Clinical Trials Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Mar 18, 2024; 15(3): 238-246
Published online Mar 18, 2024. doi: 10.5312/wjo.v15.i3.238
Correction method for moderate and severe degrees of hallux valgus associated with transfer metatarsalgia
Amangasy Zhanaspayev, Nurlan Bokembayev, Marat Zhanaspayev, Aidos Tlemissov, Sabina Aubakirova, Alexander Prokazyuk
Amangasy Zhanaspayev, Department of Traumatology and Orthopaedics, The National Scientific Center of Traumatology and Orthopaedics Named after Academician Batpenov ND, Astana 010000, Kazakhstan
Nurlan Bokembayev, Marat Zhanaspayev, Sabina Aubakirova, Department of Traumatology and Paediatric Surgery, Non-Commercial Joint-Stock Company “Semey Medical University”, Semey 071400, Kazakhstan
Aidos Tlemissov, Department of Habilitation and Rehabilitation, Center of Habilitation and Rehabilitation of Persons with Disabilities of the Abai Region, Semey 071400, Kazakhstan
Alexander Prokazyuk, Department of Anaesthesiology and Resuscitation, Center of Nuclear Medicine and Oncology, Semey 071400, Kazakhstan
Author contributions: Zhanaspayev A and Bokembayev N contributed to the patient selection and main surgeon; Zhanaspayev A, Bokembayev N, and Aubakirova S were involved in the data collection; Zhanaspayev A contributed to the idea; Bokembayev N took part in the draft writing; Tlemissov A and Aubakirova S contributed to the patient rehabilitation; Zhanaspayev M was involved in the conceptualization and supervision, statistical analysis; Zhanaspayev M and Prokazyuk A contributed to the final writing.
Institutional review board statement: The study was reviewed and approved by the Local Ethics Committee of NCJSC “Semey Medical University” (Semey, the Republic of Kazakhstan) according to protocol #2 on October 25, 2018.
Clinical trial registration statement: This study was registered at Semey Medical University (Semey, Kazakhstan) with a registration ID of 05-5798 as of December 7th, 2018. No URL is available.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marat Zhanaspayev, MD, Attending Doctor, Chief, Senior Lecturer, Senior Scientist, Department of Traumatology and Paediatric Surgery, Non-Commercial Joint-Stock Company “Semey Medical University”, 103 Abai Kunanbayev Street, Semey 071400, Kazakhstan. marat_zhanaspaev@mail.ru
Received: October 22, 2023
Peer-review started: October 22, 2023
First decision: December 28, 2023
Revised: January 7, 2024
Accepted: February 29, 2024
Article in press: February 29, 2024
Published online: March 18, 2024
Abstract
BACKGROUND

Hallux valgus (HV) is a common foot deformity that manifests with increasing age, especially in women. The associated foot pain causes impaired gait and decreases quality of life. Moderate and severe HV is a deformity that is characterized by the involvement of lesser rays and requires complex surgical treatment. In this study, we attempted to develop a procedure for this condition.

AIM

To analyse the treatment results of patients who underwent simultaneous surgical correction of all parts of a static forefoot deformity.

METHODS

We conducted a prospective clinical trial between 2016 and 2021 in which 30 feet with moderate or severe HV associated with Tailor’s bunion and metatarsalgia were surgically treated via a new method involving surgical correction of all associated problems. This method included a modified Lapidus procedure, M2M3 tarsometatarsal arthrodesis, intermetatarsal fusion of the M4 and M5 bases, and the use of an original external fixation apparatus to enhance correction power. Preoperative, postoperative, and final follow-up radiographic data and American Orthopaedic Foot and Ankle Society (AOFAS) scores were compared, and P values < 0.05 were considered to indicate statistical significance.

RESULTS

The study included 28 females (93.3%) and 2 males feet (6.7%), 20 (66.7%) of whom had a moderate degree of HV and 10 (33.3%) of whom had severe deformity. M2 and M3 metatarsalgia was observed in 21 feet, and 9 feet experienced pain only at M2. The mean follow-up duration was 11 months. All patients had good correction of the HV angle [preoperative median, 36.5 degrees, interquartile range (IQR): 30-45; postoperative median, 10 degrees, IQR: 8.8-10; follow-up median, 11.5 degrees, IQR: 10-14; P < 0.01]. At follow-up, metatarsalgia was resolved in most patients (30 vs 5). There was a clinically negligible decrease in the corrected angles at the final follow-up, and the overall AOFAS score was significantly better (median, 65 points, IQR: 53.8-70; vs 80 points, IQR: 75-85; P < 0.01).

CONCLUSION

The developed method showed good sustainability of correction power in a small sample of patients at the one-year follow-up. Randomized clinical trials with larger samples, as well as long-term outcome assessments, are needed in the future.

Keywords: Hallux valgus, Metatarsalgia, Tailor’s bunion, Lapidus procedure, Proximal metatarsal osteotomy, Splayfoot

Core Tip: Although there are several methods of surgical correction for moderate and severe hallux valgus, not all patients achieve the desired treatment result. One of the reasons for this outcome is the involvement of almost all rays of the foot. To achieve a favourable treatment result in these patients, simultaneous correction of all the elements of the deformed forefoot is needed, considering the biomechanical association of this pathology, namely, high mobility of the first and fifth metatarsals.