第1跖骨远端Chevron截骨联合软组织松解术治疗拇外翻

目的 :探讨第1跖骨远端Chevron截骨联合软组织松解术治疗轻、中度拇外翻的临床疗效。方法:自2015年6月至2017年6月,采用第1跖骨远端Chevron截骨联合软组织松解术治疗拇外翻32例(40足),其中男3例3足,女29例37足;年龄22～80岁,平均57.57岁;病程2～32年,平均14年;轻度9足,中度31足。术前患者合并拇囊炎,伴有第1跖趾关节周围疼痛并存在负重行走时疼痛加重。手术前后拍摄足负重正侧位片,比较拇外翻角(hallux valgus angle,HVA),第1、2跖骨间角(intermetatarsal angle,IMA),并采用美国足踝外科协会拇外翻评分(AOFAS)评价临床疗效。结果:32例患者获得了随访,时间12～24个月,平均15.2个月。术后切口均愈合良好,无感染、跖骨头坏死等并发症发生。术前HVA、IMA分别由(32.08±5.59)°、(11.63±2.24)°减小至术后12个月的(10.31±4.36)°、(5.02±2.34)°,差异有统计学意义(P0.05)。AOFAS评分由术前的56.75±6.42提高至术后12个月的88.80±3.99 (P0.05)。结论:第1跖骨远端Chevron截骨联合软组织松解术治疗轻、中度拇外翻畸形可获得较好的临床效果,为拇外翻治疗提供了更多的选择。     

Outcomes after Scarf Osteotomy for Treatment of Adult Hallux Valgus Deformity

Background  

Many procedures have been developed to correct hallux valgus deformity using distal soft tissue realignment, metatarsal osteotomy, and periodically, a proximal phalanx osteotomy (Akin). The ideal metatarsal osteotomy allows for varying degrees of correction with reliable improvement in deformity and patient satisfaction.     

经皮微创截骨术联合8字绷带和分趾垫外固定治疗中度拇外翻

目的:探讨经皮微创截骨术联合“8”字绷带和分趾垫外固定治疗中度拇外翻的临床疗效。方法:自2019年8月至2021年1月采用经皮微创截骨术联合“8”字绷带和分趾垫外固定治疗中度拇外翻患者23例,失访1例,最终纳入22例(30足),男4例6足,女18例24足,年龄27～66 (50.59±11.95)岁。比较术前和术后6个月患足拇外翻角(hallux valgus angle,HVA),第1、2跖骨间角(intermetatarsal angle,IMA),跖骨跨度(第1、5跖骨头之间的距离)和软组织宽度变化情况,并采用美国足踝外科协会踝-后足评分标准(American Orthopaedic Foot and Ankle Society,AOFAS)进行临床疗效评价,采用视觉模拟评分(visual analogue scale,VAS)评价足部自觉疼痛情况。结果:22例患者获得随访,时间5.7～6.4(6.13±0.85)个月。患者第1跖骨截骨处均获得骨性愈合,足趾外观畸形得到纠正,术后患足未出现跖骨头缺血性坏死、转移性跖骨痛等并发症。术后6个月患足HVA、IMA、跖骨跨度、软组织宽度、...     

第1跖骨远端改良Chevron截骨治疗[足母]外翻

背景：[足母]外翻的手术治疗方式众多,传统Chevron有一定的手术操作局限性。目的：观察采用第1跖骨远端改良Chevron截骨治疗轻中度[足母]外翻的临床治疗效果。方法：2011年12月至2012年10月采用Chevron截骨对22例患者（28足）进行[足母]外翻矫正,记录患者术前、术后美国足踝外科医师协会评分（AOFAS）,术前、术后测量第1、2跖骨间角（IMA）和躅外翻角（HVA）变化以评估矫正程度,采用AOFAS前足评分和生活功能评分简表（SF．36）评估功能恢复情况。结果：22名患者术后平均随访时间13．36个月（8～18个月）,术前患者平均AOFAS评分（43．59±6．85）分,术后平均85．55±5．66分。术前患者平均SF．36量表评分（45．42±5．54）分,术后平均（83．23±8．81）分,两者术前、术后比较有显著统计学差异（P〈0．01）。IMA术前13．80°±1．67°,术后6．70°±1．51°（P〈0．01）;HVA术前平均29．30°±2．78°,术后7．47°±2．82。（P〈0．01）。结论：第1跖骨远端改良Chevron截骨治疗轻中度蹰外翻手术操作技术简便,临床效果满意。     

