Hallux Valgus (HV) surgery is the most common surgery performed in the foot. The Cochrane review done in 2004 showed that no osteotomy is superior to another, however, surgery was shown to be superior to conservative or no treatment for Hallux Valgus deformity. We performed a postal survey in August 2005, to determine the most common procedures performed for HV deformity, type of anaesthesia used, and the length of stay for Hallux Valgus surgery across the United Kingdom. A list of foot and ankle surgeons was obtained from the BOFAS register and a questionnaire was sent. We received 122 (61%) responses from 200 questionnaires sent. Out of which 4 had retired and 118 were available for analysis. The table below demonstrates the common procedures performed by those who replied. Eight-eight percent of the surgeons used foot block along with GA, 9% used GA only and 3% performed the surgery under regional anaesthesia only. Forty percent of surgeons performed the surgery on an overnight stay basis and 30% performed the surgery as a day case. Twenty-five percent of surgeons mentioned that they performed unilateral surgery as a day case and bilateral surgery on an overnight stay basis. Less than 5% kept the patients for more than 2 days. From the responses, most surgeons in the United Kingdom perform Scarf osteotomy with or without Akin osteotomy for Hallux Valgus correction. The majority performed it on an overnight stay basis or as a day case. Most commonly, foot block along with NSAID’s were used for post-operative pain relief

Aim: We report radiological outcome following percutaneous minimally invasive corrention of Hallux Valgus using K-wire fixation. Methods: We followed 15 patients (11 bilateral operations) who had above procedure for Hallux Valgus deformity correction. All patients had pre operative and post operative x-rays assessed for Hallux Valgus angle, 1st Intermetatarsal angle and Distal Metatarsal Articular angle. We also collected clinical data including deformity correction and complications. Results: Mean age of the patients was 55.47(SD 14.27). Of the 15 procedures 11 had bilateral operations and 4 had only one side operated (total 14 right sided 12 left sided operations). Mean duration of follow up was 85.47 days (range 29 to 259). The pre operative mean Hallux Valgus angle was 37.05(SD 6.49, range 28 to 49) where as post operative it was 11.32(SD 9.07, range 0 to 33). The pre operative mean 1st Intermetatarsal angle was 16.46(SD 2.74, range 11 to 21) where as post operative it was 5.48(SD 3.62, range 1 to 16). The pre operative mean Distal metatarsal articular angle was 35.36(SD 8.38, range 18 to 51) where as post operative it was 8.29(SD 9.13, range 0 to 38). Clinically one great toe had infection post operatively requiring early removal of K-wires resulting in residual deformity. One had mild bilateral recurrence, two had mild unilateral recurrence. These patients did not require any further surgery. Conclusion: Above results indicate that Percutaneous Minimally invasive Hallux Valgus correction using K-wire fixation showed good radiological correction in various angles measured to quantify Hallux Valgus deformity

The aim of the study was to assess the clinical, radiological and paedobarographic outcome following modified Silver’s McBride’s procedure, in the treatment of Hallux Valgus. Between 1997 and 1999, Modified Silver’s McBrides procedure for Hallux Valgus was performed on 38 foot in 28 patients (18 unilateral and 10 bilateral). The median age was 60 years. The median follow up was 26 weeks. Clinical outcome measures consisted of pain, deformity, mobility, walking ability and shoe wear. Radiological outcome measures were Hallux Valgus angle, Intermetatarsal angle, 1st to 5th Metatarsal distance, 1st to 2nd metatarsal distance, and the DMAA (Distal Metatarsal Articular Angle). Paedobarographic (Musgrave) outcome of peak pressure, total force, time from heel strike to toe lift off post operatively were analysed. Preoperative visual analogue pain score was 5–8 and 0–4 postoperatively (p< 0.001). 34 feet had pain on walking preoperatively and only 11 had pain post-operatively. 12 were wearing special shoes pre- operatively and 5 post-operatively. Hallux Valgus angle was 34 pre-operatively and 19 post-operatively (p< 0.001). IMT angle was 14.53 pre-op and 10.88 postop (p< 0.001). 1st-5th MT distance was 67mm pre- op and 63mm post-op (p=0.001). 1st-2nd MT distance was 15 pre-op and 10 post-op (p=0.004). DMAA was 24.7 degrees. 21 foot an obliquity of the 1st tarsometatarsal joint was seen indicating an anatomical cause of metatarsus varus. Foot pressure studies showed a peak pressure of 1.37kg/cm2 , heel to toe off- time was 936.9ms and maximum load was 65.2 kg. There were 3 cases of superficial wound problems. One patient developed Hallux varus deformity, with no functional disability. Conclusion: Modified Silver’s McBride procedure for the treatment of Hallux Valgus is a soft tissue procedure and is a safe alternative to the commonly practiced osteotomies for correction of this disorder

