What is your primary procedure for hallux valgus?

NewsBot · Dec 6, 2006

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Surgical treatment of mild hallux valgus deformity: the state of practice among academic foot and ankle surgeons.
Foot Ankle Int. 2006 Nov;27(11):970-3
Pinney S, Song K, Chou L

BACKGROUND: The purpose of this study was to determine the operative procedure of choice among academic foot and ankle surgeons practicing in the United States for treatment of mild hallux valgus deformity.

METHODS: A hypothetical patient was created: a 60-year-old woman with a mild hallux valgus deformity (first intermetatarsal angle of 11 degrees and hallux valgus angle of 22 degrees). The patient complained of pain around the bunion, nonoperative treatment had failed, and she desired operative correction. The case was sent to academic foot and ankle surgeons to identify their operative treatment of choice. The overall response rate was 83.7% (128 of 153). To be included in the study group each surgeon had 1) foot and ankle patients comprising 50% or more of their clinical practice and 2) direct responsibility for teaching orthopaedic surgery residents. One hundred and three respondents met the inclusion criteria and formed the study group.

RESULTS: Eighty-seven percent (90 of 103) reported that they would use a distal chevron osteotomy as their primary procedure to correct the mild hallux valgus. Ten percent (10 of 103) reported that they would also add an Akin osteotomy of the proximal phalanx to enhance correction.

CONCLUSIONS: Most respondents chose a distal chevron osteotomy as their primary procedure to correct the mild hallux valgus deformity.
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NewsBot · May 1, 2012

Operative Management of Common Forefoot Deformities: A Representative Survey of Australian Orthopaedic Surgeons
Lukas Daniel Iselinm,vMunt Justin,vPanagiotis D. Symeonidis, Georg Klammer, Mellick Chehade, Peter Stavrou
Foot Ankle Spec April 30, 2012

Background. Hallux valgus and hallux rigidus are common conditions for which numerous operative interventions have been described in the literature. Various clinical and radiological measurements have been used to help grade severity and to guide treatment.

Materials and methods. A survey was e-mailed to all members of the Australian Orthopaedic Association. Questions were asked regarding respondents’ demographics as well as their preferred treatment for 3 separate cases of hallux valgus and hallux rigidus of varying severity. They were specifically asked about type of deformity correction and type of fixation. The responses were collected and statistically analyzed.

Results. The authors collected the answers of 454 respondents with a response rate of 36%. There was a disproportionately large percentage of respondents who were members of the Australian Orthopaedic Foot and Ankle Society. Preferred treatments were different for the 3 different cases. Older surgeons were more likely to use Chevron osteotomies, and Australian Orthopaedic Foot and Ankle Society members were more likely to use a scarf. Scarf osteotomy was preferred by more than 50% for the cases of moderate and severe hallux valgus, whereas first metatarsophalangeal joint fusion was preferred for the case with significant arthritic changes.

Conclusions. There are significant associations between the surgeons’ age and expertise and their training and their preferred operative intervention. Considerable differences were found in the practice of the general orthopaedic surgeons and the foot and ankle specialists. Despite the large number of surgical options available for hallux valgus, only a small number were preferred by the majority of surgeons. Although anecdotally aware that lesser deformity is treated with distal osteotomies and more severe deformity with a proximal osteotomy, the authors are unaware of any current literature that verifies this.
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NewsBot · Jul 10, 2015

Algorithm for Severe Hallux Valgus Associated With Metatarsus Adductus
Jyoti Sharma, Umur Aydogan
Foot & Ankle International July 9, 2015

