Aims

The first metatarsal pronation deformity of hallux valgus feet is widely recognized. However, its assessment relies mostly on 3D standing CT scans. Two radiological signs, the first metatarsal round head (RH) and inferior tuberosity position (ITP), have been described, but are seldom used to aid in diagnosis. This study was undertaken to determine the reliability and validity of these two signs for a more convenient and affordable preoperative assessment and postoperative comparison.

Background. The effect of hallux valgus (HV) on health-related quality of life (HRQOL) and the relationship between radiographic severity of deformity and patient reported outcome measures (PROMs) is poorly understood. The aim of this study was to compare the HRQOL of female patients with HV to the UK population. The secondary aim was to assess the correlation between PROMs, including HRQOL, with radiographic severity of deformity. Methods. Weight bearing radiographic data (hallux valgus (HVA) angle; intermetatarsal (IM) angle) were measured in consecutive female patients presenting with HV. Each patient prospectively completed the Euroqol EQ-5D-5L questionnaire (EQ-5D), Visual Analogue Scale for Pain (VAS-Pain) and Manchester Oxford Foot Questionnaire (MOXFQ). Data were stratified into age ranges and compared with an EQ-5D United Kingdom general population reference dataset. Pearson R correlation values were calculated for the PROMs and radiographic deformity. Results. Between July 2015 and March 2020, 425 consecutive female patients presented with HV for consideration for surgery. EQ-5D-5L data were prospectively collected for 396 of these patients (93.2%). Females less than 65 years with HV had a statistically significantly worse quality of life compared with females of the same age group in the general population. Above the age of 65, there was no statistically significant difference in EQ-5D-5L Index score between the two groups. There was no correlation between radiographic HV deformity and HRQOL measures or MOXFQ scores. Conclusion. Female patients presenting with HV deformity have a significantly reduced quality of life compared with the UK general population. The radiographic severity of deformity did not correlate with HRQOL measures or foot and ankle specific PROMs. Foot and ankle specific clinical PROMs moderately correlate with HRQOL and may be a better marker of the negative effect of symptomatic hallux valgus deformity on quality of life

Though there are many techniques utilised in the correction of hallux valgus (HV), no single approach has been reported to be ideal for all patients to date. A great deal of controversy remains concerning the type of osteotomy, method of fixation, and inclusion of soft tissue procedures. Herein, we compared the outcomes of two different operative techniques, the minimally-invasive modified percutaneous technique and the distal chevron osteotomy, used to treat mild to moderate hallux valgus. This study was conducted in line with the CONSORT 2010 guidelines. 41 patients (58 feet) with mild to moderate hallux valgus were randomly assigned by computer to two different groups. The first group containing 24 patients (33 feet) was treated by the modified percutaneous technique, whereas the second group included 17 patients (25 feet) treated by distal chevron osteotomy. In the modified percutaneous group, after a mean follow up of 43 months, the mean correction of hallux valgus angle (HVA) was 26.69° (P=0.00001), the mean correction of intermetatarsal angle (IMA) was 9.45° (P=0.00001), and the mean improvement of AOFAS score was 47.94 points (P=0.00001). In the chevron osteotomy group, after a mean follow up of 44 months, the mean correction of hallux valgus angle was 26.72° (P=0.00001), the mean correction of intermetatarsal angle was 9° (P=0.00001), and the mean improvement of AOFAS score was 44.76 points (P=0.00001). In our study, the modified percutaneous technique proved to be equally effective as the distal chevron osteotomy, but with fewer complications and a higher rate of patient satisfaction