Minimally invasive hallux valgus correction with Internal Hallux Fixator® — A comparative cadaver study

BackgroundThe Internal Hallux Fixator® (IHF®; Waldemar Link, Hamburg, Germany) was designed for open surgical hallux valgus correction. It allows a defined lateralisation of the first metatarsal head after V-shaped, Chevron-like distal metatarsal osteotomy in order to correct mild to middle hallux valgus deformities. The intramedullary fixation provides dynamic compression of the osteotomy and thus postoperative full weight bearing mobilization is an integral part of the therapy.This comparative cadaver model study investigates the feasibility of implanting the device using a minimally invasive technique and compares its capability of first metatarsal head lateralisation to the established 3rd generation MICA (Minimally Invasive Chevron and Akin osteotomy) technique.Methods16 fresh frozen cadaveric feet (8 left, 8 right) of 8 body donors received either MICA (Group 1), or an IHF® in a minimally invasive technique (Group 2). The achievable first metatarsal head lateralisation and operating time were measured and pitfalls recorded.ResultsThis cadaver model study confirmed, the minimally invasive implantation of the Internal Hallux Fixator® can be performed reliably via 10 mm mini incision with V-shaped distal metatarsal osteotomy. The mean first metatarsal head lateralisation was comparable between the groups with no statistically significant difference (7.2 (±1.9) mm in G1, or 8.3 (±0.8) mm in G2; p = 0.09).The IHF® was inserted and fixed in mean 3.7 (±0.6) min, whereas double screw fixation needed 10 (±3.7) min.Level of Clinical Evidence5, Cadaver model study.     

Does Hallux Valgus Exhibit a Deformity Inherent to the First Metatarsal Bone?

Hallux valgus is a common condition, and it still poses some challenges. The identification of factors associated with the development of the deformity is of paramount importance in obtaining a full correction of the disorder. Hallux pronation is one of the frequently found components, especially in larger deformities, but the cause and exact location of this condition are not fully understood. The aim of the present study was to investigate whether there is a rotational deformity inherent to the first metatarsal bone. A case-control study was conducted on patients with and without hallux valgus who were subjected to computed tomography with multiplanar reconstruction. Statistical analysis was performed by means of a mixed model adjusted for foot and gender to compare metatarsal rotation between cases and controls. Correlations between numerical quantitative measurements were investigated by means of Pearson's correlation coefficient obtained in a linear mixed model. A total of 82 feet (tests) were analyzed in the hallux valgus group and 64 feet (tests) in the control group (N = 146). The hallux valgus group was significantly different from the control group (p < .001). Mean metatarsal bone rotation was 15.36° (range 1.65° to 32.52°) in the hallux valgus group and 3.45° (range −7.40° to 15.56°) in the control group. The difference between the means was 11.9° (confidence interval 9.2° to 14.6°). In conclusion, patients with hallux valgus exhibited increased exclusive bone rotation of the first metatarsal toward pronation compared with the population without this condition.     

Komplikationen der Chevron Osteotomie

BackgroundThe Chevron osteotomy is probably the most used technique fort he correction of hallux valgus. According to the literature complications mentioned beside the classical surgical complications are avascular necrosis, hallux varus, recurrent hallux valgus and malposition.MethodsThe therapy of complications after Chevron osteotomy is in most cases a surgical solution. Hallux varus and malposition are mostly corrected by a correctional osteotomy, the solution of a avascular necrosis ist he arthrodesis.ResultsThe incidence of complications after Chevron osteotomy is described with up to 28%. This does not correlate with patients satisfaction which is in general around 90%.ConclusionThe Chevron osteotomy is one of the most if not the most used technique fort he correction of hallux valgus. With the correct indication a high percentage of patient satisfaction can be achieved. The incidence of complications is in most studies not high and usually revisions are rare.     

