Short term results of dynamic splinting for hallux valgus — A prospective randomized study

Background Hallux valgus is a common diagnosis in orthopedics. Only a few studies have analyzed the effects of conservative therapy. Therefore, the current study analyzed the effect of a dynamic hallux valgus splint.Methods Seventy patients were included in this prospective randomized trial. Patients with a hallux valgus were treated using a dynamic splint or underwent no treatment. Clinical and radiological parameters were evaluated.Results We found no significant changes in hallux valgus angle, intermetatarsal I–II angle, AOFAS score, FAOS or SF-36 score between the groups. However, a significant between-group difference was found for pain during walking and running and in the FAOS subscale for pain and pain at rest at follow-up.Conclusions Wearing a dynamic hallux valgus splint does provide some pain relief in patients with a symptomatic hallux valgus, but showed no effect on hallux valgus position.Level of evidence: 1.     

Reliability and validity of the American Orthopaedic Foot and Ankle Society Clinical Rating Scale: a pilot study for the hallux and lesser toes

BACKGROUND: The use of clinical outcomes instruments is essential for the effective interpretation of individual patient progress as well as the comparison of treatment groups. An outcomes instrument must be reliable and valid to obtain any meaningful data. The purpose of the present study was to examine the reliability and validity of the American Orthopaedic Foot and Ankle Society (AOFAS) clinical rating scale for the hallux metatarsophalangeal-interphalangeal and lesser toes metatarsophalangeal-interphalangeal joints. METHODS: Eleven patients (one man, 10 women) with an average age of 54 (range 40 to 72) years and with classic rheumatoid arthritis not currently treated for foot complaints were enrolled in the present study. The average duration of rheumatoid arthritis was 14 years. Each patient completed a set of two outcomes instruments and had a physical examination by a single clinician at the initial visit and returned at 1 week for completion of the same scales and examination. The outcomes scales used were the AOFAS clinical rating scale for the hallux, the AOFAS clinical rating scale for the lesser toes, and the previously validated Foot Function Index (FFI). Test-retest reliability was evaluated using intraclass correlation coefficients between week 1 and week 2 for the summary scores as well as for the subscales of pain and activity. Consistency between the two instruments was evaluated with Pearson correlation coefficients. RESULTS: The AOFAS clinical rating scale for the hallux and lesser toes is repeatable between 1-week trials (ICC 0.95; p < 0.05; ICC 0.80; p < 0.05, respectively). Moderately strong correlations were found between the mean values for the AOFAS hallux and FFI (r = -0.81; p < 0.05). Weaker correlations were seen between the mean values for the AOFAS lesser toes and FFI scales (r = -0.69; p < 0.05). CONCLUSIONS: The hallux subscale for pain correlates strongly with the FFI subscale for pain, suggesting high content validity (r = -0.94; p < 0.001). Ceiling effects were seen with the AOFAS lesser toe subscale for activity, limiting its usefulness in a general patient population. The AOFAS lesser toe subscale for pain and the AOFAS hallux subscale for activity correlated weakly with the FFI values (r = -0.31; r = -0.37; p > 0.05, respectively). CONCLUSIONS: Although the AOFAS hallux and lesser toe scales were found to be reliable in a rheumatoid patient population, their validity remains in question. These findings must be confirmed with larger subject numbers, with the inclusion of symptomatic patients before recommended routine use of the hallux clinical rating and lesser toe clinical rating scales.     

