Various etiologies of hallux valgus and metatarsus primus varus have been reported, but still they are not conclusively established. Furthermore, between hallux valgus and metatarsus primus varus, the question is unanswered as to which is the cause and which is the result. To determine the primary cause and attribution of high heeled position to hallux valgus and metatarsus primus varus, we selected three different types of dancer. Traditional dancers wear cotton sox and strike the heels first to move, modern dancers walk or run and jump on naked feet, and ballerinas stand, walk or jump on their toes with hard wooden shoes, so the latter two types of dancers move with extremely high-heeled position. We analyzed the plain AP roentgenography of 84 feet for 16 ballerinas, 13 modern and 13 traditional dancers. The results were as follows : 1. First metatarsalgia was noted in 38% of modern dancers and 43% of ballerinas but none in traditional dancers. 2. The mean hallux valgus angle was 13.6°±2.7° in traditional dancers, 13.5°±3.8° in modern dancers, 18°±3.3° in ballerinas which are statistically significant between ballerinas and modern, traditional dancers(P < 0.01). 3. The mean intermetatarsal angle was 10.5°±1.4° in traditional dancers, 10.6°±1.1° in modern dancers, 10.8°±1.5° in ballerinas, and metatarsus primus varus angle was 17.6 °±5.1°, 18.3°±2.7°, 19.4°±3.6°, respectively, which were all statistically insignificant(P>0.01). Therefore, it is concluded that medio-lateral compression of shoes may be the principal contributor for the hallux valgus rather than high heel, and hallux valgus is the primary deformity.
Congenital Abnormalities ; Dancing ; Foot ; Hallux Valgus ; Hallux ; Heel ; Metatarsalgia ; Radiography ; Shoes ; Strikes, Employee ; Toes

PURPOSE: The purpose of this study is to evaluate the characteristics of hallux valgus with severe hallux valgus angle (HVA) and moderate intermetatarsal angle (IMA) after proximal chevron osteotomy. MATERIALS AND METHODS: Between January 2008 and December 2010, 41 patients (48 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic severe hallux valgus deformity (HVA > or =40degrees). Patients were divided into two groups, group M (IMA <18degrees) and group S (IMA > or =18degrees). Mean age of patients was 55.7 years (34~70 years) in group M and 60.0 years (44~78 years) in group S. Mean duration of follow-up was 20.4 months (12~41 months) in group M and 18.5 months (12~35 months) in group S. Radiographic parameters, including HVA, IMA, sesamoid position, metatarsus adductus angle (MAA), and distal metatarsal articular angle (DMAA), were compared between groups. Clinical results were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS). Recurrence rate at the last follow-up was compared between group M and group S. RESULTS: Preoperative HVA and grade of sesamoid position did not differ between the groups. However, immediate postoperative HVA and grade of sesamoid position were significantly larger in group M. Preoperative MAA and DMAA were significantly larger in group M. No significant difference in AOFAS score and VAS was observed between the groups at the last follow-up. Ten of the 27 feet (37.0%) in group M and two of the 21 feet (9.5%) in group S showed hallux valgus recurrence at the last follow-up. Group M showed a significantly higher recurrence rate than group S. CONCLUSION: Recurrence rate for severe hallux valgus with moderate IMA is higher than that of severe hallux valgus with severe IMA.
Ankle ; Congenital Abnormalities* ; Follow-Up Studies ; Foot ; Hallux Valgus* ; Humans ; Metatarsal Bones ; Metatarsus ; Osteotomy ; Recurrence

