The treatment of iatrogenic hallux varus: analysis of clinical effect in 41 cases
10.3760/cma.j.cn114453-20210728-00324
- VernacularTitle:医源性 内翻的治疗：41例临床效果分析
- Author:
Wei MAO
1
;
Jianzhong ZHANG
;
Chao SUN
;
Xianjun WANG
Author Information
1. 首都医科大学附属北京同仁医院骨科，北京 100176
- Keywords:
Foot deformities;
Hallux varus;
Iatrogenic disease;
Osteotomy;
Reverse osteotomy;
Extensor hallucis brevis tenodesis;
Metatarsophalangeal joint fusion;
Later
- From:
Chinese Journal of Plastic Surgery
2022;38(9):1028-1034
- CountryChina
- Language:Chinese
-
Abstract:
Objective:The therapeutic methods and clinical efficacy of hallux varus were analyzed retrospectively, and further discussion was made to facilitate the selection of clinical treatment.Methods:The data of iatrogenic hallux varus patients who accepted surgery operation in Beijing Tongren Hospital from April 2002 to May 2012 were retrospectively analyzed. The conditions of the patients were researched comprehensively, using the following several ways to treat hallux varus deformity respectively: (1) soft tissue release(STR) combined with joint reconstruction of the lateral structure(JRLS); (2) reverse osteotomy(RO) combined with STR and JRLS; (3) metatarsophalangeal joint fusion(MJF); (4) interphalangeal joint fusion. JRLS mainly means hallux longus extensor partial tenodesis and extensor hallucis brevis tenodesis (EHBT). The hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), and the forefoot scores of American Orthopedic Foot and Ankle Society (AOFAS) were compared before and after procedures. The patients’ satisfaction with postoperative outcomes was statistically analyzed (not satisfied, in general, satisfied, very satisfied). Measurement data with normal distribution were expressed as Mean±SD, and comparison before and after operation was performed by paired t-test. Results:A total of 37 patients (41 feet) with iatrogenic hallux varus were enrolled, including 2 male and female 35 cases, aged 20-77 years old. (1) Operation method: 7 feet of STR combined with JRLS, 20 feet in which RO, STR combined with JRLS, 12 feet with MJF, 2 feet with interphalangeal joint fusion. Involving hallux longus extensor partial tenodesis (3 feet), EHBT (19 feet). (2) Analysis of surgical effect: the mean follow-up was 18.1 months (range, 12.5-24.0 months). Depend on the last survey, X-ray analysis showed that IMA and HVA were significantly improved after operation [(6.19±2.67)° vs. (2.97±2.03)°; (8.43±1.72)° vs. (-11.50±4.37) °; all P<0.01]. The AOFAS score increased from 56.39±18.78 preoperatively to 81.73±6.10 postoperatively ( P<0.01). The satisfaction survey of 41 feet with operation showed that 2 feet were not satisfied, 5 were generally satisfied, 28 were satisfied and 6 were very satisfied, the satisfaction rate was 82.9% (34/41). Conclusions:MJF is a standard choice for the treatment for rigid hallux varus with joint destruction. According to the conditions of patients, if need to preserve metatarsophalangeal joint, the operation should be combined with RO and STR. Depend on conditions of varus and stiffness, the operation may focus on reverse osteotomy or soft tissue surgery. Lateral structure reconstruction of metatarsophalangeal joint by EHBT has little negative effect on the function of the hallux, easy to operate, and good effect.
