Use of the iPhone for radiographic evaluation of hallux valgus.

PubMed

Ege, Tolga; Kose, Ozkan; Koca, Kenan; Demiralp, Bahtiyar; Basbozkurt, Mustafa

2013-02-01

The purpose of this study was to compare the measurements made using a smartphone accelerometer and computerized measurements as a reference in a series of 32 hallux valgus patients. Two observers used an iPhone to measure the hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (of anteroposterior foot radiographs in 32 patients with symptomatic hallux valgus on a computer screen. Digital angular measurements on the computer were set as the reference standard for analysis and comparison. The difference between computerized measurements and all iPhone measurements, and the difference between the first and second iPhone measurements for each observer were calculated. Inter- and intraobserver reliability of the smartphone measurement method was also tested. The variability of all measurements was similar for the iPhone and the computer-assisted techniques. The concordance between iPhone and computer-assisted angular measurements was excellent for the HVA, IMA, and DMAA. The maximum mean difference between the two techniques was 1.25 ± 1.02° for HVA, 0.92 ± 0.92° for IMA, and 1.10 ± 0.82° for DMAA. The interobserver reliability was excellent for HVA, IMA, and DMAA. The maximum mean difference between observers was 1.31 ± 0.89° for HVA, 0.90 ± 0.92° for IMA, and 0.78 ± 0.87° for DMAA. The intraobserver reliability was excellent for HVA, IMA, and DMAA. We conclude that the Hallux Angles software for the iPhone can be used for measurement of hallux valgus angles in clinical practice and even for research purposes. It is an accurate and reproducible method.

Short-Term Effects of Kinesiotaping on Pain and Joint Alignment in Conservative Treatment of Hallux Valgus.

PubMed

Karabicak, Gul Oznur; Bek, Nilgun; Tiftikci, Ugur

2015-10-01

The main aim of this study was to measure short-term effects of kinesiotaping on pain and joint alignment in the conservative treatment of hallux valgus. Twenty-one female patients diagnosed with a total of 34 feet with hallux valgus (13 bilateral, 6 right, and 2 left) participated in this study. Kinesiotaping was implemented after the first assessment and renewed in days 3, 7, and 10. The main outcome measures were pain, as assessed using visual analog scale, and hallux adduction angle, as measured by goniometry. Secondary outcome measure was patients' functional status, as measured by Foot Function Index and the hallux valgus scale of the American Orthopaedic Foot and Ankle Society (AOFAS). The radiographic results were also measured before and after 1 month of treatment. The Wilcoxon test was used to compare the differences between initial and final scores of AOFAS, as well as FFI scales and hallux valgus angle assessment scores. There was a significant reduction in goniometric measurement of hallux valgus angle (P = .001). There was a significant reduction in pain intensity (P = .001) and AOFAS and Foot Function Index scores at the end of the treatment (P = .001 and P = .001, respectively). There was a significant difference between radiographic results in 1-month control (P = .009). For this group of female patients, pain and joint alignment were improved after a 10-day kinesiotape implementation in patients with hallux valgus. The findings showed short-term decreased pain and disability in hallux valgus deformity. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

[The Akin procedure as closing wedge osteotomy for the correction of a hallux valgus interphalangeus deformity].

PubMed

Arnold, Heino

2008-12-01

Realignment of the great toe in the case of a hallux valgus interphalangeus by means of a medially based closing wedge osteotomy. Hallux valgus interphalangeus deformity, characterized by an enlarged distal articular surface angle (> 10 degrees). Correction of a hallux valgus interphalangeus deformity as an additional procedure in the case of hallux valgus surgery. Incongruent first metatarsophalangeal joint with lateral subluxation of the proximal phalanx. Isolated procedure to correct hallux valgus deformity. Lack of patient compliance. Neurovascular disturbance of the forefoot. Medially based closing wedge osteotomy of the proximal phalanx to reduce the distal articular surface angle. Fixation with a lag screw, cannulated Herbert screw, memory cramp, threaded Kirschner wire, or interosseous suture. Wound dressing to assure the position of the great toe. Radiographic documentation of the forefoot in two planes. Strict elevation of the operated foot to prevent postoperative swelling. Mobilization of the patient with a forefoot relief orthosis, until consolidation of the osteotomy is verified radiologically (4-5 weeks). Low-molecular-weight heparin for at least 1 week. Hallux valgus bandage or functional taping for 6 weeks postoperatively in patients with additional metatarsal osteotomy. Clinical and radiologic follow-up based on 32 patients showed good results. The postoperative Hallux Score of the American Orthopaedic Foot and Ankle Society improved to 89 points.

Comparative study of scarf and extended chevron osteotomies for correction of hallux valgus.

PubMed

Vopat, Bryan G; Lareau, Craig R; Johnson, Julie; Reinert, Steven E; DiGiovanni, Christopher W

2013-12-01

Scarf and chevron osteotomies are two described treatments for the correction of hallux valgus deformity, but they have traditionally been employed for different levels of severity. We hypothesized that there would be no statistically significant difference between the results of these two treatments. This study is a retrospective review of 70 consecutive patients treated operatively for moderate and severe hallux valgus malalignment. The two groups based on their operative treatment: scarf osteotomy (Group A) and extended chevron osteotomy (Group B). Preoperative and postoperative hallux valgus angle (HVA), intermetatarsal angle and distal metatarsal articular angle (DMAA) were measured at final follow-up. Charts were also assessed to determine the postoperative rate of satisfaction, stiffness, and pain. There were no statistically significant differences between Groups A and B with regard to the HVA preoperatively and postoperatively. The DMAA was statistically significantly higher for Group B both preoperatively (p=0.0403) and postoperatively (p<0.0001). The differences in HVA correction and IMA correction were not statistically significant. There were no statistically significant differences with regard to post-operative stiffness, pain, and satisfaction. The scarf and extended chevron osteotomies are capable of adequately reducing the HVA and IMA in patients with moderate to severe hallux valgus. These two techniques yielded similar patient outcomes in terms of stiffness, pain and satisfaction. Based on these results, we recommend both the scarf and extended chevron osteotomy as acceptable forms of correction for moderate to severe hallux valgus.

Z-osteotomy in hallux valgus: clinical and radiological outcome after Scarf osteotomy

PubMed Central

Jäger, Marcus; Schmidt, Michael; Wild, Alexander; Bittersohl, Bernd; Courtois, Susanne; Schmidt, Troy G.; Rüdiger, Krauspe

2009-01-01

Correction osteotomies of the first metatarsal are common surgical approaches in treating hallux valgus deformities whereas the Scarf osteotomy has gained popularity. The purpose of this study was to analyze short- and mid-term results in hallux valgus patients who underwent a Scarf osteotomy. The subjective and radiological outcome of 131 Scarf osteotomies (106 hallux valgus patients, mean age: 57.5 years, range: 22–90 years) were retrospectively analyzed. Mean follow-up was 22.4 months (range: 6 months–5 years). Surgical indications were: intermetatarsal angle (IMA) of 12–23°; increased proximal articular angle (PAA>8°), and range of motion of the metatarsophalangeal joint in flexion and extension >40°. Exclusion criteria were severe osteoporosis and/or osteoarthritis. The mean subjective range of motion (ROM) of the great toe post-surgery was 0.8±1.73 points (0: full ROM, 10: total stiffness). The mean subjective cosmetic result was 2.7±2.7 points (0: excellent, 10: poor). The overall post-operative patient satisfaction with the result was high (2.1±2.5 points (0: excellent, 10: poor). The mean hallux valgus angle improvement was 16.6° (pre-operative mean value: 37.5°) which was statistically significant (p<0.01). The IMA improved by an average of 5.96° from a pre-operative mean value of 15.4° (p<0.01). Neither osteonecrosis of the distal fragment nor perioperative fractures were noted during the follow-up. In keeping with our follow-up results, the Scarf osteotomy approach shows potential in the therapy of hallux valgus. PMID:21808668

Effect of various hallux valgus reconstruction on sesamoid location: a radiographic study.

PubMed

Huang, Eddie H; Charlton, Timothy P; Ajayi, Samuel; Thordarson, David B

2013-01-01

The correction of sesamoid subluxation is an important component of hallux valgus reconstruction with some surgeons feeling that the sesamoids can be pulled back under the first metatarsal head when imbricating the medial capsule during surgery. The purpose of this study was to radiographically assess the effect of an osteotomy on sesamoid location relative to the second metatarsal. This is a retrospective radiographic study review of 165 patients with hallux valgus treated with reconstructive osteotomies. Patients were included if they underwent a scarf or basilar osteotomy for hallux valgus but were excluded if they had inflammatory arthropathy or lesser metatarsal osteotomy. A modified McBride soft tissue procedure was performed in conjunction with the basilar and scarf osteotomies. Each patient's preoperative and postoperative radiographs were evaluated for hallux valgus angle, intermetatarsal 1-2 angle, tibial sesamoid classification, and lateral sesamoid location relative to the second metatarsal. The greatest correction of both hallux valgus and intermetatrsal 1-2 angle was achieved in basilar osteotomies (20.6 degrees and 9.7 degrees, respectively), then scarf osteotomies (14.4 degrees and 8.7 degrees, respectively). Basilar and scarf osteotomies both corrected medial sesamoid subluxation relative to the first metatarsal head an average of 2-3 classification stages. All osteotomies had minimal lateral sesamoid location change relative to the second metatarsal. The majority of sesamoid correction correlated with the intermetatarsal 1-2 correction. The concept that medial capsular plication pulls the sesamoids beneath the first metatarsal (ie, changes the location of the sesamoids relative to the second metatarsal) was not supported by our results. Level III, retrospective case series.

Outcomes in chevron osteotomy for Hallux Valgus in a large cohort.

PubMed

van Groningen, Bart; van der Steen, M C Marieke; Reijman, Max; Bos, Janneke; Hendriks, Johannes G E

2016-12-01

Clinical and radiological related outcomes have been reported for Chevron osteotomy as correction for mild to moderate hallux valgus, but only for relatively small patient series. Moreover, evaluation of the patient's point of view has mostly been conducted by means of more physician-based outcome measures. The goal of this study was to evaluate the effect of the Chevron osteotomy for hallux valgus on patients' daily lives using the Foot and Ankle Outcome Score (FAOS) as a validated and a hallux valgus specific patient reported outcome measure (PROM). Secondary outcome measures were radiological correction, complication rate, and re-operations. All 438 Chevron procedures (336 patients), at two surgical hospital sites in the period between January 2010 and October 2014, were retrospectively evaluated with a follow-up of at least 6 months. Patients were invited to fill in a cross-sectional online FAOS. For the FAOS, a total response of 60% was achieved. The FAOS ranged between 71 and 88 with a follow-up of on average 36 months. Patients with an undercorrection of their hallux valgus (11.6% of the procedures) scored significantly lower on three subscales of the FAOS (range between 61 and 77 versus 72-84). Patients who had a reoperation (12.6% of the procedures) also scored significantly lower on four subscales: 58-100 versus 73-89. Postoperative radiological measurements improved significantly with a mean difference of 6.1 (5.9; 6.4) degrees for the intermetatarsal angle and 13.7 (13.0; 14.5) degrees for the hallux valgus angle. In this large study cohort, Chevron osteotomy for hallux valgus offers good PROM scores on FAOS. These scores were significantly lower in patients with radiological undercorrection or with a reoperation. Results of the FAOS appear to modulate with physician based outcomes and therapeutic incidents. Improvement of outcome may therefore well be possible by increased attention on these surgical details. Copyright © 2016 Elsevier Ltd. All rights

[Distal osteotomy for the treatment of hallux valgus (Chevron osteotomy)].

PubMed

Stukenborg-Colsman, C; Claaßen, L; Ettinger, S; Yao, D; Lerch, M; Plaaß, C

2017-05-01

Distal osteotomies, like the Chevron osteotomy, is indicated for mild to moderate hallux valgus deformities. Splayfoot, painful pseudoexostosis, and transfer metatasalgia are observed in the clinical examination. Radiographic examination should be done with weight bearing in two planes. Preoperatively the intermetatarsal (IM), hallux valgus, and distal metatarsal articular (DMAA) angles should be measured. The operative technique is based on soft tissue and bony correction. Modifications of the osteotomy allow a shortening, lengthening, or neutral correction of the first metatarsal. With a modified Chevron osteotomy, an increased DMAA can be also corrected.

Hallux valgus correction using transarticular lateral release with distal chevron osteotomy.

PubMed

Choi, Young Rak; Lee, Ho Seong; Jeong, Jae Jung; Kim, Sang Woo; Jeon, In-Ho; Lee, Dong Ho; Lee, Woo Chun

2012-10-01

Transarticular lateral release through a medial incision can avoid a dorsal incision. This study investigated outcomes following hallux valgus correction using transarticular lateral release, distal chevron metatarsal osteotomy and Akin phalangeal osteotomy through one medial incision. Between June 2004 and May 2009, a single surgeon performed a transarticular lateral release, distal chevron metatarsal osteotomy and Akin phalangeal osteotomy through one medial incision for hallux valgus on a total of 103 feet of 68 patients. The average patient age at the time of surgery was 51 years, and the average followup was 27 months. The average preoperative and final followup results were: 1) hallux valgus angle improvement from 29 degrees to 5 degrees, 2) intermetatarsal angle from 13 degrees to 5 degrees and 3) medial sesamoid bone position from 3 to 1 (p < 0.05 for each variable). The average AOFAS scores were improved from 49 to 92, and the VAS pain scores were improved from 7 to 1 (p < 0.05 for both variables). No patient had a serious complication such as infection, avascular necrosis, nonunion, transfer-metatarsalgia, or first metatarsophalangeal joint arthritis. Hallux valgus correction using transarticular lateral release, distal chevron metatarsal osteotomy and Akin phalangeal osteotomy through one medial incision was found to be effective and safe. The advantages include that the procedure is simple, early ambulation is possible, and there is no dorsal scarring.

[A special soft tissue procedure for treatment of hallux valgus].

PubMed

Waizy, H; Stukenborg-Colsman, C; Abbara-Czardybon, M; Emmerich, J; Windhagen, H; Frank, D

2011-02-01

Maintaining the corrected position of the first metatasophalangeal axis. Reducing postoperative stiffness by forgoing a medial capsular shift. Hallux valgus deformities or recurrent hallux valgus deformities. Existing osteoarthritis, joint stiffness, large bone defects, osteonecrosis. General medical contraindications to surgical interventions and anesthesiological procedures. Operation under regional anesthesia (foot block) or general anesthesia. Tourniquet. Longitudinal skin incision medial over the pseudexostosis of the first metatarsal bone. Preparing the tendon of the Musculus abductor hallucis. Detaching the tendon from the capsule. Incision of the joint capsule with protection of the extensor hallucis longus tendon and the dorsal neurovascular bundle in an L-wise manner. Osteotomy of the first metatarsal bone. Lax sutures of the capsule in correct position and reattachment of the Musculus abductor hallucis tendon shifted toward distal and dorsal, regarding the rotation of the hallux. Postoperative elevation of the operated foot. Analgesia with nonsteroidal antiinflammatory drugs. Postoperative weight-bearing according to the osteotomy. Passive mobilization of the metatarsophalangeal joint. Dressing for 4 weeks postoperatively in the corrected position. Radiologic control after 6 weeks. Hallux valgus orthosis at night and a toe spreader for a further 6 weeks. A total of 30 isolated hallux valgus deformities with a mean preoperative intermetatarsal (IMA) angle of 12.9° (range 11-15°) were operated with a chevron osteotomy. The mean follow-up was 14.4 (range 8-17) months. The mean dorsiflexion at the last follow-up was 44° (range 20-60°). Only 2 patients had a dorsiflexion <40°. The mean reduction of the IM angle was 5.6° (range 3-7°). One patient required wound revision. There was no infection or avascular necrosis of the metatarsal head observed in the patients. At follow-up, 20 (67%) patients were completely satisfied, 9 (30%) satisfied, and 1 (3

Hallux valgus surgery affects kinematic parameters during gait

PubMed Central

Klugarova, J.; Janura, M.; Svoboda, Z.; Sos, Z.; Stergiou, N.; Klugar, M.

2017-01-01

Background The aim of our study was to compare spatiotemporal parameters and lower limb and pelvis kinematics during the walking in patients with hallux valgus before and after surgery and in relation to a control group. Methods Seventeen females with hallux valgus, who underwent first metatarsal osteotomy, constituted our experimental group. The control group consisted of thirteen females. Kinematic data during walking were obtained using the Vicon MX system. Findings Our results showed that hallux valgus before surgery affects spatiotemporal parameters and lower limb and pelvis kinematics during walking. Hallux valgus surgery further increased the differences that were present before surgery. Specifically after hallux valgus surgery, the walking speed decreased even more (p=0.09, η2= 0.19) while step time increased (p=0.002, η2=0.44) on both legs. The maximum ankle plantar flexion of the operated leg during toe off decreased to a greater extend (p=0.03, η2=0.26). The asymmetry in the hip and the pelvis movements in the frontal plane (present preoperatively) persisted after surgery. Interpretation Hallux valgus is not an isolated problem of the first ray, which could be just surgically addressed by correcting the foot’s alignment. It is a long-term progressive malfunction of the foot affecting the entire kinematic chain of the lower extremity. PMID:27792950

Factors Associated With Early Loss of Hallux Valgus Correction.

PubMed

Shibuya, Naohiro; Kyprios, Evangelos M; Panchani, Prakash N; Martin, Lanster R; Thorud, Jakob C; Jupiter, Daniel C

Recurrence is common after hallux valgus corrective surgery. Although many investigators have studied the risk factors associated with a suboptimal hallux position at the end of long-term follow-up, few have evaluated the factors associated with actual early loss of correction. We conducted a retrospective cohort study to identify the predictors of lateral deviation of the hallux during the postoperative period. We evaluated the demographic data, preoperative severity of the hallux valgus, other angular measurements characterizing underlying deformities, amount of hallux valgus correction, and postoperative alignment of the corrected hallux valgus for associations with recurrence. After adjusting for the covariates, the only factor associated with recurrence was the postoperative tibial sesamoid position. The recurrence rate was ~50% and ~60% when the postoperative tibial sesamoid position was >4 and >5 on the 7-point scale, respectively. Published by Elsevier Inc.

[The retrocapital osteotomy ("chevron") for correction of splayfoot with hallux valgus].

PubMed

Gabel, Michael

2008-12-01

Surgical treatment of hallux valgus deformity with a distal osteotomy of the first metatarsal to address an increased intermetatarsal angle (IMA) I-II. This procedure is combined with a soft-tissue procedure at the first metatarsophalangeal joint: realignment of the first ray, lateral displacement of the first metatarsal head above the sesamoids, rebalancing of the soft tissues at the metatarsophalangeal joint. Pain and soft-tissue inflammation at the bunion, impaired function of the metatarsophalangeal joint, and lateral deviation of the hallux. IMA I-II hallux valgus angle (HVA) angle (DMAA) > 10 degrees. Symptomatic osteoarthritis of the first metatarsophalangeal joint, assessed clinically or radiographically. Acute inflammation of the forefoot, osteoporosis of the first metatarsal. Vascular disturbance. Cosmetic indication only. Relative: hypermobility of the first ray, valgus malalignment of the hindfoot, previous retrocapital osteotomy. Lateral soft-tissue release. Resection of the medial pseudoexostosis. V-shaped osteotomy of the distal metatarsal I. Exostosectomy. Lateral displacement of the first metatarsal head. Screw fixation. Realignment of the metatarsophalangeal joint by tightening of the medial soft tissues. Postoperative shoe with full weight bearing. Active exercises of the foot and hallux. Physiotherapy. Prophylaxis of deep vein thrombosis depending on the degree of mobility. Radiographic control after 6 weeks. Bandage or orthosis to maintain toe alignment. IMA I-II was reduced from 13.6 degrees preoperatively to 6.6 degrees postoperatively. HVA decreased from 29.8 degrees to 8.2 degrees postoperatively.

[A cadaveric study of a new capsulorrhaphy for the surgical treatment of hallux valgus].

PubMed

Orozco-Villaseñor, S L; Monzó-Planella, M; Martín-Oliva, X; Vázquez-Escamilla, J; Mayagoitia-Vázquez, J J; Frías-Chimal, J E

2017-01-01

There are many surgical options for the treatment of hallux valgus in combination with capsular repairs for the correction of hallux valgus. This report corresponds to a descriptive study where a new capsulorrhaphy technique in hallux valgus is proposed. Six dissections were performed on cadavers with hallux valgus deformity using the following surgical technique: medial approach on the first toe longitudinally, dissecting by planes and locating the metatarsophalangeal joint capsule; it was incised longitudinally. The capsule was separated and an exostectomy of the first metatarsal head was done, the edges were regularized and a release of the abductor hallucis was performed. Later, the capsular remnant was resected and repaired. Six cadaveric feet with hallux valgus were studied, five with mild deformity, one with moderate deformity, one foot with the 2nd finger on supraductus. Many capsular repairs have been reported in the literature, including «L», triangular, «V-Y», rectangular, with satisfactory results, along with osteotomy of the first metatarsal. In this report, a new capsular repair was described. Applying this new capsular repair, we reduced the metatarsophalangeal and intermetatarsal angles and achieved a capsular closure with suitable tension; the metatarsophalangeal joint mobility was preserved.

Distal chevron osteotomy with distal soft tissue procedure for moderate to severe hallux valgus deformity.

PubMed

Bai, Long Bin; Lee, Keun Bae; Seo, Chang Young; Song, Eun Kyoo; Yoon, Taek Rim

2010-08-01

Distal chevron osteotomy has been widely employed to treat mild to moderate hallux valgus deformity. The purpose of the present study was to evaluate the outcomes of distal chevron osteotomy with a distal soft tissue procedure for the correction of moderate to severe hallux valgus. We reviewed 76 patients (86 feet) that underwent distal chevron osteotomy with a distal soft tissue procedure for symptomatic moderate to severe hallux valgus deformity. At a mean followup of 31 months, all patients were evaluated using subjective, objective and radiographic measurements. Ninety-four percent of the patients were very satisfied or satisfied. Average AOFAS score improved from 54.7 points preoperatively to 92.9 at final followup. Average hallux valgus angle changed from 36.2 degrees preoperatively to 12.4 degrees at final followup, and average first-second intermetatarsal angle changed from 17.1 to 7.3 degrees. Average tibial sesamoid position changed from 2.4 preoperatively to 1.2 at final followup. Dorsal angulation of the head was observed in two feet, and plantaflexion of the head in four feet. There were no cases of avascular necrosis of the metatarsal head. Our results indicate that distal chevron osteotomy with a distal soft tissue procedure provides an effective and reliable means of correcting moderate to severe hallux valgus deformity, and that it does so with high levels of patient satisfaction and low incidence of complications.

First metatarsal length change after basilar closing wedge osteotomy for hallux valgus.

PubMed

Day, Thomas; Charlton, Timothy P; Thordarson, David B

2011-05-01

Hallux valgus deformities with large intermetatarsal angles require a more proximal metatarsal procedure to adequately correct the deformity. Due to the relative ease of a closing wedge osteotomy, this technique was adopted but with concern over first metatarsal shortening. In this study, we primarily evaluated angular correction and first metatarsal shortening. We evaluated 70 feet in 57 patients (average age, 54 years) with 52 female and five male. The average followup was 14 (range, 6 to 45) months. The charts were reviewed for the presence of metatarsalgia. Digital radiographic measurements were made for pre- and postoperative hallux valgus and intermetatarsal angles, dorsiflexion angle of the first metatarsal, and absolute and relative shortening of the first metatarsal. The average hallux valgus angle improved from 31 to 11 degrees (p < 0.0001) and intermetatarsal angle from 13.2 to 4.4 angles (p < 0.0001). The absolute shortening of the first metatarsal was 2.2 mm and relative shortening was 0.6 mm. There was 1.3 degrees of dorsiflexion on average. Excellent correction of the deformity with minimal dorsiflexion or new complaints of metatarsalgia was found with this technique. The new method of assessing the relative shortening found to be less than the absolute shortening, which we feel more accurately reflects the functional length of the first metatarsal.

Venous thrombosis after hallux valgus surgery.

PubMed

Radl, Roman; Kastner, Norbert; Aigner, Christian; Portugaller, Horst; Schreyer, Herbert; Windhager, Reinhard

2003-07-01

Although surgery for the treatment of hallux valgus is frequently performed, the exact rate of deep vein thrombosis following this procedure is unknown. We performed a single-center, prospective, phlebographically controlled study to quantify the rate of venous thrombosis following operative correction of hallux valgus. Consecutive patients undergoing chevron bunionectomy for correction of hallux valgus deformity were enrolled in the study. Patients with clinical or hematological risk factors for venous thrombosis were excluded. One hundred patients with a mean age of 48.9 years were operated on and did not receive medical prophylaxis against thrombosis. All patients were assessed with phlebography at a mean of twenty-nine days postoperatively. Venous thrombosis was found in four patients (4%). The mean age of these patients (and standard deviation) was 61.7 +/- 6.1 years compared with a mean age of 48.4 +/- 13.9 years for the patients in whom thrombosis did not develop (p = 0.034). Patients are at a low risk for venous thrombosis following surgical treatment of hallux valgus. The need for prophylaxis against thrombosis should be calculated individually for each patient according to his or her known level of risk. Routine medical prophylaxis against thrombosis might be justified for patients over the age of sixty years.

Preliminary Results and Learning Curve of the Minimally Invasive Chevron Akin Operation for Hallux Valgus.

PubMed

Jowett, Charlie R J; Bedi, Harvinder S

Minimally invasive surgery is increasing in popularity. It is relevant in hallux valgus surgery owing to the potential for reduced disruption of the soft tissues and improved wound healing. We present our results and assess the learning curve of the minimally invasive Chevron Akin operation for hallux valgus. A total of 120 consecutive feet underwent minimally invasive Chevron Akin for symptomatic hallux valgus, of which 14 were excluded. They were followed up for a mean of 25 (range 18 to 38) months. The patients were clinically assessed using the American Orthopaedic Foot and Ankle Society score. Complications and patient satisfaction were recorded. The radiographs were analyzed and measurements recorded for hallux valgus and intermetatarsal angle correction. The mean age of the patients undergoing surgery was 55 (range 25 to 81) years. Of the 78 patients, 76 (97.4%) were female and 2 (2.6%) were male; 28 (35.9%) cases were bilateral. The mean American Orthopaedic Foot and Ankle Society score improved from 56 (range 23 to 76) preoperatively to 87 (range 50 to 100) postoperatively (p < .001). The mean hallux valgus and intermetatarsal angles preoperatively were 29.7° (range 12° to 46°) and 14.0° (range 8° to 20°). The corresponding postoperative angles were 10.3° (range 0° to 25°) and 7.6° (range 3° to 15°; p < .001). The patients were satisfied with the results of surgery in 87% of cases (92 of 106). The incidence of reoperation was 14% (15 of 106). These are the only reported results for this technique. They display a steep associated learning curve. However, the results are promising, and the learning curve is comparable to that for open hallux valgus surgery. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Evaluation of Hallux Valgus Correction With Versus Without Akin Proximal Phalanx Osteotomy.

PubMed

Shibuya, Naohiro; Thorud, Jakob C; Martin, Lanster R; Plemmons, Britton S; Jupiter, Daniel C

2016-01-01

Although the efficacy of Akin proximal phalanx closing wedge osteotomy as a sole procedure for correction of hallux valgus deformity is questionable, when used in combination with other osseous corrective procedures, the procedure has been believed to be efficacious. However, a limited number of comparative studies have confirmed the value of this additional procedure. We identified patients who had undergone osseous hallux valgus correction with first metatarsal osteotomy or first tarsometatarsal joint arthrodesis with (n = 73) and without (n = 81) Akin osteotomy and evaluated their radiographic measurements at 3 points (preoperatively, within 3 months after surgery, and ≥6 months after surgery). We found that those people who had undergone the Akin procedure tended to have a larger hallux abduction angle and a more laterally deviated tibial sesamoid position preoperatively. Although the radiographic correction of the deformity was promising immediately after corrective surgery with the Akin osteotomy, maintenance of the correction was questionable in our cohort. The value of additional Akin osteotomy for correction of hallux valgus deformity is uncertain. Published by Elsevier Inc.

No midterm benefit from low intensity pulsed ultrasound after chevron osteotomy for hallux valgus.

PubMed

Zacherl, Max; Gruber, Gerald; Radl, Roman; Rehak, Peter H; Windhager, Reinhard

2009-08-01

Chevron osteotomy is a widely accepted method for correction of symptomatic hallux valgus deformity. Full weight bearing in regular shoes is not recommended before 6 weeks after surgery. Low intensity pulsed ultrasound is known to stimulate bone formation leading to more stable callus and faster bony fusion. We performed a randomized, placebo-controlled, double-blinded study on 44 participants (52 feet) who underwent chevron osteotomy to evaluate the influence of daily transcutaneous low intensity pulsed ultrasound (LIPUS) treatment at the site of osteotomy. Follow-up at 6 weeks and 1 year included plain dorsoplantar radiographs, hallux-metatarsophalangeal-interphalangeal scale and a questionnaire on patient satisfaction. There was no statistical difference in any pre- or postoperative clinical features, patient satisfaction or radiographic measurements (hallux valgus angle, intermetatarsal angle, sesamoid index and metatarsal index) except for the first distal metatarsal articular angle (DMAA). The DMAA showed statistically significant (p = 0.046) relapse in the placebo group upon comparison of intraoperative radiographs after correction and fixation (5.2 degrees) and at the 6-week follow-up (10.6 degrees). Despite potential impact of LIPUS on bone formation, we found no evidence of an influence on outcome 6 weeks and 1 year after chevron osteotomy for correction of hallux valgus deformity.

Chevron osteotomy with lateral release and adductor tenotomy for hallux valgus.

PubMed

Potenza, Vito; Caterini, Roberto; Farsetti, Pasquale; Forconi, Fabrizio; Savarese, Eugenio; Nicoletti, Simone; Ippolito, Ernesto

2009-06-01

Distal chevron osteotomy is a procedure widely performed for the surgical treatment of painful hallux valgus. The risks and benefits of a lateral capsular release and adductor tenotomy combined with chevron osteotomy are still debated. The aim of our study was to report the clinical and radiographic outcomes of this combined procedure in mild and moderate incongruent bunion deformities, with a hallux valgus angle (HVA) up to 40 degrees and an intermetatarsal angle (IMA) up to 20 degrees. Forty-two patients (52 feet) who consecutively underwent chevron osteotomy combined with lateral release and adductor tenotomy were reviewed 24-36 months after surgery. The mean age of the patients was 53.5 (range, 43 to 64) years. All the deformities were mild to moderate, with a mean preoperative value of 28 degrees in the HVA (range, 16 degrees to 40 degrees) and of 13 degrees in the IMA (range, 9 degrees to 20 degrees). At followup, the AOFAS hallux score improved from an average of 46 to an average of 88. The HVA and IMA had an average postoperative decrease respectively of 12 degrees and 6 degrees; lateral sesamoid displacement decreased by a mean of 15%. In no case did we observe infection or nonunion of the osteotomy. In one case, painless avascular necrosis of the first metatarsal head developed. Our short-term results show that distal chevron osteotomy combined with lateral release and adductor tenotomy is a feasible surgical option to address mild to moderate hallux valgus deformity, even with an IM angle between 15 and 20 degrees. Clinical and radiographic outcomes are generally good and patient satisfaction is generally high.

The relationship of abnormal foot pronation to hallux abducto valgus--a pilot study.

PubMed

Ross, F D

1986-08-01

Abnormal foot mechanics is the most common cause of hallux abducto valgus. To date no quantitative data regarding the relationship between abnormal foot mechanics and the degree of hallux abducto valgus has been presented. An outline of the abnormal foot mechanics responsible for hallux abducto valgus is described along with a technique for measuring the extent of abnormal function. A common intrinsic abnormality responsible for hallux abducto valgus is described along with its diagnosis and orthotic treatment.

Minimally Invasive and Open Distal Chevron Osteotomy for Mild to Moderate Hallux Valgus.

PubMed

Brogan, Kit; Lindisfarne, Edward; Akehurst, Harold; Farook, Usama; Shrier, Will; Palmer, Simon

2016-11-01

Minimally invasive surgical (MIS) techniques are increasingly being used in foot and ankle surgery but it is important that they are adopted only once they have been shown to be equivalent or superior to open techniques. We believe that the main advantages of MIS are found in the early postoperative period, but in order to adopt it as a technique longer-term studies are required. The aim of this study was to compare the 2-year outcomes of a third-generation MIS distal chevron osteotomy with a comparable traditional open distal chevron osteotomy for mild-moderate hallux valgus. Our null hypothesis was that the 2 techniques would yield equivalent clinical and radiographic results at 2 years. This was a retrospective cohort study. Eighty-one consecutive feet (49 MIS and 32 open distal chevron osteotomies) were followed up for a minimum 24 months (range 24-58). All patients were clinically assessed using the Manchester-Oxford Foot Questionnaire. Radiographic measures included hallux valgus angle, the intermetatarsal angle, hallux interphalangeal angle, metatarsal phalangeal joint angle, distal metatarsal articular angle, tibial sesamoid position, shape of the first metatarsal head, and plantar offset. Statistical analysis was done using Student t test or Wilcoxon rank-sum test for continuous data and Pearson chi-square test for categorical data. Clinical and radiologic postoperative scores in all domains were substantially improved in both groups (P < .001), but there was no statistically significant difference in improvement of any domain between open and MIS groups (P > .05). There were no significant differences in complications between the 2 groups ( > .5). The midterm results of this third-generation technique show that it was a safe procedure with good clinical outcomes and comparable to traditional open techniques for symptomatic mild-moderate hallux valgus. Level III, retrospective comparative study. © The Author(s) 2016.

Comparison of Clinical Outcomes of Scarf and Chevron Osteotomies and the McBride Procedure in the Treatment of Hallux Valgus Deformity

PubMed Central

Fakoor, Mohammad; Sarafan, Naser; Mohammadhoseini, Payam; Khorami, Mohsen; Arti, Hamidreza; Mosavi, SeyedShahnam; Aghaeeaghdam, Amir

2014-01-01

Background: Hallux valgus deformity is a common chronic problem with a reported prevalence of 28.4% and its chief complaint is pain. Thus far, different surgical procedures with their proposed indications have been introduced. This study compared three current procedures, namely the chevron and scarf osteotomies and the McBride procedure. Methods: This retrospective cohort was conducted at the Ahvaz University of Medical Sciences on 44 patients with moderate hallux valgus deformity from 2010 and 2013. All of the patients underwent one of the three procedures (chevron, scarf or McBride). Preoperative and follow up radiographies were evaluated in terms of hallux valgus and intermetatarsal angle correction. The Foot and Ankle Disability Index was filled out to assess the functional outcome and the Visual Analogue Scale was used to evaluate pain. Also, satisfaction, aesthetics and the rate of recurrence was evaluated. Results: Hallux valgus angle and intermetatarsal angle correction were significantly higher in scarf, but not in chevron and McBride. However, from amongst the three procedures, there was no significant difference in terms of the Foot and Ankle Disability Index score, aesthetics, satisfaction level, pain score and recurrence rate. Conclusions: Considering that scarf osteotomy had better results in this study, we think that scarf osteotomy can be considered as a first choice for the treatment of moderate hallux valgus deformity. PMID:25207310

Comparison of Clinical Outcomes of Scarf and Chevron Osteotomies and the McBride Procedure in the Treatment of Hallux Valgus Deformity.

PubMed

Fakoor, Mohammad; Sarafan, Naser; Mohammadhoseini, Payam; Khorami, Mohsen; Arti, Hamidreza; Mosavi, SeyedShahnam; Aghaeeaghdam, Amir

2014-03-01

Hallux valgus deformity is a common chronic problem with a reported prevalence of 28.4% and its chief complaint is pain. Thus far, different surgical procedures with their proposed indications have been introduced. This study compared three current procedures, namely the chevron and scarf osteotomies and the McBride procedure. This retrospective cohort was conducted at the Ahvaz University of Medical Sciences on 44 patients with moderate hallux valgus deformity from 2010 and 2013. All of the patients underwent one of the three procedures (chevron, scarf or McBride). Preoperative and follow up radiographies were evaluated in terms of hallux valgus and intermetatarsal angle correction. The Foot and Ankle Disability Index was filled out to assess the functional outcome and the Visual Analogue Scale was used to evaluate pain. Also, satisfaction, aesthetics and the rate of recurrence was evaluated. Hallux valgus angle and intermetatarsal angle correction were significantly higher in scarf, but not in chevron and McBride. However, from amongst the three procedures, there was no significant difference in terms of the Foot and Ankle Disability Index score, aesthetics, satisfaction level, pain score and recurrence rate. Considering that scarf osteotomy had better results in this study, we think that scarf osteotomy can be considered as a first choice for the treatment of moderate hallux valgus deformity.

Modified Chevron osteotomy for hallux valgus deformity in female athletes. A 2-year follow-up study.

PubMed

Giotis, Dimitrios; Paschos, Nikolaos K; Zampeli, Franceska; Giannoulis, Dionisios; Gantsos, Apostolos; Mantellos, George

2016-09-01

Hallux valgus is an increasingly common deformity in young female athletes that constricts their daily athletic activities and influences foot cosmesis. The aim of this study was to evaluate the outcome of modified Chevron osteotomy for hallux valgus deformity in this specific population. Forty-two cases of modified Chevron osteotomies were carried out in 33 patients with mild to moderate hallux valgus deformity. Each participant was evaluated for AOFAS score, pain, range of motion, cosmetic and radiological outcome. Mean AOFAS score improved to 96.3 (p<0.001) while the mean range of motion of the metatarsophalangeal joint was maintained (p=0.138). The cosmetic result was excellent/good in 40 cases (95%). Mean metatarsophalangeal and intermetatarsal angles were decreased from 29.8° and 14.2° preoperatively to 12.2° and 8.1° postoperatively (p<0.001 and p<0.036), respectively. Modified Chevron osteotomy could offer substantial correction of hallux valgus deformity in young female athletes, with excellent clinical outcome. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Plate fixation for proximal chevron osteotomy has greater risk for hallux valgus recurrence than Kirschner wire fixation.

PubMed

Park, Chul-Hyun; Ahn, Ji-Yong; Kim, Yu-Mi; Lee, Woo-Chun

2013-06-01

The purpose of this study was to compare the results of hallux valgus surgery between feet fixed with Kirschner wires and those fixed with a plate and screws. Between December 2008 and November 2009, 53 patients (62 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic moderate to severe hallux valgus deformity. Thirty-four patients (41 feet) were stabilised with Kirschner wires (K-wire group) and 19 patients (21 feet) were stabilised with a locking plate (plate group). Clinical results were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographic parameters were compared between these groups. Recurrence rate at the last follow-up was compared between the K-wire and plate groups. Mean AOFAS score was lower in the plate group, however, the difference between the groups was not statistically significant in AOFAS score at the last follow-up. Hallux valgus angle and intermetatarsal angle were significantly larger in the plate group at the last follow-up. Mean 1-2 metatarsal (MT) distance on immediately postoperative radiographs was significant larger in the plate group. Four (9.8 %) of the 41 feet in the K-wire group and 7 (33.3 %) of the 21 feet in the plate group showed hallux valgus recurrence at the last follow-up. The plate group had a significantly higher risk of recurrence than the K-wire group. Fixation of proximal chevron osteotomy using a plate and screws has a greater risk of hallux valgus recurrence than fixation using Kirschner wires.

Extended plantar limb (modified) chevron osteotomy versus scarf osteotomy for hallux valgus correction: A randomised controlled trial.

PubMed

Mahadevan, Devendra; Lines, Stephen; Hepple, Stephen; Winson, Ian; Harries, William

2016-06-01

The purpose of this RCT was to compare the extended plantar limb (modified) chevron osteotomy with the scarf osteotomy in correcting hallux valgus deformity and improving functional scores and patient satisfaction. Patients were randomly assigned and kept blind to surgical allocation. Cases requiring additional procedures including the Akin osteotomy were excluded. Outcomes were measured at 1 year following surgery. 84 patients (109 feet) were analysed (60 modified chevron; 49 Scarf). The mean age was 50.7 years (75F: 9M). Post-operative intermetatarsal angle (IMA) was significantly lower in the modified chevron group (5.8° versus 6.9°, p=0.045). Hallux valgus angle and distal metatarsal articular angle were similar. The magnitude of IMA correction with the modified chevron was also significantly greater (9.1° versus 7.1°, p=0.007). Both osteotomies produced comparable MOxFQ scores and satisfaction ratings. The modified chevron was superior to the scarf osteotomy in correcting IMA in hallux valgus deformity. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Hallux Valgus Correction Comparing Percutaneous Chevron/Akin (PECA) and Open Scarf/Akin Osteotomies.

PubMed

Lee, Moses; Walsh, James; Smith, Margaret M; Ling, Jeff; Wines, Andrew; Lam, Peter

2017-08-01

Minimally invasive surgery is being used increasingly, including for hallux valgus surgery. Despite the growing interest in minimally invasive procedures, there have been few publications on percutaneous chevron/akin (PECA) procedures, and no studies have been published comparing PECA to open scarf/akin osteotomies (SA). This was a prospective, randomized study of 50 patients undergoing operative correction of hallux valgus using one of 2 techniques (PECA vs open SA). Data were collected preoperatively and on 1 day, 2 weeks, 6 weeks, and 6 months postoperatively. Outcome measures include the American Orthopaedic Foot & Ankle Society Hallux-Metatarsophalangeal-Interphalangeal (AOFAS-HMI) Score, visual analog pain score, hallux valgus angle (HVA), and 1-2 intermetatarsal angle (IMA). Twenty-five patients underwent PECA procedures and 25 patients received SA procedures. Both groups showed significantly improved AOFAS-HMI scores after surgery (PECA group: 61.8 to 88.9, SA group: 57.3 to 84.1, P = .560) with comparable final scores. HVA and IMA also presented similar outcomes at final follow-up ( P = .520 and P = .270, respectively). However, the PECA group showed significantly lower pain level (VAS) in the early postoperative phase (postoperative day 1 to postoperative week 6, P < .001 and P = .004, respectively). No serious complications were observed in either group. Both groups showed comparable good to excellent clinical and radiologic outcomes at final follow-up. However, the PECA group had significantly less pain in the first 6 weeks following surgery. Level of Evidence Level II, prospective comparative study.

Long-term Follow-up of a Randomized Controlled Trial Comparing Scarf to Chevron Osteotomy in Hallux Valgus Correction.

PubMed

Jeuken, Ralph M; Schotanus, Martijn G M; Kort, Nanne P; Deenik, Axel; Jong, Bob; Hendrickx, Roel P M

2016-07-01

Hallux valgus is one of the most common foot deformities. This long-term follow-up study compared the results of 2 widely used operative treatments for hallux valgus: the scarf and chevron osteotomy. Conventional weight bearing anteroposterior (AP) radiographs of the foot were made for evaluating the intermetatarsal angle and hallux valgus angle. For clinical evaluation, the American Orthopaedic Foot & Ankle Society (AOFAS) rating system for the hallux metatarsophalangeal-interphalangeal scale was used together with physical examination of the foot. These data were compared with the results from the original study. The Short Form 36 questionnaire, the Manchester-Oxford Foot Questionnaire (MOXFQ), and a general questionnaire including a visual analog scale (VAS) pain score were used for subjective evaluation. The primary outcome measures were the radiologic recurrence of hallux valgus and reoperation rate of the same toe. Secondary outcome measures were the results from the radiographs and subjective and clinical evaluation. The response rate was 76% at the follow-up of 14 years; in the chevron group, 37 feet were included compared with 36 feet in the scarf group. Twenty-eight feet in the chevron group and 27 in the scarf group developed recurrence of hallux valgus (P = .483). One patient in the scarf group had a reoperation of the same toe compared with none in the chevron group (P = .314). Current VAS pain scores and results from the SF-36, MOXFQ, and AOFAS did not significantly differ between groups. Both techniques showed similar results after 2 years of follow-up. At 14 years of follow-up, neither technique was superior in preventing recurrence. Level II, randomized controlled trial. © The Author(s) 2016.

Plantar pressures determinants in mild Hallux Valgus.

PubMed

Martínez-Nova, Alfonso; Sánchez-Rodríguez, Raquel; Pérez-Soriano, Pedro; Llana-Belloch, Salvador; Leal-Muro, Alejo; Pedrera-Zamorano, Juan Diego

2010-07-01

While podobarometric techniques have been applied to the study of pressures in Hallux Valgus (HV), little is known about its clinical and radiological determinants. So, the aim of the present study was to determine the plantar pressure pattern in participants with mild HV, comparing to a control group, and their clinical and anthropometric determinants. Biofoot/IBV(®) in-shoe system was used to evaluate 79 participants with mild HV. Computerized measurements of the 1st intermetatarsal angle (IMA) and the hallux abductus angle (HAA) were made on antero-posterior radiographs. The clinical outcome was assessed using the AOFAS score. The dependent baropodometric variables and the independent clinical and anthropometric variables were subjected to a multiple regression analysis. In both groups, the highest average pressure was in the 2nd metatarsal head (MTH). The mean pressure under the Hallux was significantly higher in HV group (controls, 146.5±92.5kPa; HV, 328.5±113.2kPa; p<0.001). An 18.6% of average pressure under the 1st MTH was accounted for pain, first ray alignment and total AOFAS score. Variations of the HAA explained 26.8% of the mean Hallux pressure. Women with mild HV present with pathologically increased pressure under the Hallux, which is caused by the altered alignment of the first ray. Pain and clinical result were associated with the pressure under the 1st MTH and the remaining variables were only moderate predictors of dynamic plantar pressures. Copyright © 2010 Elsevier B.V. All rights reserved.

Ninety-Degree Chevron Osteotomy for Correction of Hallux Valgus Deformity: Clinical Data and Finite Element Analysis

PubMed Central

Matzaroglou, Charalambos; Bougas, Panagiotis; Panagiotopoulos, Elias; Saridis, Alkis; Karanikolas, Menelaos; Kouzoudis, Dimitris

2010-01-01

Hallux valgus is a very common foot disorder, with its prevalence estimated at 33% in adult shoe-wearing populations. Conservative management is the initial treatment of choice for this condition, but surgery is sometimes needed. The 600 angle Chevron osteotomy is an accepted method for correction of mild to moderate hallux valgus in adults less than 60 years old. A modified 900 angle Chevron osteotomy has also been described; this modified technique can confer some advantages compared to the 600 angle method, and reported results are good. In the current work we present clinical data from a cohort of fifty-one female patients who had surgery for sixty-two hallux valgus deformities. In addition, in order to get a better physical insight and study the mechanical stresses along the two osteotomies, Finite Element Analysis (FEA) was also conducted. FEA indicated enhanced mechanical bonding with the modified 900 Chevron osteotomy, because the compressive stresses that keep the two bone parts together are stronger, and the shearing stresses that tend to slide the two bone parts apart are weaker, compared to the typical 600 technique. Follow-up data on our patient cohort show good or excellent long-term clinical results with the modified 900 angle technique. These results are consistent with the FEA-based hypothesis that a 900 Chevron osteotomy confers certain mechanical advantages compared to the typical 600 procedure. PMID:20648223

Comparison of the Modified McBride Procedure and the Distal Chevron Osteotomy for Mild to Moderate Hallux Valgus.

PubMed

Choi, Gi Won; Kim, Hak Jun; Kim, Taik Seon; Chun, Sung Kwang; Kim, Tae Wan; Lee, Yong In; Kim, Kyoung Ho

2016-01-01

Distal metatarsal osteotomy and the modified McBride procedure have each been used for the treatment of mild to moderate hallux valgus. However, few studies have compared the results of these 2 procedures for mild to moderate hallux valgus. The purpose of the present study was to compare the results of distal chevron osteotomy and the modified McBride procedure for treatment of mild to moderate hallux valgus according to the severity of the deformity. We analyzed the data from 45 patients (49.5%; 48 feet [49.0%]), who had undergone an isolated modified McBride procedure (McBride group), and 46 patients (50.5%; 50 feet [51.0%]), who had a distal chevron osteotomy (chevron group). We subdivided each group into those with mild and moderate deformity and compared the clinical and radiologic outcomes between the groups in relation to the severity of the deformity. The improvements in the American Orthopaedic Foot and Ankle Society scale score and the visual analog scale for pain were significantly better for the chevron group for both mild and moderate deformity. The chevron group experienced significantly greater correction in the hallux valgus angle and intermetatarsal angle for both mild and moderate deformity. The chevron group experienced a significantly greater decrease in the grade of sesamoid displacement for patients with moderate deformity. The McBride group had a greater risk of recurrence than did the chevron group for moderate deformity (odds ratio 14.00, 95% confidence interval 3.91 to 50.06, p < .001). The results of the present study have demonstrated the superiority of the distal chevron osteotomy over the modified McBride procedure for mild to moderate deformity. For patients with moderate deformity, the McBride group had a greater risk of hallux valgus recurrence than did the distal chevron group. Therefore, we recommend distal chevron osteotomy rather than a modified McBride procedure for the treatment of mild and moderate hallux valgus. Copyright

Comparison of outcomes between proximal and distal chevron osteotomy, both with supplementary lateral soft-tissue release, for severe hallux valgus deformity: A prospective randomised controlled trial.

PubMed

Park, H-W; Lee, K-B; Chung, J-Y; Kim, M-S

2013-04-01

Severe hallux valgus deformity is conventionally treated with proximal metatarsal osteotomy. Distal metatarsal osteotomy with an associated soft-tissue procedure can also be used in moderate to severe deformity. We compared the clinical and radiological outcomes of proximal and distal chevron osteotomy in severe hallux valgus deformity with a soft-tissue release in both. A total of 110 consecutive female patients (110 feet) were included in a prospective randomised controlled study. A total of 56 patients underwent a proximal procedure and 54 a distal operation. The mean follow-up was 39 months (24 to 54) in the proximal group and 38 months (24 to 52) in the distal group. At follow-up the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, tibial sesamoid position, American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal score, patient satisfaction level, and complications were similar in each group. Both methods showed significant post-operative improvement and high levels of patient satisfaction. Our results suggest that the distal chevron osteotomy with an associated distal soft-tissue procedure provides a satisfactory method for correcting severe hallux valgus deformity.

Proximal reverse chevron metatarsal osteotomy, lateral soft tissue release, and akin osteotomy through a single medial incision for hallux valgus.

PubMed

Jung, Hong-Geun; Kim, Tae-Hoon; Park, Jong-Tae; Shin, Min-Ho; Lee, Sang-Hun

2014-04-01

Scarring on the dorsal first web space after lateral soft tissue release can be a major contributor to patient dissatisfaction following hallux valgus surgery. We hypothesized that performing distal soft tissue procedure (DSTP), proximal reverse chevron metatarsal osteotomy (PCMO), and Akin osteotomy through a single medial incision would provide better clinical and radiographic results with improved patient satisfaction compared with bunion corrections performed through 2 incisions. The study included 117 feet (of 98 patients) with moderate to severe hallux valgus. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain scores, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal (MTP)-interphalangeal (IP) scores, first MTP joint range of motion (ROM), and patient satisfaction after the surgery were evaluated. Radiographically, the hallux valgus angle (HVA), intermetatarsal angle (IMA), hallux valgus interphalangeal angle (HIA), medial sesamoid position (MSP), and first to fifth metatarsal width (1-5MTW) were analyzed before and after surgery. The mean AOFAS hallux score improved from 56.3 preoperatively to 90.6 at the final follow-up, and the mean VAS pain score decreased from 6.8 preoperatively to 1.5 at the final follow-up (P < .001). Ninety-five percent of the patients were satisfied with the surgery. Radiographically, the mean HVA decreased from 36.1 degrees (range, 16.0 to 44.0 degrees) preoperatively to 5.4 degrees (range, -12.4 to 29.7 degrees) at the final follow-up (P < .001), and the mean IMA decreased from 19.0 degrees (range, 9.0 to 28.0 degrees) preoperatively to 4.5 degrees (range, -5.0 to 14.2 degrees) at the final follow-up (P < .001). The mean 1-5MTW also decreased by 16% (16 mm) from 97.3 mm (range, 85.0 to 110.0 mm) preoperatively to 81.3 mm (range, 70.0 to 95.0 mm) at the final follow-up (P < .001). We achieved very favorable clinical and radiographic outcomes

Ninety-degree chevron osteotomy for correction of hallux valgus deformity: clinical data and finite element analysis.

PubMed

Matzaroglou, Charalambos; Bougas, Panagiotis; Panagiotopoulos, Elias; Saridis, Alkis; Karanikolas, Menelaos; Kouzoudis, Dimitris

2010-04-22

Hallux valgus is a very common foot disorder, with its prevalence estimated at 33% in adult shoe-wearing populations. Conservative management is the initial treatment of choice for this condition, but surgery is sometimes needed. The 60(0) angle Chevron osteotomy is an accepted method for correction of mild to moderate hallux valgus in adults less than 60 years old. A modified 90(0) angle Chevron osteotomy has also been described; this modified technique can confer some advantages compared to the 60(0) angle method, and reported results are good. In the current work we present clinical data from a cohort of fifty-one female patients who had surgery for sixty-two hallux valgus deformities. In addition, in order to get a better physical insight and study the mechanical stresses along the two osteotomies, Finite Element Analysis (FEA) was also conducted. FEA indicated enhanced mechanical bonding with the modified 90(0) Chevron osteotomy, because the compressive stresses that keep the two bone parts together are stronger, and the shearing stresses that tend to slide the two bone parts apart are weaker, compared to the typical 60(0) technique. Follow-up data on our patient cohort show good or excellent long-term clinical results with the modified 90(0) angle technique. These results are consistent with the FEA-based hypothesis that a 90(0) Chevron osteotomy confers certain mechanical advantages compared to the typical 60(0) procedure.

Distal chevron osteotomy with lateral soft tissue release for moderate to severe hallux valgus decided using intraoperative varus stress radiographs.

