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.
Humans ; Male ; Female ; Hallux Valgus/diagnostic imaging* ; Osteotomy/methods* ; Aged ; Middle Aged ; Metatarsophalangeal Joint/surgery* ; Retrospective Studies ; Hallux Rigidus/diagnostic imaging* ; Aged, 80 and over ; Metatarsal Bones/surgery* ; Treatment Outcome ; Arthroplasty, Replacement/methods*

OBJECTIVE: To 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). CONCLUSION Youngswick-Akin osteotomy for moderate valgus deformity with mild to moderate hallux rigidus can achieve good functional recovery, pain relief, and joint space improvement.
Humans ; Osteotomy/methods* ; Hallux Valgus/diagnostic imaging* ; Male ; Female ; Middle Aged ; Hallux Rigidus/diagnostic imaging* ; Retrospective Studies ; Adult ; Aged ; Treatment Outcome ; Metatarsophalangeal Joint/surgery*

OBJECTIVE: To summarize the effectiveness of orthopedic surgery for patients with moderate and severe hallux valgus and analyze its related influencing factors. METHODS: A clinical data of 247 patients (287 feet) with moderate and severe hallux valgus, who were admitted between January 2013 and October 2024 and met the selection criteria, was retrospectively analyzed. There were 39 males and 208 females, with a median age of 57 years (range, 19-89 years). There were 207 cases of single-foot involvement and 40 cases of double-foot involvement; 159 feet were moderate hallux valgus and 128 feet were severe hallux valgus. The disease duration ranged from 3 months to 25 years, with a median of 5 years and 8 months. The hallux valgus angle (HVA), the intermetatarsal angle (IMA), proximal articular set angle (PASA), and the American Orthopaedic Foot and Ankle Society (AOFAS) scores were measured before operation and at 6 months after operation, and the differences (change values) between pre- and post-operation were calculated. All patients were grouped according to the degree of preoperative hallux valgus deformity and age, and the patients with severe hallux valgus according to different surgical procedures, and the change values of HVA, IMA, and AOFAS scores were compared between groups. All patients were grouped according to postoperative HVA, then the postoperative AOFAS scores were compared between groups. RESULTS: All patients successfully completed the operations and were followed up 6 months to 11 years and 3 months, with an average of 4 years and 6 months. The HVA, IMA, PASA, and AOFAS scores at 6 months after operation showed significant improvement compared to preoperative levels, and the differences were significant ( P<0.05). The patients with severe hallux valgus had the higher change values of HVA, IMA, and AOFAS scores than the patients with moderate hallux valgus ( P<0.05). The elderly patients had the highest change values of HVA and AOFAS scores than the young and middle-aged patients ( P<0.05). The patients with postoperative HVA ranging from 0° to 5° had the highest AOFAS scores than the other patients at 6 months after operation ( P<0.05). Among different surgical procedures for severe hallux valgus, the metatarsophalangeal joint fusion had the highest change value of HVA, the Scarf osteotomy had the highest performance in correcting the IMA, and the first metatarsal base osteotomy had the highest improvement in the postoperative AOFAS score, and the differences were significant ( P<0.05). CONCLUSION Elderly patients show the better improvement in HVA and foot function after operation. The first metatarsal base osteotomy show the better improvement in foot function than other surgical procedures. A certain HVA is allowed to remain after hallux valgus correction, and the postoperative AOFAS score is higher when the corrected HVA is in the range of 0°-5°.
Humans ; Hallux Valgus/diagnostic imaging* ; Middle Aged ; Male ; Female ; Aged ; Retrospective Studies ; Adult ; Aged, 80 and over ; Treatment Outcome ; Osteotomy/methods* ; Severity of Illness Index ; Orthopedic Procedures/methods* ; Metatarsophalangeal Joint/surgery* ; Young Adult ; Metatarsal Bones/surgery*