Shortening Proximal Chevron Metatarsal Osteotomy for Patients With a Hallux Valgus Deformity With Advanced Arthritis

To correct hallux valgus deformities in patients with advanced arthritis of the first metatarsophalangeal joint, we designed a new reverse chevron-type shortening osteotomy technique that could be used to correct valgus deformities at the proximal metatarsal level, as well as shorten and lower the metatarsal, in a 1-time procedure. Sixteen feet in 16 patients with a minimum of 18 months follow-up who underwent a shortening proximal chevron metatarsal osteotomy for a hallux valgus deformity with advanced arthritic change between January 2014 and March 2016 were reviewed in this study. Double chevron osteotomies with 20° of plantar-ward obliquity at the proximal metatarsal level were made at 5-mm intervals for simultaneous valgus correction and metatarsal shortening. An additional Weil osteotomy of the second metatarsal was performed in all feet. Patients’ mean age was 57.88 ± 6.55 years. The deformity was satisfactorily corrected by the operation. The first metatarsal was shortened by approximately 8.75 mm, and the relative length of the second metatarsal did not differ significantly postoperatively (p?=?.179). The relative second metatarsal height, as seen on forefoot axial radiographs, was maintained constantly, with no significant difference (p?=?.215). No painful plantar callosity or transfer metatarsalgia under the second metatarsal head was observed postoperatively. A shortening proximal chevron metatarsal osteotomy for hallux valgus deformities with advanced arthritic change showed a good result with respect to deformity correction and pain relief. Appropriate lowering and an additional Weil osteotomy effectively prevented postoperative pain and painful callosity under the second metatarsal head.     

旋转Scarf截骨术治疗拇外翻合并第1跖骨旋转

目的：探讨旋转Scarf截骨术治疗拇外翻（hallux valgus,HV）合并第1跖骨旋转的临床疗效。方法：自2018年1月至2019年10月采用旋转Scarf截骨术治疗35例（40足）HV合并第1跖骨旋转畸形患者,其中男5例,女30例;年龄25～76(40.32±5.43)岁。观察并比较手术前后拇外翻角（hallux valgus angle,HVA）,第1、2跖骨间角（intermetatarsal angle,IMA）,第1跖骨远端关节面角（distal metatarsal articular angle,DMAA）,第1跖骨长度（the first metatarsal length,FML）,术后采用美国矫形骨科学会足踝外科学组（American Orthopedic Foot and Ankle Society,AOFAS）拇趾-跖趾-趾间关节评分和疼痛视觉模拟评分（visual analogue scale,VAS）系统进行功能评价。结果 ：35例（40足）均获得随访,时间12～36(14.35±3.62)个月。HVA、IMA和DMAA分别由术前的（36.32±4.5...     

Does preoperative deformity diminish radiographic outcome after hallux valgus correction with scarf osteotomy?: A retrospective study of 102 cases

BackgroundScarf osteotomy is a frequently used technique to correct moderate to severe hallux valgus deformities. Recurrence of a deformity is a commonly reported complication after surgery. The aim of our study was to evaluate the impact of preoperative deformity on radiological outcome in terms of postoperative loss of correction after scarf osteotomy.Methods102 patients, in which a hallux valgus deformity was corrected with an isolated scarf osteotomy were included. Weightbearing radiographs were analyzed preoperatively, postoperatively, after 6 weeks and after three months (mean 10.9 months SD 17.2 months). The following radiological parameters were used for analysis: the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), position of the sesamoids, first metatarsal length, and first metatarsophalangeal joint congruity.ResultsSignificant correction of IMA, HVA, DMAA, sesamoid position and joint congruity was achieved (p < 0.001). The IMA improved from 15.8 ± 2.3 to 4.3 ± 2.8°, the HVA from 32.6 ± 6.8 to 9.1 ± 7.2, and the DMAA from 11.4 ± 6.9 to 8.4 ± 5.2°, respectively. In contrast to DMAA, throughout followup we could detect loss of correction for HVA and for IMA amounting 6.3° ± 5.8 and 3.8° ± 2.8 respectively. Loss of HVA correction revealed a significant correlation with preoperative DMAA, but not with the other preoperative radiological parameters.ConclusionsPreoperative deformity does not correlate with postoperative loss of correction after scarf osteotomy, except DMAA.Clinical relevanceOur results may be helpful in counseling patients regarding recurrence of hallux valgus deformity after scarf osteotomy.Level of evidenceTherapeutic, Level IV, retrospective case series.     

