单纯性踇外翻患者内侧楔骨远端关节倾斜与踇外翻关系的影像学研究北大核心CSCD

目的通过在足负重正位X线片测量与内侧楔骨远端关节倾斜相关的指标,研究其与踇外翻发生及严重程度间的关系。方法选择2018年1月—2021年2月符合标准的足负重正位X线片,测量踇外翻角(hallux valgus angle,HVA)、第1-2跖骨间夹角(intermetatarsal angle,IMA)、跖内收角(metatarsus adductus angle,MAA)、第1跖楔夹角(metatarsus cuneiform angle,MCA)、内侧楔骨远端关节倾斜角(distal medial cuneiform angle,DMCA)、第1跖骨近端关节倾斜角(proximal metatarsal articular angle,PMAA);记录第1跖楔关节(first tarsometatarsal,TMT)关节面形态。根据HVA将患者分为正常组(<15°)与踇外翻组(≥15°),比较两组患者年龄、性别、侧别、IMA、MAA、MCA、DMCA、PMAA以及TMT关节面形态。多元线性回归分析HVA、IMA的影响因素。结果 534例(679足)患者X线片符合选择标准纳入研究。其中,男220例,女314例;年龄18~82岁,平均36岁。根据HVA分组,正常组154例(168足),踇外翻组403例(511足)。两组患者性别及年龄比较,差异均有统计学意义(P<0.05);侧别比较差异无统计学意义(P>0.05)。踇外翻组IMA、MAA、MCA均大于正常组(P<0.05),DMCA与正常组比较差异无统计学意义(P>0.05)。两组TMT关节面形态均以曲面为主,差异无统计学意义(P>0.05)。经测量PMAA发现第1跖骨存在内收型、中立型和外展型3种形态,组间分型比较差异有统计学意义(P<0.05)。正常组外展型PMAA大于踇外翻组(P<0.05),内收型PMAA组间差异无统计学意义(P>0.05)。基于679足资料的多元线性回归分析显示,年龄、MCA、DMCA为HVA的影响因素(P<0.05),年龄、MAA、MCA、DMCA为IMA的影响因素(P<0.05)。结论内侧楔骨远端关节倾斜程度相对恒定,DMCA不能作为量化踇外翻的特征性角度,TMT关节面形态与踇外翻无明显关系;MAA、MCA、PMAA参与了踇外翻形成,而且MCA可以作为量化踇外翻程度的特征性角度。     

Plantar pressure characteristics in hallux valgus feet

Due to the pathoanatomical changes in hallux valgus feet, the plantar flexion moment of the first metatarsophalangeal joint is reduced. Therefore, load bearing of the hallux is decreased during push‐off. We assessed loading parameters in hallux valgus feet. Based on dorsal‐plantar weight bearing radiographs of 61 feet, the intermetatarsal‐, hallux valgus‐, distal metatarsal articulation‐angle, and sesamoid position were evaluated. Plantar pressure assessment was performed with the emed® system during level walking. We found negative correlations between hallux valgus angle and peak pressure in the great toe (r = ?0.301, p < 0.023), the maximum force of the hallux (r = ?0.481, p < 0.001), and contact time of the great toe (r = ?0.448, p < 0.001), and positive correlations for force time integral (r = 0.348, p < 0.001), contact area (r = 0.307, p < 0.020), maximum force (r = 0.430, p < 0.001), and peak pressure (r = 0.361, p < 0.006) of the fifth metatarsal head. A positive correlation between the sesamoid and the metatarsal subluxation regarding maximum force (r = 0.294, p < 0.034), and a negative correlation between the contact area of the hallux (r = ?0.232, p < 0.020) was shown. Depending on the severity, hallux valgus angle, and sesamoid subluxation, load shows significant lateral transmission in hallux valgus feet. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1688–1693, 2014.

