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Duff JR, Alecxih AG, White CC, Doty JF. Minimally Invasive First Metatarsophalangeal Joint Arthrodesis With a Low-Profile Hybrid Locking Plate and a Beveled Compression Screw: A Surgical Technique. Foot Ankle Spec 2025:19386400251331648. [PMID: 40219862 DOI: 10.1177/19386400251331648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2025]
Abstract
Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a valuable intervention for a variety of hallux pathologies and is still considered the gold standard treatment for advanced hallux rigidus, one of the most commonly encountered pathologies of the forefoot. With the advent and expansion of minimally invasive surgery (MIS) techniques, MIS First MTPJ arthrodesis offers a new approach to treat hallux conditions with the potential to limit complications and further enhance patient satisfaction. We describe a technique that affords the benefits of MIS surgery without compromising the biomechanical superiority of a dorsal hybrid low-profile plate with a beveled, partially threaded compression screw.Level of Evidence: Therapeutic, Level V: Technique article.
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Affiliation(s)
- Joseph R Duff
- Department of Orthopaedic Surgery, College of Medicine-Chattanooga, University of Tennessee, Chattanooga, TN, USA
| | - Austin G Alecxih
- Department of Orthopaedic Surgery, College of Medicine-Chattanooga, University of Tennessee, Chattanooga, TN, USA
| | - Charles C White
- Department of Orthopaedic Surgery, College of Medicine-Chattanooga, University of Tennessee, Chattanooga, TN, USA
| | - Jesse F Doty
- Department of Orthopaedic Surgery, College of Medicine-Chattanooga, University of Tennessee, Chattanooga, TN, USA
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Cho D, Kukadia S, Kumar P, Stern J, Shamrock A, Drakos M. Comparison of Clinical Outcomes Between Cheilectomy and Proximal Phalangeal Dorsiflexion Osteotomy With and Without Bone Marrow Aspirate Concentrate and Extracellular Matrix for Hallux Rigidus. Foot Ankle Int 2025:10711007251323883. [PMID: 40129040 DOI: 10.1177/10711007251323883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2025]
Abstract
BACKGROUND Hallux rigidus with an associated osteochondral lesion is a common condition that can effectively be treated with a cheilectomy and Moberg osteotomy (CM). The use of biological adjuncts such as extracellular matrix (ECM) and bone marrow aspirate concentrate (BMAC) have been suggested to facilitate healing and restore forefoot function. The aim was to report if the addition of ECM and BMAC improves clinical outcomes for the treatment of hallux rigidus. METHODS Patients who received open cheilectomy with first proximal phalangeal dorsal closing wedge osteotomy with and without ECM and BMAC for the diagnosis of hallux rigidus between February 2016 to July 2022 by the principal investigator were reviewed. A total of 137 patients were included, 71 in the cheilectomy with Moberg osteotomy group (CM) and 66 in the cheilectomy with Moberg osteotomy and ECM/BMAC group (CM + ECM/BMAC). All patients received Patient-Reported Outcomes Measurement Information System (PROMIS) surveys preoperatively and at minimum 1 year postoperatively. Postoperative complications were also noted for the patient cohort. RESULTS The average time from surgery to final follow-up was 21.6 (range, 12-36.2) months for CM patients and 27.8 (range, 12-82.5) months for CM+BMAC patients (P = .001). Both CM and CM+BMAC cohorts demonstrated significant improvement in physical function, pain interference, pain intensity, and global physical health. However, there were no significant differences in preoperative or postoperative PROMIS domains between the 2 cohorts. CONCLUSION In conclusion, this study compares short-term patient-reported clinical outcomes and complications of cheilectomy and Moberg osteotomy against cheilectomy and Moberg osteotomy with ECM and BMAC for hallux rigidus. This study suggests that any potential differences in outcomes between groups are not large enough to be clinically meaningful in the short term and that other factors may be more relevant in determining the best course of treatment. A longer follow-up is required to evaluate long-term functional and clinical outcomes, and to see if addressing the cartilage has long-term effects.
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Affiliation(s)
- David Cho
- Hospital for Special Surgery, New York, NY, USA
| | | | | | | | | | - Mark Drakos
- Hospital for Special Surgery, New York, NY, USA
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Kihara T, Kimura T, Suzuki N, Hattori A, Saito M, Kubota M. Dysfunction of the Windlass Mechanism Is Associated with Hallux Rigidus: A Case-Control Study. J Bone Joint Surg Am 2025; 107:558-564. [PMID: 39888978 PMCID: PMC11905900 DOI: 10.2106/jbjs.24.00437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2025]
Abstract
BACKGROUND The cause of hallux rigidus remains controversial. However, it is assumed that dysfunction of the windlass mechanism and metatarsus primus elevatus play a role in the pathology. Three-dimensional (3D) computed tomography (CT) imaging is ideal for analysis of movements of the foot, which involve 3D and rotational motion. The purpose of the present study was to compare the windlass mechanism in healthy normal feet with that in feet with hallux rigidus by 3D CT imaging. METHODS A total of 17 feet with hallux rigidus and 21 normal feet were selected. Hallux rigidus was classified as grade 1 or 2 with use of the Coughlin and Shurnas system. CT imaging was performed during weight-bearing and non-weight-bearing with the first metatarsophalangeal joint in a neutral position or in 30° of dorsiflexion. We measured the rotation of each joint and the height of the navicular during dorsiflexion and weight-bearing. We also compared changes in the tarsometatarsal joint and metatarsus primus elevatus in the neutral position between the non-weight-bearing and weight-bearing conditions. RESULTS During dorsiflexion, there were significant differences between the 2 groups in eversion and adduction at the talonavicular and talocalcaneal joints (p < 0.05), with less movement of bones in the hallux rigidus group. There was a significantly greater increase in height of the navicular in the control group than in the hallux rigidus group (1.2 ± 0.6 mm versus 0.7 ± 0.6 mm; p = 0.02). There was also a significant difference in metatarsus primus elevatus during the non-weight-bearing and weight-bearing conditions (p < 0.01). CONCLUSIONS Hallux rigidus restricts the movement of the Chopart joint and hindfoot associated with dorsiflexion of the first metatarsophalangeal joint, suggesting an association between hallux rigidus and windlass mechanism dysfunction. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Takumi Kihara
- Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan
- Institute for High Dimensional Medical Imaging, Jikei University School of Medicine, Tokyo, Japan
| | - Tadashi Kimura
- Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Naoki Suzuki
- Institute for High Dimensional Medical Imaging, Jikei University School of Medicine, Tokyo, Japan
| | - Asaki Hattori
- Institute for High Dimensional Medical Imaging, Jikei University School of Medicine, Tokyo, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Makoto Kubota
- Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan
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Thong YJ, Davies BM, Bedi H. Return to activities in younger individuals (<60 yrs) undergoing first metatarsophalangeal joint arthrodesis. J Foot Ankle Surg 2025; 64:192-196. [PMID: 39433210 DOI: 10.1053/j.jfas.2024.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 05/03/2024] [Accepted: 10/05/2024] [Indexed: 10/23/2024]
Abstract
Arthrodesis is a common procedure in the treatment of forefoot conditions affecting the first metatarsophalangeal (MTP) joint. Although this procedure has been shown to significantly improve individuals' activities of daily living and effectively relieve pain, there is a lack of research specifically investigating younger patients below 60 yrs of age wishing to return to sports. Our aim is to evaluate their ability to return to sports after 1st MTP joint arthrodesis. A retrospective analysis of clinical records of 159 patient that had undergone first MTP arthrodesis performed by a single surgeon was undertaken to determine pre- and postoperative sf-FAOS and sporting activity scores. The Tobit constant censoring limit model was used to analyze change in sf-FAOS scores. After the application of inclusion and exclusion criteria, 58 patients (median age 54 years, range 30 - 59) were included in the final cohort with a mean follow up of 5.3 years (range 2.0 to 9.44, SD 2.10). There was a significant improvement in the mean pain score (p<0.001), as well as an improvement in the mean function score (p<0.001). The number of hours spent in sporting activities per week were significantly higher (p<0.001) post-surgery (5.29 hours, SD 5.0) in comparison to preoperative levels (4.26 hours, SD 3.1). There was no significant change in the intensity of sporting activities (p=0.176). First MTP joint arthrodesis remains a good treatment option for younger individuals wishing to achieve a satisfactory return to sports.
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Affiliation(s)
| | - Benjamin Michael Davies
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom; OrthoSport Victoria, Epworth Richmond, Level 5, 89 Bridge Road, Richmond, VIC 3121, Australia.
| | - Harvinder Bedi
- OrthoSport Victoria, Epworth Richmond, Level 5, 89 Bridge Road, Richmond, VIC 3121, Australia; Monash University, VIC, Australia
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Kimura T, Kubota M, Kihara T, Suzuki N, Hattori A, Saito M. First ray mobility in hallux rigidus, hallux valgus, and normal feet based on weightbearing computed tomography and three-dimensional analysis: A case-control study. J Orthop Sci 2025; 30:320-324. [PMID: 38670826 DOI: 10.1016/j.jos.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 03/22/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Hallux valgus and hallux rigidus are disorders affecting the first ray and are associated with hypermobility of this structure. This study aimed to investigate the three-dimensional mobility of each joint of the first ray between feet with hallux valgus or hallux rigidus and healthy feet using weightbearing and nonweightbearing computed tomography (CT). METHODS This case-control study analyzed 17 feet of 11 healthy volunteers (control group), 16 feet of 16 patients with hallux valgus (HV group), and 16 feet of 11 patients with hallux rigidus (HR group). First, nonweightbearing foot CT imaging was performed in the supine position on a loading device with no load applied, with the legs extended and the ankle in the neutral position. Next, a load equivalent to body weight was applied for weightbearing CT imaging. Distal bone displacement relative to the proximal bone was quantified three-dimensionally under both conditions. RESULTS In the HV group, the talonavicular joint showed significantly greater eversion (P = 00.011) compared with the control group and significantly greater dorsiflexion (P = 00.027) and eversion (P < 00.01) compared with the HR group. In the medial cuneiform joint, the HV group showed significantly greater eversion (P < 00.01) and abduction (P = 00.011) than the control group. For the first tarsometatarsal joint, the HV group showed significantly greater dorsiflexion (P = 00.014), inversion (P = 00.028), and adduction (P < 00.01) than the control group, and greater inversion (P < 00.01) and adduction (P < 00.01) than the HR group. Dorsiflexion of the first tarsometatarsal joint was significantly greater in the HR group compared with the control group (P = 00.026). CONCLUSION Hypermobility of the first ray appears to be three-dimensional: in hallux valgus, it is centered at the first tarsometatarsal joint, while in hallux rigidus it is mainly in the sagittal plane at the first tarsometatarsal joint only. This difference may explain the different deformities ultimately observed in each condition.
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Affiliation(s)
- Tadashi Kimura
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan; Institute for High Dimensional Medical Imaging, The Jikei University School of Medicine, Tokyo, Japan.
| | - Makoto Kubota
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Takumi Kihara
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan; Institute for High Dimensional Medical Imaging, The Jikei University School of Medicine, Tokyo, Japan
| | - Naoki Suzuki
- Institute for High Dimensional Medical Imaging, The Jikei University School of Medicine, Tokyo, Japan
| | - Asaki Hattori
- Institute for High Dimensional Medical Imaging, The Jikei University School of Medicine, Tokyo, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Rajeev A, Yallop W, Koshy G, Devalia K. Midterm functional outcomes of synthetic cartilage implant (SCI) arthroplasty for hallux rigidus. J Foot Ankle Surg 2025; 64:144-149. [PMID: 39369950 DOI: 10.1053/j.jfas.2024.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 09/01/2024] [Accepted: 09/14/2024] [Indexed: 10/08/2024]
Abstract
Hallux rigidus is a common degenerative condition of first metatarso-phalangeal joint most commonly affecting patients above 50 years of age. The aim of our study is to evaluate the five-year results of synthetic cartilage implant (Cartiva) arthroplasty for hallux rigidus. A retrospective study of 70 patients who underwent synthetic cartilage implant interpositional arthroplasty were collected and analysed. Patients with Grade 3 to 4 hallux rigidus and who had failed conservative management were included. Patients who had previous forefoot surgery, hallux varus or valgus deformity of more than 250 and neuromuscular disease were excluded. Mean age at the time of operation was 63.4 years (range 42-84 years). The mean follow-up was 62.6 months. The functional evaluation was done using Manchester-Oxford Foot Questionnaire (MOxFQ). EQ-5D and EQVAS. 86 patients were matriculated in the study with 70 patients being assessed at five years. The average preoperative MOxFQ score improved from 35.74 (31.44-40.04) to 19.11 (11.31- 26.91) at one year after surgery. The EQ-5D scores improved from preoperative average of 9.40 (8.14-10.66) to 4.26 (2.09-6.43) at one year. The preoperative EQVAS was 61.66 (51.25-72.07) to 71.45 (60.87-82.03 at one year. At five years follow up the average MOxFQ score was 17.6 (9.92-24.38), EQ-5D - 4.8 (2.26- 6.45) and EQVAS - 72.48 (62.40-82.56). Three patients had revision to first MTP fusion due to ongoing pain. Synthetic cartilage implant has demonstrated clinical efficacy and good functional outcomes at the end of five years for the treatment of Hallux rigidus.