Background: Radiographic angles, such as the intermetatarsal angle, hallux valgus angle, and distal metatarsal articular angle, are commonly used to help guide operative planning for soft tissue and osseous treatment options for hallux valgus. Hallux valgus treatment in the setting of associated metatarsus adductus is less common and not well described. The presence of metatarsus adductus reduces the gap between the first and second metatarsals. Consequently, it complicates the measurement of the first-second intermetatarsal angle and can limit the area available for transposition of the first metatarsal head. A compensatory pronation is also created, which must be compensated for. We present 4 cases of patients that had hallux valgus with severe metatarsus adductus treated operatively, as well as a treatment algorithm.
Methods: For concomitant correction of both the metatarsus adductus and the hallux valgus, a thorough surgical treatment algorithm was implemented to address the hallux, lesser toe deformities, and pes planus deformity. Postoperatively, the patients were kept non–weight bearing for 6 weeks, followed by gradual weight bearing in a protective boot. Physical therapy was instituted at the start of weight bearing to encourage a return to activities of daily living.
Results: At follow-up, patients reported significant relief of their pain symptoms with a narrower and improved appearance of the foot. No recurrence was noted. One patient used a medial arch support but was otherwise symptom free. Radiographic measurements improved on postoperative radiographs.
Conclusions: For the treatment of hallux valgus with metatarsus adductus, the second and third metatarsals may need to be addressed for the first metatarsal to be laterally transposed adequately. Overall, this comprehensive approach addresses the hindfoot, midfoot, and forefoot for patients with hallux valgus associated with metatarsus adductus, with successful results.
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NewsBot · Oct 17, 2015

Surgical management of hallux valgus and hallux rigidus: an email survey among Swiss orthopaedic surgeons regarding their current practice.
Iselin LD et al
BMC Musculoskelet Disord. 2015 Oct 14;16(1):292. doi: 10.1186/s12891-015-0751-7.

BACKGROUND:
Various clinical and radiological criteria have been suggested to choose one of the numerous techniques in surgical treatment of hallux valgus and rigidus. We hypothesized that the surgeons' professional background will influence that choice depending on specialization, age, type and institution of training as well as his orthopaedic cultural orientation. Since Switzerland is characterized by regional languages (the most important being German and French), we were interested to learn if the linguistic differences had an influence on the orientation of the surgeons towards e.g. Anglo-American or French surgical traditions and/or sources of literature on the subject.
METHODS:
A survey was e-mailed to all members of the Swiss Orthopaedic Society (SGOT-SSOT). Questions were asked regarding respondents' demographics as well as their preferred treatment for 3 separate cases of (1) moderate and (2) severe hallux valgus and (3) hallux rigidus. The responses were collected and statistically analyzed.
RESULTS:
Two hundred thirty of 322 respondents completed the survey(response rate 46 %). as they perform foot surgery on a regular base; 39 % were members of the Swiss Orthopaedic Foot and Ankle Society (SFAS). Selected surgical treatments differed as follows: in joint sparing procedures older and busier surgeons were more likely to use Chevron osteotomies, however more than 50 % preferred a Scarf-type of osteotomy. Along the so-called "R?sti-Graben" separating the French from the German speaking part of Switzerland no significant difference was found in the choice of operation technique. Nevertheless the fact being a member of SFAS showed significant differences in technical choice in case 2 and 3.
CONCLUSIONS:
There are significant associations between the surgeons' age, expertise and training and their preferred operative intervention. Considerable differences in the surgical management were found in the practice of the general orthopaedic surgeons 72 and the foot and ankle specialists. The cultural background and training is not mirroring the classical Swiss east west discrepancy. Despite the large number of surgical options available for hallux valgus, only a small number were preferred by the majority of surgeons.
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NewsBot · Jan 29, 2016

Consensus on Surgical Management of Hallux Valgus from China.
Foot and Ankle Working Committee; Chinese Association of Orthopaedic Surgeons Orthopaedic Branch; Chinese Association of Orthopaedic Surgeons.
Orthop Surg. 2015 Nov;7(4):291-6. doi: 10.1111/os.12207.