     

A radiographic study of the relationship between metatarsus adductus and hallux valgus

The relationship between metatarsus adductus and hallux valgus was evaluated on 100 dorsoplantar weight-bearing radiographs. The metatarsus adductus angle varied positively with the degree of hallux valgus. By using measures of correlation, a significant linear association was found for women (r =.53, P <.001) and men (r =.48, P <.001). The relationship was strongest in women when all cases of abnormal metatarsus adductus (>24 degrees ) were associated with abnormal degrees of hallux valgus (>15 degrees ). This relationship was different in men in that abnormal metatarsus adductus angles were not always associated with abnormal hallux valgus angles. With male and female data combined, the prevalence of metatarsus adductus was 55% in subjects with hallux valgus deformity compared with 19% in subjects without hallux valgus. A Chi(2) test showed this to be a significant difference in the distribution of the data (P =.002). The data of this study suggests that there may be a clinical association between metatarsus adductus and hallux valgus. The need to further evaluate the role of metatarsus adductus angle in hallux valgus surgery is emphasized.     

Hemiepiphysiodesis for juvenile hallux valgus deformity: A systematic review

BackgroundAmong the numerous surgical interventions for correcting hallux valgus deformity in skeletally immature patients, hemiepiphysiodesis is a simple technique with a low complication rate yet its effectiveness remains unclear. This systematic review evaluates hemiepiphysiodesis of the first metatarsal for treating juvenile hallux valgus (JHV) deformities with respect to radiological outcomes, postoperative clinical outcomes, and postoperative complications.MethodsEMBASE, MEDLINE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) database were searched from inception to September 15th, 2022, for studies investigating hemiepephysiodesis for JHV and its effect on clinical and radiological outcomes. The search, data extraction and methodologic assessment were performed in duplicate for all included studies.ResultsSix studies out of 488 with a total of 147 feet in 85 patients were included in the final qualitative synthesis. The American Orthopaedic Foot & Ankle Society hallux metatarsophalangeal interphalangeal scale (AOFAS Hallux MTP-IP scale) was used in two studies. The mean pooled preoperative score was 62.2 ± 8.9 and improved to 88.6 ± 4.8 postoperatively in 33 patients. All six studies reported significant improvement in the hallux valgus angle (HVA) from mean preoperative angle of 29.2° ± 3.7–23.8° ± 4.5° postoperatively, while the intermetatarsal angle (IMA) preoperative and postoperative means corrected from 13.9° ± 1.1–11.4° ± 1.2°, respectively. Out of 147 feet, 21 (14.2%) had reported complications including recurrence and need for revision surgery.ConclusionThis systematic review confirms that hemiepiphysiodesis of the first metatarsal in patients with JHV has improved clinical and radiological outcomes.Level of evidenceLevel IV, Systematic review     

Radiographic Measurements of Patients With Juvenile Hallux Valgus Compared With Age-Matched Controls: A Cohort Investigation

The purpose of this study was to investigate radiographic measurements in a cohort of patients with juvenile hallux valgus (with a hallux valgus angle > 15 degrees ) using standardized weightbearing x-rays compared with an age-matched control group. First metatarsal protrusion distance, metatarsus primus adductus angle, metatarsus adductus, first metatarsal cuneiform angle, calcaneal inclination angle, and talocalcaneal angles were assessed with discriminant functional analysis. A total of 37 sets of data were analyzed from patients with a mean age of 13.45 +/- 1.75 years. The study identified 2 significant components of juvenile hallux valgus: a positive first metatarsal protrusion distance (P <.001) and metatarsal primus adductus angle (P = .002). Discriminant functional analysis was then used to determine the best predictors of juvenile hallux valgus. This analysis allowed only 1 variable, metatarsal protrusion distance, as a predictor of whether juvenile hallux valgus was present (P < .001), with 94.3% accuracy. This study showed that a positive metatarsal protrusion distance is a significant component of juvenile hallux valgus.     

