Objective To discuss the mechanisms and clinical effect of musculus extensor hallucis longus shifting in correcting hallux valgus (HV) deformity. Methods From April 2004 to December 2006,25 cases of HV (38 feet) were treated by musculus extensor hallucis longus shifing. There were 2 men and 23 women, aging from 22-60 years (mean 46.3 years).HV angle was 21.45° (mean 31.30°), intermetatarsal(IM) angle was 7-21° (mean 12.52°). The HV were corrected by cutting osteophyma of the first metatarsal bone, cutting transverse head of adductor pollicis, transferring musculus extensor hallucis longus and reconstructing its insertion. Results The patients were followed up 6-14 months after operation. HV angle and IM angle were 7.30°±2.62° and 6.50°±2.46° respectively, showing significantdifferences when compared with before operation (Plt;0.05). According to the American Orthopaedic Foot amp; Ankle Society (AOFAS) score system, the foot function was excellent in 25 feet, good in 7 feet and poor in 6 feet,and the excellent and good rate was 84.2%. Hallux varus occurred in 2 feet after 2 months of operation, metatarsophalangeal joint limitation of motion in 2feet after 3 months of operation, no HV recurred. ConclusionThe HV deforemity can be corrected by shifting the musculus extensor hallucis longus and reconstructing its insertion. It makes stress of metatarsophalangeal joint balance and prevent recurrance of HV deformity.
Objective To explore an effective micro-traumatechnic with small incision for hallux valgus. Methods From August 2002 to June 2004, 136 cases (263 feet) with hallux valgus were treated with micro-trauma technic with small incision and postoperative external elastic fixation. Of all the cases, 7 were males and 129 werefemales. Their ages ranged from 19 to 84 years. According to Coughlin classification, there were 24 gentle cases, 63 medium cases, and 49 severe cases. All the feet were with some degree of pain and flatfoot. Symptom, sign and theresults of X-ray were evaluated. Results Wound healed at stage Ⅰ.All cases were followed up for 8 to 26 months, 19 months on average. Hallux valgus of the 263 feet were completely healed, feet pain disappeared, and no nonunion or osteonecrosis was observed. Xray examination indicated that 105 feet’s hallux valgus angle was less than 12°, inter metatarsal angle less than 9°, and remedy subluxation of the tibial sesamoid less than 50%. Evaluation on the result indicated that there were 84 cases of excellent result, 48 cases of good result, 3 cases of fair result, and 1 case of poor result. The rate of excellent and good was 97%. Conclusion With less injury, less pain, complete restoration, and fewer possibility of relapse, microtrauma technic with small incision is effective in treating hallux valgus.
ObjectiveTo investigate the effectiveness of Youngswick-Akin osteotomy in the treatment of moderate hallux valgus combined with mild to moderate hallux rigidus. Methods The clinical data of 43 patients with moderate hallux valgus combined with mild to moderate hallux rigidus who were admitted between August 2019 and August 2022 and met the selection criteria were retrospectively analyzed. There were 8 males and 35 females. The age ranged from 28 to 77 years, with an average age of 59.0 years. The disease duration ranged from 10 to 35 months, with an average of 20 months. The degree of hallux rigidus included 2 cases of CoughlinⅠ degree, 29 cases of Ⅱ degree, 12 cases of Ⅲ degree. The preoperative hallux valgus angle ranged from 25° to 40°, with an average of 32°. All patients were treated with Youngswick-Akin osteotomy. The first metatarsophalangeal joint space was compared before operation and at 6 months after operation. The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were used to evaluate the functional recovery and pain relief of the patients before operation and at 6 and 24 months after operation. According to the severity of hallux rigidus, the patients were divided into mild group (Ⅰ, Ⅱ degree) and moderate group (Ⅲ degree) to compare the prognosis, including the changes of AOFAS score, VAS score, and the first metatarsophalangeal joint space. Results The operation time was 60-75 minutes (mean, 65 minutes). The intraoperative blood loss was 10-30 mL (mean, 20 mL). Two cases had superficial infection of the incision margin after operation, and healed well after dressing change and antibiotic treatment. The incisions of the other patients healed by first intention, and no medial cutaneous nerve injury of the great toe occurred. All patients were followed up 24-31 months, with an average of 25.8 months. The patient’s hallux valgus deformity was corrected without recurrence; no complication such as osteomyelitis and hallux varus occurred. The AOFAS score, VAS score, and the first metatarsophalangeal joint space after operation significantly improved when compared with those before operation, the AOFAS score and VAS score at 24 months after operation further improved when compared with those at 6 months after operation, and the differences were significant (P<0.05). The change of VAS score in mild group was significantly better than that in moderate group (P<0.05); but there was no significant difference in the changes of AOFAS score and the first metatarsophalangeal joint space between the two groups (P>0.05). ConclusionYoungswick-Akin osteotomy for moderate valgus deformity with mild to moderate hallux rigidus can achieve good functional recovery, pain relief, and joint space improvement.