Validation of the Korean Version of the Manchester-Oxford Foot Questionnaire in Patients With Hallux Valgus

The Manchester-Oxford Foot Questionnaire (MOXFQ) is a practical, reliable, and valid questionnaire for hallux valgus surgery and has been translated into several languages. However, the MOXFQ has not been translated into Korean. In the present study, we aimed to translate and evaluate the validity and reliability of the Korean version of the MOXFQ for patients affected by hallux valgus. In accordance with the guidelines of cross-cultural adaptation, we translated the English version of MOXFQ into Korean and then backward translated it into English. We sent out letters that included the Korean version of the MOXFQ, a visual analog scale measure of pain, and a validated Korean version of the short-form 36-item Health Survey to 135 patients with hallux valgus. A retest was administered after 2 weeks. Of the 135 patients, 104 responded to the first questionnaire, and 82 of the first-time responders returned their second questionnaires. We evaluated the test–retest reliability, internal consistency, concurrent validity, and construct validity of the Korean version of the MOXFQ. The intraclass correlation coefficient for test–retest reliability was 0.82 for the total MOXFQ and ranged from 0.81 to 0.82 for the 3 subscales. Cronbach's alpha for the total MOXFQ was 0.85 and ranged from 0.8 to 0.92 for the 3 subscales. Concurrent and construct validity was supported by significant correlation with the visual analog scale and short-form 36-item Health Survey subscale scores. The Korean version of the MOXFQ was tested, and it was found to be a valid and reliable instrument for patients with hallux valgus.     

American Orthopaedic Foot and Ankle Society ankle–hindfoot scale: A cross-cultural adaptation and validation study from Iran

Background

The use of valid and reliable outcome rating scales is essential for evaluating the result of different treatments and interventions. The purposes of this study were to translate and culturally adapt the American Orthopaedic Foot and Ankle Society ankle–hindfoot scale (AOFAS-AHFS) into Persian languages and evaluate its psychometric properties.

改良Ludloff截骨术的几何形态学基础及其临床应用

目的 探讨Ludloff截骨术治疗母外翻后出现跖骨短缩、抬高及远端旋转的解决方案.方法 30例正常足,摄足部正侧位X线片,测量第一跖骨的长度及矢状面截骨角.计算在不同截骨条件下跖骨的抬高、短缩及旋前的理论值.根据该理论值,设计Ludloff截骨术的手术方案治疗??外翻.18例23足??外翻患者,如第一跖骨头内旋<3°,行单纯Ludloff截骨术;内旋角度为3°~6°,需行有冠状面截骨角的Ludloff截骨术;内旋角度>6°,行基底在外侧的楔形截骨;其中8足同时行第一跖骨远端截骨术以矫正跖骨远端关节角.采用??趾跖趾-趾间关节评分表及二至五趾跖趾-趾间关节评分表(AOFAS)进行疗效评定.结果 正常足第一跖骨的长度为4.60~6.90cm,平均(6.09±0.43)cm;矢状面截骨角为20.7°~31.3°,平均25.58°±2.73°.18例患者均获得随访,随访时间6~24个月,平均18个月.??趾跖趾-趾间关节评分:90~100分18足(78%),80~89分3足(13%),70~79分足2例(9%),评分平均增加36分(术前56分,术后92分);二至五趾跖趾-趾间关节评分:90~100分5足(22%),80~89分7足(30%),70~79分11足(48%),评分平均增加21分(术前59分,术后80分).结论 根据??外翻患者第一跖骨头不同的内旋角度,选取有冠状面截骨角或有基底在外侧的楔形截骨的Ludloff截骨术,可取得较理想的临床疗效.     

Is There a Relation between AOFAS Ankle-Hindfoot Score and SF-36 in Evaluation of Achilles Ruptures Treated by Percutaneous Technique?

