Ilizarov external fixation for management of severe relapsed clubfeet in older children

BackgroundAlthough the standard treatment of clubfoot deformity is conservative by serial casting techniques, relapses are not uncommon. Management of relapsed clubfoot deformity in older children is an orthopedic challenge. There is a growing interest in management of such complex deformities using the Ilizarov technique.MethodsIn this study, the Ilizarov frame was used to correct severe relapsed clubfoot deformities in older children, whom underwent previous surgical interventions. 42 relapsed clubfeet were included. The Dimeglio classification was used for clinical assessment of the relapsed feet pre-operatively as well as post-operatively.ResultsAfter an average follow-up period of 4.6 years, and according to the Beatson and Pearson numerical assessment, favorable results (excellent or good) were found in 37 feet, while poor results took place in only five feet.ConclusionBased on the final clinical and radiographic results, the Ilizarov technique could be considered as a good management alternative for such severe deformities.     

Relapsed clubfoot correction with soft-tissue release and selective application of Ilizarov technique

The Ilizarov technique is an alternative for the treatment of complex foot deformities in children. The authors retrospectively reviewed children with relapsed clubfoot deformity, treated with soft tissue procedures and additional correction with an Ilizarov frame. Twelve consecutive patients (13 feet) with relapsed clubfoot deformity after previous surgical correction were reviewed. Treatment included open releases. An Ilizarov frame was applied as an adjunct in seven patients (mean age of 7.8 years) with severe deformity where complete intraoperative correction was not achieved. Clinical and radiographic assessment was undertaken. The mean Laaveg–Ponseti score, for the 7 feet treated with the Ilizarov frame, was 85.1 after minimum 4 years follow-up. One recurrence of forefoot deformity required metatarsal osteotomies. Postoperative radiographic measurements revealed values that can be considered as normal. Complications included pin tract infections (12% of inserted wires). Flat-topped talus was observed in 3 feet. Deformity correction was possible when soft tissue procedures were combined with the use of Ilizarov technique, in order to support and gradually improve surgical correction.     

Resistant clubfoot deformities managed by Ilizarov distraction histogenesis

Background:

Resistant clubfoot deformities of the foot and ankle remain a difficult problem even for the most experienced surgeon. We report a series of neglected resistant clubfoot deformities treated by limited surgery and Ilizarov distraction histogenesis.

Materials and Methods:

Twenty one patients with 27 feet having resistant clubfoot deformities were managed by Ilizarov distraction histogenesis from April 2005 to May 2008. The mean age was 12 years (range 8–20 years). A limited soft tissue dissection like percutaneous Achilles sheath tenotomy and plantar fasciotomy were done. Progressive correction of the deformities was achieved through the standard and simple Ilizarov frame construct setting. After removal of Ilizarov frame, a short leg walking cast was used for an additional 6 weeks, followed by an ankle foot orthrosis for 3 months.

Results:

The mean followup period was 18.7 months (range 20-36 months). The mean duration of fixator application was 3.6 months (range 3–5 months). At the time of removal of the fixator, a plantigrade foot was achieved in 25 feet and gait was improved in all patients. There was residual varus hind foot deformity in two patients. Out of 27 feet, 3 (11.11%) were rated as excellent, 17 (62.96%) as good, 5 (18.51%) as fair, and 2 (7.40%) as poor according to Reinkerand Carpenter scale. Excellent and good results (74.07%) were considered satisfactory, while fair and poor results (25.92%) were considered unsatisfactory.

Conclusion:

The short term clinical and functional results of resistant clubfoot deformities with Ilizarov''s external fixator is promising and apparently a good option.     

A comprehensive outcome comparison of surgical and Ponseti clubfoot treatments with reference to pediatric norms

Purpose

Isolated congenital clubfoot can be treated either operatively (posteromedial release) or conservatively (Ponseti method). This study retrospectively compared mid-term outcomes after surgical and Ponseti treatments to a normal sample and used multiple evaluation techniques, such as detailed gait analysis and foot kinematics.

Methods

Twenty-six children with clubfoot treated surgically and 22 children with clubfoot treated with the Ponseti technique were evaluated retrospectively and compared to 34 children with normal feet. Comprehensive evaluation included a full gait analysis with multi-segment and single-segment foot kinematics, pedobarograph, physical examination, validated outcome questionnaires, and radiographic measurements.

