Journal List > J Korean Foot Ankle Soc > v.23(4) > 1139350

Lee and Lee: Approach for the Treatment on Hallux Valgus

Abstract

Although many patients who undergo bunion repair do well and have satisfactory results, a critical evaluation of these results shows the potential for improvement. Metatarsal deformity of the hallux valgus is a 3-dimensional deformity, including rotation in the coronal plane. Theoretically, it is important to understand the 3-dimensional displacement of the first metatarsal for correcting the deformities of valgus rotation in the frontal plane. Yet the current methods of metatarsal osteotomy principally attempt to correct the deformity in the transverse plane. The modified technique for the Lapidus procedure can be used in a variety of hallux valgus conditions and severities, and the early results suggest that a powerful correction can be maintained. In addition, efforts have been made to correct the 3-dimensional deformity by performing metatarsal shaft osteotomy. In the case of degenerative arthritis, first metatarsophalangeal joint arthrodesis is a good option to correct the 3-dimensional deformation. Correction of the 3-dimensional deformity, including a rotational deformity in the frontal plane of the metatarsals, should be considered when selecting surgical treatment and is essential for achieving a good prognosis for patients with hallux valgus. This article reviews the classification and treatment of hallux valgus for correction of the 3-dimensional deformity.

Figures and Tables

Figure 1

Triaxial coordinate plane with Z-axis motion about the 1st ray.

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Figure 2

Current surgical algorithm for hallux valgus. DMO: distal metatarsal osteotomy, IMA: intermetatarsal angle, HVA: hallux valgus angle, DSTP: distal soft tissue procedure, PMO: proximal metatarsal osteotomy, MPT: metatarsophalangeal, TMT: tasometatarsal.

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Figure 3

Radiographs illustrating for the shape of the lateral edge of the first metatarsal head. (A) In case of metatarsal external rotation, the shape of lateral edge is a round shape (arrows). (B) When there is no metatarsal rotation, the shape of lateral edge had an angular shape (arrows).

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Figure 4

Radiologic findings of Triplane hallux valgus classification. (A) Radiographs showing class 1 hallux abducto valgus, with no rotation observed on the axial view. (B) Radiographs of class 2A hallux abducto valgus showing eversion of the first metatarsal and the sesamoid still in the groove with intact crista. (C) Radiographs of class 2B hallux abducto valgus showing rotation of the first metatarsal with subluxation of the sesamoid complex. (D) Radiographs of class 3 hallux abducto valgus associated with metatarsus adductus, with no first metatarsal frontal/coronal plane rotation seen on sesamoid axial view. (E) Radiographs of class 4 hallux abducto valgus showing arthrosis of the first metatarsal phalangeal sesamoid complex.

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Table 1

Triplane Hallux Valgus Classification and Treatment Algorithm*

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MT: metatarsal, OT: osteotomy, TMT: tarsometatarsal, MTA: metatarsus adductus, MTP: metatarsophalangeal.

*Radiologic findings of hallux valgus in all classification were increased hallux valgus angle and intermetatarsal angle.

Notes

Keystone of this journal was presented at the 2019 Spring Conference of The Korean Orthopaedic Association.

Financial support This study was supported by grant from Wonkwang University, 2019.

Conflict of interest None.

