Search Results (27)

Background/Objectives: Hallux valgus, or a bunion, is a prevalent foot deformity associated with pain, limited mobility, and reduced quality of life. Surgical treatments include minimally invasive and traditional open techniques, but the optimal approach remains debated. This systematic review evaluates long-term outcomes, patient satisfaction, cost-effectiveness, the influence of patient-specific factors, rehabilitation protocols, and complication rates for these methods. Methods: A comprehensive search of PubMed, Medline, EMBASE, and Cochrane databases identified 22 studies published within the last 15 years, each with a minimum follow-up of 2 years. The systematic review adhered to PRISMA-ScR guidelines. Eligible studies reported on at least one of six key outcomes, and data were extracted on radiographic and clinical results, patient satisfaction, costs, rehabilitation timelines, and adverse events. Results: Minimally invasive bunion surgery (MIBS) showed faster recovery, higher patient satisfaction, and improved quality of life compared to open surgery. Radiographic outcomes, including hallux valgus and intermetatarsal angle correction, were durable, though outcomes were less consistent for severe deformities. MIBS was more cost-effective over time, owing to shorter operating times and faster recovery. Rehabilitation was accelerated, and wound complications were fewer with MIBS. However, open techniques remained preferable for severe deformities due to their reliability in complex corrections. Conclusions: MIBS offers substantial advantages for most patients undergoing bunion surgery, including faster recovery and fewer complications. However, open techniques may be better suited for severe deformities. Further research is needed to refine patient selection criteria and evaluate long-term outcomes in diverse populations. Full article

Background/Objectives: Assessing the learning curve is essential for surgical techniques that require precision and technical adaptation. Although modified Reverdin–Isham and Akin percutaneous osteotomies (RIAOs) are well-established procedures for the treatment of hallux valgus (HV), their percutaneous nature and specific technical demands justify the evaluation of the learning curve. Therefore, this study aimed to assess the learning curve of RIAOs for the HV correction, using for the first time a Bayesian approach. Methods: Modified RIAOs were applied to treat mild-to-moderate HV in patients who were prospectively enrolled. The hallux valgus angle (HVA), inter-metatarsal angle (IMA), distal metatarsal articular angle (DMAA) and tibial sesamoid position were assessed. Clinical outcomes were evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) Scale, Visual Analog Scale (VAS) and Numerical Rating Scale (NRS). Surgery and fluoroscopy times were recorded. To evaluate the learning curve, a Bayesian analysis using a change point model was performed. Results: Analysis of 142 patients revealed three distinct phases in the learning curve, with a plateau reached after 112 procedures. Over time, the mean operation duration decreased from 55 to 27 min, and fluoroscopy time decreased from 60 to 28 s. Conclusions: A flexible change point model was used to model a learning curve, guaranteeing a robust interpretation of the data. The correction of the HV angles showed similar results in the three phases of the curve, demonstrating that the surgeon achieved positive results from the beginning of the surgery. Full article

Background: Hallux valgus is a common painful condition with tri-planar deformity of the first ray. Surgical correction consists of distal osteotomy of the first metatarsal and its lateral translation. However, in the case of hypermobility of the first cuneo-metatarsal joint (TMTJ), the associated Lapidus procedure is indicated to correct deformities along all three anatomical planes. Lapidus procedure is reported to have several contraindications and complications; for this reason, many surgeons proposed technical modification to the original procedure. We present the results of a novel surgical technique for hallux valgus correction with minimally invasive arthrodesis of first TMTJ without proximal correction of deformity, combined with a distal Austin-Chevron procedure. Materials and Methods: We retrospectively evaluated patients who underwent surgical correction of hallux valgus with our technique between January 2010 and January 2020. We collected data on demographics, anesthesiologic technique, associated surgical procedures, post-operative functional results, and complications. Dorso-plantar and lateral radiographs were performed at 6, 12, and 24 weeks after surgery or until fusion was documented. Clinical assessment considered gait analysis, pain or other disturbance, type of shoes worn, and use of orthosis. Results: A total of 240 patients were enrolled. AOFAS score, hallux valgus angle, and inter-metatarsal angle showed a significant improvement. Complications consisted of distal osteotomy non-union (1%), pain or protrusion of the screw (13%), and recurrence of deformity (2%). Overall, patients were very satisfied with the surgery in 192/278 (69%) cases, moderately satisfied in 67/278 (24%) cases, satisfied in 8/278 (3%) cases, and dissatisfied in 11/278 (4%) cases. Conclusions: Our novel surgical technique which combines in situ arthrodesis of the first tarso-metatarsal joint (TMTJ) with a distal Austin-Chevron procedure offers an effective alternative for correcting hallux valgus with first-ray hypermobility, minimizing complications associated with traditional methods. Full article

