P J Juliano, M S Myerson, B W Cunningham
Each of six below-the-knee amputation specimens were transfixed to a wooden block and mounted to a jig on an amputee testing device preloaded with 5 N applied to the proximal phalanx and displaced at a constant rate of 2 mm/min. Load displacement curves were generated for the intact joint and after sequential incisions of the lateral capsule, the adductor hallucis, and the lateral slip of the flexor hallucis brevis tendon, which caused varus dislocation of the hallux. An extensor hallucis brevis tenodesis was performed after the varus dislocation...
January 1996: Foot & Ankle International
D W Prieskorn, R A Mann, G Fritz
Hypermobility of the first metatarsal cuneiform joint has been implicated as a cause of the hallux valgus deformity. The objective definition of hypermobility at this joint, however, has not been clearly defined. We used a modified Coleman block test to accentuate motion at the first metatarsal cuneiform joint in order to measure physiologic limits of motion in vivo. This motion was compared with radiographic analysis of the feet, which included the hallux valgus angle, intermetatarsal angle, and medial cortical thickening at the midshaft of the second metatarsal...
June 1996: Foot & Ankle International
M E Easley, G M Kiebzak, W H Davis, R B Anderson
In this study, intermetatarsal angle (IMA) correction, functional outcome, and healing time for the proximal crescentic and proximal chevron osteotomies in moderate to severe hallux valgus deformity were prospectively compared. Seventy-five patients (97 feet) were prospectively randomized to either a proximal crescentic or proximal chevron osteotomy for the correction of moderate to severe hallux valgus deformity with associated metatarsus primus varus. Criteria for study entry included age (adult patients), IMA greater than or equal to 13 degrees, persistent symptoms despite nonoperative treatment, and minimum follow-up of 12 months...
June 1996: Foot & Ankle International
M J Coughlin
In an 11-year retrospective study of 45 patients (60 feet) with juvenile hallux valgus, a multiprocedural approach was used to surgically correct the deformity. A Chevron osteotomy or McBride procedure was used for mild deformities, a distal soft tissue procedure with proximal first metatarsal osteotomy was used for moderate and severe deformities with MTP subluxation, and a double osteotomy (extra-articular correction) was used for moderate and severe deformities with an increased distal metatarsal articular angle (DMAA)...
November 1995: Foot & Ankle International
Y Tourné, D Saragaglia, F Picard, B De Sousa, E Montbarbon, A Charbel
Hallux varus occurs most frequently as a result of excessive surgical correction of musculoligamentous imbalance around the metatarsophalangeal (MTP) joint of the great toe (lateral release and medial capsuloligamentous tensioning). If untreated, the condition may lead to motion loss and degenerative arthritis. In this series, 14 cases of hallux varus were treated. Medial arthrolysis was done in each case. In five cases, reconstruction of the lateral ligament (with a 1.5-mm Ligapro suture), using a new technique, accompanied the medial release...
August 1995: Foot & Ankle International
S Eustace, J O'Byrne, J Stack, M M Stephens
This study describes a method of detecting first metatarsal pronation on the basis of the movement of the inferior tuberosity of the base of 20 cadaveric first metatarsals at 0 degrees, 10 degrees, 20 degrees and 30 degrees pronation. On pronation, the inferior tuberosity of the base of the first metatarsal moved lateral to the mid-line axis. At 10 degrees, the tuberosity pointed to the junction of the inner third and outer two-thirds of a line between the midpoint and lateral tubercle of the base. At 20 degrees, it pointed to the junction of the inner two-thirds and outer third of that line...
1993: Skeletal Radiology
A Wanivenhaus, W Brettschneider
We reviewed 63 feet after plain subcapital osteotomy for simultaneous correction of hallux valgus and metatarsus primus varus. Results were evaluated clinically and by radiographs and force plate measurements. Eighty-three percent of the patients were satisfied with their surgery. The hallux valgus angle was improved by 9.3 degrees and the intermetatarsal angle by 6 degrees. The osteotomy resulted in a displacement of the metatarsal head in the lateral direction (10 mm) and in the plantar direction (11.3 mm)...