Introduction. Metatarsus adductus (MA) increases the risk of recurrence following surgery for hallux valgus (HV). The goal of this study was to analyze patients with severe MA and identify clinical/surgical factors that are associated with a lower rate of recurrent deformity. Methods. 587 patients underwent correction of HV deformity. The rate of recurrence of HV was 15% (63 out of 414 patients) in patients without MA (MA angle < 20°) and 29.6% (50 out of 173 patients) in patients with MA. 19 patients with severe MA (>31°) were identified; 8 of 19 had associated tarsometatarsal arthritis, and two patients had a skew foot deformity. Ten patients had severe valgus lesser toe deformities. Clinical information collected included associated diagnoses, the presence of arthritis of the tarsometatarsal joints, the presence and degree of lesser toe valgus deformities and surgical procedures performed. Radiographic recurrence was defined as a postoperative HVA > 20°. Results. 9/19 patients were treated with a modified Lapidus procedure and 10 patients underwent a distal first metatarsal osteotomy. Of the 9 patients who were treated with a modified Lapidus procedure, 6 patients underwent simultaneous realignment lesser metatarsal osteotomy or arthrodesis of the 2. nd. /3. rd. TMT joints. 1/9 of these patients had radiographic recurrence of deformity. Of the 10 patients who underwent a distal first metatarsal osteotomy without realignment proximal osteotomy or arthrodesis, 5 had recurrence of deformity. Of the 11 patients with severe valgus lesser toe deformity, those who were treated with simultaneous additional distal lesser metatarsal osteotomies, did not have recurrence of hallux valgus. Conclusion. The use of a modified Lapidus procedure led to a lower rate of HV deformity recurrence in comparison to isolated distal first metatarsal osteotomies. Treatment of lesser toe deformity with distal osteotomy should be included as part of the treatment algorithm

Background and aims. Hallux rigidus in the metatarsophalangeal joint (MTPJ) can be treated with arthroplasty to reduce pain and enhance motion. Few studies have investigated the functionality and the survival of HemiCap arthroplasty. Primarily we aimed to examine the medium to long-term functionality and the degree of pain after surgery. Secondarily the failure and revision rate of HemiCap implants. Methods. A total of 106 patients were operated with HemiCap arthroplasty (n=114) from 2006 to 2014, median age 53 (16 to 80) years, 78 females, 37 dorsal flange (DF) implants. Patient charts were reviewed retrospectively to collect revision data. Pre operative Coughlin/Shurnas arthrosis degree, hallux valgus (HV), intermetatarsalintermetatarsal (IM) and Distal Metaphyseal Articular Angle (DMAA) angles was were measured. Pre- and post operative 3 weeks, 6 months, 1 and 2 year2-year pain levels of the first MTPJ by Visuel Analog Skala (VAS 1–10), American Orthopaedic Foot and Ankle Score (AOFAS 0 to 100 points) and, Range of Motion (ROM), were available for 51 patients. FortysevenForty-seven of the 70 available for reexamination partook in a cross sectional follow up where the Self-Reported Foot and Ankle Score (SEFAS 0–48 points) was added to the Patients Related Outcome Measures (PROMs). Statistics. Kaplan-Meier for survival analysis, adjusted for sex, radiological angles, degree of arthrosis and dorsal flange. Prospective PROMs and ROM compared by paired t-test. Results. At 3, 5 and 7 years we had an mean implant survival of 85%, 83% and 78%. Almost all were revised due to pain, one due to malalignment and one due to loosening of the Hemicap. Dorsal flange, gender, preoperative arthrosis degree, HV, IM or DMAA angles did not statistically influence the result. For those (n=23) that were re-examined, preoperative dorsal ROM changed from mean(sd) 21 (6) to 42 (18) degrees, VAS from 7 (2) to 2 (2) and AOFAS from 61 (11) to 87 (11) (p < 0.001). At mean 5 year follow up (n=47), mean (sd) dorsal ROM was 46 (17) degrees,. AOFAS was 84 (9), VAS 2 (1) and SEFAS 42 (6) points. The dorsal flange made no statistical significant difference for ROM or PROMs, but DF displayed 51 degrees of extension vs. 44 without (p=0.1). Periprostethic lucency (<2 mm) was observed in 27/47. Conclusions. In general, we saw an acceptable implant survival rate. We did not find any predictors that influenced implant failure and the design alterations with the dorsal flange are not evident clinically. Patients who were not revised had significantly less pain, greater ROM, and better overall foot and ankle conditions than preoperatively, but the data are biased by missing numbers and revisions