Background/Objectives: Iatrogenic hallux varus is a rare complication often arising after hallux valgus surgery, characterized by medial deviation of the hallux. This report presents the case of a 58-year-old female with iatrogenic hallux varus complicated by rheumatoid arthritis (RA). The objective is to highlight the challenges and outcomes of surgical treatment in RA patients with complex foot deformities. Methods: The patient presented with severe medial deviation of the hallux and claw positioning of the lesser toes, resulting in pain and functional limitations. Radiological analysis indicated overcorrection of the first intermetatarsal angle and deformity of the lesser toes. Surgical management included arthrodesis of the first metatarsophalangeal (MTP) joint using K-wires and resection arthroplasty of the lesser metatarsals. Results: Postoperative outcomes revealed correct alignment, pain reduction, and restoration of functional capabilities. However, a non-union was observed in the first MTP arthrodesis after 24 months, which remained asymptomatic. Conclusions: This case underscores the importance of careful surgical planning in RA patients to balance joint preservation and deformity correction. Arthrodesis proved effective for stability and pain relief in RA-associated deformities, although long-term follow-up remains critical to address complications. Tailored interventions are necessary to improve the quality of life in RA patients with complex foot deformities. Full article

Objectives: To compare the safety and efficacy of open surgery (OS) and minimally invasive surgery (MIS) techniques in the correction of symptomatic hallux valgus (HV). Methods: A systematic review of studies up to January 2024 was conducted, identifying all the relevant literature comparing OS and MIS for symptomatic HV. Searches were performed across major databases including MEDLINE, Cochrane and EMBASE. A total of 32 studies were included, comprising randomised control trials, prospective and retrospective cohort studies as well as grey literature. Key outcomes assessed included radiographic measures such as the hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA), with preoperative and postoperative angles analysed to calculate the power of correction. Secondary outcomes included American Orthopaedic Foot and Ankle Society (AOFAS) scores, operative time, hospital stay duration, radiation exposure and complication rates. Both fixed-effect and random-effects models were applied based on the observed heterogeneity in the data. Results: Thirty-two studies with 2423 patients contributed to the summative outcome. Postoperative HVA and IMA were comparable between OS and MIS groups. However, MIS showed a significantly lower DMAA angle (MD = −0.90, CI: −1.55 to −0.25, p = 0.01). In radiographic correction analysis, MIS demonstrated significantly greater DMAA correction (MD = 1.09, CI: 0.43 to 1.75, p = 0.001). The odds of hardware removal were significantly higher with MIS (OR = 2.37, CI: 1.41 to 4.00, p = 0.001). Functional analysis showed that MIS achieved significantly higher postoperative AOFAS scores (MD = 2.52, CI: 0.92 to 4.13, p = 0.002). MIS was associated with a shorter operative (MD = −12.07 min, CI: −17.02 to −7.11, p < 0.00001) and a significantly shorter hospital stay (MD = −0.76, CI: −1.30 to −0.21, p = 0.007). MIS was linked to higher radiation exposure (MD = 51.18, CI: 28.71 to 73.65, p < 0.00001). Conclusions: There is no definitive superiority between MIS and OS for hallux valgus correction. While MIS offers benefits such as improved DMAA correction, higher functional AOFAS scores, shorter operative times and reduced hospital stays, it also carries risks like increased radiation exposure and a higher rate of hardware removal. The decision between MIS and OS should be personalised, taking into account the specific needs and circumstances of each patient. Larger studies are warranted to validate these findings as newer MIS techniques continue to emerge and evolve. Full article