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Affiliation(s)
- Aysha Rajeev
- Department of Trauma and Orthopaedics, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead NE9 6SX, Tyne and Wear.
| | - William Yallop
- Department of Trauma and Orthopaedics, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead NE9 6SX, Tyne and Wear.
| | - George Koshy
- Department of Trauma and Orthopaedics, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead NE9 6SX, Tyne and Wear.
| | - Kailash Devalia
- Department of Trauma and Orthopaedics, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead NE9 6SX, Tyne and Wear.
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Nakajima K. Joint-Preserving Surgeries for Hallux Rigidus Based on Etiology: A Review and Commentary. J Clin Med 2025; 14:1595. [PMID: 40095556 PMCID: PMC11899870 DOI: 10.3390/jcm14051595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2025] [Revised: 02/23/2025] [Accepted: 02/25/2025] [Indexed: 03/19/2025] Open
Abstract
In 1927, Cochrane noted that elastic resistance to dorsiflexion of the hallux was retained after the cheilectomy or dorsiflexion osteotomy of the metatarsal head and speculated that the shortening and tightness of the soft tissues below the first metatarsophalangeal joint would be the etiology of hallux rigidus. He devised a novel surgery in which the plantar tissues were divided using a plantar approach and reported good results in 12 patients with the disappearance of elastic resistance during dorsiflexion and with no recurrence. Although he identified the etiology of hallux rigidus and developed a revolutionary surgery that directly addressed the etiology, this approach has not yet been seen in current surgeries. Therefore, we hypothesized that current surgeries for hallux rigidus lack rationality regarding etiology and aimed to critically review joint-preserving surgeries based on etiology. First, we summarized the literature on proposed causes and explained how the condition progresses from shortened, tightened plantar soft tissues. We then reviewed joint-preserving surgeries in terms of etiology and treatment efficacy and finally mentioned the arthroscopic Cochrane procedure as a promising option.
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Affiliation(s)
- Kenichiro Nakajima
- Center for Foot and Ankle Surgery, Department of Orthopedic Surgery, Yashio Central General Hospital, Yashio 340-0814, Saitama, Japan
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Zhu Y, Gao M, Tan H, Yan J, Zhang H. Research progress in the etiology and minimally invasive therapy of hallux valgus. Surgeon 2025; 23:e9-e20. [PMID: 39863442 DOI: 10.1016/j.surge.2025.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 01/07/2025] [Accepted: 01/12/2025] [Indexed: 01/27/2025]
Abstract
Hallux valgus (HV) is the most common foot deformity. It has various pathogenic factors that make its pathogenesis challenging to understand. As the disease progresses, patients experience amplified pain and decreased activities, significantly affecting their quality of life. At present, clinics offer several conservative and surgical treatments that must be selected based on patient condition and disease progression. Surgical treatment is frequently the only method available to patients with HV to delay disease progression and correct the deformity after conservative treatment fails. In recent years, minimally invasive surgical treatments have gained significant attention and developed rapidly due to their well-known advantages, such as safety, efficiency, and quick recovery time. The number of literature that provides a systematic review of the subject must be increased. This review tracks recent advancements, summarizing the etiological mechanism, epidemiology, diagnosis, and treatment of HV. In addition, it emphasizes typical surgical therapies and focuses on the progress of minimally invasive treatment from the first generation to the current fourth generation. This review will serve as a systematic basis for the clinical treatment of HV and provide a reference material for future research.
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Affiliation(s)
- YongJia Zhu
- Department of Arthritis, Affiliated Hospital of Shandong Second Medical University, 2428 Yuhe Road, Kuiwen District, Weifang City, Shandong Province, 261031, PR China
| | - Ming Gao
- Department of Arthritis, Affiliated Hospital of Shandong Second Medical University, 2428 Yuhe Road, Kuiwen District, Weifang City, Shandong Province, 261031, PR China
| | - Haowen Tan
- Department of Arthritis, Affiliated Hospital of Shandong Second Medical University, 2428 Yuhe Road, Kuiwen District, Weifang City, Shandong Province, 261031, PR China
| | - JiaPeng Yan
- Department of Arthritis, Affiliated Hospital of Shandong Second Medical University, 2428 Yuhe Road, Kuiwen District, Weifang City, Shandong Province, 261031, PR China.
| | - HongFei Zhang
- Department of Arthritis, Affiliated Hospital of Shandong Second Medical University, 2428 Yuhe Road, Kuiwen District, Weifang City, Shandong Province, 261031, PR China.
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Chong KAJM, Teo SJ, Toh RX, Buhary KSM, Li Z, Tay KS. High Preoperative Pain Score is a Predictor of Cheilectomy Failure in Hallux Rigidus. J Foot Ankle Surg 2025; 64:1-6. [PMID: 39154986 DOI: 10.1053/j.jfas.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 08/05/2024] [Accepted: 08/11/2024] [Indexed: 08/20/2024]
Abstract
Hallux rigidus (HR) is a prevalent arthritic condition in the foot. Cheilectomy is a common joint-preserving procedure for HR, involving the removal of prominent osteophytes to relieve impingement of the 1st MTPJ. This study aims to identify factors associated with the failure of cheilectomy in the treatment of HR. A retrospective review of a prospectively collected database from 2007 to 2021 identified all cheilectomy cases. The minimum follow-up was 2 years. Preoperative demographic data, patient-reported outcome measures (PROMs) and foot radiographs were collected. PROMs were reassessed in postoperative reviews, and cases were categorized as successes or failures. Failure was defined by meeting at least one of the following criteria at the latest review: 1) Visual analog pain score (VAS) more than or equal to 4, 2) undergoing subsequent revision procedures, or 3) reporting poor or terrible satisfaction with the surgery. The analysis involved 66 patients, with 19 failure and 47 success cases. Both groups showed similar age, BMI, and gender profiles. Preoperative radiographic parameters were comparable between groups. However, preoperative VAS was significantly higher in the failure group: 7.16 vs 5.23 (p = .0029). Logistic regression confirmed preoperative VAS as a predictor of nonresponse (p = .023). Receiver Operating Characteristic analysis established an optimal cut-off VAS score of 7.0. Patients with a preoperative VAS score of more than 7 had an odds ratio of 5.11 (p = .0055) for failure. A higher preoperative VAS score is significantly associated with cheilectomy failure in HR treatment, suggesting a cutoff score of 7.0.
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Affiliation(s)
| | - Shao Jin Teo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Rui Xiang Toh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Zongxian Li
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Kae Sian Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Sanii R, Phan K, Krumm D, Patton DJ, Madden T, Anderson JG, Maskill JD, Bohay DR, Padley MA, Patthanacharoenphon CG. Treatment of Hallux Rigidus: Comparison of Hemiarthroplasty with Cartiva Implant, Allograft Interpositional Arthroplasty, and Arthrodesis. FOOT & ANKLE ORTHOPAEDICS 2025; 10:24730114251324184. [PMID: 40160852 PMCID: PMC11954559 DOI: 10.1177/24730114251324184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2025] Open
Abstract
Background A modern technique for the treatment of hallux rigidus (HR) is first metatarsophalangeal (MTP) hemiarthroplasty with the use of a Cartiva synthetic cartilage implant. Current scientific literature reporting early outcomes of the procedure is sparse and mixed, indicating the need for further analysis. The objective of this study was to compare improvement in visual analog scale (VAS) scores with first MTP hemiarthroplasty with Cartiva implant (HI), allograft interposition arthroplasty (IA), and arthrodesis (A) in patients who failed conservative management or cheilectomy. Methods A retrospective cohort study of 99 patients was performed. There were 49 patients in the HI group, 25 patients in the IA group, and 25 patients in the A group. A follow-up survey was administered from which updated VAS and updated American Orthopaedic Foot & Ankle Society scores were obtained. Results Mean VAS scores improved by 2.73 (SD ± 2.80) points in the HI group, 4.16 (SD ± 2.01) points in the IA group, and 4.36 (SD ± 3.67) points in the A group (P = .035). Mean AOFAS scores improved by 14.90 (SD ± 17.31) points in the HI group, 27.80 (SD ± 15.22) points in the IA group, and 27.88 (SD ± 25.34) points in the A group (P = .005). There were 3 (6.1%) revision surgeries in the HI group, 2 (8.0%) revision surgeries in the A group, and no revision surgeries in the IA group (P = .59). Within the HI group, all 3 revisions were due to pain associated with the implant and were revised to MTP arthrodesis. The A group had 1 revision due to broken hardware and 1 revision due to infection. In both cases, the patients were treated with hardware removal. Conclusion Pain and function may be slightly more improved with interpositional arthroplasty and arthrodesis for the treatment of HR, when compared to hemiarthroplasty with the Cartiva implant. Level of Evidence Level III, therapeutic studies; case-control study.
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Affiliation(s)
- Ryan Sanii
- The University of Chicago Department of Orthopaedic Surgery, Chicago, IL, USA
| | - Kevin Phan
- Orthopedic Associates of Michigan, Grand Rapids, MI, USA
| | - Drew Krumm
- Corewell Health/Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | | | - Tyler Madden
- Corewell Health/Michigan State University College of Human Medicine, Grand Rapids, MI, USA
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Capell Morera A, de Planell Mas E, Perez Palma L, Manzanares-Céspedes MC. Range of Flexion Improvement in Degenerative Stages of the First Metatarsophalangeal Joint ( Hallux rigidus) with Cross-Linked Hyaluronic Acid: A Cadaveric Study. J Funct Morphol Kinesiol 2024; 9:259. [PMID: 39728243 DOI: 10.3390/jfmk9040259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Revised: 11/29/2024] [Accepted: 12/05/2024] [Indexed: 12/28/2024] Open
Abstract
BACKGROUND Viscosupplementation consists of intraarticular hyaluronic acid injections applied to treat pain and improve joint mobility. The objective of the study was to analyze the improvement of the range of mobility of the first metatarsophalangeal joint with a single dose of cross-linked hyaluronic acid. METHODS Ten fresh frozen specimens of feet sectioned below the knee were selected. Before and after the infiltration procedure, the range of flexion was calculated for all specimen's metatarsophalangeal joints. To detect complications due to the procedure, five feet were dissected and five were sectioned with a diamond saw. RESULTS The range of the first metatarsophalangeal joint flexion differences between the preoperative and the postoperative period was as follows: (1) 47° (range, 37-51.5) to 58° (range, 49-69.5) degrees of loaded dorsiflexion (p > 0.006); (2) 41° (range, 40-51.5) to 58° (range, 52.5-66.5) degrees of unloaded dorsiflexion (p > 0.009); and (3) 14° (range, 10.5-24.25) to 16° (range, 14.25-28.5) degrees of unloaded plantarflexion (p > 0.083). No injuries of anatomical structures were observed either by anatomical dissection or in the anatomical sections. CONCLUSIONS The results obtained in this viscosupplementation study demonstrate the improvement of the range of mobility of the first metatarsophalangeal joint without evidence of extravasation and lesions of the periarticular anatomical structures.
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Affiliation(s)
- Annabel Capell Morera
- Clinical Sciences Department, Faculty of Medicine and Health Sciences, University of Barcelona, 08907 Hospitalet, Spain
| | - Elena de Planell Mas
- Clinical Sciences Department, Faculty of Medicine and Health Sciences, University of Barcelona, 08907 Hospitalet, Spain
| | - Laura Perez Palma
- Clinical Sciences Department, Faculty of Medicine and Health Sciences, University of Barcelona, 08907 Hospitalet, Spain
| | - Maria Cristina Manzanares-Céspedes
- Human Anatomy and Embryology Unit, Experimental Pathology and Therapeutics Department, Faculty of Medicine and Health Sciences, University of Barcelona, 08907 Hospitalet, Spain
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Arceri A, Di Paola G, Mazzotti A, Zielli SO, Artioli E, Langone L, Sgubbi F, Faldini C. Reviewing Evidence and Patient Outcomes of Cheilectomy for Hallux Rigidus: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:7299. [PMID: 39685757 DOI: 10.3390/jcm13237299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 11/22/2024] [Accepted: 11/28/2024] [Indexed: 12/18/2024] Open
Abstract
Background: Cheilectomy is a joint-sparing surgery for the treatment of moderate stages of Hallux Rigidus (HR). The purpose of this systematic review was to assess the clinical outcomes, range of motion (ROM), complications, and revision rates associated with cheilectomy. Methods: A literature search of the PubMed, Scopus, and Cochrane databases was performed. PRISMA guidelines were used. Risk of bias was assessed through the Newcastle-Ottawa Scale. Meta-analysis of the clinical outcomes scores was performed. Results: The initial search identified 317 articles, with 16 included. Cheilectomy improved ROM by 51.15% (41.23° to 62.32°), with greater gains in traditional (67.72%) vs. minimally invasive (48.74%) techniques. VAS decreased by 72.61%, more in traditional (79.35%) than minimally invasive (64.97%). AOFAS improved by 33.99%, from 61.83 to 82.85. Complications occurred in 11% (11.68% traditional, 9.73% minimally invasive), with residual pain (7.46%) more common in traditional and nerve injury (3.78%) in minimally invasive procedures. Revision rates were 7.4% overall (6.1% traditional, 8.8% minimally invasive). Conclusions: This procedure showed satisfactory results regardless of whether the traditional or minimally invasive technique is used. Current evidence does not allow for a definitive indication, but careful patient selection is advisable, particularly for mild to moderate cases.