Hallux valgus (HV) deformities have been well defined in the adult population. HV appears to be more prevalent in elderly and female populations and it is postulated that women's shoe wear contributes to its progression. This study was a pilot to quantify the prevalence of foot deformities and foot pain in an adolescent population. Our cohort consisted of 202 school children aged 11–17 recruited from two schools in Edinburgh. Foot health data was recorded via the Manchester Scale (MHVS) and the Oxford Ankle and Foot Questionnaire (OAFQ). Photographic assessment of all participants allowed MHVS to be calculated by two orthopaedic surgeons. The photographic assessment was then repeated by the same surgeon 12 months later to allow inter and intra observer reliability to be calculated. Results showed that the prevalence of HV in our cohort was 32.7% and there was a female preponderance 56% to 44%. Other foot measurements revealed 48.5% had HV-interphalangeus, 25.7% had a low medial longitudinal arch and 22.3% had a valgus hindfoot angle. Significantly more females (18%) than males (5%) wore shoes narrower than their feet (p=0.003). OAFQ scores revealed that foot pain was more common in those with HV deformities although not statistically significant (75% to 68%, p=0.243). The prevalence of foot pain was negatively correlated with age (r=−0.175, p=0.14). This study suggests that there is a significant prevalence of HV and foot pain amongst female adolescents. This will need to be confirmed by a population study based on power calculation informed by this pilot

Background. Evaluation of outcomes and satisfaction following hallux valgus (HV) surgery is usually retrospective and rarely uses patient-reported outcome measures (PROMs). Design. Prospective Cohort Study. Postal evaluation survey of patients who had provided pre-operative PROMs data. Methods. Consecutively recruited patients completed the Manchester-Oxford Foot Questionnaire (MOxFQ) prior to surgery. Of 91 patients (124 feet) proceeding to one-stage HV surgery, 69 of 88 eligible patients (78%; 95/124=77% feet) returned a postal follow-up questionnaire including the MOxFQ and a standard satisfaction rating for surgical outcome around 8 years (range 7.4 to 8.9) later. Results. Of the 69 respondents, patients' mean pre-operative age was 49.8 (SD 12.5) years; 66 (95.7%) were female. Of the 95 feet, 78 (82.1%) patients were ‘Very pleased’ or ‘Fairly pleased’ with the outcome, with 17/95 (17.9%) ‘Not very pleased/very disappointed’. Change in all 3 MOxFQ scales showed a significant linear relationship with satisfaction ratings (ANOVA p<0.001) with MOXFQ pain change scores for the ‘very pleased’ response in particular being significantly different from those of other response groups. Conclusions. At around 8 years following HV surgery, the majority of patients were pleased with the outcome. Change in the MOXFQ pain scale is particularly important in interpreting patients' satisfaction with surgery

Introduction: The conventional radiological assessment of hallux valgus (HV) involves measuring the intermetatarsal angle, HV angle, congruity of the metatarsophalangeal joint and the overall clinical deformity of the forefoot. However, in the current practice, these angles are seldom measured. We observed consistent displacement of the lateral sesamoid (LS) along with HV deformity. The position of the LS in relation to the head of the first metatarsal has never been studied before. We aim to study this pattern of the LS and to quantify the severity of the deformity which could help make clinical decisions. Methods: 112 radiographs of 60 consecutive patients who underwent a weight bearing radiographs of their feet were studied. Statistical analysis was performed to identify the correlation of displacement with conventional angle measurements. Results: A definite pattern in displacement of the lateral sesamoid was noted. This displacement also showed a statistical correlation with the conventional measurement of inter-metatarsal angle. Discussion: Previous research which studied the displacement of medial sesamoid in these deformities was not received with great enthusiasm due to the difficulty in locating the medial sesamoid through the head of the metatarsal. In contrast, the lateral sesamoid lies laterally and any progressive deformity makes it more accessible to assessment. We report a consistent pattern in the displacement of the LS and classified as the position as normal, mild, moderate and severe. As it does not involve any measurements, we believe, this is a quick and reliable technique of assessment of HV deformity and should help to base our operative decisions

