PROCEDURE OF RECONSTRUCTING TRANSVERSE ARCH OF THE FOREFOOT BY TRANSFERING TENDONS FOR CORRECTING HALLUX VALGUS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANXingchao , LIUJianfeng , LIUBin ,  LIUZhigang , PANYuehai , JIAXiaoyan , ZHANGYanan , SHAOJiangbo

Department of Hand and Foot Surgery, the First Hospital of Jilin University, Changchun Jilin, 130021, P. R. China;

Corresponding author：

LIUZhigang, Email: lzgn678@163.com

Keywords：

Hallux valgus; Transverse arch of forefoot; Adductor hallucis tendon; Abductor hallucis tendon

DOI：

10.7507/1002-1892.20150089

Video：

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Objective To explore the effectiveness of the procedure of reconstructing the transverse arch of the forefoot by anastomosing adductor hallucis and abductor hallucis tendons in correcting hallux valgus. Methods A retrospective analysis was made on the clinical data from 28 patients (40 feet) with hallux valgus treated with the procedure of reconstructing the transverse arch of the forefoot by anastomosing adductor hallucis and abductor hallucis tendons between January 2010 and January 2014. There were 3 males (6 feet) and 25 females (34 feet), with an average age of 51.7 years (range, 20-71 years). The unilateral foot was involved in 16 cases and bilateral feet in 12 cases. The mean disease duration was 8.9 years (range, 1-30 years). All the cases had pain of the first metacarpophalangeal joint; 22 feet had collapsed transverse arch of the forefoot combined with plantar callus, and 8 feet had collapsed transverse arch of the forefoot combined with hammer toe deformity. American Orthopaedic Foot and Ankle Society (AOFAS) score was 59.07±8.49. Preoperative X-ray showed that the hallux valgus angle (HVA) was (33.68±8.10)°, and the intermetatarsal angle (IMA) was (15.60±4.07)°. According to classification of the hallux valgus by Mann, 9 feet were rated as mild, 23 feet as moderate, and 8 feet as severe. Results Superficial infection of incision occurred in 1 case (1 foot) after surgery, and healing by first intention was obtained in the others. Two cases (3 feet) had numbness in the toes. All of 28 cases were followed up from 6 months to 4 years (1.8 years on average). Based on the AOFAS score, the results were excellent in 24 feet, good in 9 feet, fair in 4 feet, and poor in 3 feet, and the excellent and good rate was 82.5%. At last follow-up, the HVA, IMA, and AOFAS score were (15.10±5.28)°, (9.05±2.42)°, and 86.03±7.45 respectively, showing significant differences compared with preoperative ones (P=0.00). The collapsed transverse arch of the forefoot was recovered to some extent, plantar callus disappeared (14 feet), or decreased (8 feet). Recurrence of hallux valgus deformity was observed in 2 cases (3 feet) at 2 and 3 months after surgery respectively, and no hallux varus was found. Conclusion This procedure not only can effectively reduce the increased hallux valgus angle, and narrow the angle between the 1st and 2nd metatarsal, but also can relocate the sesamoid system, reconstruct the transverse arch of the forefoot, and effectively restore the physiological anatomy structure and biological function of the forefoot.

Citation： YANXingchao, LIUJianfeng, LIUBin, LIUZhigang, PANYuehai, JIAXiaoyan, ZHANGYanan, SHAOJiangbo. PROCEDURE OF RECONSTRUCTING TRANSVERSE ARCH OF THE FOREFOOT BY TRANSFERING TENDONS FOR CORRECTING HALLUX VALGUS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(4): 412-415. doi: 10.7507/1002-1892.20150089 Copy