INTRODUCTION. Hallux Valgus is a common foot condition, which may affect mobility and lifestyle. Corrective surgery is performed as a day case procedure, however, post-operatively; patients remain limited in their ability to drive for a variable period. In the laboratory settings, emergency brake response time after first metatarsal osteotomy has been studied but there is no published study of patients’ experience of driving after this surgery. This study was aimed at assessing patients’ driving ability and comfort after Hallux Valgus corrective surgery. METHODS. Fifty consecutive patients who underwent first metatarsal corrective osteotomy from January 2009 to July 2010 were reviewed. The operation type, foot side operated, postoperative complications and other conditions affecting driving were recorded from charts and operation notes. A telephonic survey was then conducted and information was recorded in a predesigned questionnaire. The questions included driving advice given by the medical staff, time interval to begin driving postoperatively, and how long the patient took to gain full confidence at driving. It was also noted whether patients required changing the type of car from manual to automatic. RESULTS. Of 50 patients, 10 never drove and were excluded. One patient had expired from unrelated health conditions. Two discontinued driving after surgery due to other (social) reasons, and one could not be contacted. The remaining thirty-six patients were analyzed. The mean age was 56.8+/-9.8 years with range of 36–74 years. Most were females (n=33, 91.7%), and the right side was operated upon in 17 (44.4%) patients. SCARF osteotomy was performed in 19 (52.8%) patients, basal osteotomy in 5 (13.9%), chevron osteotomy in 5 (13.9%) and other procedures (bunionectomy, Akin, soft tissue correction etc) were done in 7 (19.4%) patients. Out of the 28 patients driving manual cars, one required changing to automatic vehicle. The average post-operative period when patients resumed driving was 8.6 weeks with a range of 4 to 16 weeks. After SCARF, this average was 8.3 weeks (range 6–16), which was against 7.6(range 6–16) and 7.8 (range 4–12) weeks after basal and chevron procedures respectively (p=0.408). The mean period when patients reported comfortable foot control was 1.06 weeks after they had begun to drive for all groups. With SCARF this was 1.3 weeks, and 1.4 and 2.2 for basal and chevron groups respectively (p=0.162). Of the two patients that resumed driving after 16 weeks, one had infection and swelling of the foot postoperatively and the other had bilateral basal osteotomy performed simultaneously and was on crutches for 16 weeks. CONCLUSION. The mean time to resumption of automobile driving after corrective Hallux Valgus surgery is 8.6 weeks, and, on average patients takes another week to attain full confidence and comfort at driving postoperatively. There is no statistically significant difference between the types of surgery performed

The aetiology of hallux valgus is well published and largely debated. Hypermobility at the TMTJ was initially described by Morton, but it was not till Lapidus that its association with hallux valgus was hypothesized. However, little has been published on the anatomy of the tarsometatarsal joint. Our aim was to determine whether there was an anatomical basis for the coronal hypermobility in hallux valgus. Method. Anatomical dissection was completed on 42 feet from 23 bodies. Presence of hallux valgus was noted (displacement of sesamoids). Measurements and photographs were taken of the first tarsometatarsal joint and all differences noted. Observations. The TMTJ articular morphology is variable. There were 3 separate subtypes identified of the metatarsal articular surface. Results. The articular subtypes identified were called called A, B and C. Type A, was uni-facet with a single flat articular surface, Type B was bi-facet with two distinct flat articular surfaces, and Type C was tri-facet, with the presence of a lateral eminence on inferolateral surface of metatarsal. Type A was found exclusively in bodies with Hallux Valgus and Type C exclusively in bodies without Hallux Valgus. Type B was found in both groups. Type C was more common in males and type B was more common in females. The third facet was much more common in men. Another anomaly was found; measurements taken from the lowest to highest point of joint surface (mm) revealed a significantly flatter joint surface in bodies with hallux valgus. Conclusion. Coronal plane motion in varus is a consistent feature of hallux valgus. The lateral eminence acts as a sliding dovetail joint and prevents coronal plane motion and rotation. We believe we have identified a joint type that is protective of the development of hallux valgus

