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

Metatarsal Bones/surgery* ; Thumb/abnormalities* ; Metacarpal Bones/surgery* ; Plastic Surgery Procedures

OBJECTIVE: To explore early efficacy of minimally invasive Chevron Akin(MICA) osteotomy for the treatment of mild to moderate hallux valgus. METHODS: From June 2019 to April 2021, a total of 26 patients (29 feet) with mild to moderate hallux valgus, including 1 male and 25 females aged from 19 to 78 years old with an average of(38.3±19.5) years old, were treated with MICA. Preoperative and postoperative hallux valgus angle(HVA), intermetatarsal angle(IMA) and shortening of the first metatarsal were observed and compared. American Orthopedic Foot and Ankle Society (AOFAS) forefoot scoring system and visual analogue scale (VAS) were applied to evaluate clinical outcome at the final follow-up, and complications were also recorded. RESULTS: All patients obtained followed up from 12 to 33 months with an average of(19.6±5.1) months. HVA and IMA was improved from (32.3±6.6)° and (11.7±3.2)° pre-operatively to (13.0±5.3)° and (6.1±3.2)° post-operatively, respectively, which had a significant difference (P<0.01). The average shortening of the first metatarsal was (2.7±1.1) mm. AOFAS and VAS was improved from (55.7±7.4) and (6.5±1.5) preoperatively and to (88.5±7.9) and (0.7±0.4) respectively at the final follow-up, which also had a significant difference(P<0.01). According to AOFAS score, 15 feet achieved an excellent result, 11 good and 3 moderate. CONCLUSION MICA osteotomy is a safe and reliable surgical technique for mild to moderate hallux valgus with advantages of minimally invasive, rapid recovery, low complication rate and an effect improvement of hallux valgus deformity.
Adolescent ; Adult ; Aged ; Bunion ; Female ; Hallux Valgus/surgery* ; Humans ; Male ; Metatarsal Bones/surgery* ; Middle Aged ; Osteotomy/methods* ; Treatment Outcome ; Young Adult

OBJECTIVE: To evaluate clnical effect of minimally invasive osteotomy with absorbable screws in treating hallux valgus deformity. METHODS: Clnical data of 31 patients with hallux valgus deformity were retrospective analyzed from January 2019 to December 2020, and divided into absorbable screws group (17 patients) and titanium cannulated screw group (14 patients). In absorbable screws group, there were 1 male and 16 females aged from 32 to 72 years old with an average of (54.53±12.12) years old;6 patients on the left side, 5 on bilateral and 6 on the right side;1 patient was mild, 11 moderate and 5 severe;treated with minimally invasive osteotomy and fixation of absorbable screws. In titanium cannulated screw group, there were 2 males and 12 females aged from 18 to 71 years old with an average of (47.57±15.68) years old;4 patients on the left side, 4 on bilateral and 6 on the right side;1 patient was mild, 9 moderate and 4severe;treated with minimally invasive osteotomy and fixation of titanium cannulated screw. Complications between two groups were observed, changes of hallux valgus angle (HVA)and intermetatarsal angle (IMA)were detected and compared before and after operation at 12 months, American Orthopedic Foot and Ankle Society(AOFAS) and visual analogue scale(VAS) before and after operation at 12 months were also compared. RESULTS: All 31 patients were followed up from 13 to 20 months with an average of (16.61±2.47) months. Patients in absorbable screws group were followed up from 14 to 20 months with an average of (16.88±2.80) months, while patients in titanium cannulated screw group were followed up from 13 to 19 months with an average of (16.29±2.05) months;there was no difference between two groups(P>0.05). One patient in absorbable screws group occurred numbness around incision, 3 patients in titanium cannulated screw group occurred complications, including numbness around incision in 1 patient, skin irritation due to internal fixation in 1 patient, and recurrence in 1 case;there was no statistic difference between two groups (χ²=1.651, P=0.199). There were no statistic difference in HVA and IMA between two groups before and after operation at 12 months(P>0.05). There were no statistic difference between two groups in AOFAS and VAS before and after operation at 12 months(P>0.05). CONCLUSION Compare with mainstream fixation with titanium hollow screw after minmally invasive osteotomy, fixation with absorbable screw could achieve comparable clinical outcome on the basis of images and function evaluation.
Adolescent ; Adult ; Aged ; Bunion ; Female ; Hallux Valgus/surgery* ; Humans ; Hypesthesia ; Male ; Metatarsal Bones/surgery* ; Middle Aged ; Osteotomy/methods* ; Radiography ; Retrospective Studies ; Titanium ; Young Adult