The percutaneous technique of Achilles tendon repair seems to offer satisfactory clinical and functional results, although these results have been evaluated mainly using objective rating scales. Recently, some “subjective” rating scales have been combined to evaluate the results of various surgical treatments. The purpose of the present study was to compare the results of a percutaneous Achilles tendon repair evaluated objectively using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and subjectively using the Medical Outcomes Study, short-form, 36-item questionnaire (SF-36) questionnaire. A total of 17 consecutive patients were treated for acute Achilles tendon rupture using the modified percutaneous Ma and Griffith technique. We reviewed all patients with a follow-up of 24 to 64 months (mean 45.5). At the final follow-up visit, the AOFAS ankle-hindfoot score of each patient was compared with each 1 of the 8 domains of the SF-36 questionnaire, using the parametric Pearson correlation coefficient and the equivalent nonparametric Spearman rho correlation coefficient. The relation between the objective (AOFAS) and subjective (SF-36) results showed a significant correlation (Pearson's correlation coefficient) between the physical functioning (r = 0.597, p = .011) and bodily pain (r = 0.663, p = .004) SF-36 domains, and a nonstatistically significant correlation with the other SF-36 domains. Very similar results were found using the nonparametric Spearman rho correlation coefficient. These results suggest that regarding pain and function, the AOFAS ankle-hindfoot score and SF-36 provide complementary information; therefore, we believe that the SF-36 questionnaire should be used with the AOFAS ankle-hindfoot score for a more complete evaluation of the outcome.     

Reliability and validity of the Japanese Orthopaedic Association hip disease evaluation questionnaire (JHEQ) for patients with hip disease

BackgroundThe Japanese Orthopaedic Association hip disease evaluation questionnaire (JHEQ) was developed to evaluate the quality of life (QOL) in patients with hip disease. This questionnaire consists of three subscales: pain; movement; and mental. The purpose of this study was to assess the reliability and validity of the JHEQ for use as a clinical evaluation tool.MethodsWe investigated patients who visited the outpatient department at our hospital and affiliated hospital between April and May 2010. The study population comprised 286 patients (239 women) with a mean age of 56.8 years. The diagnosis was osteoarthritis of the hip in 230 patients, avascular osteonecrosis of the femoral head in 49 patients, and other conditions in 7 patients. The JHEQ questionnaire, the SF-36 questionnaire as a generic QOL scale, and the Oxford hip score (OHS) as a disease-specific scale, were filled out by the patient while waiting in the outpatient department.ResultsPearson’s correlation coefficients of 0.6 were observed between JHEQ pain and SF-36 bodily pain (BP) subscales, and between JHEQ movement and SF-36 physical functioning (PF) subscales. The JHEQ mental subscale correlated with SF-36 social functioning (SF) and BP subscales. A strong negative correlation was seen between JHEQ pain and OHS pain subscales (r = ?0.817). JHEQ movement subscale also showed a strong negative correlation with the OHS function subscale (r = ?0.715). These results indicated the convergent validity of JHEQ. The internal consistency of pain, movement, and mental subscales of JHEQ was satisfactory, indicated by Cronbach’s α coefficients of 0.92, 0.91, and 0.94, respectively. Each subscale also showed high test–retest reliability with intra-class correlation coefficients of 0.89, 0.93, and 0.85, respectively.ConclusionsWe determined the reliability and validity of JHEQ as a self-administered questionnaire that evaluates hip disease. JHEQ is useful as a tool for evaluating patients with hip disease.     

A new surgical procedure for iatrogenic hallux varus: reverse transfer of the abductor hallucis tendon: a report of 7 cases

Iatrogenic hallux varus is a possible complication of hallux valgus surgery following Mc Bride or Scarf osteotomy, with or without Akin osteotomy of the first phalanx. It may also occur following chevron osteotomy or Keller's procedure. One possibility for surgical revision of iatrogenic hallux varus is reconstruction of the lateral stabilising soft-tissue components of the first metatarsophalangeal joint. Until now, only dynamic tendon transfers, possibly combined with interphalangeal fusion, have been described. The aim of our study was to develop a static, anatomic reconstruction procedure. A new surgical technique of ligamentoplasty using the abductor hallucis tendon is described. The new method was applied in 7 feet (5 patients) with a mean follow-up over two years. Hallux varus deformities were operated by transplantation of the abductor hallucis tendon. Subsequent radiographs showed correction of most of the factors considered to be responsible for the iatrogenic deformity. The American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal (MTP-IP) score improved from 61 to 88. This new technique is a reliable, anatomic reconstruction with use of the tendon involved in the pathogenesis of the hallux varus deformity. No other functional tendon is used.     