Introduction: We present the long term results in 204 cases of Hallux Valgus deformity correction using a modified Mitchell’s osteotomy. Methods: 168 patients (204 feet) that had Mitchell’s osteotomies between 1986 and 2001 were recalled for clinical and radiological evaluation. The patients had hallux valgus angles of up to 50o and intermetatarsal angles of up to 20o. They all had a modified procedure using two crossed Kirschner wires to fix the capital fragment into plantar displacement and angulation. Lateral soft tissue release was performed when deemed necessary during the procedure. Mild to moderate arthritis of the 1st metatarsophalangeal joint was not a contraindication. The AOFAS scores as well as any complications were recorded and the Xrays were used to measure hallux valgus and intermetatarsal angles. Mann-Whitney U test was used to analyze data. Results: The mean follow up was 12.9 years. The mean AOFAS score improved from a preoperative of 49.6 to a postoperative of 87.9 points (p=0.004), due to improvement in the pain (14.2 Vs 37.6, p=0.001) and function (30.6 Vs 39.8, p=0.043) parameters. 57 cases (27.9%) had Hallux Valgus angles > 40o. Lateral soft tissue release was performed in only 16 of these cases with no significant difference in the postoperative Hallux Valgus angle compared to the ones not requiring soft tissue release (21.3o Vs 20.8o, p=0.08). There was a decrease in the pre-operative Vs post-operative incidence of lateral metatarsalgia and symptomatic callosities (18.33% Vs 11.8%, p=0.023). We had only one case of avascular necrosis. Discussion/Conclusion: Mitchell’s osteotomy is a reliable technique with successful outcomes and minimal complications when performed with accurate surgical technique, stable fixation and lateral soft tissue release when appropriate. It may also be successfully performed for Hallux Valgus angles > 40o. We believe that it has still got a role in the treatment of Hallux Valgus

Introduction: We present the long term results in 204 cases of Hallux Valgus deformity correction using a modified Mitchell’s osteotomy. Methods: 168 patients (204 feet) that had Mitchell’s osteotomies between 1986 and 2001 were recalled for clinical and radiological evaluation. The patients had hallux valgus angles of up to 50o and intermetatarsal angles of up to 20o. They all had a modified procedure using two crossed Kirschner wires to fix the capital fragment into plantar displacement and angulation. Lateral soft tissue release was performed when deemed necessary during the procedure. Mild to moderate arthritis of the 1st metatarsophalangeal joint was not a contraindication. The AOFAS scores as well as any complications were recorded and the Xrays were used to measure hallux valgus and intermetatarsal angles. Mann-Whitney U test was used to analyze data. Results: The mean follow up was 12.9 years. The mean AOFAS score improved from a preoperative of 49.6 to a postoperative of 87.9 points (p=0.004), due to improvement in the pain (14.2 Vs 37.6, p=0.001) and function (30.6 Vs 39.8, p=0.043) parameters. 57 cases (27.9%) had Hallux Valgus angles > 40o. Lateral soft tissue release was performed in only 16 of these cases with no significant difference in the postoperative Hallux Valgus angle compared to the ones not requiring soft tissue release (21.3o Vs 20.8o, p=0.08). There was a decrease in the pre-operative Vs post-operative incidence of lateral metatarsalgia and symptomatic callosities (18.33% Vs 11.8%, p=0.023). We had only one case of avascular necrosis. Discussion/Conclusion: Mitchell’s osteotomy is a reliable technique with successful outcomes and minimal complications when performed with accurate surgical technique, stable fixation and lateral soft tissue release when appropriate. It may also be successfully performed for Hallux Valgus angles > 40o. We believe that it has still got a role in the treatment of Hallux Valgus