ObjectiveTo explore the effectiveness and advantage of three-dimensional (3D) printed navigation templates assisted Ludloff osteotomy in treatment of moderate and severe hallux valgus.MethodsBetween April 2013 and February 2015, 28 patients (28 feet) with moderate and severe hallux valgus who underwent Ludloff osteotomy were randomly divided into 2 groups (n=14). In group A, the patients were treated with Ludloff osteotomy assissted with a 3D printed navigation template. In group B, the patients were treated with traditional Ludloff osteotomy. There was no significant difference in gender, age, affected side, and clinical classification between 2 groups (P>0.05). The operation time and intraoperative blood loss were recorded. The ankle function of the foot at preoperation, immediate after operation, and last follow-up were assessed by the American Orthopedic Foot and Ankle Society (AOFAS) score. Besides, the X-ray film were taken to assess the hallux valgus angle (HVA), intermetatarsal angle (IMA), and the first metatarsal length shortening.ResultsAll patients were followed up 18-40 months (mean, 26.4 months). The operation time and intraoperative blood loss in group A were significantly less than those in group B (P<0.05). The HVA, IMA, and AOFAS scores in groups A and B at immediate after operaton and last follow-up were sinificantly improved when compared with preoperative values (P<0.05); but no significant difference was found between at immediate after operation and at last follow-up (P>0.05). No significant difference was found in HVA and IMA between group A and group B at difference time points (P>0.05). There were significant differences in AOFAS score and the first metatarsal length shortening at immediate after operation and at last follow-up between 2 groups (P<0.05). Except 1 case of metastatic metatarsalgia in group B, there was no other operative complications in both groups.Conclusion3D printed navigation template assisted Ludloff osteotomy can provide accurate preoperative planning and intraoperative osteotomy. It is an ideal method for moderate and severe hallux valgus.
Objective To evaluate the primary cl inical effectiveness of Austin metatarsal osteotomy combined with transection of adductor muscle and transverse metatarsal l igament for treating mild or moderate hallux valgus through a single medial incision. Methods Between May 2006 and January 2009, 41 patients (45 feet) with mild or moderate hallux valgus were treated. There were 9 males (10 feet) and 32 females (35 feet) with an average age of 45.3 years (range, 23-71 years). The hallux valgus angle (HVA) was (33.1 ± 1.4)°, and the first and second inter-metatarsal angle was (20.4 ±1.1)°. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score of the affected foot’s function was 47.2 ± 3.7. A longitudinal medial incision was made at the first metatarsophalangeal joint. By the incision, Austin metatarsal osteotomy and lateral soft tissue release (including transection of adductor muscle and the transverse metatarsal l igament) were performed at the same time. Results During operation, 1 case had superficial peroneal nerve branch injury and suture repair was done microsurgically. All incisions healed by first intention postoperatively. All patients were followed up 16-36 months (mean, 26 months). Medial forefoot numbness occurred in 2 feet at 3 days after operation and rel ieved within 6 weeks. The X-ray films showed bone heal ing at osteotomy site within 8 weeks after operation. At last follow-up, the HVA was (10.7 ± 1.7)°, showing significant difference when compared with preoperative value (t=22.32, P=0.00), and the first and second inter-metatarsal angle was (12.1 ± 1.7)°, also showing significant difference when compared with preoperative value (t=21.17, P=0.03). The postoperative AOFAS ankle and hindfoot score of the affected foot’s function was 84.9 ± 4.5, showing significant difference when compared with preoperative score (t=20.75, P=0.01). No foot hallux varus, hallux valgus, or metatarsal necrosis occurred during follow-up. Conclusion The Austin metatarsal osteotomy combined with transection of adductor muscle, transverse metatarsal l igament through a single medial incision can effectively correct the mild or moderate hallux valgus, and avoid the scar and injury of deep peroneal nerve branches by traditional lateral incision.