OBJECTIVE: To compare the efficacy of the fourth-generation minimally invasive technique-minimally invasive extra-articular metaphyseal distal transverse osteotomy (META) and Chevron osteotomy in treatment of hallux valgus. METHODS: A total of 80 patients with hallux valgus, who underwent single-foot surgery between July 2023 and January 2025 and met the inclusion criteria, were included in the study. Among them, 40 patients were treated with META and 40 with Chevron osteotomy. There was no significant difference in baseline data between the two groups ( P>0.05), including gender, age, height, weight, body mass index, disease duration, lesion site, hallux valgus deformity degree, as well as preoperative scores of each item (pain, function, alignment, total score) in the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joint Scale (AOFAS-Hallux-MTP-IP), scores of each item (pain, walking/standing, social interaction, total score) in the Manchester-Oxford Foot Questionnaire (MOXFQ), hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position, and the 1st metatarsal head morphology. The postoperative AOFAS-Hallux-MTP-IP scores, MOXFQ scores, as well as HVA, IMA, DMAA, the 1st metatarsal head morphology, and sesamoid position measured based on weight-bearing foot X-ray films were compared between the two groups; the occurrence of postoperative complications was recorded. RESULTS: All patients in both groups were followed up 6-18 months, and there was no significant difference in the follow-up time between the two groups ( P>0.05). At last follow-up, the scores of all items in AOFAS-Hallux-MTP-IP in both groups were higher than those before operation, and the scores of all items in MOXFQ were lower than those before operation, with significant differences ( P<0.05); there was no significant difference in the change values of all items in MOXFQ between the two groups ( P>0.05). The change value in AOFAS function score in the META group was significantly higher than that in the Chevron osteotomy group ( P<0.05), while there was no significant difference in the change value of AOFAS pain score, alignment score, and total score between the two groups ( P>0.05). After operation, 1 case (2.5%) of superficial incision infection and 2 cases (5.0%) of numbness around the incision occurred in the Chevron osteotomy group, while only 2 cases (5.0%) of numbness around the incision occurred in the META group. Imaging reexamination showed that HVA, IMA, and DMAA in both groups were signifncatly smaller than those before operation ( P<0.05), and there was no significant difference in the change values of the above angles between the two groups ( P>0.05). The 1st metatarsal head morphology and sesamoid position in the META group were better than those in the Chevron osteotomy group after operation, with significant differences ( P<0.05). CONCLUSION Both META and Chevron osteotomy can correct hallux valgus deformity, improve foot function, and relieve pain, but META has more advantages in correcting metatarsal rotation and reducing dislocated sesamoids.
Humans ; Hallux Valgus/diagnostic imaging* ; Osteotomy/methods* ; Minimally Invasive Surgical Procedures/methods* ; Male ; Female ; Middle Aged ; Treatment Outcome ; Adult ; Metatarsophalangeal Joint/surgery* ; Aged ; Retrospective Studies

OBJECTIVE: To observe clinical effect of percutaneous minimally invasive osteotomy with 8-shaped bandage and hallux valgus splint fixation in treating moderate hallux valgus. METHODS: Totally 23 patients with moderate hallux valgus were treated with percutaneous minimally invasive osteotomy with 8-shaped bandage and hallux valgus splint fixation from August 2019 to January 2021, and 1 patient was loss to follow-up, and finally 22 patients(30 feet) were included, 4 males (6 feet) and 18 females(24 feet), aged from 27 to 66 years old with an average of(50.59±11.95) years old. Hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsal span (the distance between the first and the fifth metatarsal bones), changed of soft tissue width, American Orthopaedic Foot and Ankle Society(AOFAS) score, and Visual Analogue Scale (VAS) were collected and compared before operation and 6 months after operation. RESULTS: Twenty-two patients were followed up from 5.7 to 6.4 months with an average of (6.13±0.85) months. The first metatarsal osteotomy of patients were obtained bone union, and deformity of the toes was corrected. Complications such as avascular necrosis of metatarsal head and transfer metatarsalgia were not occurred. Postoperative HVA, IMA, metatarsal span, soft tissue width, VAS, AOFAS score at 6 months were significantly improved compared with pre-operation (P<0.01). According to AOFAS score at 6 months after operation, 10 feet were excellent, 18 good and 2 poor. Two feet with poor were excellent after prolonged 8-shaped bandage and hallux valgus splint fixation time. CONCLUSION Percutaneous minimally invasive osteotomy with 8-shaped bandage and hallux valgus splint fixation for the treatment of moderate hallux valgus could better correct deformity of hallux valgus, relieve foot symptoms, good recovery of postoperative function, and has a significant clinical efficacy.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Hallux Valgus/diagnostic imaging* ; Splints ; Radiography ; Bunion ; Treatment Outcome ; Metatarsal Bones/surgery* ; Osteotomy ; Bandages