OBJECTIVE: To investigate the method and clinical effect of modified Chevron osteotomy of the distal end of the first metatarsal in the treatment of moderate and severe hallux valgus. METHODS: From January 2015 to January 2019, 28 patients(30 feet) with moderate and severe hallux valgus were treated with modified Chevron osteotomy combined with lateral soft tissue release of the first metatarsophalangeal joint, including 2 males (2 feet) and 26 females (28 feet). The age ranged from 35 to 74 (57.3±9.3) years;10 feet on the left, 16 feet on the right, 2 cases on both sides(4 feet);the course of disease was 3 to 12 (9.32±3.89) years. The changes of hallux valgus angle(HVA), intermetatarsal angle(IMA) between the first and second metatarsals and distal metatarsal articular angle(DMAA) of the first metatarsal were measured and compared before and 6 months after operation. The American Orthopaedic Foot and Ankle Society(AOFAS) thumb joint scoring system was used to evaluate the curative effect. RESULTS: All 28 patients were followed up for 8 to 16 (11.28±3.42) months. The incision healed well in all patients, and there were no complications such as incision infection and metatarsal head necrosis. The healing time of osteotomy site was 6 to 10(7.12±1.34) weeks. Preoperative HVA, IMA, DMAA and AOFAS were (36.06±6.02) °, (21.78±4.16) °, (8.21±2.65) ° and (52.90±10.97) respectively, at six months after operation, they were (8.87±2.46) °, (11.66±2.84) °, (3.65±1.00) ° and (87.45±10.55) respectively, there was significant difference between preoperative and 6 months after operation(P<0.05). At 6 months after operation, AOFAS score was excellent in 20 feet, good in 7 feet and poor in 3 feet. Among the 3 patients with poor scores, 2 were excellent after revision, and 1 was significantly improved after using custom insoles. CONCLUSION Modified Chevron can effectively correct HVA, IMA and DMAA and improve functional recovery. The modified Chevron osteotomy increases the moving distance and the contact of the osteotomy surface. It can be fixed with multiple screws, has strong correction ability, and can exercise early. It is one of the optional methods for the treatment of moderate and severe hallux valgus.
Adult ; Aged ; Female ; Hallux Valgus/surgery* ; Humans ; Male ; Metatarsal Bones/surgery* ; Metatarsophalangeal Joint/surgery* ; Middle Aged ; Osteotomy ; Radiography ; Treatment Outcome

OBJECTIVE: To explore the clinical efficacy of external micro-locking plate combined with closed reduction in the treatment of fifth metatarsal comminuted fracture with severe soft tissue injury. METHODS: From January 2018 to December 2019, 13 patients received micro-locking plate combined with closed reduction treatment due to the fifth metatarsal comminuted fracture with severe soft tissue injury. There were 11 males and 2 females patients, ranging in age from 21 to 69 years. According to the fracture AO fracture classification, 9 cases belonged to type 87(S)-C2.2 and 4 cases belonged to type 87(S)-C2.1. The fifth metatarsal cuneiform articular surface was not involved, and all of them were comminuted fractures of the fifth metatarsal shaft. All soft tissues were damaged to varying degrees. Three patients got small defect of skin and soft tissue, and they were treated with debridement and suture after one-stage emergency surgery. The fracture healing and complications were observed, and the clinical efficacy was evaluated according to the midfoot function score of American Orthopaedic Foot & Ankle Society (AOFAS) at the latest follow-up. RESULTS: All patients were followed up, and the duration ranged from 3 to 12 months. One patient had delayed union. One patient had local skin necrosis and was treated with second-stage skin grafting to repair the wound surface. No external screw breakage or infection was reported, the skin soft tissue healed satisfactorily and reached bony union, with the union time ranging from 8 to 19 weeks. The postoperative functional recovery was rated according to the midfoot score of AOFAS, the score ranged from 49 to 98, and 7 patients got an excellent result, 4 good, 1 fair and 1 poor. CONCLUSION The external micro-locking plate combined with closed reduction in the treatment of fifth metatarsal comminuted fracture with severe soft tissue injury has the advantages of simple operation, good stability and low infection rate, which is helpful to the repair of soft issue injury, and the fixation can be removed early in outpatient clinic. To sum up, this surgical procedure is suitable for patients with severe soft tissue injury and comminuted fracture to avoid periosteum stripping. The space occupying is smaller than the micro-external fixator, which is convenient for patients with early functional exercise.
Adult ; Aged ; Bone Plates ; Female ; Fracture Fixation, Internal/methods* ; Fractures, Bone/surgery* ; Fractures, Comminuted/surgery* ; Humans ; Male ; Metatarsal Bones/surgery* ; Middle Aged ; Young Adult