PURPOSE: This study was designed to evaluate characteristics of foot pressure distribution with or without partial prosthetic foot in transmetatarsal amputee. MATERIALS AND METHODS: The subjects were 9 transmetatarsal amputees. Foot pressures were measured at hallux, the 1st-5th metatarsal head (MTH), mid-foot, condyle area by F-scan system in amputated or contralateral foot during active walking. RESULTS: In amputated foot, mean peak pressure was greatest in midfoot without prosthetic foot but it was greatest in hindfoot with prosthetic foot. In unaffected foot, although mean peak pressure was higher in hallux, and 1-5th MTH compared to amputated foot, it was greatest in hind foot both with and without prosthetic foot. However, in unaffected foot, mean peak pressure significantly decreased in hallux and 5th MTH after wearing the prosthetic foot. There was a significant difference in mean peak pressure in hallux and 5th MTH between amputated and unaffected foot after wearing prosthetic foot. However, other region had no significant difference with or without prosthetic foot between feet. CONCLUSIONS: The use of partial prosthetic foot tends to shift weight bearing from the heel area to forefoot and could significantly reduce hind foot peak pressure and redistributed to peak pressure. The partial prosthetic foot can also offer the peak pressure to reduction both amputated foot and unaffected foot and help to toe off during walking.
Amputees ; Foot ; Hallux ; Head ; Heel ; Humans ; Metatarsal Bones ; Prostheses and Implants ; Toes ; Weight-Bearing

PURPOSE: To evaluate the radiographic characteristics of the tarsometatarsal osteoarthritis with hallux valgus deformity and report the clinical results of the operative treatment. MATERIALS AND METHODS: This is a retrospective study of 20 patients, 22 feet who had been operated for non-traumatic tarsometatarsal osteoarthritis with hallux valgus (TMT group) and control group of hallux valgus patients without tarsometatarsal osteoarthritis (26 patients, 28 feet) from April 2004 to July 2011. Radiographic characteristics were compared between the groups, using hallux valgus angle, 1st-2nd intermetatarsal angle, metatarsal length ratio, metatarsus adductus angle, talonavicular coverage angle, talus-1st metatarsal angle, calcaneal pitch angle and medial cuneiform height. Pre- and postoperative difference of 1st-2nd metatarsal declination angle and distance between the 1st-2nd metatarsal head were evaluated. The clinical results were evaluated by American Orthopaedics Foot and Ankle Society (AOFAS) midfoot scale and visual analogue scale (VAS). RESULTS: Metatarsal length ratio was significantly larger in TMT group (p<0.001). Metatarsus adductus angle, talonavicular coverage angle, talus-1st metatarsal angle on lateral radiograph, calcaneal pitch angle and medial cuneiform height were different from control group (p<0.001, p<0.001, p=0.001, p=0.010, p=0.006). Postoperative declination of the 2nd metatarsal and distance between the 1st-2nd metatarsal head were increased (p=0.009, p=0.001). The AOFAS and VAS score were improved (p<0.001, p<0.001). CONCLUSION: Non-traumatic osteoarthritis of the tarsometatarsal joints seems to be associated with long 2nd metatarsal length, metatarsus adductus and flatfoot deformity. Spur excision may be successful to relieve symptoms when the arthritis was diagnosed in early stage.
Animals ; Ankle ; Arthritis ; Arthrodesis ; Congenital Abnormalities ; Flatfoot ; Foot ; Hallux ; Hallux Valgus ; Head ; Humans ; Joints ; Metatarsal Bones ; Metatarsus ; Osteoarthritis ; Retrospective Studies

Participation of the population in sports activity is increasing. The life expectancy is also on the rise. In addition, the average initial age of women who wear heels is decreasing. For this reason, the incidence of foot disease such as ankle instability, foot deformity, and degenerative joint disease is becoming increasingly common. There is a wide spectrum of foot disease. Common foot disease that can be treated from outpatient base will be discussed in this review.
Animals ; Ankle ; Diabetic Foot ; Female ; Foot ; Foot Deformities ; Foot Diseases ; Hallux Valgus ; Heel ; Humans ; Incidence ; Joint Diseases ; Life Expectancy ; Outpatients ; Sports