Objective To compare effectiveness of multiple metatarsal osteotomy versus first metatarsophalangeal arthrodesis in treating severe metatarsal adductus hallux valgus deformity. Methods A retrospective analysis was conducted on the clinical data of 25 patients with severe metatarsal adductus hallux valgus deformity admitted between June 2010 and May 2014 who met the selective criteria. Among them, 15 patients underwent multiple metatarsal osteotomy (osteotomy group), while 10 patients underwent first metatarsophalangeal arthrodesis (fusion group). There was no significant difference between groups (P>0.05) in gender, age, disease duration, affected side, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score for pain, intermetatarsal angle (IMA), hallux valgus angle (HVA), or metatarsal adduction angle (MAA). The osteotomy group underwent fixation with screws and/or staples fixation, while the fusion group utilized anatomic fusion plates and trans-articular compression screws. The study compared the following outcome indicators between groups: operation time, pre- and post-operative differences (change values) in AOFAS scores, VAS scores, and radiographic parameters (HVA, MAA), osteotomy healing outcomes, and recurrence of hallux valgus deformity. Results Both surgical procedures were completed successfully. The operation time was significantly shorter in the fusion group than in the osteotomy group (P<0.05). All patients were followed up 96-144 months (mean, 116 months). The follow-up time was (129.1±7.2) months in the osteotomy group and (104.4±8.0) months in the fusion group, with no significant difference between groups (P>0.05). X-ray films revealed the radiographic union in two groups, and the fusion time was significantly shorter in the fusion group than in the osteotomy group (P<0.05). At last follow-up, both groups demonstrated significant improvements in AOFAS and VAS scores compared to preoperative levels (P<0.05). However, the differences in the change values of AOFAS and VAS scores between groups were not significant (P>0.05). During follow-up, 3 cases (20%) of deformity recurrence occurred in the osteotomy group, while no recurrence was observed in the fusion group. There was no significant difference in the incidences of deformity recurrence between groups (P>0.05). ConclusionFor severe metatarsus adductus hallux valgus deformities, both multiple metatarsal osteotomy and first metatarsophalangeal arthrodesis can correct the deformity. The former preserves metatarsophalangeal joint mobility but demands high technical proficiency from the surgeon, involves relatively longer operation times, extended bone healing periods, and higher complication incidences. The latter procedure is relatively simpler, facilitates faster postoperative recovery, allows early weight-bearing, and yields more reliable outcomes, though it sacrifices first metatarsophalangeal joint mobility.
Objective To investigate the relationship between hallux valgus and the indicators associated with medial cuneiform obliquity measured on feet weight-bearing anteroposterior X-ray films. Methods Based on the feet weight-bearing anteroposterior X-ray films taken between January 2018 and February 2021 and met the criteria, the hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsus adductus angle (MAA), metatarsus cuneiform angle (MCA), distal medial cuneiform angle (DMCA), and proximal metatarsal articular angle (PMAA) were measured and the morphology of the first tarsometatarsal (TMT) were recorded. According to the HVA, the X-ray films were divided into normal group (HVA<15°) and hallux valgus group (HVA≥15°). The gender, age, sides, IMA, MAA, MCA, DMCA, PMAA, and the morphology of TMT were compared between groups. The influencing factors of HVA and IMA were analyzed by multivariate linear regression analysis. Results X-ray films of 534 patients (679 feet) met the selection criteria and were included in the study. There were 220 males and 314 females, with an average age of 36 years (mean, 18-82 years). There were 154 cases (168 feet) in the normal group and 403 cases (511 feet) in the hallux valgus group. There were significant differences in gender and age between groups (P<0.05), and no significant difference in the side (P>0.05). The IMA, MAA, and MCA in the hallux valgus group were significantly bigger than those in the normal group (P<0.05); the difference in DMCA between the two groups was not significant (P>0.05). The TMT morphology of the two groups was mainly curved, and the difference in morphology classification was not significant (P>0.05). PMAA measurement showed that there were 3 kinds of metatarsal shapes: adductive metatarsal, neutral metatarsal, and abductive metatarsal, the difference in metatarsal shapes between groups was not significant (P>0.05). The PMAA of abductive metatarsal was significantly bigger in normal group than in hallux valgus group (P<0.05), there was no significant difference in PMAA of adductive metatarsal between groups (P>0.05). Multivariate linear regression analysis showed that age, MCA, and DMCA were the influencing factors of HVA (P<0.05), and age, MAA, MCA, and DMCA were the influencing factors of IMA (P<0.05). Conclusion The medial cuneiform obliquity is relatively constant and the DMCA can not be used as the characteristic angle to quantify hallux valgus. The morphology of TMT has no relationship with hallux valgus, while MAA, MCA, and PMAA are all factors to be considered, and MCA can be used as the characteristic angle to quantify hallux valgus.