PubMed

Kim, Hyong-Nyun; Park, Yoo-Jung; Kim, Gab-Lae; Park, Yong-Wook

2013-01-01

The purpose of the present study was to investigate the outcomes of distal chevron osteotomy with lateral soft tissue release for moderate to severe hallux valgus. The patients were selected using criteria that included the degree of lateral soft tissue contracture and metatarsocuneiform joint flexibility. The contracture and flexibility were determined from intraoperative varus stress radiographs. From April 2007 to May 2009, 56 feet in 51 consecutive patients with moderate to severe hallux valgus had undergone distal chevron osteotomy with lateral soft tissue release. This was done when the lateral soft tissue contracture was not so severe that passive correction of the hallux valgus deformity was not possible and when the metatarsocuneiform joint was flexible enough to permit additional correction of the first intermetatarsal angle after lateral soft tissue release. The mean patient age was 45.2 (range 23 to 54) years, and the duration of follow-up was 27.5 (range 24 to 46) months. The mean hallux abductus angle decreased from 33.5° ± 3.1° to 11.6° ± 3.3°, and the first intermetatarsal angle decreased from 16.4° ± 2.7° to 9.7° ± 2.1°. The mean American Orthopaedic Foot and Ankle Society hallux-interphalangeal scores increased from 66.6° ± 10.7° to 92.6° ± 9.4° points, and 46 of the 51 patients (90%) were either very satisfied or satisfied with the outcome. No recurrence of deformity or osteonecrosis of the metatarsal head occurred. When lateral soft tissue contracture is not severe and when the metatarsocuneiform joint is flexible enough, distal chevron osteotomy with lateral soft tissue release can be a useful and effective choice for moderate to severe hallux valgus deformity. Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

The Gibson and Piggott osteotomy for adult hallux valgus.

PubMed

Rangrez, Arshad Bashir; Dar, Tahir Ahmed; Badoo, Abdul Rashid; Wani, Sharief Ahmed; Dhar, Shabir Ahmed; Mumtaz, Imran; Ahmed, Muzzaffar

2012-01-01

The Gibson and Piggott procedure for hallux valgus is based on sound surgical principles addressing the basic pathologies of this disorder. However, this procedure has not been studied extensively in the literature in comparison to the Mitchell and Chevron osteotomies. We report a prospective study conducted on 50 adult feet with hallux valgus. The Gibson and Piggot osteotomy was done on all the feet. We obtained 76% excellent and 18% good results with this procedure. The results bear out the fact that this procedure is a useful procedure for the management of this disorder.

[Application of three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy].

PubMed

Zhang, Yu-Hang; Bi, Da-Wei; Chen, Yi-Min; Zu, Gang; Ma, Hai-Tao

2018-03-25

To explore clinical application of three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy. From May 2013 to May 2016, 47 patients(66 feet) with mild to moderate hallux valgus treated by Chevron osteotomy according to different preoperative design were divided into computer osteotomy group(group A) and traditional osteotomy group(group B). In group A, there were 25 patients (33 feet), including 4 males(5 feet) and 21 females(28 feet) with an average age of (47.88±6.08) years old, average weight IMA was (13.58±1.15) degree, AOFAS score was 59.00±5.86, and treated individual 3D printing technology to design operation scheme. While in group B, there were 22 patients (33 feet), including 3 males (3 feet) and 19 females (28 feet) with an average age of (48.16±6.16) years old, average weight IMA was(13.51±1.14) degree, AOFAS score was 60.67±5.85, and treated with osteotomy according to surgical experience. Operation time, blood loss, hospital stays, VAS score at 1 week after operation, wound healing and improvement of postoperative weight-bearing intermetatarsal angle(IMA) were compared between two groups, AOFAS score system was used to evaluate ankle function after surgery. There was no significant difference in following-up between group A 12.41±2.32 and group B 11.73±2.76. There was 1 patient in group B were excluded. Others perform good wounds healing on the first stage after operation. There were no significant differences in operation time, blood loss, hospital stays and VAS score at 1 week after operation( P <0.05); IMA in group A was (5.21±0.88)°, (6.42±0.85)° in group B, and had significant differences between two groups ( t =5.68, P <0.05). There was obvious meaning in AOFAS score between group A 88.15±5.19 and group B 82.90±5.01( t =4.14, P <0.05). Fourteen feet in group A obtained excellent results and 19 feet good, while 5 feet in group B obtained excellent results and 27 feet good

Scarf versus chevron osteotomy in hallux valgus: a randomized controlled trial in 96 patients.

PubMed

Deenik, A R; Pilot, P; Brandt, S E; van Mameren, H; Geesink, R G T; Draijer, W F

2007-05-01

The degree of correction of hallux valgus deformity using a distal chevron osteotomy is reported as limited. The scarf osteotomy is reported to correct large intermetatarsal angles (IMA). The purpose of this study was to evaluate if one technique gave greater correction of the IMA and hallux valgus angle (HVA) than the other. After informed consent, 96 feet in 83 patients were randomized into two treatment groups (49 scarf and 47 chevron osteotomies). The results were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Valgus Scale and radiographic HVA and IMA measurements. At 27 (range 23-31) months followup both groups improved. The AOFAS score in the chevron group improved from 48 to 89 points and in the scarf group from 47 to 91 points. In the chevron group the HVA corrected from 30 to 17 degrees, and in the scarf group the HVA corrected from 29 to 18 degrees. In both groups, the IMA was corrected from 13 to 10 degrees. The differences were not statistically significant. Three patients in the chevron group developed a partial metatarsal head necrosis. In the scarf group, four patients developed grade 1 complex regional pain syndrome compared to one patient in the chevron group. No differences of statistical significance could be measured between the two groups with respect to the AOFAS score, HVA, and IMA. Although both groups showed good to excellent results, we favor the chevron osteotomy because the procedure is technically less demanding.

Interventions for treating hallux valgus (abductovalgus) and bunions.

PubMed

Ferrari, J; Higgins, J P T; Prior, T D

2004-01-01

general, there was no advantage or disadvantage using Keller's over the other techniques. When the distal osteotomy was compared to Keller's arthroplasty, the osteotomy showed evidence of improving the intermetatarsal angle and preserving joint range of motion. The arthroplasty was found to have less of an impact on walking ability compared to the arthrodesis. Six trials involving 309 participants compared chevron (and chevron-type) osteotomy with other techniques. The chevron osteotomy offered no advantages in these trials. For some outcomes, other techniques gave better results. Two of these trials (94 participants) compared a type of proximal osteotomy to a proximal chevron osteotomy and found no evidence of a difference in outcomes between techniques. Three trials involving 157 participants compared outcomes between original operations and surgeon's adaptations. There was no advantage found for any of the adaptations. Three trials involving 71 people with hallux valgus compared new methods of fixation to traditional methods. There was no evidence that the new methods of fixation were detrimental to the outcome of the patients. Four trials involving 162 participants evaluated methods of post-operative rehabilitation. The use of continuous passive motion appeared to give an improved range of motion and earlier recovery following surgery. Early weightbearing or the use of a crepe bandage were not found to be detrimental to final outcome. Only a few studies had considered conservative treatments. The evidence from these suggested that orthoses and night splints did not appear to be any more beneficial in improving outcomes than no treatment. Surgery (chevron osteotomy) was shown to be beneficial compared to orthoses or no treatment, but when compared to other osteotomies, no technique was shown to be superior to any other. Only one trial had compared an osteotomy to an arthroplasty. There was limited evidence to suggest that the osteotomy gat the osteotomy gave the better

Proximal Intermetatarsal Divergence in Distal Chevron Osteotomy for Hallux Valgus: An Overlooked Finding.

PubMed

Akpinar, Evren; Buyuk, Abdul Fettah; Cetinkaya, Engin; Gursu, Sarper; Ucpunar, Hanifi; Albayrak, Akif

2016-01-01

The goal of distal chevron osteotomy for hallux valgus is to restore proper first-toe joint alignment by performing lateral translation of the distal first metatarsal fragment (the metatarsal head). We hypothesized that in some patients this procedure might also result in involuntary medial translation of the proximal first metatarsal fragment, which we called proximal intermetatarsal divergence. The aim of the present study was to compare the pre- and postoperative radiographs of patients with hallux valgus to determine whether we could identify proximal intermetatarsal divergence. We retrospectively compared the pre- and postoperative radiographs of 29 feet in 28 patients treated with distal chevron osteotomy. Two different methods were used to measure the intermetatarsal angles: the anatomic intermetatarsal angle (aIMA) and the mechanical intermetatarsal angle (mIMA). The maximum intermetatarsal distance (MID) was also measured. We defined proximal intermetatarsal divergence as a postoperative increase in the aIMA or MID, coupled with a decrease in the mIMA. For data analysis, we divided the patients into low-angle (mild deformity) and high-angle (severe deformity) groups, according to their preoperative mIMA. The mean ± standard deviation patient age was 41 ± 14 years. In the low-angle group, the mean mIMA decreased (from 10.91° to 7.00°), the mean aIMA increased (from 11.80° to 13.55°), and the mean MID increased (from 17.97 mm to 20.60 mm; p = .001, for all). In the high-angle group, the mean mIMA decreased (from 14.30° to 6.90°; p = .001), the mean aIMA decreased (from 14.77° to 13.54°; p = .06), and the mean MID decreased (from 20.74 mm to 20.37 mm; p = .64). The results of our study suggest that proximal intermetatarsal divergence might occur after distal chevron osteotomy for hallux valgus, primarily in patients with a low preoperative mIMA. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All

Evaluating the Quality, Accuracy, and Readability of Online Resources Pertaining to Hallux Valgus.

PubMed

Tartaglione, Jason P; Rosenbaum, Andrew J; Abousayed, Mostafa; Hushmendy, Shazaan F; DiPreta, John A

2016-02-01

The Internet is one of the most widely utilized resources for health-related information. Evaluation of the medical literature suggests that the quality and accuracy of these resources are poor and written at inappropriately high reading levels. The purpose of our study was to evaluate the quality, accuracy, and readability of online resources pertaining to hallux valgus. Two search terms ("hallux valgus" and "bunion") were entered into Google, Yahoo, and Bing. With the use of scoring criteria specific to hallux valgus, the quality and accuracy of online information related to hallux valgus was evaluated by 3 reviewers. The Flesch-Kincaid score was used to determine readability. Statistical analysis was performed with t tests and significance was determined by P values <.05. Sixty-two unique websites were evaluated. Quality was significantly higher with use of the search term "bunion" as compared to "hallux valgus" (P = .045). Quality and accuracy were significantly higher in resources authored by physicians as compared to nonphysicians (quality, P = .04; accuracy, P < .001) and websites without commercial bias (quality, P = .038; accuracy, P = .011). However, the reading level was significantly more advanced for websites authored by physicians (P = .035). Websites written above an eighth-grade reading level were significantly more accurate than those written at or below an eighth-grade reading level (P = .032). The overall quality of online information related to hallux valgus is poor and written at inappropriate reading levels. Furthermore, the search term used, authorship, and presence of commercial bias influence the value of these materials. It is important for orthopaedic surgeons to become familiar with patient education materials, so that appropriate recommendations can be made regarding valuable resources. Level IV. © 2015 The Author(s).

Treatment of moderate hallux valgus by percutaneous, extra-articular reverse-L Chevron (PERC) osteotomy.

PubMed

Lucas y Hernandez, J; Golanó, P; Roshan-Zamir, S; Darcel, V; Chauveaux, D; Laffenêtre, O

2016-03-01

The aim of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a percutaneous extra-articular reverse-L chevron (PERC) osteotomy. A total of 38 patients underwent 45 procedures. There were 35 women and three men. The mean age of the patients was 48 years (17 to 69). An additional percutaneous Akin osteotomy was performed in 37 feet and percutaneous lateral capsular release was performed in 22 feet. Clinical and radiological assessments included the type of forefoot, range of movement, the American Orthopedic Foot and Ankle (AOFAS) score, a subjective rating and radiological parameters. The mean follow-up was 59.1 months (45.9 to 75.2). No patients were lost to follow-up. The mean AOFAS score increased from 62.5 (30 to 80) pre-operatively to 97.1 (75 to 100) post-operatively. A total of 37 patients (97%) were satisfied. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and the proximal articular set angle. The range of movement of the first metatarsophalangeal joint improved significantly.. There was more improvement in the range of movement in patients who had fixation of the osteotomy of the proximal phalanx. Preliminary results of this percutaneous approach are promising. This technique is reliable and reproducible. Its main asset is that it maintains an excellent range of movement. The PERC osteotomy procedure is an effective approach for surgical management of moderate hallux valgus which combines the benefits of percutaneous surgery with the versatility of the chevron osteotomy whilst maintaining excellent first MTPJ range of motion. ©2016 The British Editorial Society of Bone & Joint Surgery.

The influence of personality traits on the subjective outcome of operative hallux valgus correction.

PubMed

Radl, Roman; Leithner, Andreas; Zacherl, Maximilian; Lackner, Ursula; Egger, Josef; Windhager, Reinhard

2004-10-01

We studied prospectively the influence of personality traits on the subjective outcome of a chevron osteotomy in 42 patients with hallux valgus. The mean age of patients was 48.3 (20-70) years. Personality traits were evaluated by the means of the Freiburg Personality Inventory (FPI-R). Three months postoperatively 37 patients were satisfied, and five patients not satisfied with the operative procedure. The preoperative AOFAS Score improved from an average of 48.7 (30-65) points to 87.9 (50-100) points. A comparison of satisfied and dissatisfied patients revealed statistically significant differences in the personality traits aggressiveness (p=0.003), extraversion (p=0.001) and health worries (p=0.04). The postoperative hallux valgus angle was 12.2+/-7.8 degrees and 13.4+/-8.3 degrees (p=0.74) among satisfied and not satisfied patients, respectively, and the intermetatarsal angle (I-II) was 7.4+/-2.5 degrees and 7.6+/-4 degrees (p=0.89), respectively. The results suggest that the patient's subjective result after the operative correction may be influenced by some individual, personality profiles.

WITHDRAWN: Interventions for treating hallux valgus (abductovalgus) and bunions.

PubMed

Ferrari, Jill; Higgins, Julian Pt; Prior, Trevor D

2009-04-15

. In general, there was no advantage or disadvantage using Keller's over the other techniques. When the distal osteotomy was compared to Keller's arthroplasty, the osteotomy showed evidence of improving the intermetatarsal angle and preserving joint range of motion. The arthroplasty was found to have less of an impact on walking ability compared to the arthrodesis.Six trials involving 309 participants compared chevron (and chevron-type) osteotomy with other techniques. The chevron osteotomy offered no advantages in these trials. For some outcomes, other techniques gave better results. Two of these trials (94 participants) compared a type of proximal osteotomy to a proximal chevron osteotomy and found no evidence of a difference in outcomes between techniques.Three trials involving 157 participants compared outcomes between original operations and surgeon's adaptations. There was no advantage found for any of the adaptations.Three trials involving 71 people with hallux valgus compared new methods of fixation to traditional methods. There was no evidence that the new methods of fixation were detrimental to the outcome of the patients.Four trials involving 162 participants evaluated methods of post-operative rehabilitation. The use of continuous passive motion appeared to give an improved range of motion and earlier recovery following surgery. Early weightbearing or the use of a crepe bandage were not found to be detrimental to final outcome. Only a few studies had considered conservative treatments. The evidence from these suggested that orthoses and night splints did not appear to be any more beneficial in improving outcomes than no treatment. Surgery (chevron osteotomy) was shown to be beneficial compared to orthoses or no treatment, but when compared to other osteotomies, no technique was shown to be superior to any other. Only one trial had compared an osteotomy to an arthroplasty. There was limited evidence to suggest that the osteotomy gave the better outcomes. It

Hallux valgus in a historical French population: paleopathological study of 605 first metatarsal bones.

PubMed

Mafart, Bertrand

2007-03-01

To estimate the prevalence of hallux valgus in a historical population in France, to identify associated skeletal abnormalities, and to look for an influence of footwear changes through time. We studied the 605 first metatarsals found in the necropolis of the Notre-Dame-du-Bourg cathedral in Digne in the Alpes-de-Hautes-Provence region of southern France. The necropolis contains remains from the 5th to the 17th century. Hallux valgus was identified only in individuals older than 30years at death, and its prevalence increased significantly with age. Exostosis at the medial and dorsal aspects of the head of the first metatarsal were common in advanced forms. The prevalence was comparable in males and females in the Middle Ages but was significantly higher in males in the 16th and 17th centuries, whereas in contemporary populations females are selectively affected. The increase in the prevalence of hallux valgus over time suggests an influence of changes in footwear. The heeled shoes and boots made of stiff leather that men wore in premodern times probably promoted the development of hallux valgus. However, the prevalence of hallux valgus in women in western industrialized countries today is even higher than that in our historical population of older premodern individuals, suggesting an extremely deleterious effect of contemporary female footwear.

History of surgical treatments for hallux valgus.

PubMed

Galois, Laurent

2018-05-31

In the nineteenth century, the prevalent understanding of the hallux valgus was that it was purely an enlargement of the soft tissue, first metatarsal head, or both, most commonly caused by ill-fitting footwear. Thus, treatment had varying results, with controversy over whether to remove the overlying bursa alone or in combination with an exostectomy of the medial head. Since 1871, when the surgical technique was first described, many surgical treatments for the correction of hallux valgus have been proposed. A number of these techniques have come into fashion, and others have fallen into oblivion. Progress in biomechanical knowledge, and improvements in materials and supports have allowed new techniques to be developed over the years. We have developed techniques that sacrifice the metatarsophalangeal joint (arthrodesis, arthroplasties), as well as conservative procedures, and one can distinguish those which only involve the soft tissues from those that are linked with a first ray osteotomy.

[Clinical effect modified Chevron osteotomy combined with lateral tissue loosening in treating mild-moderate hallux valgus through internal signal approach].

PubMed

Chen, Xue-Qiang; Wu, Qun-Feng; Dong, Wei-Qin; Yu, Li-Xin; Li, Xiong-Feng

2018-03-25

To explore clinical effect of modified Chevron osteotomy combined with lateral tissue loosening for the treatment of mild-moderate hallux valgus through internal signal approach. From July 2015 to June 2016, 26 patients with mild-moderate hallux valgus treated with modified Chevron osteotomy combined with lateral tissue loosening through internal signal approach, including 2 males and 24 females aged from 45 to 65 years old with an average of(54.6±4.8) years old;the courses of diseases ranged from 1 to 5 months with an average of (7.5±3.3) months. Hallux valgus angle(HVA), inter metatarsal angle(IMA) were measured at 12 months after operation, and AOFAS score was applied to evaluate clinical effect before and after operation. All incisions were healed at stage I. No incision occurred infection, metatarsal necrosis and recurrence of hallux valgus deformity. Two patients occurred skin numbness caused by musculocutaneous nerve injury. Twenty-six patients were followed up from 6 to 12 months with an average of(9.12±2.06) months. HVA, IMA were(30.01±3.71)°, (14.00±1.50)° before operation and(9.41±4.16)°, (7.00±0.60)° after operation, which had significant difference. There was statistical significance in AOFAS score before operation 54.77±9.59 and after operation 92.73±5.47, and 19 cases obtained excellent results and 7 moderate. Modified Chevron osteotomy combined with full thread headless pressure screw fixation and lateral tissue loosening for the treatment of mild-moderate hallux valgus has advantages of excellent exposure, simple operation, stable fixation, rapid recovery. Akin osteotomy with internal capsulorrhaphy were used with lateral loosening and could recover soft tissue balance between lateral and internal, and could receive satisfied clinical effects. Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.

Bosch osteotomy and scarf osteotomy for hallux valgus correction.

PubMed

Maffulli, Nicola; Longo, Umile Giuseppe; Oliva, Francesco; Denaro, Vincenzo; Coppola, Cristiano

2009-10-01

Minimally invasive distal metatarsal osteotomies are becoming broadly accepted for correction of hallux valgus. We compared the duration of surgery, the length of hospital stay, the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Foot and Ankle Outcome Score (FAOS) in 36 patients who underwent a minimal incision subcapital osteotomy of the first metatarsal with 36 matched patients who had hallux valgus corrected by a scarf technique. The minimum follow-up was 2.1 years (mean, 2.5 years; range, 2.1-3.2 years). Patients having the osteotomy had similar AOFAS and FAOS scores with less operating time and earlier discharge. Less operative time may benefit the patients, and earlier discharge has financial implications for the hospital.

Increased hallux angle in children and its association with insufficient length of footwear: a community based cross-sectional study.

PubMed

Klein, Christian; Groll-Knapp, Elisabeth; Kundi, Michael; Kinz, Wieland

2009-12-17

Wearing shoes of insufficient length during childhood has often been cited as leading to deformities of the foot, particularly to the development of hallux valgus disorders. Until now, these assumptions have not been confirmed through scientific research. This study aims to investigate whether this association can be statistically proven, and if children who wear shoes of insufficient length actually do have a higher risk of a more pronounced lateral deviation of the hallux. 858 pre-school children were included in the study. The study sample was stratified by sex, urban/rural areas and Austrian province. The hallux angle and the length of the feet were recorded. The inside length of the children's footwear (indoor shoes worn in pre-school and outdoor shoes) were assessed. Personal data and different anthropometric measurements were taken. The risk of hallux valgus deviation was statistically tested by a stepwise logistic regression analysis and the relative risk (odds ratio) for a hallux angle > or = 4 degrees was calculated. Exact examinations of the hallux angle could be conducted on a total of 1,579 individual feet. Only 23.9% out of 1,579 feet presented a straight position of the great toe. The others were characterized by lateral deviations (valgus position) at different degrees, equalling 10 degrees or greater in 14.2% of the children's feet.88.8% of 808 children examined wore indoor footwear that was of insufficient length, and 69.4% of 812 children wore outdoor shoes that were too short. A significant relationship was observed between the lengthwise fit of the shoes and the hallux angle: the shorter the shoe, the higher the value of the hallux angle. The relative risk (odds ratio) of a lateral hallux deviation of > or = 4 degrees in children wearing shoes of insufficient length was significantly increased. There is a significant relationship between the hallux angle in children and footwear that is too short in length. The fact that the majority of the

Operative Treatment of Traumatic Hallux Valgus in Elite Athletes.

PubMed

Covell, D Jeff; Lareau, Craig R; Anderson, Robert B

2017-06-01

Traumatic hallux valgus is an increasingly common injury in the athletic population and represents a unique variant of turf toe. Failure to appropriately recognize and treat these injuries can lead to continued pain, decreased performance, progressive deformities, and ultimately degeneration of the hallux metatarsophalangeal joint. Limited literature currently exists to assist in the diagnosis, management, and operative treatment. Nineteen patients were reviewed in this series, including 12 National Football League, 6 college, and 1 high school player who was a college prospect. The average age for all patients at the time of surgery was 24.4 years (range, 19-33 years). Return to play and complications were evaluated. Overall, good operative results were obtained, with 74% of patients returning to their preinjury level of play at an average recovery time of 3.4 months. Traumatic hallux valgus is an increasingly common injury in the athletic population and represents a unique variant of turf toe. The impact of this injury cannot be overstated, as one-quarter of players were unable to return to play. Level IV, case series.

Proximal metatarsal osteotomy for hallux valgus: an audit of radiologic outcome after single screw fixation and full postoperative weightbearing

PubMed Central

2013-01-01

Background Proximal metatarsal osteotomy combined with a distal soft-tissue procedure is a common treatment for moderate to severe hallux valgus. Secure stabilisation of the metatarsal osteotomy is necessary to avoid complications such as delayed union, nonunion or malunion as well as loss of correction. The aim of this study was to report our results using a single screw for stabilisation of the osteotomy. Methods We retrospectively reviewed 151 patients with severe hallux valgus who were treated by the above mentioned way with full postoperative weightbearing in a stiff soled shoe. Mean age of patients at time of surgery was 54 years, 19 patients were male and 132 female. Assessment of clinical and radiographic results was performed after 2 days and 6 weeks. Results were also correlated to the experience of the performing surgeon. Results Mean preoperative HVA (hallux valgus angle) was 36.4 degrees, and then 3.5 degrees 2 days and 13.4 degrees 6 weeks after the procedure (p < 0.001). Mean preoperative IMA (intermetarsal angle) was 16.8 degrees, and then 6.4 degrees after 2 days and 9.8 degrees after 6 weeks (p < 0.001). Mean preoperative first metatarsal length of 56.4 mm decreased to 53.6 mm after 6 weeks. Possible non-union of the osteotomy was observed in 4 patients (2.6%) after 6 weeks. Performing residents (n = 40) operated in 65 minutes and attending surgeons (n = 111) in 45 minutes, with no significant differences in radiographic measurements between both groups. Conclusions Single screw stabilisation of proximal chevron osteotomy is a reliable method for treating severe hallux valgus deformities with satisfactory results. PMID:23725485

Equivalent correction in scarf and chevron osteotomy in moderate and severe hallux valgus: a randomized controlled trial.

PubMed

Deenik, Axel; van Mameren, Henk; de Visser, Enrico; de Waal Malefijt, Maarten; Draijer, Frits; de Bie, Rob

2008-12-01

Chevron osteotomy is a widely accepted osteotomy for correction of hallux valgus.(18) Algorithms were developed to overcome the limitations of distal osteotomies. Scarf osteotomy has become popular as a versatile procedure that should be able to correct most cases of acquired hallux valgus. The purpose of this study was to evaluate whether patients with moderate or severe hallux valgus have better correction with a scarf osteotomy as compared to chevron osteotomy. After informed consent, 136 feet in 115 patients were randomized to 66 scarf and 70 chevron osteotomies. Deformities of patients were classified as mild, moderate and severe according to IMA, and both groups were compared with independent t-tests. The results were measured using radiographic HVA, IMA and DMAA measurements. There were no statistical differences in HVA, IMA and DMAA between scarf and chevron osteotomy in mild to moderate hallux valgus. In severe hallux valgus, chevron osteotomy corrected HVA better than scarf osteotomy, although this group consisted of twelve patients only. Five patients in the chevron group and seven in the scarf group developed recurrent subluxation of the metatarsophalangeal joint. In patients with moderate and severe hallux valgus, the results of chevron osteotomy were at least as effective as a scarf osteotomy. Recurrent subluxation of the first metatatarsophalangeal joint was the main cause for insufficient correction. We favor the chevron osteotomy because it is less invasive, without sacrificing correction of HVA and IMA.

[Clinical and radiographic evaluation of a new percutaneous technique for moderate to severe hallux valgus deformity].

PubMed

Vélez-de Lachica, J C; Valdez-Jiménez, L A; Inzunza-Sánchez, J M

2017-01-01

Hallux valgus is considered the most common musculoskeletal deformity, with a prevalence of 88%. There are more than 130 surgical techniques for its treatment; currently, percutaneous ones are popular; however, they do not take into account the metatarsal-phalangeal correction angle. The aim of this study is to propose a modified technique for the correction of the percutaneous metatarsal-phalangeal and inter-metatarsal angles and to evaluate its clinical and radiological results. An experimental, prospective and longitudinal study in 10 patients with moderate to severe hallux valgus according to the classification of Coughlin and Mann were collected; the results were evaluated with the AOFAS scale at 15, 30, 60 and 90 days. The McBride technique and the technique of percutaneous anchor with the proposed amendment were performed. The AOFAS scale was applied as described, finding a progressive increase of the rating; the average correction of the inter-metatarsal angle was 8.8 degrees and of the metatarsal-phalangeal, 9.12. The modified technique of percutaneous anchor showed clear clinical and radiographic improvements in the short term. Our modified technique is proposed for future projects, including a large sample with long-term follow-up.

A comparison of proximal and distal Chevron osteotomy, both with lateral soft-tissue release, for moderate to severe hallux valgus in patients undergoing simultaneous bilateral correction: a prospective randomised controlled trial.

PubMed

Lee, K B; Cho, N Y; Park, H W; Seon, J K; Lee, S H

2015-02-01

Moderate to severe hallux valgus is conventionally treated by proximal metatarsal osteotomy. Several recent studies have shown that the indications for distal metatarsal osteotomy with a distal soft-tissue procedure could be extended to include moderate to severe hallux valgus. The purpose of this prospective randomised controlled trial was to compare the outcome of proximal and distal Chevron osteotomy in patients undergoing simultaneous bilateral correction of moderate to severe hallux valgus. The original study cohort consisted of 50 female patients (100 feet). Of these, four (8 feet) were excluded for lack of adequate follow-up, leaving 46 female patients (92 feet) in the study. The mean age of the patients was 53.8 years (30.1 to 62.1) and the mean duration of follow-up 40.2 months (24.1 to 80.5). After randomisation, patients underwent a proximal Chevron osteotomy on one foot and a distal Chevron osteotomy on the other. At follow-up, the American Orthopedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal interphalangeal (MTP-IP) score, patient satisfaction, post-operative complications, hallux valgus angle, first-second intermetatarsal angle, and tibial sesamoid position were similar in each group. Both procedures gave similar good clinical and radiological outcomes. This study suggests that distal Chevron osteotomy with a distal soft-tissue procedure is as effective and reliable a means of correcting moderate to severe hallux valgus as proximal Chevron osteotomy with a distal soft-tissue procedure. ©2015 The British Editorial Society of Bone & Joint Surgery.

Preoperative radiological factors correlated to long-term recurrence of hallux valgus following distal chevron osteotomy.

PubMed

Pentikainen, Ilkka; Ojala, Risto; Ohtonen, Pasi; Piippo, Jouni; Leppilahti, Juhana

2014-12-01

The purpose of this article was to analyze the long-term radiologic results after distal chevron osteotomy for hallux valgus treatment and to determine the preoperative radiographic factors correlating with radiological recurrence of the deformity. The study included 100 consecutive patients who received distal chevron osteotomy for hallux valgus. The osteotomy included fixation with an absorbable pin in 50 cases, and no fixation in the other 50. For 6 weeks postoperatively, half of each group used a soft cast and half had a traditional elastic bandage. Weight-bearing radiographs were evaluated at 6 weeks, 6 months, 1 year, and a mean of 7.9 (range, 5.8-9.4) years postoperatively. At the final follow-up, radiological recurrence of hallux valgus deformity (HVA > 15 degrees) was observed in 56 feet (73%). Eleven feet (14%) had mild recurrence (HVA < 20 degrees), 44 (57%) moderate (20 degrees ≥ HVA < 40 degrees), and 1 (1%) severe (HVA ≥ 40 degrees). All recurrences were painless, and thus no revision surgery was required. Long-term hallux valgus recurrence was significantly affected by preoperative congruence, DMAA, sesamoid position, HVA, and I/II IMA. Radiological recurrence of hallux valgus deformity of 15 degrees or more was very common at long-term follow-up after distal chevron osteotomy. Preoperative congruence, DMAA, sesamoid position (LaPorta), HVA, and I/II IMA significantly affected recurrence. Level III, comparative case series. © The Author(s) 2014.

Comparison of distal chevron osteotomy with and without lateral soft tissue release for the treatment of hallux valgus.

PubMed

Lee, Ho-Jin; Chung, Jin-Wha; Chu, In-Tak; Kim, Yoon-Chung

2010-04-01

A lateral soft tissue release is often performed with distal chevron osteotomy for the correction of hallux valgus deformities. However, many complications of lateral soft tissue release have been reported. To define the necessity of lateral soft tissue release, the authors compared the clinical and radiographic results of distal chevron osteotomy with and without it. 86 consecutive patients (152 feet) were enrolled in this prospective study. In Group A, 45 patients (74 feet) underwent a chevron osteotomy with lateral soft tissue release. In Group B, 41 patients (78 feet) underwent a chevron osteotomy without it. Mean followup was 1.7 years and 2.1 years, respectively. The hallux valgus angle (HVA) and intermetatarsal angle (IMA), and AOFAS score were measured preoperatively, and 1-year followup postoperatively and complications were evaluated. The change in HVA, IMA and AOFAS score were insignificant (p > 0.05) between Group A and Group B, however, the range of motion of the first metatarsophalangeal joint was significantly less in Group A (p < 0.05). Complications of digital neuritis and cosmetically dissatisfied scarring of the dorsal web space were seen only in Group A. No cases had avascular necrosis of the metatarsal head, malunion or nonunion. Lateral soft tissue release may not be needed for mild or moderate hallux valgus deformities which may prevent decreased range of motion of the first metatarsophalangeal joint, neuritis of dorsal or plantar lateral digital nerve and cosmetic dissatisfaction of a dorsal scar.

The results of Scarf osteotomy combined with distal soft tissue procedure are mostly satisfactory in surgical management of moderate to severe hallux valgus.

PubMed

Şaylı, Uğur; Akman, Budak; Tanrıöver, Altuğ; Kaspar, Çiğdem; Güven, Melih; Özler, Turhan

2017-05-29

Intrinsically stable diaphyseal osteotomy gained popularity in recent years for symptomatic hallux valgus deformities. In this study, Scarf osteotomy results, in surgical management of moderate to severe hallux valgus, are presented. Study group consisted of 40 feet of 32 (28 females, four males) patients surgically managed by Scarf osteotomy between September 2009 and 2011, with a mean age of 52,98 (range, 31-75) years at the time of surgery. Patient satisfaction and VAS were used for subjective evaluation while for objective measures AOFAS score, first metatarsophalangeal joint ROM and radiological measurements (intermetatarsal, hallux valgus and distal metatarsal articular angles) were evaluated. Mean follow-up period was 38 (range, 24-60) months. Sixteen feet (40%) were reported as very satisfied, 19 (47,5%) as satisfied and the remaining five (12,5%) as unsatisfied resulting with a total of 35 (87,5%) satisfaction. The mean preoperative VAS and AOFAS forefoot scores improved from 8,13±0,791 to 2,68±1,228 (p=0,0001) and from 58,25±6,15 to 78,25±8,13 (p=0,0001) on the final follow-up, respectively. The postoperative change of first metatarsophalangeal joint ROM was not statistically significant (p=0,281). On the radiological evaluation; intermetatarsal and hallux valgus angles improved from a mean value of 14,77±1,76 to 8,13±1,52° (p=0,0001) and from 35,28±5,86 to 20,10±5,55° (p=0,0001), respectively. Distal metatarsal articular angle did not show any statistically significant change (p=0,195). Scarf osteotomy combined with distal soft tissue procedure is a technically demanding procedure. The osteotomy is intrinsically stable and the correction power is high and the results are mostly satisfactory. Copyright © 2017. Published by Elsevier Ltd.

A Prospective Study of Distal Metatarsal Chevron Osteotomies with K-Wire Fixations to Treat Hallux Valgus Deformities.

PubMed

Baig, M N; Baig, Usman; Tariq, Ali; Din, Robert

2017-09-20

Introduction Hallux valgus is one of the most common forefoot deformities worldwide. Females are affected more often than males. The three most common clinical symptoms are the painful bunion, transfer metatarsalgia, and hammer or claw toes. Methods This case series consisted of 20 patients who had chevron osteotomy from January 2015 to January 2016. The clinical assessment was measured by The American Orthopedic Foot and Ankle Score (AOFAS), and radiologic assessment was determined by preoperative and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA). Results The patients' mean age was 56 years. Out of 20 patients, 19 were female, and one was male. The mean AOFAS improved from 51 preoperatively to 82 postoperatively. The HVA improved from 26° preoperatively to 14°. There were five complications including four Kirschner (K)-wire complications. Conclusion Distal chevron osteotomy is a reliable and time-tested procedure. The K-wire fixation has a relatively high complication rate. We planned to use other methods of fixation and then compared them with K-wires fixation results for future studies.

A Prospective Study of Distal Metatarsal Chevron Osteotomies with K-Wire Fixations to Treat Hallux Valgus Deformities

PubMed Central

Baig, Usman; Tariq, Ali; Din, Robert

2017-01-01

Introduction Hallux valgus is one of the most common forefoot deformities worldwide. Females are affected more often than males. The three most common clinical symptoms are the painful bunion, transfer metatarsalgia, and hammer or claw toes. Methods This case series consisted of 20 patients who had chevron osteotomy from January 2015 to January 2016. The clinical assessment was measured by The American Orthopedic Foot and Ankle Score (AOFAS), and radiologic assessment was determined by preoperative and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA). Results The patients’ mean age was 56 years. Out of 20 patients, 19 were female, and one was male. The mean AOFAS improved from 51 preoperatively to 82 postoperatively. The HVA improved from 26° preoperatively to 14°. There were five complications including four Kirschner (K)-wire complications. Conclusion Distal chevron osteotomy is a reliable and time-tested procedure. The K-wire fixation has a relatively high complication rate. We planned to use other methods of fixation and then compared them with K-wires fixation results for future studies. PMID:29167752

[Treatment of Hallux Valgus: Current Diagnostic Testing and Surgical Treatment Performed by German Foot and Ankle Surgeons].

PubMed

Arbab, Dariusch; Schneider, Lisa-Maria; Schnurr, Christoph; Bouillon, Bertil; Eysel, Peer; König, Dietmar Pierre

2018-04-01

Hallux valgus is one of the most prevalent foot deformities, and surgical treatment of Hallux valgus is one of the most common procedures in foot and ankle surgery. Diagnostic and treatment standards show large variation despite medical guidelines and national foot and ankle societies. The aim of this nationwide survey is a description of the current status of diagnostics and therapy of Hallux valgus in Germany. A nationwide online questionnaire survey was sent to two German foot and ankle societies. The participants were asked to answer a questionnaire of 53 questions with four subgroups (general, diagnostics, operation, preoperative management). Surgical treatment for three clinical cases demonstrating a mild, moderate and severe Hallux valgus deformity was inquired. 427 foot and ankle surgeons answered the questionnaire. 388 participants were certified foot and ankle surgeons from one or both foot and ankle societies. Medical history (78%), preoperative radiographs (100%) and preoperative radiographic management (78%) are of high or very high importance for surgical decision pathway. Outcome scores are used by less than 20% regularly. Open surgery is still the gold standard, whereas minimally invasive surgery is performed by only 7%. Our survey showed that diagnostic standards are met regularly. There is a wide variation in the type of procedures used to treat Hallux valgus deformity. TMT I arthrodesis is preferred in severe Hallux valgus, but also used to treat moderate and mild deformities. Minimally invasive surgery is still used by a minority of surgeons. It remains to be seen, to what extent minimally invasive surgery will be performed in the future. Georg Thieme Verlag KG Stuttgart · New York.

A comparison of proximal and distal chevron osteotomy for the correction of moderate hallux valgus deformity.

PubMed

Park, C-H; Jang, J-H; Lee, S-H; Lee, W-C

2013-05-01

The purpose of this study was to compare the results of proximal and distal chevron osteotomy in patients with moderate hallux valgus. We retrospectively reviewed 34 proximal chevron osteotomies without lateral release (PCO group) and 33 distal chevron osteotomies (DCO group) performed sequentially by a single surgeon. There were no differences between the groups with regard to age, length of follow-up, demographic or radiological parameters. The clinical results were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and the radiological results were compared between the groups. At a mean follow-up of 14.6 months (14 to 32) there were no significant differences in the mean AOFAS scores between the DCO and PCO groups (93.9 (82 to 100) and 91.8 (77 to 100), respectively; p = 0.176). The mean hallux valgus angle, intermetatarsal angle and sesamoid position were the same in both groups. The metatarsal declination angle decreased significantly in the PCO group (p = 0.005) and the mean shortening of the first metatarsal was significantly greater in the DCO group (p < 0.001). We conclude that the clinical and radiological outcome after a DCO is comparable with that after a PCO; longer follow-up would be needed to assess the risk of avascular necrosis.

Clinical and Radiological Outcomes Comparing Percutaneous Chevron-Akin Osteotomies vs Open Scarf-Akin Osteotomies for Hallux Valgus.

PubMed

Lai, Mun Chun; Rikhraj, Inderjeet Singh; Woo, Yew Lok; Yeo, William; Ng, Yung Chuan Sean; Koo, Kevin

2018-03-01

Minimally invasive surgeries have gained popularity due to less soft tissue trauma and better wound healing. To date, limited studies have compared the outcomes of percutaneous and open osteotomies. This study aims to investigate the clinical and radiological outcomes of percutaneous chevron-Akin osteotomies vs open scarf-Akin osteotomies at 24-month follow-up. We reviewed a prospectively collected database in a tertiary hospital hallux valgus registry. Twenty-nine feet that underwent a percutaneous technique were matched to 58 feet that underwent open scarf and Akin osteotomies. Clinical outcome measures assessed included visual analog scale (VAS) scores, American Orthopaedic Foot & Ankle Society Hallux Metatarsophalangeal-Interphalangeal score (AOFAS Hallux MTP-IP), and Short Form 36 (SF-36) Health Survey. Radiological outcomes included hallux valgus angle (HVA) and intermetatarsal angle (IMA). All patients were prospectively followed up at 6 and 24 months. Both groups showed comparable clinical and radiological outcomes at the 24-month follow-up. However, the percutaneous group demonstrated less pain in the perioperative period ( P < .001). There were significant differences in the change in HVA between the groups but comparable radiological outcomes in IMA at the 24-month follow-up. The percutaneous group demonstrated shorter length of operation ( P < .001). There were no complications in the percutaneous group but 3 wound complications in the open group. We conclude that clinical and radiological outcomes of third-generation percutaneous chevron-Akin osteotomies were comparable with open scarf and Akin osteotomies at 24 months but with significantly less perioperative pain, shorter length of operation, and less risk of wound complications. Level III, retrospective comparative series.

[Dynamic plantar pressure distribution after percutaneous hallux valgus correction using the Reverdin-Isham osteotomy].

PubMed

Rodríguez-Reyes, Gerardo; López-Gavito, Eduardo; Pérez-Sanpablo, Alberto Isaac; Galván Duque-Gastélum, Carlos; Alvarez-Camacho, Michelín; Mendoza-Cruz, Felipe; Parra-Téllez, Patricia; Vázquez-Escamilla, Jesús; Quiñones-Urióstegui, Ivett

2014-07-01

Percutaneous surgical techniques are suitable for the correction of the hallux valgus deformity. Satisfactory aesthetic and functional results obtained with the Reverdin- Isham osteotomy have been reported. The aim of this study was to describe dynamic plantar pressure redistribution after the correction of the deformity using this technique. A sample of 20 feet with mild or moderate hallux valgus was conformed and surgically treated using the Reverdin-Isham osteotomy. Clinical, radiological, surface and pressure assessments were performed pre and postoperatively. Postoperative mean (± SD) values of the American Orthopaedic Foot and Ankle Society (AOFAS) score, metatarsophalangeal, first intermetatarsal and proximal articular sect angles were 95.7 (3.3), 15.5° (5.4), 9.5° (1.5) y 5.3° (3.0), respectively. A significant decrease was observed in surface values of both lateral (P = 0.003) and medial (P = 0.001) masks of the forefoot. Mean pressure values of the lateral forefoot region denoted a significant increase (P < 0.001) while the medial forefoot region showed no change (P = 0.137). There is evidence that this particular surgical technique promotes a new plantar pressure pattern in the foot that might significantly favour the increase of the pressure observed under the lesser metatarsal heads and might not induce meaningful changes in the mean pressure registered under the first metatarsal head and hallux.

Footwear modification following hallux valgus surgery: The all-or-none phenomenon.

PubMed

Robinson, Cal; Bhosale, Abhijit; Pillai, Anand

2016-06-26

To define footwear outcomes following hallux valgus surgery, focusing on patient return to comfortable and heeled footwear and patterns of post-operative footwear selection. Surgical intervention is indicated for symptomatic cases of hallux valgus unresponsive to conservative methods, with favourable reported outcomes. The return to various types of footwear post-operatively is reflective of the degree of correction achieved, and corresponds to patient satisfaction. Patients are expected to return to comfortable footwear post-operatively without significant residual symptoms. Many female patients will additionally attempt to return to high-heeled, narrow toe box shoes. However, minimal evidence exists to guide their expectations. Sixty-five female hallux valgus patients that had undergone primary surgery between 2011 and 2013 were retrospectively identified using our hospital surgical database. Patients were reviewed using a footwear-specific outcome questionnaire at a mean 18.5 mo follow-up. Eighty-six percent of patients were able to return to comfortable footwear post-operatively with minimal discomfort. Of those intending to resume wearing heeled footwear, 62% were able to do so, with 77% of these patients wearing these as or more frequently than pre-operatively. No significant difference was observed between pre- and post-operative heel size. Mean time to return to heeled footwear was 21.4 wk post-operation. Cosmetic outcomes were very high and did not adversely impact footwear selection. We report high rates of return to both comfortable and heeled shoes in female patients following primary hallux valgus surgery. We observed an "all-or-none phenomenon" where patients rejected a return to heeled footwear unless able to tolerate them at the same frequency and heel size as pre-operatively. A minority of patients were unable to return to comfortable footwear post-operatively, which had adverse ramifications on their quality-of-life. We recommend that the

Footwear modification following hallux valgus surgery: The all-or-none phenomenon

PubMed Central

Robinson, Cal; Bhosale, Abhijit; Pillai, Anand

2016-01-01

AIM: To define footwear outcomes following hallux valgus surgery, focusing on patient return to comfortable and heeled footwear and patterns of post-operative footwear selection. METHODS: Surgical intervention is indicated for symptomatic cases of hallux valgus unresponsive to conservative methods, with favourable reported outcomes. The return to various types of footwear post-operatively is reflective of the degree of correction achieved, and corresponds to patient satisfaction. Patients are expected to return to comfortable footwear post-operatively without significant residual symptoms. Many female patients will additionally attempt to return to high-heeled, narrow toe box shoes. However, minimal evidence exists to guide their expectations. Sixty-five female hallux valgus patients that had undergone primary surgery between 2011 and 2013 were retrospectively identified using our hospital surgical database. Patients were reviewed using a footwear-specific outcome questionnaire at a mean 18.5 mo follow-up. RESULTS: Eighty-six percent of patients were able to return to comfortable footwear post-operatively with minimal discomfort. Of those intending to resume wearing heeled footwear, 62% were able to do so, with 77% of these patients wearing these as or more frequently than pre-operatively. No significant difference was observed between pre- and post-operative heel size. Mean time to return to heeled footwear was 21.4 wk post-operation. Cosmetic outcomes were very high and did not adversely impact footwear selection. CONCLUSION: We report high rates of return to both comfortable and heeled shoes in female patients following primary hallux valgus surgery. We observed an “all-or-none phenomenon” where patients rejected a return to heeled footwear unless able to tolerate them at the same frequency and heel size as pre-operatively. A minority of patients were unable to return to comfortable footwear post-operatively, which had adverse ramifications on their quality

Chevron versus Mitchell osteotomy in hallux valgus surgery: a comparative study.

PubMed

Lambers Heerspink, F O; Verburg, H; Reininga, I H F; van Raaij, T M

2015-01-01

Good clinical results have been reported for chevron and Mitchell osteotomies in mild hallux valgus (HV). The primary aim of the present study was to compare first metatarsal shortening after chevron and Mitchell osteotomies in HV. The secondary outcome measures were the degree of valgus correction, metatarsalgia, and patient satisfaction. A total of 84 patients were included in the present study and were treated from 2005 to 2007; 42 patients were in each group. The outcome measurements-first metatarsal length, HV angle, 1-2 intermetatarsal angle, satisfaction, and metatarsalgia-were taken preoperatively and at follow-up. The Mitchell osteotomy resulted in a significantly larger decrease in the first metatarsal length. No significant difference in transfer metatarsalgia was found. Approximately 30% of patients were mildly or not satisfied after HV surgery. Mitchell osteotomy leads to a larger decrease in the first metatarsal length. Patients with metatarsalgia performed poorly, and no significant differences in metatarsalgia were found. Preventing postoperative metatarsalgia is important for a successful outcome after HV surgery. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Impact of Podiatry Resident Experience Level in Hallux Valgus Surgery on Postoperative Outcomes

PubMed Central

Fleischer, Adam E.; Yorath, Martin C.; Joseph, Robert; Baron, Adam; Nordquist, Thomas; Moore, Braden; Robinson, Richmond; Reilly, Charles

2018-01-01

Background Despite modern advancements in transosseous fixation and operative technique, hallux valgus (i.e., bunion) surgery is still associated with a higher than usual amount of patient dissatisfaction, and is generally recognized as a complex and nuanced procedure requiring precise osseous and capsulotendon balancing. It stands to reason then that familiarity and skill level of trainee surgeons might impact surgical outcomes in this surgery. The aim of this study was to determine whether podiatry resident experience level influences mid-term outcomes in hallux valgus surgery. Methods Consecutive adults who underwent isolated hallux valgus surgery via distal metatarsal osteotomy at a single US metropolitan teaching hospital from January 2004 to January 2009 were contacted and asked to complete a validated outcome measure of foot health (Manchester-Oxford Foot Questionnaire) regarding their operated foot. Resident experience level was quantified using the surgical logs for the primary resident of record at the time of each case. Associations were assessed using simple, multiple and logistic regression analyses. Results A total of 102 adult patients (n=102 feet) agreed to participate with a mean age of 46.8 (SD 13.1 years, range 18-71) and average length of follow-up 6.2 years (SD 1.4, range 3.6-8.6). Level of trainee experience was not associated with postoperative outcomes in either the univariate (odds ratio 0.99 [95% CI 0.98-1.01], p = 0.827) or multivariate analyses (odds ratio 1.00 [95% CI 0.97-1.02], p = 0.907). Conclusions We conclude that podiatry resident level of experience in hallux valgus surgery does not contribute appreciably to postoperative clinical outcomes. PMID:24726058

Correction of moderate to severe hallux valgus with combined proximal opening wedge and distal chevron osteotomies: a reliable technique.

PubMed

Jeyaseelan, L; Chandrashekar, S; Mulligan, A; Bosman, H A; Watson, A J S

2016-09-01

The mainstay of surgical correction of hallux valgus is first metatarsal osteotomy, either proximally or distally. We present a technique of combining a distal chevron osteotomy with a proximal opening wedge osteotomy, for the correction of moderate to severe hallux valgus. We reviewed 45 patients (49 feet) who had undergone double osteotomy. Outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) and the Short Form (SF) -36 Health Survey scores. Radiological measurements were undertaken to assess the correction. The mean age of the patients was 60.8 years (44.2 to 75.3). The mean follow-up was 35.4 months (24 to 51). The mean AOFAS score improved from 54.7 to 92.3 (p < 0.001) and the mean SF-36 score from 59 to 86 (p < 0.001). The mean hallux valgus and intermetatarsal angles were improved from 41.6(o) to 12.8(o) (p < 0.001) and from 22.1(o) to 7.1(o), respectively (p < 0.001). The mean distal metatarsal articular angle improved from 23(o) to 9.7(o). The mean sesamoid position, as described by Hardy and Clapham, improved from 6.8 to 3.5. The mean length of the first metatarsal was unchanged. The overall rate of complications was 4.1% (two patients). These results suggest that a double osteotomy of the first metatarsal is a reliable, safe technique which, when compared with other metatarsal osteotomies, provides strong angular correction and excellent outcomes with a low rate of complications. Cite this article: Bone Joint J 2016;98-B:1202-7. ©2016 The British Editorial Society of Bone & Joint Surgery.

Inter and intra-observer reliability in assessment of the position of the lateral sesamoid in determining the severity of hallux valgus.

PubMed

Panchani, Sunil; Reading, Jonathan; Mehta, Jaysheel

2016-06-01

The position of the lateral sesamoid on standard dorso-plantar weight bearing radiographs, with respect to the lateral cortex of the first metatarsal, has been shown to correlate well with the degree of the hallux valgus angle. This study aimed to assess the inter- and intra-observer error of this new classification system. Five orthopaedic consultants and five trainee orthopaedic surgeons were recruited to assess and document the degree of displacement of the lateral sesamoid on 144 weight-bearing dorso-plantar radiographs on two separate occasions. The severity of hallux valgus was defined as normal (0%), mild (≤50%), moderate (51-≤99%) or severe (≥100%) depending on the percentage displacement of the lateral sesamoid body from the lateral cortical border of the first metatarsal. Consultant intra-observer variability showed good agreement between repeated assessment of the radiographs (mean Kappa=0.75). Intra-observer variability for trainee orthopaedic surgeons also showed good agreement with a mean Kappa=0.73. Intraclass correlations for consultants and trainee surgeons was also high. The new classification system of assessing the severity of hallux valgus shows high inter- and intra-observer variability with good agreement and reproducibility between surgeons of consultant and trainee grades. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Preemptive local anesthetic infiltration in hallux valgus one-day surgery].

PubMed

Gądek, Artur; Liszka, Henryk

2015-01-01

The surgical treatment of hallux valgus deformity is connected with significant postoperative pain. Spinal and general anesthesia as well as peripheral blocks are successfully used in foot surgery. The purpose of this study was to evaluate the influence of local anesthetic infiltration before hallux valgus one-day surgery on postoperative pain and the need for analgesics. 134 patients underwent chevron or miniinvasive Mitchell-Kramer osteotomy of the first distal metatarsal. After general anesthesia each patient randomly received an infiltration of 7ml of local anesthetic (4 ml of 0.25% bupivacaine and 3 ml of 2% lidocaine) or the same amount of normal saline 15 minutes before the skin incision. Both the patient and the surgeon were blinded. The patient was discharged after approximately 2 hours of observation. 2, 4, 8, 12, 16, 24 and 72 hours after the release of the tourniquet the level of pain was assessed by the visual analogue scale (VAS). Rescue analgesia, side effects and the use of painkillers were noted. Preemptive local anesthetic infiltration significantly decreased pain during the first 24 hours after the surgery. None of the patients from the injected group and 38 from the placebo group received 100 mg of ketoprofen intravenously for rescue analgesia in the first 2 hours after the release of the tourniquet. During the first 24 hours we noted significantly decreased use of 1000 mg of paracetamol and 100 mg mg of ketoprofen orally in the injected group. No systemic adverse effects were noted. One patient from placebo group had allergic rush after use of 100 mg ketoprofen. Preemptive local anesthetic infiltration in one-day hallux valgus surgery significantly decreases postoperative pain. It is safe, efficient and allows fast discharge.

Perioperative analgesia with a buprenorphine transdermal patch for hallux valgus surgery: a prospective, randomized, controlled study

PubMed Central

Xu, Can; Li, Mingqing; Wang, Chenggong; Li, Hui; Liu, Hua

2018-01-01

Purpose Hallux valgus surgery often results in significant postoperative pain. Adequate control of pain is essential for patient satisfaction and improves the outcome of the procedure. This study aimed to investigate the perioperative analgesic effect of a buprenorphine transdermal patch in patients who underwent hallux valgus surgery. Patients and methods A total of 90 patients were randomly divided into the following three groups based on the perioperative analgesic method: flurbiprofen axetil intravenous injection (Group F), oral celecoxib (Group C), and buprenorphine transdermal delivery system (BTDS) (Group BTDS). The pain status, degree of satisfaction, adverse effects, and administration of tramadol hydrochloride for uncontrolled pain were recorded on the night before surgery, postoperative day 1, postoperative day 2, and postoperative day 3. Results The BTDS could effectively control perioperative pain for patients undergoing hallux valgus surgery. The analgesic effect of the BTDS was better than that of oral celecoxib. In addition, statistically significant differences were not observed in the visual analog scale (VAS) scores, adverse effects, and rescue analgesia between the patients who received the BTDS and the patients who received the flurbiprofen axetil intravenous injection. However, the degree of patient satisfaction of the BTDS group was significantly higher (P<0.05) than that of the other two groups. Conclusion The BTDS (a preemptive analgesia regimen) could exert an analgesic effect during the perioperative period for patients who had received hallux valgus surgery, and this effect is beneficial for sustaining postoperative physiological and psychological states and promoting functional rehabilitation. PMID:29731664

Comparison of the proximal chevron and Ludloff osteotomies for the correction of hallux valgus.