石家庄市区1233名成年人外翻病因学调查

[目的]调查普通人群外翻角度值(hallux valgus angle,HA)及母外翻(hallux valgus,HV)患病原因。[方法]采用随机整群抽样法对石家庄市区1233名成年人逐人进行测查。调查项目包括性别、年龄、民族、文化程度、在调查地居住时间、出现症状年龄、首发症状、加重因素、减轻因素、家族史、生活习惯及生活方式共30项内容。采用量角器外测量法获得HA值。HA>15°确定为HV患者。调查资料进行logistic多元回归分析。[结果]男性HA平均值为(8.31±4.93)°,女性HA平均值为(9.72±7.12)°。共发现HV病例98例,患病率为7.95%,男性HV患病率为1.29%,女性HV患病率为11.00%,男女患病率比为1∶8.53。HV出现时间平均22岁。出现症状年龄20~45岁,平均25岁。HV患者中有家族史者占79.6%(78/98)。影响HV因素依其影响力大小依次为:遗传、性别、扁平足。影响女性HV的因素依其影响大小依次为:遗传、高跟鞋始穿年龄。HV与鞋跟高度及每日穿鞋时间无关。HV症状加重原因依次为:穿高跟鞋、长时间站立、长时间行走;症状减轻原因依次为:穿宽头平跟鞋、休息、热水泡脚、按摩。[结论]女性较男性易患HV,HV的患病主要与遗传有关,何时开始穿高跟鞋对女性患HV有重要影响。     

Radiographic angles in hallux valgus: differences between measurements made manually and with a computerized program

BACKGROUND: The objective of this study was to compare angular measurements in the evaluation of hallux valgus deformities using a goniometer and a computerized program to assess degree of concordance between the two methods and determine the reliability of manual measurements. METHODS: Angles measured included the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA), and the proximal phalangeal articular angle (PPAA), also called the hallux valgus interphalangeus angle or interphalangeal angle. Measurements were made on preoperative weightbearing radiographs in 176 patients with symptomatic hallux valgus. Manual measurements were made with a goniometer by an orthopaedic surgeon. An independent experienced technician used digitized images to perform angular measurements with the Autocad software program (Autodesk Inc., San Rafael, CA). RESULTS: HVA values obtained with the two techniques were similar. However, significantly higher mean values were obtained with the Autocad for the IMA and PPAA measurements, and higher mean values were obtained for the DMAA measurement with the manual technique. Whereas differences were more or less randomly distributed for the HVA, in the remaining patients, measurements were clearly related to the measurement technique, i.e., for the DMAA, the manual technique had a tendency to show higher values, and for the IMA and PPAA the manual technique showed lower values than the computer. Correlations between both techniques for the different angular measurements were as follows: HVA, -0.179 (p = 0.018); DMMA, -0.294 (p < 0.001); PPAA, -0.876 (p < 0.001); and IMA, -0.661 (p < 0.001). The intraclass correlation coefficient (ICC) showed that the concordance between manual and Autocad angular measurements was excellent for the HVA (ICC = 0.89) and DMAA (ICC = 0.80) and very poor for the PPAA (ICC = 0.11) and IMA (ICC = 0.42). CONCLUSIONS: Angular measurements made on weightbearing radiographs with the Autocad in patients with hallux valgus deformities were more reliable than those made with a goniometer. Although for large angles, such as HVA and DMAA, results obtained with both measurement techniques were similar. Manual measurements, however, may underestimate the true values of the smaller IMA and PPAA angles.     

Natural progression of radiographic indices in juvenile hallux valgus deformity

BackgroundThis study aimed to estimate the annual change in radiographic indices for juvenile hallux valgus (JHV) and to analyze the factors that influence deformity progression.MethodsPatients aged <15 years who had JHV and were followed up for at least 1 year were included. Hallux valgus angle (HVA), hallux interphalangeal angle, intermetatarsal angle, metatarsus adductus angle, distal metatarsal articular angle, anteroposterior talo-first metatarsal angle, and lateral talo-first metatarsal angle were evaluated. The progression rate of HVA was adjusted by multiple factors by using a linear mixed model.ResultsA total of 133 feet were included. The HVA and distal metatarsal articular angle both increased by 0.8° per year (p < 0.001 and p = 0.003, respectively). HVA increased by 1.5° per year (p < 0.001) at under the age of 10, and the HVA progression in the older patients was not statistically significant.ConclusionsJHV deformity could progress with aging. Most deformity progression could occur before the age of 10 years.     