Hallux valgus deformity is one of the most common diseases in foot and ankle surgery. Satisfactory outcomes tend to be achieved only through operative correction. However, selection of the optimal surgical strategy is always a controversial topic, and the rate of dissatisfied patients postoperativelyis still very high. It is well known that there are various pathological changes in hallux valgus deformity, so it is impossible to use one specific procedure to solve all the problems. It requires a careful preoperative physical examination and radiographic assessment to choose the best operation for each kind of deformity according to each pathalogical change, combined with good postoperative dressing, immobilization and proper rehabilitation and follow up, to improve surgical outcomes and reduce postoperative rate of complication and dissatisfaction. In order to achieve these goals, a Consensus on the Operative Correction of Hallux Valgus has been developed by the Foot and Ankle Working Committee, Orthopaedic Branch, Chinese Association of Orthopaedic Surgeons. Foot and ankle surgeons following this consensus must be fully aware of their patients' desires, carefully evaluate different pathological processes and clinical symptoms and be skilled in various procedures. Then these procedures can be easily selected, converted and combined based on preoperative plans and intraoperative conditions.
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NewsBot · Jul 14, 2016

Evidence of Treatment Algorithms for Hallux Valgus
Axel Deenik, Aart Verburg, Jan Willem Louwerens, Maarten de Waal Malefijt, and Rob de Bie
JSM Foot and Ankle' online first (full text pdf)

Background: Algorithms have been developed to aid in the decision process in order to choose an optimal surgical procedure for different types of hallux valgus. These algorithms are evaluated in this study with current level 1 and 2 studies.
Materials and methods: Criteria for typing hallux valgus and surgical procedures in the treatment algorithms as proposed by Coughlin and Robinson were categorized. PubMed searches were performed to obtain data regarding preoperative parameters and outcome of surgical procedures. Gathered data were used to assess validity of algorithms as well as the validity of factors used in preoperative planning of hallux valgus surgery and proposed advantages of specific surgical techniques.
Results: The PubMed search on preoperative criteria resulted in 196 references; four were classified as level 2 evidence. The PubMed search of surgical procedures resulted in 36 references of which seventeen were classified as level 1 or 2 evidence. Outcome was determined by severity of hallux valgus angle. The advantages of the certain procedures as advised in the algorithms to correct specific hallux valgus deformities have not been established in controlled clinical studies.
Conclusion: Widely accepted flow-charts for the treatment of hallux valgus are not based on level 1 and 2 studies. Hallux valgus angle is found to be the single significant parameter for prediction of the surgical outcome. Correction declines with hallux valgus angle exceeding 36 degrees, in these cases outcome of osteotomy becomes more uncertain.
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Quiros · Aug 2, 2016

Wilsom Mod. MIS

NewsBot · May 26, 2018

From Podiatry Today:
Emerging Concepts In Redefining Our Approach To Bunion Correction

NewsBot · Sep 2, 2018

A meta-analysis of comparative clinical studies of isolated osteotomy versus osteotomy with lateral soft tissue release in treating hallux valgus
KaissarYammine and AssiChahine
Foot and Ankle Surgery; Available online 31 August 2018

Highlights
•The soft tissue release in treating hallux valgus (HV) is reported controversial.
•The transection of the lateral sesamoido-metatarsal ligament seems beneficial.
•The benefit was found for HV angle mainly, and for M1-M2 angle.
•An added Adductor hallucis transection is probably beneficial in severe HV.
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Background
Contradictory results have been reported in the literature over the beneficial effect of the lateral soft tissue release (LSTR) when associated to an osteotomy for the treatment of hallux valgus (HV).

Materials and

Methods
Six comparative studies totalizing 425 patients (549 feet) were computed and comparing two groups: one group of patients having osteotomy alone and the other group having osteotomy with LSTR.

Results
Subgroup analysis in relation to the type of LSTR yielded significant better HVA correction (P < 0.0001) in favor of those reporting the release of the lateral sesamoido-metatarsal ligament (LSML). A moderate significance (P = 0.03) of the inter-metatarsal angle (IMA) difference was found in favor of LSTR.

