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

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

Hallux valgus continues to frustrate foot and ankle surgeons the world over. The condition is mostly clear in its aetiology but unclear in its pathogenesis. The key, as in all surgery, is decision making, patient selection and to have many surgical options available. The key things to consider are: joint congruency, the presence of arthritis, the presence of metatarsus adductus, the intermetatarsal angle, the hallux valgus angle and the presence of interphalangeal deformity. I consider true hypermobility of the first ray and Achilles tendon tightness to be less important factors. Patient expectations are particularly important as most patients with hallux valgus are women who want to wear high-heeled shoes!. The most successful operations consist of a combination of soft tissue and bony procedures. The most common error in bunion surgery, in my opinion, is the use of a procedure with inadequate power to correct the deformity. When the joint is markedly arthritic and deformed an arthrodesis is the procedure of choice. I will discuss the above points in the lecture

Aim:. To review the short to medium term radiological, clinical and functional outcomes of reconstructive surgery for severe forefoot deformities in patients with Rheumatoid arthritis. Methods:. We conducted a review of prospectively collected data of patients with Rheumatoid arthritis who received reconstructive surgery for forefoot deformities. Patients requiring metatarso-phalangeal joint arthrodesis and excision of the lesser metatarsals for hallux valgus, dislocation of the lesser metatarso-phalangeal joints and intractable plantar keratosis were included. The patients were followed up at 2 weeks, 6 weeks, 3 months and 6 months. X-Rays were performed preoperatively, postoperatively, at 6 weeks, 3 months and 6 months follow-up. Patients completed a SF36, and AOFAS (American Orthopaedic Foot and ankle Score) forefoot score preoperatively and at 6 months postoperatively. Results:. Ten feet in eight patients were included in the study. Follow-up was for a minimum of 6 months. All patients were female, with an average age of 58 years (34–69 years). Radiologically there was an average correction in the hallux valgus angle from 48 degrees to 15 degrees. The inter-metatarsal angle improved from 14 to 9 degrees. Objective scores were significantly improved. The mean SF36 score pre-operatively was 36 (24–54) and 67 (54–82) post operatively (P < 0.05). The AOFAS score improved from a mean of 32 (28–50) pre operatively to 74 (64–78) post-operatively (p < 0.05). One patient required re-operation for further metatarsal shortening due to ongoing pain and two patients required oral antibiotics for minor superficial wound infections. All hallux metatarsophalangeal joint arthrodesis procedures united in a mean time of 3.5 months. Conclusion:. Forefoot reconstruction in these very symptomatic, disabled patients resulted in significant deformity correction and improvement in function and pain. The complication rate was low. Adequate resection of the lesser metatarsals is necessary to avoid ongoing pain from the phalanx articulating with the metatarsal

Aim. To assess if immediate post-operative weight bearing has a negative influence on the results of osteotomy plus distal soft tissue repair to correct hallux valgus. Design. The results of a crescentic osteotomy plus distal soft tissue repair with Akin osteotomy added as indicated were assessed in 61 consecutive cases. Thirty five were bilateral. This gives a total of 96 feet. During this time other procedures were also performed for hallux valgus. Results. The mean age of the patients was 54 years [16–79]. Measurements of the angles were done pre-operatively, at six weeks post op and at the time of final follow-up, at least three months post-surgery. Only one case was totally lost to follow-up, although in some cases some of the measurements were lost or could not be retrieved. The mean pre-operative angle between first and second metatarsals was 14.8° and the hallux valgus angle was 29.8°. The average decrease of the intermetatarsal angle at six weeks was 5.9° and at final follow-up 5.5°. The correction of the hallux valgus at six weeks averaged 13.3° and at final follow-up 13°. Repair of an adjacent clawed second toe was done in 25 of the feet. A number of other smaller procedures were also done in a small number of cases. Superficial sepsis was present in two cases, both cleared up on treatment. In three cases it appeared that non-union was developing. In four feet hallux valgus was still present to a significant degree and these were classified as failures. The failures will be analysed and discussed endeavouring to recognise the reasons for failure. Conclusion. Immediate post-surgical weight bearing does not compromise the results of crescentic osteotomy plus distal soft tissue procedure after surgery for hallux valgus. MULTIPLE DISCLOSURES