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Affiliation(s)
- Alberto Arceri
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy
| | - Gianmarco Di Paola
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Antonio Mazzotti
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy
| | - Simone Ottavio Zielli
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Elena Artioli
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Laura Langone
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Federico Sgubbi
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy
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13
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Roukis TS, Piraino JA, Hollawell S, Kuruvilla B, Kuruvilla B, McMillen R, Zimmerman M, Hentges MJ, West T. ACFAS Clinical Consensus Statements: Hallux Rigidus. J Foot Ankle Surg 2024; 63:624-630. [PMID: 39094959 DOI: 10.1053/j.jfas.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 07/20/2024] [Indexed: 08/04/2024]
Abstract
The following are clinical consensus statements (CCS) on the topic of hallux rigidus sponsored by the American College of Foot and Ankle Surgeons. A core panel synthesized the data and divided the topic in to twelve sections, each section contained a variable number of consensus statements, based upon complexity. Overall there were 24 consensus statements synthesized for this subject matter. The 24 statements were provided to the expert panel with all available evidence to come to a consensus utilizing all available evidence.
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Affiliation(s)
- Thomas S Roukis
- Clinical Professor, University of Florida College of Medicine-Jacksonville, Department of Orthopaedic Surgery & Rehabilitation, Division of Foot & Ankle Surgery, Jacksonville, FL
| | - Jason A Piraino
- Associate Professor Chief of Foot and Ankle Surgery, Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine-Jacksonville, Jacksonville, FL.
| | | | | | | | - Ryan McMillen
- Faculty, Division of Foot and Ankle Surgery, Jefferson Hospital, Allegheny Health Network, Pittsburgh, PA
| | | | - Matthew J Hentges
- Attending Faculty of Residency, Training Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburg, PA
| | - Tenaya West
- Palo Alto Medical Foundation Mountain View, Department of Podiatry and Orthopedics, Fremont, CA
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14
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Ismail A, Hannant G, Ashour A, Broadhurst D. The Outcome of the Use of Continuous Action Compression Device for the First Metatarsophalangeal Joint Fusion. Cureus 2024; 16:e74168. [PMID: 39712823 PMCID: PMC11662993 DOI: 10.7759/cureus.74168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2024] [Indexed: 12/24/2024] Open
Abstract
INTRODUCTION First metatarsophalangeal (MTP) joint fusion is a widely accepted surgical intervention for treating severe arthritis, deformities, and instability of the first MTP joint. This paper provides a review of a single surgeon's experience with continuous compression implants (CCI), which offer a notable advantage by providing uniform compression across a larger surface area of the fusion site compared to plate and screw constructs. This design potentially reduces soft tissue irritation and, consequently, the need for subsequent implant removal. It also saves on cost and has the potential to reduce the length of surgery. METHODS A retrospective review was conducted on 27 patients (n=36 feet) who underwent primary first metatarsophalangeal joint (MTPJ) fusion using continuous compression implants (CCI) between March 2020 and April 2024 at Bradford Royal Infirmary. Patient data were collected from the surgeon's logbook and medical records. The outcomes analyzed included the fusion rate and complications. Statistical analysis was performed using SPSS version 22.0, with p<0.05 considered significant. RESULTS The mean age of the cohort was 60.24 years (range 41-90), with 88.88% female. The ratio of left to right was 70%. The mean follow-up duration was 27 months (range 6-48 months). Complete fusion of the first MTPJ was achieved in 34 out of 36 feet (94.4%). Nonunion occurred in one patient, while delayed union was observed in another. Clinically, 35 out of 36 patients (97.3%) reported satisfaction with the procedure, with one patient requiring metalwork removal and revision due to loosening. CONCLUSION Early results show that the rate of fusion achieved by using the CCI for the first MTPJ arthrodesis in our series was comparable to that of other devices quoted in the literature.
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Affiliation(s)
- Ahmed Ismail
- Orthopaedics, Bradford Royal Infirmary, Bradford, GBR
| | - Gary Hannant
- Orthopaedics and Trauma, Bradford Royal Infirmity, Bradford, GBR
| | - Ahmed Ashour
- Trauma and Orthopaedics, Queen Elizabeth Hospital Birmingham, Birmingham, GBR
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15
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Michelson JD, Charlson MD, Bernknopf JW, Carpenter RL, Brand SJ. The Role of the Flexor Hallucis Longus in the Treatment of the Painful Hallux Metatarsophalangeal Joint. Foot Ankle Int 2024; 45:1051-1058. [PMID: 39080927 DOI: 10.1177/10711007241266842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2024]
Abstract
BACKGROUND Pain in the hallux metatarsophalangeal joint (MTPJ) is very common, yet the underlying etiology remains unknown. Previous clinical research and biomechanical research has implicated stenosing flexor hallucis longus (FHL) tendonitis as a possible cause. The hypothesis of this study was that treatment solely focusing on alleviating restricted FHL excursion would be beneficial in patients with hallux MTPJ pain. METHODS This is a retrospective study of those treated in the Foot & Ankle Division between January 2009, and December 2018, who were diagnosed with FHL tendonitis with associated pain in the hallux MTPJ. Demographics, comorbidities, examination findings, imaging results, pain scores, treatment instituted, and outcome was obtained from the electronic medical record. The primary outcome was the improvement in the pain score (visual analog scale [VAS]). The surgical patients were included if their procedure was solely related to the FHL (posteromedial ankle release ± os trigonum resection). The decision to have surgery was analyzed by univariate and multivariable statistics using demographics, comorbidities, and clinical findings as potential factors (P < .05). RESULTS In 75% (59 of 79 feet), nonoperative treatment of FHL stenosis resulted in a decrease in pain scores that the patients felt was satisfactory. The operative group that had an FHL release showed decreased pain in 90% (18 of 20 feet). Multivariable analysis identified the need for immobilization (OR 9.8, 95% CI 1.8-55.2, P = .009), participating in athletics (OR 8.7, 95% CI 1.8-42.2, P = .007), and higher initial VAS (OR 1.7, 95% CI 1.3-2.3, P < .001) as being associated with the decision for surgery. CONCLUSION Previous biomechanical studies have suggested that stenosing FHL synovitis can cause increased intraarticular loading in the hallux MTPJ. The current clinical study supports this hypothesis, demonstrating that treatment focused on relieving restricted FHL excursion can ameliorate pain in the hallux MTPJ in select cases.
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Affiliation(s)
- James D Michelson
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Mark D Charlson
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Jacob W Bernknopf
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Rachel L Carpenter
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Stephen J Brand
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, USA
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16
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Bhimani R, Labib SA. Metatarsophalangeal Arthroplasty in Hallux Rigidus. Foot Ankle Clin 2024; 29:495-505. [PMID: 39068024 DOI: 10.1016/j.fcl.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
First metatarsophalangeal joint (MTPJ) arthroplasty provides hallux rigidus patients with pain relief and preserved motion, offering an alternative to arthrodesis. Recent advancements in implant technology and surgical techniques have broadened treatment options. Although good outcomes have been documented in the literature, concerns persist regarding increased complications, uncertain long-term efficacy, and challenges in managing failed arthroplasties. Addressing bone loss resulting from the procedure further complicates salvage procedures. Larger cohorts and extended studies are necessary to establish efficacy of first MTPJ arthroplasty. Decisions must weigh the trade-offs between pain relief and potential complications, requiring thorough patient-surgeon discussions.
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Affiliation(s)
- Rohan Bhimani
- Foot and Ankle Division, Department of Orthopaedic Surgery, Emory University School of Medicine, Emory Orthopedics, 1968 Hawks Lane, # 200, Atlanta, GA 30329, USA
| | - Sameh A Labib
- Foot and Ankle Division, Department of Orthopaedic Surgery, Emory University School of Medicine, Emory Orthopedics, 1968 Hawks Lane, # 200, Atlanta, GA 30329, USA.
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17
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Murawski CD, Anderson RB. Managing Hallux Rigidus in the Elite Athlete. Foot Ankle Clin 2024; 29:455-469. [PMID: 39068021 DOI: 10.1016/j.fcl.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Hallux rigidus can present a difficult problem to both competitive and elite athletic populations. Once an appropriate diagnostic workup has been performed, nonoperative management strategies, including anti-inflammatory medications, injection therapies, shoewear modifications, and orthotic devices, represent the mainstay conservative management options. Surgical management can be considered where an athlete's athletic performance is limited. A joint-sparing cheilectomy can provide a predictable return to sport at the most elite levels. The addition of a proximal phalangeal osteotomy can be considered when necessary. Arthroplasty or arthrodesis techniques can be used for persistent symptoms or progressive disease, but with less predictable outcomes.
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Affiliation(s)
- Christopher D Murawski
- Foot & Ankle Institute, OrthoCarolina, 2001 Vail Avenue, Suite 200B, Charlotte, NC 28207, USA
| | - Robert B Anderson
- Foot & Ankle Institute, OrthoCarolina, 2001 Vail Avenue, Suite 200B, Charlotte, NC 28207, USA.
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18
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Budde K, Claassen L, Plaass C, Stukenborg-Colsman C, Daniilidis K, Yao D. Synthetic cartilage implant vs. first metatarsophalangeal arthrodesis for the treatment of hallux rigidus. Arch Orthop Trauma Surg 2024; 144:4343-4354. [PMID: 39287788 PMCID: PMC11564238 DOI: 10.1007/s00402-024-05534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 09/01/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND This study evaluated the outcome of the Cartiva synthetic cartilage implant (SCI) in the treatment of hallux rigidus. METHODS In the present retrospective matched case-control study, we compared 18 patients with Cartiva SCI (mean follow-up: 17.7 months) to 18 patients with metatarsophalangeal joint arthrodesis (mean follow-up: 20 months) using multiple function measures, along with four specified visual analog subscales for pain. Pre- and postoperative radiographs were compared, and radiographic abnormalities were documented. RESULTS We observed no significant differences in function measures between groups. While both groups experienced significant pain reduction, the arthrodesis group reported significantly lower exertion pain than the Cartiva SCI group (p = 0.004). Radiographic abnormalities, including implant site enlargement (6/18, 33.3%), erosive changes of the metatarsal bone (11/18, 61.1%) or articular surfaces (10/18, 55.6%), and bright sclerotic margins (12/18, 66.7%), occurred in the Cartiva SCI group. CONCLUSION The present study showed good functional results and a high satisfaction rate after MTP joint arthrodesis, which is considered the gold standard surgical treatment for higher grade hallux rigidus. While the Cartiva SCI group did not show significant differences from the arthrodesis in most aspects of function and clinical scores, the arthrodesis group tended to have better results in terms of satisfaction, residual pain, and revision rate. Even after the short follow-up period, there were some remarkable radiographic findings in the Cartiva SCI group, the long-term effects of which are not yet evident, but which may lead to implant loss. Cartiva SCI has advantages for patients who prioritize postoperative mobility, but the potential risks should be considered in the patient's informed consent. Therefore, the present study highlights the importance of MTP joint arthrodesis for the treatment of hallux rigidus. LEVEL OF EVIDENCE Level IV - Retrospective matched case-control study.
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Affiliation(s)
- Konrad Budde
- Orthopedic Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Leif Claassen
- Orthopedic Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Rueckenprofis Hannover, Luisenstraße 10-11, 30159, Hannover, Germany
| | - Christian Plaass
- Orthopedic Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | | | | | - Daiwei Yao
- Orthopedic Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Emma Klinik, Klinik für operative Medizin GmbH & Co. KG, Frankfurter Straße 51, 63500, Seligenstadt, Germany
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19
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Williams BT, Hunt KJ. Hallux Rigidus: Anatomy and Pathology. Foot Ankle Clin 2024; 29:371-387. [PMID: 39068015 DOI: 10.1016/j.fcl.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Hallux rigidus is a common degenerative condition of the hallux metatarsophalangeal joint (MTPJ) characterized by pain, swelling, stiffness, and limited range of motion with characteristic corresponding clinical, physical examination, and radiographic findings. Many historical risks factors including trauma and family history and patient factors including hallux valgus interphalangeus and inflammatory arthropathies have a well-substantiated etiologic role in the disease process. The purpose of this section is to review the normal and pathologic anatomy and biomechanics of the hallux MTPJ while providing an overview of the current understanding and remain debate regarding the disease process.
