Health-related quality-of-life improvement after hallux valgus corrective surgery

BackgroundHallux valgus is a common forefoot deformity that affects function of foot and quality of life (QoL). This study aims to identify factors associated with clinically important improvements in QoL after hallux valgus corrective surgery.MethodsA retrospective analysis on 591 cases of hallux valgus corrective surgery performed between 2007 and 2013 was conducted. Patients’ preoperative and 2-year postoperative Physical Component Score (PCS) and Mental Component Score (MCS) were compared to identify the presence of clinically significant improvements in patient-reported QoL. A multiple logistic regression model was developed through a stepwise variable-selection model building approach. Age, BMI, preoperative patient reported outcome score, PCS, MCS, pain score, gender, side of surgery, type of surgery, and presence of lesser toe deformities or metatarsalgia were considered.ResultsMedian PCS significantly improved from 49 to 53 (p < 0.001), and median MCS remained at 56 (p = 0.724). Age, preoperative MCS and PCS were independent predictors for significant improvements of PCS at 2-year postoperatively.ConclusionThree groups of patients were more likely to have significant QoL improvements after hallux valgus corrective surgery. These were the younger patients, those with better preoperative mental health or those with poorer preoperative physical health.Level of evidence: III.     

Failures of hallux valgus surgery

More than 150 corrective procedures for hallux valgus exist and an incorrect choice of procedure leads to insufficient correction. Distal first metatarsal osteotomy cannot correct large deformities and degenerative changes at the metatarsophalangeal joint impede functional recovery. Incongruence of the joint must be corrected during surgery. Recurrence is most often caused by insufficient correction, especially of the first metatarsal bone. Overcorrection is often due to technical problems with the initial metatarsal osteotomy. This also applies to insufficiency of the first ray due to shortening or dorsal angulation. Partial first metatarsal head necrosis occasionally occurs but complete necrosis is rare. Non-union is mostly caused by incorrect osteosynthesis. During postoperative treatment the hallux must be held in the correct position to avoid failure.     

Pressure distribution after scarf osteotomy for hallux valgus surgery

AIM: This study evaluates the pressure distribution, the radiological and clinical results in patients before surgery and 6 months after scarf osteotomy for hallux valgus. METHODS: 29 patients were examined before surgery and 6 months after surgery for symptomatic hallux valgus. Pedographic analysis was performed by dividing the footprint of the patients into 8 regions of interest. For each region the maximum mean pressure and the peak pressure were evaluated. Moreover, clinicofunctional results (AOFAS score) and radiological results were evaluated. RESULTS: 6 months postoperatively, maximum mean pressure increased significantly under the medial forefoot where as the peak pressure in this region revealed indifferent results. Significant improvement of clinicofunctional results and a significant reduction of the intermetatarsal and metatarsophalangeal angle could be seen. CONCLUSION: These results confirm the clinical and radiological findings of other studies, but this study shows for the first time an increase of pressure under the first ray of the foot after hallux valgus surgery and an adaptation to the pressure distribution of normal feet.     

Distraction osteogenesis for the shortened metatarsal after hallux valgus surgery

BACKGROUND: Shortening of the first metatarsal is known to occur during hallux valgus surgeries. If the shortened first ray disrupts the normal weight transfer, then transfer metatarsalgia may result. After failed conservative treatment, a common operative option is an osteotomy of the lesser metatarsals. However, osteotomies of normal metatarsals further alter the normal anatomy and can significantly shorten the forefoot. Restoration of first metatarsal length using distraction osteogenesis may more closely restore normal foot anatomy and biomechanics and subsequently treat transfer metatarsalgia. METHODS: Five patients had distraction osteogenesis for a shortened first metatarsal that resulted from a previous hallux valgus surgery. A four-pin single-plane external fixator was applied to the first metatarsal to lengthen the metatarsal under the principles of distraction osteogenesis. Lengthening was complete once the affected first metatarsal was equal to the length of the adjacent second metatarsal. RESULTS: The mean consolidation period was 15.8 weeks. Preoperative and postoperative length of the first metatarsal was expressed as a percentage of the length of the ipsilateral second metatarsal. The preoperative mean was 77.1% and the postoperative mean was 93.8%. All osteotomies went on to consolidation, and no grafting or secondary procedures were needed. There were no postoperative infections, malrotation, or malalignment. All patients reported reduction in their forefoot pain and returned to a nonantalgic, full weightbearing gait. CONCLUSIONS: This small series depicts the potential success of distraction osteogenesis for the iatrogenically shortened first metatarsal and associated transfer metatarsalgia.     

Patient expectations for hallux valgus surgery

PURPOSE: To determine preoperative patient expectations and their relative importance for hallux valgus surgery using a patient-derived questionnaire, and whether such expectations are influenced by age, gender, or occupation. METHODS: Two patient-derived questionnaires were developed using open-ended interviews. The 19 most commonly stated expectations were included in the Patient Expectation Questionnaire: 2 related to improvement in appearance, 2 to pain reduction, and 15 to functional improvements in performing daily and recreational activities. The top 9 expectations were included in the Patient Priority Questionnaire for prioritising. RESULTS: 153 eligible patients aged 16 to 79 (mean, 47) years completed the questionnaires; 29 (19%) aged less than 40 years, 84 (55%) aged 40 to 60 years, and 40 (26%) aged more than 60 years. 86% were women and 81% were Caucasian. 62% were housewives or retired pensioners. Overall, the most important expectation was improved walking, followed by reduced pain over the bunion and wearing daily shoes. These expectations varied according to age and gender but not occupation. CONCLUSION: Patient expectations differ from those of surgeons, and vary according to patient age and gender. Understanding preoperative patient expectations is crucial to achieve better clinical outcomes and satisfaction by selecting the most appropriate operation for each patient.     