February 1993: Foot & Ankle
G J Sammarco, B J Brainard, V J Sammarco
Fifty-one cases of moderate to severe bunion deformity with hallux valgus and metatarsus primus varus in 43 patients were treated by bunionectomy, proximal Chevron metatarsal osteotomy, lateral capsulotomy, adductor tenotomy, and lashing of first and second metatarsals together. The hallux valgus angle improved an average of 19 degrees from 33 degrees (mean) preoperatively to 14 degrees (mean) postoperatively. The intermetatarsal angle improved an average of 7.3 degrees from an average of 14 degrees preoperatively to an average of 6 degrees postoperatively...
January 1993: Foot & Ankle
S J Mubarak, T J O'Brien, J R Davids
Longitudinal epiphyseal bracket (LEB) is a rare ossification anomaly in which an epiphysis brackets the diaphysis of a phalanx, metacarpal, or metatarsal. This abnormal epiphysis tethers longitudinal growth, resulting in a shortened and oval-shaped bone. Four patients with five LEBs were treated by central physiolysis and followed for a mean of 6 years. The patients had significant hallux varus deformity. Three patients had duplicated great toes, and two had tibia hemimelia significant enough to require epiphysiodesis as they neared adolescence...
January 1993: Journal of Pediatric Orthopedics
F D Goldman, J Siegel, E Barton
The authors describe radiographic results from nine patients in whom hallux varus was repaired by transferring the extensor hallucis longus tendon (EHLT) under the deep transverse intermetatarsal ligament into the proximal-lateral base of the proximal phalanx. X-ray films revealed clinically significant changes in biomechanical relations, specifically in the hallux abductus angle. No clinically significant changes were seen in the intermetatarsal angle. The EHLT transfer procedure described is a valuable surgical alternative for correction of iatrogenic hallux varus deformity when combined with the appropriate adjunctive procedures...
March 1993: Journal of Foot and Ankle Surgery
A Osterwalder, G Maestretti
The procedure known as the Metatarsus Primus Double Osteotomy ("L'ostéotomie métatarsienne bipolaire" of Schnepp-Carret) for the treatment of the hallux valgus is a logical, efficient and non-mutilating procedure. The technique consists in reducing the hallux valgus deformity by a subcapital bone wedge resection of the metatarsus primus. The bone wedge is then pinched into a second proximal osteotomy of the metatarsus primus, correcting the varus deformity in a valgus direction. This procedure is little known and is not even mentioned in the classic orthopedic literature of German and English language...
September 1993: Helvetica Chirurgica Acta
A K Sharma, A Haldar, S R Phadke, S S Agarwal
We describe a father and his daughter who had a unique pattern of preaxial brachydactyly, and unusual facial appearance. Both had short broad abducted thumbs and halluces. The second digits of both hands were also short and broad and those of feet were medially angulated. The radiographic findings were short first metacarpals and first metatarsals and hypoplastic phalanges of first two digits of hands and feet. A similar pattern of brachydactyly was described by Christian et al. [1972: Am J Hum Genet 24:694-701] and Mononen et al...
February 1, 1994: American Journal of Medical Genetics
L Loretz, S DeValentine, K Yamaguchi
A retrospective analysis of the distal "L" osteotomy with bunionectomy (Reverdin-Laird procedure) for correction of hallux abducto valgus was performed. Sixty-nine cases meeting strict eligibility and exclusion criteria underwent evaluation an average of 33.51 months after the procedure. The evaluation included radiographs, physical examination, patient survey, and medical record review. The average decreases in radiographic angles were as follows: Hallux abductus: 19.97 degrees, relative intermetatarsal angle: 7...