1.	Collan L, Kankare JA, Mattila K. The biomechanics of the first metatarsal bone in hallux valgus:a preliminary study utilizing a weight bearing extremity CT. Foot Ankle Surg, 2013,19(3):155-161.
2.	Mortier JP, Bernard JL, Maestro M. Axial rotation of the first metatarsal head in a normal population and hallux valgus patients. Orthop Traumatol Surg Res, 2012, 98(6):677-683.
3.	郄淑燕, 张庆民, 张致媛, 等. 拇外翻对前足底压力分布的改变. 医学生物力学, 2010, 25(3):224-229.
4.	Suzuki J, Tanaka Y, Takaoka T, et al. Axial radiographic evaluation in hallux valgus:evaluation of the transverse arch in the forefoot. J Orthop Sci, 2004, 9(5):446-451.
5.	Yavuz M, Hetherington VJ, Botek G, et al. Forefoot plantar shear stress distribution in hallux valgus patients. Gait Posture, 2009, 30(2):257-259.
6.	Galica AM, Hagedorn TJ, Dufour AB, et al. Hallux valgus and plantar pressure loading:the Framingham foot study. J Foot Ankle Res, 2013, 6(1):42.
7.	Nix S, Smith M, Vicenzino B. Prevalence of hallux valgus in the general population:a systematic review and meta-analysis. J Foot Ankle Res, 2010, 3:1-9.
8.	厉亚男, 王湘达, 王英振, 等. 改良型McBride矫形手术治疗足拇外翻的效果.青岛大学医学院学报, 2014, 50(6):552-554.
9.	王玉发, 高明, 马洪顺. 拇展肌与拇收肌移位吻接术前、后黏弹性实验研究. 北京生物医学工程, 2007, 26(5):535-539.
10.	王正义. 足踝外科学. 北京:人民卫生出版社, 2007:465-466.
11.	S.Terry Canale, James H. Beaty. 坎贝尔骨科手术学. 王岩, 译. 北京:人民军医出版社, 2013:3539-3591.
12.	戴鹤玲, 温建民, 孙天胜, 等. 拇趾外翻足临床疗效评价标准. 中国骨与关节损伤杂志, 2010, 25(12):1151-1152.
13.	史思峰, 董扬. 拇外翻主要病理改变及组织修复方法的选择. 中国组织工程研究与临床康复, 2009, 13(50):9958-9961.
14.	Perera AM, Mason L, Stephens MM. The pathogenesis of hallux valgus. J Bone Joint Surg (Am), 2011, 93(17):1650-1661.
15.	Iaremenko DA. Methods of study of the "transverse arch"of the foot. Orthop Trauma Protez, 1967, 28(2):20-24.
16.	鲍根喜, 王旭, 夏新雷, 等. 正常足步态周期中动态足横弓形态的初步分析.中国矫形外科杂志, 2001, 8(4):375-377.
17.	Simonsen O, Vuust M, Understrup B, et al. The transverse forefoot arch demonstrated by a novel X-ray projection. Foot and Ankle Surgery, 2009, 15(1):7-13.
18.	鲍根喜, 王旭, 顾湘杰, 等. 足横弓形态的动态分析与外翻的关系研究. 中华骨科杂志, 2001, 21 (3):134-136.
19.	宋朝晖, 张英泽, 张奉琪, 等. 正常足与外翻足横弓形态的对比性研究. 中国矫形外科杂志, 2005, 13(24):1873-1875.
20.	马昕, 顾湘杰, 陈劲松, 等. 正常足与外翻足的足横弓三维形态比较. 中华骨科杂志, 1998, 18(5):274-277.
21.	石凯, 刘志刚. "跖袖"的解剖学特点及临床意义. 中国临床解剖学杂志, 2007, 25(3):266-271.
22.	张英泽, 张奉琪, 韩久卉, 等. 长伸肌腱移位动力性矫正外翻畸形. 中国修复重建外科杂志, 2007, 21(11):1171-1174.