The Rotational Effect of Scarf Osteotomy With Transarticular Lateral Release on Hallux Valgus Correction

The purpose of this study was to explore the rotational effect of scarf osteotomy with transarticular lateral release (TALR) on hallux valgus correction. From January 2016 to January 2018, 28 consecutive patients (30 feet) were included in this study. The first intermetatarsal angle (IMA), hallux valgus angle (HVA), and round-shaped lateral edge of the first metatarsal head (R sign), and sesamoid rotation angle (SRA) were recorded prior to and 3 months after the surgery. The rotation of the capital fragment of the first metatarsal was termed the capital rotation angle (CRA) and was measured intraoperatively after the completion of scarf osteotomy. The IMA, HVA, and SRA were significantly reduced from 13.9 ± 4.9°, 34.6 ± 7.4°, and 28.7 ± 9.8° to 2.4 ± 2.3°, 7.3 ± 4.7°, and 13.4 ± 8.8°, respectively (p < .01 for all). The mean CRA was 7.0 ± 3.4° and was not significantly correlated with the reduction of IMA and SRA (p > .05 for all); nor was it significantly correlated with IMA preoperatively and postoperatively (p > .05 for all) or the reduction of SRA and IMA (p > .05). The R sign was positive in 40% (12/30) of the feet preoperatively compared to 13.3% (4/30) postoperatively (p < .001). Scarf osteotomy produced a supination effect on the capital fragment of the first metatarsal and supinated the sesamoids via lateral translation of the first metatarsal head. These changes may contribute to the correction of the pronation component of hallux valgus deformity.     

Chevron osteotomy in the treatment of hallux valgus

Fifty patients who underwent 80 chevron osteotomies for symptomatic hallux valgus were re-examined and assessed 4 years and 7 months (average) after surgery. Forty-five of the patients were satisfied with the result of their surgery, three patients suffered recurrence of their deformity and two had continuance of their symptomatology. The major complications noted were intraoperative intra-articular fracture of the metatarsal head in five feet, loss of initial repair in three feet, and tilt of the distal fragment (metatarsal head) in two feet. The Chevron osteotomy is a relatively simple procedure that corrects the varus deformity of the first metatarsal, realigns the valgus orientation of the metatarsal head, corrects the hallux valgus deformity, and improves symptomatology.     

Correction of hallux valgus deformity using the center of rotation of angulation method

Background  To correct a hallux valgus (HV) deformity quantitatively and prevent unexpected postoperative deformity, the center of rotation of angulation (CORA) method was applied during HV surgery. To correct a hallux valgus (HV) deformity quantitatively and prevent unexpected postoperative deformity, the center of rotation of angulation (CORA) method was applied during HV surgery. Methods  To create a normal foot model, radiographs of 64 normal female feet were measured. Points A and B were defined as the intersection of the intermetatarsal angle and the HV angle. CORA1 and CORA2 were defined as the intersection of the axes of the first metatarsal and the first proximal phalanx in the normal and HV models, respectively. Procedures to correct HV deformity using the CORA method were devised and were applied to HV feet, which underwent a focal dome osteotomy or medial wedge osteotomy. Results  Point A was 2.3 times the length of the second metatarsal proximally from the top of the second metatarsal head, and point B was 0.17 times the length of the first metatarsal proximally from the top of the first metatarsal head. Two methods were used to correct the deformity. With one method, a focal dome osteotomy was performed at the first metatarsal on the circle at the CORA1 and the distal fragment was moved to the standard first metatarsal axis. The first proximal phalanx was then moved around the metatarsal head to the standard axis of the first proximal phalanx at the CORA2. With the other method, a medial wedge osteotomy was performed on or proximal to the CORA2, and the distal fragment was moved to the first standard metatarsal axis. Conclusions  We propose a preoperative plan to use the CORA method to correct deformities that prevent translation of the axis or an angulation deformity. HV deformity can be corrected effectively using the CORA method.     