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Affiliation(s)
- Brady T Williams
- Division of Foot and Ankle Surgery, Department of Orthopedic Surgery, University of Colorado, 12631 East 17th Avenue, Room 4508, Aurora, CO 80045, USA
| | - Kenneth J Hunt
- Division of Foot and Ankle Surgery, Department of Orthopedic Surgery, University of Colorado, 12631 East 17th Avenue, Room 4508, Aurora, CO 80045, USA.
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20
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Jones MT, Braza S, Mallavarapu V, Behrens A, Jasper R, Stebral H, Carvalho KAMD, Barbachan Mansur NS, Dibbern K, de Cesar Netto C. Quantification of First Metatarsal Joint Surface Interactions in Hallux Rigidus Using Distance and Coverage Mapping: A Case-Control Study. Foot Ankle Int 2024; 45:1038-1046. [PMID: 39080928 DOI: 10.1177/10711007241258447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
BACKGROUND Weightbearing cone-beam computed tomography (WBCT) has proven useful for analysis of structural changes of the foot and ankle when compared to conventional radiographs. WBCT allows for extraction of distance and coverage mapping metrics, which may provide novel insight into hallux rigidus (HR). This study retrospectively assessed HR joint space using distance and coverage mapping in a case-control study. METHODS WBCT images of the foot and ankle for 20 symptomatic HR and 20 control patients were obtained. Three-dimensional models were created and analyzed using a custom semiautomatic measurement algorithm. Distance and coverage mapping metrics for the first metatarsophalangeal and metatarsosesamoid joints were extracted from the models and compared between cohorts. Relationships between these metrics and visual analog scale (VAS) scores, a patient-reported outcome of pain, were assessed in HR patients. RESULTS Overall first metatarsophalangeal joint space narrowing was noted in HR patients when compared to controls by an average of 11.8% (P = .02). However, no significant changes in the overall coverage of the joint were noted. Decreased joint space width and increased surface-to-surface coverage were only and particularly observed at the plantar medial quadrant of the first metatarsal head in HR patients relative to controls. VAS score was significantly but weakly correlated with dorsolateral quadrant coverage (R2 = 0.26, P = .03). CONCLUSION Distance and coverage mapping serve as a complementary option to current techniques of quantifying HR changes. These metrics can expand the scope of future work investigating joint articulation changes in HR.
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Affiliation(s)
- Matthew Thomas Jones
- Department of Orthopedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Samuel Braza
- Department of Orthopedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Vineel Mallavarapu
- Department of Orthopedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Andrew Behrens
- Department of Orthopedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Ryan Jasper
- Department of Orthopedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Hannah Stebral
- Department of Orthopedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | | | - Kevin Dibbern
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA
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21
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Fletcher AN, Patel V, Cerrato R. Minimally Invasive Cheilectomy for Hallux Rigidus. Foot Ankle Clin 2024; 29:471-484. [PMID: 39068022 DOI: 10.1016/j.fcl.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Hallux metatarsophalangeal joint cheilectomy is a joint-sparing technique that involves resection of the dorsal metatarsal head osteophytes; this may be achieved through minimally invasive and arthroscopic techniques. General indications for minimally invasive surgery (MIS) cheilectomy are mild-to-moderate hallux rigidus (Grades I-II) with symptomatic dorsal osteophytes causing dorsal impingement and/or shoe wear irritation in those who have failed extensive nonoperative management. The literature confirms equivalent outcomes to open cheilectomy; however, it is somewhat inconsistent regarding superiority. The theoretic benefits of MIS cheilectomy include better cosmesis, reduced wound complications, less soft tissue disruption, and faster recovery.
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Affiliation(s)
- Amanda N Fletcher
- OrthoCarolina, 2001 Vail Avenue, Suite 200B, Charlotte, NC 28207-1222, USA.
| | - Vandan Patel
- Department of Orthopaedic Surgery, University of Michigan, 2098 S Main Street, Ann Arbor, MI 48103, USA
| | - Rebecca Cerrato
- Mercy Medical Center, Baltimore, The Institute for Foot and Ankle Reconstruction, 301 St Paul Place, Institute for Foot and Ankle Reconstruction At Mercy, Baltimore, MD 21202, USA
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22
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Suh YM, Tennant JN. Classification and Radiology. Foot Ankle Clin 2024; 29:389-404. [PMID: 39068016 DOI: 10.1016/j.fcl.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
The classification systems of hallux rigidus, including the Coughlin and Shurnas, Hattrup and Johnson, Regnauld, and Roukis classifications, allow for a comprehensive understanding of the condition's severity and aid in informed treatment decisions. The common techniques of radiological imaging, such as standard plain film radiographs, MRI, magnetic resonance arthrography computed tomography (CT), weightbearing CT, and ultrasound, which enable accurate assessment of joint degeneration and associated pathologies for optimal patient care, are reviewed.
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Affiliation(s)
- Yu Min Suh
- Department of Orthopaedics, University of North Carolina at Chapel Hill, 3144 Bioinformatics Bldg, CB# 7055, Chapel Hill, NC 27599, USA.
| | - Joshua N Tennant
- Department of Orthopaedics, University of North Carolina at Chapel Hill, 3144 Bioinformatics Bldg, CB# 7055, Chapel Hill, NC 27599, USA
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23
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Yurteri A, Mercan N, Kekeç AF, Yıldırım A. Arthrodesis using Iliac Crest autograft in revision surgery of the first metatarsophalangeal joint total arthroplasty for the treatment of Hallux Rigidus: a retrospective study. J Orthop Surg Res 2024; 19:508. [PMID: 39192325 DOI: 10.1186/s13018-024-04995-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 08/12/2024] [Indexed: 08/29/2024] Open
Abstract
PURPOSE The treatments for hallux rigidus (HR) encompass a wide spectrum, including conservative methods and surgical approaches such as arthroplasty and arthrodesis. This study aims to evaluate the outcomes of revision with arthrodesis following the failure of the first metatarsophalangeal joint total arthroplasty (MTPJ1TA). MATERIALS AND METHODS Patients who had surgery at two advanced orthopedic centers between January 1, 2020, and January 1, 2024, were reviewed. Those with at least 6 months of postoperative follow-up were assessed for demographics (gender, age, side), reoperation rates, complications, Visual Analogue Scale (VAS) scores, Foot and Ankle Disability Index (FADI) scores, and American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal and Interphalangeal Scale (AOFAS-HMI) scores. Radiological evaluations included hallux valgus angle (HVA), intermetatarsal angle (IMA), dorsiflexion angle (DFA), and first ray length (FRL) in anteroposterior and lateral views. RESULTS Of 27 patients, 4 were male (15%) and 23 female (85%), with an average age of 56.18 ± 7.49 years (range 41-72). Arthrodesis was performed in 26 patients, with one requiring reoperation due to implant failure. Average VAS scores were 7.14 preoperatively and 3.55 postoperatively (p < 0.05). Average FADI scores were 50.51 preoperatively and 71.51 postoperatively (p < 0.05). Average AOFAS-HMI scores were 51.22 preoperatively and 70.59 postoperatively (p < 0.05). Average HVA was 19.7° preoperatively and 6.29° postoperatively (p < 0.05). Average IMA was 10.66° preoperatively and 11.37° postoperatively (p = 0.406). Average DFA was 34.14° preoperatively and 22.33° postoperatively (p < 0.05). Average anteroposterior FRL was 10.17 cm preoperatively and 10.77 cm postoperatively (p < 0.05). Average lateral FRL was 10.12 cm preoperatively and 10.42 cm postoperatively (p < 0.05). None of the patients in the study exhibited postoperative donor site complications or transfer metatarsalgia, while a 100% rate of bone union was observed. CONCLUSION We think that revision of MTPJ1TA with arthrodesis is a safe treatment option. Additionally, the use of an iliac crest autograft can be a viable option to restore bone stock and create a biological environment conducive to fusion. This study evaluates revision surgery with arthrodesis in the largest patient group with failed MTPJ1TA, highlighting its significance in the field. However, further studies are needed to determine the ideal surgical procedure.
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Affiliation(s)
- Ahmet Yurteri
- Department of Orthopaedics and Traumatology, Konya City Hospital, Konya, Turkey
| | - Numan Mercan
- Department of Orthopaedics and Traumatology, Kahramanmaras Necip Fazıl City Hospital, Kahramanmaras, Turkey.
| | - Ahmet Fevzi Kekeç
- Department of Orthopaedics and Traumatology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Ahmet Yıldırım
- Department of Orthopaedics and Traumatology, Health Application and Research Center University of Health Sciences, Konya City Hospital, Konya, Turkey
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Capell Morera A, De Planell-Mas E, Pérez Palma L, Manzanares Céspedes MC. Good Short- and Mid-term Outcome After Cross-Linked Hyaluronic Acid Infiltration for Hallux Rigidus: A Case Report. CLINICAL MEDICINE INSIGHTS. ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2024; 17:11795441241270120. [PMID: 39149615 PMCID: PMC11325319 DOI: 10.1177/11795441241270120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 06/24/2024] [Indexed: 08/17/2024]
Abstract
We report a first case of hallux rigidus successfully treated in an elderly patient by intra-articular infiltration of cross-linked hyaluronic acid (HA) 21 mg/mL with mannitol (Desirial Plus) and review the previous literature on the different compositions of HA infiltrative treatment applied to hallux rigidus. A 77-year-old female patient with moderate unilateral pain of 6 months of evolution and stiffness of the movement of the first metatarsophalangeal joint of the left foot, corresponding to grade 2 of the classification proposed by Coughlin and Shurnas. The objective of the study was to perform a pilot test to (a) evaluate the correct technique of intra-articular infiltration as well as (b) the use of a commercial cross-linked HA 21 mg/mL with mannitol, to a voluntary patient diagnosed with hallux rigidus. A single cross-linked HA infiltration is applied to the first metatarsophalangeal joint with an administered amount of 1 mL. The loaded dorsiflexion, the unloaded dorsiflexion, and the unloaded plantarflexion angles of the first metatarsophalangeal joint improved from 15°, 20°, and 10°, respectively, before injection to 45°, 52°, and 22°, respectively, at 14 days after injection. Moreover, these improvements maintained until the final follow-up (400 days). The intensity of pain, according to the visual analog scale, improved from 7 of 10 before the injection, passing through 4 of 10 at 14 days after the injection, to 1 of 10 at 60 days after the injection. Cross-linked HA 21 mg/mL with mannitol improves symptomatology, joint mobility of the first metatarsophalangeal joint, and quality of life in the patient with stiff hallux submitted to the pilot test. These effects have been maintained for more than 14 months.
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Affiliation(s)
| | - Elena De Planell-Mas
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Laura Pérez Palma
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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El Masry S, Boden AL, DiGiovanni GM, Cororaton AD, Ellis SJ. A Comparison of PROMIS Scores of Metatarsophalangeal Joint Arthrodesis and Polyvinyl Alcohol Hydrogel Implant Hemiarthroplasty for Hallux Rigidus. JB JS Open Access 2024; 9:e23.00158. [PMID: 39161931 PMCID: PMC11328988 DOI: 10.2106/jbjs.oa.23.00158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/21/2024] Open
Abstract
Background The current literature shows similar clinical outcomes between first metatarsophalangeal (MTP) joint arthrodesis and synthetic cartilage implant (SCI) hemiarthroplasty in the treatment of hallux rigidus; however, prior studies have not reported validated patient-reported outcome measures (PROMs). To our knowledge, this is the first study to compare PROMs using 6 domains of the validated Patient-Reported Outcomes Measurement Information System (PROMIS) in patients treated for hallux rigidus with MTP joint arthrodesis and with SCI hemiarthroplasty. In addition, this novel study provides comparative data on the complication and revision rates for each procedure. Methods A single-center, retrospective registry search identified all patients with preoperative PROMIS scores who underwent MTP joint arthrodesis or SCI hemiarthroplasty for hallux rigidus between February 2016 and June 2021. The study aimed to determine if the 2 procedures showed statistically or clinically equivalent PROMIS scores in 6 domains: physical function, pain interference, pain intensity, global physical health, global mental health, and depression. A multivariable linear regression analysis was performed to compare adjusted 1-year postoperative PROMIS scores between the 2 cohorts. Complication and revision rates were also compared. Results The study included 82 patients who underwent SCI hemiarthroplasty and 101 who underwent MTP joint arthrodesis. Demographic data and preoperative hallux rigidus severity showed no significant differences between the cohorts. PROMIS scores were mostly comparable between the 2 groups, except for the pain intensity domain. The patients who underwent MTP joint arthrodesis exhibited significantly better pain relief at 1 and 2 years postoperatively, which was supported by adjusted postoperative PROMIS scores. At 2 years, the SCI group had worse pain intensity scores and lower global physical health scores. There were no differences between the cohorts in additional PROMIS scores or complication data. Conclusions While outcomes in most of the domains were similar, MTP joint arthrodesis was more effective at mitigating pain intensity compared with SCI hemiarthroplasty. This information can guide patient counseling and decision-making when considering surgical intervention for hallux rigidus. Level of Evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Seif El Masry
- Department of Foot and Ankle Surgery, the Hospital for Special Surgery, New York, NY
| | - Allison L. Boden
- Department of Foot and Ankle Surgery, the Hospital for Special Surgery, New York, NY
| | - Grace M. DiGiovanni
- Department of Foot and Ankle Surgery, the Hospital for Special Surgery, New York, NY
| | - Agnes D. Cororaton
- Department of Foot and Ankle Surgery, the Hospital for Special Surgery, New York, NY
| | - Scott J. Ellis
- Department of Foot and Ankle Surgery, the Hospital for Special Surgery, New York, NY
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DiGiovanni GM, El Masry S, Mizher R, Jones A, Johnson AH, Ellis SJ, Conti MS. Comparing the Clinical Outcomes of Percutaneous Cheilectomy to Open Cheilectomy With Moberg Osteotomy for the Treatment of Hallux Rigidus. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241264557. [PMID: 39280930 PMCID: PMC11401145 DOI: 10.1177/24730114241264557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024] Open
Abstract
Background Both an open cheilectomy with a Moberg osteotomy and percutaneous cheilectomy have been successfully used to treat hallux rigidus and preserve motion.However, there have been no studies that have compared these 2 procedures using validated patient-reported outcomes such as the Patient Reported Outcome Measurement Information System. Methods A retrospective review of hallux rigidus patients between January 2016 and July 2021 collected 48 percutaneous cheilectomy (PC) patients and 71 open cheilectomy with Moberg (OCM) patients. Preoperative and minimum 1-year postoperative PROMIS scores were collected. Results The OCM and PC cohorts did not have significant differences in their postoperative PROMIS scores. Both cohorts had modest but significant improvements postoperatively in the physical function, pain interference, and pain intensity domains. The OCM group had a larger degree of improvement in physical function, pain interference, and pain intensity (P = .015, .011, .001, respectively). No significant difference was identified in the reoperation rate. Conclusion Patients undergoing an OCM had worse preoperative PROMIS scores and a modestly greater change in patient-reported outcomes than patients undergoing a PC. Level of Evidence Level III, retrospective review.
