Journal List > J Korean Foot Ankle Soc > v.23(4) > 1139353

Suh, Kim, and Park: Radiographic Risk Factors of Recurrent Hallux Valgus Deformity after Modified Scarf and Akin Osteotomy

Abstract

Purpose

This study investigated the recurrence rate after performing hallux valgus correction using scarf and Akin osteotomy, and also identified the correlation and cut-off values of both the preoperative and postoperative radiographic parameters as risk factors for the recurrence of hallux valgus.

Materials and Methods

We reviewed 87 hallux valgus patients (122 feet) who received scarf and Akin osteotomy from January 2007 to August 2015. The clinical outcomes were evaluated using the visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores. The radiological outcome measures included the hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) as determined on the serial weight bearing radiographs. Recurrence was defined as more than 20 degrees of HVA noted on the final follow-up radiograph. Those radiological factors associated with recurrence were evaluated and analyzed.

Results

The mean follow-up duration was 20.6 months (12.0∼46.5 months) and the mean age was 44 years (13∼80 years). The VAS and AOFAS scores were significantly improved at the time of the final follow-up (7.0 to 2.0, p<0.001; 78.0 to 92.0, p<0.001; respectively). Significant corrections in the HVA, IMA, and DMAA were obtained (p<0.001). Eleven (9.0%: 11/122) cases experienced recurrent hallux valgus deformity. The postoperative IMA, DMAA and HVA showed significant moderate to strong correlation with HVA at the final follow-up (Pearson correlation coefficient: 0.44, 0.70, and 0.88, respectively; p<0.001). Postoperative HVA>16.7 degrees, postoperative DMAA>13.9 degrees, and postoperative IMA>8.2 degrees showed statistically significant correlation with radiological recurrence at the last follow-up, and the odds ratio of each variable was high in order.

Conclusion

Our radiographic results indicated that postoperative HVA>16.7 degrees, postoperative DMAA>13.9 degrees, and postoperative IMA>8.2 degrees can be risk factors for hallux valgus recurrence. These risk factors may be helpful for modifying surgical procedures and preventing the recurrence of hallux valgus.

Figures and Tables

Figure 1

Receiver operating characteristic (ROC) curve of radiographic risk factors of hallux valgus recurrence after hallux valgus surgery. (A) Preoperative radiographic variables, (B) postoperative radiographic variables. IMA: intermetatarsal angle, HVA: hallux valgus angle, DMAA: distal metatarsal articular angle.

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Figure 2

Standing anteroposterior radiographs of recurrent hallux valgus case in a 15-year-old female foot shows (A) preoperative, (B) postoperative 2 months, and (C) postoperative 3 years follow-up. Hallux valgus angle (HVA) and intermetatarsal angle (IMA) well corrected. However, postoperative distal metatarsal articular angle (DMAA) was 13.9 degree. At last follow-up, hallux valgus recurred with HVA 28.2 degrees.

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Figure 3

Standing anteroposterior radiographs of no recurrent hallux valgus case in a 19-year-old female foot shows (A) preoperative, (B) postoperative 2 months, and (C) postoperative 2 years follow-up. Hallux valgus angle (HVA) and intermetatarsal angle (IMA) well corrected. Postoperative distal metatarsal articular angle (DMAA) was 7.1 degree. At last follow-up, the foot showed no recurrence with HVA 10 degrees.

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Table 1

Clinical and Radiological Results after Modified Scarf and Akin Osteotomy

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Values are presented as mean±standard deviation.

AOFAS: American Orthopaedic Foot and Ankle Society, VAS: visual analogue scale, HVA: hallux valgus angle, IMA: intermetatarsal angle, DMAA: distal metatarsal articular angle.

Table 2

Intraobserver Reproducibility of Radiographic Measurements

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ICC: intraclass correlation coefficient, CI: confidence interval, HVA: hallux valgus angle, IMA: intermetatarsal angle, DMAA: distal metatarsal articular angle.

Table 3

Correlation Factors with Hallux Valgus Angle of Last Follow-Up

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HVA: hallux valgus angle, IMA: intermetatarsal angle, DMAA: distal metatarsal articular angle.

*Pearson correlation coefficient.

Table 4

Area Under Curve (AUC), Cut-Off Value, Sensitivity and Specificity of Radiographic Risk Factors for Hallux Valgus Recurrence in Receiver Operating Characteristic (ROC) Curve

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HVA: hallux valgus angle, IMA: intermetatarsal angle, DMAA: distal metatarsal articular angle.

Table 5

Fisher Exact Test of Radiographic Risk Factors with Cut-Off Values for Hallux Valgus Recurrence

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Values are presented as number (%).

CI: confidence interval, HVA: hallux valgus angle, IMA: intermetatarsal angle, DMAA: distal metatarsal articular angle.

*Fisher's exact test.

Notes

The point of this thesis was presented by 28th Autumn Congress of the Korean Foot and Ankle Society.

Financial support None.

Conflict of interest None.

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