Objective To evaluate the physiological function and the anatomic structure of the first metatarsophalangeal joint for the patient withhallux valgus after a remodeling operation with the Keller’s method. Methods From April 2004 to November 2006, the first metatarsophalangeal joints in 11 patients (22 feet) with hallux valgus were remodeled with the Keller’s operation. There were 3 males and 8 females, aged 5173 years. Accordingto the Piggot typing standard, there were 17 feet of type Ⅱ (deflexion) and 5 feet of type Ⅲ (semiluxation). The hallux valgus angles(HVAs) were 2449° (average, 37°). The intermetatarsal angles (IMAs) were 90135° (average, 115°). The curative effect and the anatomic structure were evaluated by the followup and the Xray examination. Results All the cases werefollowed up for 6 to 30 months after operation (average, 14 months). According to the standard of ZHU Li Hua, et al, the results were excellent in 18 feet,good in 3 feet, and poor in 1 foot. The Xray films showed that the first meta tarsophalangeal joint of 14 feet developed mortarlike false articulation, and 8 feet developed partial false articulation. HVAs were 716° (average, 11°).IMAs were 90135° (average, 11.5°). According to the Piggot typing standard, there were 12 feet of typeⅠ(fitter) and 10 feet of type Ⅱ (deflexion). Conclusion For the patients with hallux valgus, the remodeling ofthe first metatarsophalangeal joint by the Keller’s operation can rectify HVA, improve the stability of the joints, and prevent occurrence of the insufficient muscle strength after operation.
Severe hallux valgus, a triplanar foot deformity significantly impairing patients’ quality of life, has witnessed progressive advancements in surgical management. This article systematically reviews the therapeutic progress through literature analysis, encompassing modifications of conventional surgical procedures and applications of novel techniques and innovative biomaterials. A critical analysis and discussion of these technological advancements and future developmental directions are presented to provide valuable insights and references for clinical management of severe hallux valgus.
Objective To investigate the effectiveness of basal osteotomy of the first metatarsal combined with first metatarsophalangeal joint replacement for the treatment of hallux valgus combined with hallux rigidus. Methods A retrospective analysis was conducted on the medical records of 15 patients (16 feet) with hallux valgus combined with hallux rigidus who underwent first metatarsal basal osteotomy combined with first metatarsophalangeal joint replacement between May 2019 and December 2024. The patients included 1 male and 14 females, aged 60-80 years, with an average age of 68.5 years. According to the Mann classification of hallux valgus, 2 feet were moderate and 14 feet were severe. According to the Hallux Rigidus Coughlin grading, 12 feet were grade 3 and 4 feet were grade 4. The evaluation indicators included hallux valgus angle (HVA) and intermetatarsal angle (IMA) measured on weight-bearing X-ray film at preoperation and last follow-up; the American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were used to evaluate the improvement of walking function, metatarsophalangeal joint function, and pain relief in patients. Results All patients underwent surgery successfully without complications such as vascular or nerve injury during operation. One foot developed a superficial incisional infection postoperatively, which healed after dressing changes; the remaining 15 feet had primary incision healing. All patients were followed up 5-55 months, with an average of 17.5 months. All osteotomies achieved bony union, with a union time ranging from 8 to 13 weeks, averaging 11.8 weeks; no elevation of the first metatarsal was observed. At last follow-up, no complications such as prosthesis loosening, dislocation, fracture, toe shortening, bone dissolution, synovial reaction, or metatarsalgia was found. The appearance and function of the affected feet significantly improved, and the pain significantly relieved. At last follow-up, the HVA, IMA, AOFAS score, and VAS score showed significant differences when compared with preoperative values (P<0.05). Conclusion Basal osteotomy of the first metatarsal combined with first metatarsophalangeal joint replacement for the treatment of hallux valgus with hallux rigidus can correct deformities through osteotomy, restore the normal flexion-extension axis of the metatarsophalangeal joint, relieve pain, and preserve a certain degree of mobility, achieving good short- and mid-term effectiveness.