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Affiliation(s)
- Grace M DiGiovanni
- Department of Foot and Ankle Surgery, The Hospital for Special Surgery, New York, NY, USA
| | - Seif El Masry
- Department of Foot and Ankle Surgery, The Hospital for Special Surgery, New York, NY, USA
| | - Rami Mizher
- Department of Foot and Ankle Surgery, The Hospital for Special Surgery, New York, NY, USA
| | - Agnes Jones
- Department of Foot and Ankle Surgery, The Hospital for Special Surgery, New York, NY, USA
| | - A Holly Johnson
- Department of Foot and Ankle Surgery, The Hospital for Special Surgery, New York, NY, USA
| | - Scott J Ellis
- Department of Foot and Ankle Surgery, The Hospital for Special Surgery, New York, NY, USA
| | - Matthew S Conti
- Department of Foot and Ankle Surgery, The Hospital for Special Surgery, New York, NY, USA
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Wang Y, Qi Y, Ma B, Wu H, Wang Y, Wei B, Wei X, Xu Y. Three-dimensional gait analysis of orthopaedic common foot and ankle joint diseases. Front Bioeng Biotechnol 2024; 12:1303035. [PMID: 38456008 PMCID: PMC10919227 DOI: 10.3389/fbioe.2024.1303035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024] Open
Abstract
Walking is an indispensable mode of transportation for human survival. Gait is a characteristic of walking. In the clinic, patients with different diseases exhibit different gait characteristics. Gait analysis describes the specific situation of human gait abnormalities by observing and studying the kinematics and dynamics of limbs and joints during human walking and depicting the corresponding geometric curves and values. In foot and ankle diseases, gait analysis can evaluate the degree and nature of gait abnormalities in patients and provide an important basis for the diagnosis of patients' diseases, the correction of abnormal gait and related treatment methods. This article reviews the relevant literature, expounds on the clinical consensus on gait, and summarizes the gait characteristics of patients with common ankle and foot diseases. Starting from the gait characteristics of individuals with different diseases, we hope to provide support and reference for the diagnosis, treatment and rehabilitation of clinically related diseases.
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Affiliation(s)
| | | | | | | | | | | | | | - Yongsheng Xu
- Orthopedic Center (Sports Medicine Center), Inner Mongolia People’s Hospital, Hohhot, China
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Kim J, Rajan L, Fuller RM, Mizher R, Cororaton AD, Kumar P, An TW, Deland JT, Ellis SJ. A Patient-Reported Outcome-Based Comparison of Cheilectomy With and Without Proximal Phalangeal Dorsiflexion Osteotomy for Hallux Rigidus. Foot Ankle Spec 2024; 17:67-77. [PMID: 36625277 DOI: 10.1177/19386400221147775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION This study provides the first comparison of patient-reported outcomes between isolated cheilectomy (C) and cheilectomy with Moberg (CM) osteotomy for hallux rigidus. METHODS A single-center, retrospective registry search identified all patients with preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores who underwent cheilectomy, with and without concomitant proximal phalangeal dorsiflexion osteotomy, for hallux rigidus between January 2016 and December 2020. Because there were far fewer isolated cheilectomies (62), all C patients were compared with a commensurate number of consecutive CM cases (67) using preoperative, 1-year, and 2-year PROMIS scores for physical function, pain interference, pain intensity, global physical health, global mental health, and depression, as well as complication and revision data from a chart review. A multivariable linear regression analysis was performed to compare adjusted postoperative PROMIS scores between the 2 cohorts. RESULTS There were no differences between groups among the demographic and preoperative variables compared. The CM cohort reported worse pain interference scores preoperatively (P < .001) and at 1 year postoperatively (P = .01). However, the C cohort reported worse pain intensity scores preoperatively (P < .001) and at 1 year postoperatively (P < .001). Adjusted postoperative PROMIS score comparison demonstrated that the CM cohort had better 1-year postoperative pain intensity scores (P < .05). However, there were no differences between cohorts for additional PROMIS scores or complications data. CONCLUSION The addition of a Moberg osteotomy does not appear to significantly change short- to medium-term outcomes of cheilectomy for hallux rigidus treatment. LEVELS OF EVIDENCE Level III: Retrospective comparative study.
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Affiliation(s)
- Jaeyoung Kim
- Hospital for Special Surgery, New York, New York
| | - Lavan Rajan
- Hospital for Special Surgery, New York, New York
| | | | - Rami Mizher
- Hospital for Special Surgery, New York, New York
| | | | - Prashanth Kumar
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Tonya W An
- Hospital for Special Surgery, New York, New York
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de Bot R, Stevens J, Smeets T, Witlox A, Beertema W, Hendrickx R, Meijer K, Schotanus M. Gait and dynamic pedobarographic analyses in hallux rigidus patients treated with Keller's arthroplasty, arthrodesis or cheilectomy 22 years after surgery. PeerJ 2023; 11:e16296. [PMID: 38025694 PMCID: PMC10666645 DOI: 10.7717/peerj.16296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Keller's arthroplasty, arthrodesis and cheilectomy are well-known surgical interventions for hallux rigidus. This study aimed to evaluate the effects of these surgical interventions on gait, plantar pressure distribution and clinical outcome in patients treated for hallux rigidus 22 years after surgery. Methods Spatio-temporal gait parameters and plantar pressure distribution, determined as pressure time integrals (PTIs) and peak pressures (PPs), were analyzed using a 7-foot tone analysis model. Patient-reported outcome was assessed using the Manchester-Oxford Foot Questionnaire (MOXFQ). Of the 73 patients (89 feet) from the original study, 27 patients (33 feet) and 13 healthy controls (26 feet) were available for evaluation 22 years after hallux rigidus surgery. Results Spatio-temporal gait parameters were comparable between all groups and were in line with healthy controls (P > 0.05). No differences (P > 0.05) in PTIs and PPs were found in the seven plantar zones between groups and as compared to healthy controls. MOXFQ scores in all domains (walking/standing, range 21.4-24.1; pain, range 16.5-22.2 and social interaction, range 23.8-35.4) were not clinically and statistically different (P > 0.05) between the three different surgical interventions. Conclusion These results suggest no long-term functional and biomechanical differences after these surgical interventions for hallux rigidus correction. The interventions seem to be appropriate treatment options for a selective group of patients with symptomatic hallux rigidus.
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Affiliation(s)
- Robin de Bot
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Geleen, Limburg, The Netherlands
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Jasper Stevens
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Geleen, Limburg, The Netherlands
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Thijs Smeets
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Geleen, Limburg, The Netherlands
- Smeets Loopcomfort, Sittard, Limburg, The Netherlands
| | - Adhiambo Witlox
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Wieske Beertema
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Geleen, Limburg, The Netherlands
| | - Roel Hendrickx
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Geleen, Limburg, The Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Martijn Schotanus
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Geleen, Limburg, The Netherlands
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
- School of Care and Public Health Research Institute, Faculty of Health, Medicine & Life Sciences, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
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Castro-Méndez A, Canca-Sánchez FJ, Pabón-Carrasco M, Jiménez-Cebrián AM, Córdoba-Fernández A. Evaluation of Gait Parameters on Subjects with Hallux Limitus Using an Optogait Sensor System: A Case-Control Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1519. [PMID: 37763637 PMCID: PMC10535400 DOI: 10.3390/medicina59091519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/09/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
Background and Objetives: The foot is a part of the body's kinetic chain and needs to be efficient during the entire gait cycle. Electronic Sensor Gait analysis is useful and an important tool within the area of podiatry to assess the physical state of patients that helps the comprehensive intervention in situations where the daily activity is limited. The aim of this research is to evaluate if the presence of a hallux limitus (HL) can alter gait space-time parameters and consequently can affect the take-off phase of the gait and the limitation of the range of motion (ROM) of the hallux. Materials and Methods: A case-control study was designed to verify whether there are alterations in the spatiotemporal parameters of the gait cycle between subjects with structural HL compared to the group of subjects with a normal hallux range. A total of n = 138 participants, cases (68 HL subjects) and healthy controls (70 subjects) were studied using an OptoGait LED sensor system to identify gait imbalances using OptoGait photocell gait analysis sensors. Results: Significant differences were found between the two groups with respect to stride length, gait cycle duration in seconds (for both feet) and for total stride and load response (p < 0.05). Conclusions: The limitation of the Hallux ROM may alter the normal gait patterns measured with an Optogait system. The early identification and treatment of gait disturbances due to HL are important to achieve normal gait physical activity to maintain a healthy lifestyle.
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Affiliation(s)
| | | | | | - Ana María Jiménez-Cebrián
- Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain;
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Anderson MR, Ho BS, Baumhauer JF. Republication of "Current Concepts Review: Hallux Rigidus". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231188123. [PMID: 37506124 PMCID: PMC10369095 DOI: 10.1177/24730114231188123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
Arthritis of the first metatarsophalangeal (MTP) joint, hallux rigid, is a common and disabling source of foot pain in the adult population. Hallux rigidus is characterized by diseased cartilage and large, periarticular osteophytes that result in a stiff, painful joint. Activity modification, sensible shoes, orthotics, anti-inflammatory medications and occasional intra-articular steroid injections can be attempted to alleviate the discomfort associated with hallux rigidus. A number of surgical options exist for the treatment of recalcitrant hallux rigidus. Cheilectomy is a useful treatment for dorsal impingement pain seen in mild hallux rigidus. A new polyvinyl alcohol hemi-arthroplasty implant has shown promising early and midterm results in the treatment of advanced hallux rigidus; however, arthrodesis of the first MTP joint remains the gold standard treatment for advanced hallux rigidus because of unpredictable outcomes after early-generation joint replacement implants.
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Unterfrauner I, Andronic O, Viehöfer AF, Wirth SH, Berli MC, Waibel FWA. Ulcer occurrence on adjacent toes and hallux valgus deformity after amputation of the second toe in diabetic patients. J Orthop Surg Res 2023; 18:99. [PMID: 36782206 PMCID: PMC9926725 DOI: 10.1186/s13018-023-03577-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/03/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Amputation of the second toe is associated with destabilization of the first toe. Possible consequences are hallux valgus deformity and subsequent pressure ulcers on the lateral side of the first or on the medial side of the third toe. The aim of this study was to investigate the incidence and possible influencing factors of interdigital ulcer development and hallux valgus deformity after second toe amputation. METHODS Twenty-four cases of amputation of the second toe between 2004 and 2020 (mean age 68 ± 12 years; 79% males) were included with a mean follow-up of 36 ± 15 months. Ulcer development on the first, third, or fourth toe after amputation, the body mass index (BMI) and the amputation level (toe exarticulation versus transmetatarsal amputation) were recorded. Pre- and postoperative foot radiographs were evaluated for the shape of the first metatarsal head (round, flat, chevron-type), the hallux valgus angle, the first-second intermetatarsal angle, the distal metatarsal articular angle and the hallux valgus interphalangeal angle by two orthopedic surgeons for interobserver reliability. RESULTS After amputation of the second toe, the interdigital ulcer rate on the adjacent toes was 50% and the postoperative hallux valgus rate was 71%. Neither the presence of hallux valgus deformity itself (r = .19, p = .37), nor the BMI (r = .09, p = .68), the shape of the first metatarsal head (r = - .09, p = .67), or the amputation level (r = .09, p = .69) was significantly correlated with ulcer development. The interobserver reliability of radiographic measurements was high, oscillating between 0.978 (p = .01) and 0.999 (p = .01). CONCLUSIONS The interdigital ulcer rate on the first or third toe after second toe amputation was 50% and hallux valgus development was high. To date, evidence on influencing factors is lacking and this study could not identify parameters such as the BMI, the shape of the first metatarsal head or the amputation level as risk factors for the development of either hallux valgus deformity or ulcer occurrence after second toe amputation. TRIAL REGISTRATION BASEC-Nr. 2019-01791.
