Abstract:Adolescent hallux valgus is a common problem, and there is no agreement about the best surgical technique to use to correct this deformity. Excellent results have been reported with a distal soft tissue procedure and an associated osteotomy at the base of the first metatarsal. The current study reports the early results of using an incomplete osteotomy at the base of the first metatarsal. No hardware was used to fix the osteotomy, and the postoperative immobilization was shorter. The study included 20 feet in … Show more
“…In total, 115 papers were retrieved from the initial search strategy. Nine studies met the inclusion criteria and are included in this study [ 10 – 18 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…All nine articles measured pre- and post-operative HVA and IMA. Two articles [ 11 , 18 ] did not measure the DMAA.…”
Section: Resultsmentioning
confidence: 99%
“…Numerous surgical techniques have been described to correct hallux valgus in the general population, and this considerable diversity is also reflected in the paediatric cohort [ 5 ]. In the nine articles included in this study, three used the scarf first metatarsal osteotomy [ 13 – 15 ]; two used a proximal metatarsal osteotomy [ 10 , 16 ]; one chevron distal metatarsal osteotomy [ 11 ]; one double metatarsal osteotomy [ 17 ]; one modified Simmonds–Menelaus procedure (whereby the bone fragment from the bunionectomy is used as a graft inserted into a proximally based first metatarsal opening wedge osteotomy without any internal fixation) [ 18 ]; one percutaneous technique for achieving correction, whereby a distal osteotomy and bunionectomy were performed through a small stab incision medially, a lateral soft-tissue release using a Beaver blade via a laterally based incision and a proximal phalanx wedge osteotomy via a second medial incision; finally, if the IMA was greater than 18°, a dorsal wedge osteotomy at the base of the metatarsal was performed through a dorsal approach [ 12 ]. Of the 201 operated feet, only 19 (9.5 %) were reported to have also had a proximal phalanx closing wedge (Akin) osteotomy.…”
Section: Resultsmentioning
confidence: 99%
“…Six articles did describe additional soft-tissue procedures, but there was heterogeneity between the papers’ techniques. Gicquel et al [ 12 ] performed releases of the sesamoid-phalangeal and sesamoid-metatarsal ligaments, whereas Andreacchio et al [ 18 ] released the adductor tendon and re-sutured it to the metatarsal head, as well as a transverse metatarsal ligament release and capsular shortening. Okuda et al [ 10 ] also released the adductor tendon and transverse metatarsal ligament, but the capsule was plicated with the abductor tendon.…”
Section: Resultsmentioning
confidence: 99%
“…On the duPont BRS, three studies [ 16 – 18 ] reported on a total of 69 feet (50 patients). In total, 19/69 (28 %) rated their outcome as excellent, 43/69 (62 %) as good, 6/69 (9 %) as fair and 1/69 (1 %) rated their results as poor.…”
PurposeThe management of adolescent hallux valgus (AHV) remains controversial, with reservations about both conservative and surgical treatments. Non-operative management has a limited role in preventing progression. Surgical correction of AHV has, amongst other concerns, been associated with a high prevalence of recurrence of deformity after surgery. We conducted a systematic review to assess clinical and radiological outcomes following surgery for AHV.MethodsA comprehensive literature search was performed in the Cochrane Library, CINAHL, EMBASE, Google Scholar and PubMed. The study was performed in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Demographic data, radiographic parameters and results of validated clinical scoring systems were analysed.ResultsThe published literature on AHV is largely heterogeneous and retrospective. Nine contemporary studies reporting on 140 patients (201 osteotomies) were included. The female to male ratio was 10:1. The mean age at operation was 14.5 years (range 10.5–22). The mean follow-up was 41.6 months (range 12–134). The mean post-operative American Orthopaedic Foot and Ankle Society (AOFAS) score was 85.8 (standard deviation, SD ±7.38). The mean AOFAS patient satisfaction showed that 86 % (SD ±11.27) of patients were satisfied or very satisfied with their outcome. On the duPont Bunion Rating Score (BRS), 90 % rated their outcome as good or excellent. There was a statistically significant improvement in the inter-metatarsal angle (IMA, p = 0.0003), hallux valgus angle (HVA, p < 0.0001) and distal metatarsal articular angle (DMAA, p = 0.019).ConclusionBased on the most current published evidence, contemporary surgical interventions for AHV show excellent clinical and radiological outcomes, with high patient satisfaction. The rates of recurrence and other complications are lower than the historically reported figures. There is a need for high-level, multi-centre collaborative studies with prospective data to establish the long-term outcomes and optimal surgical procedure(s).