Results

The Ponseti group had significantly better plantarflexion and dorsiflexion range of motion during gait and had greater push-off power. Residual varus was present in both treatment groups, but more so in the operative group. Gait analysis also showed that the operative group had residual in-toeing, which appeared well corrected in the Ponseti group. Pedobarograph results showed that the operative group had significantly increased varus and significantly decreased medial foot pressure. The physical examination demonstrated significantly greater stiffness in the operative group in dorsiflexion, plantarflexion, ankle inversion, and midfoot abduction and adduction. Surveys showed that the Ponseti group had significantly more normal pediatric outcome data collection instrument results, disease-specific indices, and Dimeglio scores. The radiographic results suggested greater equinus and cavus and increased foot internal rotation profile in the operative group compared with the Ponseti group.

Conclusions

Ponseti treatment provides superior outcome to posteromedial release surgery, but residual deformity still persists.     

Comparative clinical study on deformity correction accuracy of different external fixators

Purpose

In this study, the correction accuracy of Smart Correction spatial fixators and of Ilizarov-type external fixators are compared in terms of deformity complexity.

Methods

Seventy-seven (40 male, 37 female) bone segments of 57 patients treated with a Smart Correction device were compared with 94 (51 male, 43 female) segments of 68 patients treated with an Ilizarov fixator. Mean age of the Smart Correction group was 20.69?±?12.94 years, and or the Ilizarov group 22.45?±?12.18 years. Patients were categorised according to limb lengthening and the number of deformity planes.

Results

A longer correction period was found with Ilizarov (66.53?±?47.7 days) compared with Smart Correction (49.05?±?35.6 days) devices. The bone healing index of the Ilizarov group was significantly better compared with the spatial group. Residual deformity after treatment was significantly lower with the Smart Correction device; however, this relationship could not be shown between subgroups. Although there was no significant difference between subgroups, mean residual deformity was higher with the increasing number of planes of the deformity.

Conclusions

The Smart Correction fixator is an accurate device that allows ease of application and planning. It demonstrates higher accuracy for correcting deformities compared with an Ilizarov external fixator. With an increasing number of planes, the difference between the two devices becomes even more pronounced. The relationship between the complexity of the deformity and residual deformity may possibly be significantly greater in favour of the Smart Correction fixator in a study with a larger sample size.     

Good results after Ponseti treatment for neglected congenital clubfoot in Ethiopia: A prospective study of 22 children (32 feet) from 2 to 10 years of age

Background and purpose —

Neglected clubfoot deformity is a major cause of disability in low-income countries. Most children with clubfoot have little access to treatment in these countries, and they are often inadequately treated. We evaluated the effectiveness of Ponseti’s technique in neglected clubfoot in children in a rural setting in Ethiopia.

Patients and methods —

A prospective study was conducted from June 2007 through July 2010. 22 consecutive children aged 2–10 years (32 feet) with neglected clubfoot were treated by the Ponseti method. The deformity was assessed using the Pirani scoring system. The average follow-up time was 3 years.

Results —

A plantigrade functional foot was obtained in all patients by Ponseti casting and limited surgical intervention. 2 patients (4 feet) had recurrent deformity. They required re-manipulation and re-tenotomy of the Achilles tendon and 1 other patient required tibialis anterior transfer for dynamic supination deformity of the foot.

Interpretation —

This study shows that the Ponseti method with some additional surgery can be used successfully as the primary treatment in neglected clubfoot, and that it minimizes the need for extensive corrective surgery.Many children with congenital talipes equino varus (CTEV) in low-income countries end up with neglected clubfoot deformity (untreated children > 2 years) because of the lack of treatment capacity. In Ethiopia, it is estimated that there are 3,000–5,000 new CTEV cases per year, but there are no reliable data available.Neglected clubfoot is a common, disabling problem in Ethiopia. For many years, the treatment for clubfoot in Ethiopia has been nonoperative treatment with Kite’s technique, followed by a posteromedial release, with significant surgical complications and poor results (personal observations by the authors). A dramatic reduction in radical clubfoot operation has been reported in parts of the world where Ponseti treatment has been introduced (Morquende et al. 2004, Zionts et al. 2010). We have the same subjective impression in Ethiopia, but there are no published data.Ponseti treatment was introduced in Ethiopia in June 2005 at the Orthopaedic Department, Black Lion Hospital (BLH), University of Addis Ababa. It has gradually been adopted in several places in a cooperation between BLH and Cure International, Ethiopia. Several thousand children have been involved.In the past decade, the Ponseti method has become recognized globally as the gold standard for clubfoot treatment in younger children (< 2 years old) (Cooper et al. 1995, Bor et al. 2009, Pirani et al. 2009, Sætersdal et al. 2012).There have been some reports of Ponseti treatment being given successfully to children with neglected clubfoot (Verma et al. 2012, Laurenco et al. 2007, Alves et al. 2009), but there has been no general acceptance of treating children older than 2 years with this method. Today, these children are probably treated with radical operations or left untreated (De Rosa and Norrish 2012).Inspired by the results of A. F. Laurenco, which were communicated personally before his article was published in 2007, we treated some neglected children over the age of 2 years when the Ponseti treatment was started in Addis Ababa (at BLH), and the initial results were encouraging.The objective of this study was to prospectively evaluate the short-term results of using the Ponseti technique for treatment of children with neglected clubfoot deformity in a rural hospital in Ethiopia.     