Background. As hallux valgus (HV) worsens clinical and radiological signs of arthritis develop in metatarsophalangeal joint due to incongruity of joint surfaces. The purpose of this prospective study was to determine if intraoperative mapping of articular erosion of the first metatarsal head, base of the proximal phalanx, and tibial and fibular sesamoids can be correlated to clinical and/or radiographic parameters used during the preoperative assessment of the HV deformity. Materials and methods. We analysed 50 patients prospectively who underwent surgery between Jan 2009-Jan 2010. Patients with a known history of previous first metatarsophalangeal joint surgical intervention, trauma, or systemic arthritis were excluded from analysis. Preoperative demographics and AOFAS score were recorded. Intraoperative evaluation and quantification of the first metatarsal head, base of the proximal phalanx, and sesamoid articular cartilage erosion was performed. Cartilage wear was documented using International Cartilage Research Society grading. Results and Discussion. P. Bock et al have showed that the extent of cartilage lesions were clearly correlated with the degree of hallux valgus angle proving that a malaligned joint is more prone to cartilage degeneration. Kristen et al have described a correlation between a higher pre-operative hallux valgus angle and the post-operative Kitaoka et al score. The higher the preoperative hallux valgus angle, the lower the post-operative score. Our series showed the mean IMA is 15 degrees. The mean AOFAS score was 62. There was a significant positive correlation between hallux valgus angle and AOFAS score. We also found correlation between sesamoid wear and AOFAS score and HV angle. Conclusion. We conclude that preoperative clinical parameters (ie, age) and radiographic measurements (ie, HV, IMA) directly define the incidence and location of articular erosion and are helpful in the preoperative assessment of the HV deformity

In hallux valgus (HV), toe pronation is frequently seen, although there may be some with no pronation. Aims. to evaluate big toe pronation in patients with HV with a clinical and radiographic method. Material and methods. prospective study of 40 patients with HV on the waiting list for surgical treatment. Patients were standing barefoot on a rigid platform. Digital photographs were taken in a frontal plane to obtain the nail-floor angle formed by the secant line of toenail border and a line formed by the platform edge. All patients were evaluated using the AOFAS for HV and lesser toes, if they were affected. Personal and social data were obtained from clinical interviews. Charge radiographs were used to obtain HV, intermetatarsal and PASA angles, first metatarsal rotation as well as sesamoid bones displacement. Exclusion criteria: rheumatoid arthritis and previous intervention on foot or toes. Statistical analysis were performed with a multiple lineal regression. Results. the mean age was 57 years old, they were 31 female and 9 men, with an average AOFAS score of 49, they had a mean of 37° HV angle, 27° nail-floor angle, 20° first metatarsal rotation in about half of patients. We have found a statistical significant relation between HV and nail-floor angles (p<0,001), between sesamoid bones displacement and nail-floor angles (p<0,007), between first metatarsal rotation and HV angle (p<0,001. We found no statistically significant but strong relation between first metatarsal rotation and sesamoid bones displacement. Conclusion. nail-floor angle is strongly related to degree of HV, displacement of sesamoid bones and rotation of the first metatarsal

