ray position in patients with hallux rigidus, hallux valgus, and a control population with no known foot pathology. MATERIALS AND METHODS Clinical and radiographical data were retrospectively collected from 297 patients (394 feet) between the periods of January 2007 and September 2008. Patients were stratified into those having isolated HR (110 patients, 145 feet), isolated hallux valgus (HV) (118 patients, 159 feet), and control group (C) of asymptomatic volunteers (69 patients, 90 feet). Any patient with a previous history of foot trauma, surgery, or other foot or ankle pathology was excluded from the study. Standing lateral weightbearing X-rays were obtained for measurement of first to second metatarsal head elevation (Horton Index), Seiberg Index, and Sagittal Intermetatarsal Angle (IMA). RESULTS A significant difference in first ray elevation in HR population was identified by all the three measurements. Horton Index (mm) was 6.4 +/- 2.5 for HR population, as compared to 4.0 +/- 2.5 and 3.4 +/- 1.9 for the HV and C populations (p < or = 0.05). Seiberg Index (mm) measured 2.5 +/- 1.8 for the HR group, versus 1.0 < or = 1.6 and 0.24 +/- 0.9 for the HV and C groups respectively (p < or = 0.05). The sagittal IMA (degrees) were 4.5 +/- 2.5 versus 2.7 +/- 2.2 and 1.8 +/- 1.2 (p < or = 0.05). CONCLUSION This investigation does not show any etiological relation between MPE and HR, but identified a correlation between them.
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