Effectiveness of Percutaneous Proximal Closing Wedge Osteotomy With Akin Osteotomy to Correct Severe Hallux Valgus Determined by Radiographic Parameters

Kurashige, Toshinori; Suzuki, Sohtaro

doi:10.1177/1938640016668031

Cited by 13 publications

(6 citation statements)

References 21 publications

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“…Although minimally invasive techniques in foot and ankle surgery have become more popular, to date only few studies report in detail about the outcome after minimally invasive Akin osteotomy. 2,8,11,15 We present a comparative analysis of the effectiveness of open and minimally invasive Akin osteotomy using 2 different fixation techniques in direct comparison. We confirmed our first null hypothesis (H1) that both methods provide an equally sufficient HVI correction to normal range with no statistically significant differences in the resulting postoperative IPA measurements after 12 weeks (MI 4.8 degrees [SD 1.4] vs OS 5.0 degrees [SD 1.2]; P = .44).…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge only few studies investigated the outcome after minimally invasive Akin osteotomy with small case series and none of them in direct comparison to an open procedure. 2,11,15 This retrospective cohort study aimed to compare clinical and radiographic results of open vs minimally invasive Akin osteotomy using 2 different fixation methods (crossed K-wires vs double-threaded screw) and to analyze whether an intraoperative fracture of the lateral cortex causes loss of correction or delayed bone healing. We hypothesized that open and minimally invasive Akin osteotomy provide an equally sufficient HVI correction with no differences in the resulting postoperative angle measurements (H1, primary hypothesis).…”

Section: Introductionmentioning

confidence: 99%

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Minimally Invasive vs Open Akin Osteotomy

et al. 2020

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Background: Minimally invasive techniques of Akin osteotomy have grown in popularity, as early results suggest faster recovery, earlier return to work, and minimized wound healing problems. Preserving lateral cortex integrity during first phalanx osteotomy thereby presents a challenge because of the lack of direct visual control. This retrospective comparative study investigated clinical and radiographic outcomes of minimally invasive and open Akin osteotomy with different fixation methods and analyzed whether or not intraoperative violation of the lateral cortex caused loss of correction or delayed bone healing. Methods: One hundred eighty-four patients (210 feet) with symptomatic hallux valgus and pathologic interphalangeal angle (IPA) of at least 10 degrees underwent surgery combined with Akin osteotomy. Minimally invasive Akin osteotomies were fixed in 124 feet with 2 crossing percutaneous K-wires and compared to 86 Akin osteotomies by open technique with double-threaded (head and shank) screw fixation. At 1 day and 6 and 12 weeks postoperatively, IPA and bony consolidation were radiographically and clinically assessed. Results: Mean preoperative IPA was 13.4 ± 3.6 degrees in minimally invasive (MI) and 13.3 ± 3.5 degrees in open surgery (OS) cases ( P > .05). Intraoperative breach of the lateral cortex occurred in 12 (13.9%) in OS and 64 (51.6%) in MI cases. Whereas the breach occurred in open technique mainly during manual correction by applying a medial closing force, it was caused predominantly by the use of the burr in minimally invasive technique. After 12 weeks, the mean IPA was 4.1 ± 1.4 degrees in MI and 4.8 ± 1.2 degrees in OS cases ( P > .05). Bony consolidation was complete after 6 and 12 weeks in OS and MI, respectively. Three deep infections occurred in the OS Group after Lapidus arthrodesis and 2 deep infections were registered in the MI Group after minimally invasive chevron and Akin osteotomy. The infections were not at the site of the Akin osteotomy. Conclusion: Breach of the lateral cortex did not impair bone healing or correction of IPA. Minimally invasive Akin osteotomy with K-wire fixation provided equivalent correction of IPA compared to open surgery with screw fixation. Level of Evidence: Level III, retrospective comparative series.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Minimally Invasive vs Open Akin Osteotomy