Akins original description of his osteotomy did not describe the use of any metal work. Today the osteotomy is most commonly held and fixed with either a staple or screw. We describe the results obtained with a simple suture technique. Methods Data was collected prospectively on 125 patients undergoing an Akin osteotomy. Hallux valgus (HV) and intermetatarsal (IM) angles pre and postoperatively were recorded. Patients were reviewed at 6 week follow up. Cost analysis was also performed comparing different fixation types. 111 of the patients were female and 14 male. The average age at time of surgery was 49 years. 104 cases were in conjunction with hallux valgus correction while 21 cases were for hallux interphalangeus. The mean preoperative HV angle was 33.3 degrees (range 22 to 53), and the IM angle 13.3 degrees (range 9 to 25). At the 6 week follow up all patients had shown signs of radiological union. The postoperative HV angle was 12.4 degrees (range 7 to 17) and the IM angle 6.4 degrees (range 5 to 11). All patients maintained their correction. There were no complications, infections or fixation problems. All patients were satisfied with their surgery and would have it repeated again. The suture technique was the most cost effective method. We describe a quick, easy, implant free method of fixing the Akin osteotomy. There is no need for metalwork removal and in today's world of austerity and the current climate of widespread budget constraints we describe a cost effective method which is clinically just as effective as methods requiring a staple or screw

It is recognised that as the severity of hallux valgus (HV) worsens, so do the clinical and radiological signs of arthritis in the first metatarsophalangeal joint. However, few studies specifically document the degenerate changes. The purpose of this study is to determine if intraoperative mapping of articular erosive lesions of the first MTP joint can be correlated to clinical and/or radiographic parameters used during the preoperative assessment of the HV deformity. Materials & Methods. We prospectively analysed 50 patients who underwent surgery between Jan 2009 & Jan 2010. Patients with a known history of previous first metatarsophalangeal joint surgical intervention, trauma, or systemic arthritis were excluded from analysis. Preoperative demographics and AOFAS scores were recorded. Radiographic measurements were obtained from weight bearing radiographs. Intraoperative evaluation of the first metatarsal head, base of the proximal phalanx, and sesamoid articular cartilage erosion was performed. Cartilage wear was documented using International Cartilage Research Society grading. Results. three patients did not have scoring or cartilage wear documentation carried out and were excluded. The mean age was 56 years. The mean hallux valgus angle was 31 degrees. The mean IMA was 15 degrees. The mean AOFAS score was 62. Patients with no inferomedial (IM) and inferolateral (IL) wear had significantly better AOFAS score than patients who had IM & IL wear (p < 0.05). Patients who had IM & IL wear had a significantly higher HVA (p < 0.05). There was a significant positive correlation between hallux valgus angle and AOFAS score. We also found correlation between sesamoid wear and AOFAS score and HV angle. Conclusion. we conclude that preoperative clinical and radiographic measurements can be used to predict the incidence and location of articular erosions in the 1st MTPJ and are helpful in the preoperative assessment of the HV deformity

The authors report the use of a modified ‘Y-V’ medial capsular repair in association with Scarf osteotomy for Hallux valgus in 55 patients (62 feet) aged 18 to 61 years (mean 43 years) between July 2004 and July 2005. All patients were followed up for minimum 6 months by questionnaire, physical examination (American Orthopaedic Foot and Ankle Society score) and comparison of preoperative and post operative x rays. Using this technique none of the patients required an additional proximal phalangeal osteotomy (Akin Oste-otomy). At six months follow up American Orthopaedic Foot and Ankle Society score improved from 46 to 87. Intermetatarsal (IM) angle and the hallux valgus (HV) angle improved from 16 degree to 9 degree and from 31 degree to 16 degrees respectively (p less than 0.05). Of the sixty two procedures 59 did not develop any complications. Two had superficial infections which required oral antibiotics only. One partial loss of correction of hallux valgus occurred for which the patient refused a second operation. Seven cases had some residual pronation deformity of the big toe identified by the patients who felt the deformity was ‘about 50%’ compared to before the operation. Akins osteotomy achieves an apparent correction of hallux valgus without addressing subluxation of meta-tarso-phalangeal joint. Our technique reduces the meta-tarso-phalangeal joint and corrects the hallux valgus angle anatomically. We recommend the use of this modified ‘Y-V’ medial capsular repair to correct the hallux valgus angle and reduce the need for an additional procedure to augment the correction achieved during Scarf osteotomy for hallux valgus