The effect of gender in hallux valgus surgery. A propensity score matched study

BackgroundMales and females who undergo hallux valgus (HV) surgery have different expectations.MethodsData from 439 patients, with 26 males, were prospectively collected between 2007–2015. Propensity score matching (PSM) of one male to two females was performed using logistic regression of six variables to minimize selection bias. Hallux visual analogue scale (VAS) scores, AOFAS scores, SF-36, satisfaction and expectation scores were analysed at two years.ResultsThere were no significant differences in patient demographics after PSM. At two years, males and females attained similar VAS and AOFAS scores but males had significantly lower SF-36 general health score (males 68.7, females 79.3). 26.9% of males and 21.2% of females were not satisfied after surgery. Higher proportion of males did not have their expectations fulfilled (males 19.2%, females 5.8%) although this was not statistically significant.ConclusionsBoth genders attain similar outcome at two years. There is a trend towards lower expectation fulfilment in males after surgery.     

Responsiveness and minimally important change for the Manchester-Oxford foot questionnaire (MOXFQ) compared with AOFAS and SF-36 assessments following surgery for hallux valgus

OBJECTIVES: To assess responsiveness and minimally important change (MIC) for the Manchester-Oxford foot questionnaire (MOXFQ) using anchor and distribution-based approaches. Responsiveness and estimates of minimal clinically important difference (MCID) and minimal detectable change are compared with those from the Short-Form 36 (SF-36) and American Orthopaedic Foot & Ankle Society (AOFAS) measures. METHODS: A prospective observational study of 91 consecutive patients (125 foot operations) undergoing hallux valgus surgery at an orthopaedic hospital. Pre- and 12 month post-surgery, patients completed the MOXFQ and SF-36, and foot surgeons assessed all four AOFAS scores corresponding to four regions of the foot. Transition items were asked about perceived changes compared with before surgery. RESULTS: Mean changes in all domains of each instrument were statistically significant, but foot-specific MOXFQ and AOFAS domains produced much larger effect sizes (>1) than any SF-36 domains, indicating superior responsiveness. Clear associations occurred between transition items and all MOXFQ and AOFAS scores, but with only one (physical function) SF-36 domain. Anchor and distribution-based approaches identified generally comparable measures of MIC, which for the MOXFQ and AOFAS domains were between 1 and 2 standard error of measurement. In metric terms, the MCIDs were 16, 12, and 24 for the MOXFQ Walking/standing, Pain, and Social Interaction domains, respectively. CONCLUSIONS: For hallux valgus surgery, the MOXFQ is highly responsive. Performance is comparable to the AOFAS and notably better than the generic SF-36. Study estimates of MIC for the MOXFQ are useful to inform sample-size calculations for future clinical trials.     

Poor agreement between prospective and retrospective assessment of hallux surgery using the AOFAS Hallux Scale