To assess the outcome of Wilson’s osteotomy of the first metatarsal to correct Hallux Valgus. Two hundred and forty feet in 172 patients who had surgery for pain were reviewed clinically and radiologically. Age ranged from 28 to 82 years (mean 55 years) and duration of follow-up ranged from 2 to 15 years (mean 6 years). A mini external fixation was used to stabilize the osteotomy. The average AOFAS score improved from 51.6 to 89.5 points at the last follow-up. In 96% of the cases, the final outcome was satisfactory as far symptomatic improvement was concerned. A 4% only was dissatisfied with the outcome of the surgery due to metatar-salgia, restricted first metatarsophalangeal joint motion or lack of correction. There were no cases of avascular necrosis of the metatarsal head. We had five cases of delayed union but they didn’t need further surgery. The average preoperative HVA and IMA were 34.80 (range: 180–540) and 15.10 (range: 100–290), while the average postoperative HVA and IMA were 16.10 (range: 70–280) and 7.20 (range: 30–90) respectively. Wilson’s osteotomy as a method of treatment of Hallux Valgus is technically straightforward, effective and with a predictable outcome. We believe that the external fixation offered increased stability at the osteotomy site and could be the reason why patients had a very low incidence of postoperative metatarsalgia and returned to their normal activities faster, thus giving a higher satisfaction rate

Aims: Surgical treatment of forefoot deformities is a common procedure. The vast majority comprising surgery for Hallux Valgus. The indication for surgical intervention varies from pain to cosmetic reasons and footwear problems. Evidence for the effectiveness of different surgical methods is limited. The aims of this study were to perform a cross sectional population based prevalence study of surgery for forefoot deformities in Sweden and to analyze the surgical methods in use. Methods: Data on forefoot surgery were collected from the National Swedish Patient Registry between 1997 and 2000. Both ambulatory surgery (2000) and in-patient surgery (1997–2000) were collected. The data were processed to quantify the frequency of different surgical methods. Results: In 2000, a total of 4409 procedures for forefoot deformities were reported in ambulatory surgery. 82% were female and 18% were male. During 1997–2000, a total of 2547 procedures were performed performed in hospitalised patients. The gender distribution in this group was similar; 84% were female and 16% were male. The frequency distribution between different forefoot deformities will be presented. Discussion: Forefoot surgery is a common procedure, Hallux Valgus being the most frequent deformity to be corrected. The choice of surgical methods will be discussed and a validation of the National Swedish Patient Registry against the Local Reimbursement Registry in the Stockholm area will be presented

Background. In the adolescent population, operative management of hallux-valgus is controversial. Operations may be less successful than in adults and post-operative recurrence is more common before full skeletal maturity. This study assesses the radiographic, functional and qualitative outcomes of surgical Hallux Valgus correction in adolescents. Methods. Three independent reviewers retrospectively analysed pre and post-operative radiological markers of hallux valgus severity for 44 operations on patients age 13–18. The patient cohort were also asked the Manchester-Oxford foot questionnaire (MOXFQ) to assess functional outcome via telephone interview and patient notes were reviewed for any evidence of complications. Results. There was no evidence of NICE recognised complications from any of the operations performed, however there was persistence or recurrence in 20.8%, requiring a second operation in 10.3%. Radiologically, all operations performed resulted in a reduction in hallux valgus severity. The hallux valgus angle showed a mean reduction of 18.0 degrees (16.3–19.7) and the inter-metatarsal angle by 7.3 degrees (6.55–8.14). 93% of operations resulted in a good MOXFQ outcome score of less than 20 out of a possible 80 negative functional outcome points. This score worsened with age in a statistically significant manner (p=0.03) but had no significant correlation with BMI. Conclusion. Surgical correction of adolescent hallux valgus reduces the radiographic severity, which correlates with good long term outcome. This surgery provides beneficial results to the patient, however there is a high recurrence rate, correlating with younger age and this must be taken into account

