Operative treatment of hallux valgus – the effect of three osteotomy types on the first metatarsal, hallux valgus and metatarsal distal articulation angles
Abstract
Background: Modern approach to hallux valgus deformations enables not only the stage treatment considering the magnitude of the deformity but also the objective evaluation of the results.We investigated the influence of the three most commonly used osteotomies on three most common demonstrative factors, especially proximal osteotomy on the distal metatasal articulation angle.
Methods: Three groups were created regarding the magnitude of the deformation. X rays of 15 corrections in each group were reviewed (45 cases, 34 women, 2 men). Each group was treated with only one of the three osteotomies: distal chevron osteotomy (Ch), distal chevron osteotomy with medial edge (ChM) and proximal osteotomy (POT). The effect on the three most comonly used demonstrative factors were noted: first intermetatarsal angle (IM), hallux valgus angle (HV), distal metatarsal articulation angle (DMAA). The age and the demonstrative factors were compared pre- and postoperative, in and between the groups.
Results: The correct, graded selection of the patients for the treatment was confirmed and false negative results excluded. Preoperative values of HV and DMAA are significantely different between three groups (p < 0.001) while IM are not (p = 0.118). Postoperative values of the HV and IM are significantely lower in all three groups (p < 0.001). DMAA is statisticaly different (positive) postoperatively in the ChM group (p < 0.001) but not in the Ch and POT groups (P = 0.398; p = 0.456).
Conclusions: Modern approach on hallux valgus deformations enables stage treatment and objective evaluation of the results what is demonstrated by the effect of the osteotomies on the demonstrative factors. Further investigations of the factors not yet considered or even unknown are also possible as shown on the example of the difference between the expected and measured effect of POT on DMAA.
Downloads
References
Mann RA. Decision making in hallux valgus surgery. In: Wulker N, ed. Surgical skills course-Surgical treatment of foot & ankle disorders. Frankfurt: International institute of foot and ankle surgeons; 1998.
Prlja A. Stopenjsko operativno zdravljenje haluks valgusa. In: Čad G, ed. 1. kongres ortopedov Slovenije z mednarodno udeležbo; 2000 Jun 10; Portorož, Slovenija, Ljubljana: Cankarjev dom, kulturni in kongresni center, 2000
Pinney S, Song K, Chou L. Surgical treatment of mild hallux valgus deformity: the state of practice among academic foot and ankle surgeons. Foot Ankle Int 2006; 27: 970–3.
Pinney SJ, Song KR, Chou LB. Surgical treatment of severe hallux valgus: the state of practice among academic foot and ankle surgeons. Foot Ankle Int 2006; 27: 1024–28.
Dereymaeker G. Anatomy and biomechanics of hallux valgus. In: Trnka HJ, ed. First instructional course of the European foot and ankle society; 1999 Okt 1-2; Vienna, Austria.Vienna: European Foot and Ankle Society; 1999.
Coughlin MJ. Hallux valgus in men: effect of the distal metatarsal articular angle on hallux valgus correction. Foot Ankle Int 1997; 18: 463–70.
Coughlin MJ, Carlson RE. Treatment of hallux valgus with an increased distal metatarsal articulation angle: evaluation of double and triple first ray osteotomies. Foot Ankle Int 1999; 20: 762–70.
Monga P, Kumar A, Simons A. Outcome following surgery for hallux valgus: the patients’ perspective. Foot Ankle Surgery 2006; 12: 95–8.
Thordason DB, Rudicel SA, Ebramzadeh E, Gill LH. Outcome study of hallux valgus surgery-an AOFAS multi-center study. Foot Ankle Int 2001; 22: 956–9.
Tanaka Y, Takakura Y, Sugimoto K, Kumai T, Sakamoto T, Kadono K. Precise anatomic configuration changes in the first ray of the hallux valgus foot. Foot Ankle Int 2000 21: 651–6.
Munuera PV, Dominguez G, Polo J, Rebollo J. Medial deviation of the first metatarsal in incipient hallux valgus deformity. Foot Ankle Int 2006; 27: 1030–5.
Coughlin MJ, Freund E. The reliability of angular measurements in hallux valgus deformities. Foot Ankle Int 2001; 22: 369–79.
Schneider W, Csepan R, Knahr K. Reproducibility of the radiographic metatarsophalangeal angle in hallux surgery. J Bone Joint Surg 2003; 85: 494–9.
Faber FWM, Kleinrensink GJ, Mulder PGH, Verhaar JAN. Mobility of the first tarsometatarsal joint in hallux valgus patients: a radiographic analysis. Foot Ankle Int 2001; 22: 965–9.
Robinson AHN, Cullen NP, Chhaya NC, Sri-Ram K, Lynch A. Variation of the distal metatarsal articular angle with axial rotation and inclination of the first metatarsal. Foot Ankle Int 2006; 27: 1036–40.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