Preparing for hallux abducto valgus surgery

This article reviews the criteria for hallux abducto valgus surgery. Clinical and radiographic examinations are reviewed in a stepwise approach to evaluate the deformity. A hallux abducto valgus surgical evaluation form is presented in order for the podiatrist to logically assess the patient's deformity.     

外翻术后再手术的原因分析及处理对策

 目的 探讨外翻术后再手术的原因及临床处理对策。方法 回顾性分析2005年12月至2011年12月外翻术后再手术的23例患者完整资料,男 3例,女20例;年龄28～85岁,平均63.1岁。再手术时间为初次手术后6～96个月,平均27.6个月。分析23例患者外翻术后再手术原因,根据患者临床症状、体征及X线片所示选择再手术方式。结果 23例外翻患者术后再手术原因包括：复发5例,内翻2例,转移性跖痛5例,内固定松动7例,内固定断裂4例。再手术方式包括：跖楔关节融合(3例),基底截骨再次行Akin截骨(1例),基底截骨加跖趾关节融合(1例),跖趾关节融合(2例),改良Weil截骨(5例),去除内固定(11例)。术后随访时间6～36个月,平均16.5个月。美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)趾、跖趾、趾间关节评分从初次术后(65.3±7.5)分改善到再次术后(89.2±8.9)分;术后患者主观满意度评价,优17例,良4例,可2例,优良率91.3%(21/23)。结论外翻术后再手术原因较多,包括复发、内翻、转移性跖痛、内固定松动、断裂等。再手术时需仔细分析患者临床症状、体征及X线检查结果选择个性化方案进行治疗。     

Intraoperative imaging in hallux valgus surgery

BackgroundThis prospective study investigates the use of intraoperative fluoroscopy in hallux valgus surgery. To our knowledge there have been no studies questioning the benefit and reliability of intraoperative fluoroscopy in hallux valgus surgery.MethodsWe performed a prospective investigation of 28 consecutive cases undergoing hallux valgus surgery. Fluoroscopic images were examined intraoperatively and any significant findings documented. A comparison was made between these images and weight bearing films 6 weeks postoperatively to examine their reliability. We excluded those patients that went on to have an Akin osteotomy.ResultsThere were no unforseen intraoperative events that were revealed by the use of fluoroscopy and no surgical modifications were made as a result of the intraoperative images. The intraoperative films were found to be a reliable representation of the postoperative weight bearing films but a small increase in the hallux valgus angle was noted at 6 weeks and this is thought to be due to stretching of the medial soft tissue repair.ConclusionsIntraoperative fluoroscopy is a reliable technique. This study was performed at a centre which performs approximately 100 hallux valgus operations per year and that should be taken into consideration when reviewing our findings. We conclude that there may be a role for fluoroscopy for surgeons in the early stages of the surgical learning curve and for those that infrequently perform hallux valgus surgery. We cannot, however, recommend that fluoroscopy be used routinely in hallux valgus surgery.     

Forces under the hallux valgus foot before and after surgery.

Abnormalities in the hallux valgus foot and changes after surgery were investigated by measuring the distribuiion of load on the foot in walking. Hallux valgus was associated with reduced load imposed on the toes, and on the medial side of the forefoot, compared with a large sample of healthy feet. Abnormalities correlated with the degree of the deformity. Both Keller's operation and a wedge displacement osteotomy of the first metatarsal not only failed to restore normal loading but increased the abnormalities of loading seen preoperatively. A large decrease in the angle between first and second metatarsals as a result of surgery minimized this increase. A silastic arthroplasty did not carry high loads when used to treat hallux valgus, but near normal loads were imposed on it when used for hallux rigidus. Considerable variability was found in the loading distribution on the healthy feet. The distribution between first and second metatarsal heads was partially dependent upon their protrusions, relative to the direction of walking. The changes in the relationships between the loadings on the forefoot and skeletal shape in response to surgical operations are important for our understanding of treatment of the hallux valgus foot.     

Modern techniques in hallux abducto valgus surgery

Hallux abducto valgus surgery is in a constant state of evolution. Innovation is driven by surgeons pursuing the perfect procedure for any clinical scenario. The end point is to eliminate complications and produce satisfied patients. Medical device technology has helped pave the way for some recent advances in bunion surgery. The use of opening base wedge plates, locking plates for the Lapidus fusion, suture endobuttons, and staples for the Akin procedure are the focus in this review of modern techniques.     

Salvage of complications of hallux valgus surgery

Complications following hallux valgus surgery can occur and are a frequent source of patient dissatisfaction. The treatment of these complications begins with careful preoperative planning to ensure that the chosen procedure is appropriate for the specific patient. When complications occur, treatment must also be individualized to address the symptoms of the patient. This article presented an overview of the more common complications that are seen following hallux valgus surgery. Nonsurgical and surgical options for treatment were outlined to assist in the management of these complications.