The effectiveness of the Ponseti method for treating clubfoot associated with arthrogryposis: up to 8 years follow-up

Purpose

To evaluate the effectiveness of the Ponseti method in treating clubfoot associated with arthrogryposis.

Methods

Retrospective consecutive review over a 10-year period in a tertiary centre of all patients with arthrogrypotic clubfoot treated with the Ponseti method. The primary outcome measure at final follow-up was the functional correction of the deformity.

Results

There were ten children with 17 arthrogrypotic clubfeet, with an average follow-up of 5.8 years (range 3–8 years). The average age at presentation was 5 weeks (range 2–20 weeks). Deformities were severe, with an average Pirani score of 5.5 (range 3–6). Initial correction was achieved in all children with an average of 8 (range 4–10) Ponseti casts and a tendo-Achilles tenotomy (TAT) was performed in 94.1 %. Two-thirds of patients had a satisfactory outcome at final follow-up, with functional plantigrade, pain-free feet.

Conclusions

The Ponseti method is an effective first-line treatment for arthrogrypotic clubfeet to achieve functional plantigrade feet. Children will often require more casts and have a higher risk of relapse.

     

Der Taylor Spatial Frame

Introduction

Posttraumatic deformities in the lower limb are mainly multidirectional, with angulation, translation, and rotatory deformities. Acute corrections with internal fixation are often not possible due to the soft tissue damage and the extent of the deformity. The Taylor Spatial Frame (TSF) allows correction in a virtual hinge with 6 axes, thus enabling the correction of multidirectional deformities simultaneously.

Methods

From February 2003 until December 2006, we applied 31 TSFs to 20 patients with a posttraumatic deformity of the tibia and hindfoot. The mean patient age was 41 years (range 12–73). 9 patients had a nonunion of the tibia with deformity, 6 had a malunion of the lower tibia and ankle, 3 had an angular deformity after ankle fusion, and 2 had malaligned Ilizarov bone segment transports. The mean follow-up time was 25.3 months (range 10–82).

Results

In all 20 patients, full correction of the deformity was achieved. The mean time for correction was 29 days (range 5–82). On average, the frame was worn (time to healing) 164.2 days (80–300) and the mean distraction rate was 1.1 mm/day (0.5–2.0). The Web-based planning was done two times per case for full deformity correction. Complications were 3 pin-site infections, 2 insufficient callus formations and 1 pinhole stress fracture.

Conclusions

The main advantage of the TSF compared with other external frames is the ability to perform simultaneous correction of angular, axial, translational, and rotatory deformities. This enables a reduced correction time and increased patient comfort.     

Ponseti method in the treatment of post-operative relapsed idiopathic clubfoot after posteromedial release. A short term functional study

