Distal Metatarsal Osteotomy for Moderate to Severe Hallux Valgus

Cassinelli, Spenser J.; Herman, R.; Harris, Thomas J.

doi:10.1177/1071100716667280

Cited by 19 publications

(20 citation statements)

References 22 publications

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“…Varismo metatarsal acentuado, subluxação articular, pronação excessiva do hálux e intensa retração das estruturas capsuloligamentares laterais são alguns dos obstáculos a serem vencidos para alcançar uma correção satisfatória (6,12,14,(18)(19)(20) . A literatura mostra que, para a maioria dos casos de deformidades graves em hálux valgo, os tratamentos cirúrgicos mais utilizados são as osteotomias metatarsais proximais ou diafisárias, a artrodese de Lapidus e a artrodese metatarsofalangiana do hálux (6) . As osteotomias metatarsais distais, na maior parte dos estudos, são reservadas aos casos leves e moderados, pois, teoricamente, apresentam um menor poder de correção do varismo do primeiro metatarso (6,13) .…”

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“…A literatura mostra que, para a maioria dos casos de deformidades graves em hálux valgo, os tratamentos cirúrgicos mais utilizados são as osteotomias metatarsais proximais ou diafisárias, a artrodese de Lapidus e a artrodese metatarsofalangiana do hálux (6) . As osteotomias metatarsais distais, na maior parte dos estudos, são reservadas aos casos leves e moderados, pois, teoricamente, apresentam um menor poder de correção do varismo do primeiro metatarso (6,13) . Porém, já em 2008, Murawski relata bons resultados e baixo índice de complicações em uma série de 37 casos operados pela osteotomia de Chevron distal modificada, com translações laterais do fragmento capital de até 90% (5,21) .…”

Section: Discussionunclassified

“…A doença é multifatorial e a hereditariedade é o principal fator associado, visto que aproximadamente 68% dos pacientes têm antecedente familiar. A dor e o desconforto para o uso de calçados fechados estão presentes em muitos casos, acarretando limitações para as atividades cotidianas e impactando nos índices de qualidade de vida (1)(2)(3)(4)(5)(6) .…”

Section: Introductionunclassified

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Surgical treatment of moderate and severe hallux valgus: 30 cases undergoing surgery using the percutaneous Chevron technique

Silva

Baptista

2018

scijfootankle

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Objetivo: Avaliar a correção dos parâmetros radiográficos e a melhora clínica da deformidade em hálux valgo moderada e grave, tratadas pela osteotomia de Chevron percutânea. Métodos: Foram operados 26 pacientes (30 pés). Foram mensurados no pré-operatório e pós-operatório: ângulo metatarsofalangiano do hálux (MTF), ângulo intermetatarsal entre o 1 o e 2 o metatarsos (AIM), ângulo da articulação metatarsal distal (AAMD) e os escores AOFAS pré e pós-operatórios com seguimento mínimo de 6 meses. Resultados: A idade média dos pacientes foi de 52,3 anos. No pré-operatório, a média do escore AOFAS foi de 45,6, passando a 90,3 após o procedimento, com melhora estatisticamente significativa. As médias pré-operatórias dos ângulos MTF, AIM e AAMD foram respectivamente de 29,7°, 14,2° e 14,2° e as pós-operatórias foram 12,8°, 8,2° e 11,1°. A melhora nos ângulos MTF e AIM também apresentaram relevância estatística. Não houve qualquer perda nos parâmetros angulares ou piora nos escores AOFAS durante o seguimento. Conclusão: A técnica cirúrgica de Chevron percutâneo se mostrou segura e eficaz para a correção dos casos de hálux valgo moderado e grave, com melhora significativa dos parâmetros clínicos e radiográficos e baixo índice de complicações pós-operatórias.

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Section: Discussionunclassified

Section: Introductionunclassified

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Surgical treatment of moderate and severe hallux valgus: 30 cases undergoing surgery using the percutaneous Chevron technique

Silva

Baptista

2018

scijfootankle

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“…Once conservative measures have failed, distal first metatarsal (MT I) osteotomies (e.g. ReveL) are well established techniques to correct hallux valgus deformities [2][3][4]. The principal technique of these operations is to osteotomize the MT I and to shift the distal part laterally along the plumb line of the second metatarsal in the transverse plane [4].…”