BACKGROUND: Retrospective assessment of preoperative status is common in nonprospective study designs. The aim of this study was to test the hypothesis that prospective and retrospective evaluations of the preoperative patient condition in hallux surgery gives equal results and therefore can be used interchangeably. METHODS: One hundred and fifty-nine consecutive feet with hallux surgery were analyzed prospectively. Parallel to routine evaluation of the preoperative status, the AOFAS Hallux Scale was recorded prospectively. Two years after surgery, the medical records were re-evaluated for retrospective reconstruction of the AOFAS score. Simultaneously all patients were asked to assess their preoperative status retrospectively. RESULTS: Using the medical charts for retrospective assessments, the preoperative status was estimated too low compared to prospective evaluation. This effect was even more pronounced with the patients' own retrospective assessment of their preoperative status. Linear regression coefficient for prospective and retrospective data showed moderate correlation with r = 0.59 for the AOFAS Score using the medical charts and poor correlation of r = 0.24 using the patients' own retrospective assessments. Spearman's rank correlation index was p = 0.57 and p = 0.23, respectively. The coefficient of repeatability according to Bland and Altman was 25.7 and 48.7 points, respectively, for the AOFAS score. The difference between the mean values of prospective and retrospective assessment was 5.6 (13.0) points. This means that a retrospectively evaluated AOFAS Score may be 31.3 points below or 20.1 points above prospective assessments (61.6 points below or 35.7 points above compared to the patients' own retrospective self-assessments). Agreement between individual items using Kappa statistics showed poor results except for metatarsophalangeal joint motion. CONCLUSIONS: Prospectively and retrospectively evaluated AOFAS scores cannot be used interchangeably for clinical outcome evaluations. Retrospective scoring gives worse results even when evaluated using conscientiously recorded medical charts and therefore leads to overestimation of the effect of surgery. These data support prospective study designs to ensure the best outcome analysis for clinical evaluation of hallux surgery.     

Evaluation of quality of life in brachial plexus injury patients after reconstructive surgery.

To evaluate the subjective satisfaction of brachial plexus injury (BPI) patients after surgery based on the medical outcomes study 36-item short form health survey (SF-36) and to correlate their SF-36 scores with upper extremity functions. Four items were assessed statistically for 30 patients: SF-36 scores after BPI surgery were compared with Japanese standard scores; the correlation between SF-36 scores and objective joint functions; difference in SF-36 scores between each type of BPI; and influence of each joint function on the SF-36 scores. The SF-36 subscale: PF--physical functioning, RP--role-physical, BP--bodily pain, and the summary score PCS--physical component summary, were significantly inferior to the Japanese standard scores. SF-36 is more sensitive to shoulder joint function than to elbow and finger joint functions. Little correlation was found between SF-36 scores and objective evaluations of joint functions. Greater effort is needed to improve the quality of life (QOL) of BPI patients. This study showed that SF-36 is not sensitive enough to evaluate regional conditions. A region- or site-specific questionnaire is required to evaluate upper extremity surgery.     

Outcomes following cheilectomy and interpositional arthroplasty in hallux rigidus

Surgical management of hallux rigidus remains controversial. Arthrodesis is considered the gold standard. However, many patients are reluctant to undergo fusion. This paper reviews two commonly used procedures that are reasonable alternatives. A retrospective review of 19 patients (24 feet) with grade 2 osteoarthritis and 11 patients (11 feet) with grade 3 osteoarthritis was performed. The patients with grade 2 osteoarthritis were managed with a cheilectomy and the patients with grade 3 osteoarthritis with an interpositional arthroplasty. All patients were individually assessed with a subjective questionnaire, physical exam, AOFAS hallux scale, SF-36 and pedobarographic analysis. Cheilectomy patients (51.9 years) were younger than interpositional arthroplasty (59 years). Follow up between the interpositional arthroplasties (2.0 years) and cheilectomies (2.1 years) were comparable. Postoperative motion, visual analogue pain scale and SF-36 scores were comparable between groups. Cheilectomies had a higher mean AOFAS score (77.3) than interpositional arthroplasties (71.6). Weakness of the great toe was reported in 72.7% of interpositional arthroplasty patients compared to only 16.7% of patients with a cheilectomy. Patient satisfaction was 87.5% in cheilectomies and 72.7% in interpositional arthroplasties. Pedobarographic analysis demonstrated a decreased load under the great toe with increased weight transfer to the lesser metatarsal heads in all patients. The weight transfer to the lesser metatarsal heads was greatest in patients with interpositional arthroplasty. Management of moderate hallux rigidus with a cheilectomy and phalangeal osteotomy is a reliable method of relieving pain and improving function. Management of severe osteoarthritis of the joint with an interpositional arthroplasty should be considered a salvage procedure with less reliable results.     