Introduction: Hallux valgus (HV) deformity increases width of the forefoot. Criteria for a successful outcome after surgery include resolution of pain, a narrower forefoot and ability to wear conventional shoes. Skeletal width of the forefoot can be objectively measured on radiographs by a recently introduced parameter called the metatarsal span (MS). Reduction in MS can therefore be used as an outcome indicator. It is however not known if MS can be measured reliably. It is hypothesized that MS which is a linear parameter can be measured as reliably as the HV and intermetatarsal (IM) angular parameters. Methods: Digitized pre and postoperative weight bearing radiographs of twenty patients with HV were evaluated by six observers. HV and IM angles and the MS were measured using digital techniques. ANOVA was used to study inter-observer and intra-observer reliability. A 95% confidence interval was determined. Results: Inter and intra-observer agreement was present for all measurements. 95% CI for intra-observer pre and post operative measurements were ± 5° and ± 5° for HV angle, ±2° and ± 3° for IM, and ± 1.0mm and ± 3.0mm for MS. 95% CI inter-observer pre and post operative measurements were ± 4° and ± 4° for HV angle, ± 3° and ± 2° for IM angle, and ± 1.0mm and ± 2.1 mm for forefoot width, respectively. Conclusion: Digital measurements of the linear parameter MS can be obtained as reliably as angular parameters HV and IM angles. One of the criteria associated with success after hallux valgus surgery is reduction of the forefoot width. A new parameter called the metatarsal span can be a reliable objective measure to assess reduction of forefoot width and outcome after surgery for hallux valgus

Introduction There is no consensus on the superiority of either Chevron or Mitchell osteotomy in the treatment of hallux valgus. In the literature Chevron osteotomy is recommended for the mild and Mitchell’s for the moderate hallux valgus (HV) deformities. We reviewed outcomes of two of the most common distal first metatarsal osteotomies. Aims To compare the results of Chevron vs Mitchell osteotomy in the treatment of HV. To evaluate the co-relation between clinical outcome and radiological correction achieved after the two osteotomies. Method We reviewed clinical notes and pre- and postoperative radiographs of a total of 111 operations including 61 Chevron and 50 Mitchell osteotomies in 90 patients. We designed a patient-focused questionnaire to evaluate clinical outcomes that addressed the main functional outcomes concerning patients after bunion surgery. These included pain, usage of footwear postoperatively, cosmoses, development of transfer metatarsalgia and the repeatability of the procedure they had undergone. These questions were point based and a final clinical score was calculated for comparison with the radiological correction. This was also used as a measure of success of the procedure. Conclusion There is a statistically significant radiological difference in HV angle correction and the loss of first metatarsal height as seen post-operatively between patients treated with Chevron and Mitchell osteotomies for HV correction (p=0.03 and p=0.0004 respectively). There is no statistically significant difference (p=0.6) in the clinical outcomes based on the newly designed patient-focused questionnaire with either Chevron or Mitchell osteotomies at a mean follow-up of 27 months post-operatively. Clinical outcome determined by patient-focused questionnaire remains the same in-spite of radiological differences noticed post-operatively between the two osteotomies

