Clinical guidelines for hallux valgus

NewsBot · Jul 18, 2023

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Clinical practice guidelines of the Japanese Orthopaedic Association on the management of hallux valgus
Kota Watanabe et al
Journal of Orthopaedic Science; 12 July 2023

Herein, we present the third edition of the Japanese Orthopaedic Association's (JOA's) clinical practice guidelines on the management of hallux valgus. The first and second editions were published in 2008 and 2014, respectively.

Hallux valgus is one of the most common problems in the foot, for which a variety of treatment methods have been reported. However, the optimal management of hallux valgus remains controversial. Efforts to clarify the pathogenesis or effects of treatment for hallux valgus have been performed in basic and clinical studies, including randomized controlled trials. Therefore, the Committee of Clinical Practice Guideline on Hallux Valgus decided to prepare the revised version in accordance with the Medical Information Network Distribution Service (Minds) for Guideline Development 2017 [1]. Minds 2017 proposed the preferred methods for guideline preparation in Japan based on The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, Cochrane Collaboration, Agency for Healthcare Research and Quality (AHRQ), and the Oxford EBM center. In Minds 2017, the preparation procedures of the guidelines were defined precisely; in particular, the importance of a viable body of evidence was emphasized. For each clinical question (CQ), study reports were collected systematically and evaluated in terms of outcome data and study design. The results were evaluated in light of a viable body of evidence, emphasizing the balance between risk and benefit. Clinical and epidemiological characteristics, natural history, pathology, and diagnosis were not incorporated into the CQ; therefore, a commentary on these characteristics was added as a background question (BQ).

This clinical practice guideline aims to improve and standardize hallux valgus clinical practice by summarizing the answers to major CQs of hallux valgus medical care, providing the certainty of the evidence and strength of the recommendations. It should be noted that this guideline is not designed to deny the discretion of physicians. Appropriate management of patients should be determined individually, based on the situation of each institute and patient. We hope that these guidelines can be effectively applied in various clinical settings and contribute toward improving patient outcomes in hallux valgus treatment.
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NewsBot · Sep 19, 2023

Towards the Optimization of Surgical Hallux Valgus Corrections.
Krakers, S.M.
Thesis (2023)

Abstract: Surgical hallux valgus correction is still somewhat tainted by higher than anticipated rates of suboptimal outcomes. As only two-thirds of patients report being completely satisfied with the surgical outcome and the postoperative recurrence rate of hallux valgus is as high as 64% after at least five years of follow-up. Most hallux valgus recurrences are caused by surgical factors such as technical issues including the fixation method, the performance of the orthopedic surgeon, and inadequate procedure selection. Mini-C-arm fluoroscopy is frequently used perioperatively to assist the orthopedic surgeon in hardware placement and the assessment of the deformity correction to prevent technical issues and support the performances of the orthopedic surgeon. During surgical hallux valgus corrections, the objective is to correct the Hallux Valgus Angle (HVA) and Intermetatarsal Angle (IMA) to decrease the chance of hallux valgus recurrence. This process requires repeatable and consistent perioperative images that correlate with the postoperative fluoroscopic images to visualize the achieved correction accurately. To obtain consistent perioperative images, a structured protocol for the use of perioperative fluoroscopy is necessary. The surgical procedure is chosen based on the severity of the deformity and the amount of correction needed, which are assessed using two-dimensional (2D) radiographs. However, due to the multiplanar nature of hallux valgus, it is difficult to describe and quantify hallux valgus accurately and reliably on standard radiological 2D images, necessitating a reproducible three-dimensional (3D) quantification of hallux valgus. This might help to improve the adequate surgical procedure selection of hallux valgus corrections. This study presented a protocol for the efficient and effective use of perioperative fluoroscopy during surgical hallux valgus corrections that fits into the workflow of the procedure and may obtain perioperative images that correlate with the postoperative images. This may help to prevent technical issues during the procedure and improve the performances of the orthopedic surgeon. The transition toward the 3D analysis of hallux valgus requires a relevant global coordinate system in the foot. As a result, this study also presented an automated method for defining a global coordinate system in the foot and explored potential methods for the 3D quantification of hallux valgus. Although the concepts of the 3D quantifications of hallux valgus need further development and finetuning, a variety of future studies can be started to further optimize surgical hallux valgus corrections. This offers perspective to achieve consistent satisfactory, long-term outcomes.
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