A comparison between the Regnauld arthroplasty and osteotomies of the first ray for the treatment of hallux valgus

This article is a retrospective study comparing the efficacy of Regnauld arthroplasty to first ray osteotomies for the treatment of hallux valgus. One hundred consecutive cases of Regnauld arthroplasties were compared with 100 consecutive first ray osteotomies. One hundred fourty-one patients were available for follow-up, and based on clinical/radiographic examinations, 72 were treated with the osteotomy protocol (group A) and 69 with Regnauld arthroplasty (group B). Age at surgery, clinical symptoms, and preoperative radiologic findings were similar for the 2 groups; there was a preponderance of female patients (90%). The average follow-up was 49 months in group A and 51 months in group B. Clinical evaluation showed in the osteotomy group a more stable correction (79% v 49%), greater pain reduction (measured in a visual analog scale from 0 = pain free to 10 = deep intolerable pain), increased residual articular excursion of the first metatarsophalangeal joint (27 degrees of active dorsiflexion from neutral position v 8 degrees ), and less presence of central metatarsalgia (15% v 34%) (P <.05). The radiographic evaluation expressed more stable correction values in group A for the following parameters: joint preservation, sesamoid position, intermetatarsal angle (7 degrees v 12 degrees ), abduction angle of the hallux (14 degrees v 20 degrees ), and proximal articular set angle (8 degrees v 18 degrees ) (P <.05).     

The oblique proximal phalangeal osteotomy in the correction of hallux valgus

An oblique proximal phalangeal osteotomy is introduced as an alternative to the Akin procedure for the treatment of hallux valgus. It consists of a single oblique osteotomy directed from proximal-dorsal to plantar-distal. A retrospective review of 32 patients who underwent 36 oblique proximal osteotomies is presented. The mean follow-up was 11 months (range, 3 to 21 months). Pre- and postoperative radiographic measurements of the distal articular set angles showed an average correction angle of 12 degrees (range, 7 degrees to 22 degrees; SD = 2.99). Mean range of first metatarsophalangeal joint motion was 82% of the preoperative value when combined with distal metatarsal osteotomy, and 87% of the preoperative value without a distal metatarsal osteotomy. Time to clinical and radiographic healing averaged 5 weeks (range, 4 to 8 weeks). The average amount of phalangeal shortening was 1 mm (range, 0 to 2 mm). There were no delayed or nonunions. Subjective assessment conducted by retrospective review of 19 patients at 6 months postoperatively showed that 17 were completely satisfied (90%), 1 was satisfied (5%), and 1 fairly satisfied (5%). Nineteen would have the surgery again (1 with reservations). Eighteen were very satisfied with appearance and 1 was improved. Fourteen returned to shoe gear at weeks 6 to 8, and 5 returned at weeks 8 to 12. Eighteen were satisfied with pain relief and 1 was improved. The study indicates that the oblique proximal phalangeal osteotomy is an effective, reliable, and technically simple procedure for correction of deformities of the proximal phalanx. The advantages include minimal shortening, ease of adjustability, and a construct conducive to rigid fixation.     

Hallux valgus surgery: A simple method for evaluating the first-second intermetatarsal angle in the presence of metatarsus adductus

In hallux valgus surgery, the presence of metatarsus adductus complicates the evaluation of the first-second intermetatarsal angle(IMA) because it will produce an apparent reduction in the IMA because the second metatarsal is skewed closer to the first metatarsal. This can lead to an underestimation of how much the IMA should be reduced. The Kilmartin angle is a simple charting technique that will eliminate the influence of metatarsus adductus and indicate the true degree of metatarsus primus varus. This may facilitate better preoperative planning in hallux valgus surgery.     

微创治疗中重度拇趾外翻临床效果

目的探讨微创治疗拇趾外翻的疗效。方法对504例中重度拇趾外翻患者（942足）采用小磨钻专用器械截骨、手法复位、绷带外固定。结果所有病例均获随访,时间6个月-4年。疗效评定：优847足,良90足,差5足,优良率达99%以上。无术后畸形或疼痛加重发生,无一例出现骨髓炎或骨不愈合。结论此方法创伤小,不用缝合及拆线,外表美观,可早期下床活动。无明显并发症及复发,疗效可靠。     