Introduction. Despite the multiple patho-aetiological basis of Hallux valgus (HV), corrective osteotomy is a common and globally performed orthopaedic procedure. Over-correction of the inter-metatarsal angle (IMA), however, is not without consequence. Through increased joint pressures, over-correction may predispose to joint degeneration. Hypothesizing that over-correction leads to an increase in intra-articular joint pressures, we constructed a mechanical simulation of the 1. st. metatarsal-phalangeal joint. Methods. The vector forces of Flexor Hallucis Longus, Extensor Hallucis Longus, Extensor Hallucis Brevis and Adductor Hallucis, acting upon the 1. st. proximal phalanx were simulated with tensioned weighted rope. A Foley catheter balloon inflated to 1.5ml, simulated intra-articular distractive vector forces. The joint was freely mobile. At 5° IMA intervals from 10° valgus to 15° varus, intrarticular pressures were recorded using a contact pressure (Graseby™, Hertfordshire, UK) transducer attached to a calibrated manometer (Digitech Instruments™, Ulhasnagar, India). At each angle, measurements were repeated five times with removal and recalibration of the pressure monitor after each measurement. Results. A decline and subsequent increase in mean pressure was observed at each 5° interval from 10°valgus to neutral and then to 15° varus (mean±s.d.; 48.02±5.67, 24.72±1.01, 12.34±0.84, 18.96±2.46, 32.88±5.06, 42.92±4.99 milibar for 10°, 5° valgus, neutral, 5°, 10°and 15° varus IMA). One-way analysis of variance with post-hoc Tukey multiple comparison test revealed a significant increase in pressure from neutral and 5° valgus to 10° and 15° varus (p< 0.05). [First Metatarsal Phalangreal joint pressures]. Conclusion. This is the first description demonstrating increases in intrarticular pressures as the IMA tended from 5° to 15° varus, replicating inatrogenic Hallux Varus iatrogenically produced through osteotomy and over-correction of the IMA. Over-correction and increased intrarticular joint pressure may have an aetiological basis to post-operative 1. st. MTPJ degeneration. Over-correction is not a benign entity requiring consideration in Hallux Valgus corrective osteotomy

We wish to report the use of a modified ‘Y-V’ medial capsular repair in association with Chevron osteotomy fixed rigidly with Barouk screw for Hallux valgus in 45 patients (52 feet) aged 16 to 70 years (mean 47 years) between July 2004 and September 2005. All patients were retrospectively reviewed by questionnaire, physical examination (American Orthopaedic Foot and Ankle Society score) and comparison of preoperative and post operative x rays. Using this technique none of the patients required additional immobilization apart from wool and crepe bandage following surgery. All osteotomies healed without any problem. There was no deep infection reported in this series. There were two superficial infection treated with oral antibiotics. There is no recurrence of deformity so far. At an average of six months follow up American Orthopaedic Foot and Ankle Society score improved significantly. Intermetatarsal (IM) angle and the hallux valgus (HV) angles were also improved considerably. Stabilization of Chevron osteotomy with k wires, plaster of Paris is well known but these techniques have problems of infection and stiffness. Osteotomies carried out without any stabilization has high recurrence rate. Fixation of osteotomy with Barouk screw is a very simple procedure, which not only gives stability and compression to osteotomy but also reduces need for any plaster immobilization thus speed up rehabilitation. This also gives extra confidence to surgeon to allow patient for early weight bearing and mobilization. We also recommend the use of modified ‘Y-V’ medial capsular repair to correct the hallux valgus angle and reduce the meta tarso-phalangeal joint leading to reduction in possibility of recurrence

Introduction Hallux valgus (HV) is a common foot deformity with a prevalence of up to 48%. It usually affects females and its radiographic severity is expressed by various angles, such as the HV Angle, the Inter Metatarsal Angle (IMA) and the Distal Metatarsal Articular Angle (DMAA). The aim of our study was to assess the impact that HV has on patients’ quality of life and to correlate each of the above angles to SF-36 sub-scales. Method Twenty-three female patients with a mean age of 48.5 years were included in the study. Diagnosis was established by clinical and standardised radiological examination. Patients were medically fit and the only pathology that could affect their SF-36 score was HV. They all completed in the SF-36 form on their first visit at the clinic. Statistical analysis was performed via SPSS 12.0. Results Mean radiographic angular deformities measured 35, 13, and 17 degrees for HVA, IMA, and DMAA respectively. The HVA and IMA demonstrated significant association (p=0.018) as regarding their severity, indicating that they probably interact during the progression of the deformity. The Physical Component Summary score was significantly lower in our patients than the recommended norms for the same age (p=0.015). HVA significantly affected the General Health (p=0.023), IMA, the Role Physical (0.039), Role Emotional (p=0.056) and Mental Health (p=0.043). The coefficients were all negative indicating a worse health scenario as the deformity increases. Conclusion These results suggest that HV deformity seriously affects peoples’ quality of life. In addition, according to our data, surgical treatment is absolutely indicated and operative correction of the angular deformities would be expected to normalise those patients’ SF-36 score. However, this remains to be proved