References

1. Coughlin MJ, Saltzman CL, Anderson RB, Mann RA. Mann's surgery of the foot and ankle. 9th ed. Philadelphia: Saunders Elsevier;2014. p. 199–300.
2. Menz HB, Lord SR. Gait instability in older people with hallux valgus. Foot Ankle Int. 2005; 26:483–489. DOI: 10.1177/107110070502600610.
crossref
3. Coughlin MJ, Jones CP. Hallux valgus: demographics, etiology, and radiographic assessment. Foot Ankle Int. 2007; 28:759–777. DOI: 10.3113/FAI.2007.0759.
crossref
4. Jang KS, Kim TW, Kim HJ. Diagnosis and pathophysiology of hallux valgus. J Korean Foot Ankle Soc. 2014; 18:43–47. DOI: 10.14193/jkfas.2014.18.2.43.
crossref
5. Hatch DJ, Santrock RD, Smith B, Dayton P, Weil L Jr. Triplane hallux abducto valgus classification. J Foot Ankle Surg. 2018; 57:972–981. DOI: 10.1053/j.jfas.2018.02.008.
crossref
6. Ko KR, Sung KS. Corrective osteotomies in hallux valgus. J Korean Foot Ankle Soc. 2017; 21:43–49. DOI: 10.14193/jkfas.2017.21.2.43.
crossref
7. Bednarz PA, Manoli A 2nd. Modified lapidus procedure for the treatment of hypermobile hallux valgus. Foot Ankle Int. 2000; 21:816–821. DOI: 10.1177/107110070002101004.
crossref
8. Kim JY, Park JS, Hwang SK, Young KW, Sung IH. Mobility changes of the first ray after hallux valgus surgery: clinical results after proximal metatarsal chevron osteotomy and distal soft tissue procedure. Foot Ankle Int. 2008; 29:468–472. DOI: 10.3113/FAI.2008.0468.
crossref
9. Coughlin MJ, Jones CP. Hallux valgus and first ray mobility. A prospective study. J Bone Joint Surg Am. 2007; 89:1887–1898. DOI: 10.2106/JBJS.F.01139.
10. Coughlin MJ, Shurnas PS. Hallux valgus in men. Part II: first ray mobility after bunionectomy and factors associated with hallux valgus deformity. Foot Ankle Int. 2003; 24:73–78. DOI: 10.1177/107110070302400112.
crossref
11. Coughlin MJ, Freund E. Roger A. Mann Award. The reliability of angular measurements in hallux valgus deformities. Foot Ankle Int. 2001; 22:369–379. DOI: 10.1177/107110070102200503.
12. Bock P, Kluger R, Kristen KH, Mittlböck M, Schuh R, Trnka HJ. The scarf osteotomy with minimally invasive lateral release for treatment of hallux valgus deformity: intermediate and long-term results. J Bone Joint Surg Am. 2015; 97:1238–1245. DOI: 10.2106/JBJS.N.00971.
crossref
13. Chong A, Nazarian N, Chandrananth J, Tacey M, Shepherd D, Tran P. Surgery for the correction of hallux valgus: minimum five-year results with a validated patient-reported outcome tool and regression analysis. Bone Joint J. 2015; 97-B:208–214. DOI: 10.1302/0301-620X.97B2.34891.
14. Jeuken RM, Schotanus MG, Kort NP, Deenik A, Jong B, Hendrickx RP. Long-term follow-up of a randomized controlled trial comparing scarf to chevron osteotomy in hallux valgus correction. Foot Ankle Int. 2016; 37:687–695. DOI: 10.1177/1071100716639574.
crossref
15. Iyer S, Demetracopoulos CA, Sofka CM, Ellis SJ. High rate of recurrence following proximal medial opening wedge osteotomy for correction of moderate hallux valgus. Foot Ankle Int. 2015; 36:756–763. DOI: 10.1177/1071100715577195.
crossref
16. Okuda R, Kinoshita M, Yasuda T, Jotoku T, Kitano N, Shima H. Postoperative incomplete reduction of the sesamoids as a risk factor for recurrence of hallux valgus. J Bone Joint Surg Am. 2009; 91:1637–1645. DOI: 10.2106/JBJS.H.00796.
crossref
17. Okuda R, Kinoshita M, Yasuda T, Jotoku T, Kitano N, Shima H. The shape of the lateral edge of the first metatarsal head as a risk factor for recurrence of hallux valgus. J Bone Joint Surg Am. 2007; 89:2163–2172. DOI: 10.2106/JBJS.F.01455.
crossref
18. Yasuda T, Okuda R, Jotoku T, Shima H, Hida T, Neo M. Proximal supination osteotomy of the first metatarsal for hallux valgus. Foot Ankle Int. 2015; 36:696–704. DOI: 10.1177/1071100715572188.
crossref
19. Scranton PE Jr, Rutkowski R. Anatomic variations in the first ray: Part I. Anatomic aspects related to bunion surgery. Clin Orthop Relat Res. 1980; (151):244–255.
20. Kim Y, Kim JS, Young KW, Naraghi R, Cho HK, Lee SY. A new measure of tibial sesamoid position in hallux valgus in relation to the coronal rotation of the first metatarsal in CT scans. Foot Ankle Int. 2015; 36:944–952. DOI: 10.1177/1071100715576994.
crossref
21. Dayton P, Kauwe M, Feilmeier M. Clarification of the anatomic definition of the bunion deformity. J Foot Ankle Surg. 2014; 53:160–163. DOI: 10.1053/j.jfas.2013.10.007.
crossref
22. Dayton P, Feilmeier M, Kauwe M, Hirschi J. Relationship of frontal plane rotation of first metatarsal to proximal articular set angle and hallux alignment in patients undergoing tarsometatarsal arthrodesis for hallux abducto valgus: a case series and critical review of the literature. J Foot Ankle Surg. 2013; 52:348–354. DOI: 10.1053/j.jfas.2013.01.006.
crossref
23. DiDomenico LA, Fahim R, Rollandini J, Thomas ZM. Correction of frontal plane rotation of sesamoid apparatus during the Lapidus procedure: a novel approach. J Foot Ankle Surg. 2014; 53:248–251. DOI: 10.1053/j.jfas.2013.12.002.
crossref
24. Robinson AH, Cullen NP, Chhaya NC, Sri-Ram K, Lynch A. Variation of the distal metatarsal articular angle with axial rotation and inclination of the first metatarsal. Foot Ankle Int. 2006; 27:1036–1040. DOI: 10.1177/107110070602701207.
crossref
25. Yi Y, Lee WC. Comparison of three-dimensional displacement among different metatarsal osteotomies. Foot Ankle Clin. 2018; 23:193–203. DOI: 10.1016/j.fcl.2018.01.004.
crossref
26. Wagner P, Wagner E. Is the rotational deformity important in our decision-making process for correction of hallux valgus deformity? Foot Ankle Clin. 2018; 23:205–217. DOI: 10.1016/j.fcl.2018.01.009.
crossref
27. Swanton E, Mason L, Molloy A. How do i use the scarf osteotomy to rotate the metatarsal and correct the deformity in three dimensions? Foot Ankle Clin. 2018; 23:239–246. DOI: 10.1016/j.fcl.2018.01.008.
crossref
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Sung-Hyun Lee
https://orcid.org/0000-0001-6468-1456

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