Bunions

Rotation of the first metatarsal, as a component of hallux abducto valgus, is rarely discussed and is not addressed as a component of most hallux valgus corrective procedures. We believe frontal plane rotation of the first metatarsal to be an integral component of hallux abducto valgus deformity (the "third plane of deformity") and believe de-rotation is necessary for complete deformity correction. We observed the change in angular measurements commonly used in the evaluation of hallux valgus deformity in patients who underwent a modified lapidus procedure...

BACKGROUND: The modified Lapidus procedure is an accepted treatment option for patients with moderate to severe hallux valgus. Placing a plate plantar on the tension side of the arthrodesis has been shown to be biomechanically superior and has provided good clinical results. There is some concern about interference of the plantar placed plates on the tendon insertions. The purpose of this study was to determine a "safe zone" for plantar plate placement without irritation of the tendons...

We describe a rare case, never before published, of migration of a Kirschner wire used for fusion of the proximal interphalangeal in a lesser toe in a 67-year-old female into the calcaneum. This patient presented to the orthopedic clinic 6 months after elective surgery complaining of pain in her right foot. Radiographs of the foot revealed that the Kirschner wire had migrated toward the calcaneum. Computed tomography of the right foot demonstrated the Kirschner wire within the calcaneum.

BACKGROUND: For hallux valgus correction, distal first metatarsal osteotomy is generally used for minor to moderate deformities, diaphyseal osteotomy for moderate deformities and basal osteotomy or arthrodesis for severe deformities. With the advent of locking plates, there has been renewed interest in opening wedge basal osteotomy. OBJECTIVE: We undertook this study in order to understand the power and limitations of this osteotomy. METHOD: Proximal opening wedge osteotomies were performed on saw bone models in four orientations, with three different wedge sizes: (1) perpendicular to the ground (PG); (2) perpendicular to the shaft (PS); (3) perpendicular to shaft with 30° declination (DEC); (4) 30° oblique (OB)...

BACKGROUND: Obesity is a global epidemic, but its effect on foot and ankle surgeries is not well defined. This study aimed to investigate the influence of obesity on functional outcome scores, incidence of postoperative surgical site infection (SSI), and repeat surgery after hallux valgus (HV) corrective surgery. METHODS: Between January 2007 and December 2011, 452 patients who underwent HV corrective surgery at a tertiary hospital were evaluated. They were categorized into 2 groups based on their body mass index (BMI): (1) BMI less than 30 kg/m(2) (control); (2) BMI 30 kg/m(2) or more (obese)...

PURPOSE: The aim of this study was to compare clinical and radiographic outcomes of proximal opening wedge osteotomy using a straight versus oblique osteotomy. MATERIALS AND METHODS: We retrospectively reviewed 104 consecutive first metatarsal proximal opening wedge osteotomies performed in 95 patients with hallux valgus deformity. Twenty-six feet were treated using straight metatarsal osteotomy (group A), whereas 78 feet were treated using oblique metatarsal osteotomy (group B)...

The presence of intercuneiform instability is not routinely inspected within the overall surgical management of hallux valgus and has therefore been underreported as a potential cause of recurrence. We sought to demonstrate the incidence of this unique type of proximal instability to state its potential importance in the correction and definitive management of hallux valgus in patients with moderate to severe intermetatarsal angles with superimposed hypermobility. A total of 34 patients underwent 38 tarsometatarsal arthrodeses for hallux valgus correction and were retrospectively reviewed for 36 months from May 2007 to May 2010...

To better understand the safety of suture techniques to reduce the intermetatarsal angle in patients with hallux valgus deformity, we undertook a systematic review of the complications associated with the use of this technique. The suture procedures of 197 patients were analyzed for complications. The number of complications in the total group (n = 197) at a pooled mean follow-up period of 23.2 months was 39 (19.8%) and included 21 fractures (10.7%), 11 cases of hardware failure (5.6%), and 7 cases of hallux varus (3...

Joplin's neuroma is a rare perineurial fibrosis of the medial plantar digital proper nerve arising from various etiologies but most commonly after bunion surgery. Treatment for this painful great toe problem remains controversial. It is our purpose to describe our experience with this chronic pain problem, considering it to be a neuroma requiring resection. A retrospective medical record review of 8 patients with medial hallux pain related to the digital nerve was performed. Each patient had failed to respond to >6 months of nonoperative therapy...