Background: Hallux valgus is a prevalent foot deformity conventionally treated with open surgical techniques, which carry risk of complications due to extensive soft tissue dissection. Minimally invasive surgeries (MISs) as alternatives offer comparable outcomes, reduced pain, and faster recovery; however, their challenges include the risk of shortening of the first metatarsal. This study aimed to assess the efficacy of our modified MIS hallux valgus correction technique and investigate the factors that affect first metatarsal shortening. Methods: Twenty-nine feet treated with modified MIS hallux valgus surgery between 2017 and 2022 were included with an average follow-up of 29 months. Clinical outcomes were evaluated with the Manchester–Oxford Foot Questionnaire (MOXFQ), Foot Function Index (FFI), and visual analog scale for pain. Radiographic evaluations included the intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), first metatarsal length, and sesamoid grade. Results: Functional and radiographic outcomes were significantly improved (p < 0.0001 and p < 0.001, respectively). Significant correlations between patient satisfaction and the MOXFQ, FFI, and VAS scores were found, with no significant correlations between patient satisfaction and radiographic outcomes. Non-purchasing of the lateral cortex of the proximal osteotomy site was identified to increase risk of first metatarsal shortening (odds ratio [OR] = 22.09, p = 0.0064). Conclusions: Our modified MIS for hallux valgus correction showed favorable radiographic and functional outcomes. Proximal lateral cortex purchasing should be targeted to reduce postoperative shortening of the first metatarsal. Full article

Background: Hallux valgus is a common forefoot disorder with hundreds of proposed management techniques. Distal chevron osteotomy with a modified McBride procedure has been traditionally recommended for mild hallux valgus because of its simple and less invasive nature with fewer complications, faster recovery, and reliable outcomes. In recent years, the indications for this procedure have expanded to include hallux valgus with severe deformities. This study aims to compare the radiographic outcomes of the surgical treatment for moderate versus severe hallux valgus patients from the perspective of sesamoid bone reduction. Materials and Methods: A retrospective review of medical records identified 99 feet from 94 patients that were treated with distal chevron osteotomy with a modified McBride procedure. These feet were divided by the preoperative hallux valgus angle and intermetatarsal angle into the moderate and severe groups. Results: Postoperative radiographic parameters significantly improved in both groups after treatment, indicating adequate deformity correction. Improvement in the sesamoid position was better in the moderate group compared to that in the severe group. The recurrence rate in the severe group was higher than that in the moderate group without statistical significance. Conclusions: Based on the radiographic results of the postoperative position following sesamoid reduction, the distal chevron osteotomy with a modified McBride procedure is effective for treating moderate hallux valgus deformities. However, this treatment strategy may be associated with a higher recurrence rate in cases of severe hallux valgus deformity. A complete reduction in the sesamoids should be emphasized during the management of severe hallux valgus deformity. Full article

Background/Objectives: Reverdin–Isham osteotomy is effective in correcting moderate hallux valgus deformity but has certain limitations when correcting a deformity in the sagittal plane. This study aimed to evaluate the impact on pain, functionality, and radiological measures of angular corrections, and the safety of the Reverdin–Isham lateral translation technique through minimally invasive surgery in the treatment of a moderate hallux valgus compared to Reverdin–Isham standard osteotomy. Methods: A pilot 6-month prospective cohort study was conducted on adults over 18 years old with a hallux valgus in at least one foot. The study exposure was the use of the Reverdin–Isham lateral translation technique. The outcome variables were pain and functionality through VAS and AOFAS scales, respectively, and radiological measurements of the first toe metatarsophalangeal angle (MPA), first space intermetatarsal angle (IMA), proximal articular set angle (PASA), distal articular set angle (DASA), metatarsal formula, and position of sesamoids in the AP projection. Results: The study involved 60 participants. Results indicate significant reductions in pain and radiological measures in both cohorts: MPA improved by 23.13 degrees, IMA by 5.93 degrees, and sesamoid position by 4.23 degrees in patients who underwent the lateral translation technique versus 13.20, 3.30, and 1.57 degrees, respectively, in patients who experienced the standard Reverdin–Isham technique. The lateral translation method showed greater reductions in these metrics compared to the standard Reverdin–Isham technique (p < 0.05). Conclusions: Percutaneous Reverdin–Isham techniques, both standard and with lateral translations, effectively corrected moderate hallux valguses. However, the lateral translation method provided greater reductions in MPA, IMA, and sesamoid positions, making it more suitable for deformities with IMAs over 15 degrees. Full article