BackgroundRelapsed clubfeet deformity after surgical treatment by posteromedial release are frequently encountered in pediatric orthopedic practice and further revision surgery may be needed. As surgery adds more fibrosis and scaring, complication may be devastating and treatment is challenging. Ponseti method, the gold standard technique for treatment of clubfoot may be of a value in the management of postoperative relapses.Aim of the studyDetermine the effectiveness of Ponseti casting Method in treatment of relapsed idiopathic clubfoot in children after being treated with surgical posteromedial release.Materials and methodsProspective interventional study of 17 patients (25 feet) presented with a relapsed idiopathic clubfoot deformity after previous surgical posteromedial release. The patients were reviewed using Pirani and Dimeglio score. Ponseti method was done to obtain supple, flexible foot rather than a fully corrected foot, the residual deformity were treated by, heel cord lengthening or tenotomy, tibialis anterior transfer, follow up was for a minimum of 12 months.Result17 Patients (25 feet) their age ranging from 1 to 10 years were evaluated and treated. Casts were applied until the only deformities remaining were either hindfoot equinus and/or dynamic supination.22 feet required a heel cord procedure for equinus and 13 required tibialis anterior transfer for dynamic supination. The follow up (average 56.1 months) was for a minimum of one year. 4 feet had persistent heel varus deformity which required Calcaneal osteotomy later. Three feet didn’t need more casting and 2 feet were resistant cases that required further Ilizarov procedure, 4 needed lateral arch shortening and other 4 needed posterior capsulotomy. Improvement in the Pirani and Dimeglio scores was highly statistically significant.ConclusionPonseti method for treatment of relapsed clubfeet after a previous posteromedial soft tissue surgical release is an effective, non invasive, with excellent results.     

Breast reconstruction by tissue expander after radiotherapy: When the skin does not expand,the rib cage is at risk

Background

Expander-based breast reconstructions in irradiated chest walls have been documented to result in an increased risk of complications including skin necrosis, extrusion, displacement, and capsule contracture. In this article, thoracic cage deformity and rib fractures were investigated following breast reconstruction by tissue expansion.

Methods

A prospective series of 89 immediate postmastectomy tissue expander breast mound reconstructions in 81 patients, the patients were divided into two groups, reconstruction with radiotherapy (n?=?37) and without radiotherapy (n?=?52). The patients were observed for any sudden severe pain and development of capsule contracture; intraoperative assessment was done first during expander insertion then after exchange of expander with implant to detect any deformity of the chest wall. CT scans were done as an objective way to support the clinical findings in patients who developed flat or concave chest wall deformities.

Results

Patients who had reconstructions with radiotherapy developed severe capsular contractures causing severe pain and limitation in breast expansion in 35 % of reconstructions compared with 5.7 % in the control group. Twenty-six reconstructions (70.2 %) in the study group developed chest wall deformities; in four of them, the deformity was concave, and two patients (5.4 %) developed multiple rib fractures at the expander site. The overall rate of ribcage deformities in the control group was 32.6 %; all of them were simple flattening with no concave deformities. No fractures were noted in the control group.

Conclusions

Expander-based breast reconstruction in combination with radiotherapy and tight unyielding overlying skin and capsule can redirect the expansion force toward the thoracic ribcage rather than the skin causing rib deformities and possible fractures. Level of Evidence: Level IV, risk/prognostic study     

Use of the Ponseti method for recurrent clubfoot following posteromedial release

Background:

A child with recurrent or incompletely corrected clubfoot after previous extensive soft tissue release is treated frequently with revision surgery. This leads to further scarring, pain and limitations in range of motion. We have utilized the Ponseti method of manipulation and casting and when indicated, tibialis anterior tendon transfer, instead of revision surgery for these cases.

Materials and Methods:

A retrospective review of all children treated since 2002 (n = 11) at our institution for recurrent or incompletely corrected clubfoot after previous extensive soft tissue release was done. Clinical and operative records were reviewed to determine procedure performed. Ponseti manipulation and casting were done until the clubfoot deformity was passively corrected. Based on the residual equinus and dynamic deformity, heel cord lengthening or tenotomy and tibialis anterior transfer were then done. Clinical outcomes regarding pain, function and activity were reviewed.

Results:

Eleven children (17 feet) with ages ranging from 1.1 to 8.4 years were treated with this protocol. All were correctable with the Ponseti method with one to eight casts. Casts were applied until the only deformities remaining were either or both hindfoot equinus and dynamic supination. Nine feet required a heel cord procedure for equinus and 15 required tibialis anterior transfer for dynamic supination. Seven children have follow-up greater than one year (average 27.1 months) and have had excellent results. Two patients had persistent hindfoot valgus which required hemiepiphyseodesis of the distal medial tibia.

Conclusion:

The Ponseti method, followed by tibialis anterior transfer and/or heel cord procedure when indicated, can be successfully used to correct recurrent clubfoot deformity in children treated with previous extensive soft tissue release. Early follow-up has shown correction without revision surgery. This treatment protocol prevents complications of stiffness, pain and difficulty in ambulating associated with multiple soft tissue releases for clubfeet.     