Of the >100 procedures that have been proposed to treat hallux valgus or the "bunion" deformity, most have focused on correction through metatarsal osteotomies at various levels combined with soft tissue balancing procedures at the first metatarsophalangeal joint. This paradigm of metatarsal osteotomy and soft tissue balancing has been so commonplace, any argument for a fundamental change to the approach becomes uncomfortable and seems unwarranted to most foot and ankle surgeons. However, the simple fact that so many procedures exist, with so many modifications of these procedures, can be interpreted as a failure of our basic paradigm of metatarsal osteotomy and soft tissue balancing...

Absorbable devices for use in internal fixation have advanced over the years to become reliable and cost-effective alternatives to metallic hardware. In the past, biodegradable fixation involved a laborious implantation process, and induced osteolysis and inflammatory reactions. Modern iterations exhibit increased strength, smoother resorption, and lower rates of reactivity. A newer generation manufactured from silk has emerged that may address existing limitations and provide a greater range of fixation applications...

PURPOSE: First tarsometatarsal joint (TMTJ) arthrodesis is known as a powerful operative procedure to correct moderate to severe hallux valgus deformity. However, there is little evidence about actual complication rates and angular correctional power. The aims of the present study were to evaluate the (1) angular correction power and (2) complication rates of pooled data for this procedure and to perform subgroup analysis of different methods of fixation. METHODS: A systematic search for the MeSH terms "(hallux OR bunion) AND (lapidus OR TMT OR tarsometatarsal OR metatarsocuneiform) AND (fusion OR arthrodesis)" with use of the online databases MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews was conducted...

BACKGROUND: We conducted a prospective randomized trial to compare the most popular osteotomy types of operative treatment of hallux valgus (HV) used in Norway, Mitchell's osteotomy (MO) and chevron osteotomy (CO). METHODS: One hundred twenty adult female patients were prospectively randomized to treatment with either MO or CO. All operative procedures were performed with ankle block and with tourniquet applied. None of the patients received any antibiotic or antithrombotic prophylaxis...

BACKGROUND: The operative treatment for the moderate to severe bunion continues to present challenges. The indications for a single, double, or triple first ray osteotomy remain controversial. In addition, it is not clear whether an opening wedge osteotomy leads to clinically relevant arthritis at the first metatarsophalangeal joint. However, it is this theoretical concern that has led the authors to develop an isometric correction of the first ray. METHODS: Thirty-two patients underwent operative correction of hallux valgus with a double osteotomy of the first metatarsal using an opening wedge proximally and a closing wedge distally...

BACKGROUND: Despite modern advancements in transosseous fixation and operative technique, hallux valgus (i.e., bunion) surgery is still associated with a higher than usual amount of patient dissatisfaction and is generally recognized as a complex and nuanced procedure requiring precise osseous and capsulotendon balancing. It stands to reason then that familiarity and skill level of trainee surgeons might impact surgical outcomes in this surgery. The aim of this study was to determine whether podiatry resident experience level influences midterm outcomes in hallux valgus surgery (HVS)...

Proximal first metatarsal osteotomies have historically been associated with and limited to treatment of severe hallux valgus deformities. These procedures are powerful in deformity correction and overall realignment of first ray function because of their ability to correct closer to the deformity's origin. When considering all factors in bunion correction, they are good options for correction of a wide range of hallux abducto valgus deformities. This article discusses the use of proximal metatarsal osteotomies for correction of hallux valgus deformity, techniques to facilitate optimal outcome, and common complications of these osteotomies...

Arthrodesis of the first metatarsophalangeal joint (MTPJ) has commonly been used for the treatment of a variety of first MTPJ disorders, including hallux valgus. We undertook a systematic review of the electronic databases and other relevant sources to identify material relating to the reduction of the first intermetatarsal angle (IMA) after first MTPJ arthrodesis. Fifteen studies with a total of 701 first MTPJ arthrodesis procedures were identified that met the inclusion criteria. Our results showed the mean preoperative IMA was 13...

BACKGROUND: Lapidus arthrodesis with a plate and a compression screw is an established procedure in hallux valgus surgery. The present study was performed to investigate the potential benefit of a compression screw combined with a plantarly applied angle-stable, anatomically precontoured plate or a dorsomedially applied angle-stable plate. METHODS: In six pairs of human cadaver specimens, one specimen each was randomized to receive a dorsomedial H-shaped plate, while the other received a plantar plate...