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Affiliation(s)
- Ines Unterfrauner
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Octavian Andronic
- grid.7400.30000 0004 1937 0650Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Arnd F. Viehöfer
- grid.7400.30000 0004 1937 0650Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stephan H. Wirth
- grid.7400.30000 0004 1937 0650Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Martin C. Berli
- grid.7400.30000 0004 1937 0650Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Felix W. A. Waibel
- grid.7400.30000 0004 1937 0650Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Does metatarsus primus elevatus really exist in hallux rigidus? A weightbearing CT case-control study. Arch Orthop Trauma Surg 2023; 143:755-761. [PMID: 34505168 DOI: 10.1007/s00402-021-04168-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/01/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Elevated first metatarsal, Metatarsus primus elevatus (MPE), has been a topic of controversy. Recent studies have supported a significantly elevated first metatarsal in hallux rigidus on weight-bearing radiographs (WBR). However, conventional radiographs have limitations for accurate measurement. Our objective was to comparatively assess MPE and other variables which can affect the spatial relationship of the forefoot in the HR group compared to controls using weight-bearing CT (WBCT). METHODS In this single-center, retrospective, case-control study, 25 patients (30 feet) with symptomatic HR and 30 controls were selected. WBCT parameters were measured by two independent investigators. Inter-observer reliabilities were assessed using intra-class correlation coefficients (ICCs). MPE was evaluated by measuring the direct distance between 1st and 2nd metatarsals. Independent t tests were performed to compare the two groups. A threshold of MPE to diagnose HR was calculated using the Receiver Operating Characteristic (ROC) curve. RESULTS HR groups had increased hallux valgus angle (HVA) (8.52° in control vs 11.98° in HR) and MPE (2.92 vs 5.09 mm), decreased 1st metatarsal declination angle (21.09° vs 19.07°) 1st/2nd metatarsal declination ratio (87.45 vs 79.71) indicating elevated first metatarsal compared to controls. Dorsal translation of the first metatarsal at the first tarsometatarsal joint was observed in 21 (70%) patients of the HR group when defined as a step-off or discontinuation of the curvature along the first TMT joint. The threshold of MPE for diagnosis of HR was 4.19 mm with 77% sensitivity and 77% specificity. CONCLUSION Our results confirmed a significantly elevated first metatarsal in the HR group compared to controls on WBCT. A MPE greater than 4.19 mm was found to be diagnostic for symptomatic HR. Significant number of patients in the HR group (70%) had dorsal translation of the first metatarsal at the first TMT joint which can contribute to increased MPE. CLINICAL RELEVANCE The present study demonstrated significantly increased MPE in HR on WBCT and MPE greater than 4.19 mm on WBCT can be used as a diagnostic threshold for HR.
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Roth W, Hoch C, Gross CE, Scott DJ. First metatarsophalangeal arthrodesis outcomes for hallux rigidus versus hallux valgus. Foot Ankle Surg 2023; 29:50-55. [PMID: 36210270 DOI: 10.1016/j.fas.2022.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/04/2022] [Accepted: 09/14/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study compared radiographic and functional patient outcomes of 1st MTP arthrodesis between hallux rigidus (HR) and hallux valgus (HV) cohorts. METHODS A retrospective review was conducted at an academic medical center on patients who underwent 1st MTP arthrodesis during 2009-2021. In total, 136 patients (148 feet: HR=57, HV=47, combined=44) met the inclusion criteria of minimum three-month follow-up (mean=1.25 years, range=0.25-6.14 years). Data collection included patient-reported outcome measures (PROMs), radiographic markers, and complication and reoperation rates. RESULTS PROMs improved overall, with HV patients significantly improving the least. The HR group had a significantly smaller improvement in HV angle (HR=-3.6, HV=-17, Combined=-15 p < .001), intermetatarsal angle (H=-0.16, HV=-2.8, Combined=-2.6 p < .001), and 1st-5th metatarsal width (HR=-0.98, HV=-4.6, Combined=-4.6, p < .001). Complication and reoperation rates did not differ by group. CONCLUSION Outcomes of 1st MTP arthrodesis does not appear to differ between diagnostic indications of hallux rigidus, hallux valgus, or both. LEVEL OF EVIDENCE Level III, Retrospective cohort study.
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Affiliation(s)
- Warren Roth
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA
| | - Caroline Hoch
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA
| | - Christopher E Gross
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA
| | - Daniel J Scott
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA.
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Stevens J, de Bot RTAL, Hermus JPS, Schotanus MGM, Meijer K, Witlox AM. Gait analysis of foot compensation in symptomatic Hallux Rigidus patients. Foot Ankle Surg 2022; 28:1272-1278. [PMID: 35717495 DOI: 10.1016/j.fas.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 03/31/2022] [Accepted: 06/03/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Compensatory motion of foot joints in hallux rigidus (HR) are not fully known. This study aimed to clarify the kinematic compensation within the foot and to detect whether this affects plantar pressure distribution. METHODS Gait characteristics were assessed in 16 patients (16 feet) with HR and compared with 15 healthy controls (30 feet) with three-dimensional gait analysis by using the multi-segment Oxford Foot Model, measuring spatio-temporal parameters, joint kinematics and plantar pressure. RESULTS HR subjects showed less hallux plantar flexion during midstance and less hallux dorsiflexion during push-off, while increased forefoot supination was detected during push-off. No significant differences in plantar pressure were detected. Step length was significantly smaller in HR subjects, while gait velocity was comparable between groups. CONCLUSIONS HR significantly affects sagittal hallux motion, and the forefoot compensates by an increased supination during push-off. Despite this kinematic compensatory mechanism, no significant differences in plantar loading were detected.
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Affiliation(s)
- Jasper Stevens
- Department of Orthopedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands.
| | - Robin T A L de Bot
- Department of Orthopedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands.
| | - Joris P S Hermus
- Department of Orthopedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Martijn G M Schotanus
- Department of Orthopedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, Heerlen, the Netherlands; School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands.
| | - Adhiambo M Witlox
- Department of Orthopedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, the Netherlands.
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Seo DK, Kang HW, Kim JK, Song JS. Postoperative Angular Changes According to Weightbearing in Patients With Moderate to Severe Hallux Valgus. J Foot Ankle Surg 2022; 61:1161-1164. [PMID: 34801378 DOI: 10.1053/j.jfas.2021.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 02/25/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023]
Abstract
Hallux valgus is a progressive angular deformity of the big toe, the degree of which is aggravated in weightbearing stance. Hallux valgus and intermetatarsal angles on postoperative weightbearing images are usually larger than those of intraoperative fluoroscopic and immediate postoperative non-weightbearing images. Here, we hypothesized that various angular parameters of hallux valgus would increase postoperatively with weightbearing. A total of 66 feet (58 patients) of moderate to severe hallux valgus were reviewed on consecutive plain foot anteroposterior radiographs. The changes of hallux valgus, intermetatarsal, hallux valgus interphalangeal, and distal metatarsal articular angles were compared. Hallux valgus and intermetatarsal angles were significantly increased with weightbearing postoperatively (p < .001). Hallux valgus interphalangeal and distal metatarsal articular angles did not show significant changes with weightbearing (p > .5). Hallux valgus and intermetatarsal angles were increased with weightbearing after hallux valgus surgery. Mean angular changes were 5.3 and 2.7 degrees, respectively. These values should be considered in the preoperative planning and intraoperative correction processes.
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Affiliation(s)
- Dong-Kyo Seo
- Department of Orthopedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, GangNeung-si, South Korea
| | - Hyun Wook Kang
- Department of Orthopedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, GangNeung-si, South Korea
| | - Jin Kyung Kim
- Department of Orthopedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, GangNeung-si, South Korea
| | - Jae-Seok Song
- Department of Preventive Medicine & Public Health, University of Catholic Kwandong College of Medicine, Gangneung, Korea.
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Jurynec MJ, Gavile CM, Honeggar M, Ma Y, Veerabhadraiah SR, Novak KA, Hoshijima K, Kazmers NH, Grunwald DJ. NOD/RIPK2 signalling pathway contributes to osteoarthritis susceptibility. Ann Rheum Dis 2022; 81:1465-1473. [PMID: 35732460 PMCID: PMC9474725 DOI: 10.1136/annrheumdis-2022-222497] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/07/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES How inflammatory signalling contributes to osteoarthritis (OA) susceptibility is undetermined. An allele encoding a hyperactive form of the Receptor Interacting Protein Kinase 2 (RIPK2) proinflammatory signalling intermediate has been associated with familial OA. To test whether altered nucleotide-binding oligomerisation domain (NOD)/RIPK2 pathway activity causes heightened OA susceptibility, we investigated whether variants affecting additional pathway components are associated with familial OA. To determine whether the Ripk2104Asp disease allele is sufficient to account for the familial phenotype, we determined the effect of the allele on mice. METHODS Genomic analysis of 150 independent families with dominant inheritance of OA affecting diverse joints was used to identify coding variants that segregated strictly with occurrence of OA. Genome editing was used to introduce the OA-associated RIPK2 (p.Asn104Asp) allele into the genome of inbred mice. The consequences of the Ripk2104Asp disease allele on physiology and OA susceptibility in mice were measured by histology, immunohistochemistry, serum cytokine levels and gene expression. RESULTS We identified six novel variants affecting components of the NOD/RIPK2 inflammatory signalling pathway that are associated with familial OA affecting the hand, shoulder or foot. The Ripk2104Asp allele acts dominantly to alter basal physiology and response to trauma in the mouse knee. Whereas the knees of uninjured Ripk2Asp104 mice appear normal histologically, the joints exhibit a set of marked gene expression changes reminiscent of overt OA. Although the Ripk2104Asp mice lack evidence of chronically elevated systemic inflammation, they do exhibit significantly increased susceptibility to post-traumatic OA (PTOA). CONCLUSIONS Two types of data support the hypothesis that altered NOD/RIPK2 signalling confers susceptibility to OA.
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Affiliation(s)
- Michael J Jurynec
- Department of Orthopaedics, University of Utah Health, Salt Lake City, Utah, USA
- Department of Human Genetics, University of Utah Health, Salt Lake City, Utah, USA
| | - Catherine M Gavile
- Department of Orthopaedics, University of Utah Health, Salt Lake City, Utah, USA
| | - Matthew Honeggar
- Department of Orthopaedics, University of Utah Health, Salt Lake City, Utah, USA
| | - Ying Ma
- Department of Orthopaedics, University of Utah Health, Salt Lake City, Utah, USA
| | | | - Kendra A Novak
- Department of Orthopaedics, University of Utah Health, Salt Lake City, Utah, USA
| | - Kazuyuki Hoshijima
- Department of Human Genetics, University of Utah Health, Salt Lake City, Utah, USA
| | - Nikolas H Kazmers
- Department of Orthopaedics, University of Utah Health, Salt Lake City, Utah, USA
| | - David J Grunwald
- Department of Human Genetics, University of Utah Health, Salt Lake City, Utah, USA
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Slullitel G, López V, Álvarez V, Gaitán L, Calvi JP. A Refined Minimally Invasive Distal First Metatarsal Osteotomy for Moderate Hallux Valgus Treatment: The BC Procedure. J Foot Ankle Surg 2022; 61:1052-1055. [PMID: 35283035 DOI: 10.1053/j.jfas.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 11/28/2021] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
During the last 2 decades, there was an increasing interest in mini-invasive procedures for hallux valgus correction. In this scenario the Bösch technique appears to be a reproducible distal metatarsal osteotomy (DMO) to achieve a proper correction. Our DMO variant, called BC, was planned to combine the stability and predictability of the chevron osteotomy, with the power of correction, low surgical time and mini-invasive approach of the Bösch-SERI technique. The purpose of this investigation is to describe the surgical technique and report the results of this modified procedure at a minimum 2-year follow-up. Sixty-three patients who underwent the BC technique for mild and moderate hallux valgus were prospectively evaluated. Mean follow-up was 36.5 (range 23.4-59.8) months, the mean American Orthopedic Foot and Ankle Society score improved from a median of 47.4 points preoperatively to a median of 88 points postoperatively (p < .05). First MTPJ ROM did not change from preoperative period (mean 32.5°) to the postoperative period (mean 31.8°) (p > .65). All osteotomies went on to bony healing in the 6-week follow-up visit. Fifty-two (82%) of patients were either very satisfied or satisfied with the procedure (p < .05). With our numbers, BC osteotomy is shown to be a technique that can treat both mild and moderate deformities, achieving correction that is maintained over the follow-up evaluated, with a 24 relatively simple procedure and short operative time.