Conclusions
There could be a beneficial effect of transecting LSML in all cases of HV deformity, and a probable efficacy of an added adductor hallucis tendon transection when the deformity is moderate to severe.
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NewsBot · Sep 26, 2018

Hallux Valgus Correction: The Best Technique Is Still Up for Debate

NewsBot · Oct 3, 2018

Treatment trends for acquired hallux valgus among orthopedic surgeons and podiatrists
Ryan Callahan, DO, MS, Umur Aydogan, MD, Guodong Liu, Djibril Ba
AOFAS Annual Meeting 2018 1

Introduction/Purpose: Foot and ankle surgery is unique in that both orthopedic surgeons and podiatrists perform many of the
same procedures. Very little data exists comparing the two groups for treatment trends and potential complications for acquired
hallux valgus deformity. The Truven Health MarketScan® Commercial Claims and Encounters database offers a breadth of
information for comparing commercially available health insurance claims. The MarketScan® database was utilized to gain
understanding in treatment trends between podiatrists and orthopedic surgeons.
Methods: MarketScan® database was used to retrospectively search from 2005-2014 for cases involving a diagnosis of hallux
valgus (ICD-9 735.0) that included procedural codes for distal metatarsal osteotomy (CPT 28296), double osteotomy (CPT
28299), and first tarsometatarsal arthrodesis (CPT 28297). The procedures were then divided into the provider groups of
podiatry (PO) or orthopedic surgery (OS) to compare the trends in treatment options. Additionally, hospital admission within 3
months, reoperation, and pain medication prescriptions were tracked for the separate groups and for the individual procedures
within those groups.
Results: From 2005-2014, 206409 patients were identified for comparison. Podiatrists performed 87.5% of hallux valgus
corrective procedures with significantly different (p<0.0001) treatment approaches with 78.9% distal metatarsal osteotomy (OS
63.2%), 16.2% double osteotomy (OS 25.3%) , and 4.9% first tarsometatarsal arthrodesis (OS 11.5%). Orthopedic surgeons and
podiatrists demonstrated similar hospital admission rates 3 months from surgery or reoperation at 1.8% and 1.5% respectively.
Amongst all providers, there was significantly more (p<0.001) reoperations and admissions after first tarsometatarsal arthrodesis
(2.1%) when compared with distal metatarsal (1.5%) and double (1.6%) osteotomies. 9254 patients were available for
prescription drug comparison that demonstrated significantly different prescribing trends with orthopedic surgeons prescribing
hydrocodone 2.8% (PO 12.9%), oxycodone 39.4% (PO 10.8%), and tramadol 43.4% (PO 60.0%).
Conclusion: A large portion of hallux valgus correction is being performed by podiatrists amongst privately insured patients.
Podiatrists were much more likely to perform distal metatarsal osteotomy while orthopedic surgeons were more likely to
perform double osteotomies and first tarsometatarsal arthrodesis. Hospital admission within 3 months was similar for the
providers. Podiatrists were more likely to prescribe hydrocodone and tramadol while orthopedic surgeons demonstrated greater
numbers with oxycodone prescriptions.
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NewsBot · Oct 20, 2018

Incidence of Hallux Valgus primary surgical treatment. Finnish Nationwide Data From 1997 to 2014
NikkePartioaHeikkiMäenpääaTuomasHuttunenbcHeidiHaapasaloaHeikki-JussiLaineaVille M.Mattilad
Foot and Ankle Surgery; 17 October 2018

Highlights
•The overall incidence of HV operation has decreased remarkably during the last two decades in Finland.
•MT-1 osteotomy is the most common technique in the surgical treatment of HV.
•The MTP-1 joint arthrodesis incidence increased by over 1000% and TMT-1 joint arthrodesis by nearly 2000% during the last two decades in Finland
•The resection arthroplasty of first MTP joint procedure decreased remarkably 1997-2014.
•The gender difference (13% men, 87% women) is consistent with previous studies.
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Background
Many surgical procedures have been described for hallux valgus. Evidence provided by the current literature on the different procedures is, however, poor. The purpose of this study was to assess the incidence of HV surgery in Finland between 1997 and 2014 and to find out whether changes in operation techniques of HV have occurred during the study period.

Methods
The study included all adult patients (≥ 18 years) who underwent primary HV operation. Patients were included into study if they had been operated with a diagnosis of HV (ICD-10 code M20.1). The data were collected by the Finnish National Hospital Discharge Register (NHDR).

