Impact of rearfoot alignment on hallux valgus surgery outcomes

NewsBot · Apr 21, 2016

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Influence of Hindfoot Malalignment on Hallux Valgus Operative Outcomes
Alberto Gines-Cespedosa, et al
Foot & Ankle International April 20, 2016

Background: Hindfoot deformity has been described as a risk factor for poor hallux valgus (HV) surgery outcomes. However, there has been no study that demonstrates it. The purpose of this investigation was to evaluate the influence of hindfoot misalignment in HV surgery results.
Methods: All patients operated on for HV during 2010 and 2011 at 3 university hospitals were included. The preoperative and 2-year postoperative radiologic data included the HV and the intermetatarsal (IM) angles, the naviculocuboid overlap (NC), the talonavicular coverage (TN) angle, the talus?first metatarsal (T-1MT) angle, as well as the calcaneal pitch (CP) angle. Additionally, the Short Form?36 questionnaire version 2.0 (SF-36) and the American Orthopaedic Foot & Ankle Society (AOFAS) score, satisfaction and recurrence were also analyzed. A total of 207 met the inclusion criteria. There were 26 patients (12.6%) who could not be assessed at the 2-year follow-up. Patients were allocated to a varus, normal, or a valgus hindfoot tertile using the values for the CP, NC, TN, and T-1MT angles.
Results: No significant differences (P > .05) were found between the groups when the HV or IM angles, AOFAS, SF-36 Mental Composite Scale, SF-36 Physical Composite Scale, or satisfaction were compared. Similarly, no significant and strong correlations were observed (P > .05, ρ < 0.3) between any of the mentioned hindfoot measures and the outcomes scales.
Conclusion: No influence of hindfoot misalignment on HV surgery outcomes was found in the present study in terms of correction, pain, function, satisfaction, or quality of life. Patients with hindfoot misalignment did not obtain worse outcomes in HV surgery
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Admin2 · Apr 21, 2016

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Dieter Fellner · Apr 23, 2016

Readers of this abstract ought, perhaps, not take this information at face value. Even if this is a Level II study. The outcome of this work depends completely on the radiographic parameters proposed by Lee et al, that attempt to determine hindfoot deformity. It is recommended to take the reading one level further, and to review the paper by Lee et al. This forms the hub of the analysis. This analysis is sturdy only IF we can accept Lee's paper, a Level III study. I have read both papers. I remain to be convinced.

There are other issues, not least the fact the study did not discriminate between flexible and rigid deformity. Also, this is a static appraisal of foot function. Is it possible, to extrapolate from this, dynamic foot function?

Humanity rarely stands still, for very long.

If we do, it's likely we do not get a bunion.

NewsBot · Apr 12, 2021

Impact of Pes Planus on Clinical Outcomes of Hallux Valgus Surgery
Adriel You WeiTayGraham S.GohYogenTheverNicholas Eng MengYeoKevin Oon ThienKoo
Foot and Ankle Surgery; 10 April 2021

Highlights
•Increasing severity of pes planus was associated with greater preoperative hallux valgus deformity.
•Patients with pes planus undergoing hallux valgus surgery had similar pre- and postoperative clinical scores compared to controls.
•Development of hallux valgus is a chronic process and longer-term studies will be helpful to capture the longer-term impact of pes planus on hallux valgus operative outcomes.
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Background
Pes planus is associated with hallux valgus development. This study evaluated the impact of pes planus on clinical outcomes following hallux valgus surgery.

Methods
191 patients underwent Scarf osteotomy for hallux valgus. Pes planus angles including talonavicular coverage angle, lateral talus-first metatarsal angle (Meary’s angle) and lateral talocalcaneal angle were measured. The cohort was stratified into control (0°-4.0°), mild (4.1°-14.9°), moderate (15.0°-30.0°) and severe (>30.0°) pes planus groups according to Meary’s angle. Clinical outcomes were compared at baseline, 6 months and 24 months.

Results
There were 78 controls, 95 mild and 18 moderate cases of pes planus. Meary’s angle was independently associated with preoperative hallux valgus angle. Pes planus angles were not associated with pain, AOFAS, SF-36 physical or mental scores. All three groups had similar clinical outcomes and patient satisfaction.

Conclusion
Compared to patients with neutral foot arches, those with pes planus presented with more severe hallux valgus deformity but had similar clinical outcomes following surgical correction.
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NewsBot · Jan 30, 2023

Three-dimensional morphological variations in the calcaneus and talus in relation to the hallux valgus angle
Shuhei Nozaki et al
Ann Anat. 2023 Jan 22;152053

Background: The present study aimed to clarify the morphological patterns of the calcaneus and talus that are associated with hallux valgus angle (HVA) by quantifying the differences in the hindfoot bone morphology between left and right sides in HV patients with clear bilateral difference of HVA.

Methods: Three-dimensional (3D) computed tomography scans of 32 feet of 16 patients with HV who had right-to-left HVA differences of more than 5 degrees (68.8 ± 8.6 years) were enrolled, and 3D surface models of the calcaneus and talus were generated. A total of 556 and 430 landmarks were placed on the calcaneal and talar surfaces, respectively, to calculate the principal components (PCs) of shape variations. The PC scores were compared between the small and large HVA sides within an individual.

Results: The calcaneus in patients with a larger HVA (mean, 43.2 degrees) possessed slender calcaneal tuberosity, more medially oriented posterior articular surface in the coronal plane, and narrower and more concave anterior-middle articular surfaces compared to those with a small HVA (mean, 33.7 degrees). The talus with a larger HVA exhibited more medially oriented talar head in the transverse plane and more anteriorly protruded lateral region of the talar head compared to the small HVA.

Conclusions: The morphological patterns of the calcaneus in patients with a larger HVA allows the hindfoot bones to easily rotate in the everting direction, while those of the talus could induce a larger internal rotation of the first metatarsal. These morphological patterns of the calcaneus and talus could be structural factors affecting the HV.
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NewsBot · Sep 26, 2023

Characteristics of hindfoot morphology and ankle range of motion in young women with hallux valgus
Mieko Yokozuka & Kanako Okazaki
Journal of Foot and Ankle Research volume 16, Article number: 64 (2023)

Background
Hallux valgus occurs more frequently in women as they age; therefore, it is beneficial to prevent hallux valgus in younger women. The purpose of this study was to clarify the characteristics of hindfoot morphology and the range of motion of the ankle joint with hallux valgus in young women.

Methods
The participants were 140 young women (mean age 18.8 ± 0.6 years). A three-dimensional footprint automatic measurement apparatus was used to measure the hallux valgus angle in the standing position and the arch-height ratio and heel-floor angle (HFA) in the standing and chair-sitting positions. The amount of change in foot morphology owing to differences in posture was calculated. The range of motion of the ankle joint dorsiflexion, plantarflexion, inversion, and eversion was measured. Participants were classified into two groups according to the presence of hallux valgus. Statistical analysis was used to compare hindfoot morphology and range of motion between the two groups, and the correlation between foot morphology and range of motion was investigated depending on the presence of hallux valgus.

Results
With hallux valgus, the HFA tilted inwards (p = 0.010), and the change in the arch-height ratio due to the difference in posture was large (p = 0.021). There was no difference in the range of motion of the ankle joints with or without hallux valgus. In women with hallux valgus, the amount of change in arch height and HFA was correlated with the range of motion of eversion (r = 0.391, p = 0.027; r = -0.362, p = 0.042).

Conclusions
With hallux valgus, the hindfoot pronated, and the arch height decreased from sitting to standing. Furthermore, the amount of change in the hindfoot and midfoot due to posture was related to the range of motion of eversion.
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