OBJECTIVE: To explore clinical effect of Scarf osteotomy combined with soft tissue balance in treating severe hallux valgus. METHODS: Totally 38 patients(50 feet) with severe hallux valux who underwent Scarf osteotomy combined with soft tissue balance surgery from June 2019 to June 2021 were retrospectively analyzed, aged from 29 to 64 years old with an average of(54.7±6.8) years old; 26 feet on the left side and 24 feet on the right side;the courses of disease ranged from 5 to 23 years with an average of (12.4±3.9) years. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were compared before and after operation, and postoperative complications was observed. American orthopedic foot ankle society(AOFAS) score before operation and final follow-up was used to evaluate recovery of forefoot function, and visual analogue scale (VAS) was used to evaluate pain relief. RESULTS: Thirty-eight patients (50 feet) were followed up from 15 to 23 months with an average of (18.3±3.2) months. Preoperative HVA, IMA and DMAA were (44.61±3.92)°, (18.74±2.51)°, (12.85±2.11)°, and improved to (13.45±2.13)°, (7.83±1.36)°, (7.03±1.39)°at final follow-up, which had statistical differneces(P<0.05). No delayed union or nonunion of osteotomy end, fracture or loosening of internal fixation, hallux varus occurred. VAS and AOFAS score improved from (6.81±2.14), (43.6±8.4)points before operation to (1.97±0.78), (87.6±5.2) points at final follow-up, which had statistical difference(P<0.01). According to AOFAS at final follow-up, 20 feet got excellent result, 28 feet good and 2 feet moderate. CONCLUSION Scarf osteotomy combined with soft tissue balance release for severe hallux valgus has good stability and corrective effect, but learning curve and postoperative complications should be paid attention.
Adult ; Humans ; Middle Aged ; Bunion ; Hallux Valgus/diagnostic imaging* ; Metatarsal Bones/surgery* ; Osteotomy ; Postoperative Complications ; Radiography ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: To explore clinical effect of rotational Scarf osteotomy in treating hallux valgus (HV) with rotation of the first metatarsal bone. METHODS: From January 2018 to October 2019, 35 patients (40 feet) with HV and rotation deformity of the first metatarsal were treated with rotational Scarf osteotomy, including 5 males and 30 females;aged from 25 to 76 years old with an average of (40.32±5.43) years old. Hallux valgus angle(HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), the first metatarsal length (FML) were observed and compared, American Orthopedic Foot and Ankle Society(AOFAS) of hallux metatarsophalangeal interphalangeal joint score and visual analogue scale (VAS) were used to evaluate functional evaluation. RESULTS: Thirty-five patients(40 feet) were followed up from 12 to 36 months with an average of (14.35±3.62) months. HVA, IMA and DMAA were corrected from (36.32±4.51) °, (14.21±3.22) ° and (28.35±4.32) ° before operation to (14.32±5.71) °, (5.83±3.97) ° and (7.32±2.14) ° after operation respectively (P<0.05). There was no satistical difference in FML before and after operation (P>0.05). AOFAS score and VAS improved from (57.00±4.31) and (6.00±1.21) before operation to (90.31±3.28) and (1.42±0.83) after operation, respectively, and had significant difference(P<0.05);according to AOFAS score, 23 feet got excellent results, 15 feet good and 2 feet fair. CONCLUSION Rotational Scarf osteotomy with strong correction and high dimension could effectively correct HV combined with rotation deformity of the first metatarsal bone, improve function of the forefoot, and obtain good clinical results.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Hallux Valgus/diagnostic imaging* ; Metatarsal Bones/surgery* ; Fluorometholone ; Rotation ; Treatment Outcome ; Radiography ; Bunion ; Osteotomy/methods*

PURPOSE: The aim of this study was to investigate new point-connecting measurements for the hallux valgus angle (HVA) and the first intermetatarsal angle (IMA), which can reflect the degree of subluxation of the first metatarsophalangeal joint (MTPJ). Also, this study attempted to compare the validity of midline measurements and the new point-connecting measurements for the determination of HVA and IMA values. MATERIALS AND METHODS: Sixty feet of hallux valgus patients who underwent surgery between 2007 and 2011 were classified in terms of the severity of HVA, congruency of the first MTPJ, and type of chevron metatarsal osteotomy. On weight-bearing dorsal-plantar radiographs, HVA and IMA values were measured and compared preoperatively and postoperatively using both the conventional and new methods. RESULTS: Compared with midline measurements, point-connecting measurements showed higher inter- and intra-observer reliability for preoperative HVA/IMA and similar or higher inter- and intra-observer reliability for postoperative HVA/IMA. Patients who underwent distal chevron metatarsal osteotomy (DCMO) had higher intraclass correlation coefficient for inter- and intra-observer reliability for pre- and post-operative HVA and IMA measured by the point-connecting method compared with the midline method. All differences in the preoperative HVAs and IMAs determined by both the midline method and point-connecting methods were significant between the deviated group and subluxated groups (p=0.001). CONCLUSION: The point-connecting method for measuring HVA and IMA in the subluxated first MTPJ may better reflect the severity of a HV deformity with higher reliability than the midline method, and is more useful in patients with DCMO than in patients with proximal chevron metatarsal osteotomy.
Adult ; Aged ; Female ; Foot ; Hallux Valgus/*diagnostic imaging/surgery ; Humans ; Male ; Metatarsal Bones/*diagnostic imaging/surgery ; Metatarsophalangeal Joint/*diagnostic imaging/surgery ; Middle Aged ; Osteotomy/*methods ; Postoperative Period ; Reproducibility of Results ; Weight-Bearing