Failed Hallux Valgus Surgery Aim. We aim to explore the reasons behind long term failure of hallux valgus surgery. Patients & Methods. A series of patients with problems following failed hallux valgus surgery presenting to a tertiary referral unit is presented. There were 47 patients with 55 problematic feet, 45 were female. The mean age was 59 years (Range 25–79). The failed bunions were compared to a prospectively collected series of 80 patients with successful 1st metatarsal osteotomies, 40 ludloff and 40 scarf osteotomies. Before the index surgery, all the patients in the failed group, the predominant symptom was pain. Only 53% admitted deformity was an issue. A wide spectrum of procedures were performed, 13 Wilson's, 11 Keller's, 8 Chevron, 3 Bunionectomy, 2 Scarf, 1 Basal and 1 Mitchell's. In 16 patients the original procedure was unknown. The mean time to developing problems was 9.4 years (Range 0–45) with mean time to presentation 13.6 years. (Range 0–47) Radiographs revealed 2/3 of patients had relative shortening of the first metatarsal. Over 80% of x-rays demonstrated evidence of degenerative change. The mean AOFAS score deteriorated with increased shortening. The failed bunions had statistically significantly different AOFAS pain scores (15.1 vs 31.9 p < 0.05), function scores (25.02 vs 31.9 p < 0.05). Additionally, the hallux valgus angle was significantly higher (24 vs 11.7 p < 0.05) although there was no change in DMMA between the two groups (13 vs 7.6 p > 0.05). There was a significantly higher incidence of first ray shortening (12% vs 0% p < 0.05). Discussion. This represents an unusual series, with nothing similar in the literature. Problems following hallux valgus surgery do not present for over 10 years. Functional Scores deteriorate with increasing shortening. MTPJ degeneration is common and from our data we are unable to explain why

In moderate and severe Hallux Valgus metatarsus varus and incongruency of the joints are often important features. Basal osteotomy and distal soft tissue release can often achieve adequate correction of intermetatarsal angle (IMA) and joint alignment.. We retrospectively evaluated the results of Basal Osteotomy in 26 feet in 20 patients between January 1999 and December 2003. American Orthopaedics Foot & Ankle Society Score (AOFAS) was used for assessment. A subjective grading system was used to check patient’s satisfaction. The surgical technique consisted of crescentic basal osteotomy, lateral distal soft tissue release and medial capsular plication according to Roger Mann. Fourteen osteotomies were fixed with K wires that needed second operation to remove them. Barouk Screw was used to fix the osteotomy in 12 feet. Patients were mobilised in High heeled shoe postoperatively. Average age was 55.2 years and average follow-up was 25.8 months. The average preoperative Hallux Valgus Angle (HVA) and IMA were 37.38° and 17.27° respectively. At follow-up the HVA and IMA averaged 13.3° and 6.4° respectively. Sixteen feet had incongruent joint preoperatively that became congruent after surgery. In 25 feet sesamoid position improved after surgery. Average AOFAS score was 88.8. 94% patients were highly satisfied and graded their results as good to excellent. One patient had AOFAS score of < 50 due to her generalised poly-arthralgia and osteoporosis. K wire was broken across the TMT joint in one case and needed removal under GA. This lead to change of our practice as we started using Barouk screw to fix the osteotomy. Other complications consisted of decreased sensations over medial side of toe in three and mild metatarsalgia in one foot. Basal osteotomies with distal soft tissue release in the treatment of Hallux valgus give good correction of the deformity and high patient satisfaction. Barouk screw provides stable fixation