November 1993: Journal of Foot and Ankle Surgery
V J Hetherington, S L Shields, K R Wilhelm, D M Laporta, B J Nicklas
A study was undertaken to evaluate the use of ORTHOSORB absorbable pin fixation for distal first ray osteotomies, in the management of hallux valgus. Data presented include 20 osteotomies fixated with ORTHOSORB absorbable pins in a crossing fashion, performed in 14 patients with an average follow-up period of 11 months. The patient population presented with an average age of 30, all were female. The patient pool was evaluated for hallux abductus, metatarsus primus varus, tibial sesamoid position, quality and quantity of range of motion at the first metatarsophalangeal joint, metatarsalgia, and osteolysis, both before and after surgery...
May 1994: Journal of Foot and Ankle Surgery
T Tiamfook, D J Sartoris, J Goldberg
Bone radiographs of 15 males who underwent a toe-hand transplant were studied to characterize alterations in the biomechanics of the foot after the procedure. Anteroposterior, lateral, and sesamoid radiographic views were used. Previous research has assessed this surgery clinically; however, this is one of the first investigations of this technique using conventional radiographs. Definite trends were observed on the operative foot, including stress reaction, disuse osteopenia, arch angle changes, and alignment alterations...
May 1994: Journal of Foot and Ankle Surgery
T C Skalley, M S Myerson
Forty two patients (45 feet) who underwent operative correction of acquired hallux varus were retrospectively evaluated. The causes of hallux varus included complications after hallux valgus surgery (36), trauma (3), rheumatoid arthritis (3), unknown (2), and osteoarthritis (1). The methods of surgical correction were determined by the underlying etiology, the age and activity level of the patient, and the site of primary deformity. Surgical corrections included medial soft tissue release alone (2), medial soft tissue release combined with tendon transfer (17), metatarsal osteotomy with (1) or without (1) additional tendon transfer, arthrodesis (17), and resection arthroplasty (7)...
September 1994: Clinical Orthopaedics and related Research
D A Peterson, J L Zilberfarb, M A Greene, R C Colgrove
The incidence of avascular necrosis of the metatarsal head following distal first metatarsal osteotomy combined with adductor tendon release has not been documented in a large series of patients. Of 82 consecutive procedures in 64 patients performed between 1986 and 1988, 42 patients (58 procedures) were available for clinical and radiographic examination. Average follow-up was 2.5 years (range 1.0-4.2 years). There were 35 L-shaped and 23 chevron osteotomies which were combined with a lateral soft tissue release that included adductor tenotomy...
February 1994: Foot & Ankle International
L C McCluskey, J E Johnson, G T Wynarsky, G F Harris
Proximal metatarsal osteotomies are often performed in patients with hallux valgus and significant metatarsus primus varus. The crescentic osteotomy is popular; however, some authors have reported malunion of the metatarsal shaft caused by dorsal angulation of the osteotomy in a significant number of cases. Recently, proximal transverse "V" osteotomies have been reported to have good results, with rapid healing and no dorsal malunions. We compared the stability of a transverse, proximal "V" osteotomy, using two 0...
May 1994: Foot & Ankle International
W M Granberry, C H Hickey
Adult hallux varus is an uncommon clinical entity usually caused by an inflammatory arthropathy or overcorrection during bunion reconstruction. We present five cases of unexplained spontaneous hallux varus. Clinically, all patients initially were found to have flexible deformities, and no evidence of underlying inflammatory disease or history of trauma. Symptoms were easily relieved with shoe wear modifications. Two of the patients developed more rigid deformities and subsequent medial callusing of the first toe and varus deformities of the lesser toes...
April 1994: Foot & Ankle International
R Jawish
MATERIAL AND METHODS: Open wedge osteotomy of the first cuneiform was used for correction of metatarsus varus primus. The osteotomy interested the medial, dorsal and plantar face of the first cuneiform, but lateral cortex should be carefully left intact, it is used like a hinge for opening the osteotomy. This procedure is carried out when varus of the tarsometatarsal joint is superior to 20 degree, it is reduced to its normal value, between 5 and 10 degree. Osteotomy is stabilized with bone graft...
1994: Revue de Chirurgie Orthopédique et Réparatrice de L'appareil Moteur
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