For hallux valgus correction, distal first metatarsal osteotomy is generally used for minor to moderate deformities, diaphyseal osteotomy for moderate deformities and basal osteotomy or fusion for severe deformities. With the advent of locking plates, there has been renewed interest in opening wedge basal osteotomy. As little has been written about its geometry, we undertook this study in order to understand its power and limitations. Proximal opening wedge osteotomies were performed on saw bone models in four orientations, with three different wedge sizes: 1. Perpendicular to the ground (PG); 2. Perpendicular to the shaft (PS); 3. Perpendicular to shaft with 30° declination (DEC); 4. 30° oblique (OB). Pre- and post-osteotomy measurements were made of axial and plantar translation and intermetatarsal angle. Plantar translation and intermetatarsal angle correction increased with increasing wedge size. The DEC osteotomy produced the greatest increase in length of metatarsal shaft, while the PS osteotomy gave the least. The most plantar translation was achieved with the DEC osteotomy. Overall, the PS osteotomy gave the largest correction of the intermetatarsal angle. Although there are several published clinical case series of the proximal opening wedge osteotomy, this is the first study to fully evaluate its geometry

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

Purpose:. To describe a plating technique for the Lapidus procedure as an alternative to the traditional screw fixation technique. To look at the complications experienced during the Lapidus procedure and to find possible solutions to prevent these complications. Methods:. A retrospective study of 34 Lapidus procedures in 26 patients (8 bilateral) between 2006 and 2009 was performed. All were done with a plating technique and a primary bone graft. The indications were:. metatarsus primus varus. hypermobility. degenerative TMT joint. Results:. The average intermetatarsal angle pre-operatively was 17.1° and this was reduced to 6,4° post – operatively. The complications experienced were:. post –operative metal removal = 6. transfer metatarsalgia = 1. hallux varus = 1. screw breakage = 1. delayed union = 1. non-union = 1. Conclusion:. The plating technique for the Lapidus procedure gives stable fixation and the outcome compares well with other methods of fixation

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 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

Introduction. Lisfranc joint injuries account for only 0.2% of all fractures but early diagnosis improves the chances of a better outcom]. Radiographic signs, such as diastasis (>2mm) of the 1–2 interspace, are subtle and. often missed, leading to a poorer outcome. We present a new radiographic sign, less likely to result in missed diagnoses. Null nypothesis: The intermetarsal angle remains unchanged in Lisfranc injuries. Method. A series of radiographs demonstrating Lisfranc injury were interspersed with normal and postoperative cases. Evidence of fixation was obscured. A selection of Foundation and Core Trainee medical staff measured the intermetatarsal angle (IMA) on two separate occasions. The measuring technique was demonstrated with no explanation for the reason behind the measurement. Results. The intra-class correlation (ICC) between observers was 0.96 and a mean 0.86 (range 0.69–0.96) for individual observers. IMA on comparative weight bearing AP views of injured and normal side, using Wilcoxon-signed rank test demonstrated a P< 0.0001 with mean values of 6.6 degrees (normal) versus 4.85 degrees (injured) and standard deviation of 1.97 & 1.91 degrees respectively. Conclusion. The high ICC value suggests that this radiographic sign is easily taught, reliable and reproducible. Analysis of individual angles suggests that there is a significant difference between the normal and pathological IMA. We therefore reject our null hypothesis. The data supports our proposition that that the IMA becomes more parallel in Lisfranc injuries and that this is an easily recognised sign, which could help reduce the incidence of missed injuries. Elucidation of the exact anatomical pathology responsible is the basis for further, anatomical, studies