PubMed

Choi, Woo Jin; Yoon, Han Kook; Yoon, Hang Seob; Kim, Bom Soo; Lee, Jin Woo

2009-12-01

Although several studies have described good results of proximal chevron and Ludloff osteotomies, there have been no studies comparing the results of these two techniques at a single institution. We consecutively evaluated 46 patients who underwent proximal chevron osteotomies and 52 patients who underwent Ludloff osteotomies. Patients were evaluated by preoperative and postoperative weight bearing radiographs and the American Orthopaedic Foot and Ankle Society (AOFAS) hallux MP score. Both groups had similarly high AOFAS scores and good correction by radiographic parameters. No statistically significant differences were found with respect to correction of hallux valgus angle (HVA) and intermetatarsal angle (IMA) between the two groups. Significant shortening of the first metatarsal was found after Ludloff osteotomy (p < 0.05). At 6 weeks after surgery, the pain subscore was significantly lower in the proximal chevron group than in the Ludloff group (p < 0.05). The proximal chevron and Ludloff osteotomies yielded equivalent clinical and radiological results. The Ludloff osteotomy with lag screw fixation is more stable and does not require postoperative hardware removal, although it is technically demanding and has a tendency toward greater shortening of the first metatarsal.

Being overweight has limited effect on SCARF osteotomy outcome for hallux valgus correction.

PubMed

Milczarek, Marcin A; Milczarek, Julia J; Tomasik, Bartłomiej; Łaganowski, Przemysław; Nowak, Krzysztof; Domżalski, Marcin

2017-04-01

The purpose of this study was to investigate the association between body mass index (BMI) and the results of SCARF osteotomy of the first metatarsal for hallux valgus (HV) correction, as the literature on this is scant. This prospective study was carried out between 2011 and 2015. One hundred and thirty-three patients diagnosed with moderate to severe HV underwent a SCARF corrective osteotomy. We divided the patients into two groups according to their BMI: normal and overweight. Postoperative follow-up was two years. All patients were examined twice by two medical doctors simultaneously: pre-operatively and post-operatively at two years' follow-up. Data collected included biometrical records, X-rays [HV angle (HVA), intermetatarsal angle (IMA), American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Index (AOFAS-HMI) and visual analogue scale (VAS) for pain and satisfaction]. There was a significant difference between patient age (p = 0.001), age at onset (p < 0.001) and AOFAS-HMI (p = 0.035) at follow-up. Other parameters were similar in both groups. Regardless of BMI, the radiological outcome was comparable. Despite a significant difference in AOFAS-HMI results, pain and satisfaction level were similar. The authors agreed that high BMI has protective role in the prevalence of HV.

Tensile Properties of the Deep Transverse Metatarsal Ligament in Hallux Valgus: A CONSORT-Compliant Article.

PubMed

Abdalbary, Sahar Ahmed; Elshaarawy, Ehab A A; Khalid, Bahaa E A

2016-02-01

The deep transverse metatarsal ligament (DTML) connects the neighboring2 metatarsal heads and is one of the stabilizers connecting the lateral sesamoid and second metatarsal head. In this study, we aimed to determine the tensile properties of the DTML in normal specimens and to compare these results with hallux valgus specimens. We hypothesized that the tensile properties of the DTML would be different between the 2 groups of specimens.The DTML in the first interspace was dissected from 12 fresh frozen human cadaveric specimens. Six cadavers had bilateral hallux valgus and the other 6 cadavers had normal feet. The initial length (L0) and cross-sectional area (A0) of the DTML were measured using a digital caliper, and tensile tests with load failure were performed using a material testing machine.There were significant between-groups differences in the initial length (L0) P = 0.009 and cross-sectional area (A0) of the DTML P = 0.007. There were also significant between-groups differences for maximum force (N) P = 0.004, maximum distance (mm) P = 0.005, maximum stress (N/mm) P = 0.003, and maximum strain (%) P = 0.006.The DTML is an anatomical structure for which the tensile properties differ in hallux valgus.

Comparison of distal soft-tissue procedures combined with a distal chevron osteotomy for moderate to severe hallux valgus: first web-space versus transarticular approach.

PubMed

Park, Yu-Bok; Lee, Keun-Bae; Kim, Sung-Kyu; Seon, Jong-Keun; Lee, Jun-Young

2013-11-06

There are two surgical approaches for distal soft-tissue procedures for the correction of hallux valgus-the dorsal first web-space approach, and the medial transarticular approach. The purpose of this study was to compare the outcomes achieved after use of either of these approaches combined with a distal chevron osteotomy in patients with moderate to severe hallux valgus. One hundred and twenty-two female patients (122 feet) who underwent a distal chevron osteotomy as part of a distal soft-tissue procedure for the treatment of symptomatic unilateral moderate to severe hallux valgus constituted the study cohort. The 122 feet were randomly divided into two groups: namely, a dorsal first web-space approach (group D; sixty feet) and a medial transarticular approach (group M; sixty-two feet). The clinical and radiographic results of the two groups were compared at a mean follow-up time of thirty-eight months. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale hallux metatarsophalangeal-interphalangeal scores improved from a mean and standard deviation of 55.5 ± 12.8 points preoperatively to 93.5 ± 6.3 points at the final follow-up in group D and from 54.9 ± 12.6 points preoperatively to 93.6 ± 6.2 points at the final follow-up in group M. The mean hallux valgus angle in groups D and M was reduced from 32.2° ± 6.3° and 33.1° ± 8.4° preoperatively to 10.5° ± 5.5° and 9.9° ± 5.5°, respectively, at the time of final follow-up. The mean first intermetatarsal angle in groups D and M was reduced from 15.0° ± 2.8° and 15.3° ± 2.7° preoperatively to 6.5° ± 2.2° and 6.3° ± 2.4°, respectively, at the final follow-up. The clinical and radiographic outcomes were not significantly different between the two groups. The final clinical and radiographic outcomes between the two approaches for distal soft-tissue procedures were comparable and equally successful. Accordingly, the results of this study suggest that the medial transarticular

Point-Connecting Measurements of the Hallux Valgus Deformity: A New Measurement and Its Clinical Application

PubMed Central

Seo, Jeong-Ho; Boedijono, Dimas

2016-01-01

Purpose The aim of this study was to investigate new point-connecting measurements for the hallux valgus angle (HVA) and the first intermetatarsal angle (IMA), which can reflect the degree of subluxation of the first metatarsophalangeal joint (MTPJ). Also, this study attempted to compare the validity of midline measurements and the new point-connecting measurements for the determination of HVA and IMA values. Materials and Methods Sixty feet of hallux valgus patients who underwent surgery between 2007 and 2011 were classified in terms of the severity of HVA, congruency of the first MTPJ, and type of chevron metatarsal osteotomy. On weight-bearing dorsal-plantar radiographs, HVA and IMA values were measured and compared preoperatively and postoperatively using both the conventional and new methods. Results Compared with midline measurements, point-connecting measurements showed higher inter- and intra-observer reliability for preoperative HVA/IMA and similar or higher inter- and intra-observer reliability for postoperative HVA/IMA. Patients who underwent distal chevron metatarsal osteotomy (DCMO) had higher intraclass correlation coefficient for inter- and intra-observer reliability for pre- and post-operative HVA and IMA measured by the point-connecting method compared with the midline method. All differences in the preoperative HVAs and IMAs determined by both the midline method and point-connecting methods were significant between the deviated group and subluxated groups (p=0.001). Conclusion The point-connecting method for measuring HVA and IMA in the subluxated first MTPJ may better reflect the severity of a HV deformity with higher reliability than the midline method, and is more useful in patients with DCMO than in patients with proximal chevron metatarsal osteotomy. PMID:26996576

Management of pain on hallux valgus with percutaneous intra-articular Pulse-Dose Radiofrequency.

PubMed

Masala, Salvatore; Fiori, Roberto; Calabria, Eros; Raguso, Mario; de Vivo, Dominique; Cuzzolino, Alessandro; Simonetti, Giovanni

2017-01-01

The purpose of our study was to investigate the role of intra-articular pulse-dose radiofrequency in management of painful hallux valgus refractory to conservative therapies. Between November 2010 and April 2012, 51 patients (15 male, 36 female) with a median age of 71.4 years were included in our clinical trial. Under fluoroscopic guidance we introduced a 22 gauge 10 cm length cannula by a percutaneous access in the first metatarsophalangeal joint and its tip was placed intra-articularly. After removing the spindle, a radiofrequency needle with a 5 mm active tip was introduced. The following parameters were used: 1200 pulses at high voltage (45 V) with 20 msec duration followed by 480 msec silent phases. A great reduction in pain intensity was documented at 1 week, 1 month and 3 months after procedures. Pain intensity increased between 5 and 8 months after treatments, so we performed a second procedure in all patients between 7 months and 9 months since the first treatment. Also in this case we obtained a great reduction of pain intensity in the first 3 months after the procedure. Pain intensity returned at preprocedural values after 9 months after second procedure. No complications were observed. Our experience shows pulse-dose radiofrequency is a safe, repeatable and effective technique for managing patients with symptomatic hallux valgus in the short and medium term. Pulse-dose radiofrequency may improve pain control and quality of life in patients with hallux valgus refractory to conservative therapies. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

Effect of medial arch support foot orthosis on plantar pressure distribution in females with mild-to-moderate hallux valgus after one month of follow-up.

PubMed

Farzadi, Maede; Safaeepour, Zahra; Mousavi, Mohammad E; Saeedi, Hassan

2015-04-01

Higher plantar pressures at the medial forefoot are reported in hallux valgus. Foot orthoses with medial arch support are considered as an intervention in this pathology. However, little is known about the effect of foot orthoses on plantar pressure distribution in hallux valgus. To investigate the effect of a foot orthosis with medial arch support on pressure distribution in females with mild-to-moderate hallux valgus. Quasi-experimental. Sixteen female volunteers with mild-to-moderate hallux valgus participated in this study and used a medial arch support foot orthosis for 4 weeks. Plantar pressure for each participant was assessed using the Pedar-X(®) in-shoe system in four conditions including shoe-only and foot orthosis before and after the intervention. The use of the foot orthosis for 1 month led to a decrease in peak pressure and maximum force under the hallux, first metatarsal, and metatarsals 3-5 (p < 0.05). In the medial midfoot region, peak pressure, maximum force, and contact area were significantly higher with the foot orthosis than shoe-only before and after the intervention (p = 0.00). A foot orthosis with medial arch support could reduce pressure beneath the hallux and the first metatarsal head by transferring the load to the other regions. It would appear that this type of foot orthosis can be an effective method of intervention in this pathology. Findings of this study will improve the clinical knowledge about the effect of the medial arch support foot orthosis used on plantar pressure distribution in hallux valgus pathology. © The International Society for Prosthetics and Orthotics 2014.

Rehabilitation after hallux valgus surgery: importance of physical therapy to restore weight bearing of the first ray during the stance phase.

PubMed

Schuh, Reinhard; Hofstaetter, Stefan G; Adams, Samuel B; Pichler, Florian; Kristen, Karl-Heinz; Trnka, Hans-Joerg

2009-09-01

Operative treatment of people with hallux valgus can yield favorable clinical and radiographic results. However, plantar pressure analysis has demonstrated that physiologic gait patterns are not restored after hallux valgus surgery. The purpose of this study was to illustrate the changes of plantar pressure distribution during the stance phase of gait in patients who underwent hallux valgus surgery and received a multimodal rehabilitation program. This was a prospective descriptive study. Thirty patients who underwent Austin (n=20) and scarf (n=10) osteotomy for correction of mild to moderate hallux valgus deformity were included in this study. Four weeks postoperatively they received a multimodal rehabilitation program once per week for 4 to 6 weeks. Plantar pressure analysis was performed preoperatively and 4 weeks, 8 weeks, and 6 months postoperatively. In addition, range of motion of the first metatarsophalangeal joint was measured, and the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot questionnaire was administered preoperatively and at 6 months after surgery. The mean AOFAS score significantly increased from 60.7 points (SD=11.9) preoperatively to 94.5 points (SD=4.5) 6 months after surgery. First metatarsophalangeal joint range of motion increased at 6 months postoperatively, with a significant increase in isolated dorsiflexion. In the first metatarsal head region, maximum force increased from 117.8 N to 126.4 N and the force-time integral increased from 37.9 N.s to 55.6 N.s between the preoperative and 6-month assessments. In the great toe region, maximum force increased from 66.1 N to 87.2 N and the force-time integral increased from 18.7 N.s to 24.2 N.s between the preoperative and 6-month assessments. A limitation of the study was the absence of a control group due to the descriptive nature of the study. The results suggest that postoperative physical therapy and gait training may lead to improved function and weight bearing of the first

L'ostéotomie de scarf dans le traitement de l'hallux valgus: à propos de 19 cas

PubMed Central

Boussakri, Hassan; Bachiri, Mohammed; Elidrissi, Mohammed; Shimi, Mohammed; Elibrahimi, Abdelhalim; Elmrini, Abdelmajid

2014-01-01

L'ostéotomie de Scarf constitue une technique chirurgicale bien décrite, grâce à ses résultats excellents, elle est considérée comme un traitement de choix de l'hallux valgus. Le but de ce travail est de décrire le profil épidémiologique et radio-clinique des hallux valgus, ainsi qu’évaluer les résultats radiologiques et fonctionnels des patients traités par la technique classique d'ostéotomie de Scarf. Nous avons mené une étude rétrospective, concernant 22 ostéotomies de Scarf chez 19 patients, opérés d'hallux valgus entre mai 2009 et janvier 2013. Le recul moyen était de 22,5 mois (3-42 mois). L'âge moyen des patients au moment de l'intervention était de 49 ans, avec des extrêmes de 19 et 75 ans. Tous les patients ont bénéficié d'une évaluation clinique et radiologique préopératoire et postopératoire ainsi qu'une analyse statistique. Au dernier recul, selon des critères subjectifs, nos résultats étaient très satisfaisants dans 42%, satisfaisants dans 52% et déçus dans 6%, et en fonction du score de l'AOFAS, les résultats étaient nettement améliorée avec un AOFAS préopératoire de 57% à 84% en postopératoire. Concernant les résultats radiologiques, la déformation métatarsophalangienne (angle M1P1) a été corrigée (43,63 °-12,8°) avec une p très significative (p <0,001). D'autre part une amélioration de l'Angle moyen M1M2, passer de 18,18° préopératoire à 12,95° au dernier recul, avec une correction significative (p <0,001). Le valgus épiphysaire de premier métatarsien (AADM) a été statistiquement amélioré (p <0,001), passer de 24,45° à 7,91°. Concernant les complications nous avons noté un cas de sepsis précoce superficiel géré par une antibiothérapie adaptée, deux cas de névrome et un cas d'ostéonécrose. Par contre on n'a pas noté aucune fracture per opératoire du premier métatarsien. Nous concluons que l'ostéotomie de Scarf est une technique reproductible fiable, en pleine �

Hallux Valgus Deformity and Treatment: A Three-Dimensional Approach: Modified Technique for Lapidus Procedure.

PubMed

Santrock, Robert D; Smith, Bret

2018-06-01

In a hallux valgus deformity, the problem is deviation of the hallux at the metatarsophalangeal joint and of the first metatarsal at the tarsometatarsal joint. Although anterior-posterior radiograph findings have been prioritized, deviation in the other planes can substantially change visible cues. The modified technique for Lapidus procedure procedure, uses all 3 planes to evaluate and correct the deformity, making radiographic measurements less useful. Using a triplane framework and focusing on the apex of the deformity, all bunions become the same modified technique for Lapidus procedure can be performed regardless of the degree of deformity, always includes triplane correction, and deformity size becomes irrelevant. Copyright © 2018 Elsevier Inc. All rights reserved.

Postoperative pain and preemptive local anesthetic infiltration in hallux valgus surgery.

PubMed

Gądek, Artur; Liszka, Henryk; Wordliczek, Jerzy

2015-03-01

Several techniques of anesthesia are used in foot surgery. Preemptive analgesia helps to prevent the development of hypersensitivity in the perioperative period. The aim of our study was to assess the role of preemptive local anesthetic infiltration and postoperative pain after hallux valgus surgery. We evaluated 118 patients who underwent modified chevron and mini-invasive Mitchell-Kramer bunionectomy of the first distal metatarsal. After spinal anesthesia each patient randomly received an infiltration of local anesthetic or the same amount of normal saline 10 minutes before the skin incision. We measured the intensity of pain 4, 8, 12, 16, 24, and 72 hours after the release of the tourniquet using a visual analogue scale (VAS). Rescue analgesia and all other side effects were noted. Preemptive analgesia resulted in less pain during the first 24 hours after surgery. The decrease of VAS score was significantly lower in the study group during all the short postoperative periods measured. The rescue analgesia was administered in 11.9% of patients in the injected group and 42.4% in the placebo group (P < .05). In the injected group we did not observe significant difference in VAS score between patients post-chevron and miniinvasive Mitchell-Kramer osteotomy of the first distal metatarsal. No systemic adverse effects were noted. One persistent injury of dorsomedial cutaneous nerve was observed. Preemptive local anesthetic infiltration was an efficient and safe method to reduce postoperative pain after hallux valgus surgery. The analgesic effect was satisfactory in both traditional and minimally invasive techniques. © The Author(s) 2014.

Karl Ludloff (1864-1945): An Inventive Orthopedic Surgeon, His Work and His Surgical Technique for the Correction of Hallux Valgus.

PubMed

Markatos, Konstantinos; Karaoglanis, Georgios; Damaskos, Christos; Garmpis, Nikolaos; Tsourouflis, Gerasimos; Laios, Konstantinos; Tsoucalas, Gregory

2018-05-01

The purpose of this article is to summarize the work and pioneering achievements in the field of orthopedic surgery of the German orthopedic surgeon Karl Ludloff. Ludloff had an impact in the diagnostics, physical examination, orthopedic imaging, and orthopedic surgical technique of his era. He was a pioneer in the surgical treatment of dysplastic hip, anterior cruciate ligament reconstruction, and hallux valgus. His surgical technique for the correction of hallux valgus, initially stabilized with plaster of Paris, remained unpopular among other orthopedic surgeons for decades. In the 1990s, the advent and use of improved orthopedic materials for fixation attracted the interest of numerous orthopedic surgeons in the Ludloff osteotomy for its ability to correct the deformity in all 3 dimensions, its anatomic outcomes, and its low recurrence rate and patient satisfaction.

Impact of podiatry resident experience level in hallux valgus surgery on postoperative outcomes.

PubMed

Fleischer, Adam E; Yorath, Martin C; Joseph, Robert M; Baron, Adam; Nordquist, Thomas; Moore, Braden J; Robinson, Richmond C O; Reilly, Charles H

2014-06-15

Despite modern advancements in transosseous fixation and operative technique, hallux valgus (i.e., bunion) surgery is still associated with a higher than usual amount of patient dissatisfaction and is generally recognized as a complex and nuanced procedure requiring precise osseous and capsulotendon balancing. It stands to reason then that familiarity and skill level of trainee surgeons might impact surgical outcomes in this surgery. The aim of this study was to determine whether podiatry resident experience level influences midterm outcomes in hallux valgus surgery (HVS). Consecutive adults who underwent isolated HVS via distal metatarsal osteotomy at a single US metropolitan teaching hospital from January 2004 to January 2009 were contacted and asked to complete a validated outcome measure of foot health (Manchester-Oxford Foot Questionnaire) regarding their operated foot. Resident experience level was quantified using the surgical logs for the primary resident of record at the time of each case. Associations were assessed using linear and logistic regression analyses. A total of 102 adult patients (n = 102 feet) agreed to participate with a mean age of 46.8 years (standard deviation 13.1, range 18-71) and average length of follow-up 6.2 y (standard deviation 1.4, range 3.6-8.6). Level of trainee experience was not associated with postoperative outcomes in either the univariate (odds ratio 0.99 [95% confidence interval, 0.98-1.01], P = 0.827) or multivariate analyses (odds ratio 1.00 [95% confidence interval, 0.97-1.02], P = 0.907). We conclude that podiatry resident level of experience in HVS does not contribute appreciably to postoperative clinical outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

Effects of Corrective Taping on Balance and Gait in Patients With Hallux Valgus.

PubMed

Gur, Gozde; Ozkal, Ozden; Dilek, Burcu; Aksoy, Songul; Bek, Nilgun; Yakut, Yavuz

2017-05-01

Taping is an effective temporary therapy for improving hallux valgus (HV) in adults. Although HV has been demonstrated to impair postural balance, there is a lack of information about how corrective taping affects balance and gait patterns in adults with HV deformity. Eighteen middle-aged female patients (average age, 53.5 years) with HV were included. Corrective tape was applied to correct HV angulation. A series of balance and gait stability tests were performed before applying tape and 1 hour after the tape was applied with a Balance Master computerized posturography device. The study involved the following tests: modified clinical test of sensory interaction and balance (mCTSIB), unilateral stance (US), limit of stability (LoS), step up/over (SUO), and walk across (WA) tests. No significant difference was found between the no-tape and taped condition in the static balance mCTSIB and US tests ( P > .05). The taping intervention resulted in significant improvement in the dynamic balance measures for the LoS test's backward reaction time and left maximum excursion ( P < .05), a significantly higher impact index bilaterally in the SUO assessment ( P < .05), and an increase in step width mean and variability in the WA test ( P < .05). Taping for correcting HV angulation had negative acute effects on dynamic balance in the SUO and WA tests and positive effects in the LoS test. Corrective taping, although a form of conservative treatment for hallux valgus, has been insufficiently studied in terms of effects on balance. Our results show that taping, as an acute effect, may impair balance in middle-aged adults when walking or ascending and descending stairs.

Change in First Metatarsal Length After Proximal and Distal Chevron Osteotomies for Hallux Valgus Deformity.

PubMed

Lee, Jun Young; Lee, Yeon Soo; Song, Kyoung Chul; Choi, Kwi Youn

2015-01-01

The present study assessed the changes in the length of the first metatarsal bone after performing proximal chevron metatarsal osteotomy (PCMO) or distal Chevron metatarsal osteotomy (DCMO) for patients with hallux valgus deformity. A total of 60 patients with moderate-to-severe hallux valgus deformity from July 2009 to July 2011 were randomly divided into the PCMO and DCMO groups, with 30 patients in each group. The distal soft tissue procedure was performed in the same method for both groups. Measurements were performed preoperatively, postoperatively, and at the last follow-up visit at 6.1 ± 0.8 months. The postoperative length change with respect to the preoperative length was 0.7 ± 2.5 mm and -0.7 ± 5.1 mm for the PCMO and DCMO groups, respectively, with a slight lengthening of the first metatarsal bone in the PCMO group and a shortening in the DCMO group (p < .01). The follow-up length change with respect to the preoperative length was -2.1 ± 3.0 mm and -4.4 ± 2.2 mm for the PCMO and DCMO groups, respectively, demonstrating a clear shortening of the first metatarsal length at the last follow-up point in the DCMO group (p < .01).When DCMO and the distal soft tissue procedure were performed, significant shortening was found at 6 months of follow-up. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Proximal opening wedge osteotomy with wedge-plate fixation compared with proximal chevron osteotomy for the treatment of hallux valgus: a prospective, randomized study.

PubMed

Glazebrook, Mark; Copithorne, Peter; Boyd, Gordon; Daniels, Timothy; Lalonde, Karl-André; Francis, Patricia; Hickey, Michael

2014-10-01

Hallux valgus with an increased intermetatarsal angle is usually treated with a proximal metatarsal osteotomy. The proximal chevron osteotomy is commonly used but is technically difficult. This study compares the proximal opening wedge osteotomy of the first metatarsal with the proximal chevron osteotomy for the treatment of hallux valgus with an increased intermetatarsal angle. This prospective, randomized multicenter (three-center) study was based on the clinical outcome scores of the Short Form-36, the American Orthopaedic Foot & Ankle Society forefoot questionnaire, and the visual analog scale for pain, activity, and patient satisfaction. Subjects were assessed prior to surgery and at three, six, and twelve months postoperatively. Surgeon preference was evaluated based on questionnaires and the operative times required for each procedure. No significant differences were found for any of the patients' clinical outcome measurements between the two procedures. The proximal opening wedge osteotomy was found to lengthen, and the proximal chevron osteotomy was found to shorten, the first metatarsal. The intermetatarsal angles improved (decreased) significantly, from 14.8° ± 3.2° to 9.1° ± 2.9 (mean and standard deviation) after a proximal opening wedge osteotomy and from 14.6° ± 3.9° to 11.3° ± 4.0° after a proximal chevron osteotomy (p < 0.05 for both). Operative time required for performing a proximal opening wedge osteotomy is similar to that required for performing a proximal chevron osteotomy (mean and standard deviation, 67.1 ± 16.5 minutes compared with 69.9 ± 18.6 minutes; p = 0.510). Opening wedge and proximal chevron osteotomies have comparable radiographic outcomes and comparable clinical outcomes for pain, satisfaction, and function. The proximal opening wedge osteotomy lengthens, and the proximal chevron osteotomy shortens, the first metatarsal. The proximal opening wedge osteotomy was subjectively less technically demanding and was

A comparison of Chevron and Lindgren-Turan osteotomy techniques in hallux valgus surgery: a prospective randomized controlled study.

PubMed

Uygur, Esat; Özkan, Namık Kemal; Akan, Kaya; Çift, Hakan

2016-01-01

The aim of this prospective randomized controlled single-blind study was to compare the results of Chevron and Lindgren-Turan osteotomy techniques for treatment of moderate hallux valgus. A total of 66 female patients (34 in Chevron group, 32 Lindgren-Turan group) were recruited in this study and followed up for an average of 26.08 months. Operative procedures were performed by 2 surgeons, and patients were evaluated by an another researcher who was blinded to the surgical technique. The groups were compared for their radiological and clinical results. Both techniques was clinically and radiologically effective (p<0.01). However, no significant differences were found between the 2 groups regarding American Orthopaedic Foot and Ankle Society's clinical rating system, Painful Foot Evaluation scale of Maryland University scores, or radiologic evaluation (p>0.05). Compared to the Chevron group, the Lindgren-Turan group was found to have shorter surgical duration (p<0.05) and significantly more shortening at the first metatarsal (p<0.05). In moderate hallux valgus deformity, both the Chevron and Lindgren-Turan osteotomy techniques are clinically and radiologically safe, effective, and reliable alternatives. No superiority was detected in either technique. Although shortening at the first metatarsal in the Lindgren-Turan group was radiologically significant, the results were clinically tolerable.

Surgical Treatment of Moderate Hallux Valgus: A Comparison of Distal Chevron Metatarsal Osteotomy With and Without Lateral Soft-Tissue Release.

PubMed

Grle, Maki; Vrgoc, Goran; Bohacek, Ivan; Hohnjec, Vladimir; Martinac, Marko; Brkic, Iva; Stefan, Lovro; Jotanovic, Zdravko

2017-12-01

The purpose of the study was to determine whether lateral soft-tissue release (LSTR) has a beneficial or detrimental effect on the outcome of distal Chevron first metatarsal osteotomy (DCMO) in the treatment of moderate hallux valgus (HV). We compared the effect of different surgical treatments in 2 groups of patients: group I (23 patients, 25 feet, average age of 55 [from 43 to 77] years) was subjected to DCMO only, whereas group II (18 patients, 23 feet, average age of 59 [from 52 to 70] years]) was subjected to DCMO with LSTR. The American Orthopaedic Foot and Ankle Society's Hallux Metatarsophalangeal-Interphalangeal scale survey was conducted postoperatively, followed by the brief survey on postoperative patient satisfaction. The patient follow-up period was from 18 to 24 months after surgical treatment, on average. After surgical intervention, both groups of patients presented with an improved HV angle, but there was no significant difference between the groups. However, group II showed significant improvements in medial sesamoid bone position and patient satisfaction scores as compared with group I. Our midterm follow-up of surgical treatments for moderate HV deformity suggests that both procedures provide good postoperative results. However, according to our results, DCMO with LSTR provides better results than procedures without LSTR. Therapeutic, Level III: Retrospective comparative study.

Prospective randomized study of chevron osteotomy versus Mitchell's osteotomy in hallux valgus.

PubMed

Buciuto, Robert

2014-12-01

We conducted a prospective randomized trial to compare the most popular osteotomy types of operative treatment of hallux valgus (HV) used in Norway, Mitchell's osteotomy (MO) and chevron osteotomy (CO). One hundred twenty adult female patients were prospectively randomized to treatment with either MO or CO. All operative procedures were performed with ankle block and with tourniquet applied. None of the patients received any antibiotic or antithrombotic prophylaxis. The follow-up period was 3 years. Clinical results were rated according to the American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating System (CRS). HV in the MO group was reduced from 30 (range, 20 to 44) to 15 (range, 8 to 24) degrees and IM angle from 11 (range, 6 to 14) to 7 (range, 4 to 11) degrees. HV in the CO group was reduced from 31 (range, 22 to 42) to 16 (range, 6 to 24) degrees and IM angle from 14 (range, 8 to 20) to 6 (range, 2 to 10) degrees. Transfer metatarsalgia occurred in 36 (60%) patients and hammertoe in 6 (10%) patients in the MO group. In the CO group, metatarsalgia occurred in 5 patients. The median loss of postoperative HV correction was 4 (range, 2 to 10) degrees in mild deformity and 6 (6 to 10) degrees in moderate deformity. Patients treated with CO had significantly better results for AOFAS CRS, number of postoperative complications, patient satisfaction, and length of sick leave for the employed patients. Based on our results, we consider that in female patients CO should be regarded as the first-line procedure for treatment of mild and moderate HV. Level I, prospective randomized study. © The Author(s) 2014.

Wound healing complications in patients with and without systemic diseases following hallux valgus surgery.

PubMed

Kromuszczyńska, Justyna; Kołodziej, Łukasz; Jurewicz, Alina

2018-01-01

There are many defined risk factors for wound healing. Comorbidities and their treatment are identified to be one of them. The aim of this study is to verify whether there are significant differences in wound healing between patients with and without systemic diseases, who underwent hallux valgus correction with Scarf osteotomy. A total of 155 consecutive patients were included into this prospective study. All of the patients underwent Scarf osteotomy for hallux valgus correction. In 60,6% of patients comorbidities were present, most often hypertension (57 patients, 36,8%), hypothyroidism (19 patients 12,3%) and diabetes (7 patients, 4,5%) occurred. Most of the patients were women (96,1%). During the study complication rate was noted. Patients underwent follow-up: 1,2, 3, 6 and 12 weeks and 6 months after the surgery. Preoperatively and during the last visit treatment results were assessed with AOFAS HMI scale. Scar assessment was performed by independent observer with VAS followed by patient scar assessment with VSS. In 30 patients complications were noted (19,4%). Surgical site infection was found in 6 patients (3,9%). In 13 patients (8,4%) partial wound dehiscence occurred, in 5 of them (3,2%) additional skin closure (Steri-Strips) was applied. Treatment results assessed with AOFAS HMI scale were good and very good in both healthy and comorbidity group, and the results improved significantly after surgical procedure. Scar assessment with VAS was on the average 1,5 pts. Average result in VSS was 2 pts. Results in both scales were rated as very good. No statistically significant differences were found in both healthy and comorbidity group in scar assessment. Based on the results of the study authors believe there are no significant differences between patients with and without comorbidities in aspects like: complication rate, surgery result and scar assessment as long as foot surgery is concerned.

Association Between Patient Factors and Outcome of Synthetic Cartilage Implant Hemiarthroplasty vs First Metatarsophalangeal Joint Arthrodesis in Advanced Hallux Rigidus.

PubMed

Goldberg, Andy; Singh, Dishan; Glazebrook, Mark; Blundell, Chris M; De Vries, Gwyneth; Le, Ian L D; Nielsen, Dominic; Pedersen, M Elizabeth; Sakellariou, Anthony; Solan, Matthew; Younger, Alastair S E; Daniels, Timothy R; Baumhauer, Judith F

2017-11-01

We evaluated data from a clinical trial of first metatarsophalangeal joint (MTPJ1) implant hemiarthroplasty and arthrodesis to determine the association between patient factors and clinical outcomes. Patients ≥18 years with hallux rigidus grade 2, 3, or 4 were treated with synthetic cartilage implant MTPJ1 hemiarthroplasty or arthrodesis. Pain visual analog scale (VAS), Foot and Ankle Ability Measure (FAAM) sports and activities of daily living (ADL) scores, and Short Form-36 Physical Function (SF-36 PF) subscore were obtained preoperatively, and at 2, 6, 12, 24, 52, and 104 weeks postoperatively. Final outcome data, great toe active dorsiflexion motion, secondary procedures, radiographs, and safety parameters were evaluated for 129 implant hemiarthroplasties and 47 arthrodeses. The composite primary endpoint criteria for clinical success included VAS pain reduction ≥30%, maintenance/improvement in function, no radiographic complications, and no secondary surgical intervention at 24 months. Predictor variables included hallux rigidus grade; gender; age; body mass index (BMI); symptom duration; prior MTPJ1 surgery; preoperative hallux valgus angle, range of motion (ROM), and pain. Two-sided Fisher exact test was used ( P < .05). Patient demographics and baseline outcome measures were similar. Success rates between implant MTPJ1 hemiarthroplasty and arthrodesis were similar ( P > .05) when stratified by hallux rigidus grade, gender, age, BMI, symptom duration, prior MTPJ1 surgery status, and preoperative VAS pain, hallux valgus, and ROM. Synthetic cartilage implant hemiarthroplasty was appropriate for patients with grade 2, 3, or 4 hallux rigidus. Its results in those with associated mild hallux valgus (≤20 degrees) or substantial preoperative stiffness were equivalent to MTPJ1 fusion, irrespective of gender, age, BMI, hallux rigidus grade, preoperative pain or symptom duration. Level II, randomized clinical trial.

Lengthening of the shortened first metatarsal after Wilson's osteotomy for hallux valgus.

PubMed

Singh, D; Dudkiewicz, I

2009-12-01

Metatarsalgia is a recognised complication following iatrogenic shortening of the first metatarsal in the management of hallux valgus. The traditional surgical treatment is by shortening osteotomies of the lesser metatarsals. We describe the results of lengthening of iatrogenic first brachymetatarsia in 16 females. A Scarf-type osteotomy was used in the first four cases and a step-cut of equal thicknesses along the axis of the first metatarsal was performed in the others. The mean follow-up was 21 months (19 to 26). Relief of metatarsalgia was obtained in the six patients in whom 10 mm of lengthening had been achieved, compared to only 50% relief in those where less than 8 mm of lengthening had been gained. One-stage step-cut lengthening osteotomy of the first metatarsal may be preferable to shortening osteotomies of the lesser metatarsals in the treatment of metatarsalgia following surgical shortening of the first metatarsal.

A Comparison of Two Designs of Postoperative Shoe on Function, Satisfaction, and Back Pain After Hallux Valgus Surgery.

PubMed

Patel, Shelain; Garg, Parag; Fazal, M Ali; Shahid, Muhammad S; Park, Derek H; Ray, Pinak S

2018-06-01

The reverse camber shoe is commonly used after hallux valgus corrective surgery to offload the forefoot but is associated with back pain and poor compliance. Recent designs of postoperative shoes may obviate the need for a reverse camber. The purpose of this study was to compare the effects of a reverse camber shoe and a noncambered shoe with transitional rigidity after hallux valgus correction. A cohort of 80 feet was prospectively studied undergoing surgery at a single NHS trust. The first 40 feet received the reverse cambered Jura Medical Off-loader Heel shoe and the subsequent 40 feet received the noncambered DonJoy Podalux shoe. No demographic differences existed between the groups and data were collected at 2 weeks, 6 weeks, and 6 months. The Manchester-Oxford Foot Questionnaire (MOXFQ), a 5-question survey and dichotomous question about back pain was used to assess clinical outcome and radiographs were reviewed by 2 orthopaedic surgeons to monitor for loss of correction. Both groups experienced comparable improvements in MOXFQ and shoe satisfaction from 2 weeks compared with 6 weeks. Six patients experienced back pain in the reverse cambered shoe group and none in the noncambered shoe group. Five patients stopped using the reverse cambered shoe during the first 6 weeks after surgery and none stopped using their prescribed noncambered shoe. No loss of corrections were observed in either group. Both shoe designs gave equal foot specific functional and radiological outcomes, but the noncambered shoe with transitional rigidity was associated with less back pain and better compliance. Level II: Prospective comparative study.

Biodegradable magnesium-based screw clinically equivalent to titanium screw in hallux valgus surgery: short term results of the first prospective, randomized, controlled clinical pilot study

PubMed Central

2013-01-01

Purpose Nondegradable steel-and titanium-based implants are commonly used in orthopedic surgery. Although they provide maximal stability, they are also associated with interference on imaging modalities, may induce stress shielding, and additional explantation procedures may be necessary. Alternatively, degradable polymer implants are mechanically weaker and induce foreign body reactions. Degradable magnesium-based stents are currently being investigated in clinical trials for use in cardiovascular medicine. The magnesium alloy MgYREZr demonstrates good biocompatibility and osteoconductive properties. The aim of this prospective, randomized, clinical pilot trial was to determine if magnesium-based MgYREZr screws are equivalent to standard titanium screws for fixation during chevron osteotomy in patients with a mild hallux valgus. Methods Patients (n=26) were randomly assigned to undergo osteosynthesis using either titanium or degradable magnesium-based implants of the same design. The 6 month follow-up period included clinical, laboratory, and radiographic assessments. Results No significant differences were found in terms of the American Orthopaedic Foot and Ankle Society (AOFAS) score for hallux, visual analog scale for pain assessment, or range of motion (ROM) of the first metatarsophalangeal joint (MTPJ). No foreign body reactions, osteolysis, or systemic inflammatory reactions were detected. The groups were not significantly different in terms of radiographic or laboratory results. Conclusion The radiographic and clinical results of this prospective controlled study demonstrate that degradable magnesium-based screws are equivalent to titanium screws for the treatment of mild hallux valgus deformities. PMID:23819489

Minimal Clinically Important Differences for American Orthopaedic Foot & Ankle Society Score in Hallux Valgus Surgery.

PubMed

Chan, Hiok Yang; Chen, Jerry Yongqiang; Zainul-Abidin, Suraya; Ying, Hao; Koo, Kevin; Rikhraj, Inderjeet Singh

2017-05-01

The American Orthopaedic Foot & Ankle Society (AOFAS) score is one of the most common and adapted outcome scales in hallux valgus surgery. However, AOFAS is predominantly physician based and not patient based. Although it may be straightforward to derive statistical significance, it may not equate to the true subjective benefit of the patient's experience. There is a paucity of literature defining MCID for AOFAS in hallux valgus surgery although it could have a great impact on the accuracy of analyzing surgical outcomes. Hence, the primary aim of this study was to define the Minimal Clinically Important Difference (MCID) for the AOFAS score in these patients, and the secondary aim was to correlate patients' demographics to the MCID. We conducted a retrospective cross-sectional study. A total of 446 patients were reviewed preoperatively and followed up for 2 years. An anchor question was asked 2 years postoperation: "How would you rate the overall results of your treatment for your foot and ankle condition?" (excellent, very good, good, fair, poor, terrible). The MCID was derived using 4 methods, 3 from an anchor-based approach and 1 from a distribution-based approach. Anchor-based approaches were (1) mean difference in 2-year AOFAS scores of patients who answered "good" versus "fair" based on the anchor question; (2) mean change of AOFAS score preoperatively and at 2-year follow-up in patients who answered good; (3) receiver operating characteristic (ROC) curves method, where the area under the curve (AUC) represented the likelihood that the scoring system would accurately discriminate these 2 groups of patients. The distribution-based approach used to calculate MCID was the effect size method. There were 405 (90.8%) females and 41 (9.2%) males. Mean age was 51.2 (standard deviation [SD] = 13) years, mean preoperative BMI was 24.2 (SD = 4.1). Mean preoperative AOFAS score was 55.6 (SD = 16.8), with significant improvement to 85.7 (SD = 14.4) in 2 years ( P value

Use of 3D Printed Bone Plate in Novel Technique to Surgically Correct Hallux Valgus Deformities

PubMed Central

Smith, Kathryn E.; Dupont, Kenneth M.; Safranski, David L.; Blair, Jeremy; Buratti, Dawn; Zeetser, Vladimir; Callahan, Ryan; Lin, Jason; Gall, Ken

2016-01-01

Three-dimensional (3-D) printing offers many potential advantages in designing and manufacturing plating systems for foot and ankle procedures that involve small, geometrically complex bony anatomy. Here, we describe the design and clinical use of a Ti-6Al-4V ELI bone plate (FastForward™ Bone Tether Plate, MedShape, Inc., Atlanta, GA) manufactured through 3-D printing processes. The plate protects the second metatarsal when tethering suture tape between the first and second metatarsals and is a part of a new procedure that corrects hallux valgus (bunion) deformities without relying on doing an osteotomy or fusion procedure. The surgical technique and two clinical cases describing the use of this procedure with the 3-D printed bone plate are presented within. PMID:28337049

Hallux valgus, ankle osteoarthrosis and adult acquired flatfoot deformity: a review of three common foot and ankle pathologies and their treatments

PubMed Central

Crevoisier, Xavier; Assal, Mathieu; Stanekova, Katarina

2016-01-01

The pathogenesis of hallux valgus deformity is multifactorial. Conservative treatment can alleviate pain but is unable to correct the deformity. Surgical treatment must be adapted to the type and severity of the deformity. Success of surgical treatment ranges from 80% to 95%, and complication rates range from 10% to 30%. Ankle osteoarthrosis most commonly occurs as a consequence of trauma. Ankle arthrodesis and total ankle replacement are the most common surgical treatments of end stage ankle osteoarthrosis. Both types of surgery result in similar clinical improvement at midterm; however, gait analysis has demonstrated the superiority of total ankle replacement over arthrodesis. More recently, conservative surgery (extraarticular alignment osteotomies) around the ankle has gained popularity in treating early- to mid-stage ankle osteoarthrosis. Adult acquired flatfoot deformity is a consequence of posterior tibial tendon dysfunction in 80% of cases. Classification is based upon the function of the tibialis posterior tendon, the reducibility of the deformity, and the condition of the ankle joint. Conservative treatment includes orthotics and eccentric muscle training. Functional surgery is indicated for treatment in the early stages. In case of fixed deformity, corrective and stabilising surgery is performed. Cite this article: Crevoisier X, Assal M, Stanekova K. Hallux valgus, ankle osteoarthrosis and adult acquired flatfoot deformity: a review of three common foot and ankle pathologies and their treatments. EFORT Open Rev 2016;1:58–64. DOI: 10.1302/2058-5241.1.000015. PMID:28461929

The correlation between calcaneal valgus angle and asymmetrical thoracic-lumbar rotation angles in patients with adolescent scoliosis.

PubMed

Park, Jaeyong; Lee, Sang Gil; Bae, Jongjin; Lee, Jung Chul

2015-12-01

[Purpose] This study aimed to provide a predictable evaluation method for the progression of scoliosis in adolescents based on quick and reliable measurements using the naked eye, such as the calcaneal valgus angle of the foot, which can be performed at public facilities such as schools. [Subjects and Methods] Idiopathic scoliosis patients with a Cobb's angle of 10° or more (96 females, 22 males) were included in this study. To identify relationships between factors, Pearson's product-moment correlation coefficient was computed. The degree of scoliosis was set as a dependent variable to predict thoracic and lumbar scoliosis using ankle angle and physique factors. Height, weight, and left and right calcaneal valgus angles were set as independent variables; thereafter, multiple regression analysis was performed. This study extracted variables at a significance level (α) of 0.05 by applying a stepwise method, and calculated a regression equation. [Results] Negative correlation (R=-0.266) was shown between lumbar lordosis and asymmetrical lumbar rotation angles. A correlation (R=0.281) was also demonstrated between left calcaneal valgus angles and asymmetrical thoracic rotation angles. [Conclusion] Prediction of scoliosis progress was revealed to be possible through ocular inspection of the calcaneus and Adams forward bending test and the use of a scoliometer.

Accuracy of estimating Unicondylar Knee Replacement implant varus/valgus angles from antero-posterior radiographs.

PubMed

Khare, Rahul; Jaramaz, Branislav

2016-12-01

Unicondylar Knee Replacement (UKR) is an orthopedic surgical procedure to reduce pain and improve function in the knee. Load-bearing long-standing antero-posterior (AP) radiographs are typically used postoperatively to measure the leg alignment and assess the varus/valgus implant orientation. However, implant out-of-plane rotations, user variability, and X-ray acquisition parameters introduce errors in the estimation of the implant varus/valgus estimation. Previous work has explored the accuracy of various imaging modalities in this estimation. In this work, we explored the impact of out-of-plane rotations and X-ray acquisition parameters on the estimation of implant component varus/valgus angles. For our study, we used a single CT scan and positioned femoral and tibial implants under varying orientations within the CT volume. Then, a custom software application was used to obtain digitally reconstructed radiographs from the CT scan with implants under varying orientations. Two users were then asked to manually estimate the varus/valgus angles for the implants. We found that there was significant inter-user variability (p < 0.05) in the varus/valgus estimates for the two users. However, the 'ideal' measurements, obtained using actual implant orientations, showed small errors due to variations in implant orientation. We also found that variation in the projection center does not have a statistically significant impact (p < 0.01) on the estimation of implant varus/valgus angles. We conclude that manual estimates of UKR implant varus/valgus orientations are unreliable.

Clinical outcome after Chevron-Akin double osteotomy versus isolated Chevron procedure: a prospective matched group analysis.

PubMed

Lechler, Philipp; Feldmann, Christine; Köck, Franz Xaver; Schaumburger, Jens; Grifka, Joachim; Handel, Martin

2012-01-01

Hallux valgus is a frequent condition of the forefoot, resulting in cosmetic deformity and pain. Chevron osteotomy (CO) is widely employed for the treatment of hallux valgus. Chevron-Akin double osteotomy (CAO) was previously described and superiority over an isolated Chevron procedure was assumed. The objective of this study was to compare the short-to-middle term outcomes of CO and CAO. This study included 72 patients with established diagnosis of mild-to-moderate hallux valgus, treated by either isolated CO or CAO. The CO group included 46 patients (mean 51.5 years) with a mean hallux valgus angle of 27°, while the CAO group included 26 subjects (mean 53.1 years) and a mean hallux valgus angle of 32° preoperatively. All patients were reviewed by physical examination, and standardized questionnaire, and pre- and postoperative standing X-rays were performed. Matched group analysis was carried out to analyze statistical differences of both techniques. The patients were assessed and group matched at a mean of 1.37 years for the CO group and 1.04 years for the CAO group, postoperatively. Mean improvement of HVA (hallux valgus angle) was 10.6° in the CO group and the CAO group improved by 17.5°. DMAA (distal metatarsal articular angle) improved in the CO group by 5.4° and in the CAO by 13.7°. Mean AOFAS score improved by 27.9 (CO) and 21.5 (CAO). Patient satisfaction was high in both groups, with a tendency towards higher values within the CAO group. These findings indicate that Chevron-Akin double osteotomy is a save and practicable procedure for the treatment of mild-to-moderate hallux valgus. Superiority of combined Chevron-Akin procedure over an isolated Chevron osteotomy might be limited to distinct clinical settings, but should not be generally assumed.

Hallux Valgus, By Nature or Nurture? A Twin Study.

PubMed

Munteanu, Shannon E; Menz, Hylton B; Wark, John D; Christie, Jemma J; Scurrah, Katrina J; Bui, Minh; Erbas, Bircan; Hopper, John L; Wluka, Anita E

2017-09-01

To evaluate the contributions of shared but unmeasured genetic and environmental factors to hallux valgus (HV). Between 2011 and 2012, 74 monozygotic (MZ) and 56 dizygotic (DZ) female twin pairs self-reported HV and putative risk factors, including footwear use across their lifespan. Estimates of casewise concordance (P C ), correlation (ρ), and odds ratios (ORs) were calculated, adjusting for age and other risk factors, and compared between MZ and DZ pairs using logistic regression, generalized estimating equations, and a maximum likelihood-based method, respectively. A total of 70 participants (27%) reported HV, with 12 MZ and 7 DZ pairs being concordant. After adjusting for age, twins were correlated (ρ = 0.27 [95% confidence interval (95% CI) 0.08, 0.46]) and concordant (P C  = 0.45 [95% CI 0.29, 0.61]; mean age 58 years), with no difference between MZ and DZ pairs (P = 0.7). HV was associated with regularly wearing footwear with a constrictive toe-box during the fourth decade (adjusted OR 2.73 [95% CI 1.12, 6.67]). This risk factor was correlated in MZ (ρ = 0.38 [95% CI 0.15, 0.60]) but not DZ (ρ = -0.20 [95% CI -0.43, 0.03]) pairs. These correlations were significantly different (P = 0.002). Twins are correlated for HV, but we found no evidence that correlation was due to shared genetic factors. We identified an environmental risk factor, footwear with a constrictive toe-box, that is not shared to the same extent by MZ and DZ pairs, contrary to the assumption of the classic twin model. Footwear, and possibly genetic factors and unknown shared environmental factors, could contribute to developing HV. © 2016, American College of Rheumatology.

Proximal Opening Wedge Osteotomy Provides Satisfactory Midterm Results With a Low Complication Rate.

PubMed

Oravakangas, Rami; Leppilahti, Juhana; Laine, Vesa; Niinimäki, Tuukka

2016-01-01

Hallux valgus is one of the most common foot deformities. Proximal opening wedge osteotomy is used for the treatment of moderate and severe hallux valgus with metatarsus primus varus. However, hypermobility of the first tarsometatarsal joint can compromise the results of the operation, and a paucity of midterm results are available regarding proximal open wedge osteotomy surgery. The aim of the present study was to assess the midterm results of proximal open wedge osteotomy in a consecutive series of patients with severe hallux valgus. Thirty-one consecutive adult patients (35 feet) with severe hallux valgus underwent proximal open wedge osteotomy. Twenty patients (35.5%) and 23 feet (34.3%) were available for the final follow-up examination. The mean follow-up duration was 5.8 (range 4.6 to 7.0) years. The radiologic measurements and American Orthopaedic Foot and Ankle Society hallux-metatarsophalangeal-interphalangeal scores were recorded pre- and postoperatively, and subjective questionnaires were completed and foot scan analyses performed at the end of the follow-up period. The mean hallux valgus angle decreased from 38° to 23°, and the mean intermetatarsal angle correction decreased from 17° to 10°. The mean improvement in the American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal score increased from 52 to 84. Two feet (5.7%) required repeat surgery because of recurrent hallux valgus. No nonunions were identified. Proximal open wedge osteotomy provided satisfactory midterm results in the treatment of severe hallux valgus, with a low complication rate. The potential instability of the first tarsometatarsal joint does not seem to jeopardize the midterm results of the operation. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

[Modified chevron osteotomy with lateral release and screw fixation for treatment of severe hallux deformity].

PubMed

Hofstaetter, S G; Schuh, R; Trieb, K; Trnka, H J

2012-12-01

This prospective study examined the clinical and radiological results of the Chevron osteotomy with screw fixation and distal soft tissue release up to an intermetatarsal angle of 19°. Furthermore, the results are presented for patients over the age of 70 years, and whether or not there is a higher complication rate. 86 feet of patients between 23 and 81 years were included in the study. Apart from the overall group, a group with an intermetatarsal angle of 16° to 19° and a group of patients over 70 years old were eavaluated. They were evaluated preoperatively and at follow-up after an average of 3.3 years according to the American Orthopaedic Foot and Ankle Society score. The AOFAS score showed a significant improvement from 55 points preoperatively to 90 points at follow-up. The preoperative hallux valgus angle decreased significantly from 32° to 5° and the preoperative intermetatarsal angle decreased from 14° to 6°. Patient satisfaction in the overall group was rated in 92 % as excellent or good. Also, the patient group with 16° to 19° angles and the patients over 70 years showed a significant improvement of clinical and radiological parameters. The complication rate was very low in all groups. The results show that the Chevron osteotomy is a very good surgical technique with few complications for the correction of splay foot with hallux valgus deformity. We showed that by using the modified technique with a long plantar arm, an excessive soft tissue release and screw fixation, the indication can be extended up to an intermetatarsal angle of 19° when using screw fixation. Furthermore the patients over 70 years of age showed a significant improvement of clinical and radiological parameters without serious complications such as avascular necrosis or dislocation of the metatarsal head. Georg Thieme Verlag KG Stuttgart · New York.

Ultrasound evaluation of intrinsic plantar muscles and fascia in hallux valgus

PubMed Central

Lobo, César Calvo; Marín, Alejandro Garrido; Sanz, David Rodríguez; López, Daniel López; López, Patricia Palomo; Morales, Carlos Romero; Corbalán, Irene Sanz

2016-01-01

Abstract A cross-sectional area (CSA) and thickness reduction of the abductor hallucis (AbH) is shown in subjects with hallux valgus (HV). To date, other soft-tissue structures have not been researched in relation with HV. The aim of this study was to compare the CSA and thickness of the intrinsic plantar muscles and fascia (PF) between feet with and without HV. Therefore, a cross-sectional and case-control study was performed using B-mode with an iU22 Philips ultrasound system and a 5 to 17-MHz transducer. The CSA and thickness were measured for the AbH, flexor digitorum brevis (FDB) and flexor hallucis brevis (FHB), and also the thickness for the anterior, middle, and posterior PF portions. A convenience sample of 40 feet, 20 with HV and 20 without HV, was recruited from a clinical and research center. A multivariate regression analysis using linear regression was performed to evaluate the ultrasound imaging measurements (α = 0.05). Consequently, statistically significant differences were observed between the groups (P < 0.05) for the AbH and FHB thickness, and CSA reduction, and also the plantar fascia thickness increase in favor of the HV group. On the contrary, the FDB thickness and CSA did not show statistically significant differences (P ≥ 0.05). In conclusion, the CSA and thickness of the AbH and FHB intrinsic plantar muscles are reduced, whereas the thickness of the anterior, middle, and posterior PF portions are increased, in subjects with HV compared with those without HV. PMID:27828846

Is it too early to move to full electronic PROM data collection?: A randomized controlled trial comparing PROM's after hallux valgus captured by e-mail, traditional mail and telephone.

PubMed

Palmen, Leonieke N; Schrier, Joost C M; Scholten, Ruben; Jansen, Justus H W; Koëter, Sander

2016-03-01

Patient reported outcome measures (PROM's) after hallux valgus surgery are used to rate the effectiveness as perceived by the patient. The interpretability of these PROM's is highly dependent on participation rate. Data capture method may be an important factor contributing to the response rate. We investigated the effect on response rate of traditional paper mail, telephone and e-mail PROM's after hallux valgus surgery. All consecutive patients operated between January and September 2013, were identified. Included patients were randomized by envelope in three groups: traditional pen and paper mail, e-mail and telephone. They were asked to fill in a FFI and EQ-5D. Two weeks later non-responders were sent a reminder. Of the 73 included patients, 25 were approached by mail, 24 by e-mail and 24 patients by telephone. The response rate on traditional mail was highest (88%), while response on e-mail was lowest (33%). Response rate on telephone was also high (79%). Response rate on traditional mail and telephone was significantly higher (p<0.001) than response on e-mail. Though electronic data collection has enormous potential, this study shows that e-mail yields unacceptable low response rates. It is too early to replace traditional pen-and-paper PROM's by electronic questionnaires. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Traumeel S® for pain relief following hallux valgus surgery: a randomized controlled trial

PubMed Central

2010-01-01

Background In spite of recent advances in post-operative pain relief, pain following orthopedic surgery remains an ongoing challenge for clinicians. We examined whether a well known and frequently prescribed homeopathic preparation could mitigate post-operative pain. Method We performed a randomized, double blind, placebo-controlled trial to evaluate the efficacy of the homeopathic preparation Traumeel S® in minimizing post-operative pain and analgesic consumption following surgical correction of hallux valgus. Eighty consecutive patients were randomized to receive either Traumeel tablets or an indistinguishable placebo, and took primary and rescue oral analgesics as needed. Maximum numerical pain scores at rest and consumption of oral analgesics were recorded on day of surgery and for 13 days following surgery. Results Traumeel was not found superior to placebo in minimizing pain or analgesic consumption over the 14 days of the trial, however a transient reduction in the daily maximum post-operative pain score favoring the Traumeel arm was observed on the day of surgery, a finding supported by a treatment-time interaction test (p = 0.04). Conclusions Traumeel was not superior to placebo in minimizing pain or analgesic consumption over the 14 days of the trial. A transient reduction in the daily maximum post-operative pain score on the day of surgery is of questionable clinical importance. Trial Registration This study was registered at ClinicalTrials.gov. # NCT00279513 PMID:20380750

Stabilization of chevron bunionectomy with a capsuloperiosteal flap.

PubMed

Guclu, Berk; Kaya, Alper; Akan, Burak; Koken, Murat; Kemal Us, Ali

2011-04-01

Distal chevron osteotomy (DCO) for mild to moderate hallux valgus deformity is inherently more stable than the other forms of distal metatarsal osteotomy, but complications such as loss of correction, infection, joint stiffness, delayed union, malunion and nonunion can occur. In this study, we evaluated the use of a capsuloperiosteal flap for stabilization of DCO in the treatment of hallux valgus. A retrospective study was conducted on 59 patients (88 feet) that underwent distal Chevron osteotomy stabilized only with a capsuloperiosteal flap for mild and moderate hallux valgus deformity with a mean followup of 11.3 years. Clinical evaluation was calculated using the hallux score of the American Orthopaedic Foot and Ankle Society (AOFAS). The score improved from a preoperative mean of 52 to a mean of 91.5 points at last followup. Average hallux valgus angle changed from 30.3 degrees preoperatively to 14.2 degrees postoperatively at the last followup. Intermetatarsal angle 1-2 changed from 13.6 degrees preoperatively to 10.2 degrees postoperatively. The correction proved to be consistent with only an average of 3.4-degree correction loss and 4.9-degree loss in the range of motion. Eighty-six feet (97.7%) were pain free. Discomfort with shoewear was absent in 84 feet (95.5%) postoperatively and 24 of 25 (96%) patients were satisfied cosmetically. Capsuloperiosteal flap stabilization of distal chevron osteotomy for mild-moderate hallux valgus yielded excellent clinical results at long-term followup.

Observed changes in radiographic measurements of the first ray after frontal plane rotation of the first metatarsal in a cadaveric foot model.

PubMed

Dayton, Paul; Feilmeier, Mindi; Hirschi, Jordan; Kauwe, Merrell; Kauwe, John S K

2014-01-01

We observed the changes in the angular measurements commonly used in the evaluation of the first metatarsal and first metatarsophalangeal joint in cadaveric specimens before and after frontal plane rotation of the first metatarsal. Measurements of the first and second intermetatarsal angle (IMA), hallux abductus angle, proximal articular set angle, and tibial sesamoid position (TSP) were taken after varying degrees of varus and valgus rotation of the first metatarsal. Standard dorsoplantar radiographs were taken at 0°, 10°, 20°, and 30° of valgus rotation of the first metatarsal and repeated at 10°, 20°, and 30° varus rotation of the first metatarsal. The data were analyzed using a mixed linear model to compare the change in each angle measurement over the range of valgus and varus rotation. The change in the TSP was significant in both valgus and varus rotations (p = .0004 and p = .028, respectively), an increase in valgus rotation causing an increase in the TSP and an increase in varus rotation causing a decrease in TSP. The change in the IMA was significant compared with valgus rotation (p = .028), showing that as the valgus rotation increased, the IMA also increased. However, compared with the varus rotation, the correlation was not significant (p = .18). The proximal articular set angle and hallux abductus angle measurements, compared with metatarsal rotation, showed positive trends but were not statistically significant. From our results and a review of the published data, we have hypothesized that frontal plane rotation of the first metatarsal is an integral component of hallux abducto valgus pathologic features, specifically in relation to the TSP and IMA. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Hallux rigidus: How do I approach it?

PubMed Central

Lam, Aaron; Chan, Jimmy J; Surace, Michele F; Vulcano, Ettore

2017-01-01

Hallux rigidus is a degenerative disease of the first metatarsalphalangeal (MTP) joint and affects 2.5% of people over age 50. Dorsal osteophytes and narrowed joint space leads to debilitating pain and limited range of motion. Altered gait mechanics often ensued as 119% of the body force transmit through the 1st MTP joint during gait cycle. Precise etiology remains under debate with trauma being often cited in the literature. Hallux valgus interphalangeus, female gender, inflammatory and metabolic conditions have all been identified as associative factors. Clinical symptoms, physical exam and radiographic evidence are important in assessing and grading the disease. Non-operative managements including nonsteroidal antiinflammatory drugs, intra-articular injections, shoe modification, activity modification and physical therapy, should always be attempted for all hallux rigidus patients. The goal of surgery is to relieve pain, maintain stability of the first MTP joint, and improve function and quality of life. Operative treatments can be divided into joint-sparing vs joint-sacrificing. Cheilectomy and moberg osteotomy are examples of joint-sparing techniques that have demonstrated great success in early stages of hallux rigidus. Arthrodesis is a joint-sacrificing procedure that has been the gold standard for advanced hallux rigidus. Other newer procedures such as implant arthroplasty, interpositional arthroplasty and arthroscopy, have demonstrated promising early patient outcomes. However, future studies are still needed to validate its long-term efficacy and safety. The choice of procedure should be based on the condition of the joint, patient’s goal and expectations, and surgeon’s experience with the technique. PMID:28567339

Characteristics of Selected Anthropometric Foot Indicators in Physically Active Students.

PubMed

Bac, Aneta; Bogacz, Gabriela; Ogrodzka-Ciechanowicz, Katarzyna; Kulis, Aleksandra; Szaporów, Tomasz; Woźniacka, Renata; Radlińska, Natalia

2018-05-01

The aim of this study was to determine the type of medial longitudinal arch (MLA) in students of Krakow universities, investigate the relationship between physical activity and the shaping of the feet, and examine the relationship between hallux valgus angle and the type of footwear chosen most often. The study group consisted of 120 students, of which 56 respondents were students of the University School of Physical Education in Krakow, whereas the remaining 64 respondents were students of the Pedagogical University of Krakow. To evaluate the MLA, a podoscope was used, which allowed us to determine the length and width of the foot, and calculation of the Clarke angle, heel angle γ, and the angle of hallux valgus. All students were also subjected to a measurement of body weight and height. There was a statistically significant relationship between physical activity and the Clarke angle in the group of women studying at the University School of Physical Education. There was no correlation between the hallux valgus angle and the type of footwear chosen most often in the research groups. The most frequently diagnosed type of longitudinal and transverse arch foot in the research group was normal MLA. There was no relationship between physical activity and transverse arch foot in any of the research groups.

Correlation of Postoperative Position of the Sesamoids After Chevron Osteotomy With Outcome.

PubMed

Shi, Glenn G; Henning, Peter; Marks, Richard M

2016-03-01

Postoperative incomplete reduction of the sesamoids has been identified as a potential risk factor for hallux valgus recurrence after proximal osteotomy. However, it is not known whether the postoperative sesamoid position is a risk factor in hallux valgus correction via distal chevron osteotomy with or without dorsal webspace release (DWSR). In this retrospective study, 169 patients who underwent distal chevron osteotomy with or without DWSR were reviewed. Preoperative and postoperative (6 weeks, 6 months, 12 months) weightbearing radiographs were evaluated. Functional hallux valgus angle (HVA), intermetatarsal angle (IMA), and the position of the tibial sesamoid were graded using the center of head method. Seventy-six radiographs were available for review at the 12-month follow-up. Of these, 41 patients underwent DWSR procedure and 35 did not. In both groups, correction of all 3 parameters (HVA, IMA, tibial sesamoid position) were significant at the 12-month follow-up. Comparison of the postoperative results of the 2 groups showed no statistically significant differences. Four feet demonstrated displaced sesamoid position at the 12-month follow-up, with radiographic evidence of recurrence in just one. No significant relationship was found between postoperative sesamoid position and hallux valgus recurrence that occurred in 4 feet. Combining DWSR with a distal chevron osteotomy did not delay healing or increase risk of avascular necrosis, but it did not significantly improve angular measurements or sesamoid position. The concept that postoperative sesamoid position can be used to predict hallux valgus recurrence was not supported by our results when looking at distal chevron correction. Level III, retrospective comparative study. © The Author(s) 2015.

[PERSONALIZED DISTAL FEMORAL VALGUS RESECTION ANGLE IN PRIMARY TOTAL KNEE ARTHROPLASTY].

PubMed

Wang, Xilong; Shang, Xifu; Ll, Guoyuan; He, Rui; Zheng, Jie

2015-01-01

To investigate the feasibility and effectiveness of a personalized distal femoral valgus resection angle for improving postoperative coronal alignment of lower limb in total knee arthroplasty (TKA). A retrospective analysis was made on the clinical data of 50 patients who received primary TKA between January 2013 and February 2013. There were 11 male and 39 female patients with degenerative knee osteoarthritis. The patients were divided into 2 groups. In test group (n=25), the resection angle was adjusted to the femoral mechanical anatomical angle (FMA); in control group (n=25), a fixed distal valgus resection angle of 5° was used. There was no significant difference in gender, age, body mass index, disease duration, sides, grade, preoperative FMA, mechanical femorotibial angle (MFT), and preoperative Knee Society Score (KSS) between 2 groups (P > 0.05). Whole long X-ray film was taken to measure FMA and MFT at 3 days after operation, postoperative KSS was used to evaluate the knee function after 6 and 15 months. MFT was (-0.20 ± 1.87)° in test group and was (1.71 ± 3.67)° in control group, showing significant difference between 2 groups (t = 2.32, P = 0.02). The ideal MFT angle (0 ± 3)° was achieved in 22 patients (88%) of test group and in 16 patients (64%) of control group, showing significant difference between 2 groups (χ2 = 2.32, P = 0.02). Primary healing of incision was obtained in all patients of 2 groups. No deep venous thrombosis occurred. The patients of 2 groups were followed up 15 months after operation. There was significant difference in KSS between test and control groups at 6 months (88.23 ± 2.57 vs. 82.92 ± 2.59) (t = 7.26, P = 0.00) and at 15 months (90.76 ± 2.77 vs. 88.65 ± 1.77) (t = 3.20, P = 0.02). No sign of prosthesis loosening was observed by X-ray examination. Compared with using of a fixed distal femoral resection angle, an individual FMA can significantly improve the postoperative MFT and promote early recovery of the knee

Ultrasound evaluation of intrinsic plantar muscles and fascia in hallux valgus: A case-control study.

PubMed

Lobo, César Calvo; Marín, Alejandro Garrido; Sanz, David Rodríguez; López, Daniel López; López, Patricia Palomo; Morales, Carlos Romero; Corbalán, Irene Sanz

2016-11-01

A cross-sectional area (CSA) and thickness reduction of the abductor hallucis (AbH) is shown in subjects with hallux valgus (HV). To date, other soft-tissue structures have not been researched in relation with HV. The aim of this study was to compare the CSA and thickness of the intrinsic plantar muscles and fascia (PF) between feet with and without HV. Therefore, a cross-sectional and case-control study was performed using B-mode with an iU22 Philips ultrasound system and a 5 to 17-MHz transducer. The CSA and thickness were measured for the AbH, flexor digitorum brevis (FDB) and flexor hallucis brevis (FHB), and also the thickness for the anterior, middle, and posterior PF portions. A convenience sample of 40 feet, 20 with HV and 20 without HV, was recruited from a clinical and research center. A multivariate regression analysis using linear regression was performed to evaluate the ultrasound imaging measurements (α = 0.05). Consequently, statistically significant differences were observed between the groups (P < 0.05) for the AbH and FHB thickness, and CSA reduction, and also the plantar fascia thickness increase in favor of the HV group. On the contrary, the FDB thickness and CSA did not show statistically significant differences (P ≥ 0.05). In conclusion, the CSA and thickness of the AbH and FHB intrinsic plantar muscles are reduced, whereas the thickness of the anterior, middle, and posterior PF portions are increased, in subjects with HV compared with those without HV.

Medial capsular interpositional arthroplasty for severe hallux rigidus.

PubMed

Hahn, Michael Patrick; Gerhardt, Nels; Thordarson, David B

2009-06-01

Multiple surgical options have been described for severe hallux rigidus. One option is capsular interpositional arthroplasty. We report our initial results with a technique using the thicker medial capsule as our interpositional material instead of the dorsal capsule and extensor hallucis brevis (EHB). Twenty-two patients with grade IV hallux rigidus underwent minimal proximal phalanx resection (modified Keller) with preservation of the flexor hallucis brevis (FHB) insertion and medial capsular interpositional arthroplasty. Postoperative AOFAS hallux MTP-IP scores (mean 77.8), and SF-36 scores (mean 68.7 on physical function, 79.5 role limitations) demonstrated clinical improvement compared to historical controls. Alignment and stability were well maintained (mean preoperative HV angle of 11.8 degrees, mean postoperative HV angle of 13.0 degrees). Dorsiflexion/plantarflexion arc of motion showed sustained improvement (mean 38.4 degrees preoperative, mean 62.3 degrees postoperative). These results are comparable to other forms of interpositional arthroplasty and arthrodesis for end stage arthritis of the hallux MTPJ.

Bone morphotypes of the varus and valgus knee.

PubMed

Thienpont, E; Schwab, P E; Cornu, O; Bellemans, J; Victor, J

2017-03-01

Coronal deformity correction with total knee arthroplasty (TKA) is an important feature in the treatment of osteoarthritis (OA). The hypothesis of this study was that bone morphology would be different in varus and valgus deformity, both before osteoarthritis development as well as during and after the disease process of OA. Retrospective study with measurements on preoperative and postoperative full leg standing radiographs of 96 patients who underwent TKA. The included patients were selected for this study because they had an OA knee on one side and a non-arthritic knee on the contralateral side presenting the same type of alignment as the to-be-operated knee (varus or valgus alignment on both sides). The control group of 46 subjects was a group of patients with neutral mechanical alignment who presented for ligamentous problems. A single observer measured mechanical alignment, anatomical alignment, anatomical-mechanical femoral angle and intra-articular bone morphology parameters with an accuracy of 1°. Varus OA group has less distal femoral valgus (mLDFA 89°) than control group (87°) and valgus OA group (mLDFA 85°). Varus OA group has same varus obliquity as control group (MPTA 87°) but more than valgus OA group (MPTA 90°). Joint Line Congruency Angle (JLCA) is 3°open on lateral side in varus and medially open in valgus OA group (2°). The non-arthritic valgus group presents a constitutional mechanical valgus of 184° Hip-Knee-Ankle (HKA) angle. Varus deformity in OA as measured with an HKA angle (HKA) <177° is a combination of distal femoral wear, tibial varus obliquity and lateral joint line opening. Valgus deformity in OA with an HKA > 183° is a combination of femoral distal joint line obliquity and wear combined with medial opening due to medial collateral ligament stretching. The clinical importance of bone morphotype analysis is that it shows the intra-articular potential of alignment correction when mechanical axis cuts are performed. Bone

Role of intraoperative varus stress test for lateral soft tissue release during chevron bunion procedure.

PubMed

Kim, Hyong-Nyun; Suh, Dong-Hyun; Hwang, Pil-Sung; Yu, Sun-O; Park, Yong-Wook

2011-04-01

The purpose of this study was to evaluate the clinical results of distal chevron osteotomy performed in conjunction with selective lateral soft tissue release. The criterion for doing a lateral soft tissue release was assessed by determining the ease and completeness of passive hallux valgus correction at the time of surgery. Between August 2005 and November 2007, 48 feet in 43 patients classified as having mild to moderate hallux valgus were retrospectively studied. Distal chevron osteotomy without lateral soft tissue release was performed in 26 cases (Group 1) when passive correction of the hallux valgus deformity was possible. Distal chevron osteotomy with lateral soft tissue release was performed in 22 cases (Group 2) when passive correction was not possible. Average followup was 23 (range, 12 to 28) months. Clinical results were assessed using radiographic parameters [hallux valgus angle (HVA), first and second intermetatarsal angle (1,2 IMA)], AOFAS scale and patient's subjective satisfaction. For Group 1: the average correction of HVA was 12.8 degrees, the average correction of IMA was 4.7 degrees, and the AOFAS score improved an average of 29.2 points at the last followup. Thirteen patients were very satisfied and ten patients were satisfied with the results. No patient was dissatisfied. For Group 2: the average correction of HVA was 19.1 degrees, the average correction of IMA was 7 degrees and AOFAS score improved at an average of 31.8 points at the last followup. Twelve patients were very satisfied, seven patients were satisfied and one patient, who had stiffness of the first metatarsophalangeal joint, was dissatisfied with the result. Distal chevron osteotomy with selective lateral soft tissue release based on the ability to passively correct the hallux valgus deformity lead to safe and stable correction.

Hallux valgus surgery may produce early improvements in balance control: results of a cross-sectional pilot study.

PubMed

Sadra, Saba; Fleischer, Adam; Klein, Erin; Grewal, Gurtej S; Knight, Jessica; Weil, Lowell Scott; Weil, Lowell; Najafi, Bijan

2013-01-01

Hallux valgus (HV) is associated with poorer performance during gait and balance tasks and is an independent risk factor for falls in older adults. We sought to assess whether corrective HV surgery improves gait and balance. Using a cross-sectional study design, gait and static balance data were obtained from 40 adults: 19 patients with HV only (preoperative group), 10 patients who recently underwent successful HV surgery (postoperative group), and 11 control participants. Assessments were made in the clinic using body-worn sensors. Patients in the preoperative group generally demonstrated poorer static balance control compared with the other two groups. Despite similar age and body mass index, postoperative patients exhibited 29% and 63% less center of mass sway than preoperative patients during double-and single-support balance assessments, respectively (analysis of variance P =.17 and P =.14, respectively [both eyes open condition]). Overall, gait performance was similar among the groups, except for speed during gait initiation, where lower speeds were encountered in the postoperative group compared with the preoperative group (Scheffe P = .049). This study provides supportive evidence regarding the benefits of corrective lower-extremity surgery on certain aspects of balance control. Patients seem to demonstrate early improvements in static balance after corrective HV surgery, whereas gait improvements may require a longer recovery time. Further research using a longitudinal study design and a larger sample size capable of assessing the long-term effects of HV surgical correction on balance and gait is probably warranted.

Valgus-varus motion of the knee in normal level walking and stair climbing.

PubMed

Yu, B; Stuart, M J; Kienbacher, T; Growney, E S; An, K-N

1997-07-01

OBJECTIVE: The knee valgus-varus moment and the knee angles were compared between normal level walking and stair climbing. DESIGN: Ten healthy subjects were tested for ascent, descent, and level walking. BACKGROUND: An understanding of the normal valgus-varus motion of the knee during stair climbing is needed to apply biomechanical analysis of stair climbing as a evaluation tool for knee osteoarthritis patients. METHODS: A motion analysis system, three force plates, and a flight of stairs were used to collect kinematic and kinetic data. The knee angles and moments were calculated from the collected kinematic and kinetic data. RESULTS: The knee varus angle for the maximum knee valgus moments in stair climbing was significantly greater than that in level walking. The knee valgus moment was significantly correlated to ground reaction forces and knee valgus-varus angle during stair climbing and level walking. CONCLUSIONS: There is a coupling between the knee valgus-varus motion and flexion-extension motion. Ground reaction forces are the major contributors to the within-subject variation in the knee valgus-varus moment during stair climbing and level walking. The knee valgus-varus angle is a major contributor to the between-subject variation in the knee valgus moment during stair climbing and level walking.

Scarf versus chevron osteotomy for the correction of 1-2 intermetatarsal angle in hallux valgus: a systematic review and meta-analysis.

PubMed

Smith, Simon E; Landorf, Karl B; Butterworth, Paul A; Menz, Hylton B

2012-01-01

The chevron and scarf osteotomies are commonly used for the surgical management of hallux valgus (HV). However, there is debate as to whether one osteotomy provides more 1-2 intermetatarsal (1-2 IMA) correction than the other. The objective of this systematic review and meta-analysis was to compare the effectiveness of 3 types of first metatarsal osteotomy for reducing the 1-2 IMA in HV correction: the chevron osteotomy, the long plantar arm (modified) chevron osteotomy, and the scarf osteotomy. A systematic search for eligible studies was performed of the following databases: Medline, Embase (Ovid), CINAHL (EBSCO Host), and The Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials. Only English-language studies previous to May 2010 were included in the review. Additional hand and electronic content searches of relevant foot and orthopaedic journals were performed. Criteria for inclusion in this analysis included systematic reviews of randomized controlled trials, prospective and retrospective cohort studies, and case-control studies, as well as case-series studies involving the chevron, scarf, or long plantar arm chevron osteotomy of >20 participants with a minimum of 80% follow-up. Quality of evidence of the included studies was assessed with the Grading of Recommendations Assessment, Development and Evaluation system. All pooled analyses were based on a fixed effects model. There was a total of 1351 participants who underwent either a chevron (n = 1028), scarf (n = 300), or long plantar arm chevron osteotomy (n = 23). Only one study for the long plantar arm chevron group fitted the eligibility criteria for this review; however, it was not amenable to meta-analysis. The chevron osteotomy was associated with a mean reduction of 1-2 IMA from preoperative to postoperative of 5.33° (95% confidence interval, 5.12 to 5.54, p < .001), and the scarf osteotomy was associated with a mean reduction of 6.21° (95% confidence

Effect of First Tarsometatarsal Joint Derotational Arthrodesis on First Ray Dynamic Stability Compared to Distal Chevron Osteotomy.

PubMed

Klemola, Tero; Leppilahti, Juhana; Laine, Vesa; Pentikäinen, Ilkka; Ojala, Risto; Ohtonen, Pasi; Savola, Olli

2017-08-01

Hallux valgus alters gait, compromising first ray stability and function of the windlass mechanism at the late stance. Hallux valgus correction should restore the stability of the first metatarsal. Comparative studies reporting the impact of different hallux valgus correction methods on gait are rare. We report the results of a case-control study between distal chevron osteotomy and first tarsometatarsal joint derotational arthrodesis (FTJDA). Two previously studied hallux valgus cohorts were matched: distal chevron osteotomy and FTJDA. Seventy-seven feet that underwent distal chevron osteotomy (chevron group) and 76 feet that underwent FTJDA (FTJDA group) were available for follow-up, with a mean of 7.9 years (range, 5.8-9.4 years) and 5.1 years (range, 3.0-8.3 years), respectively. Matching criteria were the hallux valgus angle (HVA) and a follow-up time difference of a maximum 24 months. Two matches were made: according to the preoperative HVA and the HVA at late follow-up. Matching provided 30 and 31 pairs, respectively. Relative impulses (%) of the first toe (T1) and metatarsal heads 1 to 5 (MTH1-5), weightbearing radiographs, and American Orthopaedic Foot & Ankle Society (AOFAS) (hallux metatarsophalangeal-interphalangeal [MTP-IP]) scores were studied. The relative impulse of MTH1 was higher in the FTJDA group, whereas a central dynamic loading pattern was seen in the chevron group. This result remained when relative impulses were analyzed according to the postoperative HVA. The mean difference in the HVA at follow-up was 6.2 degrees (95% confidence interval, 3.0-9.5; P = .001) in favor of the FTJDA group. The dynamic loading capacity of MTH1 was higher in the FTJDA group in comparison to the chevron group. The follow-up HVA remained better in the FTJDA group. Level III, case-control study.

Non-surgical treatment of hallux valgus: a current practice survey of Australian podiatrists.

PubMed

Hurn, Sheree E; Vicenzino, Bill T; Smith, Michelle D

2016-01-01

Patients with hallux valgus (HV) frequently present to podiatrists for non-surgical management, with a wide range of concerns including pain, footwear difficulty and quality of life impacts. There is little research evidence guiding podiatrists' clinical decisions surrounding non-surgical management of HV. Thus practitioners rely largely upon clinical experience and expert opinion. This survey was conducted to determine whether a consensus exists among Australian podiatrists regarding non-surgical treatment of HV, and secondly to explore common presenting concerns and physical examination findings associated with HV. An online survey was distributed to Australian podiatrists in mid-2013 via the professional association in each state (approximately 1900 members). Podiatrists indicated common treatments recommended, presenting problems and physical examination findings associated with HV in juveniles, adults and older adults. Proportions were calculated to determine the most common responses, and Chi-squared tests were used to examine differences in treatment recommendations according to HV patient age group and podiatrist demographics. Of 210 survey respondents, 65 % (136) were female and 80 % (168) were private practitioners. Complete survey responses were received from 159 podiatrists for juvenile HV, 146 for adults and 141 for older adults. Seven different non-surgical treatment options were commonly recommended (by >50 % podiatrists), although recommendations differed between adult, older adult and juvenile HV. Common treatments included footwear advice or modification, custom and prefabricated orthotic devices, addition of padding, and muscle strengthening/retraining exercises. Padding was more likely to be utilised in older adults, while exercises were more likely to be prescribed for juveniles. A diverse range of presenting problems and physical examination findings were reported to be associated with HV. Despite the lack of empirical evidence in this area

Integrating health economics into the product development cycle: a case study of absorbable pins for treating hallux valgus.

PubMed

Vallejo-Torres, Laura; Steuten, Lotte; Parkinson, Bonny; Girling, Alan J; Buxton, Martin J

2011-01-01

The probability of reimbursement is a key factor in determining whether to proceed with or abandon a product during its development. The purpose of this article is to illustrate how the methods of iterative Bayesian economic evaluation proposed in the literature can be incorporated into the development process of new medical devices, adapting them to face the relative scarcity of data and time that characterizes the process. A 3-stage economic evaluation was applied: an early phase in which simple methods allow for a quick prioritization of competing products; a mid-stage in which developers synthesize the data into a decision model, identify the parameters for which more information is most valuable, and explore uncertainty; and a late stage, in which all relevant information is synthesized. A retrospective analysis was conducted of the case study of absorbable pins, compared with metallic fixation, in osteotomy to treat hallux valgus. The results from the early analysis suggest absorbable pins to be cost-effective under the beliefs and assumptions applied. The outputs from the models at the mid-stage analyses show the device to be cost-effective with a high probability. Late-stage analysis synthesizes evidence from a randomized controlled trial and informative priors, which are based on previous evidence. It also suggests that absorbable pins are the most cost-effective strategy, although the uncertainty in the model output increased considerably. This example illustrates how the method proposed allows decisions in the product development cycle to be based on the best knowledge that is available at each stage.

A comparison of men's and women's strength to body mass ratio and varus/valgus knee angle during jump landings.

PubMed

Haines, Tracie L; McBride, Jeffrey M; Triplett, N Travis; Skinner, Jared W; Fairbrother, Kimberly R; Kirby, Tyler J

2011-10-01

The purpose of this investigation was to compare valgus/varus knee angles during various jumps and lower body strength between males and females relative to body mass. Seventeen recreationally active females (age: 21.94 ± 2.59 years; height: 1.67 ± 0.05 m; mass: 64.42 ± 8.39 kg; percent body fat: 26.89 ± 6.26%; squat one-repetition maximum: 66.18 ± 19.47 kg; squat to body mass ratio: 1.03 ± 0.28) and 13 recreationally active males (age: 21.69 ± 1.65 years; height: 1.77 ± 0.07 m; mass: 72.39 ± 9.23 kg; percent body fat: 13.15 ± 5.18%; squat one-repetition maximum: 115.77 ± 30.40 kg; squat to body mass ratio: 1.59 ± 0.31) performed a one-repetition maximum in the squat and three of each of the following jumps: countermovement jump, 30 cm drop jump, 45 cm drop jump, and 60 cm drop jump. Knee angles were analysed using videography and body composition was analysed by dual-energy X-ray absorptiometry to allow for squat to body mass ratio and squat to fat free mass ratio to be calculated. Significant differences (P ≤ 0.05) were found between male and female one-repetition maximum, male and female squat to body mass ratio, and male and female squat to fat free mass ratio. Significant differences were found between male and female varus/valgus knee positions during maximum flexion of the right and left leg in the countermovement jump, drop jump from 30 cm, drop jump from 45 cm, and drop jump from 60 cm. Correlations between varus/valgus knee angles and squat to body mass ratio for all jumps displayed moderate, non-significant relationships (countermovement jump: r = 0.445; drop jump from 30 cm: r = 0.448; drop jump from 45 cm: r = 0.449; drop jump from 60 cm: r = 0.439). In conclusion, males and females have significantly different lower body strength and varus/valgus knee position when landing from jumps.

Second Metatarsal Transfer Lesions Due to First Metatarsal Shortening After Distal Chevron Metatarsal Osteotomy for Hallux Valgus.

PubMed

Ahn, Jiyong; Lee, Ho Seong; Seo, Jeong Ho; Kim, Ju Yeong

2016-06-01

The first metatarsal bone can shorten after a distal chevron metatarsal osteotomy (DCMO). This shortening can result in a postoperative second metatarsal transfer lesion. The aim of the present study was to investigate the occurrence of second metatarsal transfer lesions after DCMO. This study involved 185 feet (138 patients), with hallux valgus (HV) deformity, treated with DCMO with Akin osteotomy. The mean patient age was 51.7 years (range, 21 to 74). Patients were followed for an average of 28 months, between June 2004 and June 2010. We measured the length of first metatarsal relative to second metatarsal preoperatively and postoperatively, using Morton's and Hardy-Clapham's methods. A second metatarsal transfer lesion was defined as a newly developed lesion, including metatarsalgia, a painful callosity, or a painless callosity, which was not present prior to the DCMO. The relation of the shortened first metatarsal after DCMO with the occurrence of second metatarsal transfer lesion was evaluated. Second metatarsal transfer lesions (painless callosity) developed in 5 feet (2.7%) of 185 feet. Twenty-four preoperative second metatarsal lesions were improved postoperatively. The median shortening of the first metatarsal bone after DCMO was 0.6 mm according to Morton's method (range, -6.4 to 6.4), and 1.9 according to Hardy-Clapham's method (range, -5.8 to 5.8). According to the extent of first metatarsal shortening after DCMO by Hardy-Clapham's method and Morton's method, there was no significant difference of the occurrence of second transfer metatarsal lesions (P = .259 and P = .176, respectively). In our study, second metatarsal transfer lesions developed in 2.7% of feet after DCMO. The occurrence of second metatarsal transfer lesions did not appear to be correlated with the degree of first metatarsal shortening in cases with less than 5.8 mm shortening. Level IV, retrospective case series. © The Author(s) 2016.

Effects of a lower limb functional exercise programme aimed at minimising knee valgus angle on running kinematics in youth athletes.

PubMed

Sheerin, Kelly R; Hume, Patria A; Whatman, Chris

2012-11-01

To investigate the effectiveness of 8-weeks of lower limb functional exercises on frontal plane hip and knee angles during running in youth athletes. Pre- and post-intervention quantitative experimental. Nineteen athletes (11 male, 8 female, 11.54 ± 1.34 years) from a long-term athletic development programme had 3-dimensional running gait measured pre and post an 8-week exercise intervention. Youth athletes randomised to control (upper limb strengthening exercises) or experimental (lower limb functional exercises aimed at minimising knee valgus angle) interventions completed the exercises during the first 10 min of training, three mornings a week. Pre- and post-parallel groups' analysis provided estimates of intervention effects for control and experimental groups. Differences in pre- to post-intervention changes in mean frontal plane angles between control and experimental groups were trivial for the left hip (0.1°) and right knee (-0.3°). There was a small beneficial decrease in right hip joint angle (0.4°) but a very large (ES = 0.77, CI 0.1-3.7) detrimental increase in left knee valgus angle (1.9°) between groups. The 8-week lower limb functional exercises had little beneficial effects on lower limb hip and knee mechanics in youth athletes aged 9-14 years. Copyright © 2012 Elsevier Ltd. All rights reserved.

Bunion correction using proximal chevron osteotomy: a single-incision technique.

PubMed

Sammarco, G J; Russo-Alesi, F G

1998-07-01

Proximal chevron first metatarsal osteotomy with lateral capsulotomy, adductor tenotomy, and binding of the first and second metatarsals was reviewed in 88 consecutive cases. Seventy-two cases in 55 patients are reported, with an average clinical follow-up of 41 months. The hallux valgus angle improved an average of 15 degrees , from 32.0 degrees preoperatively to an average of 17.0 degrees postoperatively. The intermetatarsal I-II angle improved an average of 5.5 degrees, from 15.3 degrees preoperatively to 9.0 degrees postoperatively. The lateral plantar first metatarsal angle did not change. First metatarsal length was decreased by 2.0 mm. Union occurred at an average of 2 months. Sesamoid position improved 49%, from a preoperative average subluxation of 80% to a postoperative average subluxation of 29%. Subjective foot score profiles improved from a preoperative average of 70.1/100 to a postoperative average of 94.4/100 with respect to pain, deformity, motion, disability, and cosmesis. There were 10 patients with complications, including three patients with delayed unions, two with second metatarsal stress fractures, one with hallux varus, two with hallux limitus, one with progressive arthritis, one with cellulitis, and one with hallux elevatus. Eighty-four percent of the patients stated that they would undergo the procedure again without reservation, 9% would proceed with reservation, and 7% would not proceed with surgery again if offered. This technique provides reliable successful long-term results for the treatment of moderate and severe symptomatic bunion, hallux valgus, and metatarsus primus varus.

Early results using a biodegradable magnesium screw for modified chevron osteotomies.

PubMed

Plaass, Christian; Ettinger, Sarah; Sonnow, Lena; Koenneker, Soeren; Noll, Yvonne; Weizbauer, Andreas; Reifenrath, Janin; Claassen, Leif; Daniilidis, Kiriakos; Stukenborg-Colsman, Christina; Windhagen, Henning

2016-12-01

This is the first larger study analyzing the use of magnesium-based screws for fixation of modified Chevron osteotomies in hallux valgus surgery. Forty-four patients (45 feet) were included in this prospective study. A modified Chevron osteotomy was performed on every patient and a magnesium screw used for fixation. The mean clinical follow up was 21.4 weeks. The mean age of the patients was 45.5 years. Forty patients could be provided with the implant, in four patients the surgeon decided to change to a standard metallic implant. The AOFAS, FAAM and pain NRS-scale improved markedly. The hallux valgus angle, intermetatarsal angle and sesamoid position improved significantly. Seven patients showed dorsal subluxation, rotation or medial shifting of the metatarsal heads within the first 3 months. One of these patients was revised, in all others the findings were considered clinically not significant or the patients refused revision. This study shows the feasibility of using magnesium screws in hallux valgus-surgery. Surgeons starting with the use of these implants should be aware of the proper handling of these implants and should know about corrosion effects during healing and its radiographic appearance. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2207-2214, 2016. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Biomechanical Comparison Study of Three Fixation Methods for Proximal Chevron Osteotomy of the First Metatarsal in Hallux Valgus

PubMed Central

Kim, Jin Su; Young, Ki Won; Kim, Ji Soo; Lee, Kyung Tai

2017-01-01

Background Fixation of proximal chevron metatarsal osteotomy has been accomplished using K-wires traditionally and with a locking plate recently. However, both methods have many disadvantages. Hence, we developed an intramedullary fixation technique using headless cannulated screws and conducted a biomechanical study to evaluate the superiority of the technique to K-wire and locking plate fixations. Methods Proximal chevron metatarsal osteotomy was performed on 30 synthetic metatarsal models using three fixation techniques. Specimens in group I were fixated with K-wires (1.6 mm × 2) and in group II with headless cannulated screws (3.0 mm × 2) distally through the intramedullary canal. Specimens in group III were fixated with a locking X-shaped plate (1.3-mm thick) and screws (2.5 mm × 4). Eight metatarsal specimens were selected from each group for walking fatigue test. Bending stiffness and dorsal angulation were measured by 1,000 repetitions of a cantilever bending protocol in a plantar to dorsal direction. The remaining two samples from each group were subjected to 5 mm per minute axial loading to assess the maximal loading tolerance. Results All samples in group I failed walking fatigue test while group II and group III tolerated the walking fatigue test. Group II showed greater resistance to bending force and smaller dorsal angulation than group III (p = 0.001). On the axial loading test, group I and group II demonstrated superior maximum tolerance to group III (54.8 N vs. 47.2 N vs. 28.3 N). Conclusions Authors have demonstrated proximal chevron metatarsal osteotomy with intramedullary screw fixation provides superior biomechanical stability to locking plate and K-wire fixations. The new technique using intramedullary screw fixation can offer robust fixation and may lead to better outcomes in surgical treatment of hallux valgus. PMID:29201305

Biomechanical Comparison Study of Three Fixation Methods for Proximal Chevron Osteotomy of the First Metatarsal in Hallux Valgus.

PubMed

Kim, Jin Su; Cho, Hun Ki; Young, Ki Won; Kim, Ji Soo; Lee, Kyung Tai

2017-12-01

Fixation of proximal chevron metatarsal osteotomy has been accomplished using K-wires traditionally and with a locking plate recently. However, both methods have many disadvantages. Hence, we developed an intramedullary fixation technique using headless cannulated screws and conducted a biomechanical study to evaluate the superiority of the technique to K-wire and locking plate fixations. Proximal chevron metatarsal osteotomy was performed on 30 synthetic metatarsal models using three fixation techniques. Specimens in group I were fixated with K-wires (1.6 mm × 2) and in group II with headless cannulated screws (3.0 mm × 2) distally through the intramedullary canal. Specimens in group III were fixated with a locking X-shaped plate (1.3-mm thick) and screws (2.5 mm × 4). Eight metatarsal specimens were selected from each group for walking fatigue test. Bending stiffness and dorsal angulation were measured by 1,000 repetitions of a cantilever bending protocol in a plantar to dorsal direction. The remaining two samples from each group were subjected to 5 mm per minute axial loading to assess the maximal loading tolerance. All samples in group I failed walking fatigue test while group II and group III tolerated the walking fatigue test. Group II showed greater resistance to bending force and smaller dorsal angulation than group III ( p = 0.001). On the axial loading test, group I and group II demonstrated superior maximum tolerance to group III (54.8 N vs. 47.2 N vs. 28.3 N). Authors have demonstrated proximal chevron metatarsal osteotomy with intramedullary screw fixation provides superior biomechanical stability to locking plate and K-wire fixations. The new technique using intramedullary screw fixation can offer robust fixation and may lead to better outcomes in surgical treatment of hallux valgus.

Efficacy of Arnica montana D4 for healing of wounds after Hallux valgus surgery compared to diclofenac.

PubMed

Karow, Jens-Hagen; Abt, Hans-Peter; Fröhling, Markus; Ackermann, Hanns

2008-01-01

This study was undertaken to answer the question: "Is Arnica D4 as efficacious as diclofenac in relation to symptoms and wound healing after foot surgery?" In this randomized double-blinded, parallel-group study (GCP-standard), the efficacy of Arnica D4 10 pillules (taken orally, 3 times per day) and diclofenac sodium, 50 mg (taken orally, 3 times per day) were investigated for equivalence in 88 patients 4 days after hallux valgus surgery. Outcome parameters were (1) postoperative irritation, (2) patient mobility, (3) rated pain, and (4) use of analgesics. The hierarchic equivalence test based on one-sided Wilcoxon-Mann-Whitney-U confidence intervals (CIs) was used. Equivalence was perceived, when the lower margin of the 95% CI was > 0.36 corresponding to a range of equivalence of 1/2 standard deviation. Arnica D4 and diclofenac were equivalent for wound irritation (lower margin of the 95% CI on day 4: 0.4729 for rubor; 0.3674 for swelling; 0.4106 for calor) and patient mobility (0.4726). A descriptive analysis showed the superiority of Arnica D4 with respect to patient mobility (p = 0.045). With respect to pain, Arnica D4 was inferior to diclofenac (lower margin of the 95% CI 0.026). No significant differences were found regarding the use of additional analgesics during the 4 postoperative days (Dipidolor, Janssen-Cilag, Neuss, Germany; p = 0.54; Tramal, Grünenthal, Aachen, Germany; p = 0.1; and Novalgin, AVENTIS-Pharma, Bad Soden, Germany; p = 0.1). Arnica D4 was significantly better tolerated than diclofenac (p = 0.049). Nine (9) patients (20.45%) of the diclofenac group and 2 (4.5%) of the Arnica D4 group reported intolerance. There was no disturbance in wound healing in any of the patients. Arnica D4 is 60% cheaper than diclofenac. After foot operations, Arnica D4 can be used instead of diclofenac to reduce wound irritation.

[Arthrodesis of the First Metatarsophalangeal Joint by Locking Plate].

PubMed

Kunovský, R; Pink, T; Jarošík, J

2017-01-01

PURPOSE OF THE STUDY The authors in their paper evaluate a group of patients who underwent arthrodesis of the first metatarsophalangeal joint using a locking plate. MATERIAL AND METHODS In the period 2010-2015, we performed surgery in 51 patients (56 forefeet), of which in 5 cases bilaterally and in 46 cases unilaterally, in 38 women and 13 men. The mean age was 57.8 years, the mean follow-up was 3.1 years. The indications for surgery were hallux rigidus in 23 patients, hallux valgus in 15 patients, hallux varus in 3 patients, and hallux erectus in 2 patients. In 4 patients the surgery was performed for valgus deformity associated with rheumatoid arthritis, 9 patients were indicated for a failure of the prior surgical intervention. In all 56 forefeet, the anatomic, low-profile titanium plate Variable Angle LCP 1st MTP Fusion Plate 2.4/2.7 was used. RESULTS According to Gainor s score the surgical outcomes were assessed as excellent in 46 patients who underwent surgery (90%), good in 4 patients (8%), fair in 1 patient (2%), and poor in 0 patient (0%). In 53 forefeet, the control radiographs showed solid bone union. In 2 patients and 3 forefeet, non-union of the arthrodesis occurred. In 2 forefeet, revision arthrodesis was performed, after which solid bone union followed. Malpositioned union was reported in 5 forefeet, of which in 4 cases into valgosity and in 1 case into dorsiflexion. DISCUSSION Numerous fixation materials can be used for arthrodesis of the first metatarsophalangeal joint. The use of the least stable Kirschner wires (cerclage) is being abandoned and substituted with a more stable fixation by screws, memory staples and locking plates. The achievement of excellent results requires proper positioning of the arthrodesis. Impingement syndrome between the big toe and the second toe can result in painful callosities formation, too large dorsiflexion can lead to a hallux hammertoe, with reduced big toe support function, to metatarsalgia. CONCLUSIONS The

Role of Fixation and Postoperative Regimens in the Long-Term Outcomes of Distal Chevron Osteotomy: A Randomized Controlled Two-by-Two Factorial Trial of 100 Patients.

PubMed

Pentikäinen, Ilkka; Piippo, Jouni; Ohtonen, Pasi; Junila, Juhani; Leppilahti, Juhana

2015-01-01

The necessity of chevron osteotomy fixation is controversial and evidence for the effectiveness of postoperative regimens is limited. In a prospective, randomized study, we compared the long-term results of 2 operative techniques (osteotomy fixation versus no fixation) and 2 postoperative regimens (a soft cast versus an elastic bandage) in 100 patients who underwent surgery for hallux valgus. Clinical evaluations with the American Orthopaedic Foot and Ankle Society (AOFAS) scale scoring were performed at baseline and 6 weeks, 6 months, 1 year, and a mean of 7.9 years postoperatively. The mean AOFAS function score were better in the group treated without osteotomy fixation and with an elastic bandage at 6 weeks postoperatively, but the differences then disappeared. The total AOFAS scores improved significantly in all 4 subgroups during the first 12 months; however, in the long term, some deterioration occurred. In the AOFAS scores, the average function, alignment, and total points were significantly worse when the preoperative hallux valgus angles exceeded 30°. The incidence of complication was low (1%); there was 1 superficial wound infection. The AOFAS score did not differ statistically among the groups in our population. An elastic bandage for postoperative treatment is recommended. The risk of recurrence is greater and functional result worse if the preoperative hallux valgus angle exceeds 30°. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Factors affecting femoral rotational angle based on the posterior condylar axis in gap-based navigation-assisted total knee arthroplasty for valgus knee.

PubMed

Lee, Sung-Sahn; Lee, Yong-In; Kim, Dong-Uk; Lee, Dae-Hee; Moon, Young-Wan

2018-01-01

Achieving proper rotational alignment of the femoral component in total knee arthroplasty (TKA) for valgus knee is challenging because of lateral condylar hypoplasia and lateral cartilage erosion. Gap-based navigation-assisted TKA enables surgeons to determine the angle of femoral component rotation (FCR) based on the posterior condylar axis. This study evaluated the possible factors that affect the rotational alignment of the femoral component based on the posterior condylar axis. Between 2008 and 2016, 28 knees were enrolled. The dependent variable for this study was FCR based on the posterior condylar axis, which was obtained from the navigation system archives. Multiple regression analysis was conducted to identify factors that might predict FCR, including body mass index (BMI), Kellgren-Lawrence grade (K-L grade), lateral distal femoral angles obtained from the navigation system and radiographs (NaviLDFA, XrayLDFA), hip-knee-ankle (HKA) axis, lateral gap under varus stress (LGVS), medial gap under valgus stress (MGVS), and side-to-side difference (STSD, MGVS - LGVS). The mean FCR was 6.1° ± 2.0°. Of all the potentially predictive factors evaluated in this study, only NaviLDFA (β = -0.668) and XrayLDFA (β = -0.714) predicted significantly FCR. The LDFAs, as determined using radiographs and the navigation system, were both predictive of the rotational alignment of the femoral component based on the posterior condylar axis in gap-based TKA for valgus knee. A 1° increment with NaviLDFA led to a 0.668° decrement in FCR, and a 1° increment with XrayLDFA led to a 0.714° decrement. This suggests that symmetrical lateral condylar hypoplasia of the posterior and distal side occurs in lateral compartment end-stage osteoarthritis with valgus deformity.

Effects of flexor-pronator muscle loading on valgus stability of the elbow with an intact, stretched, and resected medial ulnar collateral ligament.

PubMed

Udall, John H; Fitzpatrick, Michael J; McGarry, Michelle H; Leba, Thu-Ba; Lee, Thay Q

2009-01-01

The medial ulnar collateral ligament (MUCL) is an important passive stabilizer to the valgus stresses that athletes experience during overhead throwing motion. However, the role of the flexor-pronator muscles as active stabilizers to valgus stress is not well defined in the literature. The objectives of this study were to quantify the relative contribution of the individual flexor-pronator muscles to valgus stability of the elbow and how this relationship was affected by ligament status. A custom elbow testing system and Microscribe 3DLX were used for biomechanical testing. Flexor-pronator muscles were loaded to simulate contraction, and the valgus angle of the elbow was measured in eight cadaveric specimens at 30 degrees , 60 degrees , and 90 degrees of elbow flexion with 3 different valgus torques applied to the forearm. Loads based on muscle cross-sectional area were applied to the flexor carpi ulnaris (FCU), flexor digitorum superficialis (FDS), and pronator teres (PT). The effect of each muscle was evaluated by unloading the individual muscle while the other 2 remained loaded, resulting in 5 loading conditions: no muscles loaded, all muscles loaded, unloaded FCU, unloaded FDS, and unloaded PT. Valgus angle was measured for 3 MUCL ligament conditions: intact, stretched, and cut. The effect of muscle loading on valgus angle was similar for each ligament condition. Loading the flexor-pronator muscles significantly decreased valgus angle of the elbow in all testing conditions (P < .01). Unloading the FDS significantly increased valgus angle compared to all muscles loaded in all testing conditions (P < .016). Unloading the FCU and PT significantly increased valgus angle in less than half of the testing conditions. The FDS, PT, and FCU are all active stabilizers of the elbow to valgus stress. The FDS is the biggest contributor amongst the flexor-pronator muscles.

Radiographic Measurements of the Affected and Unaffected Feet in Patients with Unilateral Hallux Limitus A Case-Control Pilot Study.

PubMed

Knox, Andrew F; Bryant, Alan R

2016-05-01

Controversy exists regarding the structural and functional causes of hallux limitus, including metatarsus primus elevatus, a long first metatarsal, first-ray hypermobility, the shape of the first metatarsal head, and the presence of hallux interphalangeus. Some articles have reported on the radiographic evaluation of these measurements in feet affected by hallux limitus, but no study has directly compared the affected and unaffected feet in patients with unilateral hallux limitus. This case-control pilot study aimed to establish whether any such differences exist. Dorsoplantar and lateral weightbearing radiographs of both feet in 30 patients with unilateral hallux limitus were assessed for grade of disease, lateral intermetatarsal angle, metatarsal protrusion distance, plantar gapping at the first metatarsocuneiform joint, metatarsal head shape, and hallux abductus interphalangeus angle. Data analysis was performed using a statistical software program. Mean radiographic measurements for affected and unaffected feet demonstrated that metatarsus primus elevatus, a short first metatarsal, first-ray hypermobility, a flat metatarsal head shape, and hallux interphalangeus were prevalent in both feet. There was no statistically significant difference between feet for any of the radiographic parameters measured (Mann-Whitney U tests, independent-samples t tests, and Pearson χ(2) tests: P > .05). No significant differences exist in the presence of the structural risk factors examined between affected and unaffected feet in patients with unilateral hallux limitus. The influence of other intrinsic factors, including footedness and family history, should be investigated further.

The biomechanical effect of increased valgus on total knee arthroplasty: a cadaveric study.

PubMed

Bryant, Brandon J; Tilan, Justin U; McGarry, Michelle H; Takenaka, Nobuyuki; Kim, William C; Lee, Thay Q

2014-04-01

The effects of valgus load on cadaveric knees following total knee arthroplasty (TKA) were investigated using a custom testing system. TKAs were performed on 8 cadaveric knees and tested at 0°, 30°, and 60° knee flexion in both neutral and 5° valgus. Fuji pressure sensitive film was used to quantify contact areas and pressures and MCL strain was determined using a Microscribe digitizing system. Lateral tibiofemoral pressures increased (P < 0.05) at all knee flexion angles with valgus loading. Patellofemoral contact characteristics did not change significantly (P > 0.05). Significant increases in strain were observed along the anterior and posterior border of the MCL at all knee flexion angles. These findings suggest that valgus loading increases TKA joint contact pressures and MCL strain with increasing knee flexion which may increase implant instability. © 2014.

[The minimally invasive Chevron and Akin osteotomy (MICA)].

PubMed

Altenberger, Sebastian; Kriegelstein, Stefanie; Gottschalk, Oliver; Dreyer, Florian; Mehlhorn, Alexander; Röser, Anke; Walther, Markus

2018-04-18

Percutaneous correction of a hallux valgus deformity with or without transfer metatarsalgia. Hallux valgus deformity up to 20° intermetatarsal angle, without instability of the first tarsometatarsal joint. Symptomatic arthritis of the first metatarsophalangeal joint, as well as instability of the first tarsometatarsal joint. Percutaneous performed osteotomy of the distal metatarsal 1 in combination with a medial closing wedge osteotomy of the proximal phalanx of the first toe. The use of a postoperative shoe with a rigid sole allows adapted weight bearing in the first 6 weeks. Active and passive mobilization can start immediately after surgery. The method is very effective to treat even severe deformities with or without metatarsalgia. The amount of correction is similar to open procedures. We recommend cadaver training to become familiar with this technique. Thus, complications such as nerve, vessel or tendon injuries can be avoided. The intraoperative radiation exposure remains significantly elevated even for experienced surgeons. In addition to the aesthetic benefits, there is less soft tissue traumatization compared to conventional open procedures. There is no need of bloodlessness. The minimally invasive Chevron and Akin osteotomy is a safe and powerful technique for the treatment of hallux valgus deformity.

[Austin's horizontal V-shaped sliding osteotomy of the metatarsal head [Chevron-osteotomy) in the treatment of hallux valgus].

PubMed

Steinböck, G

1996-08-01

From 1983 to 1995, 1587 patients suffering from hallux abductovalgus were treated with the Austin bunionectomy. The operation consists of a medial exostosis removal, a V-shaped laterally directed displacement osteotomy of the metatarsal head, lateral release and medial reefing of the capsulo-ligamentous structures. Lateral transposition is facilitated by performing a sufficient lateral release consisting of dissection of the lateral metatarsophalangeal ligament and separation of the adductor tendon from the base of the phalanx and the lateral sesamoid. In the case of intermetatarsal angles greater than 15 degrees, the metatarsal-sesamoid ligament is also severed just above the lateral sesamoid. The periosteum is stripped in a limited fashion dorsally and toward the plantar, leaving its insertion at the metatarsal head intact. After this procedure, reposition of the metatarsal head onto the sesamoids is usually possible and is maintained by reconstruction of the medial metatarsal-sesamoid ligament. In the author's own research material, metatarsophalangeal angles larger than 50 degrees and intermetatarsal angles of over 20 degrees could be corrected. Pronation of the toe is usually corrected by tenotomy of the abductor tendon near the base of the phalanx. Avascular necrosis is extremely rare with a careful operative technique. In our extensive research material, four cases of AVN were recognized. Provided there is free motion of the joint (60-0-20), mild radiological signs of osteoarthritis are no contraindication for the operation. Even in the aged, good results can be achieved provided there are no trophic problems. The Austin bunionectomy has proved to be a versatile method for treating bunion problems. The possibility of transposing the metatarsal head laterally, toward the plantar, proximally and distally by altering the direction of the osteotomy, as well as tilting it medially or laterally, has made this osteotomy an invaluable tool for addressing various

Leg stiffness, valgus knee motion, and Q-angle are associated with hypertrophic soft patella tendon and idiopathic knee pain in adolescent basketball players.

PubMed

Satkunskiene, Danguole; Mickevicius, Mantas; Snieckus, Audrius; Kamandulis, Sigitas

2017-01-01

Knee pain without knee degenerative symptoms is a common phenomenon among young basketball players. The aim of this study was to identify factors predisposing young basketball players to suffer from knee pain. The study involved 20 male adolescent (14-15 years) basketball players who were divided into two equal groups based on knee pain symptoms. Legs torque was tested on an isokinetic dynamometer. The length, elongation and the cross-sectional area (CSA) of the patellar tendon were measured with ultrasonography. Quadriceps angle (Q-angle), knee valgus motion, and joint angular displacement in the sagittal plane were analyzed using video recording during countermovement jump. Ground reaction force was measured using a force platform. Knee pain (KP) participants had a significantly lower Q-angle (P=0.045) and lower maximum varus knee angle (P=0.035), and a greater knee inside displacement (P=0.039) during squat phase. In the KP group, the CSA at the top of the tendon was significantly greater than in the middle (P=0.006) and at the bottom (P=0.039). Absolute tendon stiffness (P=0.013) and Young's modulus (P=0.034) were significantly lower in the KP group compared with controls. Leg stiffness during landing was significantly greater in the control group (P=0.015). Leg stiffness, valgus knee motion, and Q-angle are associated with hypertrophic soft patella tendon and idiopathic knee pain in adolescent basketball players.

Effectiveness of surgery for adults with hallux valgus deformity: a systematic review.

PubMed

Klugarova, Jitka; Hood, Victoria; Bath-Hextall, Fiona; Klugar, Miloslav; Mareckova, Jana; Kelnarova, Zuzana

2017-06-01

Hallux valgus (HV) is a common foot deformity. In severe stages of this condition, surgery is often necessary. Currently, there is no systematic review comparing the effectiveness of surgery over conservative treatment. The objective of this review was to establish the effectiveness of surgery compared to conservatory management for adults with HV. The current review included adults (18 years or over) with HV deformity, excluding adults with neurological problems causing foot deformities, for example, cerebral palsy, neuropathy, stroke and multiple sclerosis. The review included any type of HV surgery compared to no surgery, conservative treatment or different types of HV surgeries. The primary outcome was gait measurement, and secondary outcomes included quality of life, patient satisfaction, pain assessed using any validated assessment tool and adverse events. The review included randomized controlled trials. The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in 16 databases without language and date limitations. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments developed by the Joanna Briggs Institute (JBI). Data were extracted from papers included in the review using the standardized data extraction tool developed by the JBI. Quantitative data were, where possible, pooled in statistical meta-analysis using RevMan5 (Copenhagen: The Nordic Cochrane Centre, Cochrane). Effect sizes expressed as risk ratio (for categorical data) and mean differences (MD) or standardized MD (for continuous data) and their 95% confidence intervals were calculated for analysis. Where statistical pooling was not possible, the findings have been presented in narrative form. Searching identified 2412 citations. After removal of duplicates, paper retrieval and critical appraisal, 25 studies

Valgus osteotomy and repositioning and fixation with a dynamic hip screw and a 135º single-angled barrel plate for un-united and neglected femoral neck fractures.

PubMed

Gupta, Sameer; Kukreja, Sunil; Singh, Vivek

2014-04-01

To review the outcome of 60 patients who underwent valgus subtrochanteric osteotomy and its repositioning for un-united and neglected femoral neck fractures. 60 patients (mean age, 35 years) underwent valgus subtrochanteric osteotomy and repositioning of the osteotomy and fixation with a dynamic hip screw and a 135° single-angled barrel plate for closed un-united femoral neck fractures after failed internal fixation (n=27) or neglected (>3 weeks) fractures (n=33). The most common fracture type was transcervical (n=48), followed by subcapital (n=6) and basal (n=6). All patients had displaced femoral neck fractures (Garden types 3 and 4). According to the Pauwel angle, 45 fractures were type 2 (30º-70º) and 15 were type 3 (>70º). Patients were followed up for a mean of 3.5 (range, 2-7.5) years. The mean Pauwel angle of the fracture was corrected from 65° (range, 50°-89°) to 26° (range, 25°-28°). Bone union was achieved in 56 patients after a mean of 3.9 (range, 3-5.5) months. The mean Harris hip score improved from 65 to 87.5. Outcome was excellent in 30 patients, good in 24, and poor in 6. Four of the patients developed avascular necrosis; 2 of whom nonetheless achieved a good outcome. Valgus osteotomy and repositioning and fixation with a dynamic hip screw and a 135° single-angled barrel plate was effective treatment for un-united and neglected femoral neck fractures.

Primary and coupled motions of the native knee in response to applied varus and valgus load.

PubMed

Gladnick, Brian P; Boorman-Padgett, James; Stone, Kyle; Kent, Robert N; Cross, Michael B; Mayman, David J; Pearle, Andrew D; Imhauser, Carl W

2016-06-01

Knowledge of the complex kinematics of the native knee is a prerequisite for a successful reconstructive procedure. The aim of this study is to describe the primary and coupled motions of the native knee throughout the range of knee flexion, in response to applied varus and valgus loads. Twenty fresh-frozen cadaver knees were affixed to a six degree of freedom robotic arm with a universal force-moment sensor, and loaded with a 4Nm moment in varus and valgus at 0, 15, 30, 45, and 90° of knee flexion. The resulting tibiofemoral angulation, displacement, and rotation were recorded. For each parameter investigated, the knee joint demonstrated more laxity at higher flexion angles. Varus angulation increased progressively from zero (2.0° varus) to 90 (5.2° varus) degrees of knee flexion (p<0.001). Valgus angulation also increased progressively, from zero (1.5° valgus) to 90 (3.9° valgus) degrees of knee flexion (p<0.001). At all flexion angles, the magnitude of tibiofemoral angle deviation was larger with varus than with valgus loading (p<0.05). We conclude that the native knee exhibits small increases in coronal plane laxity as the flexion angle increases, and that the knee has generally more laxity under varus load than with valgus load throughout the Range of Motion (ROM). Larger differences in laxity of more than 2 to 3°, or peak laxity specifically during the range of mid-flexion, were not found in our cadaver model and are not likely to represent normal coronal plane kinematics. Level V, biomechanical cadaveric study. Copyright © 2016 Elsevier B.V. All rights reserved.

Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity.

PubMed

Eberbach, Helge; Mehl, Julian; Feucht, Matthias J; Bode, Gerrit; Südkamp, Norbert P; Niemeyer, Philipp

2017-03-01

Realignment osteotomies of valgus knee deformities are usually performed at the distal femur, as valgus alignment is considered to be a femoral-based deformity. This dogma, however, has not been proven in a large patient population. Valgus malalignment may also be caused by a tibial deformity or a combined tibial and femoral deformity. The purposes of this study were (1) to analyze the coronal geometry of patients with valgus malalignment and identify the location of the underlying deformity and (2) to investigate the proportion of cases that require realignment osteotomy at the tibia, the femur, or both locations to avoid an oblique joint line. Cross-sectional study; Level of evidence, 3. The analysis included 420 standing full-leg radiographs of patients with valgus malalignment (mechanical femorotibial angle [mFTA], ≥4°). A systematic analysis of the coronal leg geometry was performed including the mFTA, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and joint-line convergence angle (JLCA). The localization of the deformity was determined according to the malalignment test described by Paley, and patients were assigned to 1 of 4 groups: femoral-based valgus deformity, tibial-based valgus deformity, femoral- and tibial-based valgus deformity, or intra-articular/ligamentary-based valgus deformity. Subsequently, the ideal osteotomy site was identified with the goal of a postoperative change of the joint line of two different maximum values, ±2° and ±4°, from its physiological varus position of 3°. Measurements of the coronal alignment revealed a mean (±SD) mFTA of 7.4° ± 4.3° (range, 4°-28.2°). The mean mLDFA and mean mMPTA were 84.8° ± 2.4° and 90.9° ± 2.6°, respectively. The mean JLCA was 1.2° ± 3.1°. The majority (41.0%) of valgus deformities were tibial based, 23.6% were femoral based, 26.9% were femoral and tibial based, and 8.6% were intra-articular/ligamentary based. To achieve a

The role of foot morphology on foot function in diabetic subjects with or without neuropathy.

PubMed

Guiotto, Annamaria; Sawacha, Zimi; Guarneri, Gabriella; Cristoferi, Giuseppe; Avogaro, Angelo; Cobelli, Claudio

2013-04-01

The aim of this study was to investigate the role of foot morphology, related with respect to diabetes and peripheral neuropathy in altering foot kinematics and plantar pressure during gait. Healthy and diabetic subjects with or without neuropathy with different foot types were analyzed. Three dimensional multisegment foot kinematics and plantar pressures were assessed on 120 feet: 40 feet (24 cavus, 20 with valgus heel and 11 with hallux valgus) in the control group, 80 feet in the diabetic (25 cavus 13 with valgus heel and 13 with hallux valgus) and the neuropathic groups (28 cavus, 24 with valgus heel and 18 with hallux valgus). Subjects were classified according to their foot morphology allowing further comparisons among the subgroups with the same foot morphology. When comparing neuropathic subjects with cavus foot, valgus heel with controls with the same foot morphology, important differences were noticed: increased dorsiflexion and peak plantar pressure on the forefoot (P<0.05), decreased contact surface on the hindfoot (P<0.03). While results indicated the important role of foot morphology in altering both kinematics and plantar pressure in diabetic subjects, diabetes appeared to further contribute in altering foot biomechanics. Surprisingly, all the diabetic subjects with normal foot arch or with valgus hallux were no more likely to display significant differences in biomechanics parameters than controls. This data could be considered a valuable support for future research on diabetic foot function, and in planning preventive interventions. Copyright © 2012 Elsevier B.V. All rights reserved.

Preoperative varus-valgus kinematic pattern throughout flexion persists more strongly after cruciate-retaining than after posterior-stabilized total knee arthroplasty.

PubMed

Hino, Kazunori; Oonishi, Yoshio; Kutsuna, Tatsuhiko; Watamori, Kunihiko; Iseki, Yasutake; Kiyomatsu, Hiroshi; Watanabe, Seiji; Miura, Hiromasa

2016-08-01

Restoration of normal knee kinematics is key to improving patient satisfaction and functional outcomes after total knee arthroplasty (TKA). However, the effect of preoperative varus-valgus kinematics due to knee osteoarthritis on the postoperative kinematics is unclear. The function of the knee ligament contributes to both knee stability and kinematics. The aim of this study was to evaluate changes in varus-valgus kinematics before and after TKA using a navigation system, in addition to comparing the pre- and postoperative changes in kinematic patterns between cruciate-retaining (CR)- and posterior-stabilized (PS)-TKAs. Forty knees treated with TKA were evaluated (CR-TKA 20; PS-TKA 20). Manual mild passive knee flexion was applied while moving the leg from full extension to flexion. The varus-valgus angle was automatically measured by a navigation system at every 10° of the flexion angle, and the kinematics were evaluated. Kinematic patterns throughout flexion can be classified into five types. The pre- and postoperative kinematic patterns were similar in 60% of patients who underwent CR-TKA, whereas they were similar in only 25% of those who underwent PS-TKA. The mean change in the size of the varus-valgus angle throughout flexion did not differ between CR-TKA and PS-TKA. However, the distribution of changes in the size of the varus-valgus angle differed between CR-TKA and PS-TKA. We obtained the following results: 1) some patterns of varus-valgus kinematics are noted under unloading conditions despite recovery of neutral alignment in extension and 2) the preoperative varus-valgus kinematic pattern persisted more strongly after CR-TKA than after PS-TKA. Copyright © 2015 Elsevier B.V. All rights reserved.

Correlation between static radiographic measurements and intersegmental angular measurements during gait using a multisegment foot model.

PubMed

Lee, Dong Yeon; Seo, Sang Gyo; Kim, Eo Jin; Kim, Sung Ju; Lee, Kyoung Min; Farber, Daniel C; Chung, Chin Youb; Choi, In Ho

2015-01-01

Radiographic examination is a widely used evaluation method in the orthopedic clinic. However, conventional radiography alone does not reflect the dynamic changes between foot and ankle segments during gait. Multiple 3-dimensional multisegment foot models (3D MFMs) have been introduced to evaluate intersegmental motion of the foot. In this study, we evaluated the correlation between static radiographic indices and intersegmental foot motion indices. One hundred twenty-five females were tested. Static radiographs of full-leg and anteroposterior (AP) and lateral foot views were performed. For hindfoot evaluation, we measured the AP tibiotalar angle (TiTA), talar tilt (TT), calcaneal pitch, lateral tibiocalcaneal angle, and lateral talcocalcaneal angle. For the midfoot segment, naviculocuboid overlap and talonavicular coverage angle were calculated. AP and lateral talo-first metatarsal angles and metatarsal stacking angle (MSA) were measured to assess the forefoot. Hallux valgus angle (HVA) and hallux interphalangeal angle were measured. In gait analysis by 3D MFM, intersegmental angle (ISA) measurements of each segment (hallux, forefoot, hindfoot, arch) were recorded. ISAs at midstance phase were most highly correlated with radiography. Significant correlations were observed between ISA measurements using MFM and static radiographic measurements in the same segment. In the hindfoot, coronal plane ISA was correlated with AP TiTA (P < .001) and TT (P = .018). In the hallux, HVA was strongly correlated with transverse ISA of the hallux (P < .001). The segmental foot motion indices at midstance phase during gait measured by 3D MFM gait analysis were correlated with the conventional radiographic indices. The observed correlation between MFM measurements at midstance phase during gait and static radiographic measurements supports the fundamental basis for the use of MFM in analysis of dynamic motion of foot segment during gait. © The Author(s) 2014.

[Total knee arthroplasty by lateral parapatellar approach for valgus knee].

PubMed

Zhou, Dian-ge; Zhang, Bin; Kou, Bo-long; Lü, Hou-shan

2007-07-17

To investigate the effect of lateral parapatellar approach in total knee arthroplasty (TKA) of valgus knee. Lateral parapatellar approach of total knee arthroplasty was applied in 8 patients (10 knees) with severe valgus osteoarthritis knee (bilateral in 2 cases and unilateral in 6 cases), with the valgus angle > 15 degrees , 1 male (1 knee) and 7 females (9 knee), aged 68.2 (58 - 79), 7 cases (9 knees) being of the Krackow type I and 1 case (1 knee) of the Krackow type I, I. After incision of the skin through lateral knee, ilio-tibial band was prolonged by apple pie arthroplasty. The joint capsule was cut open laterally 2 - 4 cm from the para-patellar edge. Soft tissue balance was performed by releasing I - T band in Gerdy tubercle, lateral collateral ligament and poster-lateral capsule from the femur and tibial side. Valgus angle of distal femur cutting were five degree. Whiteside line and trans-epicondylar line were used as AP rotational cutting reference. All patellar of the group were resurfaced. Capsule closure is completed with the knee flexed. The expanded deep lateral soft tissue sleeve (coronal Z-plasty) is sutured with the medial retinaculum sleeve (superficial layer). Follow-up was conducted for 19.6 months (1 - 51 months). Seven cases (9 knees) were replaced by posterior stabilized cemented prostheses (TC-Dynamic, PLUS), one case (1 knee) was replaced by RT prosthesis (RT-PLUS(TM) Solution, PLUS). After operation, the valgus deformity of all patients was corrected and all patients could walk 100 m with or without the help of walking holders. The average range of motion (ROM) was improved from the pre-operative. 95.6 degrees (85 degrees - 110 degrees ) to the post-operative 117.1 degrees (100 degrees - 125 degrees ). The average femorotibial angle (FTA) was corrected from the pre-operative. 27.6 degrees (20 degrees - 40 degrees ) to the post-operative 6.8 degrees (5 degrees - 9 degrees ). The Knee Score System (KSS) score and functional score were

The "moving valgus stress test" for medial collateral ligament tears of the elbow.

PubMed

O'Driscoll, Shawn W M; Lawton, Richard L; Smith, Adam M

2005-02-01

The diagnosis of a painful partial tear of the medial collateral ligament in overhead-throwing athletes is challenging, even for experienced elbow surgeons and despite the use of sophisticated imaging techniques. The "moving valgus stress test" is an accurate physical examination technique for diagnosis of medial collateral ligament attenuation in the elbow. Cohort study (diagnosis); Level of evidence, 2. Twenty-one patients underwent surgical intervention for medial elbow pain due to medial collateral ligament insufficiency or other abnormality of chronic valgus overload, and they were assessed preoperatively with an examination called the moving valgus stress test. To perform the moving valgus stress test, the examiner applies and maintains a constant moderate valgus torque to the fully flexed elbow and then quickly extends the elbow. The test is positive if the medial elbow pain is reproduced at the medial collateral ligament and is at maximum between 120 degrees and 70 degrees. The moving valgus stress test was highly sensitive (100%, 17 of 17 patients) and specific (75%, 3 of 4 patients) when compared to assessment of the medial collateral ligament by surgical exploration or arthroscopic valgus stress testing. The mean shear range (ie, the arc within which pain was produced with the moving valgus stress test) was 120 degrees to 70 degrees. The mean angle at which pain was at a maximum was 90 degrees of elbow flexion. The moving valgus stress test is an accurate physical examination technique that, when performed and interpreted correctly, is highly sensitive for medial elbow pain arising from the medial collateral ligament.

The effect of isolated valgus moments on ACL strain during single-leg landing: A simulation study

PubMed Central

Shin, Choongsoo S.; Chaudhari, Ajit M.; Andriacchi, Thomas P.

2009-01-01

Valgus moments on the knee joint during single-leg landing have been suggested as a risk factor for anterior cruciate ligament (ACL) injury. The purpose of this study was to test the influence of isolated valgus moment on ACL strain during single-leg landing. Physiologic levels of valgus moments from an in vivo study of single-leg landing were applied to a three-dimensional dynamic knee model, previously developed and tested for ACL strain measurement during simulated landing. The ACL strain, knee valgus angle, tibial rotation, and medial collateral ligament (MCL) strain were calculated and analyzed. The study shows that the peak ACL strain increased nonlinearly with increasing peak valgus moment. Subjects with naturally high valgus moments showed greater sensitivity for increased ACL strain with increased valgus moment, but ACL strain plateaus below reported ACL failure levels when the applied isolated valgus moment rises above the maximum values observed during normal cutting activities. In addition, the tibia was observed to rotate externally as the peak valgus moment increased due to bony and soft-tissue constraints. In conclusion, knee valgus moment increases peak ACL strain during single-leg landing. However, valgus moment alone may not be sufficient to induce an isolated ACL tear without concomitant damage to the MCL, because coupled tibial external rotation and increasing strain in the MCL prevent proportional increases in ACL strain at higher levels of valgus moment. Training that reduces the external valgus moment, however, can reduce the ACL strain and thus may help athletes reduce their overall ACL injury risk. PMID:19100550

Chevron closing base wedge bunionectomy.

PubMed

Bruyn, J M

1993-01-01

The Chevron-base wedge Association for Osteosynthesis fixated bunionectomy provides a stable, aggressive correction of the severe hallux abducto valgus deformity. It is intended for the bunion requiring a double osteotomy in order to adequately reduce both intermetatarsal and proximal articular facet angle with minimal shortening and elevation. This article presents the rationale for the procedure, technique, and a 4-year follow-up of six patients with eight Chevron-base wedge bunionectomies.

Chitayat syndrome: hyperphalangism, characteristic facies, hallux valgus and bronchomalacia results from a recurrent c.266A>G p.(Tyr89Cys) variant in the ERF gene.

PubMed

Balasubramanian, M; Lord, H; Levesque, S; Guturu, H; Thuriot, F; Sillon, G; Wenger, A M; Sureka, D L; Lester, T; Johnson, D S; Bowen, J; Calhoun, A R; Viskochil, D H; Bejerano, G; Bernstein, J A; Chitayat, D

2017-03-01

In 1993, Chitayat et al. , reported a newborn with hyperphalangism, facial anomalies, and bronchomalacia. We identified three additional families with similar findings. Features include bilateral accessory phalanx resulting in shortened index fingers; hallux valgus; distinctive face; respiratory compromise. To identify the genetic aetiology of Chitayat syndrome and identify a unifying cause for this specific form of hyperphalangism. Through ongoing collaboration, we had collected patients with strikingly-similar phenotype. Trio-based exome sequencing was first performed in Patient 2 through Deciphering Developmental Disorders study. Proband-only exome sequencing had previously been independently performed in Patient 4. Following identification of a candidate gene variant in Patient 2, the same variant was subsequently confirmed from exome data in Patient 4. Sanger sequencing was used to validate this variant in Patients 1, 3; confirm paternal inheritance in Patient 5. A recurrent, novel variant NM_006494.2:c.266A>G p.(Tyr89Cys) in ERF was identified in five affected individuals: de novo (patient 1, 2 and 3) and inherited from an affected father (patient 4 and 5). p.Tyr89Cys is an aromatic polar neutral to polar neutral amino acid substitution, at a highly conserved position and lies within the functionally important ETS-domain of the protein. The recurrent ERF c.266A>C p.(Tyr89Cys) variant causes Chitayat syndrome. ERF variants have previously been associated with complex craniosynostosis. In contrast, none of the patients with the c.266A>G p.(Tyr89Cys) variant have craniosynostosis. We report the molecular aetiology of Chitayat syndrome and discuss potential mechanisms for this distinctive phenotype associated with the p.Tyr89Cys substitution in ERF . Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Effects of the lapidus arthrodesis and chevron bunionectomy on plantar forefoot pressures.

PubMed

King, Christy M; Hamilton, Graham A; Ford, Lawrence A

2014-01-01

Hallux valgus with or without first ray insufficiency has been strongly implicated as a contributing factor in lesser metatarsal overload. The principle goals of a bunionectomy are to relieve the pain, correct the deformity, and restore first metatarsophalangeal joint congruity. Until now, little evidence has been available to assess the effects of bunionectomy procedures on forefoot pressure. The primary aim of the present prospective study was to evaluate the preoperative and postoperative plantar pressures after 2 specific bunionectomies: the chevron bunionectomy and Lapidus arthrodesis. A total of 68 subjects, 34 in each group, were included for radiographic and pedographic evaluation. Both procedures demonstrated radiographic improvements in the mean intermetatarsal and hallux abductus angles. The mean hallux plantar pressure decreased significantly in both procedure groups (p < .001). However, Lapidus group exhibited an increase in the mean fifth metatarsal head plantar pressure (p = .008) and pressure under the fifth metatarsal as a percentage of the total forefoot pressure (p = .01). Furthermore, the pressure under the second metatarsal as a percentage of the total forefoot pressure decreased significantly (p = .01). This study suggests that the Lapidus arthrodesis and chevron bunionectomy both provide correction for hallux valgus deformity, but when comparing forefoot load sharing pressures, the Lapidus arthrodesis appeared to have greater influence on the load sharing distribution of forefoot pressure than did the bunionectomy employing the chevron osteotomy. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Injury tolerance and moment response of the knee joint to combined valgus bending and shear loading.

PubMed

Bose, Dipan; Bhalla, Kavi S; Untaroiu, Costin D; Ivarsson, B Johan; Crandall, Jeff R; Hurwitz, Shepard

2008-06-01

Valgus bending and shearing of the knee have been identified as primary mechanisms of injuries in a lateral loading environment applicable to pedestrian-car collisions. Previous studies have reported on the structural response of the knee joint to pure valgus bending and lateral shearing, as well as the estimated injury thresholds for the knee bending angle and shear displacement based on experimental tests. However, epidemiological studies indicate that most knee injuries are due to the combined effects of bending and shear loading. Therefore, characterization of knee stiffness for combined loading and the associated injury tolerances is necessary for developing vehicle countermeasures to mitigate pedestrian injuries. Isolated knee joint specimens (n=40) from postmortem human subjects were tested in valgus bending at a loading rate representative of a pedestrian-car impact. The effect of lateral shear force combined with the bending moment on the stiffness response and the injury tolerances of the knee was concurrently evaluated. In addition to the knee moment-angle response, the bending angle and shear displacement corresponding to the first instance of primary ligament failure were determined in each test. The failure displacements were subsequently used to estimate an injury threshold function based on a simplified analytical model of the knee. The validity of the determined injury threshold function was subsequently verified using a finite element model. Post-test necropsy of the knees indicated medial collateral ligament injury consistent with the clinical injuries observed in pedestrian victims. The moment-angle response in valgus bending was determined at quasistatic and dynamic loading rates and compared to previously published test data. The peak bending moment values scaled to an average adult male showed no significant change with variation in the superimposed shear load. An injury threshold function for the knee in terms of bending angle and shear

Tibiofemoral Osteoarthritis and Varus-Valgus Laxity

PubMed Central

Freisinger, Gregory M.; Schmitt, Laura C.; Wanamaker, Andrea B.; Siston, Robert A.; Chaudhari, Ajit M. W.

2017-01-01

The purpose of this study was to systematically review and synthesize the literature measuring varus-valgus laxity in individuals with tibiofemoral osteoarthritis (OA). Specifically, we aimed to identify varus-valgus laxity differences between persons with OA and controls, by radiographic disease severity, by frontal plane knee alignment, and by sex. We also aimed to identify if there was a relationship between varus-valgus laxity and clinical performance and self-reported function. We systematically searched for peer-reviewed original research articles in PubMed, Scopus, and CINAHL to identify all existing literature regarding knee OA and objective measurement of varus-valgus laxity in vivo. Forty articles were identified that met the inclusion criteria and data were extracted. Varus-valgus laxity was significantly greater in individuals with OA compared with controls in a majority of studies, while no study found laxity to be significantly greater in controls. Varus-valgus laxity of the knee was reported in persons with OA and varying degrees of frontal plane alignment, disease severity, clinical performance, and self-reported function but no consensus finding could be identified. Females with knee OA appear to have more varus-valgus laxity than males. Meta-analysis was not possible due to the heterogeneity of the subject populations and differences in laxity measurement devices, applied loading, and laxity definitions. Increased varus-valgus laxity is a characteristic of knee joints with OA. Large variances exist in reported varus-valgus laxity and may be due to differences in measurement devices. Prospective studies on joint laxity are needed to identify if increased varus-valgus laxity is a causative factor in OA incidence and progression. PMID:27680888

A DYNAMIC VALGUS INDEX THAT COMBINES HIP AND KNEE ANGLES: ASSESSMENT OF UTILITY IN FEMALES WITH PATELLOFEMORAL PAIN.

PubMed

Scholtes, Sara A; Salsich, Gretchen B

2017-06-01

Two=dimensional motion analysis of lower=extremity movement typically focuses on the knee frontal plane projection angle, which considers the position of the femur and the tibia. A measure that includes the pelvis may provide a more comprehensive and accurate indicator of lower=extremity movement. Hypothesis/Purpose: The purpose of the study was to describe the utility of a two=dimensional dynamic valgus index (DVI) in females with patellofemoral pain. The hypothesis was that the DVI would be more reliable and valid than the knee frontal plane projection angle, be greater in females with patellofemoral pain during a single=limb squat than in females without patellofemoral pain, and decrease in females with patellofemoral pain following instruction. Study Design: Controlled Laboratory Study. Data were captured while participants performed single limb squats under two conditions: usual and corrected. Two=dimensional hip and knee angles and a DVI that combined the hip and knee angles were calculated. Three=dimensional sagittal, frontal, and transverse plane angles of the hip and knee and a DVI combining the frontal and transverse plane angles were calculated. The two=dimensional DVI demonstrated moderate reliability (ICC=0.74). The correlation between the two=dimensional and three=dimensional DVI's was 0.635 (p<0001). Females with patellofemoral pain demonstrated a greater two=dimensional DVI (31.14 °±13.36 °) than females without patellofemoral pain (18.30 °±14.97 °; p=0.010). Females with patellofemoral pain demonstrated a decreased DVI in the corrected (19.04 °±13.70 °) versus usual (31.14 °±13.36 °) condition (p=0.001). The DVI is a reliable and valid measure that may provide a more comprehensive assessment of lower=extremity movement patterns than the knee frontal plane projection angle in individuals with lower=extremity musculoskeletal pain problems. 2b.

Patient's Height and Hip Medial Offset Are the Main Determinants of the Valgus Cut Angle During Total Knee Arthroplasty.

PubMed

Drexler, Michael; Abolghasemian, Mansour; Barbuto, Richard; Naini, Mohsen S; Voshmeh, Neda; Rutenberg, Tal F; Schwarzkopf, Ran; Backstein, David J

2017-05-01

Valgus cut angle (VCA), defined as the angle between the anatomical and the mechanical axes of femur, is an important parameter upon which a critical step of knee arthroplasty is based. Some variables have been proposed to affect the magnitude of this cut. However, little information is available regarding whether a generic value can be used, or if a patient-specific value from a long leg X-ray, or factors that can be determined preoperatively, is necessary to accurately set the VCA. Standard standing 3-joint views were used to measure a number of anatomical measurements in 358 limbs, 202 patients (116 women, 86 men). Neck-shaft angle, medial offset, femoral length (FL), distal femoral articular angle, and VCA were measured. Demographic data including gender and height were extracted from hospital charts. The correlation of VCA with each of the other factors was evaluated using linear regression and t-test and finally multivariate analysis. The average VCA was 5.76° (range 4-8). Gender and distal femoral articular angle were not related to VCA (P = .343 and .995). FL was found to be a function of height with similar effects on multivariate analysis. Only the height (or FL) and femoral offset were identified as independent factors, with a negative correlation for the former (P < .001) and a positive correlation for the latter (P < .001). Femoral offset and height are the 2 independent factors determining VCA. Other parameters are indirectly related to these 2 factors. Tall patients with a small femoral offset have smaller VCA and short patients with a large offset have larger VCA. The wide variety of VCA values does not support using a generic value for all patients during knee arthroplasty. Copyright © 2016 Elsevier Inc. All rights reserved.

Tibial condylar valgus osteotomy (TCVO) for osteoarthritis of the knee: 5-year clinical and radiological results.

PubMed

Chiba, Ko; Yonekura, Akihiko; Miyamoto, Takashi; Osaki, Makoto; Chiba, Goji

2017-03-01

Tibial condylar valgus osteotomy (TCVO) is a type of opening-wedge high tibial osteotomy for advanced medial knee osteoarthritis (OA) with subluxated lateral joint. We report the concept, the current surgical technique with a locking plate, and the short-term clinical and radiological results of this procedure. 11 knees with medial OA and a widened lateral joint were treated by TCVO (KL stage III: 6, IV: 5). In this procedure, by the L-shaped osteotomy from the medial side of the proximal tibia to the intercondylar eminence and the valgus correction, lateralization of the mechanical axis and reduction of the subluxated lateral joint are obtained with early postoperative weight-bearing. Before, 6 months, 1, and 5 years after the operation, a visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), alignment of the lower extremity, and congruency and stability of the femorotibial joint were investigated. The VAS improved from an average of 73 mm to 13 mm, and the total WOMAC score from 52 to 14 before to 5 years after the operation, respectively. The mechanical axis changed from 1 to 60%, and the FTA changed from 186° to 171°. The joint line convergence angle (JLCA) changed from 6° to 1°, and the angle difference of JLCA between varus and valgus stress improved from 8° to 4° after the procedure. Improvements in pain and activities of daily living were observed by TCVO along with valgus correction of the lower extremity and stabilization of the femorotibial joint.

Radiographic assessment of knee-ankle alignment after total knee arthroplasty for varus and valgus knee osteoarthritis.

PubMed

Gao, Fuqiang; Ma, Jinhui; Sun, Wei; Guo, Wanshou; Li, Zirong; Wang, Weiguo

2017-01-01

There are unanswered questions about knee-ankle alignment after total knee arthroplasty (TKA) for varus and valgus osteoarthritis (OA) of the knee. The aim of this retrospective study was to assess knee-ankle alignment after TKA. The study consisted of 149 patients who had undergone TKA due to varus and valgus knee OA. The alignment and angles in the selected knees and ankles were measured on full-length standing anteroposterior radiographs, both pre-operatively and post-operatively. The paired t-test and Pearson's correlation tests were used for statistical analysis. The results showed that ankle alignment correlated with knee alignment both pre-operatively and postoperatively (P<0.05). The pre-operative malalignment of the knee was corrected (P<0.05), and the ankle tilt angle was accordingly improved in the operative side after TKA (P<0.05). In addition, TKA had little effect on knee-ankle alignment on the non-operative side (P>0.05). These findings indicated that routine TKA could correct the varus or valgus deformity of a knee, and improve the tilt of the ankle. Ankle alignment correlated with knee alignment both pre-operatively and postoperatively. Both pre-operative knee and ankle malalignment can be simultaneously corrected following TKA. Level III. Copyright © 2016 Elsevier B.V. All rights reserved.

Early proximal tibial valgus osteotomy as a very important prognostic factor in Thai children with infantile tibia vara.

PubMed

Kaewpornsawan, Kamolporn; Tangsataporn, Suksan; Jatunarapit, Ratiporn

2005-10-01

To find the effectiveness of the early surgery (2-3 years of age)as a very important prognostic factor affecting the outcomes in Thai children with infantile tibia vara and all the prognostic factors including the usefulness of arthrographic study in correcting the deformity. From 1994 to 2004, sixteen children aged average 3.61 years old (2.08-7.0) were treated in Siriraj Hospital and diagnosed as infantile tibia vara by Langenskiold radiographic staging were included in the present study and retrospectively reviewed with an average of 6.4 years follow up (range 6 month - 11.1 years). All cases were initially treated by surgery because of low compliance for brace or brace failure. They consisted of 3 boys and 13 girls. There were 24 legs including the bilateral involvement in 8 cases (2 boy and 6 girls). After arihrography, the midshaft fibular osteotomy was performed then the proximal tibial dome-shaped valgus osteotomy was done and fixed with 2 pins. The desired position was 12 degree knee valgus . The patients were divided in two groups, 1)group A,the successful group with the knee becoming normal without any deformity after single osteotomy, 2)group B,the recurrent group with recurrence of the varus deformity required further corrective osteotomies to make normal axis of the knee. All variables were analyzed and compared between group A and group B. The general characteristics and radiographic findings were recorded in 1)age, 2)sex, 3)side, 4)weight in kilogram and in percentage of normal or overweight(obesity) compared with the standard Thai weight chart, 5)tibiofemoral angle (TFA) pre and postoperative treatment, 6) metaphyseal diaphyseal angle (MDA), 7)the medial physeal slope angle (MPS, 8)The preoperative arthrographic articulo-diaphyseal angle (ADA), 9.arthrographic articulo-medial physeal angle (AMPA). There were 14 legs in group A and the remaining 10 legs were in group B (average 2.4 operations). All cases healed in good alignment of the legs without

Bunions (Hallux Abducto Valgus)

MedlinePlus

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Descriptive quantitative analysis of hallux abductovalgus transverse plane radiographic parameters.

PubMed

Meyr, Andrew J; Myers, Adam; Pontious, Jane

2014-01-01

Although the transverse plane radiographic parameters of the first intermetatarsal angle (IMA), hallux abductus angle (HAA), and the metatarsal-sesamoid position (MSP) form the basis of preoperative procedure selection and postoperative surgical evaluation of the hallux abductovalgus deformity, the so-called normal values of these measurements have not been well established. The objectives of the present study were to (1) evaluate the descriptive statistics of the first IMA, HAA, and MSP from a large patient population and (2) to determine an objective basis for defining "normal" versus "abnormal" measurements. Anteroposterior foot radiographs from 373 consecutive patients without a history of previous foot and ankle surgery and/or trauma were evaluated for the measurements of the first IMA, HAA, and MSP. The results revealed a mean measurement of 9.93°, 17.59°, and position 3.63 for the first IMA, HAA, and MSP, respectively. An advanced descriptive analysis demonstrated data characteristics of both parametric and nonparametric distributions. Furthermore, clear differentiations in deformity progression were appreciated when the variables were graphically depicted against each other. This could represent a quantitative basis for defining "normal" versus "abnormal" values. From the results of the present study, we have concluded that these radiographic parameters can be more conservatively reported and analyzed using nonparametric descriptive and comparative statistics within medical studies and that the combination of a first IMA, HAA, and MSP at or greater than approximately 10°, 18°, and position 4, respectively, appears to be an objective "tipping point" in terms of deformity progression and might represent an upper limit of acceptable in terms of surgical deformity correction. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Osteochondral microdamage from valgus bending of the human knee.

PubMed

Meyer, Eric G; Villwock, Mark R; Haut, Roger C

2009-08-01

Valgus bending of the knee is promoted as an anterior cruciate ligament injury mechanism and is associated with a characteristic "footprint" of bone bruising. The hypothesis of this study was that during ligamentous failure caused by valgus bending of the knee, high tibiofemoral contact pressures induce acute osteochondral microdamage. Four knee pairs were loaded in valgus bending until gross injury with or without a tibiofemoral compression pre-load. The peak valgus moment and resultant motions of the knee joint were recorded. Pressure sensitive film documented the magnitude and location of tibiofemoral contact. Cartilage fissures were documented on the tibial plateau, and microcracks in subchondral bone were documented from micro-computed tomography scans. Injuries were to the anterior cruciate ligament in three knees and the medial collateral ligament in seven knees. The mean (standard deviation) peak bending moment at failure was 107 (64)Nm. Valgus bending produced regions of contact on the lateral tibial plateau with average maximum pressures of approximately 30 (8)MPa. Cartilage fissures and subchondral bone microcracks were observed in these regions of high contact pressure. Combined valgus bending and tibiofemoral compression produce slightly higher contact pressures, but do not alter the gross injury pattern from isolated valgus bending experiments. Athletes who sustain a severe valgus knee bending moment, may be at risk of acute osteochondral damage especially if the loading mechanism occurs with a significant tibiofemoral compression component.

Plantar fasciitis and its relationship with hallux limitus.

PubMed

Aranda, Yolanda; Munuera, Pedro V

2014-05-01

We sought to determine whether patients with plantar fasciitis have limited dorsiflexion in the first metatarsophalangeal joint and which type of foot, pronated or supinated, is most frequently associated with plantar fasciitis. The 100 study participants (34 men and 66 women) were divided into two groups: patients with plantar fasciitis and controls. The Foot Posture Index and dorsiflexion of the first metatarsophalangeal joint were compared between the two groups, and a correlation analysis was conducted to study their relationship. In the plantar fasciitis group there was a slight limitation of dorsiflexion of the hallux that was not present in the control group (P < .001). Hallux dorsiflexion and the Foot Posture Index were inversely correlated (Spearman correlation coefficient, -0.441; P < .01). Participants with plantar fasciitis presented less hallux dorsiflexion than those in the control group, and their most common foot type was the pronated foot.

Single absorbable polydioxanone pin fixation for distal chevron bunion osteotomies.

PubMed

Deorio, J K; Ware, A W

2001-10-01

The distal chevron osteotomy is a well-established technique for correction of symptomatic mild to moderate metatarsus primus varus with hallux valgus deformity. Fixation of the osteotomy ranges from none to bone pegs, Kirschner wires, screws, or absorbable pins. We evaluated one surgeon's (J.K.D.) results of distal chevron osteotomy fixation with a single, nonpredrilled, 1.3-mm poly-p-dioxanone pin and analyzed any differences in patients with unilateral or bilateral symptomatic metatarsus primus varus with hallux valgus deformities. All osteotomies healed without evidence of infection, osteolysis, nonunion, or necrosis. Equal correction was achieved in unilateral and bilateral procedures. The technique is quick and easy, and adequate fixation is achieved.

Sharper angle, higher risk? The effect of cutting angle on knee mechanics in invasion sport athletes.

PubMed

Schreurs, Mervin J; Benjaminse, Anne; Lemmink, Koen A P M

2017-10-03

Cutting is an important skill in team-sports, but unfortunately is also related to non-contact ACL injuries. The purpose was to examine knee kinetics and kinematics at different cutting angles. 13 males and 16 females performed cuts at different angles (45°, 90°, 135° and 180°) at maximum speed. 3D kinematics and kinetics were collected. To determine differences across cutting angles (45°, 90°, 135° and 180°) and sex (female, male), a 4×2 repeated measures ANOVA was conducted followed by post hoc comparisons (Bonferroni) with alpha level set at α≤0.05a priori. At all cutting angles, males showed greater knee flexion angles than females (p<0.01). Also, where males performed all cutting angles with no differences in the amount of knee flexion -42.53°±8.95°, females decreased their knee flexion angle from -40.6°±7.2° when cutting at 45° to -36.81°±9.10° when cutting at 90°, 135° and 180° (p<0.01). Knee flexion moment decreased for both sexes when cutting towards sharper angles (p<0.05). At 90°, 135° and 180°, males showed greater knee valgus moments than females. For both sexes, knee valgus moment increased towards the sharper cutting angles and then stabilized compared to the 45° cutting angle (p<0.01). Both females and males showed smaller vGRF when cutting to sharper angles (p<0.01). It can be concluded that different cutting angles demand different knee kinematics and kinetics. Sharper cutting angles place the knee more at risk. However, females and males handle this differently, which has implications for injury prevention. Copyright © 2017 Elsevier Ltd. All rights reserved.

Parametric study of orthopedic insole of valgus foot on partial foot amputation.

PubMed

Guo, Jun-Chao; Wang, Li-Zhen; Chen, Wei; Du, Cheng-Fei; Mo, Zhong-Jun; Fan, Yu-Bo

2016-01-01

Orthopedic insole was important for partial foot amputation (PFA) to achieve foot balance and avoid foot deformity. The inapposite insole orthosis was thought to be one of the risk factors of reamputation for foot valgus patient, but biomechanical effects of internal tissues on valgus foot had not been clearly addressed. In this study, plantar pressure on heel and metatarsal regions of PFA was measured using F-Scan. The three-dimensional finite element (FE) model of partial foot evaluated different medial wedge angles (MWAs) (0.0°-10.0°) of orthopedic insole on valgus foot. The effect of orthopedic insole on the internal bone stress, the medial ligament tension of ankle, plantar fascia tension, and plantar pressure was investigated. Plantar pressure on medial heel region was about 2.5 times higher than that of lateral region based on the F-Scan measurements. FE-predicted results showed that the tension of medial ankle ligaments was the lowest, and the plantar pressure was redistributed around the heel, the first metatarsal, and the lateral longitudinal arch regions when MWA of orthopedic insole ranged from 7.5° to 8.0°. The plantar fascias maintained about 3.5% of the total load bearing on foot. However, the internal stresses from foot bones increased. The simulation in this study would provide the suggestion of guiding optimal design of orthopedic insole and therapeutic planning to pedorthist.

Elbow arthroscopy: valgus extension overload.

PubMed

Ahmad, Christopher S; Conway, John E

2011-01-01

Valgus torque combined with deceleration produces high compression and shear forces acting on the posteromedial olecranon and the posteromedial trochlea. This valgus extension overload process may cause posteromedial trochlea chondromalacia, chondral flap formation, osteochondrosis, subchondral erosion, a subchondral insufficiency fracture, and marginal exostosis formation. Olecranon pathologies include proximal stress reaction, a posteromedial tip stress fracture, a transverse proximal process stress fracture, exostosis formation, exostosis fragmentation, and intra-articular loose bodies. Symptoms include posteromedial elbow pain during the deceleration phase of the throwing motion. The extension impingement test reproduces posterior or posteromedial pain similar to that experienced while throwing. Special radiographic techniques and CT scans can show loose bodies and osteophyte fragmentation. Surgical treatment is indicated when symptoms persist despite nonsurgical management. Based on clinical and basic science research, all patients with valgus extension overload should be comprehensively evaluated for medial ulnar collateral ligament insufficiency. Surgical treatment is limited to the resection of osteophytes only; normal olecranon should not be resected.

An explorative investigation of functional differences in plantar center of pressure of four foot types using sample entropy method.

PubMed

Mei, Zhanyong; Ivanov, Kamen; Zhao, Guoru; Li, Huihui; Wang, Lei

2017-04-01

In the study of biomechanics of different foot types, temporal or spatial parameters derived from plantar pressure are often used. However, there is no comparative study of complexity and regularity of the center of pressure (CoP) during the stance phase among pes valgus, pes cavus, hallux valgus and normal foot. We aim to analyze whether CoP sample entropy characteristics differ among these four foot types. In our experiment participated 40 subjects with normal feet, 40 with pes cavus, 19 with pes valgus and 36 with hallux valgus. A Footscan ® system was used to collect CoP data. We used sample entropy to quantify several parameters of the investigated four foot types. These are the displacement in medial-lateral (M/L) and anterior-posterior (A/P) directions, as well as the vertical ground reaction force of CoP during the stance phase. To fully examine the potential of the sample entropy method for quantification of CoP components, we provide results for two cases: calculating the sample entropy of normalized CoP components, as well as calculating it using the raw data of CoP components. We also explored what are the optimal values of parameters m (the matching length) and r (the tolerance range) when calculating the sample entropy of CoP data obtained during the stance phases. According to statistical results, some factors significantly influenced the sample entropy of CoP components. The sample entropies of non-normalized A/P values for the left foot, as well as for the right foot, were different between the normal foot and pes valgus, and between the normal foot and hallux valgus. The sample entropy of normalized M/L displacement of the right foot was different between the normal foot and pes cavus. The measured variable for A/P and M/L displacements could serve for the study of foot function.

Intra- and Interobserver Reliability of Three Classification Systems for Hallux Rigidus.

PubMed

Dillard, Sarita; Schilero, Christina; Chiang, Sharon; Pham, Peter

2018-04-18

There are over ten classification systems currently used in the staging of hallux rigidus. This results in confusion and inconsistency with radiographic interpretation and treatment. The reliability of hallux rigidus classification systems has not yet been tested. The purpose of this study was to evaluate intra- and interobserver reliability using three commonly used classifications for hallux rigidus. Twenty-one plain radiograph sets were presented to ten ACFAS board-certified foot and ankle surgeons. Each physician classified each radiograph based on clinical experience and knowledge according to the Regnauld, Roukis, and Hattrup and Johnson classification systems. The two-way mixed single-measure consistency intraclass correlation was used to calculate intra- and interrater reliability. The intrarater reliability of individual sets for the Roukis and Hattrup and Johnson classification systems was "fair to good" (Roukis, 0.62±0.19; Hattrup and Johnson, 0.62±0.28), whereas the intrarater reliability of individual sets for the Regnauld system bordered between "fair to good" and "poor" (0.43±0.24). The interrater reliability of the mean classification was "excellent" for all three classification systems. Conclusions Reliable and reproducible classification systems are essential for treatment and prognostic implications in hallux rigidus. In our study, Roukis classification system had the best intrarater reliability. Although there are various classification systems for hallux rigidus, our results indicate that all three of these classification systems show reliability and reproducibility.

High-heeled shoes and musculoskeletal injuries: a narrative systematic review

PubMed Central

Barnish, Maxwell S; Barnish, Jean

2016-01-01

Objectives To conduct the first systematic review from an epidemiological perspective regarding the association between high-heeled shoe wear and hallux valgus, musculoskeletal pain, osteoarthritis (OA) and both first-party and second-party injury in human participants without prior musculoskeletal conditions. Setting A systematic review of international peer-reviewed scientific literature across seven major languages. Data sources Searches were conducted on seven major bibliographic databases in July 2015 to initially identify all scholarly articles on high-heeled shoes. Supplementary manual searches were conducted. Titles, abstracts and full-text articles were sequentially screened to identify all articles assessing epidemiological evidence regarding the association between high-heeled shoe wear and hallux valgus, musculoskeletal pain, OA and both first-party and second-party injury in human participants without prior musculoskeletal conditions. Standardised data extraction and quality assessment (Threats to Validity tool) were conducted. Primary and secondary outcome measures Musculoskeletal pain or OA as assessed by clinical diagnosis or clinical assessment tool. First-party or second-party injury. Results 644 unique records were identified, 56 full-text articles were screened and 18 studies included in the review. Four studies assessed the relationship with hallux valgus and three found a significant association. Two studies assessed the association with OA and neither found a significant association. Five studies assessed the association with musculoskeletal pain and three found a significant association. Eight studies assessed first-party injury and seven found evidence of a significant injury toll associated with high-heeled shoes. One study provided data on second-party injury and the injury toll was low. Conclusions High-heeled shoes were shown to be associated with hallux valgus, musculoskeletal pain and first-party injury. No conclusive evidence

Prenatal diagnosis of congenital hallux varus deformity associated with pericentric inversion of chromosome 9.

PubMed

Gürel, Sebahat Atar

2015-04-01

Congenital hallux varus is a rare deformity of the great toe characterized by adduction of the hallux and medial displacement of the first metatarsophalangeal joint. Prenatal diagnosis of congenital hallux varus is presented herein. A 32-year-old woman was referred to our unit due to significant deviation of the fetal right great toe at 22(+2) weeks of pregnancy. Ultrasound examination revealed a thick and short great toe, which was significantly angulated medially on the right side. Amniocentesis was performed and the result was reported as inv(9) (p11;q12). After delivery, the clinical examination confirmed the prenatal diagnosis. To our knowledge, this is the first reported prenatal diagnosis of an isolated congenital hallux varus. Congenital hallux varus can be diagnosed easily in the prenatal period by 2-D and 4-D ultrasonography. Prenatal karyotyping should be taken into consideration, especially in the presence of associated anomalies, such as polydactyly and clubfoot. © 2014 The Author. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

Traumatic hallux varus repair utilizing a soft-tissue anchor: a case report.

PubMed

Labovitz, J M; Kaczander, B I

2000-01-01

Hallux varus is usually iatrogenic in nature; however, congenital and acquired etiologies have been described in the literature. The authors present a case of traumatic hallux varus secondary to rupture of the adductor tendon. Surgical correction was performed using a soft tissue anchor for maintenance of the soft tissues utilized for repair.

[Melorheostosis of the foot: a case report of a rare entity].

PubMed

Craiovan, B; Zeiler, G; Delling, G; Schuh, A

2006-12-01

Melorheostosis is a rare bony dysplasia and often recognised just sporadically by chance. We present a case of a 15 year old girl who presented a melorheostosis of the left foot. After birth there was recognized a shortening and deformity of the 2nd toe on the left foot. Furthermore she had an interphalangeal hallux valgus that displaced the 2nd toe increasingly. Thus in the last years there were more and more difficulties to wear normal shoes. Conservative therapy was not successful. We performed a lengthening extending osteotomy of the 2nd toe (a modified Weil osteotomy) and an Akin osteotomy of the interphalangeal hallux valgus. Since the surgical procedure the patient is out of any complaints. We demonstrate the radiologic and histologic findings and discuss the relevant literature and possible etiology.

[Clinical effect of total knee arthroplasty on patients with knee osteoarthritis combined with mild to moderate valgus knee deformity].

PubMed

Chen, Peng; Zeng, Min; Xie, Jie; Wang, Long; Su, Weiping; Hu, Yihe

2016-09-28

To investigate the clinical effect of total knee arthroplasty on patients with knee osteoarthritis combined with mild to moderate valgus knee deformity.
 A total of 15 patients received total knee arthroplasty for correcting mild (10°-15°) to moderate (15°-30°) valgus knee between January 2011 and February 2014 in Xiangya Hospital of Central South University. We adopted a stable prosthesis surgery through patellar medial approach, osteophytes cleaning, conventional osteotomy, a selective soft tissue release and balance technical correcting of knee valgus deformity. Then conventional anticoagulation and symptomatic rehabilitation was utilized. Preoperative and postoperative X-ray was conducted in patients with measuring femor-tibial angle (FTA) and inspecting the prosthesis position. FTA, visual analog scale (VAS) standard, and parallel knee scoring system (KSS) were used to evaluate the clinical effect.
 Fifteen patients were followed up for 14 to 36 (22.40±11.88) months. The hospitalization time was 7-13 (7.73±1.58) d; operative time was 58-110 (81.8±16.85) min, the dominant blood loss was 140-600 (337.30±143.65) mL. Two cases had knee extension hysteresis, and the knee activity recovered after exercise. Leg power lines were normal. Three postoperative cases suffered anterior knee pain. They were subjected to celecoxib analgesic treatment and the pain gradually eased after 3 months. One postoperative case showed incision discharge and swelling, which was healed after change of dressing. During follow-up, review of X-ray film does not show prosthesis loose, subsidence and other complications. The knee valgus angle (8.1±1.8)°, knee motion range (107.33±9.61)°, KSS knee score (74.7±14.5, 75.3±2.7) and pain score (2.5±0.9) were significantly better than the preoperative (P<0.05). The clinical and function KSS scores showed that the improvement rate was 80%. 
 Total knee arthroplasty is an effective way to treat patients with knee osteoarthritis

Angle and Base of Gait Long Leg Axial and Intraoperative Simulated Weightbearing Long Leg Axial Imaging to Capture True Frontal Plane Tibia to Calcaneus Alignment in Valgus and Varus Deformities of the Rearfoot and Ankle.

PubMed

Boffeli, Troy J; Waverly, Brett J

2016-01-01

The long leg axial view is primarily used to evaluate the frontal plane alignment of the calcaneus in relation to the long axis of the tibia when standing. This view allows both angular measurement and assessment for the apex of varus and valgus deformity of the rearfoot and ankle with clinical utility in the preoperative, intraoperative, and postoperative settings. The frontal plane alignment of the calcaneus to the long axis of the tibia is rarely fixed in the varus or valgus position because of the inherent flexibility of the foot and ankle, which makes patient positioning critical to obtain accurate and reproducible images. Inconsistent patient positioning and imaging techniques are commonly encountered with the long leg axial view for a variety of reasons, including the lack of a standardized or validated protocol. This angle and base of gait imaging protocol involves positioning the patient to align the tibia with the long axis of the foot, which is represented by the second metatarsal. Non-weightbearing long leg axial imaging is commonly performed intraoperatively, which requires a modified patient positioning technique to capture simulated weightbearing long leg axial images. A case series is presented to demonstrate our angle and base of gait long leg axial and intraoperative simulated weightbearing long leg axial imaging protocols that can be applied throughout all phases of patient care for various foot and ankle conditions. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Conservative management of pes valgus with plantar flexed talus, flexible.

PubMed

Bleck, E E; Berzins, U J

1977-01-01

The type of flat foot that we have called pes valgus with plantar flexed talus, flexible, was treated in children with the Helfet heel seat or the UCBL shoe insert. In follow-up examination of 71 cases for periods longer than one year, 79 per cent of the patients showed that the UCBL shoe insert and the Helfet heel seat improved the clinical and roentgenographic appearance of the foot. The Helfet heel seat is recommended in cases where the plantar flexion angle of the talus is 35 to 45 degrees and the UCBL shoe insert in those cases of plantar flexion of the talus greater than 45 degrees.

Ultrasonically assisted anchoring of biodegradable implants for chevron osteotomies - clinical evaluation of a novel fixation method.

PubMed

Olms, Kai; Randt, Thorsten; Reimers, Nils; Zander, Nils; Schulz, Arndt P

2014-01-01

Reconstructive osteotomies for the treatment of Hallux valgus are among the most prevalent procedures in foot and ankle surgery. The combination of biodegradable materials with an innovative method for fixation by application of ultrasonic energy facilitates a new bonding method for fractures or osteotomies. As clinical experience is still limited, the aim of this study was to assess the safety and performance of the SonicPin system for fixation of Austin/Chevron osteotomies. Chevron osteotomy was performed on 30 patients for the treatment of Hallux valgus. The used SonicPins were made from polylactide and are selectively melted into the cancellous bone structure during insertion by ultrasonic energy. Patients were followed for one year, which included X-ray and MRI examinations as well as evaluation of life quality by EQ-5D (EuroQol). The MRI after three months showed adequate bone healing in all cases and no signs of foreign body reactions, which was again confirmed by MRI 12 months postoperatively. The bony healing after 12 months was uneventful without any signs of foreign body reactions. In summary, based on the low complication rate and the significant improvement in health related quality of life (EQ-5D) reported in this study, fixation of an Austin/Chevron osteotomy with a SonicPin for treatment of Hallux valgus can be considered to be safe and efficient over the short term. Therapeutic Level III.

Ultrasonically Assisted Anchoring of Biodegradable Implants for Chevron Osteotomies – Clinical Evaluation of a Novel Fixation Method

PubMed Central

Olms, Kai; Randt, Thorsten; Reimers, Nils; Zander, Nils; Schulz, Arndt P.

2014-01-01

Reconstructive osteotomies for the treatment of Hallux valgus are among the most prevalent procedures in foot and ankle surgery. The combination of biodegradable materials with an innovative method for fixation by application of ultrasonic energy facilitates a new bonding method for fractures or osteotomies. As clinical experience is still limited, the aim of this study was to assess the safety and performance of the SonicPin system for fixation of Austin/Chevron osteotomies. Chevron osteotomy was performed on 30 patients for the treatment of Hallux valgus. The used SonicPins were made from polylactide and are selectively melted into the cancellous bone structure during insertion by ultrasonic energy. Patients were followed for one year, which included X-ray and MRI examinations as well as evaluation of life quality by EQ-5D (EuroQol). The MRI after three months showed adequate bone healing in all cases and no signs of foreign body reactions, which was again confirmed by MRI 12 months postoperatively. The bony healing after 12 months was uneventful without any signs of foreign body reactions. In summary, based on the low complication rate and the significant improvement in health related quality of life (EQ-5D) reported in this study, fixation of an Austin/Chevron osteotomy with a SonicPin for treatment of Hallux valgus can be considered to be safe and efficient over the short term. Level of Clinical Evidence: Therapeutic Level III. PMID:24851140

Effects of foot rotation positions on knee valgus during single-leg drop landing: Implications for ACL injury risk reduction.

PubMed

Teng, P S P; Kong, P W; Leong, K F

2017-06-01

Non-contact anterior cruciate ligament (ACL) injuries commonly occur when athletes land in high risk positions such as knee valgus. The position of the foot at landing may influence the transmission of forces from the ankle to the knee. Using an experimental approach to manipulate foot rotation positions, this study aimed to provide new insights on how knee valgus during single-leg landing may be influenced by foot positions. Eleven male recreational basketball players performed single-leg drop landings from a 30-cm high platform in three foot rotation positions (toe-in, toe-forward and toe-out) at initial contact. A motion capture system and a force plate were used to measure lower extremity kinematics and kinetics. Knee valgus angles at initial contact (KVA) and maximum knee valgus moments (KVM), which were known risk factors associated with ACL injury, were measured. A one-way repeated measures Analysis of Variance was conducted (α=0.05) to compare among the three foot positions. Foot rotation positions were found to have a significant effect on KVA (p<0.001, η 2 =0.66) but the difference between conditions (about 1°) was small and not clinically meaningful. There was a significant effect of foot position on KVM (p<0.001, η 2 =0.55), with increased moment observed in the toe-out position as compared to toe-forward (p=0.012) or toe-in positions (p=0.002). When landing with one leg, athletes should avoid extreme toe-out foot rotation positions to minimise undesirable knee valgus loading associated with non-contact ACL injury risks. Copyright © 2017 Elsevier B.V. All rights reserved.

Rolled Tendon Allograft Interposition Arthroplasty for Salvage Surgery of the Hallux Metatarsophalangeal Joint.

PubMed

Thomas, Danielle; Thordarson, David

2018-04-01

Hallux rigidus is a common osteoarthritic disease of the first metatarsophalangeal joint (MTPJ). Few salvage treatment options exist that preserve motion for patients who have failed an initial procedure and who are not amenable to fusion, typically patients who are active or who would like to wear high heels. Allograft tendon interpositional arthroplasty is an unconventional salvage treatment option that may preserve motion and prevent bone loss. A retrospective chart review is reported of 19 patients who failed previous procedures and refused fusion who underwent allograft tendon interpositional arthroplasty of the hallux MTPJ by a single surgeon between 2012 and 2015. Outcomes included the American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale assessment as well as measurement of apparent joint space on anterior to posterior and lateral views. The cumulative average AOFAS score for all patients was 68.5 preoperatively and 74.1 postoperatively. The average AOFAS pain subscore was 24.7 preoperatively and 26.8 postoperatively (SD = 7.7 and 13.8, respectively). Radiographically, patients had an increase in apparent joint space from pre- to postoperatively, most notable on the lateral view (0.6 to 4.7 mm; SD = 0.7 and 3.2 mm). Five patients required a second operative procedure, for an overall 26% reoperation rate. One patient underwent hallux MTPJ fusion after the interpositional arthroplasty. An additional 4 patients (21%) had symptoms requiring a steroid injection, and another 3 patients (16%) were recommended to undergo a revision procedure based on their symptoms. Rolled allograft tendon interposition arthroplasty performed poorly as a salvage strategy for failed previous hallux MTPJ surgery for hallux rigidus because of a high rate of complication and minimal benefits. The senior author has abandoned the technique. Level IV, retrospective case series.

Resection Arthroplasty for Resistant Ulcers Underlying the Hallux in Insensate Diabetics.

PubMed

Tamir, Eran; Tamir, Jeremy; Beer, Yiftah; Kosashvili, Yona; Finestone, Aharon S

2015-08-01

Foot ulcers carry considerable morbidity in patients with peripheral neuropathy and frequently lead to foot amputation. The purpose of this study was to present our experience treating recalcitrant ulcers underlying the hallux interphalangeal joint in patients with diabetes mellitus (DM)-related neuropathy with a first metatarsophalangeal (MTPJ1) resection arthroplasty. We retrospectively reviewed the computerized medical files of patients with diabetic neuropathy treated with a MTPJ1 resection arthroplasty. We performed 28 arthroplasties on 20 patients with a mean age of 59 years. The patients had a diagnosis of DM for a mean of 10.7 years. Of the ulcers, 26 were grade 1A ulcers, and 2 were grade 2A ulcers (University of Texas score); the ulcer's mean age was 5.4 months. The mean dorsiflexion of the hallux before surgery was 46 degrees. The primary ulcer recovered in a mean of 3.1 weeks. Major complications (wound dehiscence and infection) occurred in 6 of 28 operations. Patients returned to normal activity 4 weeks after all procedures except in the 6 patients with dehiscence. In a subgroup of patients with follow-up longer than a year, the ulcer recurred after 4 of 18 arthroplasties (22%) between 3 and 12 months due to postoperative hallux rigidus. In the remaining 14 of 18 arthroplasties (78%), there was no recurrence during a mean follow-up of 26 months. MTPJ1 resection arthroplasty may be considered in a patient with resistant plantar hallux ulcerations, even in the absence of hallux rigidus. As with all operations on neuropathic feet in patients with DM, the surgeon and the patient should be aware that there is a significant likelihood of complications, but most are treatable. Level IV, case series. © The Author(s) 2015.

Current surgical strategies for total arthroplasty in valgus knee

PubMed Central

Nikolopoulos, Dimitrios; Michos, Ioannis; Safos, George; Safos, Petros

2015-01-01

The majority of orthopaedic surgeons even currently agree that primary total arthroplasty in valgus knees with a deformity of more than ten degrees may prove challenging. The unique sets of bone and soft tissue abnormalities that must be addressed at the time of the operation make accurate axis restoration, component orientation and joint stability attainment a difficult task. Understanding the specific pathologic anatomic changes associated with the valgus knee is a prerequisite so as to select the proper surgical method, to optimize component position and restore soft-tissue balance. The purpose of this article is to review the valgus knee anatomical variations, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. It will also be underlying the up-to-date main approaches and surgical techniques be proposed in the English literature both for bone cuts and soft tissue management of valgus knees. PMID:26191494

Weightbearing CT in normal hindfoot alignment - Presence of a constitutional valgus?

PubMed

Burssens, A; Van Herzele, E; Leenders, T; Clockaerts, S; Buedts, K; Vandeputte, G; Victor, J

2017-02-16

The normal hindfoot angle is estimated between 2° and 6° of valgus in the general population. These results are solely based on clinical findings and plain radiographs. The purpose of this study is to assess the hindfoot alignment using weightbear CT. Forty-eight patients, mean age of 39.6±13.2 years, with clinical and radiological absence of hindfoot pathology were included. A weightbear CT was obtained and allowed to measure the anatomical tibia axis (TAx) and the hindfoot alignment (HA). The HA was firstly determined using the inferior point of the calcaneus (HA IC ). A density measurement of this area was subsequently performed to analyze if this point concurred with an increased ossification, indicating a higher load exposure. Secondly the HA was determined by dividing the calcaneus in the long axial view (HALA) and compared to the (HA IC ) to point out any possible differences attributed to the measurement method. Reliability was assessed using an intra class correlation coefficient (ICC). The mean HA IC equaled 0.79° of valgus±3.2 (ICC HA IC =0.73) with a mean TAx of 2.7° varus±2.1 (ICCTA=0.76). The HALA equaled 9.1° of valgus±4.8 (ICCHA LA=0.71) and differed significantly by a P<0.001 from the HA IC , which showed a more neutral alignment. Correlation between both was shown to be good by a Spearman's correlation coefficient of 0.74. The mean density of the inferior calcaneal area equaled 271.3±84.1 and was significantly higher than the regional calcaneal area (P<0.001). These results show a more neutral alignment of the hindfoot in this group of non-symptomatic feet as opposed to the generally accepted constitutional valgus. This could have repercussion on hindfoot position during fusion or in quantifying the correction of a malalignment. The inferior calcaneus point in this can be used during pre-operative planning of a hindfoot correction as an anatomical landmark due to its shown influence on load transfer. Copyright © 2017 European Foot and

Clinical relevance of valgus deformity of proximal femur in cerebral palsy.

PubMed

Lee, Kyoung Min; Kang, Jong Yeol; Chung, Chin Youb; Kwon, Dae Gyu; Lee, Sang Hyeong; Choi, In Ho; Cho, Tae-Joon; Yoo, Won Joon; Park, Moon Seok

2010-01-01

Proximal femoral deformity related to physis has not been studied in patients with cerebral palsy (CP). This study was performed to investigate the clinical relevance of neck shaft angle (NSA), head shaft angle (HSA), and proximal femoral epiphyseal shape in patients with CP, which represent the deformities of metaphysis, physis, and epiphysis, respectively. Three hundred eighty-four patients with CP (mean age 9.1 y, 249 males and 135 females) were included. Extent of involvement and functional states [Gross Motor Function Classification System (GMFCS) level] were obtained. Radiographic measurements including NSA, HSA, and qualitative shape of the proximal femoral epiphysis were evaluated and analyzed according to extent of involvement and GMFCS level. Reliability and correlation with each measurement were assessed. Multiple regression test was performed to examine the significant contributing factors to migration percentage (MP) that represents hip instability. NSA showed excellent interobserver reliability with intraclass correlation coefficients of 0.976. Correlation with the MP was higher in the NSA (r=0.419, P<0.001) than in the HSA (r=0.256, P<0.001). NSA, HSA, and MP tended to increase with increasing GMFCS level, and proportion of valgus deformed proximal femoral epiphysis also increased with increasing GMFCS level, which means valgus deformity and unstable hips in the less favorable functional states. Multiple regression analysis revealed NSA, GMFCS level, and shape of the proximal femoral epiphysis to be significant factors affecting MP. NSA appeared to be more clinically relevant than HSA in evaluating proximal femoral deformity in patients with CP. Shape of proximal femoral epiphysis is believed to have clinical implications in terms of hip instability. Diagnostic level II.

Improved ankle push-off power following cheilectomy for hallux rigidus: a prospective gait analysis study.

PubMed

Smith, Sheryl M; Coleman, Scott C; Bacon, Stacy A; Polo, Fabian E; Brodsky, James W

2012-06-01

There is limited objective scientific information on the functional effects of cheilectomy. The purpose of this study was to test the hypothesis that cheilectomy for hallux rigidus improves gait by increasing ankle push-off power. Seventeen patients with symptomatic Stage 1 or Stage 2 hallux rigidus were studied. Pre- and postoperative first metatarsophalangeal (MTP) range of motion and AOFAS hallux scores were recorded. A gait analysis was performed within 4 weeks prior to surgery and repeated at a minimum of 1 year after surgery. Gait analysis was done using a three-dimensional motion capture system and a force platform embedded in a 10-m walkway. Gait velocity sagittal plane ankle range of motion and peak sagittal plane ankle push-off power were analyzed. Following cheilectomy, significant increases were noted for first MTP range of motion and AOFAS hallux score. First MTP motion improved an average of 16.7 degrees, from means of 33.9 degrees preoperatively to 50.6 degrees postoperatively (p<0.001). AOFAS hallux score increased from 62 to 81 (p<0.007). As demonstrated through gait anaylsis, a significant increase in postoperative peak sagittal plane ankle push-off power from 1.71±0.92 W/kg to 2.05±0.75 W/kg (p<0.04). In addition to clinically increased range of motion and improved AOFAS Hallux score, first MTP joint cheilectomy produced objective improvement in gait, as measured by increased peak sagittal-plane ankle push-off power.

Foot Disorders, Foot Posture, and Foot Function: The Framingham Foot Study

PubMed Central

Hagedorn, Thomas J.; Dufour, Alyssa B.; Riskowski, Jody L.; Hillstrom, Howard J.; Menz, Hylton B.; Casey, Virginia A.; Hannan, Marian T.

2013-01-01

Introduction Foot disorders are common among older adults and may lead to outcomes such as falls and functional limitation. However, the associations of foot posture and foot function to specific foot disorders at the population level remain poorly understood. The purpose of this study was to assess the relation between specific foot disorders, foot posture, and foot function. Methods Participants were from the population-based Framingham Foot Study. Quintiles of the modified arch index and center of pressure excursion index from plantar pressure scans were used to create foot posture and function subgroups. Adjusted odds ratios of having each specific disorder were calculated for foot posture and function subgroups relative to a referent 3 quintiles. Results Pes planus foot posture was associated with increased odds of hammer toes and overlapping toes. Cavus foot posture was not associated with the foot disorders evaluated. Odds of having hallux valgus and overlapping toes were significantly increased in those with pronated foot function, while odds of hallux valgus and hallux rigidus were significantly decreased in those with supinated function. Conclusions Foot posture and foot function were associated with the presence of specific foot disorders. PMID:24040231

The association of foot structure and footwear fit with disability in children and adolescents with Down syndrome.

PubMed

Lim, Polly Qx; Shields, Nora; Nikolopoulos, Nikolaos; Barrett, Joanna T; Evans, Angela M; Taylor, Nicholas F; Munteanu, Shannon E

2015-01-01

Foot deformity, flat feet, and the use of ill-fitting footwear are common in children and adolescents with Down syndrome (DS). The aim of this study was to determine whether these observations are associated with foot-specific disability in this group. A cross-sectional study design. Foot structure (foot posture determined using the Arch Index, presence of hallux valgus and lesser toe deformities) and footwear fit (determined by length and width percentage differences between the participant's foot and footwear) were assessed in 50 participants with DS (22 females, 28 males) aged five to 18 with a mean (SD) age of 10.6 (3.9) years. Foot-specific disability was determined using the parent-reported Oxford Ankle Foot Questionnaire for Children (OxAFQ-C). Associations between foot structure and footwear fit with the four domains (Physical, School and play, Emotional and Footwear) of the OxAFQ-C were determined using multivariate regression modelling. The mean (SD) Arch Index was 0.29 (0.08), and the prevalence of flat feet, hallux valgus and lesser toe deformities was 76%, 10% and 12% respectively. Few participants wore footwear that was too short (10%), but the use of footwear that was too narrow was common (58%). The presence of hallux valgus was significantly associated with increased disability for the OxAFQ-C School and play domain scores. The use of narrow-fitting footwear was significantly associated with increased levels of disability for the OxAFQ-C Physical, School and play, and Emotional domains. However, these variables only explained between 10% to 14% of the variance in the OxAFQ-C domain scores. There were no significant associations between foot structure and footwear fit with the OxAFQ-C Footwear domain scores. Flatter feet and lesser toe deformities are not associated with foot-specific disability in children and adolescents with DS. Hallux valgus is associated with foot-specific disability during school and play activities. Ill-fitting footwear (too

The risk of avascular necrosis following chevron osteotomy: a prospective study using bone scintigraphy.

PubMed

Shariff, Raheel; Attar, Fahad; Osarumwene, Donald; Siddique, Rehan; Attar, Gulam Dastagir

2009-04-01

Controversy exists with regard to the effects of chevron osteotomy on blood supply and subsequent development of avascular necrosis (AVN) of the first metatarsal head. The aim of this study was to assess the incidence of avascular necrosis in our centre following chevron osteotomy for hallux valgus, using bone scintigraphy. Thirty nine patients who had a chevron osteotomy for treatment of hallux valgus were prospectively studied. Mean follow-up was 14 months. Bone scintigraphy was used to assess metatarsal head perfusion at an average 8.5 weeks post operatively. Three patients (7.7%) showed abnormal bone scan around the metatarsal head. Further evaluation of these patients did not show any sign of AVN. We conclude there appears to be a risk of circulatory disturbance to the metatarsal head following chevron osteotomy of the first metarsal (7.7% in this study); however this does not translate into clinically significant AVN.

Valgus extension overload syndrome and stress injury of the olecranon.

PubMed

Ahmad, Christopher S; ElAttrache, Neal S

2004-10-01

Basic science studies have improved our understanding of the pathomechanics for valgus extension overload and olecranon stress fractures. These disorders result from repetitive abutment of the olecranon into the olecranon fossa combined with valgus torques, resulting in impaction and shear along the posteromedial olecranon. The patient history and physical examination are similar for each disorder. Imaging studies including plain radiographs, computed tomography, MRI or bone scan may be necessary for accurate diagnosis. Clinical and basic science support mandatory and careful assessment of the medial collateral ligament when valgus extension overload is identified and limited debridement of the olecranon when surgery is indicated. For stress fractures that fail nonoperative management, treatment with internal fixation provides good results.

Finite element analysis of the valgus knee joint of an obese child.

PubMed

Sun, Jun; Yan, Songhua; Jiang, Yan; Wong, Duo Wai-Chi; Zhang, Ming; Zeng, Jizhou; Zhang, Kuan

2016-12-28

Knee valgus and varus morbidity is at the second top place in children lower limb deformity diseases. It may cause abnormal stress distribution. The magnitude and location of contact forces on tibia plateau during gait cycle have been indicated as markers for risk of osteoarthritis. So far, few studies reported the contact stress and force distribution on tibial plateau of valgus knee of children. To estimate the contact stresses and forces on tibial plateau of an 8-year old obese boy with valgus knee and a 7-year old healthy boy, three-dimensional (3D) finite element (FE) models of their left knee joints were developed. The valgus knee model has 36,897 nodes and 1,65,106 elements, and the normal knee model has 78,278 nodes and 1,18,756 elements. Paired t test was used for the comparison between the results from the 3D FE analysis method and the results from traditional kinematic measurement methods. The p value of paired t test is 0.12. Maximum stresses shifted to lateral plateau in knee valgus children while maximum stresses were on medial plateau in normal knee child at the first peak of vertical GRF of stance phase. The locations of contact centers on medial plateau changed 3.38 mm more than that on lateral plateau, while the locations of contact centers on medial plateau changed 1.22 mm less than that on lateral plateau for healthy child from the first peak to second peak of vertical GRF of stance phase. The paired t test result shows that there is no significant difference between the two methods. The results of FE analysis method suggest that knee valgus malalignment could be the reason for abnormal knee load that may cause knee problems in obese children with valgus knee in the long-term. This study may help to understand biomechanical mechanism of valgus knees of obese children.

Developmental pattern of tibiofemoral angle in healthy north-east Indian children.

PubMed

Baruah, R K; Kumar, S; Harikrishnan, S V

2017-10-01

Physiological range of tibiofemoral angle (TFA) is poorly defined and may lead to unnecessary therapeutic interventions. Studies on TFA developmental pattern suggest that racial and ethnic differences are present; children in north-east India who have not yet been studied need to be evaluated. Cross-sectional study of clinical TFA, intermalleolar distance and intercondylar distance in 1020 healthy north-east Indian children aged from 2 to 18 years was done. Height, weight and body mass index were also recorded. At two years of age the mean TFA was valgus. The values reached a peak of 8.55° (standard deviation (SD) 1.01) valgus at seven years of age. The TFA then gradually stabilised to 3.18° (SD 1.18) valgus by 18 years of age. There was no significant difference in TFA between male and female patients. The present study is the largest and only the third such study on Indian children and the first on healthy northeast Indian children. By the end of two years most children had valgus angulation. This, along with the peak angulation observed, was similar to most of the other studies. The age at peak angulation and subsequent stabilisation of valgus angulation varied greatly among children of different origins, especially non-Indian children. Data can be used to identify children who require further follow-up/evaluation and can serve as guidelines during deformity correction and future studies. The development of TFA in this cohort is not different from other children of India but differs from children of other ethnic origins.

[Short-Term Results of Surgical Treatment of Patients with Hallux Rigidus].

PubMed

Dygrýnová, M; Uvízl, M; Gallo, J

2017-01-01

PURPOSE OF THE STUDY Hallux rigidus is common and degenerative arthritis of the first metatarsophalangeal joint. The aim of this study was to assess the results of cheilectomy and total joint replacement (TJR) in patients with hallux rigidus. Minimum duration of followup was 18 months. MATERIAL AND METHODS The study included fifty-nine patients who underwent surgery at our Department due to hallux rigidus between January 2013 and December 2014. Thirty-seven patients underwent cheilectomy and twenty-two patients had total joint arthroplasty using METIS®. The outcomes were assessed by comparing preoperative and postoperative ranges of motion, VAS (Visual Analogue Scale), AOFAS-HMI (American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Interphalangeal) and patients' satisfaction with operative treatment. Preoperative and postoperative outcomes were compared for the individual types of surgery using the repeated measures ANOVA. The level of statistical significance was set at p < 0.01. RESULTS The mean age was 47.9 ± 7.0 years in patients who underwent cheilectomy and 62.5 ± 5.5 years in patients after TJR METIS®. There was a significant decrease (p < 0.001) in the VAS pain score and a significant improvement in dorsiflexion, range of movements, AOFAS-HMI scores in both the treatment groups. In both the groups more than 75% of patients reported good or excellent subjective results. DISCUSSION Our results are in agreement with findings of other studies assessing the results of cheilectomy and TJR surgery in patients with hallux rigidus. Direct comparison of the VAS pain score, AOFAS-HMI and ranges of motion across studies is difficult because of variability in the evaluation systems. Cheilectomy is mostly recommended for young active patients with mild osteoarthritis. Moreover, it is also possible to use minimally invasive surgery with early and reliable outcomes. At our Department, we perform cheilectomy also in younger patients with moderate

Youngswick-Austin versus distal oblique osteotomy for the treatment of Hallux Rigidus.

PubMed

Viladot, Antonio; Sodano, Luca; Marcellini, Lorenzo; Zamperetti, Marco; Hernandez, Elsa Sanchez; Perice, Ramon Viladot

2017-08-01

Hallux Rigidus is the most common degenerative joint pathology of the foot. Several procedures are described for the management of this deformity. In this prospective study we compared Youngswick-Austin and distal oblique osteotomy in the treatment of grade II Hallux Rigidus, in terms of clinical outcomes, efficacy and complications. Forty-six patients (50 feet) with moderate Hallux Rigidus (Regnauld grade II) were recruited and operated between March 2009 and December 2012. Surgical technique was Youngswick-Austin osteotomy (Group A) or distal oblique osteotomy (Group B). Mean follow-up was 42.7 ±12.2 (range, 24-70) months. Both groups achieved significant improvement of AOFAS score and first metatarsophalangeal joint range of motion (p value <.05). The mean AOFAS score improved from a preoperative score of 44.1 ±11.8 to 89.2 ± 9.4 (24 months) in Group A and from 40.9 ±11.3 to 89.5 ±7.2 (24 months) in Group B. At 24 months, the average improvement of first metatarsophalangeal joint range of motion was 20.9° in Group A and 22.4° in Group B. The postoperative AOFAS score and joint range of motion were comparable in both groups. For this specific patient population Youngswick-Austin and distal oblique osteotomies provides subjective patient improvement and increases the first metatarsophalangeal joint range of motion. The results of grade II Hallux Rigidus treatment were comparable when using a Youngswick-Austin or distal oblique osteotomy. Level II, prospective comparative study. Copyright © 2017 Elsevier Ltd. All rights reserved.

Total knee arthroplasty for severe valgus knee deformity.

PubMed

Zhou, Xinhua; Wang, Min; Liu, Chao; Zhang, Liang; Zhou, Yixin

2014-01-01

Primary total knee arthroplasty (TKA) in severe valgus knees may prove challenging, and choice of implant depends on the severity of the valgus deformity and the extent of soft-tissue release. The purpose of this study was to review 8 to 11 years (mean, 10 years) follow-up results of primary TKA for varient-III valgus knee deformity with use of different type implants. Between January 2002 and January 2005, 20 women and 12 men, aged 47 to 63 (mean, 57.19 ± 6.08) years old, with varient-III valgus knees underwent primary TKA. Of the 32 patients, 37 knees had varient-III deformities. Pie crusting was carefully performed with small, multiple inside-out incisions, bone resection balanced the knee in lieu of soft tissue releases that were not used in the series. Cruciate-retaining knees (Gemini MKII, Link Company, Germany) were used in 13 knees, Genesis II (Simth & Nephew Company, USA) in 14 knees, and hinged knee (Endo-Model Company, Germany) in 10 knees. In five patients with bilateral variant-III TKAs, three patients underwent 1-stage bilateral procedures, and two underwent 2-stage procedures. All implants were cemented and the patella was not resurfaced. The Hospital for Special Surgery (HSS) knee score was assessed. Patients were followed up from 8 to 11 years. The mean HSS knee score were improved from 50.33 ± 11.60 to 90.06 ± 3.07 (P < 0.001). The mean tibiofemoral alignment were improved from valgus 32.72° ± 9.68° pre-operation to 4.89° ± 0.90° post-operation (P < 0.001). The mean range of motion were improved from 93.72° ± 23.69° pre-operation to 116.61 ± 16.29° post-operation (P < 0.001). No patients underwent revision. One patient underwent open reduction and internal fixation using femoral condylar plates for supracondylar femoral fractures secondary to a fall at three years. Three patients developed transient peroneal nerve palsies, which resolved within nine months. Two patients developed symptomatic deep vein thrombosis that was managed with

Dynamic foot function and morphology in elite rugby league athletes of different ethnicity.

PubMed

Gurney, Jason K; Kersting, Uwe G; Rosenbaum, Dieter

2009-05-01

It has long been assumed that foot function and morphology differ between ethnicities. However, quantitative research proving or disproving this relationship is sparse. As a starting point, the objective of this study was to investigate the plantar loading characteristics and foot geometry of athletes from three ethnicities, being Caucasian, Maori and Pacific Islanders. Four plantar pressure parameters were compared in 28 male elite rugby league players using an EMED-AT plantar pressure distribution platform [Novel GmbH, Munich, Germany] and the five-step method. Foot geometry measures were also taken, including arch index, coefficient of spreading, hallux angle and sub-arch angle. Five trials were collected per foot at a self-selected speed. It was found that Caucasian and Maori subjects had a relatively wider forefoot than the Pacific Island subjects; however the Pacific Islanders' foot was found to be wider than both these ethnicities in absolute terms. While Caucasian subjects loaded the toes to a much greater extent than the Maori and Pacific Island subjects, the latter demonstrated a greater loading of the mid and forefoot regions. Pacific Island subjects revealed a significantly more pronounced hallux valgus angle as compared to the Caucasian and Maori subjects. The results of this study may be relevant for/should be taken into consideration in footwear design issues, where allowances need to be made during the design process for anatomical differences between ethnicities. However these observations cannot be generalised to whole ethnic populations, and further research is required on non-athletes to build on the current research findings.

Impact of Soft Tissue Imbalance on Knee Flexion Angle After Posterior Stabilized Total Knee Arthroplasty.

PubMed

Tsukada, Sachiyuki; Fujii, Tomoko; Wakui, Motohiro

2017-08-01

This study was performed to assess the impact of soft tissue imbalance on the knee flexion angle 2 years after posterior stabilized total knee arthroplasty (TKA). A total of 329 consecutive varus knees were included to assess the association of knee flexion angle 2 years after TKA with preoperative, intraoperative, and postoperative variables. All intraoperative soft tissue measurements were performed by a single surgeon under spinal anesthesia in a standardized manner including the subvastus approach, reduced patella, and without use of a pneumonic tourniquet. Multiple linear regression analysis showed no significant correlations in terms of intraoperative valgus imbalance at 90-degree flexion or the difference in soft tissue tension between 90-degree flexion and 0-degree extension (β = -0.039; 95% confidence interval [CI], -0.88 to 0.80; P = .93 and β = 0.015; 95% CI, -0.29 to 0.32; P = .92, respectively). Preoperative flexion angle was significantly correlated with knee flexion angle 2 years after TKA (β = 0.42; 95% CI, 0.33 to 0.51; P < .0001). Avoiding valgus imbalance at 90-degree flexion and aiming for strictly equal soft tissue tension between 90-degree flexion and 0-degree extension had little practical value with regard to knee flexion angle 2 years after posterior stabilized TKA. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

A numerical simulation approach to studying anterior cruciate ligament strains and internal forces among young recreational women performing valgus inducing stop-jump activities.

PubMed

Kar, Julia; Quesada, Peter M

2012-08-01

Anterior cruciate ligament (ACL) injuries are commonly incurred by recreational and professional women athletes during non-contact jumping maneuvers in sports like basketball and volleyball, where incidences of ACL injury is more frequent to females compared to males. What remains a numerical challenge is in vivo calculation of ACL strain and internal force. This study investigated effects of increasing stop-jump height on neuromuscular and bio-mechanical properties of knee and ACL, when performed by young female recreational athletes. The underlying hypothesis is increasing stop-jump (platform) height increases knee valgus angles and external moments which also increases ACL strain and internal force. Using numerical analysis tools comprised of Inverse Kinematics, Computed Muscle Control and Forward Dynamics, a novel approach is presented for computing ACL strain and internal force based on (1) knee joint kinematics and (2) optimization of muscle activation, with ACL insertion into musculoskeletal model. Results showed increases in knee valgus external moments and angles with increasing stop-jump height. Increase in stop-jump height from 30 to 50 cm lead to increase in average peak valgus external moment from 40.5 ± 3.2 to 43.2 ± 3.7 Nm which was co-incidental with increase in average peak ACL strain, from 9.3 ± 3.1 to 13.7 ± 1.1%, and average peak ACL internal force, from 1056.1 ± 71.4 to 1165.4 ± 123.8 N for the right side with comparable increases in the left. In effect this study demonstrates a technique for estimating dynamic changes to knee and ACL variables by conducting musculoskeletal simulation on motion analysis data, collected from actual stop-jump tasks performed by young recreational women athletes.

Predictors of Frontal Plane Knee Moments During Side-Step Cutting to 45 and 110 Degrees in Men and Women: Implications for Anterior Cruciate Ligament Injury.

PubMed

Sigward, Susan M; Cesar, Guilherme M; Havens, Kathryn L

2015-11-01

To compare frontal plane knee moments, and kinematics and kinetics associated with knee valgus moments between cutting to 45 and 110 degrees, and to determine the predictive value of kinematics and ground reaction forces (GRFs) on knee valgus moments when cutting to these angles. Also, to determine whether sex differences exist in kinematics and kinetics when cutting to 45 and 110 degrees. Cross-sectional study. Laboratory setting. Forty-five (20 females) healthy young adult soccer athletes aged 16 to 23 years. Kinematic and kinetic variables were compared between randomly cued side-step cutting maneuvers to 45 and 110 degrees. Predictors of knee valgus moment were determined for each task. Kinematic variables: knee valgus angle, hip abduction, and internal rotation angles. Kinetic variables: vertical, posterior, and lateral GRFs, and knee valgus moment. Knee valgus moments were greater when cutting to 110 degrees compared with 45 degrees, and females exhibited greater moments than males. Vertical and lateral GRFs, hip internal rotation angle, and knee valgus angle explained 63% of the variance in knee valgus moment during cutting to 45 degrees. During cutting to 110 degrees, posterior GRF, hip internal rotation angle, and knee valgus angle explained 41% of the variance in knee valgus moment. Cutting tasks with larger redirection demands result in greater knee valgus moments. Similar factors, including shear GRFs, hip internal rotation, and knee valgus position contribute to knee valgus loading during cuts performed to smaller (45 degrees) and larger (110 degrees) angles. Reducing vertical and shear GRFs during cutting maneuvers may reduce knee valgus moments and thereby potentially reduce risk for anterior cruciate ligament injury.

Increased knee valgus alignment and moment during single-leg landing after overhead stroke as a potential risk factor of anterior cruciate ligament injury in badminton.

PubMed

Kimura, Yuka; Ishibashi, Yasuyuki; Tsuda, Eiichi; Yamamoto, Yuji; Hayashi, Yoshimitsu; Sato, Shuichi

2012-03-01

In badminton, knees opposite to the racket-hand side received anterior cruciate ligament (ACL) injuries during single-leg landing after overhead stroke. Most of them occurred in the backhand-side of the rear court. Comparing lower limb biomechanics during single-leg landing after overhead stroke between the forehand-side and backhand-side court may help explain the different injury rates depending on court position. The knee kinematics and kinetics during single-leg landing after overhead stroke following back-stepping were different between the forehand-side and backhand-side court. Controlled laboratory study. Hip, knee and ankle joint kinematic and knee kinetic data were collected for 17 right-handed female college badminton players using a 3-dimensional motion analysis system. Subjects performed single-left-legged landing after an overhead stroke following left and right back-stepping. The kinematic and kinetic data of the left lower extremities during landing were measured and compared between left and right back-steps. Hip flexion and abduction and knee valgus at the initial contact, hip and knee flexion and knee valgus at the maximum knee flexion and the maximum knee valgus moment were significantly larger for the left back-step than the right back-step (p<0.05). Significant differences in joint kinematics and kinetics of the lower extremity during single-leg landing after overhead stroke were observed between different back-step directions. Increased knee valgus angle and moment following back-stepping to the backhand-side might be related to the higher incidence of ACL injury during single-leg landing after overhead stroke.

Anthropometric Measurements as Predictors of the Degree of Carrying Angle in College Baseball Players

ERIC Educational Resources Information Center

Cox, Chris

2011-01-01

Scope and Method of Study: The goal of this study was to examine whether or not height, shoulder range of motion, hip width, shoulder width, and pitching experience were predictors for increased carrying angle of the throwing side. The premise of the study is based on an assumption that valgus extension overload produces tensile strain on the…

Kinematic adaptations of the hindfoot, forefoot, and hallux during cross-slope walking.

PubMed

Damavandi, Mohsen; Dixon, Philippe C; Pearsall, David J

2010-07-01

Despite cross-slope surfaces being a regular feature of our environment, little is known about segmental adaptations required to maintain both balance and forward locomotion. The purpose of this study was to determine kinematic adaptations of the foot segments in relation to transverse (cross-sloped) walking surfaces. Ten young adult males walked barefoot along an inclinable walkway (level, 0° and cross-slope, 10°). Kinematic adaptations of hindfoot with respect to tibia (HF/TB), forefoot with respect to hindfoot (FF/HF), and hallux with respect to forefoot (HX/FF) in level walking (LW), inclined walking up-slope (IWU), i.e., the foot at the higher elevation, and inclined walking down-slope (IWD), i.e., the foot at the lower elevation, were measured. Multivariate analysis of variance (MANOVA) for repeated measures was used to analyze the data. In the sagittal plane, the relative FF/HF and HX/FF plantar/dorsiflexion angles differed across conditions (p=0.024 and p=0.026, respectively). More importantly, numerous frontal plane alterations occurred. For the HF/TB angle, inversion of IWU and eversion of IWD was seen at heel-strike (p<0.001). This pattern reversed with IWU showing eversion and IWD inversion in early stance (p=0.024). For the FF/HF angle, significant differences were observed in mid-stance with IWD revealing inversion while IWU was everted (p<0.004). At toe-off, the pattern switched to eversion of IWD and inversion of IWU (p=0.032). The information obtained from this study enhances our understanding of the kinematics of the human foot in stance during level and cross-slope walking. Copyright © 2010 Elsevier B.V. All rights reserved.

Multiobjective optimization of cartilage stress for non-invasive, patient-specific recommendations of high tibial osteotomy correction angle - a novel method to investigate alignment correction.

PubMed

Zheng, Keke; Scholes, Corey J; Chen, Junning; Parker, David; Li, Qing

2017-04-01

Medial opening wedge high tibial osteotomy (MOWHTO) is a surgical procedure to treat knee osteoarthritis associated with varus deformity. However, the ideal final alignment of the Hip-Knee-Ankle (HKA) angle in the frontal plane, that maximizes procedural success and post-operative knee function, remains controversial. Therefore, the purpose of this study was to introduce a subject-specific modeling procedure in determining the biomechanical effects of MOWHTO alignment on tibiofemoral cartilage stress distribution. A 3D finite element knee model derived from magnetic resonance imaging of a healthy participant was manipulated in-silico to simulate a range of final HKA angles (i.e. 0.2°, 2.7°, 3.9° and 6.6° valgus). Loading and boundary conditions were assigned based on subject-specific kinematic and kinetic data from gait analysis. Multiobjective optimization was used to identify the final alignment that balanced compressive and shear forces between medial and lateral knee compartments. Peak stresses decreased in the medial and increased in the lateral compartment as the HKA was shifted into valgus, with balanced loading occurring at angles of 4.3° and 2.9° valgus for the femoral and tibial cartilage respectively. The concept introduced here provides a platform for non-invasive, patient-specific preoperative planning of the osteotomy for medial compartment knee osteoarthritis. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

Location of the Common Peroneal Nerve in Valgus Knees-Is the Reported Safe Zone for Well-Aligned Knees Applicable?

PubMed

Yang, Dejin; Shao, Hongyi; Zhou, Yixin; Tang, Hao; Guo, Shengjie

2017-11-01

Lateral soft-tissue release can jeopardize the common peroneal nerve (CPN) in total knee arthroplasty for valgus knees. Previous studies reporting safe zones to protect the CPN were based on well-aligned knees. We conducted this study to compare the localization of the CPN in well-aligned knees and in valgus knees. We conducted a consecutive 3-dimensional radiographic study on magnetic resonance images of 58 well-aligned knees and 39 valgus knees. We measured the distance between the CPN and the tibia, as well as the mediolateral, anteroposterior, and angular location of the CPN. We compared the results between well-aligned knees and valgus knees. We found that there is an increased distance between the CPN and the tibia at the level of the tibial cut, but not at the joint line in valgus knees. It is safer to release the posterolateral capsule at the tibial side than at the level above this. The angular location and the mediolateral or anteroposterior location of the CPN in valgus knees are similar to those of well-aligned knees. The location of the CPN in valgus knees is similar to that in well-aligned knees. The previously reported safe zone in well-aligned knees is applicable in valgus knees to protect the CPN. Copyright © 2017 Elsevier Inc. All rights reserved.

Patient-Directed Valgus Stress Radiograph of the Knee: A New and Novel Technique.

PubMed

Mauerhan, David R; Cook, Kyle D; Botts, Tonia D; Williams, Sherita T

2016-01-01

The radiographic investigation of patients with medial-compartment osteoarthritis of the knee is a critical element in the decision-making process of determining whether the patient is a candidate for unicompartmental or total knee arthroplasty. A valgus stress radiograph of the affected knee is an essential part of this radiographic investigation. Historically, this has been performed with manual stress applied by the surgeon or the radiologic technologist; thus, this examination requires 2 individuals to complete. In addition to being inefficient, 1 individual is exposed to radiation, which can be undesirable over many exposures and in a long career. For these reasons, we instituted a quality improvement project to develop a method of obtaining the valgus stress view with 1 technologist that would obviate these concerns. Of 78 examinations performed, 5 studies did not show complete correction of the varus deformity. Of these, 3 showed complete correction on a manual valgus stress radiograph, and 2 did not. Three patients displayed collapse of the lateral compartment, indicating a nonfunctional lateral compartment. The remaining 70 patients had identical radiographic results with both the manual and patient-directed valgus stress.

Carpal valgus in llamas and alpacas: Retrospective evaluation of patient characteristics, radiographic features and outcomes following surgical treatment

PubMed Central

Hunter, Barbara; Duesterdieck-Zellmer, Katja F.; Huber, Michael J.; Parker, Jill E.; Semevolos, Stacy A.

2014-01-01

This study evaluated outcomes of surgical treatment for carpal valgus in New World camelids and correlated successful outcome (absence of carpal valgus determined by a veterinarian) with patient characteristics and radiographic features. Univariable and multivariable analyses of retrospective case data in 19 camelids (33 limbs) treated for carpal valgus between 1987 and 2010 revealed that procedures incorporating a distal radial transphyseal bridge were more likely (P = 0.03) to result in success after a single surgical procedure. A greater degree of angulation (> 19°, P = 0.02) and younger age at surgery (< 4 months, P = 0.03) were associated with unsuccessful outcome. Overall, 74% of limbs straightened, 15% overcorrected, and 11% had persistent valgus following surgical intervention. To straighten, 22% of limbs required multiple procedures, not including implant removal. According to owners, valgus returned following implant removal in 4 limbs that had straightened after surgery. PMID:25477542

[Surgical technique and clinical results of total knee arthroplasty in treating endstage gonarthrosis combined with valgus knee deformity].

PubMed

Wang, Xingshan; Weng, Xisheng; Lin, Jin; Jin, Jin; Qian, Wenwei

2012-05-01

To investigate the surgical technique and the clinical results of total knee arthroplasty (TKA) in treating end-stage gonarthrosis combined with valgus knee deformity. Between November 1998 and October 2010, 64 patients (72 knees) with end-stage gonarthrosis combined with valgus knee deformity underwent TKA by a medial parapatellar approach. Of the 64 patients, 18 were male and 46 were female with an average age of 62.5 years (range, 23-82 years), including 44 cases (49 knees) of osteoarthritis, 17 cases (20 knees) of rheumatoid arthritis, 2 cases (2 knees) of haemophilic arthritis, and 1 case (1 knee) of post-traumatic arthritis. Bilateral knees were involved in 8 cases, and single knee in 56 cases. The flexion and extension range of motion (ROM) of the knee joint was (82.2 +/- 28.7) degrees; the femur-tibia angle (FTA) was (18.0 +/- 5.8) degrees; according to Knee Society Score (KSS) criterion, the preoperative clinical score was 31.2 +/- 10.1 and functional score was 37.3 +/- 9.0. According to Krackow's classification, there were 65 knees of type I and 7 knees of type II. By medial parapatellar approach, conventional osteotomy and Ranawat soft tissue release were performed in all cases. Prosthesis of preserved posterior cruciate ligament were used in 7 cases (7 knees), posterior stabilize prosthesis in 54 cases (60 knees), constrained prosthesis in 4 cases (5 knees). Incisions healed by first intention in all cases. Peroneal nerve palsy occurred in 1 patient with haemophilic arthritis, severe valgus deformity (FTA was 41 degrees), and flexion contracture (20 degrees), which was cured after 1 year of conservative treatment. Revison surgery was performed in 1 case of deep infection at 2 years after surgery. All the patients were followed up 4.9 years on average (range, 1-13 years). At last follow-up, the FTA was (7.0 +/- 2.5) degrees, showing significant difference when compared with preoperative value (t = 15.502, P = 0.000). The KSS clinical score was 83.0 +/- 6

Varus-valgus stability at 90° flexion correlates with the stability at midflexion range more widely than that at 0° extension in posterior-stabilized total knee arthroplasty.

PubMed

Hino, Kazunori; Kutsuna, Tatsuhiko; Watamori, Kunihiko; Kiyomatsu, Hiroshi; Ishimaru, Yasumitsu; Takeba, Jun; Watanabe, Seiji; Shiraishi, Yoshitaka; Miura, Hiromasa

2017-10-01

Midflexion stability can potentially improve the outcome of total knee arthroplasty (TKA). The purpose of this study was to evaluate the correlation between varus-valgus stability at 0° of extension and 90° of flexion and that at the midflexion range in posterior-stabilized (PS)-TKA. Forty-three knees that underwent PS-TKA were evaluated. Manual mild passive varus-valgus stress was applied to the knees, and the postoperative maximum varus-valgus stability was measured every 10° throughout range of motion, using a navigation system. Correlations between the stability at 0°, 90° of flexion, and that at each midflexion angle were evaluated using Spearman's correlation coefficients. The stability of 0° modestly correlated with that of 10°-20°, but it did not significantly correlate with that of 30°-80°. However, the stability of 90° strongly correlated with that of 60°-80°, modestly correlated with that of 40°-50°, weakly correlated with that of 20°-30°, and did not correlate with that of 10°. The present study confirmed the importance of acquiring stability at 90° flexion to achieve midflexion stability in PS-TKA. However, initial flexion stability did not strongly correlate with the stability at either 0° or 90°. Our findings can provide useful information for understanding varus-valgus stability throughout the range of motion in PS-TKA. Attention to soft tissue balancing is necessary to stabilize a knee at the initial flexion range in PS-TKA.

The effect of ankle position on the exam for first ray mobility.

PubMed

Grebing, Brett R; Coughlin, Michael J

2004-07-01

The clinical assessment of first ray motion in the sagittal plane, as originally described by Morton, is difficult to quantify. Different reports have shown inconsistent values and variability between the manual exam and examination using an external measuring device. The authors hypothesize that when performing a manual examination for evidence of increased first ray motion, the magnitude of first ray mobility varies as the position of ankle dorsiflexion/plantarflexion varies. Using an external caliper (a modified Klaue device), the authors quantified first ray motion in reference to variable ankle positions in a group of normal patients, a group of patients with untreated moderate and severe hallux valgus, a group who had undergone a successful metatarsophalangeal joint arthrodesis for hallux valgus, and a small group who had previously undergone a plantar fasciectomy. A total of 119 feet (109 patients) were measured. In addition to first ray motion, radiographic data were compared between groups. With the ankle in the neutral dorsiflexion position, the mean first ray motion was 4.9 mm for the control group, 7.0 mm for the hallux valgus group, 4.4 mm for the metatarsophalangeal fusion group, and 7.7 mm for the plantar fasciectomy group. There was a significant decrease (p < .05) in first ray motion when the ankle was moved to the dorsiflexed position for all four groups. There was a significant increase in first ray motion when the ankle was moved to the plantarflexed position (p < .01) for all groups except the plantar fasciectomy group. No significant difference in first ray motion was observed for the plantar fasciectomy group between the neutral and plantarflexed ankle positions (p < .05). The exam for first ray mobility is influenced by the position of the ankle and may explain the discrepancy between the manual exam and measurement with an external device. Recommendations for the manual exam of first ray mobility are given.

Impaired Varus-Valgus Proprioception and Neuromuscular Stabilization in Medial Knee Osteoarthritis

PubMed Central

Chang, Alison H.; Lee, Song Joo; Zhao, Heng; Ren, Yupeng; Zhang, Li-Qun

2014-01-01

Impaired proprioception and poor muscular stabilization in the frontal plane may lead to knee instability during functional activities, a common complaint in persons with knee osteoarthritis (KOA). Understanding these frontal plane neuromechanical properties in KOA will help elucidate the factors contributing to knee instability and aid in the development of targeted intervention strategies. The study objectives were to compare knee varus-valgus proprioception, isometric muscle strength, and active muscular contribution to stability between persons with medial KOA and healthy controls. We evaluated knee frontal plane neuromechanical parameters in 14 participants with medial KOA and 14 age- and gender-matched controls, using a joint driving device (JDD) with a customized motor and a 6-axis force sensor. Analysis of covariance with BMI as a covariate was used to test the differences in varus-valgus neuromechanical parameters between these two groups. The KOA group had impaired varus proprioception acuity (1.08 ± 0.59° vs. 0.69 ± 0.49°, p < 0.05), decreased normalized varus muscle strength (1.31 ± 0.75% vs. 1.79 ± 0.84% body weight, p < 0.05), a trend toward decreased valgus strength (1.29 ± 0.67% vs. 1.88 ± 0.99%, p = 0.054), and impaired ability to actively stabilize the knee in the frontal plane during external perturbation (4.67 ± 2.86 vs. 8.26 ± 5.95 Nm/degree, p < 0.05). The knee frontal plane sensorimotor control system is compromised in persons with medial KOA. Our findings suggest varus-valgus control deficits in both the afferent input (proprioceptive acuity) and muscular effectors (muscle strength and capacity to stabilize the joint). PMID:24321442

Chevron osteotomy for the treatment of hallux valgus.

PubMed

Horne, G; Tanzer, T; Ford, M

1984-03-01

Seventy-six chevron osteotomies with follow-up periods ranging from six months to eight years were reviewed. The majority of patients had pain over the bunion prior to operation, and 27 also presented with second metatarsalgia. After surgery there was a marked decrease of pain in the first metatarsophalangeal joint, and in 18 feet the second metatarsalgia was either eliminated or markedly decreased. Most patients were pleased with the appearance of the feet after surgery, but almost one-third of the women complained of difficulty in wearing high heels. The surgical technique is straightforward, but careful attention to detail is necessary to obtain a consistent and satisfactory result.

Angle-stable and compressed angle-stable locking for tibiotalocalcaneal arthrodesis with retrograde intramedullary nails. Biomechanical evaluation.

PubMed

Mückley, Thomas; Hoffmeier, Konrad; Klos, Kajetan; Petrovitch, Alexander; von Oldenburg, Geert; Hofmann, Gunther O

2008-03-01

Retrograde intramedullary nailing is an established procedure for tibiotalocalcaneal arthrodesis. The goal of this study was to evaluate the effects of angle-stable locking or compressed angle-stable locking on the initial stability of the nails and on the behavior of the constructs under cyclic loading conditions. Tibiotalocalcaneal arthrodesis was performed in fifteen third-generation synthetic bones and twenty-four fresh-frozen cadaver legs with use of retrograde intramedullary nailing with three different locking modes: a Stryker nail with compressed angle-stable locking, a Stryker nail with angle-stable locking, and a statically locked Biomet nail. Analyses were performed of the initial stability of the specimens (range of motion) and the laxity of the constructs (neutral zone) in dorsiflexion/plantar flexion, varus/valgus, and external rotation/internal rotation. Cyclic testing up to 100,000 cycles was also performed. The range of motion and the neutral zone in dorsiflexion/plantar flexion at specific cycle increments were determined. In both bone models, the intramedullary nails with compressed angle-stable locking and those with angle-stable locking were significantly superior, in terms of a smaller range of motion and neutral zone, to the statically locked nails. The compressed angle-stable nails were superior to the angle-stable nails only in the synthetic bone model, in external/internal rotation. Cyclic testing showed the nails with angle-stable locking and those with compressed angle-stable locking to have greater stability in both models. In the synthetic bone model, compressed angle-stable locking was significantly better than angle-stable locking; in the cadaver bone model, there was no significant difference between these two locking modes. During cyclic testing, five statically locked nails in the cadaver bone model failed, whereas one nail with angle-stable locking and one with compressed angle-stable locking failed. Regardless of the bone model

Biomechanical effects of valgus knee bracing: a systematic review and meta-analysis.

PubMed

Moyer, R F; Birmingham, T B; Bryant, D M; Giffin, J R; Marriott, K A; Leitch, K M

2015-02-01

To review and synthesize the biomechanical effects of valgus knee bracing for patients with medial knee osteoarthritis (OA). Electronic databases were searched from their inception to May 2014. Two reviewers independently determined study eligibility, rated study quality and extracted data. Where possible, data were combined into meta-analyses and pooled estimates with 95% confidence intervals (CI) for standardized mean differences (SMD) were calculated. Thirty studies were included with 478 subjects tested while using a valgus knee brace. Various biomechanical methods suggested valgus braces can decrease direct measures of medial knee compressive force, indirect measures representing the mediolateral distribution of load across the knee, quadriceps/hamstring and quadriceps/gastrocnemius co-contraction ratios, and increase medial joint space during gait. Meta-analysis from 17 studies suggested a statistically significant decrease in the external knee adduction moment (KAM) during walking, with a moderate-to-high effect size (SMD = 0.61; 95% CI: 0.39, 0.83; P < 0.001). Meta-regression identified a near-significant association for the KAM effect size and duration of brace use only (β, -0.01; 95% CI: -0.03, 0.0001; P = 0.06); with longer durations of brace use associated with smaller treatment effects. Minor complications were commonly reported during brace use and included slipping, discomfort and poor fit, blisters and skin irritation. Systematic review and meta-analysis suggests valgus knee braces can alter knee joint loads through a combination of mechanisms, with moderate-to-high effect sizes in biomechanical outcomes. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Longitudinal bracketed epiphysis of proximal phalanx of the great toe with congenital hallux varus managed simultaneously with monorail external fixator: a case report.

PubMed

Verma, Vineet; Batra, Amit; Singla, Rohit; Gogna, Paritosh; Magu, Narender; Gupta, Rakesh

2014-02-01

Longitudinal bracketed epiphysis (delta phalanx) is a rare congenital anomaly that affects phalanges in the hand more commonly than toes. We present a rare case of congenital hallux varus with longitudinal bracketed epiphysis of proximal phalanx with bifid distal phalanx of the great toe, which was managed with monorail type of external fixator. To the best of our knowledge, this is the first report of its successful implementation in simultaneous treatment of longitudinal bracketed epiphysis of the proximal phalanx of the great toe and hallux varus. Apart from adding to the literature a case of rare subtype of delta phalanx with hallux varus, the present study highlights the role of a reliable alternative in its management.

Comparison of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in the treatment of advanced hallux rigidus.

PubMed

Erdil, Mehmet; Elmadağ, Nuh Mehmet; Polat, Gökhan; Tunçer, Nejat; Bilsel, Kerem; Uçan, Vahdet; Erkoçak, Omer Faruk; Sen, Cengiz

2013-01-01

The purpose of the present study was to compare the functional results of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in hallux rigidus. The data from patients treated from 2006 to 2010 for advanced stage hallux rigidus were retrospectively reviewed. A total of 38 patients who had at least 2 years (range 24 to 66 months, mean 31.1) of follow-up were included in the present study. Of the 38 patients, 12 were included in the total joint replacement group (group A), 14 in the resurfacing hemiarthroplasty group (group B), and 12 in the arthrodesis group (group C). At the last follow-up visit, the functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society-Hallux Metatarsophalangeal Interphalangeal (AOFAS-HMI) scale, visual analog scale (VAS), and metatarsophalangeal range of motion. Significant improvements were seen in the AOFAS-HMI score, with a decrease in the VAS score in all 3 groups. According to the AOFAS-HMI score, no significant difference was found between groups A and B. However, in group C, the AOFAS-HMI scores were significantly lower than in the other groups owing to the lack of motion. According to the final VAS scores, no significant difference was found between groups A and B; however, the VAS score had decreased significantly more in group C than in the other groups. No major complications occurred in any of the 3 groups. After 2 years of follow-up, all the groups had good functional outcomes. Although arthrodesis is still the most reliable procedure, implant arthroplasty is also a good alternative for advanced stage hallux rigidus. Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Relationships Between Varus–Valgus Laxity of the Severely Osteoarthritic Knee and Gait, Instability, Clinical Performance, and Function

PubMed Central

Freisinger, Gregory M.; Hutter, Erin E.; Lewis, Jacqueline; Granger, Jeffrey F.; Glassman, Andrew H.; Beal, Matthew D.; Pan, Xueliang; Schmitt, Laura C.; Siston, Robert A.; Chaudhari, Ajit M.W.

2017-01-01

Increased varus–valgus laxity has been reported in individuals with knee osteoarthritis (OA) compared to controls. However, the majority of previous investigations may not report truly passive joint laxity, as their tests have been performed on conscious participants who could be guarding against motion with muscle contraction during laxity evaluation. The purpose of this study was to investigate how a measure of passive knee laxity, recorded when the participant is under anesthesia, is related to varus–valgus excursion during gait, clinical measures of performance, perceived instability, and self-reported function in participants with severe knee OA. We assessed passive varus–valgus knee laxity in 29 participants (30 knees) with severe OA, as they underwent total knee arthroplasty (TKA). Participants also completed gait analysis, clinical assessment of performance (6-min walk (6 MW), stair climbing test (SCT), isometric knee strength), and self-reported measures of function (perceived instability, Knee injury, and Osteoarthritis Outcome Score (KOOS) a median of 18 days before the TKA procedure. We observed that greater passive varus–valgus laxity was associated with greater varus–valgus excursion during gait (R2 =0.34, p =0.002). Significant associations were also observed between greater laxity and greater isometric knee extension strength (p =0.014), farther 6 MW distance (p =0.033) and shorter SCT time (p =0.046). No relationship was observed between passive varus–valgus laxity and isometric knee flexion strength, perceived instability, or any KOOS subscale. The conflicting associations between laxity, frontal excursion during gait, and functional performance suggest a complex relationship between laxity and knee cartilage health, clinical performance, and self-reported function that merits further study. PMID:27664972

Long-term results of total knee arthroplasty for valgus knees: soft-tissue release technique and implant selection.

PubMed

Rajgopal, Ashok; Dahiya, Vivek; Vasdev, Attique; Kochhar, Hemanshu; Tyagi, Vipin

2011-04-01

To report long-term results of total knee arthroplasty (TKA) for valgus knees. 34 women and 19 men aged 39 to 84 (mean, 74) years with valgus knees underwent primary TKA by a senior surgeon. Of the 78 knees, 43, 29, and 6 had type-I, type-II, and type-III valgus deformities, respectively. A preliminary lateral soft-tissue release was performed, and the tibia and femur were prepared. The tight lateral structures were released using the pie-crusting technique. In 92% of the knees, cruciate-retaining implants were used. In knees with severe deformity and medial collateral ligament insufficiency, the posterior cruciate ligament was sacrificed and constrained implants were used. The Hospital for Special Surgery (HSS) knee score was assessed, as were tibiofemoral alignment, range of motion, stability, and evidence of loosening or osteolysis. Patients were followed up for 8 to 14 (mean, 10) years. All knees had a good patellar position and were clinically stable in both mediolateral and anteroposterior planes. No radiolucency was noted. The mean HSS knee score improved from 48 to 91 (p<0.001). The mean tibiofemoral alignment improved from valgus 20 to 5 degrees (p<0.001). The mean range of motion improved from 65 to 110 degrees (p<0.001). One patient developed a deep infection at year 4, and 2 had periprosthetic fractures at years 6 and 8. Adequate lateral soft-tissue release is the key to successful TKAs in valgus knees. The choice of implant depends on the severity of the valgus deformity and the extent of soft-tissue release needed to obtain a stable, balanced flexion and extension gap, in order to achieve minimal constraint with maximum stability.

The dowel technique for first metatarso-phalangeal joint arthrodesis in revision surgery with bone loss.

PubMed

Malagelada, Francesc; Welck, Matthew J; Clark, Callum

2017-02-27

The operative management of failed first metatarso-phalangeal joint (MTPJ) surgery is often complicated by bone loss and shortening of the hallux. Restoration of first ray length and alignment often cannot be achieved with in situ fusion and reconstruction techniques with bone graft are therefore required. We present a novel technique of longitudinal (proximo-distal) bone dowel arthrodesis for first MTPJ arthrodesis with bone loss. Between August 2007 and February 2015, eight patients have been treated by the senior author with this technique. The mean age at surgery was 60.5 years (range 45-80) with seven females and one male. Index surgery was MTPJ arthrodesis (three patients), Keller excision arthroplasty (two patients), MTPJ hemiarthroplasty (two patients) and silastic arthroplasty (one patient). Clinical and radiological fusion was assessed and other radiological measurements included hallux valgus angle (HVA) and length of the hallux (LOH). All patients achieved fusion at a mean of 9.3 weeks (range 6-12) from surgery and only one patient required removal of metalwork. There were no major complications. The HVA improved in all cases from 21.4±2.8 pre-operatively to 11.6±3.5 post-operatively (p>0.05). The LOH also increased in all cases from 82.1±8.3mm to 86.7±8.2mm (p>0.05). The subgroup of patients who were revised from an arthroplasty, where maintenance of length rather than increase in length was desirable (hemiarthroplasty, silastic) had significantly lower increase in LOH than those revised from a non-arthroplasty index surgery (arthrodesis, Keller) (p=0.029). The dowel technique is successful for first MTPJ arthrodesis revision surgery with optimal union rates and satisfactory radiographic and clinical outcomes. It is an effective and versatile option for managing bone loss and deformity of the hallux. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Development of a finite element model of female foot for high-heeled shoe design.

PubMed

Yu, Jia; Cheung, Jason Tak-Man; Fan, Yubo; Zhang, Yan; Leung, Aaron Kam-Lun; Zhang, Ming

2008-01-01

Wearing high-heeled shoes may produce deleterious effects on the musculoskeletal system while elevation of the shoe heel with arch insole insert is used as a treatment strategy for plantar fasciitis. Due to limitations of the experimental approaches, direct measurements of internal stress/strain of the foot are impossible or invasive. This study aims at developing a finite element model for evaluating the biomechanical effects of high-heeled support on the ankle-foot complex. A 3D anatomically detailed FE model of the female foot and ankle together with a high-heeled support was developed and used to investigate the plantar contact pressure and internal loading responses of the bony and soft tissue structures of the foot with varying heel heights during simulated balanced standing. In the balanced standing position with high-heeled support, a pronounced increase in von Mises stress at the first metatarsophalangeal (MTP) joint was predicted. The strain on plantar fascia decreased compared to the flat horizontal support and valgus deformity of the hallux was not significant. The increased stress in forefoot especially at the first MTP segment during prolonged high-heeled standing may contribute to progressive hallux valgus (HV) deformity. However, the reduced tensile strain in the plantar fascia with heel elevation may help relieve plantar fasciitis related pain and inflammation.

The effect of repetitive baseball pitching on medial elbow joint space gapping associated with 2 elbow valgus stressors in high school baseball players.

PubMed

Hattori, Hiroshi; Akasaka, Kiyokazu; Otsudo, Takahiro; Hall, Toby; Amemiya, Katsuya; Mori, Yoshihisa

2018-04-01

To prevent elbow injury in baseball players, various methods have been used to measure medial elbow joint stability with valgus stress. However, no studies have investigated higher levels of elbow valgus stress. This study investigated medial elbow joint space gapping measured ultrasonically resulting from a 30 N valgus stress vs. gravitational valgus stress after a repetitive throwing task. The study included 25 high school baseball players. Each subject pitched 100 times. The ulnohumeral joint space was measured ultrasonographically, before pitching and after each successive block of 20 pitches, with gravity stress or 30 N valgus stress. Two-way repeated measures analysis of variance and Pearson correlation coefficient analysis were used. The 30 N valgus stress produced significantly greater ulnohumeral joint space gapping than gravity stress before pitching and at each successive 20-pitch block (P < .01). For the 2 stress methods, ulnohumeral joint space gapping increased significantly from baseline after 60 pitches (P < .01). Strong significant correlations were found between the 2 methods for measurement of medial elbow joint space gapping (r = 0.727-0.859, P < .01). Gravity stress and 30 N valgus stress may produce different effects with respect to medial elbow joint space gapping before pitching; however, 30 N valgus stress appears to induce greater mechanical stress, which may be preferable when assessing joint instability but also has the potential to be more aggressive. The present results may indicate that constraining factors to medial elbow joint valgus stress matched typical viscoelastic properties of cyclic creep. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Bilateral Carpus Valgus with Cranial Bowing of the Distal Radius in a Foal

PubMed Central

Caron, J. P.; Fretz, P. B.; Pharr, J. W.; Bailey, J. V.

1986-01-01

Bilateral carpus valgus with concomitant outward rotation and cranial bowing of the distal radii was diagnosed in a crossbred foal. The foal was not lame on admission and showed no radiographic evidence of carpal bone abnormalities. Surgery was limited to the most severely affected leg, and consisted of a combination of growth promotion (periosteal transection and stripping) and temporary physeal retardation (transphyseal bridging) procedures. Correction of the valgus deformity was nearly complete in the operated limb and substantial improvement was observed in the cranial bowing and outward rotation in both limbs, five months postoperatively. ImagesFigure 1.Figure 2. PMID:17422668

Reliability and Validity of Observational Risk Screening in Evaluating Dynamic Knee Valgus

PubMed Central

Ekegren, Christina L.; Miller, William C.; Celebrini, Richard G.; Eng, Janice J.; MacIntyre, Donna L.

2012-01-01

Study Design Nonexperimental methodological study. Objectives To determine the interrater and intrarater reliability and validity of using observational risk screening guidelines to evaluate dynamic knee valgus. Background A deficiency in the neuromuscular control of the hip has been identified as a key risk factor for non-contact anterior cruciate ligament (ACL) injury in post pubescent females. This deficiency can manifest itself as a valgus knee alignment during tasks involving hip and knee flexion. There are currently no scientifically tested methods to screen for dynamic knee valgus in the clinic or on the field. Methods Three physiotherapists used observational risk screening guidelines to rate 40 adolescent female soccer players according to their risk of ACL injury. The rating was based on the amount of dynamic knee valgus observed on a drop jump landing. Ratings were evaluated for intrarater and interrater agreement using kappa coefficients. Sensitivity and specificity of ratings were evaluated by comparing observational ratings with measurements obtained using 3-dimensional (3D) motion analysis. Results Kappa coefficients for intrarater and interrater agreement ranged from 0.75 to 0.85, indicating that ratings were reasonably consistent over time and between physiotherapists. Sensitivity values were inadequate, ranging from 67–87%. This indicated that raters failed to detect up to a third of “truly high risk” individuals. Specificity values ranged from 60–72% which was considered adequate for the purposes of the screen. Conclusion Observational risk screening is a practical and cost-effective method of screening for ACL injury risk. Rater agreement and specificity were acceptable for this method but sensitivity was not. To detect a greater proportion of individuals at risk of ACL injury, coaches and clinicians should ensure that they include additional tests for other high risk characteristics in their screening protocols. PMID:19721212

[Case report: comprehensive treatment of forefoot with double brachymetatarsia in one surgical stage].

PubMed

Caldiño-Lozada, I; Gallegos-de la Torre, O; Esperón-Hernández, R

2017-01-01

Brachymetatarsia (shortening of the metatarsal) directly affects the transversal arch of the foot causing severe deformities, such as hallux valgus, divergent toes, overlapping toes, metatarsalgia, all of these alter the biomechanics of the foot and gait. Treatment consists of two main techniques, one-stage lengthening with bone graft or elongation through callotaxis with external fixator; there are variants of both techniques used to minimize the disadvantages of each. The objective of treatment must be to return the structural harmony to the forefoot, improving the biomechanics, resulting in a satisfactory outcome for the patients. This article presents a surgical treatment for feet with closed physis to obtain the appropriate metatarsal formula and to reestablish aesthetics and function. This case was treated by means of one-stage lengthening with bone graft to the affected metatarsal; shortening of the adjacent metatarsals; hallux valgus alignment through the necessary osteotomies and the treatment of deformities of the lesser toes as needed. This surgical technique has as one of its advantages the correction of the entire forefoot at one time, without the need of an external fixator and its required postoperative care. Its main disadvantages are its dependence on structural bone graft and the need of postoperative dressing until healing of the bone has taken place. Satisfactory clinical and radiographical outcomes were obtained in treated patient.

Combined versus individual effects of a valgus knee brace and lateral wedge foot orthotic during stair use in patients with knee osteoarthritis.

PubMed

Moyer, Rebecca; Birmingham, Trevor; Dombroski, Colin; Walsh, Robert; Giffin, J Robert

2017-05-01

The aim of this study was to investigate the combined and individual biomechanical effects of a valgus knee brace and a lateral wedge foot orthotic during stair ascent and descent in patients with knee osteoarthritis (OA). Thirty-five patients with varus alignment and medial knee OA were prescribed a custom valgus knee brace and lateral wedge foot orthotic. Knee angles and moments in the frontal and sagittal planes were determined from 3D gait analysis completed under four randomized conditions: (1) control (no knee brace or foot orthotic), (2) knee brace, (3) foot orthotic, and (4) combined knee brace and foot orthotic. Additional measures included the vertical ground reaction force, trunk lean, toe out and gait speed. During the combined use of a knee brace and foot orthotic, significant decreases in the knee adduction angle (2.17, 95%CI: 0.50-3.84, p=0.013) and 2nd peak EKAM (0.35, 95%CI: 0.17-0.52, p<0.001) were observed during stair descent; and significant increases in the EKFM were observed during stair ascent (0.54, 95%CI: 0.30-0.78, p<0.001) and descent (1stpk: 0.48, 95%CI: 0.15-0.80, p=0.005; 2ndpk: 0.55, 95%CI: 0.34-0.76, p<0.001). Fewer gait compensations were observed between conditions during stair descent compared to ascent, except for toe out. Findings suggest greater effects on gait when both knee brace and foot orthotic are used together, resulting in a more normal gait pattern. However, whether or not a true change in knee joint load can be inferred when using these orthoses remains unclear. Further research is required to determine the clinical importance of the observed changes. Copyright © 2017. Published by Elsevier B.V.

Does the type of sport practised influence foot posture and knee angle? Differences between footballers and swimmers.

PubMed

Lopezosa-Reca, Eva; Gijon-Nogueron, Gabriel; Garcia-Paya, Irene; Ortega-Avila, Ana Belen

2018-03-04

This aim of this study is to observe the differences in foot posture and the angle of the knee according to different physical activities. Seventy-eight football players and 72 swimmers were recruited, and in each case a foot posture analysis, based on the foot posture index (FPI), was conducted and the Q angle of the knee was determined. The following mean values were obtained for the lower extremities: in the swimmers, FPI 6.45 ± 2.04 and Q angle 15.38º ± 3.79º. In the footballers, FPI 2.23 ± 1.72 and Q angle 13.16º ± 1.36º. There were statistically significant differences (p < 0.001) between the two groups. The swimmers presented a foot posture with a tendency towards pronation, and a Q angle with a tendency towards valgus, while the results for the footballers were within the normal range.

Should the Ipsilateral Hamstrings Be Used for Anterior Cruciate Ligament Reconstruction in the Case of Medial Collateral Ligament Insufficiency? Biomechanical Investigation Regarding Dynamic Stabilization of the Medial Compartment by the Hamstring Muscles.

PubMed

Herbort, Mirco; Michel, Philipp; Raschke, Michael J; Vogel, Nils; Schulze, Martin; Zoll, Alexander; Fink, Christian; Petersen, Wolf; Domnick, Christoph

2017-03-01

Semitendinosus and gracilis muscles are frequently harvested for autologous tendon grafts for cruciate ligament reconstruction. This study investigated the joint-stabilizing effects of these hamstring muscles in cases of insufficiency of the medial collateral ligament (MCL). First, both the semitendinosus and gracilis muscles can actively stabilize the joint against valgus moments in the MCL-deficient knee. Second, the stabilizing influence of these muscles decreases with an increasing knee flexion angle. Controlled laboratory study. The kinematics was examined in 10 fresh-frozen human cadaveric knees using a robotic/universal force moment sensor system and an optical tracking system. The knee kinematics under 5- and 10-N·m valgus moments were determined in the different flexion angles of the (1) MCL-intact and (2) MCL-deficient knee using the following simulated muscle loads: (1) 0-N (idle) load, (2) 200-N semitendinosus (ST) load, and (3) 280-N (200/80-N) combined semitendinosus/gracilis (STGT) load. Cutting the MCL increased the valgus angle under all tested conditions and angles compared with the MCL-intact knee by 4.3° to 8.1° for the 5-N·m valgus moment and 6.5° to 11.9° for the 10-N·m valgus moment ( P < .01). The applied 200-N simulated ST load reduced the valgus angle significantly at 0°, 10°, 20°, and 30° of flexion under 5- and 10-N·m valgus moments ( P < .05). At 0°, 10°, and 20° of flexion, these values were close to those for the MCL-intact joint under the respective moments (both P > .05). The combined 280-N simulated STGT load significantly reduced the valgus angle in 0°, 10°, and 20° of flexion under 5- and 10-N·m valgus moments ( P < .05) to values near those for the intact joint (5 N·m: 0°, 10°; 10 N·m: 0°, 10°, 20°; P > .05). In 60° and 90° of flexion, ST and STGT loads did not decrease the resulting valgus angle of the MCL-deficient knee without hamstring loads ( P > .05 vs deficient; P = .0001 vs intact). In this

Relationship between foot posture measurements and force platform parameters during two balance tasks in older and younger subjects

PubMed Central

Carvalho, Carlos E.; da Silva, Rubens A.; Gil, André W.; Oliveira, Márcio R.; Nascimento, Juliana A.; Pires-Oliveira, Deise A. A.

2015-01-01

[Purpose] The aim of this study was to compare age-related differences in balance and anthropometric posture measurements of the foot and to determine any relationship between them. [Subjects and Methods] Sixty-eight older and 42 younger adults participated in this study. Foot posture was tested for four domains: 1) hallux flexion and extension range of motion using a goniometer, 2) navicular height and 3) length of the foot using a pachymeter, and 4) footprint (width of forefoot, arch index and hallux valgus). Balance was tested under two conditions on a force platform: bipodal in 60-s trials and unipodal in 30-s trials. The sway area of the center of pressure and velocity in the anteroposterior and mediolateral directions were computed. [Results] Older individuals showed significantly poorer balance compared with younger adults under in the unipodal condition (center of pressure area 9.97 vs. 7.72 cm2). Older people presented a significantly lower hallux mobility and higher values for width of the forefoot and transverse arch index than younger adults. The correlations between all foot posture and center of pressure parameters varied across groups, from weak to moderate (r −0.01 to −0.46). Low hallux mobility was significantly related to higher center of pressure values in older people. [Conclusion] These results have clinical implications for balance and foot posture assessments. PMID:25931713

Relationship between foot posture measurements and force platform parameters during two balance tasks in older and younger subjects.

PubMed

Carvalho, Carlos E; da Silva, Rubens A; Gil, André W; Oliveira, Márcio R; Nascimento, Juliana A; Pires-Oliveira, Deise A A

2015-03-01

[Purpose] The aim of this study was to compare age-related differences in balance and anthropometric posture measurements of the foot and to determine any relationship between them. [Subjects and Methods] Sixty-eight older and 42 younger adults participated in this study. Foot posture was tested for four domains: 1) hallux flexion and extension range of motion using a goniometer, 2) navicular height and 3) length of the foot using a pachymeter, and 4) footprint (width of forefoot, arch index and hallux valgus). Balance was tested under two conditions on a force platform: bipodal in 60-s trials and unipodal in 30-s trials. The sway area of the center of pressure and velocity in the anteroposterior and mediolateral directions were computed. [Results] Older individuals showed significantly poorer balance compared with younger adults under in the unipodal condition (center of pressure area 9.97 vs. 7.72 cm(2)). Older people presented a significantly lower hallux mobility and higher values for width of the forefoot and transverse arch index than younger adults. The correlations between all foot posture and center of pressure parameters varied across groups, from weak to moderate (r -0.01 to -0.46). Low hallux mobility was significantly related to higher center of pressure values in older people. [Conclusion] These results have clinical implications for balance and foot posture assessments.

Hallux amputation after a freshwater stingray injury in the Brazilian Amazon.

PubMed

Monteiro, Wuelton Marcelo; Oliveira, Sâmella Silva de; Sachett, Jacqueline de Almeida Gonçalves; Silva, Iran Mendonça da; Ferreira, Luiz Carlos de Lima; Lacerda, Marcus Vinícius Guimarães

2016-01-01

Freshwater stingray injuries are a common problem in the Brazilian Amazon, affecting mostly riverine and indigenous populations. These injuries cause severe local and regional pain, swelling and erythema, as well as complications, such as local necrosis and bacterial infection. Herein, we report a case of bacterial infection and hallux necrosis, after a freshwater stingray injury in the Brazilian Amazon, which eventually required amputation. Different antimicrobial regimens were administered at different stages of the disease; however, avoiding amputation through effective treatment was not achieved.

Correction of static axial alignment in children with knee varus or valgus deformities through guided growth: Does it also correct dynamic frontal plane moments during walking?

PubMed

Böhm, Harald; Stief, Felix; Sander, Klaus; Hösl, Matthias; Döderlein, Leonhard

2015-09-01

Malaligned knees are predisposed to the development and progression of unicompartmental degenerations because of the excessive load placed on one side of the knee. Therefore, guided growth in skeletally immature patients is recommended. Indication for correction of varus/valgus deformities are based on static weight bearing radiographs. However, the dynamic knee abduction moment during walking showed only a weak correlation to malalignment determined by static radiographs. Therefore, the aim of the study was to measure the effects of guided growth on the normalization of frontal plane knee joint moments during walking. 15 legs of 8 patients (11-15 years) with idiopathic axial varus or valgus malalignment were analyzed. 16 typically developed peers served as controls. Instrumented gait analysis and clinical assessment were performed the day before implantation and explantation of eight-plates. Correlation between static mechanical tibiofemoral axis angle (MAA) and dynamic frontal plane knee joint moments and their change by guided growth were performed. The changes in dynamic knee moment in the frontal plane following guided growth showed high and significant correlation to the changes in static MAA (R=0.97, p<0.001). Contrary to the correlation of the changes, there was no correlation between static and dynamic measures in both sessions. In consequence two patients that had a natural knee moment before treatment showed a more pathological one after treatment. In conclusion, the changes in the dynamic load situation during walking can be predicted from the changes in static alignment. If pre-surgical gait analysis reveals a natural load situation, despite a static varus or valgus deformity, the intervention must be critically discussed. Copyright © 2015 Elsevier B.V. All rights reserved.

The Valgus Inclination of the Tibial Component Increases the Risk of Medial Tibial Condylar Fractures in Unicompartmental Knee Arthroplasty.

PubMed

Inoue, Shinji; Akagi, Masao; Asada, Shigeki; Mori, Shigeshi; Zaima, Hironori; Hashida, Masahiko

2016-09-01

Medial tibial condylar fractures (MTCFs) are a rare but serious complication after unicompartmental knee arthroplasty. Although some surgical pitfalls have been reported for MTCFs, it is not clear whether the varus/valgus tibial inclination contributes to the risk of MTCFs. We constructed a 3-dimensional finite elemental method model of the tibia with a medial component and assessed stress concentrations by changing the inclination from 6° varus to 6° valgus. Subsequently, we repeated the same procedure adding extended sagittal bone cuts of 2° and 10° in the posterior tibial cortex. Furthermore, we calculated the bone volume that supported the tibial component, which is considered to affect stress distribution in the medial tibial condyle. Stress concentrations were observed on the medial tibial metaphyseal cortices and on the anterior and posterior tibial cortices in the corner of cut surfaces in all models; moreover, the maximum principal stresses on the posterior cortex were larger than those on the anterior cortex. The extended sagittal bone cuts in the posterior tibial cortex increased the stresses further at these 3 sites. In the models with a 10° extended sagittal bone cut, the maximum principal stress on the posterior cortex increased as the tibial inclination changed from 6° varus to 6° valgus. The bone volume decreased as the inclination changed from varus to valgus. In this finite element method, the risk of MTCFs increases with increasing valgus inclination of the tibial component and with increased extension of the sagittal cut in the posterior tibial cortex. Copyright © 2016 Elsevier Inc. All rights reserved.

Medial Elbow Joint Space Increases With Valgus Stress and Decreases When Cued to Perform A Maximal Grip Contraction.

PubMed

Pexa, Brett S; Ryan, Eric D; Myers, Joseph B

2018-04-01

Previous research indicates that the amount of valgus torque placed on the elbow joint during overhead throwing is higher than the medial ulnar collateral ligament (UCL) can tolerate. Wrist and finger flexor muscle activity is hypothesized to make up for this difference, and in vitro studies that simulated activity of upper extremity musculature, specifically the flexor digitorum superficialis and flexor carpi ulnaris, support this hypothesis. To assess the medial elbow joint space at rest, under valgus stress, and under valgus stress with finger and forearm flexor contraction by use of ultrasonography in vivo. Controlled laboratory study. Participants were 22 healthy males with no history of elbow dislocation or UCL injury (age, 21.25 ± 1.58 years; height, 1.80 ± 0.08 m; weight, 79.43 ± 18.50 kg). Medial elbow joint space was measured by use of ultrasonography during 3 separate conditions: at rest (unloaded), under valgus load (loaded), and with a maximal grip contraction under a valgus load (loaded-contracted) in both limbs. Participants lay supine with their arm abducted 90° and elbow flexed 30° with the forearm in full supination. A handgrip dynamometer was placed in the participants' hand to grip against during the contracted condition. Images were reduced in ImageJ to assess medial elbow joint space. A 2-way (condition × limb) repeated-measures analysis of variance and Cohen's d effect sizes were used to assess changes in medial elbow joint space. Post hoc testing was performed with a Bonferroni adjustment to assess changes within limb and condition. The medial elbow joint space was significantly larger in the loaded condition (4.91 ± 1.16 mm) compared with the unloaded condition (4.26 ± 1.23 mm, P < .001, d = 0.712) and the loaded-contracted condition (3.88 ± 0.94 mm, P < .001, d = 1.149). No significant change was found between the unloaded and loaded-contracted conditions ( P = .137). Medial elbow joint space increases under a valgus load and then

Greater Growth of Proximal Metatarsals in Bird Embryos and the Evolution of Hallux Position in the Grasping Foot.

PubMed

Botelho, João Francisco; Smith-Paredes, Daniel; Soto-Acuña, Sergio; Núñez-León, Daniel; Palma, Verónica; Vargas, Alexander O

2017-01-01

In early theropod dinosaurs-the ancestors of birds-the hallux (digit 1) had an elevated position within the foot and had lost the proximal portion of its metatarsal. It no longer articulated with the ankle, but was attached at about mid-length of metatarsal 2 (mt2). In adult birds, the hallux is articulated closer to the distal end of mt2 at ground level with the other digits. However, on chick embryonic day 7, its position is as in early theropods at half-length of mt2. The adult distal location is acquired during embryonic days 8-10. To assess how the adult phenotype is acquired, we produced fate maps of the metatarsals of day 6 chicken embryos injecting the lipophilic tracer DiI. The fates of these marks indicate a larger expansion of the metatarsals at their proximal end, which creates the illusory effect that d1 moves distally. This larger proximal expansion occurs concomitantly with growth and early differentiation of cartilage. Histological analysis of metatarsals shows that the domains of flattened and prehypertrophic chondrocytes are larger toward the proximal end. The results suggest that the distal position of the hallux in the avian foot evolved as a consequence of an embryological period of expansion of the metatarsus toward the proximal end. It also brings attention to the developmental mechanisms leading to differential growth between epiphyses and their evolutionary consequences. © 2016 Wiley Periodicals, Inc.

Foot Structure in Boys with Down Syndrome.

PubMed

Puszczałowska-Lizis, Ewa; Nowak, Krzysztof; Omorczyk, Jarosław; Ambroży, Tadeusz; Bujas, Przemysław; Nosiadek, Leszek

2017-01-01

Down syndrome (DS) is associated with numerous developmental abnormalities, some of which cause dysfunctions of the posture and the locomotor system. The analysis of selected features of the foot structure in boys with DS versus their peers without developmental disorders is done. The podoscopic examination was performed on 30 boys with DS aged 14-15 years. A control group consisted of 30 age- and gender-matched peers without DS. The feet of boys with DS are flatter compared to their healthy peers. The hallux valgus angle is not the most important feature differentiating the shape of the foot in the boys with DS and their healthy peers. In terms of the V toe setting, healthy boys had poorer results. Specialized therapeutic treatment in individuals with DS should involve exercises to increase the muscle strength around the foot joints, enhancing the stabilization in the joints and proprioception. Introducing orthotics and proper footwear is also important. It is also necessary to monitor the state of the foot in order to modify undertaken therapies.

Foot Structure in Boys with Down Syndrome

PubMed Central

Nowak, Krzysztof; Omorczyk, Jarosław; Ambroży, Tadeusz; Nosiadek, Leszek

2017-01-01

Introduction and Aim Down syndrome (DS) is associated with numerous developmental abnormalities, some of which cause dysfunctions of the posture and the locomotor system. The analysis of selected features of the foot structure in boys with DS versus their peers without developmental disorders is done. Materials and Methods The podoscopic examination was performed on 30 boys with DS aged 14-15 years. A control group consisted of 30 age- and gender-matched peers without DS. Results The feet of boys with DS are flatter compared to their healthy peers. The hallux valgus angle is not the most important feature differentiating the shape of the foot in the boys with DS and their healthy peers. In terms of the V toe setting, healthy boys had poorer results. Conclusions Specialized therapeutic treatment in individuals with DS should involve exercises to increase the muscle strength around the foot joints, enhancing the stabilization in the joints and proprioception. Introducing orthotics and proper footwear is also important. It is also necessary to monitor the state of the foot in order to modify undertaken therapies. PMID:28904967

Dynamic knee valgus alignment influences impact attenuation in the lower extremity during the deceleration phase of a single-leg landing.

PubMed

Tamura, Akihiro; Akasaka, Kiyokazu; Otsudo, Takahiro; Shiozawa, Jyunya; Toda, Yuka; Yamada, Kaori

2017-01-01

Dynamic knee valgus during landings is associated with an increased risk of non-contact anterior cruciate ligament (ACL) injury. In addition, the impact on the body during landings must be attenuated in the lower extremity joints. The purpose of this study was to investigate landing biomechanics during landing with dynamic knee valgus by measuring the vertical ground reaction force (vGRF) and angular impulses in the lower extremity during a single-leg landing. The study included 34 female college students, who performed the single-leg drop vertical jump. Lower extremity kinetic and kinematic data were obtained from a 3D motion analysis system. Participants were divided into valgus (N = 19) and varus (N = 15) groups according to the knee angular displacement during landings. The vGRF and angular impulses of the hip, knee, and ankle were calculated by integrating the vGRF-time curve and each joint's moment-time curve. vGRF impulses did not differ between two groups. Hip angular impulse in the valgus group was significantly smaller than that in the varus group (0.019 ± 0.033 vs. 0.067 ± 0.029 Nms/kgm, p<0.01), whereas knee angular impulse was significantly greater (0.093 ± 0.032 vs. 0.045 ± 0.040 Nms/kgm, p<0.01). There was no difference in ankle angular impulse between the groups. Our results indicate that dynamic knee valgus increases the impact the knee joint needs to attenuate during landing; conversely, the knee varus participants were able to absorb more of the landing impact with the hip joint.

How to report and monitor the performance of waiting list management.

PubMed

Torkki, Markus; Linna, Miika; Seitsalo, Seppo; Paavolainen, Pekka

2002-01-01

Potential problems concerning waiting list management are often monitored using mean waiting times based on empirical samples. However, the appropriateness of mean waiting time as an indicator of access can be questioned if a waiting list is not managed well, e.g., if the queue discipline is violated. This study was performed to find out about the queue discipline in waiting lists for elective surgery to reveal potential discrepancies in waiting list management. There were 1,774 waiting list patients for hallux valgus or varicose vein surgery or sterilization. The waiting time distributions of patients receiving surgery and of patients still waiting for an operation are presented in column charts. The charts are compared with two model charts. One model chart presents a high queue discipline (first in-first out) and another a poor queue discipline (random) queue. There were significant differences in waiting list management across hospitals and patient categories. Examples of a poor queue discipline were found in queues for hallux valgus and varicose vein operations. A routine waiting list reporting should be used to guarantee the quality of waiting list management and to pinpoint potential problems in access. It is important to monitor not only the number of patients in the waiting list but also the queue discipline and the balance between demand and supply of surgical services. The purpose for this type of reporting is to ensure that the priority setting made at health policy level also works in practise.

Trampoline fracture of the proximal tibial metaphysis in children may not progress into valgus: a report of seven cases and a brief review.

PubMed

Kakel, R

2012-06-01

Fracture of the proximal tibial metaphysis in children is a rare injury but notorious for carrying the risk of subsequent valgus deformity of the tibia. Trampoline-caused fracture of the proximal tibial metaphysis in children may not progress into valgus. We followed up six children who collectively sustained seven fractures of the proximal tibial metaphysis while trampolining with other heavier and/or older children. Initial and follow-up x-rays were reviewed by an orthopaedic surgeons and two radiologists. None of the patients developed valgus deformity with follow-up. Trampoline is associated with a specific type of injury to the proximal tibia when children are trampolining with other heavier children even without falling off the trampoline. This fracture is linear and complete, often non-displaced. Unlike "other" proximal tibial metaphyseal fractures, trampoline-associated proximal tibial metaphysical fracture in children is not associated with a risk of subsequent valgus deformity. Level 4. case series. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

[Lesser toe deformities. Definition, pathogenesis, and options for surgical correction].

PubMed

Arnold, H

2005-08-01

Whereas in the past resection arthroplasty was - in analogy to hallux valgus surgery - the preferred therapy to correct lesser toe deformities, the point of view has undergone a change. Much interest is directed toward functional aspects that require reconstructive management. Whenever possible the integrity of joint play should be saved. Above all the metatarsophalangeal joint of the lesser toes is worth being preserved to prevent a severe disturbance of the biomechanics of the foot. Tendon transfers and subtle corrective osteotomies such as the Weil procedure allow restricting resection procedures to contraction deformities.

Intra-rater reliability of hallux flexor strength measures using the Nintendo Wii Balance Board.

PubMed

Quek, June; Treleaven, Julia; Brauer, Sandra G; O'Leary, Shaun; Clark, Ross A

2015-01-01

The purpose of this study was to investigate the intra-rater reliability of a new method in combination with the Nintendo Wii Balance Board (NWBB) to measure the strength of hallux flexor muscle. Thirty healthy individuals (age: 34.9 ± 12.9 years, height: 170.4 ± 10.5 cm, weight: 69.3 ± 15.3 kg, female = 15) participated. Repeated testing was completed within 7 days. Participants performed strength testing in sitting using a wooden platform in combination with the NWBB. This new method was set up to selectively recruit an intrinsic muscle of the foot, specifically the flexor hallucis brevis muscle. Statistical analysis was performed using intra-class coefficients and ordinary least product analysis. To estimate measurement error, standard error of measurement (SEM), minimal detectable change (MDC) and percentage error were calculated. Results indicate excellent intra-rater reliability (ICC = 0.982, CI = 0.96-0.99) with an absence of systematic bias. SEM, MDC and percentage error value were 0.5, 1.4 and 12 % respectively. This study demonstrates that a new method in combination with the NWBB application is reliable to measure hallux flexor strength and has potential to be used for future research and clinical application.

Foot ulcer risk and location in relation to prospective clinical assessment of foot shape and mobility among persons with diabetes.

PubMed

Cowley, Matthew S; Boyko, Edward J; Shofer, Jane B; Ahroni, Jessie H; Ledoux, William R

2008-11-01

We assessed baseline clinical foot shape for 2939 feet of diabetic subjects who were monitored prospectively for foot ulceration. Assessments included hammer/claw toes, hallux valgus, hallux limitus, prominent metatarsal heads, bony prominences, Charcot deformity, plantar callus, foot type, muscle atrophy, ankle and hallux mobility, and neuropathy. Risk factors were linked to ulcer occurrence and location via a Cox proportional hazards model. Hammer/claw toes (hazard ratio [HR] (95% confidence interval [CI])=1.43 (1.06, 1.94) p=0.02), marked hammer/claw toes (HR=1.77 (1.18, 2.66) p=0.006), bony prominences (HR=1.38 (1.02, 1.88), p=0.04), and foot type (Charcot or drop foot vs. neutrally aligned) (HR=2.34 (1.33, 4.10), p=0.003) were significant risk factors for ulceration adjusting for age, body mass index, insulin medication, ulcer history and amputation history. With adjustment for neuropathy only hammer/claw toes (HR=1.40 (1.03, 1.90), p=0.03) and foot type (HR=1.76 (1.04, 3.04), p=0.05) were significantly related to ulceration. However, there was no relationship between ulcer location and foot deformity. Certain foot deformities were predictive of ulceration, although there was no relationship between clinical foot deformity and ulcer location.

Triple management of cubitus valgus deformity complicating neglected nonunion of fractures of lateral humeral condyle in children: a case series.

PubMed

Abed, Yasser; Nour, Khaled; Kandil, Yasser Roshdy; El-Negery, Abed

2018-02-01

Long standing nonunion of the lateral humeral condyle (LHC) usually results in elbow pain and instability with progressive cubitus valgus and tardy ulnar neuritis. Surgical treatment of long standing nonunion is still a controversial issue due to the reported complications, such as stiffness, loss of elbow motion, and avascular necrosis of the LHC fragment. In this study, we reported the outcomes of treatment of cubitus valgus deformity in long standing nonunion of the LHC in children treated with combined triple management (fixation of the nonunion site, dome corrective osteotomy, and anterior transposition of ulnar nerve) through a modified para-triceptal approach. We evaluated ten patients with cubitus valgus deformity more than 20 degrees after neglected nonunion of the lateral humeral condyle more than 24 months. Only childern with post-operative follow up more than 24 months were included in this study. All patients were evaluated clinically, radio logically, and by pre- and post-operative functional evaluation using Mayo elbow performance score. For evaluation of ulnar nerve affection, the Akahori's system was used. There were six females and four males with the average age of 7.7 years at operation. The left elbow was affected in six patients and the right elbow was affected in four patients. The average time between fracture of the LHC and operation was 40.3 months with average post-operative follow up of 44.3 months. The average carrying angle of the healthy side was 5.5 degrees and pre-operative carrying angle of the affected side was 33.5 degrees. The average post-operative carrying angle of the affected side was 6.1 degrees. The improvement of the carrying angle at the last follow up was found statistically significant (p < 0.05). All six patients that had pre-operative various degrees of ulnar nerve affection had completely improved at last follow up. The osteotomy site united in an average time of 43 days, whereas the LHC nonunion site

The influence of the Peroneus Longus muscle on the foot under axial loading: A CT evaluated dynamic cadaveric model study.

PubMed

Dullaert, K; Hagen, J; Klos, K; Gueorguiev, B; Lenz, M; Richards, R G; Simons, P

2016-05-01

Subtle hypermobility of the first tarsometatarsal joint can occur concomitantly with other pathologies and may be difficult to diagnose. Peroneus Longus muscle might influence stability of this joint. Collapse of the medial longitudinal arch is common in flatfoot deformity and the muscle might also play a role in correcting Meary's angle. A radiolucent frame was used to simulate weightbearing during CT examination. Eight pairs fresh-frozen lower legs were imaged in neutral position under non-weightbearing (75N), weightbearing (700N) and with 15kg weights hung from Peroneus Longus tendon. Measurements included first metatarsal rotation, intermetatarsal angle, first tarsometatarsal joint subluxation and Meary's angle. Weightbearing significantly increased Meary's angle and significantly decreased first tarsometatarsal joint subluxation (both P<0.01). Pulling Peroneus Longus tendon significantly increased first metatarsal rotation (P<0.01), significantly decreased the intermetatarsal angle (P<0.01) and increased non-significantly Meary's angle (P=0.52). A considerable effect weightbearing has on the medial longitudinal arch and first tarsometatarsal joint was observed. Pulling Peroneus Longus tendon improved first metatarsal subluxation but increased its rotation. The study calls into question the importance of this tendon in maintaining the medial longitudinal arch and raises concerns about rotational deformity of the first metatarsal following hallux valgus correction without first tarsometatarsal arthrodesis. Study outcomes will provide more insight in foot pathology. Weightbearing affects anatomy of the foot. No reliable information is available concerning the influence of the Peroneus muscle. This study investigates the influence of weightbearing and the impact the Peroneus muscle on the anatomy of the foot. Copyright © 2016. Published by Elsevier Ltd.

Progressive valgus angulation of the ankle secondary to loss of fibular congruity treated with medial tibial hemiepiphysiodesis and fibular reconstruction.

PubMed

Lesiak, Alex C; Esposito, Paul W

2014-06-01

The fibula is an important stabilizer of the lateral ankle. Discontinuity of the fibular shaft can lead to progressive pain and shortening of the fibula, ultimately causing loss of lateral support to the ankle. Two children, who sustained segmental bone loss of the shaft of the fibula, developed progressive symptomatic valgus of the ankle with widening of the mortice and lateral subluxation of the talus. Both patients were treated with fibular plating and grafting with tricalcium sulfate with acute reconstitution of fibular length. Distal medial tibial hemiepiphysiodesis was simultaneously performed. One patient required revision plating and grafting 14 months after the index surgery because of plate failure. The valgus angulation and the widened medial mortice were corrected in the ankles of both patients, who returned to full activities. The patients were followed to maturity; the correction has been maintained, and they remain asymptomatic. The technique used in these cases can correct valgus angulation secondary to loss of fibular congruity rather than only halting progression of the deformity.

Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers.

PubMed

Tang, Ulla Hellstrand; Zügner, Roland; Lisovskaja, Vera; Karlsson, Jon; Hagberg, Kerstin; Tranberg, Roy

2015-01-01

Foot deformities, neuropathy, and dysfunction in the lower extremities are known risk factors that increase plantar peak pressure (PP) and, as a result, the risk of developing foot ulcers in patients with diabetes. However, knowledge about the prevalence of these factors is still limited. The aim of the present study was to describe the prevalence of risk factors observed in patients with diabetes without foot ulcers and to explore possible connections between the risk factors and high plantar pressure. Patients diagnosed with type 1 (n=27) or type 2 (n=47) diabetes (mean age 60.0±15.0 years) were included in this cross-sectional study. Assessments included the registration of foot deformities; test of gross function at the hip, knee, and ankle joints; a stratification of the risk of developing foot ulcers according to the Swedish National Diabetes Register; a walking test; and self-reported questionnaires including the SF-36 health survey. In-shoe PP was measured in seven regions of interests on the sole of the foot using F-Scan(®). An exploratory analysis of the association of risk factors with PP was performed. Neuropathy was present in 28 (38%), and 39 (53%) had callosities in the heel region. Low forefoot arch was present in 57 (77%). Gait-related parameters, such as the ability to walk on the forefoot or heel, were normal in all patients. Eighty percent had normal function at the hip and ankle joints. Gait velocity was 1.2±0.2 m/s. All patients were stratified to risk group 3. Hallux valgus and hallux rigidus were associated with an increase in the PP in the medial forefoot. A higher body mass index (BMI) was found to increase the PP at metatarsal heads 4 and 5. Pes planus was associated with a decrease in PP at metatarsal head 1. Neuropathy did not have a high association with PP. This study identified several potential risk factors for the onset of diabetic foot ulcers (DFU). Hallux valgus and hallux rigidus appeared to increase the PP under the medial

Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers

PubMed Central

Tang, Ulla Hellstrand; Zügner, Roland; Lisovskaja, Vera; Karlsson, Jon; Hagberg, Kerstin; Tranberg, Roy

2015-01-01

Objective Foot deformities, neuropathy, and dysfunction in the lower extremities are known risk factors that increase plantar peak pressure (PP) and, as a result, the risk of developing foot ulcers in patients with diabetes. However, knowledge about the prevalence of these factors is still limited. The aim of the present study was to describe the prevalence of risk factors observed in patients with diabetes without foot ulcers and to explore possible connections between the risk factors and high plantar pressure. Patients and methods Patients diagnosed with type 1 (n=27) or type 2 (n=47) diabetes (mean age 60.0±15.0 years) were included in this cross-sectional study. Assessments included the registration of foot deformities; test of gross function at the hip, knee, and ankle joints; a stratification of the risk of developing foot ulcers according to the Swedish National Diabetes Register; a walking test; and self-reported questionnaires including the SF-36 health survey. In-shoe PP was measured in seven regions of interests on the sole of the foot using F-Scan®. An exploratory analysis of the association of risk factors with PP was performed. Results Neuropathy was present in 28 (38%), and 39 (53%) had callosities in the heel region. Low forefoot arch was present in 57 (77%). Gait-related parameters, such as the ability to walk on the forefoot or heel, were normal in all patients. Eighty percent had normal function at the hip and ankle joints. Gait velocity was 1.2±0.2 m/s. All patients were stratified to risk group 3. Hallux valgus and hallux rigidus were associated with an increase in the PP in the medial forefoot. A higher body mass index (BMI) was found to increase the PP at metatarsal heads 4 and 5. Pes planus was associated with a decrease in PP at metatarsal head 1. Neuropathy did not have a high association with PP. Conclusions This study identified several potential risk factors for the onset of diabetic foot ulcers (DFU). Hallux valgus and hallux

Distal Femoral Osteotomy for the Valgus Knee: Medial Closing Wedge Versus Lateral Opening Wedge: A Systematic Review.

PubMed

Wylie, James D; Jones, Daniel L; Hartley, Melissa K; Kapron, Ashley L; Krych, Aaron J; Aoki, Stephen K; Maak, Travis G

2016-10-01

(1) To determine the radiographic correction/healing rate, patient-reported outcomes, reoperation rate, and complication rate after distal femoral osteotomy (DFO) for the valgus knee with lateral compartment pathology. (2) To summarize the reported results of medial closing wedge and lateral opening wedge DFO. We conducted a systematic review of PubMed, MEDLINE, and CINAHL to identify studies reporting outcomes of DFOs for the valgus knee. Keywords included "distal femoral osteotomy," "chondral," "cartilage," "valgus," "joint restoration," "joint preservation," "arthritis," and "gonarthrosis." Two authors first reviewed the articles; our study exclusion criteria were then applied, and the articles were included on the basis relevance defined by the aforementioned criteria. The Methodological Index for Nonrandomized Studies scale judged the quality of the literature. Sixteen studies were relevant to the research questions out of 191 studies identified by the original search. Sixteen studies were identified reporting on 372 osteotomies with mean follow-up of 45 to 180 months. All studies reported mean radiographic correction to a near neutral mechanical axis, with 3.2% nonunion and 3.8% delayed union rates. There was a 9% complication rate and a 34% reoperation rate, of which 15% were converted to arthroplasty. There were similar results reported for medial closing wedge and lateral opening wedge techniques, with a higher conversion to arthroplasty in the medial closing wedge that was confounded by longer mean follow-up in this group (mean follow-up 100 v 58 months). DFOs for the valgus knee with lateral compartment disease provide improvements in patient-reported knee health-related quality of life at midterm follow-up but have high rates of reoperation. No evidence exists proving better results of either the lateral opening wedge or medial closing wedge techniques. Level IV, systematic review of Level IV studies. Copyright © 2016 Arthroscopy Association of North

Biomechanical Comparison of Fixation With a Single Screw Versus Two Kirschner Wires in Distal Chevron Osteotomies of the First Metatarsal: A Cadaver Study.

PubMed

Trost, Matthias; Bredow, Jan; Boese, Christoph Kolja; Loweg, Lennard; Schulte, Tobias Ludger; Scaal, Martin; Eysel, Peer; Oppermann, Johannes

Distal chevron osteotomy is a common procedure for surgical correction of hallux valgus. Osteosynthesis with 1 screw or 2 Kirschner wires has been commonly used. We compared the stability of the 2 techniques in distal chevron osteotomy. Sixteen first metatarsals from fresh-frozen human cadaver feet (9 different cadaveric specimens) were used. A standardized distal chevron osteotomy was performed. One first metatarsal from each pair was assigned to group 1 (3.5-mm cortical screw; n = 8) and one to group 2 (two 1.6-mm Kirschner wires; n = 8). Using a materials testing machine, the head of the first metatarsals was loaded in 2 different configurations (cantilever and physiologic) in succession. In the cantilever configuration, the relative stiffness of the osteosynthesis compared with intact bone was 59% ± 27% in group 1 and 68% ± 18% in group 2 (p = .50). In the physiologic configuration, it was 38% ± 25% in group 1 and 35% ± 7% in group 2 (p = .75). The failure strength in the cantilever configuration was 187 ± 105 N in group 1 and 259 ± 71 N in group 2 (p = .21). No statistically significant differences were found in stability between the 2 techniques. The use of 1 screw or 2 Kirschner wires had no significant differences in their biomechanical loading capacity for osteosynthesis in distal chevron osteotomies for treatment of hallux valgus. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

The Efficacy of a Silicone Sheet in Postoperative Scar Management.

PubMed

Kim, Jin Sam; Hong, Joon Pio; Choi, Jong Woo; Seo, Dong Kyo; Lee, Eun Sook; Lee, Ho Seong

2016-09-01

Silicone gel sheeting has been introduced to prevent scarring, but objective evidence for its usefulness in scar healing is limited. Therefore, the authors' objective was to examine the effectiveness of silicone gel sheeting by randomly applying it to only unilateral scars from a bilateral hallux valgus surgery with symmetrical closure. In a prospective randomized, blinded, intraindividual comparison study, the silicone gel sheeting was applied to 1 foot of a hallux valgus incision scar (an experiment group) for 12 weeks upon removal of the stitches, whereas the symmetrical scar from the other foot was left untreated (a control group). The scars were evaluated at 4 and 12 weeks after the silicon sheet application. The Vancouver Scar Scale was used to measure the vascularity, pigmentation, pliability, height, and length of the scars. Adverse effects were also evaluated, and they included pain, itchiness, rash, erythema, and skin softening. At weeks 4 and 12, the experiment group scored significantly better on the Vancouver Scar Scale in all items, except length (P < .05 for all except the length of scar), compared with the control group. In all items, adverse effects of the experiment group were significantly lower than those of the control group at week 12, suggesting that direct attachment of the silicone sheet does not cause adverse effects (P < .05). To the authors' knowledge, this is one of the first models to minimize bias related to scar evaluation by using symmetrical scars. The early silicone sheet application did show a significant improvement in prevention of postoperative scarring.

Association of knee confidence with pain, knee instability, muscle strength, and dynamic varus-valgus joint motion in knee osteoarthritis.

PubMed

Skou, Søren T; Wrigley, Tim V; Metcalf, Ben R; Hinman, Rana S; Bennell, Kim L

2014-05-01

To investigate associations between self-reported knee confidence and pain, self-reported knee instability, muscle strength, and dynamic varus-valgus joint motion during walking. We performed a cross-sectional analysis of baseline data from 100 participants with symptomatic and radiographic medial tibiofemoral compartment osteoarthritis (OA) and varus malalignment recruited for a randomized controlled trial. The extent of knee confidence, assessed using a 5-point Likert scale item from the Knee Injury and Osteoarthritis Outcome Score, was set as the dependent variable in univariable and multivariable ordinal regression, with pain during walking, self-reported knee instability, quadriceps strength, and dynamic varus-valgus joint motion during walking as independent variables. One percent of the participants were not troubled with lack of knee confidence, 17% were mildly troubled, 50% were moderately troubled, 26% were severely troubled, and 6% were extremely troubled. Significant associations were found between worse knee confidence and higher pain intensity, worse self-reported knee instability, lower quadriceps strength, and greater dynamic varus-valgus joint motion. The multivariable model consisting of the same variables significantly accounted for 24% of the variance in knee confidence (P < 0.001). Worse knee confidence is associated with higher pain, worse self-reported knee instability, lower quadriceps muscle strength, and greater dynamic varus-valgus joint motion during walking. Since previous research has shown that worse knee confidence is predictive of functional decline in knee OA, addressing lack of knee confidence by treating these modifiable impairments could represent a new therapeutic target. Copyright © 2014 by the American College of Rheumatology.

Results of total knee replacement with a cruciate-retaining model for severe valgus deformity--a study of 48 patients followed for an average of 9 years.

