Osteotomy of the hallux proximal phalanx.

Osteotomy of the proximal phalanx appears to be used more frequently and with increasing indications. It rarely is indicated as the only surgical procedure and often is combined with a secondary procedure. In hallux valgus surgery, a proximal or distal metatarsal osteotomy often is used, and in hallux rigidus, a cheilectomy usually is added. The advantage of a proximal phalanx osteotomy is that it enables an extra-articular correction, which avoids breaching the metatarsophalangeal joint. This extra-articular correction may prevent joint stiffness and long-term joint changes.     

Scarf versus proximal closing wedge osteotomy in hallux valgus treatment

Aim  The aim of this study was to evaluate the distal metatarsal articular angle as a key factor in choosing between the proximal closing wedge osteotomy and scarf osteotomy. Method  The investigation involved 40 feet: 32 females aged 13–68 in whom 24 unilateral and 8 bilateral operations had been performed from 24 to 63 months previously. Results  There were statistically significant differences between groups in the postoperative hallux valgus angle and in first metatarsal shortening. We found an inverse correlation between the preoperative distal metatarsal articular angle and intermetatarsal angle improvement after proximal closing wedge osteotomy and a positive correlation after scarf osteotomy. Conclusion  This study confirmed the value of distal metatarsal articular angle assessment.     

Extension osteotomy for hallux rigidus with dorsal impingement

We evaluated the long-term results of extension osteotomy of the proximal phalanx as a treatment for hallux rigidus. One hundred and eight extension osteotomies in 89 patients were reviewed clinical and radiologically, or by means of a postal questionnaire. Mean age was 58 years (range 19–81) and 74% were female. The length of follow-up was 25–164 months, with a mean of 82 (6.8 years).Seventy-six percent of the 108 procedures had a good or satisfactory result at review with 60% of the patients being completely pain-free. Seventy-four percent of the patients were satisfied with the operation. The average range of dorsiflexion at the first metatarsophalangeal joint at review was 41° (range 5–80) with 63% having greater than 30° of dorsiflexion.We found good results on medium to long-term follow-up for the treatment of hallux rigidus with dorsal impingement symptoms.     

The importance of the length of the first metatarsal and the proximal phalanx of hallux in the etiopathogeny of the hallux rigidus

The purpose of this study was to determine if the relative length of the first metatarsal and the proximal phalanx of the hallux, in respect to the total foot length, were associated with the incidence of hallux rigidus. For this retrospective study, lateral radiographs from 132 cases with hallux rigidus and a control group of 132 normal feet were reviewed.We measured the following parameters: the index between the foot length and first metatarsal length, the proximal phalanx of the hallux length, and the sum of the first metatarsal length and the proximal phalanx of the hallux length.We found a statistically significant difference (p: 0.002) between the two groups in the Foot L/1st Mtt L index, and no statistical difference in the Foot L/Phalanx L index.We think that a greater length of first metatarsal is involved in the etiopathogeny of hallux rigidus.     

Correction of valgus second toe by closing wedge osteotomy of the proximal phalanx

BACKGROUND: Valgus deviation of the second toe can be associated with metatarsophalangeal joint pain, footwear fitting problems, and cosmetic concerns. It also reduces the buttress effect of the second toe on the hallux and may allow progression of hallux valgus. The traditional operative approaches for digital arthrodesis or lesser metatarsal osteotomy have unpredictable results. METHODS: This study reviewed the effect of a closing wedge osteotomy on the proximal phalanx in 26 women with an average age of 59 years (SD 10) who had a valgus second toe. The patients had weightbearing radiographs preoperatively and at an average 28 months postoperatively. Clinical examination assessed for floating toe, range of metatarsophalangeal joint motion, and patient satisfaction. RESULTS: Before surgery the average second toe valgus angle measured 28 degrees and at final review this had reduced to 14 degrees (p < 0.001). Postoperatively, the average range of dorsiflexion of the digit was 42 degrees (SD 20). The average plantarflexion was 16 degrees (SD 10). Floating of the digit was noted in five patients and recurrence of the deformity in four patients. Nineteen patients (73%) were completely satisfied with the outcome of their surgery, seven were satisfied with reservations, and no patient was dissatisfied. Twenty five patients (96%) considered their second toe to be better than before the operation. CONCLUSIONS: Closing wedge osteotomy of the second toe is technically simple, reasonably safe, and relatively effective for valgus deformity of the second toe. Recurrence of the second toe valgus usually was associated with recurrence of hallux valgus.     