BACKGROUNDTreating developmental dysplasia of the hip is often challenging. The difficulties include not only the hip surgery itself but also the treatment of the associated lower-limb valgus deformity. However, there have been very few studies on such deformity in patients with developmental hip dysplasia. In this study, we investigated the prevalence and severity of lower-limb valgus deformity, along with the relationship between the severity of valgus deformity and mechanical alterations of the hip or the ipsilateral knee.

METHODSTwo hundred and six affected lower limbs of 116 adult patients with untreated developmental dysplasia of the hip were included in the study, grouped according to the severity of hip dysplasia. Each study participant's radiographs were measured to quantitatively evaluate the mechanical axis deviation of the lower limb, and further to evaluate the prevalence and severity of the lower-limb valgus deformity. Some mechanical alterations of the hip and the ipsilateral knee were also measured on the radiographs.

RESULTSOf the affected lower limbs, 14.1% had valgus deformities. Study participants with Crowe type III hip dysplasia had the most severe deformity and the highest prevalence of deformity. Severity of valgus deformity had a strong positive correlation with the lateral migration of the femoral head but not with the superior migration. A decreased lateral distal femoral angle contributed to the lower-limb valgus deformity, and the lateral distal femoral angle had a strong negative correlation with the severity of valgus deformity.

CONCLUSIONSHip dysplasia is commonly associated with lower-limb valgus deformity, and the severity of the lower-limb valgus deformity is mostly affected by lateral migration but not superior migration of the femoral head. The valgus deformity may originate mainly in the distal femur, in addition to the hip joint itself. These findings can be taken into account when planning to treat the patients with hip dysplasia.

Adolescent ; Adult ; Aged ; Female ; Femur Head ; diagnostic imaging ; pathology ; surgery ; Hallux Valgus ; diagnostic imaging ; pathology ; surgery ; Hip Dislocation, Congenital ; diagnostic imaging ; pathology ; surgery ; Hip Joint ; diagnostic imaging ; pathology ; surgery ; Humans ; Joint Deformities, Acquired ; diagnostic imaging ; pathology ; surgery ; Male ; Middle Aged ; Radiography ; Young Adult

OBJECTIVETo investigate efficacy of simple osteotomy for correct hallux valgus,and explore its scope and condition.

METHODSFrom December 2009 to April 2011, 20 patients (32 feet) with hallux valgus were treated by simple osteotomy. There were 1 male (1 foot), 19 females (31 feet) with an average age of 40 years (ranged, 22 to 64 years). The course of disease ranged from 2 to 31 years(mean 12 years). Among them, 6 feet were mild, 20 feet were moderate, 6 feet were serious. Patients had symptoms of metatarsophalangeal joint pain, but tensity of lateral soft tissue were normal. Hallux Valgus Angle (HVA) and Intermetatarsal Angle (IMA) were examined before and after treatment. The criteria of hallux valgus was used to evaluate the effects from valgus deformity, activity of metatarsophalangeal joint, satisfaction of patients.

RESULTSTwenty patients were followed up from 6 to 18 months with an average of 8.5 months. The wounds were healed well, no infection and metatarsal head necrosis occurred, 95.1% of patients were satisfied with the efficacy. Average AOFAS score increased from preoperative (53.1 +/- 7.5) points to the final follow-up (93.1 +/- l.9) points (P<0.05), the average correct HVA increased from preoperative (33.4 +/- 7.8) degrees to postoperative (11.9 +/- 3.6) degrees (P<0.05), the average IMA were decreased from preoperative (12.3 +/- 3.0) degrees to postoperative (6.3 +/- 1.9) degrees (P<0.05), tibial sesamoid position improved from 1.9 to 0.9 (P<0.05).

CONCLUSIONthe main pathological changes of hallux valgus patients with normal tension of lateral soft tissue is metatarsal adduction, simple osteotomy can get satisfactory results, no need to cut adductor muscle.

Adult ; Female ; Follow-Up Studies ; Hallux Valgus ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Male ; Metatarsal Bones ; diagnostic imaging ; physiopathology ; surgery ; Middle Aged ; Osteotomy ; methods ; Recovery of Function ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult