OBJECTIVE: To compare clinical effect of Ludloff operation on the clinical efficacy of patients with hallux valgus combined with hammertoe of the second toe. METHODS: The clinical data of 66 patients with hallux valgus treated with Ludloff surgery from July 2015 to July 2022 were retrospectively analyzed. According to exclusion criteria, 33 patients with hallux valgus combined with hammertoe were finally included as case group, and 33 patients with simple hallux valgus were paired as control group. There were 11 males and 22 females in case group, aged from 24 to 62 years old with an average of (33.6±12.7) years old;body mass index (BMI) ranged from 19 to 25 kg·m^-2 with an average of(21.7±3.1) kg·m^-2;17 patients on the left side and 16 patients on the right side;hallux valgus angle (HVA) ranged from 25° to 47° with an average of (36.3±10.2) °;the intermetatarsal angle (IMA) ranged from 13° to 21° with an average of (16.9±3.2) °. There were 12 males and 21 females in control group, aged from 22 to 61 years old with an average of (32.2±10.9) years old;BMI ranged from 18 to 26 kg·m^-2 with an average of (22.0±4.2) kg·m^-2;15 patients on the left side and 18 patients on the right side;HVA ranged from 26° to 46° with an average of (37.2±9.3) °;IMA ranged from 12° to 21° with an average of (17.3±4.7) °. HVA, IMA, American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores and visual analogue scale (VAS) were compared at 3, 6 and 12 months after operation between two groups. RESULTS: Both groups were completed 1 year postoperative follow-up. Postoperative cutaneous margin necrosis occurred in 2 patients of case group and incision rupture occurred in 1 patient of control group. There was no significant difference between two groups (χ²=0.058, P>0.05). Both groups were achieved bone union at stageⅠat 12 weeks after opertaion, and no recurrence of bunion was observed during follow-up. Three months after operation, AOFAS forefoot function score of case group was (73.4±8.6), which was lower than that of control group (82.1±10.3), and the difference was statistically significant (P<0.05). There were no significant differences in HVA, IMA, AOFAS and VAS between two groups at 6 and 12 months after operation (P>0.05). CONCLUSION Ludloff surgery for the treatment of bunions with malleform toe of the second toe is slow in the early postoperative functional recovery, but it did not affect the long-term clinical outcome of the patients.
Humans ; Hallux Valgus/physiopathology* ; Male ; Female ; Middle Aged ; Adult ; Retrospective Studies ; Hammer Toe Syndrome/physiopathology* ; Young Adult

OBJECTIVE: To compare clinical efficacy of intermetatarsal incision and lateral soft tissue release of medial incision combined with Scarf osteotomy in treating moderate to severe hallux valgus (HV). METHODS: A retrospective analysis was conducted on clinical data of 42 patients with moderate to severe HV admitted from January 2022 to December 2022. According to different incisions, the patients were divided into medial incision group with 22 patients (22 feet) and intermetatarsal incision group with 20 patients (20 feet). In medial incision group, there were 3 males and 19 females, aged from 40 to 69 years old with an average of (55.0±11.4) years old;body mass index (BMI) ranged from 21 to 29 kg·m-2 with an average of (25.2±2.1) kg·m-2;the courses of disease ranged from 8 to 16 years with average of (12.0±2.2) years;11 patients with moderate deformity and 11 patients with severe deformity. In transplantar incision group, there were 3 males and 17 females, aged from 39 to 68 years old with an average of (53.0±7.5) years old;BMI ranged from 20 to 28 kg·m^-2 with an average of (24.8±1.9) kg·m^-2;the courses of disease ranged from 9 to 17 years with an average of (14.0±3.1) years;9 patients with moderate deformity and 11 patients with severe deformity. Hallux valgus angle (HVA) and the first-second intermetatarsal angle (IMA), American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores and complications between two groups before operation and 12 months after operation were observed and compared. RESULTS: All patients were successfully completed the surgery and were followed up for 12 to 15 months with an average of (13.52±1.65) months. There were no statistically significant difference in HVA and IMA between two groups before operation and 12 months after operation (P>0.05). AOFAS forefoot scores of medial incision group before operation and 12 months after operation were (45.0±6.8) and (86.0±6.7) respectively, and those of transmetatarsal incision group were (46.0±7.4) and (83.0±7.5) respectively. Postoperative AOFAS forefoot scores between two groups at 12 months were statistically significant compared with those of before operation (P<0.01). According to AOFAS forefoot scores, 8 patients got excellent result, 14 good in medial incision group;while 6 excellent and 14 good in transplantar incision group. At 12 months, postoperative AOFAS forefoot score of functional score of in medial incision group(38.0±2.5), was better than that in transplantar incision group (34.0±2.2), and the difference was statistically significant (P<0.05). One patient in medial incision group occurred HV deformity, mild numbness occurred in 3 toes in transplantar incision group, and 3 patients were dissatisfied with scar. No complications such as infection, nonunion of bones or ischemic necrosis of metatarsal heads occurred in either group. CONCLUSION Both intermetatarsal incision and lateral soft tissue release of medial incision combined with Scarf osteotomy can effectively treat moderate to severe HV. The functional recovery after medial incision is better than that after intermetatarsal incision.
Humans ; Male ; Female ; Hallux Valgus/physiopathology* ; Middle Aged ; Osteotomy/methods* ; Adult ; Aged ; Retrospective Studies ; Treatment Outcome ; Metatarsal Bones/surgery*

OBJECTIVE: To explore short-term clinical efficacy of minimally invasive diagnosis and treatment system for hallux valgus in guiding the treatment of hallux valgus. METHODS: From March 2021 to November 2023, 68 patients (136 feet) with hallux valgus were treated under guidance of minimally invasive diagnosis and treatment system, including 12 males and 56 females;aged from 25 to 68 years old with an average of (42.5±8.5) years old, the course of disease ranged from 3.2 to 15.6 years with an average of (10.3±2.6) years. The changes of hallux valgus angle (HVA) and intermetatarsal angle (IMA), visual analog scale (VAS) and American Orthopaedic Foot Ankle Society (AOFAS) forefoot score were recorded and compared before operation and 12 months after operation. RESULTS: Sixty-five patients (130 feet) were followed up for 12 to 15 months with an average of (13.8±0.5) months, 3 patients (6 feet) were not followed up as required. HVA and IMA improved from (35.5±3.5) ° and (12.5±2.0) ° before operation to (10.5±2.5) ° and (8.5±1.5) °12 months after operation, respectively, with statistically significant differences (P<0.05);VAS decreased from (5.5±1.2) before operation to (1.2±0.5) at 12 months after operation, and the difference was statistically significant (P<0.05);AOFAS forefoot score increased from (50.6±5.1) before operation to (93.8±5.6) at 12 months after operation, with a statistically significant difference (P<0.05). Among them, 102 feet were got excellent result, 24 feet good, and 4 feet fair. Two patients were developed calf intermuscular vein thrombosis, and were cured after 3 months of symptomatic treatment. CONCLUSION Under the guidance of minimally invasive diagnosis and treatment system for hallux valgus, the treatment of HV could obviously improve HVA and IMA, and significantly alleviate pain symptoms, and accelerate functional recovery.
Humans ; Hallux Valgus/diagnosis* ; Male ; Female ; Middle Aged ; Adult ; Aged ; Minimally Invasive Surgical Procedures/methods* ; Treatment Outcome

OBJECTIVE: To compare the difference in forefoot width between minimally invasive extra-articular osteotomy via small incision and traditional Chevron osteotomy in the treatment of hallux valgus. METHODS: A retrospective analysis was conducted on the clinical data of 45 patients with hallux valgus between April 2019 and July 2022. Among them, 22 cases underwent minimally invasive extra-articular osteotomy via small incision (minimally invasive group), and 23 cases underwent traditional Chevron osteotomy (traditional group). There was no significant difference in the baseline data between the two groups ( P>0.05), including gender, age, affected side, Mann classification of hallux valgus, disease duration, and preoperative intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), bony forefoot width, soft tissue forefoot width, osteophyte width, and American Orthopaedic Foot and Ankle Society (AOFAS) score. The osteotomy healing time and the occurrence of complications in the two groups were recorded. The differences between pre- and post-operation (changes) in various imaging indicators and AOFAS scores in the two groups were calculated. And the bony forefoot width and soft tissue forefoot width at 1, 6, and 12 months after operation were also recorded and compared between the two groups. RESULTS: One case of skin injury occurred during operation in the minimally invasive group, while 3 cases of poor wound healing occurred after operation in the traditional group. None of the patients experienced infections, nerve injuries, or other complications. All patients were followed up 12-31 months (mean, 22.5 months). The osteotomy healed in the two groups and no significant difference in healing time between the two groups was found ( P>0.05). The IMA, HVA, DMAA, osteophyte width, and AOFAS score at 12 months after operation significantly improved compared to those before operation ( P<0.05). There was no significant difference between the two groups in the changes of IMA, HVA, and osteophyte width ( P>0.05). However, the differences in the changes of AOFAS score and DMAA were significant ( P<0.05). There was no significant difference between the two groups in bony and soft tissue forefoot widths at different time points after operation ( P>0.05). However, there were significant differences in the two groups between the pre- and post-operation ( P<0.05). CONCLUSION The minimally invasive extra-articular osteotomy via small incision for hallux valgus, despite not removing the medial osteophyte of the first metatarsal, can still effectively improve the forefoot width and osteophyte width. While correcting the IMA and HVA, it can more effectively restore the DMAA, resulting in better AOFAS scores.
Humans ; Hallux Valgus/surgery* ; Osteotomy/methods* ; Male ; Female ; Minimally Invasive Surgical Procedures/methods* ; Retrospective Studies ; Middle Aged ; Forefoot, Human/pathology* ; Adult ; Treatment Outcome ; Aged

OBJECTIVE: To explore the effectiveness of triple osteotomy in correcting severe hallux valgus with the first metatarsal pronation deformity. METHODS: A retrospective analysis was conducted on the clinical data of 29 patients (40 feet) with severe hallux valgus accompanied by the first metatarsal pronation deformity, who were admitted between January 2022 and December 2023 and met the selection criteria. There were 8 males (10 feet) and 21 females (30 feet), with an average age of 50.0 years (range, 44-62 years). The disease duration ranged from 5 to 9 years (mean, 6.5 years). All patients underwent triple osteotomy to correct the deformity. The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were used to evaluate joint function and pain before and after operation. Based on pre- and post-operative X-ray films, hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were measured to evaluate the correction of hallux valgus; the shape classification of the lateral edge of the first metatarsal and the pronation of first metatarsal angle (PFMA) were observed to assess the correction of the first metatarsal pronation deformity. RESULTS: A superficial infection occurred in 1 foot and the incison healed after dressing change; the remaining incisions healed by first intention. All patients were followed up 12-18 months (mean, 12.6 months). Three cases (4 feet) experienced limited movement of the metatarsophalangeal joint after operation, and the joint function recovered after strengthening functional exercises. During follow-up, no recurrence of deformity or secondary metatarsal pain occurred. Compared with preoperative scores, the AOFAS score increased and the VAS score decreased at last follow-up, and the differences were significant ( P<0.05). Radiographic examination showed that the osteotomy achieved bony healing, with the healing time of 2.5-6.2 months (mean, 4.1 months). The hallux valgus deformity was corrected, and the IMA, HVA, and DMAA were significantly smaller at last follow-up when compared with those before operation ( P<0.05). The first metatarsal pronation deformity was also corrected; there was no R-type (R-type for pronation deformity) on the lateral edge of the first metatarsal at last follow-up, and the PFMA decreased compared with preoperative levels ( P<0.05) and was corrected to the normal range. CONCLUSION Triple osteotomy can achieve good effectiveness for correcting severe hallux valgus with the first metatarsal pronation deformity. The functional training of the first metatarsophalangeal joint needs to be strengthened.
Humans ; Hallux Valgus/diagnostic imaging* ; Osteotomy/methods* ; Female ; Male ; Middle Aged ; Adult ; Retrospective Studies ; Metatarsal Bones/diagnostic imaging* ; Treatment Outcome ; Pronation ; Radiography

Severe hallux valgus, a triplanar foot deformity significantly impairing patients' quality of life, has witnessed progressive advancements in surgical management. This article systematically reviews the therapeutic progress through literature analysis, encompassing modifications of conventional surgical procedures and applications of novel techniques and innovative biomaterials. A critical analysis and discussion of these technological advancements and future developmental directions are presented to provide valuable insights and references for clinical management of severe hallux valgus.
Humans ; Hallux Valgus/surgery* ; Osteotomy/methods* ; Bone Transplantation/methods* ; Orthopedic Procedures/methods*

First metatarsophalangeal joint arthrodesis, as a corrective measure for severe hallux valgus deformity, has a long history and remains in use today. Indications for the first metatarsophalangeal joint arthrodesis include severe hallux valgus deformity, recurrent hallux valgus, hallux deformity in rheumatoid arthritis, severe hallux rigidus, joint infection, primary or secondary osteoarthritis, hallux valgus deformity due to neuromuscular disorders, and severe gouty arthritis. Innovative research continues to emerge in biomechanics and materials science related to the first metatarsophalangeal joint arthrodesis. Surgical fixation options are diverse and evolving, encompassing traditional screws and plates alongside novel intramedullary fixation systems and shape-memory alloy implants. Biomechanical studies, gait analysis research, and clinical trials consistently demonstrate minimal postoperative impact on gait and no significant impairment of functional mobility. When performed with proper technique, complications are rare. The first metatarsophalangeal joint arthrodesis is an effective and reliable method for treating severe hallux valgus deformity.
Humans ; Hallux Valgus/surgery* ; Arthrodesis/instrumentation* ; Metatarsophalangeal Joint/surgery* ; Bone Screws ; Treatment Outcome

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 compare effectiveness of multiple metatarsal osteotomy versus first metatarsophalangeal arthrodesis in treating severe metatarsal adductus hallux valgus deformity. METHODS: A retrospective analysis was conducted on the clinical data of 25 patients with severe metatarsal adductus hallux valgus deformity admitted between June 2010 and May 2014 who met the selective criteria. Among them, 15 patients underwent multiple metatarsal osteotomy (osteotomy group), while 10 patients underwent first metatarsophalangeal arthrodesis (fusion group). There was no significant difference between groups ( P>0.05) in gender, age, disease duration, affected side, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score for pain, intermetatarsal angle (IMA), hallux valgus angle (HVA), or metatarsal adduction angle (MAA). The osteotomy group underwent fixation with screws and/or staples fixation, while the fusion group utilized anatomic fusion plates and trans-articular compression screws. The study compared the following outcome indicators between groups: operation time, pre- and post-operative differences (change values) in AOFAS scores, VAS scores, and radiographic parameters (HVA, MAA), osteotomy healing outcomes, and recurrence of hallux valgus deformity. RESULTS: Both surgical procedures were completed successfully. The operation time was significantly shorter in the fusion group than in the osteotomy group ( P<0.05). All patients were followed up 96-144 months (mean, 116 months). The follow-up time was (129.1±7.2) months in the osteotomy group and (104.4±8.0) months in the fusion group, with no significant difference between groups ( P>0.05). X-ray films revealed the radiographic union in two groups, and the fusion time was significantly shorter in the fusion group than in the osteotomy group ( P<0.05). At last follow-up, both groups demonstrated significant improvements in AOFAS and VAS scores compared to preoperative levels ( P<0.05). However, the differences in the change values of AOFAS and VAS scores between groups were not significant ( P>0.05). During follow-up, 3 cases (20%) of deformity recurrence occurred in the osteotomy group, while no recurrence was observed in the fusion group. There was no significant difference in the incidences of deformity recurrence between groups ( P>0.05). CONCLUSION For severe metatarsus adductus hallux valgus deformities, both multiple metatarsal osteotomy and first metatarsophalangeal arthrodesis can correct the deformity. The former preserves metatarsophalangeal joint mobility but demands high technical proficiency from the surgeon, involves relatively longer operation times, extended bone healing periods, and higher complication incidences. The latter procedure is relatively simpler, facilitates faster postoperative recovery, allows early weight-bearing, and yields more reliable outcomes, though it sacrifices first metatarsophalangeal joint mobility.
Humans ; Osteotomy/methods* ; Hallux Valgus/diagnostic imaging* ; Retrospective Studies ; Arthrodesis/instrumentation* ; Treatment Outcome ; Metatarsal Bones/diagnostic imaging* ; Metatarsophalangeal Joint/diagnostic imaging* ; Male ; Female ; Bone Screws ; Adult ; Middle Aged ; Bone Plates ; Pain Measurement

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*