Short scarf osteotomy (SSO) retains the versatility of standard scarf in treating moderate and severe hallux valgus deformity with the added benefit of less invasiveness translated into less soft-tissue stripping, reduced exposure, less metalwork, less operative time and reduced cost. We present our medium-term clinical, radiographic and patient satisfaction results. All patients who underwent SSO between January 2015 and December 2017 were eligible (98). Exclusion criteria were: follow up less than a year, additional 1st ray procedures, inflammatory arthropathy, infection, peripheral vascular disease and hallux rigidus. Eighty-four patients (94 feet) were included: 80 females / 4 males with average age of 51-year-old (24–81). Minimum follow up was 12 months (12–28). Weight-bearing x-rays and AOFAS score were compared pre- and postoperatively. Non-parametric Mann-Whitney U test assessed statistical significance of our results. Hallux valgus angle (HVA) improved from preoperative mean of 30.8° (17.4°–46.8°) to 12° (4°–30°) postoperatively (p=0.0001). Intermetatarsal angle (IMA) improved from preoperative mean of 15.1° (10.3°–21.1°) to 7.1° (4°–15.1°) postoperatively (p=0.0001). Average sesamoid coverage according to Reynold's tibial sesamoid position improved from average grade 2.18 (1–3) to 0.57 (0–2) (p=0.0001). Average AOFAS score improved from 51.26 (32–88) to 91.1 (72–100) (p=0.0001). Ninety percent of patients were satisfied and 83% wound recommend the surgery. No troughing phenomenon or fractures. Four overcorrections were found 3 of which did not require surgery. One recurrence at 18 months was treated with standard scarf. We believe that this technique offers a safer, quicker and equally versatile way of dealing with Hallux Valgus

Introduction. Hallux Valgus was thought to alter the forefoot function with defuctioning of the first ray with a resulting overloading of the second ray. The scarf osteotomy is a z-osteotomy of the first metatarsal and is proposed to correct anatomical and functional deformities of hallux valgus. This study was conducted to evaluate forefoot pressures using the Musgrave foot print system following this procedure in a district general hospital. Method. We prospectively collected the data from 43 feet in 31 consecutive patients. We evaluated the forefoot function using peak pressure, force time integral and pressure time integral parts of pedobarographs (Musgrave) pre-operatively, three and six months postoperatively. Results. The mean peak pressure under the first metatarsal head was reduced from 3.09 (95% CI 2.49 −3.70) to 2.25 (95% CI1.80–2.71) at six months. The mean peak pressure under the second metatarsal head was reduced from 6.29 (95% CI 5.44–7.13) to 5.01 (95% CI 3.98–6.05) at six months. Force time integral under the first metatarsal head was reduced from 1.34 (95% CI 1.06–1.62) to 0.97 (95% CI 0.74–1.19)) at six months. Force time integral under the second metatarsal head also reduced from 2.66 (95% CI 2.27–3.06) to 2.41(95% CI 1.98–2.85). Pressure time integrals also showed similar changes. Conclusion. Scarf osteotomy produced decrease in the forefoot pressures under the medial part of forefoot. We have not noticed significant alteration of forefoot pressures under the lateral part of forefoot

We present the long-term results of a single institute’s experience of the Mann 3 in 1 procedure. This prospective study initially selected 36 feet (25 patients) with severe hallux valgus, classified by a HV angle < 40° or IM angle> 15°, for the Mann 3 in 1 procedure. Preoperative and postoperative standing radiographs were taken to calculate the correction of the deformity, and a postoperative subjective questionnaire was completed which was based on the assessment criteria suggested by the American Orthopaedic Foot and Ankle Society in 1984. The initial follow-up was completed at up to one year. The original cohort of patients was contacted again at 10 years (range 9–11 years) to repeat the same questionnaire and radiographs. In total 19 patients (27 feet) were contactable with an average age of 51 years (range 34–74). The questionnaire revealed one patient unable to perform the same occupation and three patients unable to perform the same activities due to ongoig problems with the operated feet. Thirteen patients had to wear modified footwear but only 2 required specially made shoes. Sixteen of the nineteen (84%) were pleased or satisfied with pain relief and appearance following the procedure, with 14 stating that they would undergo the procedure again given the same circumstance and 5 patients that would not. The complications included 8 patients requiring screw removal, 2 patients with metatarsalgia, one patient undergoing multiple further corrective procedures and one requiring a second ray amputation for osteomyelitis. Sixteen patients (23 feet) were available for repeat radiographic assessment. This revealed that there had been some recurrence of the deformity with the initial correction of the HV angle being a mean of 40° (range 36–51°) to 15° (9–23°) at up to one year and 23° (0–52°) at ten years. Similarly with the mean IM angle initially corrected from 18° (15–25°) to 8.5°(6–12°), being 14° (7–20°) at ten years. In conclusion, despite some recurrence of the deformity on x-ray the subjective satisfaction with this procedure is good. Care should be taken in patient selection but the Mann 3 in 1 appears to be a good procedure for the correction of severe Hallux Valgus