PURPOSE: This study was performed to evaluate the impact of the lesser toe operation on the overall clinical outcomes, and to analyze the clinical results of concomitant surgery for hallux valgus and lesser toe deformities. MATERIALS AND METHODS: Forty-six cases underwent surgery for hallux valgus with concomitant lesser toe deformities were followed up for at least 1 year. Lesser toe deformities consisted of 9 crossover toes, 10 claw toes, 12 hammer toes and 15 bunionettes. Clinical evaluation was performed according to AOFAS (American Orthopaedic Foot and Ankle Society) score, patient's satisfaction score, and pain VAS (visual analogue scale) score. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and period to union were measured. Preoperative expectation about lesser toe deformities, postoperative satisfaction, complication rate, hospitalization period, medical expenses, and frequency of outpatient follow-up were analyzed. RESULTS: AOFAS score, VAS score, HAV and IMA had improved significantly. On preoperative expectation of patients, correction of lesser toe deformities was ranked third, following the improvement of big toe(bunion) pain and the correction of hallux valgus. Patient's satisfaction score was average 92.8 points, and the importance of lesser toe operation was 30.2%. When compared to hallux valgus operation only, there were average 2.5 days of additional hospitalization, 2.4 times of additional outpatient follow-up, 386000 won of additional medical expenses. CONCLUSION: Combined operation for hallux valgus and concomitant lesser toe deformities showed good clinical results. When compared to hallux valgus operation only, there were longer hospitalization, more frequent follow-up, more medical expenses, more complications. However, lesser toe deformity correction in patients underwent hallux valgus operation is considerable, because of high preoperative expectation and postoperative satisfaction.
Animals ; Ankle ; Bunion, Tailor's ; Congenital Abnormalities ; Follow-Up Studies ; Foot ; Hallux ; Hallux Valgus ; Hammer Toe Syndrome ; Hospitalization ; Humans ; Outpatients ; Toes

OBJECTIVE: The purpose of the present study was to assess the short term result of the reconstruction of forefoot deformity, commonly seen in rheumatoid patients. METHODS: 15 patients (20 feet) were evaluated and the average follow up period was 18.4 months. The reconstructive procedure included the arthrodesis of the first metatarsophalangeal joint of hallux, the lesser metatarsophalangeal resection arthroplasty, and extensor tenotomy of lesser toes. The subjective and the objective findings were studied, using the rating scale of The American Orthopaedic Foot and Ankle society, and the radiological measurement. RESULTS: Subjective assessment with respect to pain, function, alignment was excellent in ten feet (50%), good in ten feet (50%), and no fair and poor. The hallux valgus angle (HVA) and 1st intermetatarsal angle were improved from 48.4+/-4.23 and 16.5+/-2.08 to 13.5+/-1.96 and 11.0+/-1.28 degrees respectively. The average dorsiflexion angle was 18.95+/-2.20 degrees. All arthrodesis site were fused within average 8 weeks after operation. The overall complication of the procedure was few and reoperation was none. CONCLUSION: The reconstructive procedure, including the arthrodesis of the first metatarsophalangeal joint and the lesser metatarsophalangeal resection arthroplasty with extensor tenotomy was regarded as a good option for treating a rheumatoid forefoot deformity surgically.
Ankle ; Arthrodesis ; Arthroplasty ; Congenital Abnormalities* ; Follow-Up Studies ; Foot ; Hallux ; Hallux Valgus ; Humans ; Metatarsophalangeal Joint ; Reoperation ; Tenotomy ; Toes