中文改编版颈部疼痛和残疾量表的信度和效度

目的评估中文改编版颈部疼痛和残疾量表（SC-NPAD）的信度和效度。方法将颈部疼痛和残疾量表翻译、修订成中文版,对2008年5月至2009年3月117例第二军医大学附属长海医院骨科门诊患者进行测试,其中106例（90．1%）患者完成问卷。对量表进行因子分析,定义分量表并评估其内部一致性。第一次完成问卷5～7d,随机选择36例患者对应发放第二份问卷,共35例进入重复性测试;同时对SF-36健康调查量表（SF-36）进行发放和回收。对SC-NPAD和SF-36量表进行相关性分析。结果因子分析结果表明,SC-NPAD4个分量表——“疼痛”、“残疾”、“颈部特殊功能”和“情感和认知的影响”的内部一致性分别为0．935、0．952、0．955和0．910,重测信度良好（r=0．813,P=0．000）。SC-NPAD的所有分量表与SF-36及其生理功能、社会功能、物理职能、活力、躯体疼痛等5个独立域明显相关。结论SC-NPAD具有良好的信度和效度,适用于对中国颈部疼痛人群的评估。     

Interpositional Arthroplasty in the Treatment of Hallux Rigidus: A Systematic Review

Hallux rigidus is the most common arthritic condition of the foot. Interpositional arthroplasty (IPA) is indicated for advanced-stage hallux rigidus and attempts to maintain joint motion through insertion of a biologic spacer into the joint. However, the data evaluating the effectiveness of IPA are limited. The purpose of this study was to systematically review the outcomes of IPA in the treatment of hallux rigidus. MEDLINE, EMBASE, and Cochrane Library databases were systematically reviewed based on the preferred reporting items for systematic reviews and meta-analyses guidelines. Outcomes collected and analyzed included: American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal (HMI) score, visual analogue scale score, short-form 36 score, range of motion (ROM), radiographic parameters, and postoperative complications. The level and quality of clinical evidence were recorded and assessed. Sixteen studies with a total of 428 patients met inclusion/exclusion criteria. The mean AOFAS-HMI score improved from 51.6 ± 10.1 (range 35.0-64.2) preoperatively to 86.0 ± 7.7 (range 71.6-95.4) postoperatively (p ≤ .001) at weighted mean follow-up of 58.0 ± 34.5 (range 16.5-135.6) months. The preoperative weighted mean total ROM was 39.3° ± 9.6° (range 24.2-49.9) and the postoperative weighted mean total ROM was 61.5° ± 4.8° (range 54.0-66.5) (p ≤ .001). The complication rate was 21.5% with metatarsalgia as the most commonly reported complication. One study was level 3 and 15 studies were level 4 clinical evidence. This systematic review demonstrates improvement in functional and ROM outcomes following IPA procedure at mid-term follow-up. The procedure however has a moderate complication rate. In addition, there is a low level and quality of evidence in the current literature with inconsistent reporting of data.     

Cross-cultural adaptation and validation of a Bengali version of the modified fibromyalgia impact questionnaire