Purpose: The advantages of the Scarf osteotomy are the greater ROM and the ability of better Stabilisation. We had compared our results with this theory. Methods-Results: At 41 patients with mean age 52,5, y(16–70) we made 47 Scarf osteotomies. At 25 patients we made also corrective osteotomies at the kleiner toes. The preoperative criteria for our study were degenerative Osteoarthritis of the 1st MP joint, HV angle> 40° or IM I-II angle> 20°. The postoperative and radiologic control was continued for 11–18 months(M. 18m). 38 patients were very satisfied with the results,2 sat-isfied, 1 patient was claimed for reduced ROM of the 1st PIP joint. The mean rehabilitation time was 2,9 months(1,5–6M). Pre- and postoperative compare had shown a change at AOFAS score from 48 (19–80) to 87 (35–100),change of the HVA from 35,2° (29°–48°) to 16°(4°–33°) and change of the IM I-II angle from 14,7°(11°–19°) to 8,4°(6°–12°). The DMAA didn’t show any particular change. The major shortening of the 1st Metatarsal was 3mm. A t 1 patient we find early osteoarthitic changes, but we have seen no pseudarthrosis or Metatarsal Head Necrosis. At 10 patients we measured the 1st MP joint ROM< 75° and at 1 patient < 30°. Conclusions: The Scarf osteotomy with the modified Mc Bride procedure is an effective method for the treatment of Hallux Valgus

Purpose: There are many different operations for hallux valgus and it is often difficult to know which one to perform. Many of the patients who present with hallux valgus have first ray hypermobility. We use the metatarsocuneiform arthrodesis for the treatment of symptomatic Hallux Valgus with hypermobility of the first ray. We present a retrospective evaluation of the results for a consecutive series from one surgeon. Methods: The patients were evaluated using the American Orthopedic Foot and Ankle Society Score (AOFAS) post operatively. The post operative complications were recorded and the surgical correction measured on the pre and post operative radiographs. Results: 41 metatarsocuneiform arthrodeses were performed in 40 patients. The average hallux valgus angle was 36.8 pre operatively and 7.3 post operatively. The average intermetatarsal angle was 17.3 pre operatively and 6.9 post operatively. The average post operative AOFAS score was 86.4. There were no problems with wound healing. All the arthrodeses had fused at 3 months. Two patients required screw removal. Conclusions: Metatarsocuneiform arthrodesis gives good clinical and radiological results in patients with hallux valgus and a hypermobile first ray

The purpose of this retrospective study was to report the results using scarf, first metatarsal osteotomies, in correcting Hallux Valgus deformity with H-V angle > 35°. During the period 2003–2008 we did 23 scarf, first metatarsal osteotomies in 15 patients (8 bilateral).In order to evaluate the effectiveness of this operation, patients were clinically (aofas score) and radiologically (X –ray in 4, 8, 12 weeks) assessed. Mean follow up was 32 months. The results evaluated with the aofas score in order to study the function, the pain and the overall satisfaction of the patients. We had excellent results in 13 %, very good in 48 % good 32% and poor 7 %.There was only one complication and no one infection. According the above results it seems that scarf osteotomy is quite reliable surgical treatment of severe Hallux – Valgus deformity with an increased IM angle