微创Chevron-Akin截骨术治疗轻中度拇外翻的早期疗效分析

目的 :探讨微创Chevron-Akin(minimally invasive Chevron-Akin,MICA)截骨术治疗轻中度拇外翻的早期临床疗效。方法:自2019年6月至2021年4月,采用MICA截骨术治疗26例(29足)轻中度拇外翻患者,其中男1例,女25例;年龄19～78(38.3±19.5)岁。观察并比较手术前后拇外翻角(hallux valgus angle,HVA),第1、2跖骨间角(intermetatarsal angle,IMA),第1跖骨短缩。末次随访时采用美国骨科足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)前足评分系统及视觉模拟评分(visual analogue scale,VAS)评价治疗效果,并记录相关并发症。结果:26例(29足)均获得随访,时间12～33(19.6±5.1)个月。HVA、IMA分别由术前的(32.3±6.6)°、(11.7±3.2)°矫正为术后的(13.0±5.3)°、(6.1±3.2)°,差异有统计学意义(P<0.01);第1跖骨短缩(2.7±1.1) m...     

Pronation of the First Metatarsal in Hallux Valgus Deformity

Axial rotation of the 1^st metatarsal (M1) as a factor in the development of hallux valgus (HV) deformity was described early by authors in the consideration of the pathology. However, for almost two decades, it was largely overlooked as HV was thought to be a two dimensional forefoot deformity bound in the transverse and sagittal planes. Thus, during this time period, many of the methods developed to measure and describe this deformity were biplanar in nature, adding to the limited understanding of this deformity. Subsequently, operative techniques for HV were also devised to correct any deformity of these two planes, leaving the frontal rotational status of the M1 uncorrected. Recently, as our imaging and understanding of this deformity improves, authors and clinicians have begun to re-consider M1 axial rotation as a principal feature of HV. The aim of this paper is to provide the most recent understanding of M1 axial rotation and how its consideration has changed temporally within the field of foot and ankle surgery.     

Minimally invasive surgery for young female patients with mild-to-moderate juvenile hallux valgus deformity

BackgroundWe aimed to compare the clinical and radiographic outcomes of minimally invasive surgery (MIS) and distal chevron metatarsal osteotomy (DCMO) for young female patients with mild-to-moderate juvenile hallux valgus deformity.MethodsWe retrospectively reviewed the radiographs and clinical findings of young female patients with mild-to-moderate juvenile hallux valgus who underwent MIS (25 feet) or DCMO (30 feet). In 12 of 25 MIS feet, 2.0-mm bio-absorbable pins were used as an additional fixation device crossing the osteotomy site, and 1.4-mm Kirschner wires were used in the remaining 13 feet.ResultsRadiographic and clinical parameters preoperatively and at the final follow-up were not significantly different between the 2 groups. There were no significant differences in the increments of hallux valgus angle (HVA), distal metatarsal articular angle, medial sesamoid position, first metatarsal length, metatarsal length index, or relative second metatarsal length. Two MIS subgroups according to the additional fixation device showed no significant differences in HVA, the first to second intermetatarsal angle lateral translation ratio, or plantar offset at the final follow-up.ConclusionsMIS for young female patients with mild-to-moderate juvenile hallux valgus deformity had similar radiographic and clinical outcomes compared to DCMO. Regarding additional fixation crossing the osteotomy site, both temporary Kirschner wires and absorbable pins showed no radiographic differences in terms of correction maintenance.Level of evidence: 3.     

Hallux Valgus Surgery in the Athlete: Current Evidence

Hallux valgus is a common disorder characterized by a medial deviation of the 1st metatarsal, eventually leading to subluxation and pain of the 1st metatarsophalangeal joint. This can inhibit sports activity. Despite being a common forefoot pathology, debate exists regarding the appropriate surgical approach in the athletic population. Paucity in literature exists with reporting of outcomes of 1st metatarsal procedures leading to best outcomes. This review was able to identify 5 studies of surgical correction of hallux valgus in athletes published to date. The aim is to guide the physician in treating athletes with hallux valgus deformity. Currently, the literature supports distal 1st metatarsal osteotomy (Chevron) with a return to activity of approximately 3 months for mild to moderate deformity, and the Ludloff osteotomy for moderate to severe deformity at a slightly slower time frame of return to sports. At best, the Lapidus procedure allows approximately 80% of patients to return to activity. Studies need to document activity level and return to sport in order to help guide treatment.     

改良Chevron 截骨术治疗中重度足拇外翻

目的:探讨第1跖骨远端改良Chevron截骨治疗中重度拇外翻的方法和临床疗效.方法:2015年1月至2019年1月采用改良Chevron截骨结合第1跖趾关节外侧软组织松解手术治疗28例(30足)中重度拇外翻患者,其中男2例(2足),女26例(28足);年龄35 ～74 (57.3±9.3)岁;左侧10足,右侧16足;双...     

Three-dimensional computer analysis of the modified Ludloff osteotomy

BACKGROUND: The Ludloff first metatarsal osteotomy is used to correct the increased 1-2 intermetatarsal angle associated with hallux valgus deformity. We studied the spatial geometry of this osteotomy to determine the ideal parameters of the osteotomy saw cut and its rotation to give an optimal correction. METHODS: Three-dimensional computer modeling software was used to perform a virtual Ludloff osteotomy of the first metatarsal. Different geometric parameters of the osteotomy were studied. The osteotomy was rotated in virtual space and the geometric changes occurring in the virtual bone were then measured by the software. RESULTS: The optimal Ludloff osteotomy started at the dorsum of the first metatarsal base at the first tarsometatarsal joint and extended distally and plantarly to a point just proximal to the sesamoid articulation. A tilt of 10 degrees in the coronal plane of the osteotomy was necessary to limit first metatarsal head elevation. The best axis of rotation was within 5 mm of the proximal end of the osteotomy. CONCLUSIONS: The optimal geometric parameters of a modified Ludloff osteotomy limited first metatarsal shortening, elevation, and sagittal plane rotational malalignment that may occur with the use of this osteotomy.     

Die „Ludloff“-Osteotomie zur Korrektur der Hallux-valgus-Deformität

OBJECTIVE: Correction of a symptomatic hallux valgus deformity. INDICATIONS: A hallux valgus deformity in which the intermetatarsal angle I-II exceeds 15 degrees and the shaft of the first metatarsal is broad enough to allow a rotational osteotomy. CONTRAINDICATIONS: Hypermobility of the first ray. Severe osteoporosis. Degenerative arthritis of the first metatarsophalangeal joint. SURGICAL TECHNIQUE: Longitudinal incision over the first intermetatarsal space. Division of the metatarsosesamoid ligament together with the tendon of the adductor hallucis muscle. Opening of the lateral articular capsule of the first metatarsophalangeal joint allowing a tension-free realignment of the head of the first metatarsal with the sesamoids. Medial longitudinal incision along the first metatarsal starting over the medial cuneiform bone and ending at the proximal phalanx of the great toe. Oblique osteotomy of the proximal two thirds of the first metatarsal in a proximal dorsal to distal plantar direction and lateral rotation of the distal fragment around a proximally placed 3-mm AO screw. Additional fixation with one BOLD screw. Trimming of the protruding bone and of bunion. Medial metatarsophalangeal capsulorraphy. RESULTS: Between September 1998 and October 1999, 76 feet underwent a Ludloff osteotomy. Patients were followed up clinically and radiographically for 36 months (24-56 months). The mean hallux valgus angle was reduced from 37 degrees to 14 degrees and the mean intermetatarsal angle I-II from 18 degrees to 9 degrees. Using a four-point scale 81% of the patients were satisfied or very satisfied with the result of the operation. 95% of them felt no or very mild pain.