老年人(足母)外翻畸形围手术期处理

[目的]探讨老年人(足母)趾外翻畸形围手术期处理的意义和诊治要点.[方法]自2000年1月～2006年12月实施老年人(足母)趾外翻矫形术45例,69足;病人年龄60～79岁,平均66.6岁,伴随疾病9种,共46个病变.手术前对伴随疾病作全面诊断,妥善治疗.根据(足母)趾外翻畸形程度、病人年龄及伴随症选择最佳麻醉和手术方式.术后注意预防各种并发症及实施适合老年人的康复治疗.[结果]本组45例,手术全部成功.围手术期伴随疾病无发作或加重,未出现全身及局部并发症.术后患足X线片,与术前比较:(足母)趾外翻角平均改善25°;第Ⅰ、Ⅱ跖骨间角平均改善7°.[结论]老年人(足母)趾外翻畸形保守治疗无效应当采取手术治疗,完善的围手术处理是手术成功和病人安全的保证.     

Akin截骨术在拇外翻手术应用的探讨

背景：Akin截骨术能够纠正拇外翻手术中残留拇趾畸形但也存在并发症,总结探讨在拇外翻手术时联合应用Akin截骨治疗拇外翻的临床疗效并探讨使用指征。 方法：总结分析2006年10月至2010年10月,在拇外翻手术时联合应用Akin截骨术48足,软组织手术加Akin截骨术6足,chevon截骨术加Akin截骨术29足,跖骨基底截骨加Akin截骨术8足,第一跖楔关节融合加Akin截骨术5足。 结果：所有病例均获得随访,随访时间6个月至5年,平均30．3个月,未见拇外翻复发病例。术前拇外翻角为37．2°±8．9°,IMA为16．5°±6．7°;术后拇外翻角为13±6．8°,IMA为8．9°．±4．5°。术前AOFAS评分为（43±10．5）分,术后为（84±7．8）分,具有统计学意义。 结论：在拇外翻手术时,根据趾骨畸形情况联合应用Akin截骨术可以降低拇外翻手术复发率,临床效果确切,但需要严格掌握手术适应证。     

无内固定的微创方法治疗拇趾外翻

目的:探讨一种无内固定的拇趾外翻的治疗方法。方法:对我科16例患者32足拇外翻采用第一跖骨远端截骨无内固定的微创方法治疗。结果:随访3个月至1年,16例32足均治疗效果良好。结论:这种无内固定的拇外翻的治疗方法治疗拇外翻,效果良好,安全,可靠。     

Surgical treatment of hallux valgus deformity in rheumatoid arthritis: Clinical and radiographic evaluation of modified lapidus technique

The authors evaluated a modified Lapidus technique for 21 rheumatoid hallux valgus deformities. The technique corrects the deformity by performing arthrodesis of the first tarsometatarsal joint and preservation of the first metatarsophalangeal (MTP) joint. The authors clinically studied patients' subjective improvement of pain and footwear comfort, as well as their satisfaction with the outcome of the surgery. The study also analyzed radiographic changes of the hallux valgus angle (HVA) and two intermetatarsal angles, one between the first and the second (M1/2) and the other between the first and the fifth (M1/5). They were measured before the surgery, 3 weeks after the surgery, and at the last follow-up. Pain relief was great or moderate in 17 feet and footwear comfort was improved in 16 feet. Fifteen patients were satisfied or satisfied with some reservations. The average HVA significantly decreased from 44.1 degrees preoperatively to 10.6 postoperatively and significantly increased again to 29.1 at the last follow-up. The average M1/2 and M1/5 significantly decreased postoperatively (from 13 to 8.3 and from 32.2 to 21.1, respectively), and the reduction of M1/2 remained at the last follow-up (8.7), while M1/5 significantly increased again (28.3). This modified Lapidus technique is a useful method for rheumatoid hallux valgus deformity, which can preserve the first MTP joint.     

