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ABSTRACT: The Cochrane review of hallux valgus surgery has disputed the scientific validity of hallux valgus research. Scoring systems and surrogate measures such as x-ray angles are commonly reported at just one year post operatively but these are of dubious relevance to the patient. In this study we extended the follow up to a minimum of 8 years and sought to address patient specific concerns with hallux valgus surgery. The long term follow up also allowed a comprehensive review of the complications associated with the combined rotation scarf and Akin osteotomies.
Between 1996 and 1999, 101 patients underwent rotation scarf and Akin osteotomies for the treatment of hallux valgus. All patients were contacted and asked to participate in this study. 50 female participants were available allowing review of 73 procedures. The average follow up was over 9 years and the average age at the time of surgery was 57. The participants were physically examined and interviewed.
Post-operatively, in 86% of the participants there were no footwear restrictions. Stiffness of the first metatarsophalangeal joint was reported in 8% (6 feet); 10% were unhappy with the cosmetic appearance of their feet, 3 feet had hallux varus, and 2 feet had recurrent hallux valgus. There were no foot-related activity restrictions in 92% of the group. Metatarsalgia occurred in 4% (3 feet). 96% were better than before surgery and 88% were completely satisfied with their post-operative result. Hallux varus was the greatest single cause of dissatisfaction. The most common adverse event in the study was internal fixation irritation. Hallux valgus surgery is not without risk and these findings could be useful in the informed consent process.
When combined the rotation scarf and Akin osteotomies are an effective treatment for hallux valgus that achieves good long-term correction with a low incidence of recurrence, footwear restriction or metatarsalgia. The nature of the osteotomies allows early return to normal shoes and activity without the need for postoperative immobilisation in a plaster cast.
Journal of Foot and Ankle Research 02/2010; 3:2. · 1.33 Impact Factor
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ABSTRACT: Osteoarthrosis of the second metatarsocuneiform joint presents as pain, stiffness and osteophytic thickening of the midfoot. This study sought to determine the effectiveness and outcome of surgical fusion of osteoarthritic second metatarsocuneiform (MC) joint. The association between the condition and second metatarsal length was also explored.
A series of 23 patients (22 female) of average age 58 years (SD 4.9) underwent second MCJ fusion and were reviewed at an average of 42 months (SD 19.5) postoperatively. The second MC joint fusion involved resection of the joint surfaces and internal fixation with a 3-hole 2.7-mm plate. A variety of graft materials were utilized.
The AOFAS midfoot rating scale score rose from a preoperative mean of 47 (SD 13) to a mean 90.5 (SD 12.5) postoperatively, p < 0.0001. Seventeen patients (74%) were completely satisfied. Four patients (17%) were satisfied with reservations. Two patients (9%) were dissatisfied. Twenty-one patients (91%) considered that they were better than before the operation and two patients were no better. Nonunion occurred in three patients and internal fixation was removed in four patients. One patient went onto develop osteoarthrosis in the third MC joint. We could not establish a causal relationship between osteoathrosis of the second MC joint and second metatarsal length.
Fusion of the second MCJ is a moderately effective treatment for osteoarthrosis of the joint. In this series of patients, 74% were pain-free and nonunion was the most serious complication encountered, no patient was made worse by surgery.
The Foot and Ankle Online Journal 12/2008; 29(11):1079-87. · 1.22 Impact Factor
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ABSTRACT: Valgus deviation of the second toe can be associated with metatarsophalangeal joint pain, footwear fitting problems, and cosmetic concerns. It also reduces the buttress effect of the second toe on the hallux and may allow progression of hallux valgus. The traditional operative approaches for digital arthrodesis or lesser metatarsal osteotomy have unpredictable results.
This study reviewed the effect of a closing wedge osteotomy on the proximal phalanx in 26 women with an average age of 59 years (SD 10) who had a valgus second toe. The patients had weightbearing radiographs preoperatively and at an average 28 months postoperatively. Clinical examination assessed for floating toe, range of metatarsophalangeal joint motion, and patient satisfaction.
Before surgery the average second toe valgus angle measured 28 degrees and at final review this had reduced to 14 degrees (p < 0.001). Postoperatively, the average range of dorsiflexion of the digit was 42 degrees (SD 20). The average plantarflexion was 16 degrees (SD 10). Floating of the digit was noted in five patients and recurrence of the deformity in four patients. Nineteen patients (73%) were completely satisfied with the outcome of their surgery, seven were satisfied with reservations, and no patient was dissatisfied. Twenty five patients (96%) considered their second toe to be better than before the operation.
Closing wedge osteotomy of the second toe is technically simple, reasonably safe, and relatively effective for valgus deformity of the second toe. Recurrence of the second toe valgus usually was associated with recurrence of hallux valgus.
The Foot and Ankle Online Journal 12/2007; 28(12):1260-4. · 1.22 Impact Factor
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ABSTRACT: The main bony procedures used in the treatment of second hammertoe are excisional arthroplasty and arthrodesis of the proximal interphalangeal (PIP) joint. While a number of studies have reported the outcomes after PIP joint arthrodesis, there are few reports of the outcome of excisional arthroplasty of the PIP joint for the correction of second hammertoes. The purpose of this study was to evaluate the long-term outcome of PIP joint excisional arthroplasty.
Seventy-five patients (100 toes) who had excisional arthroplasty of the PIP joint for the correction of second hammertoe were reviewed at an average followup of 44 months. All patients were seen in clinic and were physically examined to assess the alignment and function of each digit. The radiographs were evaluated preoperatively. The AOFAS clinical rating scale was used preoperatively and at final followup. Patients were asked to rate their satisfaction on a scale of 0 to 10 and were asked if they would be happy to have the surgery under similar circumstances again.
The mean preoperative AOFAS clinical rating scale was 46. At final followup this increased to 94, showing an average improvement of 48 points (p < 0.0001). The mean satisfaction on a scale of 0 to 10 (with 0 equaling complete dissatisfaction and 10 complete satisfaction) was 9.3 (SD 1.3). One patient would not have been happy to undergo outpatient surgery again, because of a change in her social circumstances.
In a group of 75 patients who had PIP joint arthroplasty for the correction of second hammertoe, high levels of satisfaction were achieved. No serious complications were encountered, and revision surgery was required in just two cases. Floating toe was the most common complication encountered, and although this did decrease the level of patient satisfaction in seven patients it was not a cause of footwear irritation or pain in any patient.
The Foot and Ankle Online Journal 04/2005; 26(4):320-5. · 1.22 Impact Factor
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ABSTRACT: Seventeen patients (20 feet) underwent Weil osteotomies of the second and third metatarsals for the treatment of central metatarsalgia and were reviewed at an average of 18 months postoperatively. Fourteen patients were completely satisfied with the results of their surgery (85%), one patient was satisfied, one patient satisfied with reservations and one patient was dissatisfied. The American Orthopaedic Foot and Ankle Society clinical rating scale improved by an average of 44 points. One patient had complete recurrence of symptoms, eight out of the 40 toes involved in surgery were floating, four toes were stiff, there were three cases of infection, and transfer metatarsalgia affected the fourth metatarsal in one case. The Weil osteotomy is an effective and safe procedure for the treatment of central metatarsalgia.
The Foot and Ankle Online Journal 06/2002; 23(5):415-9. · 1.22 Impact Factor