Section: Introductionmentioning

confidence: 99%

Augmented Reality Guided Osteotomy in Hallux Valgus Correction

Viehöfer

Wirth

Zimmermann

et al. 2020

Preprint

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Background An optimal osteotomy angle avoids shortening of the first metatarsal bone after hallux valgus surgery and therefore reduces the risk of transfer-metatarsalgia. The purpose of the present ex-vivo study was to investigate whether augmented reality (AR) would improve accuracy of the distal osteotomy during hallux valgus surgery. Methods Distal osteotomies of the first metatarsals were performed on a foot model by two surgeons with different levels of surgical experience each with (AR, n=15x2) or without (controls, n=15x2) overlay of a hologram depicting an angle of osteotomy perpendicular to the second metatarsal. Subsequently, the deviation of the osteotomy angle in the transverse plane was analyzed. Results Overall, the AR decreased the range of impression and the AR guided osteotomies were more accurate (4.9 ± 4.2°) compared to the freehand cuts (6.7± 6.1°) by tendency (p=0.2). However, while the inexperienced surgeon performed more accurate osteotomies with AR with a mean angle of 6.4± 3.5° compared to freehand 10.5 ± 5.5° (p=0.02), no significant difference was noticed for the experienced surgeon with an osteotomy angle of around 3° in both cases. Conclusion This pilot-study suggests that AR guided osteotomies can potentially improve accuracy during hallux valgus correction, particularly for less experienced surgeons.

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“…Nevertheless, there is no single gold standard treatment. 1,4 Despite the ability to achieve good correction with proximal and distal osteotomies, these procedures have inherent risks such as malunion, nonunion, metatarsal shortening, transfer metatarsalgia, loss of fixation, and avascular necrosis of the first metatarsal head. 7,2 In addition, these procedures are designed to alter osseous alignment and, in the case of osteotomies, entail extra-articular correction of an intraarticular deformity.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Hallux Valgus Deformity Using a Suture Button Device: A Preliminary Report

Gonzalez

Smith

Bluman

et al. 2018

Foot & Ankle Orthopaedics

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Background: Hallux valgus (HV) is commonly treated with proximal or distal first metatarsal osteotomy. Despite good correction, these procedures have inherent risks such as malunion, nonunion, metatarsal shortening, loss of fixation, and avascular necrosis. Suture button fixation has been used for HV treatment. It avoids the risks of corrective osteotomies while maintaining reduction of the intermetatarsal angle (IMA). The goal of this study was to assess the radiographic and functional outcomes of patients undergoing HV correction with a distal soft tissue procedure and proximal suture button fixation. Methods: The authors retrospectively reviewed the charts and radiographs of 22 patients who had undergone HV correction using a distal soft tissue correction and proximal fixation with a miniature suture button device (Mini TightRope; Arthrex, Inc, Naples, FL). Mean follow-up was 27.7 months. The IMA, hallux valgus angle (HVA), and sesamoid station were measured on radiographs obtained preoperatively as well as in the immediate postoperative period and at final follow-up. Preoperative and postoperative Short Form-36 (SF-36) and Foot and Ankle Ability Measure (FAAM) scores were collected. Postoperative complications, and any additional operative procedures performed were also recorded. Results: The mean preoperative IMA and HVA were 16.9 and 32.6 degrees, respectively. The mean immediate postoperative IMA was 5.2 degrees (P < .0001) and the mean HVA was 9.8 degrees (P < .0001). At final follow-up, the mean IMA was 8.2 degrees (P < .0001) and the mean HVA was 16.7 degrees (P < .0001). The average change in HVA from preoperative to final follow-up was 16.0 degrees and the average change in IMA from preoperative to final follow-up was 8.6 degrees (P < .0001). Sesamoid station assessment at the 2-week follow-up showed that 22 patients (100%) were in the normal position group; at final follow-up, 17 patients (77%) had normal position and 5 patients (23%) had displaced position. Although there were no clinically symptomatic recurrences, asymptomatic radiographic recurrence was noted in 5 patients (23%) who had a final HVA >20 degrees. All components of the FAAM and the SF-36 showed improvement from preoperative to final follow-up, although these changes were not statistically significant. Three patients experienced complications, including an intraoperative second metatarsal fracture, a postoperative second metatarsal stress fracture, and a postoperative deep vein thrombosis. Conclusion: The use of a distal soft tissue procedure in conjunction with proximal suture button fixation is a safe and effective procedure for treating symptomatic HV deformity. Our results show that this technique can correct the IMA, HVA, and sesamoid station without the need for osteotomy. Level of evidence: Level IV.

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Distal Metatarsal Osteotomy for Moderate to Severe Hallux Valgus

Abstract: Level V, expert opinion.

Cited by 19 publications

References 22 publications

Surgical treatment of moderate and severe hallux valgus: 30 cases undergoing surgery using the percutaneous Chevron technique

Surgical treatment of moderate and severe hallux valgus: 30 cases undergoing surgery using the percutaneous Chevron technique

Augmented Reality Guided Osteotomy in Hallux Valgus Correction

Treatment of Hallux Valgus Deformity Using a Suture Button Device: A Preliminary Report

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