Correction of complex equino cavo varus foot deformity in skeletally mature patients by Ilizarov external fixation versus staged external–internal fixation

Background

Complex foot deformity is a multi-planar foot deformity with many etiologic factors. Different corrective procedures using Ilizarov external fixation have been described which include, soft tissue release, V-osteotomy, multiple osteotomies and triple fusion.

Methods

In this study we compare the results of two groups of skeletally mature patients with complex foot deformity who were treated by two different protocols. The first group (27 patients, 29 feet) was treated by triple fusion fixed by Ilizarov external fixator until union. The second group (29 patients, 30 feet), was treated by triple fusion with initial fixation by Ilizarov external fixation until correction of the deformity was achieved clinically, and then the Ilizarov fixation was replaced by internal fixation using percutaneous screws. Both groups were compared as regard the surgical outcome and the incidence of complications.

Results

There was statistically significant difference between the two groups regarding duration of external fixation and duration of casting with shorter duration in the group 2. Also there was statistically significant difference between both groups regarding pin tract infection with less incidence in group 2.

Conclusion

Early removal of Ilizarov external fixation after correction of the deformity and percutaneous internal fixation using 6.5 cannulated screws can shorten the duration of treatment and be more comfortable for the patient with a low risk of recurrence or infection     

Skeletal findings in children recently initiating glucocorticoids for the treatment of nephrotic syndrome

Summary

Eighty children with nephrotic syndrome underwent lumbar spine densitometry and vertebral morphometry soon after glucocorticoid initiation. We found an inverse relationship between glucocorticoid exposure and spine areal bone mineral density (BMD) Z-score and a low rate of vertebral deformities (8%).

Introduction

Vertebral fractures are an under-recognized complication of childhood glucocorticoid-treated illnesses. Our goal was to study the relationships among glucocorticoid exposure, lumbar spine areal BMD (LS BMD), and vertebral shape in glucocorticoid-treated children with new-onset nephrotic syndrome.

Methods

Lateral thoracolumbar spine radiography and LS BMD were performed in 80 children with nephrotic syndrome (median age 4.4?years; 46 boys) within the first 37?days of glucocorticoid therapy. Genant semiquantitative grading was used as the primary method for vertebral morphometry; the algorithm-based qualitative (ABQ) method was used for secondary vertebral deformity analysis.

Results

Six of the 78 children with usable radiographs (8%; 95% confidence interval 4 to 16%) manifested a single Genant grade 1 deformity each. All deformities were mild anterior wedging (two at each of T6, T7, and T8). Four of the 78 children (5%; 95% confidence interval 2 to 13%) showed one ABQ sign of fracture each (loss of endplate parallelism; two children at T6 and two at T8). Two of the children with ABQ signs also had a Genant grade 1 deformity in the same vertebral body. None of the children with a Genant or ABQ deformity reported back pain. An inverse relationship was identified between LS BMD Z-score and glucocorticoid exposure.

Conclusions

Although we identified an inverse relationship between steroid exposure and LS BMD soon after glucocorticoid initiation for childhood nephrotic syndrome, there was only a low rate of vertebral deformities. The clinical significance of these findings requires further study.     

Congenital idiopathic talipes equinovarus before and after walking age: observations and strategy of treatment from a series of 88 cases

Background

We reviewed a series of newborns, toddlers and ambulating children affected by idiopathic congenital talipes equinovarus (clubfoot). Taking into account the time of diagnosis, stiffness of the deformity and walking age, nonsurgical or surgical treatment was considered. This study reports clinical outcomes, early complications and relapse at mid-term follow-up.

Materials and methods

Fifty-two clubfeet were diagnosed at birth, 12 in non-ambulating children aged between 4 and 12 months and 24 in ambulating children. Feet were classified using the Pirani score. Newborns and toddlers were treated with serial casting (Ponseti); however, toddlers also underwent open Achilles tendon lengthening (2 feet) and posteromedial release (3 feet). In all ambulating children, surgical treatment was always performed: selective medial release combined with cuboid subtraction osteotomy (1 foot), posteromedial release (6 feet), and posteromedial release combined with cuboid subtraction osteotomy (17 feet).

Results

The average follow-up was 5 years (1–6 years). In newborns treated with Ponseti, the results were excellent in 42 feet, good in 6, and poor in 4. In non-ambulating children, the results were excellent in 9 feet, and good in 3. In ambulating children, the results were excellent in 5 feet, good in 16, and poor in 3. No major complications were reported. No overcorrections were observed. The need for open surgery was higher in cases of delayed treatment. In cases of relapse, re-casting and/or more extensive surgery was considered.