Adolescent hallux valgus is a progressive deformity of childhood. Patients with this disorder complain of pain, deformity, redness at the site of deformity, shoewear limitation and altered cosmesis. Surgery to correct the bunion is considered as pain gets worst, deformity increases or significant shoe wear limitation is present. However, there is still not an uniformly satisfying surgical treatment for the adolescent hallux valgus. This kind of surgery has been often associated with a high rate of recurrence and poor results. The adolescent condition often includes significant metatarsus primus varus as a primary element. This is the reason why isolated soft tissue procedures frequently fail. Surgical treatment often combines first metatarsal osteotomy with a soft tissue realignement of the first metatarsal phalangeal joint. Simmonds and Menelaus in 1960 reported their results with an osteotomy of the base of the first metatarsal in addition to McBride’s soft tissue recostruction. The procedure addresses the three main components of the adolescent hallux valgus deformity: the medial eminence, the hallux valgus and the metatarsus primus varus. Although Simmonds and Menelaus did not use any internal fixation to fix the osteotomy site, they performed a complete transverse osteotomy at the base of the first metatarsus. Besides they used an immobilization for six weeks in the post operative period. We describe a modified procedure where the osteotomy is performed incompletely at the base of the first metatarsal bone and we shortened the post operative immobilization period with a cast for three weeks. Simmonds’ procedure does not interfere with the sesamoid bones while in our method a repositioning of the sesamoids below the metatarsal head has been performed. Materials and methods: From 1997 to 2000, 22 feet in 12 female and 1 male patients were treated surgically with the modified Simmonds-Menelaus bunion procedure. A primary operation was performed on all feet treated. The average age at surgery was 12.4 years (range 10.5 – 14.6 years). Preoperative, postoperative and final follow up evaluation included history, physical examination, record of range of motion of the first metatarsophalangeal joint, anteroposterior and lateral radiograph of the feet in the weight bearing position. Results: Lenght of follow up averaged 3.9 years. The average pre operative Hallux Valgus Angle (HVA) was 31.2°. The average pre operative Inter Metatarsal Angle ( IMA) was 13.5°. The average HVA was reduced to 17.8°; the IMA was reduced to 11.3°. Of the 22 feet with preoperative subluxation of the sesamoids, all feet were improved after operation and none were worse. In order to assess our outcomes we used the duPont bunion rating score, which incorporates objective and subjective criteria. We had 5 excellent and 17 good results. There were no fair or poor results. Conclusion: Our proposed modified procedure is easy to perform and does not need any internal fixation device. The complications linked to the use of the hardware are removed. Our proposed procedure does not interfere with the shape or the length of the first metatarsal and does not preclude the possibility of further surgical correction

Introduction and Objectives: The technique modified by Regnauld makes it possible to correct the MTP angle and the DASA, shorten the first phalange preserving the MTP joint, and its articular congruence and functionality. Assessment of results at 2 years follow-up of 147 cases treated with this technique. Materials and Methods: Causes: Hallux Valgus 111; Hallux Rigidus 36. Sex: Women 114, men 33. mean age 70 years. Associated surgery: Proximal chevron-type osteotomy of the first MTT: 23; Scarft-type diaphyseal osteotomy: 1; osteotomy of the base of the first MTT: 11; double osteotomy: 5; subcapital Weils-type osteotomy: 15. Preoperative AOFAS test score 39.6. Mean follow-up 2.3 years. Pre and postoperative measurement of metatarsophalangeal angles. Postoperative assessment at 1 month, 6 m, 1 year and 2 years with X-ray, AOFAS scale. Results: Postoperative assessment using the AOFAS scale: < 1 month: 65, < 6 months: 78, < 1 year: 89, < 2 year: 82. AOFAS scale at 2 years: Moderate pain 2%. Narrow shoes 11%. Moderate MTP restriction 35%. Severe MTP restriction 2%. Infrequent mobility with severe IP restriction 9%. Asymptomatic malalignment 5%. Subjective assessment: Very satisfied 25%. Satisfied 68%. Not very satisfied 5% (occasional pain). Unsatisfied 2% (daily pain). The evolution of the values of the MTP angle were: preoperative MTP angle 34.7°, MTP angle 4 weeks postoperatively 8.1°, MTP angle at 1 year 14.7°, MTP angle at 2 years18.1°. Discussion and Conclusions: Satisfactory results (93%). This technique corrects the MTP angle, preserves the MTF joint and makes it possible to associate with it other surgical techniques to modify the intermetatarsal angle. By preserving the MTP joint we prevent early evolution of hallux rigidus. Very little loss of MTP correction at 2 years (10°), with no clinical correlation