Is Our Current Paradigm for Evaluation and Management of the Bunion Deformity Flawed? A Discussion of Procedure Philosophy Relative to Anatomy

Dayton, Paul; Kauwe, Merrell; Feilmeier, Mindi

doi:10.1053/j.jfas.2014.09.010

Cited by 49 publications

(19 citation statements)

References 28 publications

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“…Numerous studies have shown that the metatarsal is not inherently deformed in hallux valgus, and that the anatomic CORA of the first ray lies at the first tarsometatarsal (TMT) joint. 5,14,15,18,24,25 The anatomic CORA must be considered when choosing the optimal correction method for hallux valgus in order to reduce potential recurrence and prevent the formation of secondary deformities.…”

Section: Introductionmentioning

confidence: 99%

Multicenter Early Radiographic Outcomes of Triplanar Tarsometatarsal Arthrodesis With Early Weightbearing

et al. 2019

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Background:Hallux valgus is a multiplanar deformity of the first ray. Traditional correction methods prioritize the transverse plane, a potential factor resulting in high recurrence rates. Triplanar first tarsometatarsal (TMT) arthrodesis uses a multiplanar approach to correct hallux valgus in all 3 anatomical planes at the apex of the deformity. The purpose of this study was to investigate early radiographic outcomes and complications of triplanar first TMT arthrodesis with early weightbearing.Methods:Radiographs and charts were retrospectively reviewed for 57 patients (62 feet) aged 39.7 ± 18.9 years undergoing triplanar first TMT arthrodesis at 4 institutions between 2015 and 2017. Patients were allowed early full weightbearing in a boot walker. Postoperative radiographs were compared with preoperative radiographs for hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position (TSP), and lateral round sign. Any complications were recorded.Results:Radiographic results demonstrated significant improvements in IMA (13.6 ± 2.7 degrees to 6.6 ± 1.9 degrees), HVA (24.2 ± 9.3 degrees to 9.7 ± 5.1 degrees), and TSP (5.0 ± 1.3 to 1.9 ± 0.9) from preoperative to final follow-up ( P < .001). Lateral round sign was present in 2 of 62 feet (3.2%) at final follow-up compared with 52 of 62 feet (83.9%) preoperatively. At final follow-up, recurrence was 3.2% (2/62 feet), and the symptomatic nonunion rate was 1.6% (1/62 feet). Two patients required hardware removal, and 2 patients required additional Akin osteotomy.Conclusion:Early radiographic outcomes of triplanar first TMT arthrodesis with early weightbearing were promising with low recurrence rates and maintenance of correction.Level of Evidence:Level IV, retrospective case series.

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Section: Introductionmentioning

confidence: 99%

Multicenter Early Radiographic Outcomes of Triplanar Tarsometatarsal Arthrodesis With Early Weightbearing

et al. 2019

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“…We believe the lack of significant and sustained change in the sagittal plane is likely to be due to the center of rotation of angulation (CORA) not being at the osteotomy site, and that one utilizes an osteotomy to correct a largely soft tissue-driven pathology. 2 That pathology is complex and not fully understood when considered in the context of a concomitant pes planus deformity. 1,3,5 The surgical technique used was as per the previously published descriptions from your unit.…”

Section: Dear Editormentioning

confidence: 99%

Response to “Letter Regarding: Pes Planus Deformity and Its Association With Hallux Valgus Recurrence Following Scarf Osteotomy”

Heyes¹,

Mason²,

Molloy³

2021

Foot Ankle Int.

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“…The medial prominence at the first MTP joint is due to increased prominence of the first metatarsal head. 22,47,66,70,90 Concomitant Disorders Metatarsus adductus. The prevalence of metatarsus adductus is high in patients with hallux valgus.…”

Section: Pathophysiologymentioning

confidence: 99%

Hallux Valgus

Ray

Friedmann

Hanselman

et al. 2019

Foot & Ankle Orthopaedics

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Hallux valgus is a common condition that results from a complex positional deformity of the first ray. The bunion or medial prominence that results from the lateral deviation and pronation of the hallux is only one component of the 3-dimensional deformity. Hallux valgus can lead to considerable pain and altered joint mechanics. The precise biomechanical etiology remains under debate. Predisposing factors include female sex, age, constricting footwear, and family history. Metatarsus adductus, equinus contracture, hammertoe deformity, and pes planus often coexist with hallux valgus. Nonoperative treatment involves patient education, shoe modifications, toe pads and positioning devices, and activity modifications. Surgery is considered in patients who fail nonoperative treatment with the goal of pain relief, correction of the deformity, improved first ray stability, and improved quality of life. More than 100 different procedures have been described to treat hallux valgus; they include combinations of soft tissue balancing, metatarsal osteotomies, and fusion of either the metatarsophalangeal (MTP) or tarsometatarsal (TMT) joint. The choice of procedures depends on the severity and location of the deformity as well as surgeon preference. Recent advances in operative techniques include minimally invasive surgery and correction of rotational deformity.

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Is Our Current Paradigm for Evaluation and Management of the Bunion Deformity Flawed? A Discussion of Procedure Philosophy Relative to Anatomy

Cited by 49 publications

References 28 publications

Multicenter Early Radiographic Outcomes of Triplanar Tarsometatarsal Arthrodesis With Early Weightbearing

Multicenter Early Radiographic Outcomes of Triplanar Tarsometatarsal Arthrodesis With Early Weightbearing

Response to “Letter Regarding: Pes Planus Deformity and Its Association With Hallux Valgus Recurrence Following Scarf Osteotomy”

Hallux Valgus

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