Conclusions

Early treatment enables a high rate of good correction to be obtained with serial casting and limited surgery. Conversely, if the deformity is observed after walking age surgery should be considered. Serial casting in cases of late observation and relapse have demonstrated encouraging results.

Level of evidence

IV.

     

Moderne unikondyläre Kniearthroplastik

Background

Unicondylar knee arthroplasty (UKA) is an established therapeutic option for advanced medial or lateral gonarthrosis.

Objectives

The cornerstones of a successful UKA, careful patient selection, preoperative planning and precise operation technique, are discussed in this overview article.

Importance

In contrast to total knee arthroplasty, UKA allows preservation of the contralateral and patellofemoral compartments as well as the cruciate ligaments and is often associated with rapid postoperative recovery, improved knee kinematics and knee function. However, UKA is technically very demanding. High revision rates have been reported in particular with widespread application, according to national joint replacement registries.

Conclusion

Successful UKA relies on meticulous patient selection, preoperative planning and surgical technique. It is justified to broaden classic UKA indications. In medial and lateral UKA three types of mechanical varus-valgus deformity can be encountered: type 1 (isolated intraarticular deformity), type 2 (pronounced deformity due to extraarticular varus deformity in medial UKA or valgus deformity in lateral UKA), type 3 (reduced deformity due to extraarticular valgus deformity in medial UKA or varus deformity in lateral UKA). We believe these deformities should be addressed accordingly with surgical technique.     

Assessment of percutaneous V osteotomy of the calcaneus with Ilizarov application for correction of complex foot deformities

Complex foot deformity can be described as a foot with multiplanar abnormalities with or without shortening of the foot. Conventional surgical treatment may not be able to correct these deformities. In this study we evaluate the results of percutaneous V osteotomy of the calcaneus with an Ilizarov external fixator for treatment of complex foot deformity. Twenty feet with a complex deformity were treated by the Ilizarov method in 15 patients. The aetiologic factors were neglected or relapsed clubfoot (13 patients) and poliomyelitis (2 patients). All patients underwent percutaneous V osteotomy of the calcaneus and gradual correction of the deformity using Ilizarov's method. The mean duration of fixator application was 9.5 months (range, 6-13 months). The mean follow-up period was 1.8 years (range, 1 to 3 years). At the time of fixator removal, a plantigrade foot was achieved in 18 cases; gait was improved in all patients. There was residual varus deformity in two patients. A pin-tract infection was observed in all patients. No recurrence of the deformity occurred. The V osteotomy offers the most options for correction of complex foot deformities. Percutaneous technique is particularly useful for the complex foot deformity that has poor skin coverage, with poor blood supply. Gradual correction with the Ilizarov method yields good results for complex foot deformities.     

Transosseous capsuloplasty improves the outcomes of Lindgren–Turan distal metatarsal osteotomy in moderate to severe hallux valgus deformity

Introduction

Lindgren–Turan osteotomy used in hallux valgus deformity is a subcapital, transverse displacement osteotomy of the first metatarsal without any additional capsular repair. The aims of this study are to describe a transosseous capsuloplasty technique in this procedure and evaluate whether capsuloplasty would improve the clinical and radiological outcomes in patients with moderate to severe hallux valgus deformity.

Methods

Twenty-three feet operated by Lindgren–Turan osteotomy (Group B) and 25 feet operated by the same osteotomy combined with transosseous capsuloplasty (Group A) were evaluated retrospectively for the correction of the hallux valgus, intermetatarsal and distal metatarsal articular angles, sesamoid reduction, American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating Scale as well as patient satisfaction. The mean postoperative follow-up was 14 (range 12–28) months.

Results

All radiological parameters improved considerably as a result of both groups. However, postoperative improvements in intermetatarsal and distal metatarsal articular angles were greater in Group A. Complete reduction of medial sesamoid was achieved in 52% of patients in Group A, whereas 17.4% of patients in Group B had complete reduction. AOFAS scores and number of patients with complete satisfaction in Group A were significantly greater than that in Group B.

Conclusion

Better clinical and radiological outcomes can be achieved in patients with moderate to severe hallux valgus deformity operated by Lindgren–Turan distal metatarsal osteotomy, when it combines with transosseous capsuloplasty.