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Affiliation(s)
- Gastón Slullitel
- Institute of Orthopedics "Dr. Jaime Slullitel", Santa Fe, Argentina
| | - Valeria López
- Institute of Orthopedics "Dr. Jaime Slullitel", Santa Fe, Argentina.
| | - Victoria Álvarez
- Institute of Orthopedics "Dr. Jaime Slullitel", Santa Fe, Argentina
| | - Laura Gaitán
- Institute of Orthopedics "Dr. Jaime Slullitel", Santa Fe, Argentina
| | - Juan P Calvi
- Institute of Orthopedics "Dr. Jaime Slullitel", Santa Fe, Argentina
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Althoff AD, Ramamurti P, Vennitti C, Kamalapathy P, Park JS, Werner BC, Cooper MT. Preoperative Risk Factors for Primary Metatarsophalangeal Arthroplasty Revision to MTP Arthrodesis for Hallux Rigidus. Foot Ankle Int 2022; 43:1242-1249. [PMID: 35642682 DOI: 10.1177/10711007221094837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Revision or conversion to arthrodesis following metatarsophalangeal (MTP) joint arthroplasty are salvage procedures to manage complications of MTP joint arthroplasty. The purpose of this study is to use a national administrative database to characterize nationwide trends of patients undergoing hallux MTP arthrodesis vs arthroplasty for hallux rigidus. Additionally, the authors sought to evaluate demographic trends and evaluate influence of patient-related risk factors in those undergoing MTP arthroplasty revision to arthrodesis. METHODS Patients who underwent MTP arthroplasty for diagnosis of hallux rigidus from 2010 to 2019 were identified in the Mariner subset of the PearlDiver database. Patients were included if they had undergone MTP arthroplasty for the diagnosis of hallux rigidus. Notably, the database lacks resolution about critical features of the arthroplasty design and materials. The revision cohort encompassed patients who underwent subsequent ipsilateral MTP arthrodesis or arthroplasty within 2 years of index arthroplasty procedure. Demographic characteristics and medical comorbidities were examined as potential patient-related risk factors for arthroplasty revision or revision to fusion. Univariate analyses were performed to analyze differences in patient demographics, comorbidities, and risk factors. A multivariate regression analysis was subsequently conducted to control for confounding variables. RESULTS 2750 patients underwent primary MTP arthroplasty for diagnosis of hallux rigidus. Of these, 44 (1.6%) underwent revision arthroplasty and 188 patients (6.8%) were revised to arthrodesis within the first 2 years after the index procedure. Multivariate regression analysis indicates that obesity (odds ratio [OR] 1.48, 95% CI 1.05-2.09), depression (OR 1.59, 95% CI 1.15-2.20), and steroid use (OR 2.94, 95% CI 1.30-6.65) were associated with a statistically significant increase in revision to arthrodesis from primary arthroplasty. CONCLUSION Revision arthrodesis following primary MTP arthroplasty for hallux rigidus within 2 years was found to be a relatively common occurrence in this national insurance database study. Risk factors for revision arthroplasty to arthrodesis within 2 years of primary arthroplasty include obesity, depression, and steroid use. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Alyssa D Althoff
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Pradip Ramamurti
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Corinne Vennitti
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Pramod Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Joseph S Park
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Minton T Cooper
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
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Çıra S, Yılmaz R, Karpuz S, Yılmaz H, Akkurt HE. Comparison of the efficacies of peloid therapy and paraffin treatment given as an adjuncts to exercise therapy in patients with hallux rigidus: a randomized, uncontrolled, prospective study. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:1699-1710. [PMID: 35654863 DOI: 10.1007/s00484-022-02311-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
Although it is thought that peloid and paraffin treatments may have positive effect on pain, functional status, and quality of life in patients with hallux rigidus (HR), there are no comprehensive and comparative studies with a high level of evidence. We aimed to compare peloid and paraffin treatments in symptomatic hallux rigidus patients. A total of 113 patients diagnosed with HR between May 2019 and June 2021 were included in the study. After exclusion criteria, the remaining 90 patients were randomly divided into two groups: the peloid therapy group (peloid therapy + home exercise) and the paraffin therapy group (paraffin therapy + home exercise). Peloid and paraffin treatments were applied for 2 weeks (5 days a week for a total of 10 sessions). Patients were evaluated before treatment, at the end of treatment, and one month after treatment. The groups were compared in terms of pain, functional status, quality of life, and joint range of motion. In the final analysis, 40 patients in each treatment group were compared. Statistically significant improvements were achieved for all parameters at the end of treatment and at follow-up, and the treatments were found to be highly effective. As a result of the comparison, the methods were not found to be superior to each other. The present study is the first randomized study comparing peloid therapy and paraffin therapy given as an adjuncts to exercise therapy. Exercise therapy plus peloid and exercise therapy plus paraffin treatments seem to have similar effects on HR; however, controlled trials are necessary for confirmation of our results.
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Affiliation(s)
- Seda Çıra
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Konya Beyhekim Training and Research Hospital, Konya, Turkey.
| | - Ramazan Yılmaz
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Konya Beyhekim Training and Research Hospital, Konya, Turkey
| | - Savaş Karpuz
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Konya Beyhekim Training and Research Hospital, Konya, Turkey
| | - Halim Yılmaz
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Konya Beyhekim Training and Research Hospital, Konya, Turkey
| | - Halil Ekrem Akkurt
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Konya Beyhekim Training and Research Hospital, Konya, Turkey
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Anwander H, Alkhatatba M, Lerch T, Schmaranzer F, Krause FG. Evaluation of Radiographic Features Including Metatarsus Primus Elevatus in Hallux Rigidus. J Foot Ankle Surg 2022; 61:831-835. [PMID: 34974984 DOI: 10.1053/j.jfas.2021.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/24/2021] [Accepted: 11/29/2021] [Indexed: 02/03/2023]
Abstract
The etiology of hallux rigidus remains a controversial issue in foot and ankle surgery, i.e., the relationship between metatarsus primus elevatus (MPE) and hallux rigidus. The purpose of this study was to evaluate several radiographic parameters including first metatarsal elevation in patients with hallux rigidus compared to a matched control group. A retrospective case control study was performed including 50 feet, 25 feet with and 25 feet without hallux rigidus. In the patients with hallux rigidus, the first metatarsal was more elevated than in the control group (8.3 ± 1.7 mm vs 3.0 ± 2.0 mm, p < .001) and in 60% of patients with hallux rigidus MPE was diagnosed, compared to zero patients in the control group (p < .001). The lateral 1 to 2 intermetatarsal angle was higher in patients with hallux rigidus (3.6 ± 2.5 vs -0.7 ± 2.8; p < .001). The first metatarsal declination angle was not different between the 2 groups. Intraclass correlation coefficient between 2 observers for measuring the first metatarsal elevation was 0.929 (p < .001). In the current study, increased elevation of the first metatarsal, a higher incidence of MPE and increased lateral 1 to 2 intermetatarsal angle were found in patients with hallux rigidus compared to the control group. These findings support the theory of an association between MPE and hallux rigidus. Further high reliability of first metatarsal elevation measurement was found in our study.
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Affiliation(s)
- Helen Anwander
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mohammad Alkhatatba
- Department of Special Surgery, Jordan University of Science and Technology, Irbid, Jordan
| | - Till Lerch
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian G Krause
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Comparison between Weightbearing-CT semiautomatic and manual measurements in Hallux Valgus. Foot Ankle Surg 2022; 28:518-525. [PMID: 35279395 DOI: 10.1016/j.fas.2022.02.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/11/2022] [Accepted: 02/19/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Radiographic measurements are an essential tool to determine the appropriate surgical treatment and outcome for Hallux Valgus (HV). HV deformity is best evaluated by weight-bearing computed tomography (WBCT). The objective was (1) to assess the reliability of WBCT computer-assisted semi-automatic imaging measurements in HV, (2) to compare semi-automatic with manual measurements in the setting of an HV, and (3) to compare semi-automatic measurements between HV and control group. METHODS In this retrospective IRB (ID# 201904825) approved study, we assessed patients with hallux valgus deformity. The sample size calculation was based on the hallux valgus angle (HVA). Thus to obtain the 0.8 power, including 26 feet with HV in this study, was necessary. Our control group consisted of 19 feet from 19 patients without HV. Raw multiplanar data was evaluated using software CubeVue®. In the axial plane, hallux valgus angle (HVA), intermetatarsal angle (IMA), and interphalangeal angle (IPA) were measured. The semiautomatic 3D measurements were performed using the Bonelogic®Software. Inter-rater reliabilities were performed using ICC. Agreement between methods was tested using the Bland-Altman plots. The difference between Patologic and Control cases using semi-automatic measurements was assessed with the Wilcoxon signed-rank test. Alpha risk was set to 5% (α = 0.05). P ≤ 0.05 were considered significant. RESULTS Reliabilities utilizing ICC were over 0.80 for WBCT manual measurements and WBCT semi-automatic readings. Inter and intraobserver agreement for Manual and Semi-automatic WBCT measurements demonstrated excellent reliability. CONCLUSIONS Semi-automatic measurements are reproducible and comparable to measurements performed manually. The software differentiated pathological from non-pathological conditions when subjected to semi-automatic measurements. The development of advanced semi-automatic segmentation software with minimal user intervention is essential for the establishment of big data and can be integrated into clinical practice, facilitating decision-making.
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Artioli E, Mazzotti A, Zielli S, Bonelli S, Arceri A, Geraci G, Faldini C. Keller's arthroplasty for hallux rigidus: A systematic review. Foot Ankle Surg 2022; 28:526-533. [PMID: 35279396 DOI: 10.1016/j.fas.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/25/2022] [Accepted: 02/28/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several surgical procedures have been described to treat hallux rigidus. Keller arthroplasty is a joint-sacrificing procedure proposed in 1904. Considering the current trends to mini-invasiveness and the debate about the technique's suitability, this review intends to state Keller arthroplasty results and the conditions where it could be still adopted in the treatment of hallux rigidus. METHODS Selected articles were reviewed to extract: population data, surgical indications, different surgical techniques, clinical and radiological outcomes, and complications. RESULTS Seventeen retrospective studies were selected, counting 508 patients. Mean age at surgery was 55 years. Patients were affected by moderate-severe hallux rigidus. Three modified Keller arthroplasty were identified. Good clinical and radiological outcomes were reported. Metatarsalgia was the most frequent complication (12%). CONCLUSION Despite for many authors KA seems a viable surgical treatment for middle aged and elderly patients affected by moderate-severe hallux rigidus, the available literature provides little evidence on the real efficacy and safety of the technique. A non-negligible percentage of complications may occur, and therefore is essential to set correct indications through an accurate patients' selection.
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Affiliation(s)
- E Artioli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - A Mazzotti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy.
| | - S Zielli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - S Bonelli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - A Arceri
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - G Geraci
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - C Faldini
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy
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Miana A, Paola M, Duarte M, Nery C, Freitas M. Gait and Balance Biomechanical Characteristics of Patients With Grades III and IV Hallux Rigidus. J Foot Ankle Surg 2022; 61:452-455. [PMID: 34649787 DOI: 10.1053/j.jfas.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/08/2021] [Indexed: 02/03/2023]
Abstract
Patients with hallux rigidus (HR) tend to develop a characteristic alteration in walking to lessening pain and compensate for the limited range of motion at the first metatarsophalangeal (MTP1) joint that might be affected balance and gait. The goal of this study was to perform an integrated biomechanical description of gait and balance of symptomatic patients with either grade as III or IV HR in comparison with healthy subjects. Eleven patients (7 men) with HR (60 ± 7 years, 1.60 ± 0.07 m, and 70 ± 13 kg) and 16 (7 men) healthy subjects (70 ± 8 years, 1.66 ± 0.10 m, and 74 ± 14 kg) were included. Subjects performed 2 tasks: walking (5 trials of straight walking for at least 6 meters) and bipedal quiet standing for 30 seconds. For these 2 tasks the following variables were measured: range of motion of the MTP1 joint, plantar pressure distribution during the stance phase of walking, and the postural sway during quiet standing. Plantar pressure was measured in up 15 walking trials with a mat pressure sensor. The MTP1 joint range of motion for flexion/extension during walking was significantly smaller for the patients with HR than for the control group (HR: 14 ± 8°, control: 44 ± 5°; t(17) = -9.7, p < .001). The forefoot plantar pressure distribution among different regions of the foot in patients with HR was not statistically different than the control group, but there was a tendency of higher pressures in the lateral metatarsal heads (p = .06). As description of the postural sway during quiet standing, the center of pressure area was not different between HR and the control group (p > .05). Decreased MTP1 joint range of motion for flexion/extension during walking in symptomatic high-grade HR patients can be associated with higher pressure in the lateral metatarsal heads while the impact on postural sway is not affected.