Background: The outcomes of first metatarsal (M1) distal osteotomies in hallux valgus (HV) can be improved, especially for intermetatarsal angle (IMA) correction, which is mainly based on lateral displacement of the M1 head (i.e., translation) through the osteotomy. Conversely, there is a spontaneous reduction in the IMA in first metatarsophalangeal joint (MTP1) arthrodesis. But we do not know whether this can be applied to distal osteotomies. We propose a distal osteotomy, called 3D chevron, which combines supination and varization of the M1 head. This might realign soft tissues around the MTP1, potentially leading to a spontaneous reduction in the IMA by an analogous mechanism to MTP1 fusion. Therefore, our study aimed to assess whether spontaneous reductions in IMAs exist in distal M1 osteotomies in the absence of lateral translations of M1 heads. Methods: A prospective continuous series of 25 3D chevrons was performed. Two groups were formed during surgery. Patients requiring no M1 head lateral displacement were included in the “successful correction without translation” group, and patients requiring M1 head lateral displacement were included in the “failed correction without translation” group. Radiographic analysis was performed preoperatively and at 1 year postoperatively. Results: Twenty-two women and three men, with a mean age of 44.8 ± 14.2 years and a mean body mass index of 22.6 ± 4.1 kg/m², underwent follow-up at one year after surgery. The “successful correction without translation” group was composed of HV with milder deformities (13/25 HVs, median preoperative IMA = 13 (IQR 2)) compared to the “failed correction without translation” group (median IMA = 16 (IQR 2.25) p < 0.001). Spontaneous reductions in IMAs were observed in the “successful correction without translation” group, with a median decrease in the IMA of 6 degrees (CI95%[5.5; 8.0]; p < 0.001) between preoperative and 1-year radiographs. Conclusion: Distal osteotomies allow for spontaneous reduction in the IMA in HV. First metatarsal head translation through an osteotomy should not be considered as the only procedure to correct IMAs in distal osteotomies. Full article

Introduction: Subtalar Arthroereisis (STA) is a surgical intervention for pediatric flexible flatfoot (PFF), primarily targeting hindfoot alignment by limiting excessive subtalar eversion. However, its effects on forefoot parameters remain underexplored. This study aims to investigate radiological changes following STA in pediatric patients. Materials and Methods: A retrospective analysis was conducted on consecutive patients treated with STA for PFF. First ray-related angles, including the Hallux Valgus Angle (HVA) and the Intermetatarsal Angle (IMA), alongside hindfoot radiological parameters such as the Meary, Calcaneal Pitch, and Costa Bartani angles, were assessed. Subgroup analysis by gender was performed, and correlations between demographic and preoperative radiological parameters were examined. Results: Forty-one patients (81 feet) with an average age of 11.6 years were included, with a mean follow-up duration of 6.4 months. No significant differences were observed in first ray-related angles pre-and postoperatively, with the mean IMA changing from 7.97° to 7.18° and the mean HV angles changing from 9.51° to 8.66°. Noteworthy improvements were seen in flat foot angles, including the Meary, Calcaneal Pitch, and Costa Bartani angles, postoperatively. The age subgroup analysis revealed similar trends in IMA and HVA changes between Group A (who underwent surgery before peak growth) and Group B (who underwent surgery after peak growth). Higher preoperative angles tended to improve, while lower preoperative IMAs and HVAs tended to worsen postoperatively, all remaining within normal ranges. Conclusion: STA showed positive radiological outcomes for PFF treatment, while negligible changes in first ray-related angles were observed. The age subgroup analysis indicated similar trends regardless of operation timing. Higher preoperative angles tended to improve, while lower preoperative angles tended to worsen postoperatively, despite all falling within non-pathological ranges. Further research is warranted to confirm this correlation. Full article