Long-term results of the retrocapital metatarsal percutaneous osteotomy for hallux valgus

Purpose

The current trend in hallux valgus surgery is directed toward percutaneous procedures. However, no evidence that any of these methods of treatment are superior to the others has been described, excepting studies in the long term. The aim of this study was to analyse a series of patients who had undergone a percutaneous distal retrocapital osteotomy of the first metatarsal, and had been followed up for ten years.

Methods

We carried out a clinical and radiological evaluation of 115 feet ten years after surgery.

Results

The AOFAS scale results in the tenth postoperative year remained significantly favourable compared to their corresponding values in the preoperative period, yielding an improvement of 42.2 points overall on average. In relation to radiological findings, the mean hallux angle was maintained below 20 °, with a mean intermetatarsal angle of 8.1 °.

Conclusion

Percutaneous retrocapital metatarsal osteotomy for treatment of mild to moderate hallux valgus is effective in the long term, with the advantages of a minimally invasive procedure.     

A modified Austin/chevron osteotomy for treatment of hallux valgus and hallux rigidus

Abstract

The purpose of this brief paper is to present the preliminary results of a modified Austin/chevron osteotomy for treatment of hallux valgus and hallux rigidus. In this procedure, the dorsal arm of the osteotomy is performed orthogonal to the horizontal plane of the first metatarsal, the main advantage being that this allows much easier and more accurate multiplanar correction of first metatarsal deformities. From 2010 to 2013, 184 consecutive patients with symptomatic hallux valgus and 48 patients with hallux rigidus without severe metatarsophalangeal joint degeneration underwent such modified chevron osteotomy. Mean patient age was 54.9 (range 21–70) years, and mean follow-up duration was 41.7 (range 24–56) months. Ninety-three percent of patients were satisfied with the surgery. Mean American Orthopaedic Foot and Ankle Society (AOFAS) score improved from 56.6 preoperatively to 90.6 at last follow-up, and mean visual analog scale (VAS) pain score decreased from 5.7 preoperatively to 1.6 at final follow-up (p < 0.05). In patients treated for hallux valgus, mean hallux valgus angle decreased from 34.1° preoperatively to 6.2° at final follow-up, and mean intermetatarsal angle decreased from 18.5° preoperatively to 4.1° at final follow-up (p < 0.05). One patient developed postoperative transfer metatarsalgia, treated successfully with second-time percutaneous osteotomy of the minor metatarsals, whilst one patient had wound infection that resolved with systemic antibiotics.

Level of evidence

Level IV.     

Contemporary approaches to stage II and III hallux rigidus: the role of metallic hemiarthroplasty of the proximal phalanx

Metallic proximal phalangeal hemiarthroplasty has been described for the surgical treatment of moderate to severe hallux rigidus. This long-term follow-up of an extended case series of 37 patients who underwent the index operation demonstrated a high rate (93%) of patient satisfaction, and significant improvement in Foot Function Index scores.     

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

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

Extra-articular osteotomy for malunited unicondylar fractures of the proximal phalanx

PURPOSE: To evaluate an extra-articular osteotomy rather than an intra-articular osteotomy in the treatment of malunited unicondylar fractures of the proximal phalanx. METHODS: An extra-articular osteotomy was used to correct the deformity resulting from a malunion of a unicondylar fracture of the proximal phalanx in 5 patients. A closing wedge osteotomy that was stabilized with tension band fixation accomplished realignment of the joint. Each patient was evaluated at a minimum of 1 year after surgery for radiographic healing, correction of angulation, digital motion, postoperative complications, current level of pain with motion, and overall satisfaction with the procedure. RESULTS: All of the osteotomies healed by 10 to 12 weeks after surgery with an average angular correction from 25 degrees to 1 degrees . The average proximal interphalangeal joint motion improved to 86 degrees from the preoperative average of 40 degrees , whereas the average total digital motion improved from 154 degrees before surgery to 204 degrees at follow-up evaluation. CONCLUSIONS: This method of extra-articular osteotomy for malunited unicondylar fractures of the proximal phalanx is highly reproducible, avoids the risks of intra-articular surgery, and leads to a predictable outcome.