Short- and long-term results for severe hallux valgus correction using a first metatarsal distal osteotomy

PurposeThe purpose of this study is to analyze the short- and long-term results of severe hallux valgus (HV) treated with a L-Reverse osteotomy.MethodsPatients treated with L-Reverse osteotomy for severe HV between the years 2006–2015 were included. Patients were evaluated preoperatively, at 3 months and 4 or more years postoperatively. Changes in the HV angle (HVA) and intermetatarsal angle (IMA) were measured. Clinical outcomes were assessed using the AOFAS score.Results28 patients were included. Pre-operative IMA changed from 18.1° (18–18.9°) to 7° (6.3–8.5°), and HVA from 38.5° (34.5–41.3°) to 10.0° (8.4–11.8°) at 3 month follow up (p < 0.005). Long term follow up was of 5.6 (4.9–6.4) years. IMA value was 7.5° (6.1°?8.1°) and HVA was 10.1° (6.7°?16.3°), with no statistical difference with initial correction (p = 0.14). Median AOFAS score was 92.7 (89–4–96.1).ConclusionL-Reverse osteotomy can achieve correction of HV severe deformities with good outcomes in long term follow up.Level of evidenceIII     

选择性跖骨远端截骨治疗中重度(足母)外翻

[目的]探讨选择性跖骨远端截骨治疗(足母)外翻的手术适应证、手术方法及疗效.[方法]对2007年3月～2011年1月本院60例(101足)中度及重度(足母)外翻进行回顾性分析.双足41例,单足19例.其中女性57例,男性3例;年龄23～81岁,平均62.6岁.[结果]本组60例(101足)均获随访,随访时间6～48个月,平均22个月.参照美国足踝外科协会Maryland(足母)跖趾关节百分评分系统,90～ 100分40例(66足);80～89分16例(30足);70～79分4例(5足);优良率95％.术前HVA 30°～44°,平均36°;术后10.5°～21°,平均15.3°.IMA 13°～18°,平均16°;术后6°～10°,平均8.5°.第1跖趾关节活动度术前0°～30°,平均16°;术后为25°～50°,平均35°.第1跖骨长度较术前减少3 ～6 mm,平均4.2mm.[结论]本术式为软组织合并骨性手术,手术方法简单,创伤较小,跖骨头成形充分,术后不需要辅助内固定等优点,是一种值得推广的术式.     

微创治疗拇趾外翻手术时机与疗效分析

目的探讨微创治疗拇趾外翻手术时机与疗效关系。方法对采用微创治疗的200例患者（375足）术前和术后8周外翻角（HVA）和第1、2跖骨间角（IMA）进行分组比较。结果随着年龄增大，拇趾外翻逐渐加重。不同程度拇外翻患者微创手术疗效不一。结论40岁以后年龄对本微创手术疗效影响不大，而与拇趾外翻严重程度关系密切。中重度拇趾外翻且年龄在50～60岁者为较好的手术时机。     

Off-axis view radiographs for assessing hallux valgus interphalangeus in hallux valgus deformity: A comparison with the traditional anteroposterior standing radiographs

BackgroundThe newly described anteroposterior “off-axis view” (OAV) radiograph might help detect a hallux valgus interphalangeus (HVI) deformity more precisely compared to anteroposterior standing radiographs.MethodsA radiographic assessment of HVI angles was performed using preoperative standing anteroposterior and OAV radiographs for 67 ft. Intra- and interobserver agreement for all angles and their correlation with HV severity were analyzed.ResultsThe proximal-to-distal phalangeal articular angle showed less intra- and interobserver variance (intraclass correlation coefficient: 0.825) than did the other angles. OAV radiographs showed less interobserver reliability than did standing radiographs. HVI was underestimated significantly, by up to 5°, on standing radiographs compared to OAV radiographs (p < 0.001). The mean differences between OAV and standing radiographs were 3.7° and 5.0° for the proximal-to-distal phalangeal articular and hallux interphalangeal angles, respectively, and were more pronounced for moderate-to-severe HV deformities.ConclusionAngular measurements of HVI on traditional anteroposterior standing radiographs are significantly smaller than on OAV radiographs. Furthermore, angular measurements on OAV radiographs are associated with higher interobserver reliability. The most precise angle representing an HVI deformity might be the proximal-to-distal phalangeal articular angle.Clinical RelevanceOur findings may facilitate preoperative decision-making for additional akin osteotomy in HV correction.Level of EvidenceLevel II.