Results
The total incidence of primary HV operations was 66.7 per 100 000 person-years in 1997 and 41.4 per 100 000 person-years in 2014. The incidence of arthroplasty operations of the MTP-1 joint decreased while at the same time the incidence of the MTP-1 joint arthrodesis and TMT-1 arthrodesis increased. The gender difference (13% men, 87% women) is consistent with previous studies.

Conclusion
This study shows a significant decreasing trend of HV operations in Finland between 1997 and 2014. During the study period, the incidence of MTP I joint arthroplasty decreased, and since 2005 the incidence of MT-1-osteotomies has almost halved. At the same time, the incidence of MTP-1 joint arthrodesis increased by over 1000% and TMT-1 joint arthrodesis by nearly 2000%.
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NewsBot · Nov 17, 2022

Comparative Analysis of Hallux Valgus Surgical Techniques: A Systematic Review
Atish Amin et al
Source

Introduction/Purpose:
Hallux valgus is a foot deformity where the distal portion of the hallux deviates laterally, forming a bunion. Here we review three surgical techniques for correction of the deformity: lapidus arthrodesis (LA), minimally invasive surgery (MIS), or proximal chevron osteotomy (PCO). The purpose of this study was to compare the hallux valgus angle (HVA) and intermetatarsal angle (IMA) for radiologic outcomes, and the American Orthopaedic Foot & Ankle Society Score (AOFAS) score for quality of life outcomes, between treatment groups.
Methods:
We performed a literature search, with strict inclusion and exclusion criteria, for identifying pertinent references. After review, and resolution of any disagreements by consensus among 5 raters, a total of 42 studies were included in this analysis.
Results:
The mean HVA difference (postoperative to preoperative) was 23.68 for PCO and 21.40 for LA. The mean IMA difference was 9.53 for PCO and 8.12 for LA. The mean of postoperative HVA was calculated to be11.81 for MIS and 9.13 for LA. The mean of postoperative IMA was calculated to be 8.39 for MIS and 6.60 for LA. The postoperative AOFAS mean was 86.00 for MIS and 86.46 for LA. No studies directly compared surgical methods; the results that follow describe each technique summarized separately.
Conclusion:
We discovered that HVA and IMA difference means were higher in PCO vs LA, with a larger difference signifying better radiologic correction. HVA and IMA postoperative means were lower in LA vs MIS. A smaller postoperative angle signifies more physiologic correction. Postoperative AOFAS means were similar in MIS vs LA. Further research should be done to evaluate an ideal procedure and explore better techniques for hallux valgus correction.
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NewsBot · Apr 24, 2024 at 1:53 AM

A Systematic Review of Osteotomies to Correct Hallux Valgus in the First Metatarsal
M. Santos et al
Appl. Sci. 2024, 14(7), 3043; https://doi.org/10.3390/app14073043

Hallux valgus is one of the most common deformities of the forefoot. When addressing hallux valgus, surgical management plays a central role, with the majority of techniques consisting of cutting (osteotomy) and reshaping the overall anatomy of the metatarsal and phalanx. Understanding and analyzing the results of many osteotomies to treat hallux valgus is essential. This systematic review aims to summarize a structure of the different practices used through osteotomies to correct hallux valgus in the metatarsal, the results obtained, and the methodologies used to provide a follow-up. This systematic search was carried out using three databases: the National Library of Medicine, Science Direct, and Sage Journals. This research mainly focused on analyzing the outcomes and post-operative results of the various osteotomies of the first metatarsal manuscripts that addressed more than just the procedure analysis or its results, which were excluded, as in the case of combined pathologies. Fifteen manuscripts were included for full-text analysis based on comparative/explanatory studies of surgical procedures for hallux valgus metatarsal osteotomies and their clinical outcomes. The clinical results were analyzed in two aspects: the dimensional analysis of the metatarsal before and after the surgical procedure and the technologies used to obtain the follow-up. This review will guide future research into the more comprehensive use of the metatarsal osteotomy process and where engineering can and should intervene and make the procedures more precise and straightforward.
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