1. Collan L, Kankare JA, Mattila K. The biomechanics of the first metatarsal bone in hallux valgus:a preliminary study utilizing a weight bearing extremity CT. Foot Ankle Surg, 2013,19(3):155-161.
2. Mortier JP, Bernard JL, Maestro M. Axial rotation of the first metatarsal head in a normal population and hallux valgus patients. Orthop Traumatol Surg Res, 2012, 98(6):677-683.
3. 郄淑燕, 张庆民, 张致媛, 等. 拇外翻对前足底压力分布的改变. 医学生物力学, 2010, 25(3):224-229.
4. Suzuki J, Tanaka Y, Takaoka T, et al. Axial radiographic evaluation in hallux valgus:evaluation of the transverse arch in the forefoot. J Orthop Sci, 2004, 9(5):446-451.
5. Yavuz M, Hetherington VJ, Botek G, et al. Forefoot plantar shear stress distribution in hallux valgus patients. Gait Posture, 2009, 30(2):257-259.
6. Galica AM, Hagedorn TJ, Dufour AB, et al. Hallux valgus and plantar pressure loading:the Framingham foot study. J Foot Ankle Res, 2013, 6(1):42.
7. Nix S, Smith M, Vicenzino B. Prevalence of hallux valgus in the general population:a systematic review and meta-analysis. J Foot Ankle Res, 2010, 3:1-9.
8. 厉亚男, 王湘达, 王英振, 等. 改良型McBride矫形手术治疗足拇外翻的效果.青岛大学医学院学报, 2014, 50(6):552-554.
9. 王玉发, 高明, 马洪顺. 拇展肌与拇收肌移位吻接术前、后黏弹性实验研究. 北京生物医学工程, 2007, 26(5):535-539.
10. 王正义. 足踝外科学. 北京:人民卫生出版社, 2007:465-466.
11. S.Terry Canale, James H. Beaty. 坎贝尔骨科手术学. 王岩, 译. 北京:人民军医出版社, 2013:3539-3591.
12. 戴鹤玲, 温建民, 孙天胜, 等. 拇趾外翻足临床疗效评价标准. 中国骨与关节损伤杂志, 2010, 25(12):1151-1152.
13. 史思峰, 董扬. 拇外翻主要病理改变及组织修复方法的选择. 中国组织工程研究与临床康复, 2009, 13(50):9958-9961.
14. Perera AM, Mason L, Stephens MM. The pathogenesis of hallux valgus. J Bone Joint Surg (Am), 2011, 93(17):1650-1661.
15. Iaremenko DA. Methods of study of the "transverse arch"of the foot. Orthop Trauma Protez, 1967, 28(2):20-24.
16. 鲍根喜, 王旭, 夏新雷, 等. 正常足步态周期中动态足横弓形态的初步分析.中国矫形外科杂志, 2001, 8(4):375-377.
17. Simonsen O, Vuust M, Understrup B, et al. The transverse forefoot arch demonstrated by a novel X-ray projection. Foot and Ankle Surgery, 2009, 15(1):7-13.
18. 鲍根喜, 王旭, 顾湘杰, 等. 足横弓形态的动态分析与外翻的关系研究. 中华骨科杂志, 2001, 21 (3):134-136.
19. 宋朝晖, 张英泽, 张奉琪, 等. 正常足与外翻足横弓形态的对比性研究. 中国矫形外科杂志, 2005, 13(24):1873-1875.
20. 马昕, 顾湘杰, 陈劲松, 等. 正常足与外翻足的足横弓三维形态比较. 中华骨科杂志, 1998, 18(5):274-277.
21. 石凯, 刘志刚. "跖袖"的解剖学特点及临床意义. 中国临床解剖学杂志, 2007, 25(3):266-271.
22. 张英泽, 张奉琪, 韩久卉, 等. 长伸肌腱移位动力性矫正外翻畸形. 中国修复重建外科杂志, 2007, 21(11):1171-1174.

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Chinese Journal of Reparative and Reconstructive Surgery

PROCEDURE OF RECONSTRUCTING TRANSVERSE ARCH OF THE FOREFOOT BY TRANSFERING TENDONS FOR CORRECTING HALLUX VALGUS

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