It is likely that the peroneus longus tendon acts as a structure resisting the varus force upon the first column of the foot. Our study was designed to examine the possibility that absence of the peroneus longus insertion into the first metatarsal and first cuneiform will destabilize the first metatarsal. The fresh frozen cadaveric specimens of the lower leg were obtained. There were six right feet. The specimens appeared normal visually and roentgenographically. The tibial remnant was rodded by an intramedullary rod and the sprcimen was positioned in a specially designed rig so that standing position of the foot was simulated. The tibia was then loaded with twenty pounds. To obtain reproducible radiographic landmarks radioopaque beads were implanted underneath the level of the cortex through small drill holes in the following location : First metatarsal (one bead in the head, another bead in the base). The second metatarsal (again one bead in the head, on e bean in the base). To simulate the contraction of the peroneus longus muscle a suture was placed into the proximal end of the tendon, brought through two pulleys and loaded with a five pound weight. To create a varus force on the first metatarsal a stab incision was made over the base of the first metatarsal at its medial aspect and a suture was passed through the base of the first metatarsal. The suture was guided over a pulley and loaded with ten pounds. The second metatarsal head was fixed to the bottom of the rig with a smooth Steinmann pin. At this point an AP roentgenogram was taken of the footto assure proper positioning of the foot. Thereafter, the soft tissue between the first and second toe were cut sequentially : (1) Transection of the skin of the first web space both dorsally and plantarly. (2) Transection of the adductor hallucis tendon and the intermetatarsal ligament. (3) Transection of the peroneus longus tendon at its insertion. Each step in the transaction of the soft tissues was followed by another X-ray examination. In each roentgenogram the proximal and distal beads in the first and second metatarsal were connected by a line and the angles between those lines were measured. The results were statistically analyzed with the Friedman Chi square test between each step of the ten feet. Following the first and second step angular changes are not significant. Following the final step, adding release of the tendon insertion of the peroneus longus, the angle changes from 15.95 to 20.55 degrees (difference 4.60 degrees) and this is significant (p < 0.05).
Cadaver ; Foot ; Head ; Leg ; Ligaments ; Metatarsal Bones ; Metatarsus ; Posture ; Skin ; Sutures ; Tendons ; Tibia ; Toes

PURPOSE: The objective of this study was to examine the clinical results and effectiveness of resection arthroplasty for correction of lesser toe deformity. MATERIALS AND METHODS: From January 2000 to November 2012, 92 cases of resection arthroplasty for lesser toe deformity were reviewed. Hammer toe was the most common type of deformity, accounting for 44 toes (33 patients). Hallux valgus was the most common comorbid illness. Second toe was the most commonly affected toe and proximal interphalangeal joint was the most common location of resection arthroplasty (69 toes, 75.0%). We also analyzed the alignment of phalanges using the last follow-up weight bearing radiographic image. The analysis included clinical evaluation with American Orthopaedic Foot and Ankle Society (AOFAS) score as well as subjective satisfaction. RESULTS: Flexor tenotomy (19 cases) was the most common combined surgery. Floating toe (4 cases) was the most common complication. The last follow-up alignment of phalanges was better than good in 71 toes (77.2%) in anteroposterior view and in 69 toes (75.0%) in lateral view. Sixty one cases (85.9%) resulted in better satisfaction than 'good' and the final average AOFAS score was 87.4. CONCLUSION: Resection arthroplasty is a valuable surgical option for treatment of lesser toe deformity, with high patient satisfaction, easy surgical technique and remarkable correction of deformity.
Ankle ; Arthroplasty* ; Congenital Abnormalities* ; Follow-Up Studies ; Foot ; Hallux Valgus ; Hammer Toe Syndrome ; Joints ; Patient Satisfaction ; Tenotomy ; Toes* ; Weight-Bearing

PURPOSE: To evaluate the clinical results of lengthening in first brachymetatarsia using a distraction osteogensis with an external fixator. MATERIALS AND METHODS: Fifteen cases in nine patients, who had received firstmetatarsal distraction osteogenesis from January 1996 to December 2002, were enrolled in this study. At the final follow-up, the application time of the external fixator was measured and the percentage of lengthening, healing index, complication rate, and the patients satisfaction was analyzed. The patients satisfaction was evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) scores, which were scored according to the level of stiffness, pain, function, and alignment. RESULTS: The score according to the AOFAS-Hallux Metatarsophalangeal joint and Inter-Phalangeal joint scale was excellent in 13 patients and good in 2. All patients were satisfied with the procedure. The average percentage of lengthening was 48.7%. The average healing index was 72.8 days/cm. The major complication was a cavus foot, which was noticed in four feet. All the first toes showed some decrease in motion at the metatarsophalangeal joint. The other complications were hallux valgus, angulation of the metatarsals, and a pin tract infection each in two feet. CONCLUSION: Distraction osteogenesis is an effective method for first brachymetatarsia. However, excessive lengthening can cause potential complications.
Ankle ; External Fixators ; Follow-Up Studies ; Foot ; Hallux Valgus ; Humans ; Joints ; Metatarsal Bones ; Metatarsophalangeal Joint ; Orthopedics ; Osteogenesis, Distraction* ; Toes