“…In total, 115 papers were retrieved from the initial search strategy. Nine studies met the inclusion criteria and are included in this study [ 10 – 18 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…All nine articles measured pre- and post-operative HVA and IMA. Two articles [ 11 , 18 ] did not measure the DMAA.…”
Section: Resultsmentioning
confidence: 99%
“…Numerous surgical techniques have been described to correct hallux valgus in the general population, and this considerable diversity is also reflected in the paediatric cohort [ 5 ]. In the nine articles included in this study, three used the scarf first metatarsal osteotomy [ 13 – 15 ]; two used a proximal metatarsal osteotomy [ 10 , 16 ]; one chevron distal metatarsal osteotomy [ 11 ]; one double metatarsal osteotomy [ 17 ]; one modified Simmonds–Menelaus procedure (whereby the bone fragment from the bunionectomy is used as a graft inserted into a proximally based first metatarsal opening wedge osteotomy without any internal fixation) [ 18 ]; one percutaneous technique for achieving correction, whereby a distal osteotomy and bunionectomy were performed through a small stab incision medially, a lateral soft-tissue release using a Beaver blade via a laterally based incision and a proximal phalanx wedge osteotomy via a second medial incision; finally, if the IMA was greater than 18°, a dorsal wedge osteotomy at the base of the metatarsal was performed through a dorsal approach [ 12 ]. Of the 201 operated feet, only 19 (9.5 %) were reported to have also had a proximal phalanx closing wedge (Akin) osteotomy.…”
Section: Resultsmentioning
confidence: 99%
“…Six articles did describe additional soft-tissue procedures, but there was heterogeneity between the papers’ techniques. Gicquel et al [ 12 ] performed releases of the sesamoid-phalangeal and sesamoid-metatarsal ligaments, whereas Andreacchio et al [ 18 ] released the adductor tendon and re-sutured it to the metatarsal head, as well as a transverse metatarsal ligament release and capsular shortening. Okuda et al [ 10 ] also released the adductor tendon and transverse metatarsal ligament, but the capsule was plicated with the abductor tendon.…”
Section: Resultsmentioning
confidence: 99%
“…On the duPont BRS, three studies [ 16 – 18 ] reported on a total of 69 feet (50 patients). In total, 19/69 (28 %) rated their outcome as excellent, 43/69 (62 %) as good, 6/69 (9 %) as fair and 1/69 (1 %) rated their results as poor.…”
PurposeThe management of adolescent hallux valgus (AHV) remains controversial, with reservations about both conservative and surgical treatments. Non-operative management has a limited role in preventing progression. Surgical correction of AHV has, amongst other concerns, been associated with a high prevalence of recurrence of deformity after surgery. We conducted a systematic review to assess clinical and radiological outcomes following surgery for AHV.MethodsA comprehensive literature search was performed in the Cochrane Library, CINAHL, EMBASE, Google Scholar and PubMed. The study was performed in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Demographic data, radiographic parameters and results of validated clinical scoring systems were analysed.ResultsThe published literature on AHV is largely heterogeneous and retrospective. Nine contemporary studies reporting on 140 patients (201 osteotomies) were included. The female to male ratio was 10:1. The mean age at operation was 14.5 years (range 10.5–22). The mean follow-up was 41.6 months (range 12–134). The mean post-operative American Orthopaedic Foot and Ankle Society (AOFAS) score was 85.8 (standard deviation, SD ±7.38). The mean AOFAS patient satisfaction showed that 86 % (SD ±11.27) of patients were satisfied or very satisfied with their outcome. On the duPont Bunion Rating Score (BRS), 90 % rated their outcome as good or excellent. There was a statistically significant improvement in the inter-metatarsal angle (IMA, p = 0.0003), hallux valgus angle (HVA, p < 0.0001) and distal metatarsal articular angle (DMAA, p = 0.019).ConclusionBased on the most current published evidence, contemporary surgical interventions for AHV show excellent clinical and radiological outcomes, with high patient satisfaction. The rates of recurrence and other complications are lower than the historically reported figures. There is a need for high-level, multi-centre collaborative studies with prospective data to establish the long-term outcomes and optimal surgical procedure(s).
ObjectiveThis study aimed to present a treatment algorithm for the correction of the hallux valgus deformity in Cerebral Palsy (CP) patients and to discuss the outcomes based on our clinical and radiological results.Methods29 patients (45 feet) were included in the study. The mean age of the patients at the time of the surgery was 14 (range 6–22) years. The mean follow-up was 33 (range 22–59) months. A reconstructive procedure was performed on 19 patients (27 feet); a soft tissue surgery and exostectomy of the bunion in six patients (11 feet); and MTP joint arthrodesis in four patients (7 feet). The hallux valgus angle (HVA) and the anteroposterior intermetatarsal angle (IMA) were used for radiologic evaluation and the DuPont Bunion Rating Score was used for clinical evaluation.ResultsThe follow-up period was 36 (range 22–59) months in reconstructive group, 27 (range 24–29) months in soft tissue group, and 29 (range 23–41) months in MTP arthrodesis group. Significant improvements were detected in hallux valgus angle in three groups postoperatively but in soft tissue group correction loss was observed during follow up. Best results were achieved in arthrodesis group and worse in soft tissue group in terms of clinical evaluation.ConclusionAccording to our results isolated soft tissue procedures are ineffective in CP patients. Soft tissue procedure combined with metatarsal osteotomy has satisfactory results.Level of evidenceLevel IV, therapeutic study.
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