Hallux valgus is a common condition and surgical correction has remained a challenge. Scarf osteotomy with Akin procedure is well accepted method. Akin procedure gives spurious correction of the distal alignment of big toe. This study was performed to see alternative way to get best correction without additional phalangeal procedure. Senior author used innovative Y-V medial capsulorraphy with standard Scarf osteotomy. This technique allows reduction of MP joint along with correction of pronation deformity and reduction of sesamoids. We report the use of a modified Y-V medial capsular repair in association with Scarf osteotomy for Hallux valgux in 45 patients (55 feet) aged 18 to 76 years (mean 43 years) between October 2004 and December 2005. Clinical follow up was both subjective and objective. Patients were asked about rating of their satisfaction and objective assessment was done in form of AOFAS score. Using this technique none of the patients required an additional proximal phalangeal osteotomy with metatarsal osteotomy. At six months follow up American Orthopaedic Foot and Ankle Society score improved from 46 to 87. Intermetatarsal (IM) angle and the hallux valgus (HV) angle improved from 16° to 9° and from 31° to 16° respectively (p< 0.05). At final follow up 8 patients were very satisfied, 12 were satisfied while 5 were not satisfied. Of the 55 procedures 51 did not develop any complications. Two had superficial infections, treated successfully with oral antibiotics only. Two patients had recurrence, one was treated with Akin and second patient declined surgery as she was not bothered with it. We recommend the use of this modified ‘Y-V’ medial capsular repair to reduce the need for an additional procedure to augment the correction achieved during Scarf osteotomy for hallux valgus. This reduces hallux valgus angle and maintains it

Introduction: The Lapidus procedure is a fusion operation of the 1st tarso-metatarsal joint for the treatment of moderate to severe hallux valgus (HV) in association with first ray hypermobility. This procedure has been shown to produce excellent correction of the deformity but is associated with complications such as prolonged healing and non-union. This study aims to determine the effectiveness of the procedure in correcting the HV deformity; record patient satisfaction and the incidence of complications. Materials and Methods: Patients who underwent a Lapidus procedure at Glasgow Royal Infirmary between November 2001 and October 2006 were reviewed. Gender, age, previous surgery for HV, complications and outcome were investigated. Pre and post-operative HV and intermetatarsal (IM) angles were obtained from weight-bearing radiographs. Results: 24 Lapidus procedures were performed on 21 patients, all female. 3 underwent bilateral procedures. The average age was 50.9 years. 7 feet (29%) had been operated on previously for HV. The HV angle improved from a pre-operative mean value of 44.3° to 15° post-operatively (average reduction 29.4°). The IM angle improved from 13.4° to 8.1° (average reduction 5.2°). There were 7 (29%) non-unions. 10 patients (42%) had minor transient complications. 12 patients (57.14%) were happy with the outcome while 7 patients (33.33%) expressed dissatisfaction. 2 patients remain under review. Discussion: Excellent anatomical correction of the HV deformity can be achieved with the Lapidus procedure. It is, however, a technically challenging procedure and only just over half of the patients were satisfied with the results. In addition, we encountered higher non-union rates than previous studies. Conclusion: The Lapidus procedure is extremely effective in correcting severe HV deformities but patient satisfaction is low and the complication rate is significant. In our view, the role of this procedure in HV corrective surgery requires further evaluation