et al. 2020

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“…The most important finding of the study was that the MI LR of the first MTP joint was a safe and reliable technique that was performed in cadavers without damaging any neurovascular structures or articular cartilage. Both the PATR and EPLR techniques aimed to release the adductor tendon, and they were successful in doing so without a significant Carvalho et al, 7 Martínez Nova et al, 30 Kurashige et al 22 Adductor hallucis tendon Biz et al, 4 Díaz Fernández, 15 Martinez Nova et al, 31 Cervi et al, 8 Pichierri et al 34 Adductor hallucis tendon and partial lateral capsule Scala et al 35 Phalangeal head of adductor tendon and adherences between lateral sesamoid and plantar side of the capsule De Lavigne et al 12 Adductor tendon, plantar capsule, and transverse metatarsal ligament Lee et al 23 Lateral part of the plantar plate and lateral phalangeal-sesamoid ligament Gicquel et al 18 Lateral phalangeal-sesamoid ligament and both medial and lateral suspensory ligaments Jowett et al 21 Lateral phalangeal-sesamoid ligament Lucas et al, 26 Crespo Romero et al, 10 Siclari et al, 37 Brogan et al 6 Not specified during technique description Bauer et al, 2,3 Di Giorgio et al 16 "Abductor" tendon transverse head and capsule difference (P = .85). The PATR was successful in achieving a complete release of the tendon, whereas the EPLR achieved a three-fourths release in most of the cases.…”

Section: Discussionmentioning

confidence: 99%

Anatomical Study of Minimally Invasive Lateral Release Techniques for Hallux Valgus Treatment

et al. 2020

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Background: Lateral release (LR) for the treatment of hallux valgus is a routinely performed technique, either by means of open or minimally invasive (MI) surgery. Despite this, there is no available evidence of the efficacy and safety of MI lateral release. Our aim was to study 2 popular techniques for MI LR in cadavers by subsequently dissecting the released anatomical structures. Methods: Twenty-two cadaveric feet were included in the study and allocated into 2 groups, 1 for each procedure: 1 group underwent a MI adductor tendon release (AR), and in the other group, an extensive percutaneous lateral release (EPLR) (adductor tendon, suspensory ligament, phalanx-sesamoid ligament, lateral head of flexor hallucis brevis, and deep transverse metatarsal ligament) was performed. Anatomical dissection was performed to identify neurovascular injuries and to verify the released structures. Results: Both techniques demonstrated to be effective in reproducing a MI LR. A satisfactory release of the adductor tendon was achieved equally in both techniques ( P = .85), being partial in most EPLR cases and full in the majority of AR cases. The EPLR was successful in releasing the intended additional structures ( P < .05). One case of inadvertent complete section of the flexor hallucis longus was identified in the percutaneous adductor tendon release group. No cases of dorsolateral nerve injury were seen with either of the techniques. Conclusion: Percutaneous lateral release was a reliable and accurate technique in this cadaveric model. The MI AR proved to be more effective in fully releasing the adductor tendon while the ER was intended and able to release a number of other structures. Clinical Relevance: MI LR is a safe procedure that could obviate the need for open surgery to achieve the same surgical goal. It can be associated to either open or MI osteotomies in the correction of hallux valgus.

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“…For HV deformities, we performed concurrently two minimally invasive chevron (Akin) osteotomies (MICA) 5 and one percutaneous proximal closing wedge metatarsal osteotomy, commonly referred to as "basal osteotomy," Akin osteotomy, and lateral release of the first metatarsophalangeal joint (MTPj) 6 (Fig. 1).…”

Section: Operative Techniquementioning

confidence: 99%

Minimally invasive surgery for interdigital and lateral fifth toe corns: Case reports

Kurashige¹

2021

Foot & Ankle Surgery: Techniques, Reports & Cases

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The most common locations of the corn are on top of the dorsal lateral aspect of the fifth toe and in the interdigital space between the fourth and fifth toes. Lateral fifth toe corns form as a result of extrinsic pressure from footwear. Interdigital corns form over the condyles of the phalanx between the toes, and can be soft and very painful in most cases. When conservative treatment fails, surgical treatment is indicated. Surgical treatment consists of partial or complete condylectomy and syndactylization. However, it is difficult to correct interdigital corns because of the narrow webspace and risk of painful postoperative scar. No prior study has been published on minimally invasive surgery for lateral fifth toe and interdigital corns, with the exception of some publications on the explanation of the technique. We investigated six toes from five patients using a minimally invasive surgical procedure that consisted of partial condylectomy with correction of associated deformities. We achieved successful results in the absence of major complications or recurrence during one year follow-up periods. This is the first case series that reports on minimally invasive surgery for painful toe corn.

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Effectiveness of Percutaneous Proximal Closing Wedge Osteotomy With Akin Osteotomy to Correct Severe Hallux Valgus Determined by Radiographic Parameters

Abstract: Therapeutic, Level IV: Case series.

Cited by 13 publications

References 21 publications

Minimally Invasive vs Open Akin Osteotomy

Minimally Invasive vs Open Akin Osteotomy

Anatomical Study of Minimally Invasive Lateral Release Techniques for Hallux Valgus Treatment

Minimally invasive surgery for interdigital and lateral fifth toe corns: Case reports

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