ABSTRACT: BACKGROUND: Currently, no validated instruments are available to measure the health status of Bangladeshi patients with fibromyalgia (FM). The aims of this study were to cross-culturally adapt the modified Fibromyalgia Impact Questionnaire (FIQ) into Bengali (B-FIQ) and to test its validity and reliability in Bangladeshi patients with FM. METHODS: The FIQ was translated following cross-cultural adaptation guidelines and pretested in 30 female patients with FM. Next, the adapted B-FIQ was physician-administered to 102 consecutive female FM patients together with the Health Assessment Questionnaire (HAQ), selected subscales of the SF-36, and visual analog scales for current clinical symptoms. A tender point count (TPC) was performed by an experienced rheumatologist. Forty randomly selected patients completed the B-FIQ again after 7 days. Two control groups of 50 healthy people and 50 rheumatoid arthritis (RA) patients also completed the B-FIQ. RESULTS: For the final B-FIQ, five physical function sub-items were replaced with culturally appropriate equivalents. Internal consistency was adequate for both the 11-item physical function subscale (alpha = 0.73) and the total scale (alpha = 0.83). With exception of the physical function subscale, expected correlations were generally observed between the B-FIQ items and selected subscales of the SF-36, HAQ, clinical symptoms, and TPC. The B-FIQ was able to discriminate between FM patients and healthy controls and between FM patients and RA patients. Test-retest reliability was adequate for the physical function subscale (r = 0.86) and individual items (r = 0.73-0.86), except anxiety (r = 0.27) and morning tiredness (r = 0.64). CONCLUSION: This study supports the reliability and validity of the B-FIQ as a measure of functional disability and health status in Bangladeshi women with FM.     

Osteochondral Fresh Allograft Transfer to Address Osteochondral Defect of the First Metatarsal Head in Early Hallux Limitus

Osteochondral fresh allograft transfer of the first metatarsal can be an accepted surgical management option for early stages of hallux limitus. This study consisted of evaluating clinical outcomes with patients who underwent this procedure. Thirteen (N=13) patients were included in this study, 10 (76.9%) were female and 3 (23.1%) were male. The mean age was 52.2 (range, 27-61) years and the mean body mass index was 25.3 (range, 33.8-19.4) kg/m². Intraoperative evaluation of osteochondral defects of the first metatarsal demonstrated a mean diameter size of 8.2 mm. Ten (76.9%) patients had a concomitant cheilectomy procedure performed. The mean follow-up was 41.0 (range, 3.5-89.1) months. American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale questionnaire and patient satisfaction survey were completed. The mean AOFAS Hallux Metatarsophalangeal-Interphalangeal score, which was determined postoperatively, was 71.2 (range, 55-85) of 100. Four (30.8%) patients with overall scores below 60 (range, 55-59) reported moderate daily pain at the first metatarsophalangeal joint. Mean AOFAS pain score was 26.9 (range, 20-30) of 40. Mean AOFAS function score was 30.8 (range, 24-35) of 45. Mean AOFAS alignment score was 13.4 (range, 8-15) of 15. There was statistical significance in mean AOFAS total score when comparing hallux limitus grade 1 versus grade 2, as well as when comparing grade 1 versus grade 3, p < .05. There was no significance in mean AOFAS total score when comparing number of plugs used, body mass index, and size of defect. However, an overall improvement in preoperative symptoms and patient satisfaction was documented and therefore osteochondral fresh allograft transfer can be considered a reasonable option in treating defects found at the first metatarsal head.     

A Modified Foot and Ankle Score for Assessing Patient Outcomes After First Metatarsophalangeal Arthrodesis

First metatarsophalangeal (MTP) arthrodesis is commonly used to treat many end-stage first MTP diseases. The most widely used scale for measuring the clinical outcomes after this procedure, the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal–Interphalangeal scale, has not been adequately validated and does not measure specific foot functions. Another outcome measure, the patient-reported Foot and Ankle Outcome Score (FAOS) has acceptable construct validity but poor content validity. The FAOS scale has 42 questions, many of which are unrelated to the hallux. We designed a short-form FAOS (sf-FAOS) consisting of 11 questions that are more relevant to first MTP arthrodesis. The sf-FAOS includes a pain subscale and a function subscale, and the score of each subscale ranges from 0 (worst outcome) to 100 (best outcome). Our study has shown that the sf-FAOS scale has acceptable validity, reliability, and responsiveness. In 21 feet (16 patients) with hallux valgus after >1 year of follow-up, the mean sf-FAOS pain score had improved by 44.9 points after surgery (from 51.2 to 96.0; p?<?.001), and the mean sf-FAOS function score had improved by 22.5 points (from 47.3 to 69.8; p?<.001). The improvement in the function score for running and jumping was limited.     