Background: Central metatarsal pressure is increased in patients with hallux valgus, but the pedographic outcomes after hallux valgus (HV) correction are inconclusive. No known literature has reported the pedographic outcomes after HV correction with Minimally Invasive Chevron and Akin Osteotomy (MICA). Methods: A prospective cohort of 31 feet from 25 patients with moderate-to-severe symptomatic HV but without metatarsalgia underwent MICA and was evaluated using radiographic parameters and pedographic measurements (Footscan^®, RSscan International, Olen, Belgium). Data were collected preoperatively and 3 months after surgery. Results: The radiographic parameters of the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, first metatarsal head lateral shape, and lateral sesamoid grade significantly improved after MICA. The corrected first metatarsal length was significantly shortened by 2.3 mm, with consistent second metatarsal protrusion distance, lateral Meary’s angle, and calcaneal pitch angle. Max force, max pressure, cumulative force, and cumulative pressure on the central metatarsals did not show significant changes between pre- and post-operative measurements, while these parameters significantly decreased in the hallux and first metatarsal area. Conclusion: MICA effectively corrects radiographic parameters but does not reduce central metatarsal loading in patients with moderate-to-severe HV without metatarsalgia. Full article

Background: Hallux valgus (HV) morphological alterations impact forefoot kinetics. Surgery aims to restore both the morphology and function. Plantar pressure (PP) distribution systems represent an innovative additional tool to evaluate the hallux functional outcome after surgery in order to assess the hallux dorsiflexion, coupled with plantar flexion of the first ray. However, the literature reports limited evidence regarding the rebalancing of the plantar pressure distribution following surgery. The purpose of the present study was to examine the PP distribution in HV patients before and after a distal metatarsal osteotomy using a novel anatomically based protocol for in-shoe plantar load analysis during gait. Methods: A consecutive series of 18 patients with mild-to-moderate symptomatic HV who underwent a distal metatarsal osteotomy (S.E.R.I. technique) were prospectively evaluated using clinical scores (AOFAS and NRS), radiographic parameters (hallux valgus angle, intermetatarsal angle), and PP measurements via W-INSHOE© (Medicapteurs, Balma, France). Data were collected preoperatively and 12 months after surgery. Results: At 12 months follow-up, 3 patients were lost to follow-up, leaving 15 patients (24 HV) for examination. Both clinical and radiographical outcomes showed significant improvements from the pre- to postoperative periods. The PP distribution pattern revealed a significant increase in the peak pressure under the first metatarsal head associated with a significant increase in the peak pressure under the central metatarsals area between the pre- and postoperative periods. Conclusions: PP measurement systems hold promise as an additional clinical tool, yet current findings remain inconclusive. Further long-term follow-up studies that incorporate additional parameters are warranted. Full article

Hallux valgus deformity (HVD) involves subluxation of the first metatarsophalangeal joint. While HVD is primarily considered a forefoot condition, midfoot instability may play a significant role in its development and severity. However, very few studies have placed a heavy emphasis on studying this phenomenon. Therefore, this review had a particular focus on understanding midfoot instability based on weightbearing imaging assessments of the TMT joint. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched five databases for studies on midfoot instability in HVD patients. The severity of HVD was defined by hallux valgus angle (HVA) and distal metatarsal articular angle (DMAA). Data was extracted, and articles were graded using the Methodological Index for Non-Randomized Studies (MINORS). Of 547 initially retrieved articles, 23 met the inclusion criteria. Patients with HVD showed higher HVA and DMAA on weightbearing radiographs (WBRG) and weightbearing computed tomography (WBCT) compared to healthy individuals. Midfoot instability was assessed through intermetatarsal angle (IMA) and tarsometatarsal angle (TMT angle). Patients with HVD exhibited greater IMA and TMT angles on both WBRG and WBCT. This review highlights the importance of weightbearing imaging assessments for midfoot instability in HVD. IMA and TMT angles can differentiate between healthy individuals and HVD patients, emphasizing the significance of midfoot assessment in understanding HVD pathology. These findings validate the limited evidence thus far in the literature pertaining to consistent midfoot instability in HVD patients and are able to provide ample reasoning for physicians to place a larger emphasis on midfoot imaging when assessing HVD in its entirety. Full article