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Karaismailoğlu B, Kara M. Characteristics and research trends of 50 most-cited hallux rigidus papers. Foot (Edinb) 2022; 51:101903. [PMID: 35255400 DOI: 10.1016/j.foot.2021.101903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 10/23/2021] [Accepted: 12/28/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The bibliometric studies in the field of orthopaedics have gained popularity since they can determine the characteristics and research trends of most influential papers in specific subjects. This study aimed to evaluate the 50 most-cited articles related to hallux rigidus, and analyze possible factors associated with increased citation counts. METHODS The available literature about hallux rigidus on Web of Science database until January 2021 were analyzed and the 50 most-cited articles were determined. The characteristics of the papers were documented and analyzed for any relationship or correlation with total citation or citation per year (citation density) values. RESULTS The average citation number and citation density were 52.8 (range: 26-243) and 3 (range: 0.8-12.8), respectively. The average author number was 3.4, while the average institution number was 1.9. The USA had the highest number of articles with 29. Twenty-six papers were case-series, only 3 studies had level 1 and only 2 had level 2 evidence. The highest number of articles were published in Foot and Ankle International with 22 papers. Forty papers were clinical studies while 10 were reviews. Five studies were multicentric. CONCLUSION This study provided the general characteristic and research trends of 50 most influential hallux rigidus papers. The number of institutions and references were positively correlated with citation density, indicating a higher chance of getting cited for papers with collaborations from different institutions and papers using more references from other works. Publication year was also positively correlated with citation density, indicating the better performance of more recent articles. LEVEL OF CLINICAL EVIDENCE Level 3.
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Affiliation(s)
- Bedri Karaismailoğlu
- Istanbul University Cerrahpasa Medical School, Department of Orthopedics and Traumatology, Istanbul, Turkey.
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Balesar VV, Koster LA, Kaptein BL, Keizer SB. Five-Year Prospective Roentgen Stereophotogrammetric and Clinical Outcomes of the BioPro MTP-1 Hemiarthroplasty. Foot Ankle Int 2022; 43:637-645. [PMID: 34962173 DOI: 10.1177/10711007211061366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mixed results for functional outcomes and long-term fixation have been reported for first metatarsophalangeal arthroplasty. This prospective study was designed to evaluate the migration of the BioPro metatarsophalangeal-1 (MTP-1) joint hemiprosthesis with Roentgen stereophotogrammetric analysis (RSA). Migration patterns of the prosthesis, prosthesis-induced erosion of the metatarsal bone, and clinical outcomes were evaluated sequentially to 5 years postoperation (PO). METHODS Eleven female patients received the BioPro-1 hemiprosthesis. Prosthesis translation and metatarsal erosion were measured with RSA at immediately PO, 6 weeks, and 3, 6, 12, 36, and 60 months postoperatively. Clinical assessment was done by patient questionnaires. RESULTS RSA data of 9 patients were available for analysis. Median (range) number of markers used in RSA analysis, condition number, and mean error of markers around the prosthesis were 4 (3-7), 320 (208-862), and 0.13 (0.02-0.28), respectively. Progressive subsidence was seen up to 3 years PO (mean 2.1 mm, SE 0.32). Progressive metatarsal erosion was found from 1 year PO (mean 0.49 mm, SE 0.15). Pain, function, and quality scores improved after surgery and did not deteriorate at later follow-up moments. CONCLUSION Model-based RSA of the BioPro-1 prosthesis shows nonstabilizing medial and distal translation and metatarsal erosion. Despite the measured migration and erosion, clinical outcomes improved and remained similar up to 5 years postoperation. LEVEL OF EVIDENCE Level II, prospective analysis of MTP-1 hemiprosthesis.
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Affiliation(s)
| | | | - Bart L Kaptein
- Leiden Universitair Medisch Centrum, Leiden, the Netherlands
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Saur M, Lucas Y Hernandes J, Barouk P, Bejarano-Pineda L, Maynou C, Laffenetre O. Average 4-Year Outcomes of Distal Oblique First Metatarsal Osteotomy for Stage 1 to 3 Hallux Rigidus. Foot Ankle Int 2022; 43:463-473. [PMID: 34747650 DOI: 10.1177/10711007211052298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux rigidus is the second most frequent pathology of the first ray. Surgical options for degenerative metatarsophalangeal joint disease are either joint destructive or conservative procedures. The hypothesis was that oblique distal shortening osteotomy of the first metatarsal is an effective conservative technique for the management of stage 1 to 3 hallux rigidus. METHODS We conducted a retrospective cohort study of 87 feet with Coughlin and Shurnas's stage 1-3 hallux rigidus, operated between 2009 and 2019. The cohort consisted in 72 patients (87 feet) with an average age of 57±9 (30/79) years; 22 of 87 (25.3%) feet had the first metatarsal surgery performed in isolation; 65 of 87 (74.7%) had concomitant forefoot procedures, including 31 of 87 (35.6%) with Akin phalangeal osteotomies and 34 of 87 (39.1%) with Moberg phalangeal osteotomies.We evaluated the American Orthopaedic Foot & Ankle Society (AOFAS) Scale, subjective satisfaction, joint amplitudes, shortening rate, and occurrence of postoperative complications with a mean follow-up of 51 months (16/134). RESULTS The AOFAS score increased from 54.2±11.3 (25/70) preoperatively to 92.2±7.8 (62/100) postoperatively (P < .001). Patients reported excellent or good outcome in 95.4% of cases. The 40-point self-reported pain subscale score improved from 19.6 (± 10.0) to 37.4 (± 5.4), P < .001.The overall range of motion increased from 61±21 (20/110) degrees to 69±17 (35/120) degrees (P < .001). The mean first metatarsal shortening rate (SRpo) was 9.6%. Neither the Coughlin grade, the metatarsal index, or the SRpo influenced the AOFAS score. At 6-month follow-up, 15 patients had transfer metatarsalgia compared with 5 at last follow-up without requiring another surgical procedure. The risk was not significantly different according to Coughlin's stage, preoperative metatarsal index, or SRpo. CONCLUSION Oblique distal osteotomy of the first metatarsal for stage 1-3 hallux rigidus, often in combination with other first ray procedures, performed well during our follow-up time period, with a high subjective satisfaction rate and few complications. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Maurise Saur
- Centre Médico-Universitaire du Pied, Hôpital Pellegrin, Centre Hospitalier Universitaire, Bordeaux, France
| | - Julien Lucas Y Hernandes
- Centre Médico-Universitaire du Pied, Hôpital Pellegrin, Centre Hospitalier Universitaire, Bordeaux, France
| | - Pierre Barouk
- Centre de Chirurgie Orthopédique et Sportive, Centre du pied, Mérignac, France
| | - Lorena Bejarano-Pineda
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, USA
| | - Carlos Maynou
- Service d'Orthopédie A, Hôpital Roger Salengro, Centre Hospitalier Régional Universitaire, Lille, France
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Kaplan DJ, Chen JS, Colasanti CA, Dankert JF, Kanakamedala A, Hurley ET, Mercer NP, Stone JW, Kennedy JG. Needle Arthroscopy Cheilectomy for Hallux Rigidus in the Office Setting. Arthrosc Tech 2022; 11:e385-e390. [PMID: 35256980 PMCID: PMC8897605 DOI: 10.1016/j.eats.2021.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/08/2021] [Indexed: 02/03/2023] Open
Abstract
Hallux rigidus is a progressive degenerative process of the first metatarsophalangeal joint characterized by altered joint mechanics and formation of dorsal osteophytes. Cheilectomy is the preferred operative intervention at early stages. Technologic advances, patient preference, and cost considerations combine to stimulate the development of minimally invasive and in-office interventions. This Technical Note highlights our technique for needle arthroscopy cheilectomy for hallux rigidus, which can be used either in the operating room or in the wide-awake office setting.
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Affiliation(s)
- Daniel J Kaplan
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Jeffrey S Chen
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | | | - John F Dankert
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Ajay Kanakamedala
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Eoghan T Hurley
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Nathaniel P Mercer
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - James W Stone
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - John G Kennedy
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
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The discrepancy between radiographically-assessed and self-recognized hallux valgus in a large population-based cohort. BMC Musculoskelet Disord 2022; 23:31. [PMID: 34983473 PMCID: PMC8729003 DOI: 10.1186/s12891-021-04978-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background There has been a paucity of literature revealing the discrepancy between self-recognition about hallux valgus (HV) and radiographically-evaluated foot configuration. Knowing this discrepancy will help to make a comparative review of the findings of previous literatures about epidemiological studies about the prevalence of HV. Questions/purposes (1) Is there a discrepancy between radiographically-assessed and self-recognized HV in the general population? (2) What factors affect the self-recognition of HV in the general population? Methods The fifth survey of the Research on Osteoarthritis/Osteoporosis against Disability study involved 1996 participants who had undergone anterior-posterior radiography of bilateral feet and answered a simple dichotomous questionnaire on self-recognition of HV. Measurements of the HV angle (HVA), interphalangeal angle of the hallux (IPA), and intermetatarsal angle between 1st and 2nd metatarsals (IMA) were performed using radiographs. Radiographic diagnosis of HV was done using the definition of hallux valgus angle of 20° or more. After univariate comparison of the participant backgrounds and radiographic measurements between participants with or without self-recognition of HV, multivariable logistic regression analysis was conducted in order to reveal independent factors affecting self-recognition. Results Significant difference was found between the prevalence of radiographically-assessed and self-recognized HV (29.8% vs. 16.5%, p < 0.0001). The prevalence of self-recognized HV increased with the progression of HV severity from a single-digit percentage (normal grade, HVA < 20°) up to 100% (severe grade, HVA ≥ 40°). A multivariable logistic regression analysis demonstrated that HVA, IMA, and female sex were independent positive factors for self-recognition of HV (HVA [per 1° increase]: OR, 1.18; 95% CI, 1.15–1.20; p < 0.0001; IMA [per 1° increase]: OR, 1.15; 95% CI, 1.09–1.20; p < 0.0001; and female sex [vs. male sex]: OR, 3.47; 95% CI, 2.35–5.18; p < 0.0001). Conclusions There was a significant discrepancy between radiographically-assessed and self-recognized HV which narrowed with the progressing severity of HV. HVA, IMA, and female sex were independent positive factors for self-recognition of HV. Attention needs to be paid to potentially lowered prevalence of HV in epidemiological studies using self-reporting based on self-recognition.
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Mosca M, Caravelli S, Vocale E, Fuiano M, Massimi S, Di Ponte M, Censoni D, Grassi A, Ceccarelli F, Zaffagnini S. Hallux valgus associated to osteoarthritis: Clinical-radiological outcomes of modified SERI technique at mid- to long-term follow-up. A retrospective analysis. Foot Ankle Surg 2022; 28:49-55. [PMID: 33574005 DOI: 10.1016/j.fas.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/08/2021] [Accepted: 01/23/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Treatment of hallux valgus deformity associated with mild or moderate osteoarthritis (OA) is still a topic of debate. In the literature, there are few studies concerning the management of patients affected by this condition. This study aims to report the experience at mid- to long-term results of an original joint-preserving surgical technique. MATERIALS AND METHODS Patients affected by mild to moderate hallux valgus deformity and associated to grade 1-2 OA and treated with modified Simple-Effective-Rapid-Inexpensive (SERI) technique from 2008 to 2018 were selected. Inclusion criteria were mild or moderate hallux valgus angle (HVA) <40° and an intermetatarsal angle (IMA) <20° and associated grade 1-2 OA of the first metatarso-phalangeal joint (MTPJ). RESULTS 128 feet in 120 consecutive patients, undergone modified SERI procedure, have been retrospectively reviewed at a mean follow-up of 5.1 ± 3.8 years (range 2-11). American Orthopaedics Foot Ankle Society (AOFAS) score that was significantly improved from 44.2 ± 13.2 to 88.2 ± 9.6. Pre-operative average HVA and IMA values decreased respectively from 31.6° ± 3.9° to 9.1° ± 4.4° and from 16.2° ± 3.8° to 7.2° ± 3.1°. The average distal metatarsal articular angle (DMAA) value improved from 28.2° ± 6.5° to 7.1° ± 6°. OA of the first MTPJ highlighted a grade 1 in 46 feet and a grade 2 in 82 feet pre-operatively and a grade 0 in 30 feet, grade 1 in 82 feet, and grade 2 in 16 feet at the final follow-up. CONCLUSIONS The modifications to the SERI technique could extend the indications to patients affected by hallux valgus with mild to moderate OA. The wider case series and the longer follow-up of this study make us believe this technique is very useful for improving the quality of life in these patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- M Mosca
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - S Caravelli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - E Vocale
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M Fuiano
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - S Massimi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M Di Ponte
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - D Censoni
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Grassi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - F Ceccarelli
- Clinica Ortopedica, Azienda ospedaliero-universitaria Parma, Parma, Italy
| | - S Zaffagnini
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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