Fourth-generation percutaneous or minimally invasive hallux valgus surgery utilizes a transverse osteotomy to achieve deformity correction. There are only a small number of series reporting the clinical and radiological outcomes of transverse osteotomies, many of which have methodological limitations such as small sample size, limited radiographic follow up or use of non-validated outcome measures. The aim of this study was to provide a methodological robust investigation into percutaneous transverse osteotomies for hallux valgus deformity. A prospective series of consecutive patients undergoing fourth generation metatarsal extra-capsular transverse osteotomy (META) performed by a single surgeon (PL) between November 2017 and January 2023. The primary outcomes were radiographic deformity correction and clinical foot function assessed using the Manchester-Oxford Foot questionnaire (MOXFQ). Radiographic deformity (Hallux valgus angle (HVA) and intermetatarsal angle (IMA), sesamoid position) was assessed according to AOFAS guidelines. Secondary outcomes included Visual Analogue Scale for Pain and radiographic deformity recurrence (defined as HVA >20° at final radiographic follow up).Background
Method
Hallux Valgus (HV) is a common forefoot deformity that can cause pain and difficulty with walking. There are a range of surgical techniques to treat HV deformity, but there is a risk of recurrence. This paper reviews the clinical assessment and management of recurrent HV as well as a detailed description of how percutaneous surgical techniques can be used to treat recurrent HV. This paper identifies technical challenges of percutaneous HV surgery for recurrent HV deformity as well as strategies to address and mitigate these. This was a multicenter retrospective review of adult patients who had recurrent hallux valgus deformity (defined as hallux valgus angle>15° and having previously undergone primary surgical intervention for HV deformity correction) who were treated with a percutaneous metatarsal extra-capsular transverse osteotomy (META) technique, with at least one year of follow-up data. Demographic information, hallux valgus angle, intermetatarsal angle, Manchester-Oxford Foot Questionnaire (MOXFQ), visual analog scale (VAS), and EQ-5D-5L scores were collected.Background
Method
A local injection may be used as an early option in the treatment of Morton’s neuroma, and can be performed using various medications. The aim of this study was to compare the effects of injections of hyaluronic acid compared with corticosteroid in the treatment of this condition. A total of 91 patients were assessed for this trial, of whom 45 were subsequently included and randomized into two groups. One patient was lost to follow-up, leaving 22 patients (24 feet) in each group. The patients in the hyaluronic acid group were treated with three ultrasound-guided injections (one per week) of hyaluronic acid (Osteonil Plus). Those in the corticosteroid group were treated with three ultrasound-guided injections (also one per week) of triamcinolone (Triancil). The patients were evaluated before treatment and at one, three, six, and 12 months after treatment. The primary outcome measure was the visual analogue scale for pain (VAS). Secondary outcome measures included the American Orthopaedic Foot and Ankle Society (AOFAS) score, and complications.Aims
Methods
Infiltration is considered the first treatment option for symptomatic Morton's neuroma and can be performed with various medications. The aim of this study was to compare the effects of hyaluronic acid infiltration versus corticosteroid injection in the treatment of Morton's neuroma. A randomised clinical trial was conducted with 46 patients (50 feet) diagnosed with Morton's neuroma. After randomisation, the control group (CG) received three injections (one per week) of triamcinolone (Triancil®) guided by ultrasound, while the study group (SG) received three applications of hyaluronic acid (Osteonil Plus®). Patients were followed up for six months after the intervention. The primary outcome measure used was the Visual Pain Analog Scale (VAS). Secondary endpoints included patient-reported outcome measures using the American Orthopaedic Foot & Ankle Society (AOFAS) score and complications.Background
Methods
Hallux rigidus is a common condition characterised by first metatarsophalangeal joint (MTPJ) degeneration, pain and limited range of motion (ROM). The gold standard surgical treatment is arthrodesis, providing good pain relief but sacrifices ROM. Recently the Cartiva synthetic cartilage implant (SCI) has been utilised as an interpositional arthroplasty, aiming to reduce pain whilst preserving range of motion. Current evidence for Cartiva SCI is largely based on a single cohort with mixed outcomes. We sought to evaluate the clinical outcomes of Cartiva SCI compared to arthrodesis undertaken in our centre. Retrospective review of patients undergoing Cartiva SCI or arthrodesis for treating hallux rigidus was conducted. Preoperative arthritis was radiographically graded using the Vanore classification. Patient reported outcomes (PROMs) were assessed using EuroQol 5-dimension score (EQ-5D-5L) and Manchester-Oxford Foot Questionnaire (MOXFQ).Background
Methods
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. 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.Background
Methods
Recent large studies of third-generation minimally invasive hallux valgus surgery (MIS) have demonstrated significant improvement in clinical and radiological outcomes. It remains unknown whether these clinical and radiological outcomes are maintained in the medium to long-term. The aim of this study was to investigate the five-year clinical and radiological outcomes following third-generation MIS hallux valgus surgery. A retrospective observational single surgeon case series of consecutive patients undergoing primary isolated third-generation percutaneous Chevron and Akin osteotomies (PECA) for hallux valgus with a minimum 60 month clinical and radiographic follow up. Primary outcome was radiographic assessment of the hallux valgus angle (HVA) and intermetatarsal angle (IMA) pre-operatively, 6 months and ≥60 months following PECA. Secondary outcomes included the Manchester-Oxford Foot Questionnaire, patient satisfaction, Euroqol-5D Visual Analogue Scale and Visual Analogue Scale for Pain.Background
Methods
There are many different procedures described for the correction of hallux valgus deformity. Minimally invasive surgery has become increasingly popular, with clinical and radiological outcomes comparable to traditional open osteotomy approaches. There is increasing interest in hallux valgus deformity correction using third-generation minimally invasive chevron akin osteotomy (MICA) technique. To assess the radiographic correction and 2 year clinical outcomes of third-generation MICA using validated outcome measures.Background
Objective