Various modifications of distal chevron metatarsal osteotomy (DCMO) have been introduced for correcting moderate hallux valgus deformity; however, the amount of correction may be limited, and complications, such as the recurrence of the deformity and avascular necrosis of the metatarsal head, have been a problem. This study aimed to present a modified 90-degree DCMO technique that overcomes the previously reported shortcomings and to report a successful short-term radiographic outcome. Sixty-eight consecutive patients who underwent the operation with our modified DCMO technique and twenty-two consecutive patients with the conventional DCMO technique (control group) were retrospectively analyzed. The radiographic measurements were evaluated preoperatively, at two months post operation, and at the final follow-up. Both groups showed a significant correction of the hallux valgus angle, first–second intermetatarsal angle, distal metatarsal articular angle, and sesamoid position at the final follow-up, while the amount of correction was significantly greater in the modified DCMO group. In both groups, there were no cases of complications such as avascular necrosis of the metatarsal head, nonunion, and surgical site infection appearing throughout the follow-up period. Therefore, the modified 90-degree DCMO technique is effective and safe, which could serve as a favorable option to treat moderate hallux valgus deformity. Full article

Background: The purpose of the present study was to compare the degree of sesamoid reduction after hallux valgus correction between distal chevron metatarsal osteotomy (DCMO) and S.E.R.I. (simple, effective, rapid, and inexpensive) osteotomy, and to analyze the effects on the recurrence of hallux valgus. Methods: We retrospectively analyzed the foot radiographs of 60 feet (30 DCMO and 30 SERI) treated for hallux valgus from August 2013 to July 2017. Radiographic assessments were performed preoperatively, at early follow-up (at a mean of 3.1 months) and at the most recent follow-up (at a mean of 16.7 months). The location of the medial sesamoid was classified into seven stages, in accordance with the method described by Hardy and Clapham; stage IV or less was defined as the normal position for the medial sesamoid, and stage V or greater was defined as lateral displacement of the sesamoid. The pre- and post-operative hallux valgus angle, 1–2 intermetatarsal angle, and sesamoid position were compared between the two groups. Results: The mean follow-up period was 18.4 (12–36) months in the DCMO group and 15.0 (12–36) months in the S.E.R.I. group (p = 0.108). The radiologic results showed that the hallux valgus angles were not significantly different between the two groups preoperatively and at the early follow-up: preoperatively, they were 28.8 ± 7.7 in the DCMO group and 32.6 ± 9.5 in the S.E.R.I. group (p = 0.101), and they were 10.4 ± 4.0 and 8.7 ± 5.0 (p = 0.148) at the early follow-up, respectively. However, at the most recent follow-up, the DCMO group (13.9 ± 5.6) showed significantly higher hallux valgus angles than the S.E.R.I. group (10.4 ± 6.4, p = 0.030), and there were no differences between the recurrence of hallux valgus in the DCMO group (13%)and that in the S.E.R.I. group (10%) (p = 0.553). There were no significant differences in the 1–2 intermetatarsal angles between the two groups at the early follow-up (6.1 ± 2.5 vs. 4.8 ± 3.1, p = 0.082) and at the most recent follow-up (7.3 ± 2.9 vs. 6.6 ± 3.5, p = 0.408). After hallux-valgus-correction surgery, the stage change of the tibia sesamoid position from the preoperative stage to the initial follow-up was significantly larger in the S.E.R.I. group (−4.4 ± 1.4) than in the DCMO group (−3.4 ± 1.1) (p = 0.003); the changes from the preoperative stage to the last follow-up were also significantly larger in the SERI group (−3.3 ± 1.7) than in the DCMO group (−2.4 ± 1.5) (p = 0.028); however, the changes from the initial follow-up to the last follow-up showed no significant differences between the two groups (+1.0 ± 1.1 in the DCMO group vs. +1.1 ± 1.2 in the S.E.R.I. group) (p = 0.822). The medial sesamoid was laterally subluxated in all the preoperative cases in the DCMO and S.E.R.I. groups. The lateral subluxation of the tibia sesamoid was more frequently observed in the DCMO group (four cases, 13%) than in the S.E.R.I. group (0 cases, 0%) (p = 0.038) at the early follow-up. Conclusion: In conclusion, our results demonstrated that the S.E.R.I. procedure is superior to DCMO in decreasing the hallux valgus angle and showed that the early post-operative reduction in the sesamoids can be a risk factor for the recurrence of hallux valgus. Full article