Mid-Term Functionality and Survival of 116 HemiCAP® Implants for Hallux Rigidus

Hallux rigidus can be treated with a proximal hemiarthroplasty (HemiCAP®) to preserve the motion in the first metatarsophalangeal joint and reduce pain. This study examines the functionality, and survival rates of HemiCAP® implants, with or without a dorsal flange. One hundred and five patients were treated with a HemiCAP® (N = 116 HemiCAPs®) between 2006 and 2014. Revision rates, arthrosis score, hallux valgus (HV), intermetatarsal (IM), distal metaphyseal articular angle (DMAA), visual analog scale (VAS) (1-10 points), American Orthopaedic Foot and Ankle Score (AOFAS) MTP-IP (AOFAS 0-100 points), SF-12, range of motion (ROM), and radiographs were analyzed pre- and postoperatively. Statistics: Kaplan-Meier survival analysis, Cox-regression, and paired t tests. At 2, 4, and 6 years, the implant survival was 87%, 83%, and 81%, respectively. All revised due to pain. Dorsal flange, gender, arthrosis, HV, IM, and DMAA did not influence the results. At the mean 5-year follow-up (n = 47) median (range) dorsal ROM was 45° (10°-75°), AOFAS was mean 87.2 ± 10.8, VAS was 2 ± 1.6, and SEFAS was 42 ± 6 points. The dorsal flange made no significant difference for ROM or patient-reported outcome measures compared to the HemiCAP® with no dorsal flange. Twenty-three patients with preoperative data were re-examined, and preoperative dorsal ROM mean difference (confidence interval [CI]) increased 20.7° (13.9°-27.4°), VAS decreased with a mean difference (CI) of ?4.7 (?5.8 to 3.5), and AOFAS increased with a mean difference (CI) 26.2 (20.2-32.2) (for all p < .001). The 6-year survival rate of the HemiCAP® implant was 81%. The design change to dorsal flange was not evident clinically. Unrevised patients had significantly less pain, greater ROM, and better foot and ankle function than preoperatively.     

Short Term Radiographic and Patient Outcomes of a Biplanar Plating System for Triplanar Hallux Valgus Correction

Hallux valgus is a complex deformity with a variety of techniques described for correction. A biplanar plating system for triplanar correction system has been developed to address both the translation and rotational component of the hallux valgus deformity and allow an accelerated weightbearing protocol. The purpose of this study was to determine the correction and complications using radiographic parameters and patient reported outcomes. We sought to determine prognostic factors for successful correction, including age, gender, and preoperative deformity. From the medical records, we collected preoperative data. Patient-reported outcomes were obtained using AOFAS Hallux Metatarsophalangeal-Interphalangeal score, FAAM, and SF-12 scores preoperatively and postoperatively. Imaging was reviewed at preoperative and postoperative visits to determine hallux valgus angle, intermetatarsal angle, and tibial sesamoid position. Fifty-seven procedures, in 55 patients, were performed. There were 7 complications and mean follow-up time was 45.7 weeks (+ 28.3 weeks). Age over 62.5 years were associated with an increased risk of complications (p = .018). Males had an increased rate of complications (71%) compared with females. Radiographic parameters were significantly improved from preoperative values at alltime points (p < .05). Only the AOFAS Hallux Metatarsophalangeal-Interphalangeal score was statistically significant at 3, 6 and 12 months. We sought to determine the effectiveness of biplanar plating and triplanar correction procedure with early weightbearing. Over a 12 month follow-up period, our results showed significant improvement in deformity and maintained correction. AOFAS Hallux Metatarsophalangeal-Interphalangeal scores significantly improved from the preoperative to the postoperative state. Our results show a nonunion rate of 5.2%, which is comparable to prior studies.