OBJECTIVE: To compare clinical efficacy of scarf osteotomy and double metatarsal osteotomy(DMO) in treating moderate to severe hallux valgus. METHODS: Fifty patients (81 feet) with moderate to severe hallux valgus deformity were treated from January 2017 to December 2019, and were divided into Scarf osteotomy (SO) group or DMO group according to different osteotomy methods. There were 26 patients (44 feet) in SO group, including 1 male and 25 females, aged from 48 to 65 years old with an average of (55.5±4.67) years old;18 patients (30 feet) with moderate and 8 patients (14 feet) with severe. There were 24 patients(37 feet) in DMO group, including 1 male and 23 females, aged from 45 to 62 years old with an average of (52.1±6.8) years old;there were 14 patients (24 feet) with moderate and 10 patients (13 feet) with severe. Hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and relative length of the first metatarsal(RLFM) on weight-bearing anteroposterior radiographs before and after operation were compared. American Orthopaedic Foot and Ankle Society (AOFAS) hallux, metatarsal, and interphalangeal joint scores was used for evaluate clinical effects. Weight bearing time and complications were observed. RESULTS: Fivty patients were followed up. The follow-up time in SO group ranged from 12 to 36 months with an average of(20.50±6.22) months and from 16 to 28 months with an avaerge of(19.80±2.44) months in DMO group while there was no significant difference between two groups(P>0.05). All incision healed at stage I, and osteotomy healed at (20.31±3.17) months after operation. One patient occurred hallux adduction deformity, without transferred metatarsalgia;2 patients occurred metastatic metatarsalgia in DMO group. There were no significant difference in HVA, IMA, DMAA, and AOFAS scores between two groups(P>0.05) before and after operation. There was no significant difference in RLFM between two groups(P>0.05), while had significant difference in RLFM between two groups at final follow-up (P<0.05). Partial weight-bearing time and full weight-bearing time in SO group were significantly earlier than those in DMO group (P<0.05). CONCLUSION Both of Scarf osteotomy and the first metatarsal biplane osteotomy could effectively treat moderate to severe hallux valgus deformity, with similar imaging and clinical evaluation. However, the relative length of the first metatarsal bone in SO group was longer than that in DMO group after operation, and the time of weight bearing in Scarf osteotomy is earlier than that of double metatarsal osteotomy of the first metatarsal.
Female ; Humans ; Male ; Middle Aged ; Aged ; Hallux Valgus/surgery* ; Hallux ; Metatarsal Bones/surgery* ; Case-Control Studies ; Bunion ; Treatment Outcome ; Osteotomy/methods* ; Metatarsalgia

OBJECTIVE: To explore clinical effect of the first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy in treating hallux valgus with severe metatarsal adduction. METHODS: From March 2017 to August 2021, 37 patients ( 69 feet ) with severe plantar adductor hallux valgus were treated with the first metatarsophalangeal joint fusion combined with rotational Weil osteotomy were retrospectively analyzed, including 8 males(11 feet) and 29 females (58 feet), aged from 67 to 83 years old with an average of (70.03±2.87) years old;3 cases on the left side, 2 cases on the right side and 32 cases on both sides. Visual analogue scale(VAS) was used to evaluate degree of pain relief before operation, 6 weeks after operation and at the final follow-up. American Orthopaedic Foot and Ankle Surgery (AOFAS) forefoot score was used to evaluate function of the affected foot before operation and final follow-up. Hallux valgus angle(HVA) and intermetatarsal angle(IMA) were measured before operation and at the final follow-up. RESULTS: Thirty-seven patients(69 feet) were followed up from 12 to 48 months with an average of(22.8±0.6) months. Bone healing was achieved at the first metatarsophalangeal joint from 7 to 10 weeks with an average of (8.00±1.21) weeks after operation, without delay and nonunion. HVA was increased from (44.30±2.84)° before operation to (15.20±2.13) °at the final follow-up, and had statistical difference(t=65.781, P<0.05);while no difference in IMA before and after operation(P>0.05). VAS was decreased from (6.73±1.48) points to (2.78±0.71) points at 6 months after operation(t=3.279, P<0.05), and had difference compared with the latest follow-up(1.16±1.12)(t=4.859, P<0.05). AOFAS forefoot score increased from (52.14±5.78) preoperatively to (86.70±4.86) at the fonal follow-up, and 25 feet got excellent results, 40 feet good and 4 feet fair. CONCLUSION The first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy in treating severe plantar adduction hallux valgus could significantly relieve pain and appearance of forefoot, stabilize the first sequence, and significantly improve walking function.
Male ; Female ; Humans ; Aged ; Aged, 80 and over ; Metatarsal Bones/surgery* ; Hallux Valgus/surgery* ; Retrospective Studies ; Rotation ; Treatment Outcome ; Osteotomy/methods* ; Metatarsophalangeal Joint/surgery* ; Bunion ; Toes

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*