Hallux valgus angle as a predictor of recurrence following proximal metatarsal osteotomy

admin · Aug 9, 2011

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Hallux valgus angle as a predictor of recurrence following proximal metatarsal osteotomy
Ryuzo Okuda, Mitsuo Kino****a, To****o Yasuda, Tsuyoshi Jotoku, Hiroaki Shima and Masaki Takamura
Journal of Orthopaedic Science (online first)

Background
Postoperative recurrence of hallux valgus is a common complication. We hypothesized that patients who are at higher risk for recurrence of hallux valgus following a proximal metatarsal osteotomy could be recognized preoperatively and at the early follow-up on the basis of their radiographic evaluation. The purpose of this study was to clarify the relationship between the hallux valgus angle, intermetatarsal angle, and recurrence of hallux valgus.

Methods
We performed a case–control study of patients treated with a proximal metatarsal osteotomy for hallux valgus. Dorsoplantar weight-bearing radiographs of 72 feet were assessed preoperatively, at the early follow-up interval (mean 10 weeks), and at the most recent follow-up interval (mean 33 months).

Results
The rate of recurrence was 13.9% (ten feet). Risk factors for recurrence were preoperative hallux valgus angle >40° [odds ratio (OR) = 5.1; 95% confidence interval (CI) 1.3–20.8]. Decreased risks of hallux valgus recurrence were a hallux valgus angle ≤15° (OR = 0.036, 95% CI = 0.0056–0.24, p = 0.0005), and an intermetatarsal angle <10° (OR = 0.083, 95% CI = 0.015–0.46, p = 0.0075) at the time of the early follow-up with the numbers available.

Conclusions
Our radiographic results indicated that a preoperative hallux valgus angle >40° can be a risk factor for hallux valgus recurrence. Decreased risk factors for recurrence included hallux valgus angle ≤15° and an intermetatarsal angle <10° at the early follow-up. These risk factors may be helpful for modifying surgical procedures, improving surgical outcome, and predicting hallux valgus recurrence.
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drsarbes · Aug 10, 2011

Yawn...the the worse the deformity the less likely of a successful correction.
I never would have guessed.
Steve

Kidsfeet · Aug 10, 2011

Yes, but this is data to support your "guess" which is invaluable dontcha think?

NewsBot · Nov 14, 2015

Radiographic Recurrence of Deformity After Hallux Valgus Surgery in Patients With Metatarsus Adductus
Amiethab Aiyer, Jeffery Shub, Raheel Shariff, Li Ying, Mark Myerson
Foot & Ankle International November 13, 2015

Background: Metatarsus adductus (MA) is a congenital condition that may lead to the development of hallux valgus (HV). The associated anatomic deformities may lead to recurrence of the HV in patients with MA. The goals of the study were to identify radiographic rates of recurrence of HV following surgery for HV in patients with MA.
Methods: Between 2002 and 2013, 587 patients who underwent HV surgery were retrospectively identified. The radiographic parameters recorded included the hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the metatarsus adductus angle (MAA) obtained from initial radiographs and at final follow-up. The MAA was considered abnormal if the value was greater than 20 degrees. Radiographic recurrence was defined as HV deformity >20 degrees.
Results: The rate of radiographic recurrence of HV was 15% in patients without MA and 29.6% in patients with MA (P < .05). In the group with MA, rate of deformity recurrence did not differ among the operative procedures performed (Lapidus, 28.5%; distal first metatarsal osteotomy, 29.4%; proximal first metatarsal osteotomy, 28.9%). Patients with severe MA (MAA > 31 degrees) were found to have a recurrence rate of 18%, whereas those with less severe MA (MAA < 31 degrees) were found to have a recurrence rate of 82%. Of the patients with severe MA who did not have radiographic recurrence of HV, 60% had undergone a Lapidus arthrodesis and realignment arthrodesis of the second/third tarsometatarsal joints.
Conclusion: The rate of radiographic recurrence for patients with MA undergoing HV correction was ~30%. This finding was consistent with our hypothesis that MA increases the risk of radiographic recurrence of HV deformity irrespective of the procedure performed. We believe the lower rate of recurrence of HV among patients with severe MA deformities is suggestive that more complete management of the deformity is warranted.
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NewsBot · Mar 22, 2016

Point-Connecting Measurements of the Hallux Valgus Deformity: A New Measurement and Its Clinical Application
Jeong-Ho Seo et al
Yonsei Med J. 2016 May;57(3):741-747

Purpose
The aim of this study was to investigate new point-connecting measurements for the hallux valgus angle (HVA) and the first intermetatarsal angle (IMA), which can reflect the degree of subluxation of the first metatarsophalangeal joint (MTPJ). Also, this study attempted to compare the validity of midline measurements and the new point-connecting measurements for the determination of HVA and IMA values.

Materials and Methods
Sixty feet of hallux valgus patients who underwent surgery between 2007 and 2011 were classified in terms of the severity of HVA, congruency of the first MTPJ, and type of chevron metatarsal osteotomy. On weight-bearing dorsal-plantar radiographs, HVA and IMA values were measured and compared preoperatively and postoperatively using both the conventional and new methods.

Results
Compared with midline measurements, point-connecting measurements showed higher inter- and intra-observer reliability for preoperative HVA/IMA and similar or higher inter- and intra-observer reliability for postoperative HVA/IMA. Patients who underwent distal chevron metatarsal osteotomy (DCMO) had higher intraclass correlation coefficient for inter- and intra-observer reliability for pre- and post-operative HVA and IMA measured by the point-connecting method compared with the midline method. All differences in the preoperative HVAs and IMAs determined by both the midline method and point-connecting methods were significant between the deviated group and subluxated groups (p=0.001).

Conclusion
The point-connecting method for measuring HVA and IMA in the subluxated first MTPJ may better reflect the severity of a HV deformity with higher reliability than the midline method, and is more useful in patients with DCMO than in patients with proximal chevron metatarsal osteotomy.
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NewsBot · Apr 16, 2016

Assessing Precision of the Radiographic Metatarsophalangeal Angle in Hallux Valgus
Domingo Molina, MD; Anand Padmanabha, MD; Vinod K. Panchbhavi, MD, FACS; Clark R. Andersen, BS
Texas Orthopedic Journal; 2016

Introduction: Radiographic measurement of the first metatarsophalangeal (MTP) angle is critical in selecting a procedure for the treatment of hallux valgus deformity and a major criterion of postoperative success. The current five methods of measurement utilize a first metatarsal axis based on reference points within the first metatarsal. Previous studies have not been able to account for imprecision produced by anatomic variation and/or surgical correction of the first metatarsal. In this study, we adapted a recently published radiographic method for measuring the first interphalangeal angle to calculate the MTP angle without using reference points within the first metatarsal. The aim of this study was to assess the reproducibility of this method.

Methods: Using interobserver variances in 42 sets of anteroposterior weight-bearing radiographs of our patients who underwent distal chevron osteotomy, we compared the preoperative and postoperative reproducibility of this method to an existing means of measuring the MTP angle that is currently described by literature as having the greatest reproducibility.

Results: The existing method was shown to differ from our method with regard to interobserver variability, with 10 times greater variance in the preoperative case, 3 times greater variance in the postoperative case, and 6 times greater variance when both categories were combined.

Discussion: This study supports the hypothesis that a method that does not rely on reference points within the first metatarsal for measuring the MTP angle is more precise than a method that does.
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