PubMed

Koskinen, Esa; Remes, Ville; Paavolainen, Pekka; Harilainen, Arsi; Sandelin, Jerker; Tallroth, Kaj; Kettunen, Jyrki; Ylinen, Pekka

2011-06-01

The objectives of the present study were to find out the results and the factors affecting survival after primary knee arthroplasty with a cruciate-retaining prosthesis in severe valgus deformity. Forty-eight patients (52 knees) participated in the current follow-up study. All patients were followed at least 5 years or to first revision. Mean follow-up time was 9 years (range, 1 to 17 years).The Kaplan-Meier analysis revealed 79% (95% CI 68% to 91%) survival rate with revision for any reason and 81% (95% CI 70% to 93%) survival rate with revision for instability as an endpoint at 10 years. Preoperatively TFA was 23° (range, 15°-51°) in valgus and 7° (range, 21° valgus-4° varus) in valgus postoperatively. Of the 14 re-operated patients, eight were revised because of progressive postoperative medial collateral ligament instability. All re-operations were performed during the first 4 years of the follow-up. The mean TFA was 15.5° valgus postoperatively for those eight and the odds ratio for a revision was 2 (95% CI 1-3, p = 0.025) when compared to the rest of the study population. The residual valgus deformity increases the risk of re-operation and it should be avoided. If proper soft-tissue balance cannot be achieved or there is no functional medial collateral ligament present more constrained implants should be used. In selected cases where both bony correction and ligament balancing have properly been achieved the use of a cruciate-retaining type of prosthesis is justified. Copyright © 2010 Elsevier B.V. All rights reserved.

[Hindfoot valgus. Diagnosis and therapy of flatfoot].

PubMed

Radl, R; Fuhrmann, G; Maafe, M; Krifter, R-M

2012-04-01

The clinical finding of flatfoot is characterized by a flattening of the medial longitudinal arch and valgus deformity of the hindfoot. The differential diagnosis of flatfoot is the physiological, flexible, contracted flatfoot, which occurs as a congenital or acquired deformity. Congenital flatfoot deformity requires early intensive therapy, while a flexible flatfoot in children has a good prognosis and conservative treatment usually leads to a stable and sufficient load-bearing foot. Severe flatfoot in children can be corrected successfully by simple, minimally invasive procedures. In adults with symptomatic flatfoot, which usually occurs due to an insufficiency of the tendon of the tibialis posterior, conservative therapy with insoles, shoe modifications and physiotherapeutic measures can lead to significant improvement, otherwise surgical correction is recommended. Early, stage-appropriate therapy helps to prevent an impending decompensation of the hindfoot.

Comparison of calcaneal fixation of a retrograde intramedullary nail with a fixed-angle spiral blade versus a fixed-angle screw.

PubMed

Klos, Kajetan; Gueorguiev, Boyko; Schwieger, Karsten; Fröber, Rosemarie; Brodt, Steffen; Hofmann, Gunther O; Windolf, Markus; Mückley, Thomas

2009-12-01

Retrograde intramedullary nailing is an established technique for tibiotalocalcaneal arthrodesis (TTCA). In poor bone stock (osteoporosis, neuroarthropathy), device fixation in the hindfoot remains a problem. Fixed-angle spiral-blade fixation of the nail in the calcaneus could be useful. In seven matched pairs of human below-knee specimens, bone mineral density (BMD) was determined, and TTCA was performed with an intramedullary nail (Synthes Hindfoot Arthrodesis Nail HAN Expert Nailing System), using a conventional screw plus a fixed-angle spiral blade versus a conventional screw plus a fixed-angle screw, in the calcaneus. The constructs were subjected to quasi-static loading (dorsiflexion/plantarflexion, varus/valgus, rotation) and to cyclic loading to failure. Parameters studied were construct neutral zone (NZ) and range of motion (ROM), and number of cycles to failure. With dorsiflexion/plantarflexion loading, the screw-plus-spiral-blade constructs had a significantly smaller ROM in the quasi-static test (p = 0.028) and early in the cyclic test (p = 0.02); differences in the other parameters were not significant. There was a significant correlation between BMD and cycles to failure for the two-screw constructs (r = 0.94; p = 0.002) and for the screw-plus-spiral-blade constructs (r = 0.86; p = 0.014). In TTCA with a HAN Expert Nailing System, the use of a calcaneal spiral blade can further reduce motion within the construct. This may be especially useful in poor bone stock. Results obtained in this study could be used to guide the operating surgeon's TTCA strategy.

Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years.

PubMed

Song, Hyung Keun; Choi, Ho June; Yang, Kyu Hyun

2016-12-01

The aim of our study was to identify the risk factors for avascular necrosis of the femoral head (AVN) and fixation failure (FF) after screw osteosynthesis in patients with valgus angulated femoral neck fractures. We conducted a retrospective study of 308 patients (mean age, 72.5 years, range, 50-97 years), with a mean follow-up of 21.4 months (range, 12-64 months). The risk for failure in treatment (FIT) associated with patient- and fracture-related factors was evaluated by logistic regression analyses. FIT was identified in 32 cases (10.3%): 22 cases (7.1%) of AVN and 10 cases (3.2%) of FF. Initial valgus tilt>15° (p=0.023), posterior tilt>15° (p=0.012), and screw sliding distance (p=0.037) were significantly associated with FIT. FIT occurred in 7 patients (5.2%) with B1.2.1 fractures and 17 patients (48.6%) with B1.1.2 fractures (p<0.001). The odds of FIT were 17-fold higher in patients with initial valgus and posterior tilts>15° (B1.1.2) compared to patients with <15° of tilt in both planes (B1.2.1). The severity of initial deformity predicts AVN and FF in patients with valgus angulated femoral neck fractures. Patients with an initial valgus and posterior tilt>15° are reasonable candidates for primary arthroplasty due to high risk of FIT. Copyright © 2016 Elsevier Ltd. All rights reserved.

The percutaneous pie-crusting medial release during arthroscopic procedures of the medial meniscus does neither affect valgus laxity nor clinical outcome.

PubMed

Jeon, Sang-Woo; Jung, Min; Chun, Yong-Min; Lee, Su-Keon; Jung, Woo Seok; Choi, Chong Hyuk; Kim, Sung-Jae; Kim, Sung-Hwan

2017-12-28

To analyze the effect of percutaneous pie-crusting medial release on valgus laxity before and after surgery and on clinical outcomes. Eight-hundred fourteen consecutive patients who underwent an arthroscopic procedure for the medial compartment of the knee were evaluated retrospectively. Sex, age, type of operation (meniscectomy, meniscal repair, and posterior root repair), type of accompanying surgery (none, cartilage procedure, ligament procedure and osteotomy) were documented. Sixty-four patients who underwent percutaneous pie-crusting medial release (release group) and 64 who did not undergo medial release (non-release group) were matched using the propensity score method. Each patient was evaluated for the following variables: degree of valgus laxity on stress radiographs, Lysholm knee score, visual analog scale score, and International Knee Documentation Committee knee score and grade. At the 24-month follow-up, no significant increase in side-to-side differences in the valgus gap was observed in comparison to the preoperative value in the release group [preoperative, - 0.1 ± 1.3 mm; follow-up, - 0.1 ± 1.4 mm; (n.s.)]. The follow-up Lysholm score, visual analog scale score and International Knee Documentation Committee knee score and grade were similar between the two groups. Percutaneous pie-crusting medial release is an additional procedure that can be performed during arthroscopic surgery for patients with a narrow medial joint space of the knee. Percutaneous pie-crusting medial release reduces iatrogenic injury to the cartilage and does not produce any residual valgus laxity of the knee. IV.

A pictorial review of reconstructive foot and ankle surgery: hallux abductovalgus

PubMed Central

Meyr, Andrew J; Singh, Salil; Chen, Oliver; Ali, Sayed

2015-01-01

This pictorial review focuses on basic procedures performed within the field of podiatric surgery, specifically for the hallux abductovalgus or “bunion” deformity. Our goal is to define objective radiographic parameters that surgeons utilize to initially define deformity, lead to procedure selection and judge post-operative outcomes. We hope that radiologists will employ this information to improve their assessment of post-operative radiographs following reconstructive foot surgeries. First, relevant radiographic measurements are defined and their role in procedure selection explained. Second, the specific surgical procedures of the distal metatarsal, metatarsal shaft, metatarsal base, and phalangeal osteotomies are described in detail. Additional explanations of arthrodesis of the first metatarsal-phalangeal and metatarsal-cuneiform joints are also provided. Finally, specific plain film radiographic findings that judge post-operative outcomes for each procedure are detailed. PMID:26622935

Revision with suture-tape augmentation after failed collateral ligament reconstruction for chronic interphalangeal instability of the hallux.

PubMed

Cho, Byung-Ki; Park, Ji-Kang; Choi, Seung-Myung; SooHoo, Nelson F

2017-12-01

Chronic varus instability or recurrent subluxation following isolated interphalangeal dislocation of the hallux is a rare injury. No consensus has been reached regarding the best joint-salvage procedure for patients with the failed collateral ligament reconstruction using tendon graft. We report a case who achieved satisfactory clinical outcome through a modified surgical procedure (revision collateral ligament reconstruction augmented with suture-tape). Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Varus and valgus stress tests after total knee arthroplasty with and without anesthesia.

PubMed

Tsukeoka, Tadashi; Tsuneizumi, Yoshikazu

2016-03-01

Retrospective studies demonstrated inadequate soft tissue balance is associated with the long-term outcome of total knee arthroplasty (TKA). However, most of these studies have evaluated the joint laxity only postoperatively without anesthesia. Therefore information about the effect of anesthesia on knee laxity is important for soft tissue balancing at the time of surgery. This study was conducted to determine how anesthesia affects the varus and valgus stress tests after TKA. A consecutive series of 26 patients undergoing staged bilateral TKA was evaluated. Varus and valgus laxity of the knee with the TKA implant was measured a few days before the contralateral TKA without anesthesia and again immediately after the contralateral TKA under spinal anesthesia. The laxity was significantly increased from 3.0° to 3.6° (p = 0.005) and from 4.7° to 5.7° (p = 0.007) in medial and lateral side, respectively, when the stress tests were performed under anesthesia in comparison to the laxity measured without anesthesia. The major change in laxity (≥3°) was measured in 6 (23%) patients tested without anesthesia. Anesthesia significantly influenced knee joint laxity after TKA. The findings of this study suggest that muscular forces impart a stabilizing force across the joint.

Postoperative Knee Flexion Angle Is Affected by Lateral Laxity in Cruciate-Retaining Total Knee Arthroplasty.

PubMed

Nakano, Naoki; Matsumoto, Tomoyuki; Muratsu, Hirotsugu; Takayama, Koji; Kuroda, Ryosuke; Kurosaka, Masahiro

2016-02-01

Although many studies have reported that postoperative knee flexion is influenced by preoperative conditions, the factors which affect postoperative knee flexion have not been fully elucidated. We tried to investigate the influence of intraoperative soft tissue balance on postoperative knee flexion angle after cruciate-retaining (CR) total knee arthroplasty (TKA) using a navigation and an offset-type tensor. We retrospectively analyzed 55 patients with osteoarthritis who underwent TKA using e.motion-CR (B. Braun Aesculap, Germany) whose knee flexion angle could be measured at 2 years after operation. The exclusion criteria included valgus deformity, severe bony defect, infection, and bilateral TKA. Intraoperative varus ligament balance and joint component gap were measured with the navigation (Orthopilot 4.2; B. Braun Aesculap) while applying 40-lb joint distraction force at 0° to 120° of knee flexion using an offset-type tensor. Correlations between the soft tissue parameters and postoperative knee flexion angle were analyzed using simple linear regression models. Varus ligament balance at 90° of flexion (R = 0.56; P < .001) and lateral compartment gap at 90° of flexion (R = 0.51; P < .001) were positively correlated with postoperative knee flexion angle. In addition, as with past studies, joint component gap at 90° of flexion (R = 0.30; P < .05) and preoperative knee flexion angle (R = 0.63; P < .001) were correlated with postoperative knee flexion angle. Lateral laxity as well as joint component gap at 90° of flexion is one of the most important factors affecting postoperative knee flexion angle in CR-TKA. Copyright © 2016 Elsevier Inc. All rights reserved.

Relationships between age at menarche, walking gait base of support, and stance phase frontal plane knee biomechanics in adolescent females

PubMed Central

Grannis, Kimberly A.; Sherwood, Richard J.; Duren, Dana L

2016-01-01

Background Age at menarche impacts patterns of pubertal growth and skeletal development. These effects may carry over into variation in biomechanical profiles involved in sports-related traumatic and overuse knee injuries. The present study investigated whether age at menarche is a potential indicator of knee injury risk through its influence on knee biomechanics during normal walking. Objective To test the hypothesis that earlier menarche is related to post-pubertal biomechanical risk factors for knee injuries, including a wider, more immature gait base of support, and greater valgus knee angles and moments. Design Cross-sectional observational study. Setting University research facility. Participants Healthy, post-menarcheal, adolescent females. Methods Age at menarche was obtained by recall questionnaire. Pubertal growth and anthropometric data were collected using standard methods. Biomechanical data were taken from tests of walking gait at self-selected speed. Reflective marker position data were collected using a three-dimensional quantitative motion analysis system, and three force plates recorded kinetic data. Main Outcome Measures Age at menarche; growth and anthropometric measurements; base of support; static knee frontal plane angle; dynamic knee frontal plane angles and moments during stance. Results Earlier menarche was significantly correlated with abbreviated pubertal growth and post-pubertal retention of immature traits, including a wider base of support. Earlier menarche and wider base of support were both correlated with more valgus static knee angles, more valgus knee abduction angles and moments at foot-strike, and a more valgus peak knee abduction angle during stance. Peak knee abduction moment during stance was not correlated with age at menarche or base of support. Conclusions Earlier menarche and its effects on growth are associated with retention of a relatively immature gait base of support and a tendency for static and dynamic valgus knee

Validation of hand and foot anatomical feature measurements from smartphone images

NASA Astrophysics Data System (ADS)

Amini, Mohammad; Vasefi, Fartash; MacKinnon, Nicholas

2018-02-01

A smartphone mobile medical application, previously presented as a tool for individuals with hand arthritis to assess and monitor the progress of their disease, has been modified and expanded to include extraction of anatomical features from the hand (joint/finger width, and angulation) and foot (length, width, big toe angle, and arch height index) from smartphone camera images. Image processing algorithms and automated measurements were validated by performing tests on digital hand models, rigid plastic hand models, and real human hands and feet to determine accuracy and reproducibility compared to conventional measurement tools such as calipers, rulers, and goniometers. The mobile application was able to provide finger joint width measurements with accuracy better than 0.34 (+/-0.25) millimeters. Joint angulation measurement accuracy was better than 0.50 (+/-0.45) degrees. The automatically calculated foot length accuracy was 1.20 (+/-1.27) millimeters and the foot width accuracy was 1.93 (+/-1.92) millimeters. Hallux valgus angle (used in assessing bunions) accuracy was 1.30 (+/-1.29) degrees. Arch height index (AHI) measurements had an accuracy of 0.02 (+/-0.01). Combined with in-app documentation of symptoms, treatment, and lifestyle factors, the anatomical feature measurements can be used by both healthcare professionals and manufacturers. Applications include: diagnosing hand osteoarthritis; providing custom finger splint measurements; providing compression glove measurements for burn and lymphedema patients; determining foot dimensions for custom shoe sizing, insoles, orthotics, or foot splints; and assessing arch height index and bunion treatment effectiveness.

Reliability of doming and toe flexion testing to quantify foot muscle strength.

PubMed

Ridge, Sarah Trager; Myrer, J William; Olsen, Mark T; Jurgensmeier, Kevin; Johnson, A Wayne

2017-01-01

Quantifying the strength of the intrinsic foot muscles has been a challenge for clinicians and researchers. The reliable measurement of this strength is important in order to assess weakness, which may contribute to a variety of functional issues in the foot and lower leg, including plantar fasciitis and hallux valgus. This study reports 3 novel methods for measuring foot strength - doming (previously unmeasured), hallux flexion, and flexion of the lesser toes. Twenty-one healthy volunteers performed the strength tests during two testing sessions which occurred one to five days apart. Each participant performed each series of strength tests (doming, hallux flexion, and lesser toe flexion) four times during the first testing session (twice with each of two raters) and two times during the second testing session (once with each rater). Intra-class correlation coefficients were calculated to test for reliability for the following comparisons: between raters during the same testing session on the same day (inter-rater, intra-day, intra-session), between raters on different days (inter-rater, inter-day, inter-session), between days for the same rater (intra-rater, inter-day, inter-session), and between sessions on the same day by the same rater (intra-rater, intra-day, inter-session). ICCs showed good to excellent reliability for all tests between days, raters, and sessions. Average doming strength was 99.96 ± 47.04 N. Average hallux flexion strength was 65.66 ± 24.5 N. Average lateral toe flexion was 50.96 ± 22.54 N. These simple tests using relatively low cost equipment can be used for research or clinical purposes. If repeated testing will be conducted on the same participant, it is suggested that the same researcher or clinician perform the testing each time for optimal reliability.

Increases in tibial force imbalance but not changes in tibiofemoral laxities are caused by varus-valgus malalignment of the femoral component in kinematically aligned TKA.

PubMed

Riley, Jeremy; Roth, Joshua D; Howell, Stephen M; Hull, Maury L

2018-01-29

The purposes of this study were to quantify the increase in tibial force imbalance (i.e. magnitude of difference between medial and lateral tibial forces) and changes in laxities caused by 2° and 4° of varus-valgus (V-V) malalignment of the femoral component in kinematically aligned total knee arthroplasty (TKA) and use the results to detemine sensitivities to errors in making the distal femoral resections. Because V-V malalignment would introduce the greatest changes in the alignment of the articular surfaces at 0° flexion, the hypotheses were that the greatest increases in tibial force imbalance would occur at 0° flexion, that primarily V-V laxity would significantly change at this flexion angle, and that the tibial force imbalance would increase and laxities would change in proportion to the degree of V-V malalignment. Kinematically aligned TKA was performed on ten human cadaveric knee specimens using disposable manual instruments without soft tissue release. One 3D-printed reference femoral component, with unmodified geometry, was aligned to restore the native distal and posterior femoral joint lines. Four 3D-printed femoral components, with modified geometry, introduced V-V malalignments of 2° and 4° from the reference component. Medial and lateral tibial forces were measured during passive knee flexion-extension between 0° to 120° using a custom tibial force sensor. Eight laxities were measured from 0° to 120° flexion using a six degree-of-freedom load application system. With the tibial component kinematically aligned, the increase in the tibial force imbalance from that of the reference component at 0° of flexion was sensitive to the degree of V-V malalignment of the femoral component. Sensitivities were 54 N/deg (medial tibial force increasing > lateral tibial force) (p < 0.0024) and 44 N/deg (lateral tibial force increasing > medial tibial force) (p < 0.0077) for varus and valgus malalignments, respectively. Varus-valgus

In vivo determination of the direction of rotation and moment-angle relationship of individual elbow muscles.

PubMed

Zhang, L; Butler, J; Nishida, T; Nuber, G; Huang, H; Rymer, W Z

1998-10-01

The direction of rotation (DOR) of individual elbow muscles, defined as the direction in which a muscle rotates the forearm relative to the upper arm in three-dimensional space, was studied in vivo as a function of elbow flexion and forearm rotation. Electrical stimulation was used to activate an individual muscle selectively, and the resultant flexion-extension, supination-pronation, and varus-valgus moments were used to determine the DOR. Furthermore, multi-axis moment-angle relationships of individual muscles were determined by stimulating the muscle at a constant submaximal level across different joint positions, which was assumed to result in a constant level of muscle activation. The muscles generate significant moments about axes other than flexion-extension, which is potentially important for actively controlling joint movement and maintaining stability about all axes. Both the muscle DOR and the multi axis moments vary with the joint position systematically. Variations of the DOR and moment-angle relationship across muscle twitches of different amplitudes in a subject were small, while there were considerable variations between subjects.

Prevalence estimation and familial tendency of common forefoot deformities in Turkey: A survey of 2662 adults.

PubMed

Şaylı, Uğur; Altunok, Elif Çiğdem; Güven, Melih; Akman, Budak; Biros, Jnev; Şaylı, Ayşe

2018-02-19

This survey was designed to evaluate the prevalence estimations of HV, bunionette, hammertoe as well as their relations to shoe wearing and also familial tendency, in Turkey. Two thousand six hundred sixty two volunteers (1615 females and 1047 males) with a mean age of 34.15 ± 14.23 (range; 18 to 96) years were asked to answer the predetermined questionnaire between January and June, 2016. Hallux valgus, hammertoe and bunionette images were provided as references and every adult participant without any known forefoot problems or past forefoot surgery history was asked to rate his/her foot and to respond the questions about family history and shoe wearing habits. Responses were statistically analyzed. The prevalence estimations of hallux valgus, bunionette and hammertoe were calculated as 54.3%, 13.8% and 8.9% and positive family history rates were 53.2%, 61.2% and 56.1%, respectively. All three deformities were more common in females than in males (p < 0.001). Nonetheless the older age group reported significantly higher prevalence rates for only HV (p < 0.001). Likewise, among the three deformities, females reported a higher rate of positive family history only in HV compared to men (p < 0.001). Constricting shoe wear was found to affect HV incidence in women (p < 0.001) and bunionette incidence in both sexes (p < 0.01). This study concludes that forefoot deformities are common with high familial tendency. Hence it is worthwhile to work on molecular genetics and this may enable the anticipation of forthcoming deformities in order to take early action in prevention, in nearly the half of the population. Copyright © 2018 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Study on the foot shape characteristics of the elderly in China.

PubMed

Luo, Xiang Dong; Xue, Chao-Hua; Li, Yan

2017-12-01

With aging, the feet of the elderly above 60 years old in China present degenerative changes, deformities, and diseases, which significantly affect their daily activities. The authors aimed to study the morphological characteristics of the feet and identify the foot type according to size (length and width) and defect characteristics of elderly feet in China. A convenient sample of 1000 subjects above 60 years old was recruited mainly in the regions of Shanghai, Shaanxi, Henan, Hebei, and Sichuan in China. Foot images were collected, and 800 (male 398, female 402) valid questionnaires were recovered. A total of 800 elderly subjects as the test group were invited to measure their foot sizes by means of a Footprint Collector (Tong Yuan Tang Health Management Limited, Qingdao in Shandong province). The foot type of the elderly was compared with that of the general adult Chinese population as the control group using the t-test for independent samples. Hallux valgus (46.9%) and flat foot (50.0%) were the most common foot shape deformities. The most frequent foot diseases were foot scaling (91.2%) and calluses (96.3%). The medial width of the first metatarsal-toe joint of the elderly was significantly higher (elderly female, 44.95±4.86mm; elderly male, 48.55±4.94mm) than that of the general adult population (adult female, 40.18±3.43mm; adult male, 43.22±3.20mm) (p<0.01). The foot length of the elderly was not significantly different from that of the general adult Chinese population. The width of the first metatarsal-toe joint in the forefoot of the elderly was significantly higher than that of the general adult Chinese population, which was consistent with the result that a high proportion of elderly subjects presented hallux valgus. Copyright © 2017 Elsevier Ltd. All rights reserved.

Postoperative alignment of TKA in patients with severe preoperative varus or valgus deformity: is there a difference between surgical techniques?

PubMed

Rahm, Stefan; Camenzind, Roland S; Hingsammer, Andreas; Lenz, Christopher; Bauer, David E; Farshad, Mazda; Fucentese, Sandro F

2017-06-21

There have been conflicting studies published regarding the ability of various total knee arthroplasty (TKA) techniques to correct preoperative deformity. The purpose of this study was to compare the postoperative radiographic alignment in patients with severe preoperative coronal deformity (≥10° varus/valgus) who underwent three different TKA techniques; manual instrumentation (MAN), computer navigated instrumentation (NAV) and patient specific instrumentation (PSI). Patients, who received a TKA with a preoperative coronal deformity of ≥10° with available radiographs were included in this retrospective study. The groups were: MAN; n = 54, NAV; n = 52 and PSI; n = 53. The mechanical axis (varus / valgus) and the posterior tibial slope were measured and analysed using standing long leg- and lateral radiographs. The overall mean postoperative varus / valgus deformity was 2.8° (range, 0 to 9.9; SD 2.3) and 2.5° (range, 0 to 14.7; SD 2.3), respectively. The overall outliers (>3°) represented 30.2% (48 /159) of cases and were distributed as followed: MAN group: 31.5%, NAV group: 34.6%, PSI group: 24.4%. No significant statistical differences were found between these groups. The distribution of the severe outliers (>5°) was 14.8% in the MAN group, 23% in the NAV group and 5.6% in the PSI group. The PSI group had significantly (p = 0.0108) fewer severe outliers compared to the NAV group while all other pairs were not statistically significant. In severe varus / valgus deformity the three surgical techniques demonstrated similar postoperative radiographic alignment. However, in reducing severe outliers (> 5°) and in achieving the planned posterior tibial slope the PSI technique for TKA may be superior to computer navigation and the conventional technique. Further prospective studies are needed to determine which technique is the best regarding reducing outliers in patients with severe preoperative coronal deformity.

The chevron osteotomy and avascular necrosis.

PubMed

Rothwell, Matthew; Pickard, James

2013-03-01

Avascular necrosis (AVN) of the first metatarsal head following the chevron procedure for hallux valgus correction, has been reported widely in the literature; however, in practice it is rarely encountered and may be an over reported myth associated with the chevron technique. Although an infrequent complication, the consequences for those who develop post-operative AVN can be severe. This paper presents an overview of the pathogenesis and classification of AVN. It reviews the vascular anatomy of the first metatarsal with reference to the surgical technique of chevron osteotomy with lateral release. Imaging techniques are described and the management of AVN and revision surgery are also discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.

Anchor enhanced capsulorraphy in bunionectomies using an L-shaped capsulotomy.

PubMed

Gould, John S; Ali, Sheriff; Fowler, Rachel; Fleisig, Glenn S

2003-01-01

The objective of this study was to investigate potential benefit of a suture anchor-enhanced capsulorraphy in the early maintenance of correction in bunionectomies. We compared, retrospectively, in successive series, the loss of correction of the Hallux Valgus (HV) and intermetatarsal (IM) angle, in those repaired with an L-shaped capsulorraphy enhanced with anchors to those without. Intraoperative and second week postoperative simulated weightbearing anterior posterior (AP) X-rays were used to evaluate results. By using only intraoperative and early postoperative X-rays, we should have effectively eliminated extraneous factors that might have influenced our results. A Total of 106 cases were investigated, 65 of which were repaired using anchors, the remaining 41 without. In the anchor group, 38 underwent a proximal metatarsal concentric shelf osteotomy (CSO)/modified McBride procedure, while the remaining 27 had a distal Chevron correction. In the without-anchor group, 21 had a CSO/modified McBride procedure while 20 underwent the Chevron procedure. In the without-anchor group, the average HV and IM loss of correction was 4.60 degrees (range, -2 to 21 degrees) and 0.6 degrees (range, -1 to 9 degrees) respectively. In the anchor group, the corresponding loss was 2.8 degrees (range, -3 to 17 degrees) and 0.6 degrees (range, -2 to 14 degrees) respectively. These results, when statistically analyzed, demonstrated that while the IM angle change was not statistically significant, the HV angle change was statistically significant, implying that the anchor plays a significant role in maintaining the surgical correction in both the distal Chevron and CSO/ modified McBride bunionectomies.

Effect of Forefoot Strike on Lower Extremity Muscle Activity and Knee Joint Angle During Cutting in Female Team Handball Players.

PubMed

Yoshida, Naruto; Kunugi, Shun; Mashimo, Sonoko; Okuma, Yoshihiro; Masunari, Akihiko; Miyazaki, Shogo; Hisajima, Tatsuya; Miyakawa, Shumpei

2015-06-01

The purpose of this study is to examine the effects of different strike forms, during cutting, on knee joint angle and lower limb muscle activity. Surface electromyography was used to measure muscle activity in individuals performing cutting manoeuvres involving either rearfoot strikes (RFS) or forefoot strikes (FFS). Three-dimensional motion analysis was used to calculate changes in knee angles, during cutting, and to determine the relationship between muscle activity and knee joint angle. Force plates were synchronized with electromyography measurements to compare muscle activity immediately before and after foot strike. The valgus angle tends to be smaller during FFS cutting than during RFS cutting. Just prior to ground contact, biceps femoris, semitendinosus, and lateral head of the gastrocnemius muscle activities were significantly greater during FFS cutting than during RFS cutting; tibialis anterior muscle activity was greater during RFS cutting. Immediately after ground contact, biceps femoris and lateral head of the gastrocnemius muscle activities were significantly greater during FFS cutting than during RFS cutting; tibialis anterior muscle activity was significantly lower during FFS cutting. The results of the present study suggest that the hamstrings demonstrate greater activity, immediately after foot strike, during FFS cutting than during RFS cutting. Thus, FFS cutting may involve a lower risk of anterior cruciate ligament injury than does RFS cutting.

The effect of tibiotalar alignment on coronal plane mechanics following total ankle replacement.

PubMed

Grier, A Jordan; Schmitt, Abigail C; Adams, Samuel B; Queen, Robin M

2016-07-01

Gait mechanics following total ankle replacement (TAR) have reported improved ankle motion following surgery. However, no studies have addressed the impact of preoperative radiographic tibiotalar alignment on post-TAR gait mechanics. We therefore investigated whether preoperative tibiotalar alignment (varus, valgus, or neutral) resulted in significantly different coronal plane mechanics or ground reaction forces post-TAR. We conducted a non-randomized study of 93 consecutive end-stage ankle arthritis patients. Standard weight-bearing radiographs were obtained preoperatively to categorize patients as having neutral (±4°), varus (≥5° of varus), or valgus (≥5° of valgus) coronal plane tibiotalar alignment. All patients underwent a standard walking assessment including three-dimensional lower extremity kinetics and kinematics preoperatively, 12 and 24 months postoperatively. A significant group by time interaction was observed for the propulsive vertical ground reaction force (vGRF), coronal plane hip range of motion (ROM) and the peak hip abduction moment. The valgus group demonstrated an increase in the peak knee adduction angle and knee adduction angle at heel strike when compared to the other groups. Coronal plane ankle ROM, knee and hip angles at heel strike, and the peak hip angle exhibited significant increases across time. Peak ankle inversion moment, peak knee abduction moment and the weight acceptance vGRF also exhibited significant increases across time. Neutral ankle alignment was achieved for all patients by 2 years following TAR. Restoration of neutral ankle alignment at the time of TAR in patients with preoperative varus or valgus tibiotalar alignment resulted in biomechanics similar to those of patients with neutral preoperative tibiotalar alignment by 24-month follow-up. Copyright © 2016 Elsevier B.V. All rights reserved.

Relationships Between Age at Menarche, Walking Gait Base of Support, and Stance Phase Frontal Plane Knee Biomechanics in Adolescent Girls.

PubMed

Froehle, Andrew W; Grannis, Kimberly A; Sherwood, Richard J; Duren, Dana L

2017-05-01

Age at menarche impacts patterns of pubertal growth and skeletal development. These effects may carry over into variation in biomechanical profiles involved in sports-related traumatic and overuse knee injuries. The present study investigated whether age at menarche is a potential indicator of knee injury risk through its influence on knee biomechanics during normal walking. To test the hypothesis that earlier menarche is related to postpubertal biomechanical risk factors for knee injuries, including a wider, more immature gait base of support, and greater valgus knee angles and moments. Cross-sectional observational study. University research facility. Healthy, postmenarcheal, adolescent girls. Age at menarche was obtained by recall questionnaire. Pubertal growth and anthropometric data were collected by using standard methods. Biomechanical data were taken from tests of walking gait at self-selected speed. Reflective marker position data were collected with a 3-dimensional quantitative motion analysis system, and 3 force plates recorded kinetic data. Age at menarche; growth and anthropometric measurements; base of support; static knee frontal plane angle; and dynamic knee frontal plane angles and moments during stance. Earlier menarche was correlated significantly with abbreviated pubertal growth and postpubertal retention of immature traits, including a wider base of support. Earlier menarche and wider base of support were both correlated with more valgus static knee angles, more valgus knee abduction angles and moments at foot-strike, and a more valgus peak knee abduction angle during stance. Peak knee abduction moment during stance was not correlated with age at menarche or base of support. Earlier menarche and its effects on growth are associated with retention of a relatively immature gait base of support and a tendency for static and dynamic valgus knee alignment. This biomechanical profile may put girls with earlier menarche at greater risk for sports

The Validity of a New Low-Dose Stereoradiography System to Perform 2D and 3D Knee Prosthetic Alignment Measurements.

PubMed

Meijer, Marrigje F; Velleman, Ton; Boerboom, Alexander L; Bulstra, Sjoerd K; Otten, Egbert; Stevens, Martin; Reininga, Inge H F

2016-01-01

The EOS stereoradiography system has shown to provide reliable varus/valgus (VV) measurements of the lower limb in 2D (VV2D) and 3D (VV3D) after total knee arthroplasty (TKA). Validity of these measurements has not been investigated yet, therefore the purpose of this study was to determine validity of EOS VV2D and VV3D. EOS images were made of a lower limb phantom containing a knee prosthesis, while varying VV angle from 15° varus to 15° valgus and flexion angle from 0° to 20°, and changing rotation from 20° internal to 20° external rotation. Differences between the actual VV position of the lower limb phantom and its position as measured on EOS 2D and 3D images were investigated. Rotation, flexion or VV angle alone had no major impact on VV2D or VV3D. Combination of VV angle and rotation with full extension did not show major differences in VV2D measurements either. Combination of flexion and rotation with a neutral VV angle showed variation of up to 7.4° for VV2D; maximum variation for VV3D was only 1.5°. A combination of the three variables showed an even greater distortion of VV2D, while VV3D stayed relatively constant. Maximum measurement difference between preset VV angle and VV2D was 9.8°, while the difference with VV3D was only 1.9°. The largest differences between the preset VV angle and VV2D were found when installing the leg in extreme angles, for example 15° valgus, 20° flexion and 20° internal rotation. After TKA, EOS VV3D were more valid than VV2D, indicating that 3D measurements compensate for malpositioning during acquisition. Caution is warranted when measuring VV angle on a conventional radiograph of a knee with a flexion contracture, varus or valgus angle and/or rotation of the knee joint during acquisition.

Inter-segment foot motion in girls using a three-dimensional multi-segment foot model.

PubMed

Jang, Woo Young; Lee, Dong Yeon; Jung, Hae Woon; Lee, Doo Jae; Yoo, Won Joon; Choi, In Ho

2018-05-06

Several multi-segment foot models (MFMs) have been introduced for in vivo analyses of dynamic foot kinematics. However, the normal gait patterns of healthy children and adolescents remain uncharacterized. We sought to determine normal foot kinematics according to age in clinically normal female children and adolescents using a Foot 3D model. Fifty-eight girls (age 7-17 years) with normal function and without radiographic abnormalities were tested. Three representative strides from five separate trials were analyzed. Kinematic data of foot segment motion were tracked and evaluated using an MFM with a 15-marker set (Foot 3D model). As controls, 50 symptom-free female adults (20-35 years old) were analyzed. In the hindfoot kinematic analysis, plantar flexion motion in the pre-swing phase was significantly greater in girls aged 11 years or older than in girls aged <11 years, thereby resulting in a larger sagittal range of motion. Coronal plane hindfoot motion exhibited pronation, whereas transverse plane hindfoot motion exhibited increased internal rotation in girls aged <11 years. Hallux valgus angles increased significantly in girls aged 11 years or older. The foot progression angle showed mildly increased internal rotation in the loading response phase and the swing phase in girls aged <11 years old. The patterns of inter-segment foot motion in girls aged 11 years or older showed low-arch kinematic characteristics, whereas those in girls aged 11 years or older were more similar to the patterns in young adult women. Copyright © 2018 Elsevier B.V. All rights reserved.

Effects of ballet training of children in Turkey on foot anthropometric measurements and medial longitudinal arc development.

PubMed

Ozdinc, Sevgi Anar; Turan, Fatma Nesrin

2016-07-01

To investigate the effects of ballet training on foot structure and the formation of the medial longitudinal arc in childhood, and the association of body mass index with structural change secondary to ballet training. This study was conducted at Öykü Ballet and Dance School and Trakya University, Edirne, Turkey, from September 2007 to November 2008, and comprised girl students who were taking ballet classes, and a group of those who were not taking such who acted as the controls. Static footprints of both feet of all participants were taken with an ink paedogram. Parameters evaluated from footprints included foot length, metatarsal width, heel width and medial longitudinal arch. The relationship between the parameters, the ballet starting age, training duration and body mass index was investigated. Of the 67 participants, there were 36(53.7%) in the experimental group and 31(48.3%) in the control group. The difference between age, height, weight and body mass index between the two groups was insignificant (p>0.05). The average ballet starting age was 6.47±1.55 years and duration was 4.36±2.002 years. Positive correlations were found between body mass index and foot length, metatarsal width, heel width, medial longitudinal arch contact width and halluxvalgus angle; between ballet starting age and metatarsal width, heel width; between duration of training and foot length, metatarsal width and hallux valgus angle (p?0.05 each). Evidence supporting the education in children on foot anthropometric measurements and medial longitudinal arc development could not be found.

Hindfoot Valgus following Interlocking Nail Treatment for Tibial Diaphysis Fractures: Can the Fibula Be Neglected?

PubMed Central

Uzun, Metin; Kara, Adnan; Adaş, Müjdat; Karslioğlu, Bülent; Bülbül, Murat; Beksaç, Burak

2014-01-01

Purpose. We evaluated whether intramedullary nail fixation for tibial diaphysis fractures with concomitant fibula fractures (except at the distal one-third level) managed conservatively with an associated fibula fracture resulted in ankle deformity and assessed the impact of the ankle deformity on lower extremity function. Methods. Sixty middle one-third tibial shaft fractures with associated fibular fractures, except the distal one-third level, were included in this study. All tibial shaft fractures were anatomically reduced and fixed with interlocking intramedullary nails. Fibular fractures were managed conservatively. Hindfoot alignment was assessed clinically. Tibia and fibular lengths were compared to contralateral measurements using radiographs. Functional results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Foot and Ankle Disability Index Score (FADI). Results. Anatomic union, defined as equal length in operative and contralateral tibias, was achieved in 60 fractures (100%). Fibular shortening was identified in 42 fractures (68%). Mean fibular shortening was 1.2 cm (range, 0.5–2 cm). Clinical exams showed increased hindfoot valgus in 42 fractures (68%). The mean KOOS was 88.4, and the mean FADI score was 90. Conclusion. Fibular fractures in the middle or proximal one-third may need to be stabilized at the time of tibial intramedullary nail fixation to prevent development of hindfoot valgus due to fibular shortening. PMID:25544899

Comparison of Chevron and Distal Oblique Osteotomy for Bunion Correction.

PubMed

Scharer, Brandon M; DeVries, J George

2016-01-01

The chevron osteotomy is a standard procedure by which bunions are corrected. One of us routinely performs a distal oblique osteotomy, which, to the best of our knowledge, has not been described for the correction of bunion deformities. The purpose of the present study was to compare the short- and medium-term results of the distal oblique and chevron osteotomies for bunion correction. We performed a retrospective clinical and radiographic comparison of patients who had undergone a distal oblique or chevron osteotomy for the correction of bunion deformity. In addition, a prospective patient satisfaction survey was undertaken. A total of 55 patients were included in the present study and were treated from January 2012 to November 2014. Of the 55 patients, 27 (49.2%) were in the chevron group and 28 (50.8%) in the distal oblique group. Radiographically, no statistically significant difference was found between the 2 groups with respect to postoperative first intermetatarsal angle (p < .0001) and hallux valgus angle (p < .0001), but a greater change was found in the intermetatarsal angle in the distal oblique group (p = .467). Prospective patient satisfaction scores were available for 33 patients (60%), 16 (29%) in the chevron group and 17 (31%) in the distal oblique group. When converting the satisfaction score to a numerical score, the chevron group scored 3.3 ± 1.1 and the distal oblique group scored 3.2 ± 0.8 (p = .812). We found that the distal oblique osteotomy used in the present study is simple and reliable and showed radiographic correction and patient satisfaction equivalent to those in the chevron osteotomy. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

[Utilization of a porous alumina ceramic spacer in tibial valgus open-wedge osteotomy: fifty cases at 16 months mean follow-up].

PubMed

Bové, J C

2002-09-01

The aim of this work was to study the behavior of an inert porous alumina ceramic spacer used with a plate fixation for open-wedge tibial valgus osteotomy in patients with osteoarthritis of the knee and genu varum. The population included 50 patients who underwent surgery between October 1994 and December 2000. There were 31 women and 19 men, mean age 55 years at surgery (26 right knees and 24 left knees). Patients were reviewed at 3 weeks, 6 weeks, 3 months, 6 months, and one year, then every 2 years. Clinical and radiological data were available for all patients. Mean follow-up was 16 months. Two patients were lost to follow-up at 5 and 6 months. The results of the open-wedge tibial osteotomy were in agreement with the usual outcome reported in the literature concerning pain relief, functional recovery, joint motion, angle correction, and good preservation of the clinical and radiological result. Three fracture lines were observed on the lateral tibial plateau but did not affect final outcome or angle correction. There was however one case with loss of correction due to fracture of the screws. Radiographically, at 6 months, there were 9 thin lucent lines around the spacer (24%) which did not affect final outcome. Bone healing was achieved at 3 months on the average in all cases except 2 (4%) where healing was achieved at 8 and 13 months. The porous alumine spacer is a reliable biocompatible and mechanically stable element helpful for achieving bone healing. Integration into bone tissue was radiographically satisfactory. There were no specific complications related to use of the spacer.

Demographic and clinical factors associated with radiographic severity of first metatarsophalangeal joint osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot.

PubMed

Menz, H B; Roddy, E; Marshall, M; Thomas, M J; Rathod, T; Myers, H; Thomas, E; Peat, G M

2015-01-01

To explore demographic and clinical factors associated with radiographic severity of first metatarsophalangeal joint osteoarthritis (OA) (First MTPJ OA). Adults aged ≥50 years registered with four general practices were mailed a Health Survey. Responders reporting foot pain within the last 12 months were invited to undergo a clinical assessment and weight-bearing dorso-plantar and lateral radiographs of both feet. Radiographic first MTPJ OA in the most severely affected foot was graded into four categories using a validated atlas. Differences in selected demographic and clinical factors were explored across the four radiographic severity subgroups using analysis of variance (ANOVA) and ordinal regression. Clinical and radiographic data were available from 517 participants, categorised as having no (n = 105), mild (n = 228), moderate (n = 122) or severe (n = 62) first MTPJ OA. Increased radiographic severity was associated with older age and lower educational attainment. After adjusting for age, increased radiographic first MTPJ OA severity was significantly associated with an increased prevalence of dorsal hallux and first MTPJ pain, hallux valgus, first interphalangeal joint (IPJ) hyperextension, keratotic lesions on the dorsal aspect of the hallux and first MTPJ, decreased first MTPJ dorsiflexion, ankle/subtalar joint eversion and ankle joint dorsiflexion range of motion, and a trend towards a more pronated foot posture. This cross-sectional study has identified several dose-response associations between radiographic severity of first MTPJ OA and a range of demographic and clinical factors. These findings highlight the progressive nature of first MTPJ OA and provide insights into the spectrum of presentation of the condition in clinical practice. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Influence of varus/valgus positioning of the Nanos® and Metha® short-stemmed prostheses on stress shielding of metaphyseal bone.

PubMed

Brinkmann, V; Radetzki, F; Gutteck, N; Delank, S; Zeh, A

2017-03-01

The aim of this study was to analyze bone remodeling around the Nanos® (Smith & Nephew) and Metha® (Aesculap AG) implants as a function of varus/valgus stem positioning. In 75 patients with diagnosed coxarthrosis, either Nanos® (n= 51) or Metha® (n= 24) prostheses were implanted. Digital assessment of plain radiographs immediately, 97 days, and 381 days after THA showed no clinically-relevant migration, angulation, or change in offset and center of rotation. The DEXA scans showed significant BMD changes in Gruen zones 1 (-12.8%), 2 (-3.3%), 6 (+6.4%), and 7(-7.8%)(t-test). The pre/postoperative CCD for the Nanos® was 129°/ 135° and for the Metha® 131°/ 127°. Linear regression analysis showed no prediction for BMD by postoperative CCD or stem type. In conclusion, there was no clinically-relevant influence on proximal femur BMD according to varus/valgus implantation of the Nanos® or Metha® prostheses.

Metatarsal head resurfacing arthroplasty in the treatment of hallux rigidus: is it reliable treatment option?

PubMed

Circi, E; Tuzuner, T; Sukur, E; Baris, A; Kanay, E

2016-08-01

This study looks at the failure and complications arising secondary to resurfacing and hemi-arthroplasty done at the metatarsal head in patients with hallux rigidus. Our report includes a review of the relevant literature to verify the validity of our techniques. We performed metatarsal head resurfacing with hemi-arthroplasty using the HemiCap(®), on 12 patients with hallux rigidus between the dates of March 2010 and October 2013. The mean follow-up period was 22.3 months (range 12-54). All patients were clinically and radiologically evaluated according to the American Orthopedics Foot and Ankle Society (AOFAS) functional scale and the Coughlin and Shurnas classification. The recorded mean AOFAS score showed an increase from the preoperative score of 49.2 ± 13.1 to a postoperative follow-up score of 80.8 ± 13.1 (p < 0.001). Pain scores also showed an improvement from 16.5 ± 7.1 points preoperatively to 32.5 ± 6.9 points during the postoperative follow-up (p < 0.001). The mean function score improved from 17.7 ± 7.6 points preoperatively to 33.2 ± 7.6 points during the final postoperative follow-up (p < 0.001). Furthermore, the mean range of motion improved from 16.3 ± 4.8° preoperatively to 45.4 ± 13.2° postoperatively (p < 0.001). Three patients (25 %) reported pain at rest. Surgical revision was done on these patients who have significant pain that limited their range of motion. Favorable outcomes were achieved by performing minimal bone resection which also helps maintain metatarso-phalangeal joint function through metatarsal head resurfacing arthroplasty. We expect the failure rates to decrease with the advancements of surgical techniques. Selecting the appropriate patient populous in the application of the technique is crucial in attaining successful clinical results.

Revision ulnar collateral ligament reconstruction using a suspension button fixation technique.

PubMed

Lee, Gregory H; Limpisvasti, Orr; Park, Maxwell C; McGarry, Michelle H; Yocum, Lewis A; Lee, Thay Q

2010-03-01

Revision ulnar collateral ligament reconstruction remains a challenging problem. The objective of this study was to biomechanically evaluate an ulnar collateral ligament reconstruction technique using a suspension button fixation technique that can be used even in the case of ulnar cortical bone loss. An ulnar suspension fixation technique for ulnar collateral ligament reconstruction can restore elbow kinematics and demonstrate failure strength comparable to that of currently available techniques. Controlled laboratory study. Nine pairs of cadaveric elbows were dissected free of soft tissue and potted. After simulating ulnar cortical bone loss, ulnar collateral ligament reconstruction was performed in 1 elbow of each pair using palmaris longus autograft and a 30-mm RetroButton suspended from the far (lateralmost) ulnar cortex. A docking technique was used for humeral fixation of the graft. Elbow valgus angle was quantified using a Microscribe 3DLX digitizer at multiple elbow flexion angles. Valgus angle was measured with the ulnar collateral ligament intact, transected, and reconstructed. In addition, load-to-failure testing was performed in 1 elbow of each pair. Release of the ulnar collateral ligament caused a significant increase in valgus angle at each flexion angle tested (P < .002). Reconstructed elbows demonstrated no significant differences in valgus angle from the intact elbow at all flexion angles tested. Load-to-failure tests showed that reconstructed elbows had an ultimate torque (10.3 + or - 5.7 N x m) significantly less than intact elbows (26.4 + or - 10.6 N x m) (P = .001). Ulnar collateral ligament reconstruction using a suspension button fixation technique reliably restored elbow kinematics to the intact state. Load-to-failure testing demonstrated comparable fixation strength to several historic controls of primary reconstruction techniques despite the simulated ulnar cortical bone loss. Ulnar collateral ligament reconstruction using a suspension

Screw Versus Plate Fixation for Chevron Osteotomy: A Retrospective Study.

PubMed

Andrews, Boyd J; Fallat, Lawrence M; Kish, John P

2016-01-01

The chevron osteotomy is a popular procedure used for the correction of moderate hallux abducto valgus deformity. Fixation is typically accomplished with Kirschner wires or bone screws; however, in cystic or osteoporotic bone, these could be inadequate, resulting in displacement of the capital fragment. We propose using a locking plate and interfragmental screw for fixation of the chevron osteotomy that could reduce the healing time and decrease the incidence of displacement. We performed a retrospective cohort study for chevron osteotomies on 75 feet (73 patients). The control groups underwent fixation with 1 screw in 30 feet (40%) and 2 screws in 30 feet (40%). A total of 15 feet (20%) were included in the locking plate and interfragmental screw group. The patients were followed up until bone healing was achieved at a median of 7 (range 6 to 14) weeks. Our hypothesis was that those treated with the locking plate and interfragmental screw would have a faster healing time and fewer incidents of capital fragment displacement compared with the 1- or 2-screw groups. The corresponding mean intervals to healing for the 1-screw group was 7.71 ± 1.28 (range 6 to 10) weeks, for the 2-screw group was 7.27 ± 1.57 (range 6 to 14) weeks, and for the locking plate and interfragmental screw group was 7.01 ± 1.00 (range 6 to 9) weeks. One case of capital fragment displacement occurred in the single screw group and one in the 2-screw group. No displacement occurred in the locking plate and interfragmental screw group. Neither finding was statistically significant. However, we believe the locking plate and interfragmental screw could be a viable option in patients with osteoporotic and cystic bone changes for correction of hallux abducto valgus. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Effect of foot type on knee valgus, ground reaction force, and hip muscle activation in female soccer players.

PubMed

Rath, Meghan E; Stearne, David J; Walker, Cameron R; Cox, Jaime C

2016-05-01

The purpose of this study was to determine the degree to which subtalar joint pronation resulting from a supple planus foot affects knee alignment, hip muscle activation and ground reaction force attenuation in female athletes during a broad jump-to-cut maneuver. Twelve National Collegiate Athletic Association (NCAA) Division II female soccer players (age=19.4±1.4 years, height=1.64±0.05 m, mass=64.10±4.8 kg) were identified as having either supple planus (SP) or rigid feet (RF). Participants completed three broad jump-to-cut trials onto a force plate while EMG and motion data were collected. Muscle activation levels (percentage of maximal voluntary contraction [%MVC]) in the gluteus maximus, gluteus medius, biceps femoris, and rectus femoris were calculated, and peak vertical and medial shear force, rate of loading, and valgus angle were collected for each trial. Mann-Whitney U tests revealed no statistical significance between foot-type groups, however, effect size statistics revealed practical significance for between-group %MVC biceps femoris (d=1.107), %MVC gluteus maximus (d=1.069), and vertical ground reaction force (d=1.061). Athletes with a SP foot type may experience decreased hip muscle activation associated with increased vertical ground reaction force during a broad jump-to-cut maneuver. This might result in reduced dynamic stability and neuromuscular control during deceleration, potentially increasing the risk of non-contact ACL injury in female soccer players.

Optimizing intramedullary entry location on the proximal humerus based on variations of neck-shaft angle.

PubMed

Jeong, Jinyoung; Jung, Hyun-Woo

2015-09-01

The purpose of this study was to define the relationship between the humeral neck-shaft angle (NSA) and variations in the ideal entry portal aligned with the long axis of the intramedullary canal of the proximal humerus. Three-dimensional images of 36 cadaveric humeri with various NSAs were reconstructed by a computerized surgical simulation program. The anteroposterior, mediolateral, and linear distances between a line from the center of the proximal medullary canal to the bicipital groove were measured. Differences among humeri with various NSAs were analyzed. The intramedullary axis line was located a mean of 9 ± 2 mm posteriorly and 11 ± 3 mm medially from the bicipital groove. The axis line was 9 ± 2 mm posterior and 11 ± 2 mm medial with a standard NSA. The axis line in humeri with a varus NSA was 8 ± 2 mm posteriorly and 9 ± 2 mm medially, whereas the axis line was 10 ± 3 mm posteriorly and 14 ± 3 mm medially with a valgus NSA. The differences in the mediolateral distances between the groups were significant (P < .00009). Care should be taken in choosing the entry portal position in humeri with various NSAs as the entry portal position differs according to the NSA. It is recommended that the location of the entry portal be moved toward the center of the humeral head to align with the centerline of the intramedullary canal in humeri with a valgus NSA in particular. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Bilateral carpal valgus deformity in hand-reared cheetah cubs (Acinonyx jubatus).

PubMed

Bell, Katherine M; van Zyl, Malan; Ugarte, Claudia E; Hartman, Angela

2011-01-01

Four hand-reared cheetah cubs (Acinonyx jubatus) exhibited progressively severe bilateral valgus deformity of the carpi (CV) during the weaning period. Radiographs of the thoracic limbs suggested normal bone ossification, and serum chemistry was unremarkable. All affected cubs developed CV shortly after the onset of gastroenteritis, which was treated medically, and included use of a prescription diet. A sudden decrease in growth rate was associated with gastrointestinal disease. Before gastroenteritis and CV, affected cubs had higher growth rates than unaffected cubs, despite similar mean daily energy intake. Return to normal thoracic limb conformation was consequent to dietary manipulation (including a reduction in energy intake and vitamin and mineral supplementation), as well as decreased growth rates and recovery from gastroenteritis. The cause of the CV is likely to have been multi-factorial with potentially complex physiological interactions involved. © 2010 Wiley-Liss, Inc.

The superficial medial collateral ligament is the primary medial restraint to knee laxity after cruciate-retaining or posterior-stabilised total knee arthroplasty: effects of implant type and partial release.

PubMed

Athwal, Kiron K; Daou, Hadi El; Kittl, Christoph; Davies, Andrew J; Deehan, David J; Amis, Andrew A

2016-08-01

The aim of this study was to quantify the contributions of medial soft tissues to stability following cruciate-retaining (CR) or posterior-stabilised (PS) total knee arthroplasty (TKA). Using a robotic system, eight cadaveric knees were subjected to ±90-N anterior-posterior force, ±5-Nm internal-external and ±8-Nm varus-valgus torques at various flexion angles. The knees were tested intact and then with CR and PS implants, and successive cuts of the deep and superficial medial collateral ligaments (dMCL, sMCL) and posteromedial capsule (PMC) quantified the percentage contributions of each structure to restraining the applied loads. In implanted knees, the sMCL restrained valgus rotation (62 % across flexion angles), anterior-posterior drawer (24 and 10 %, respectively) and internal-external rotation (22 and 37 %). Changing from CR TKA to PS TKA increased the load on the sMCL when resisting valgus loads. The dMCL restrained 11 % of external and 13 % of valgus rotations, and the PMC was significant at low flexion angles. This work has shown that medial release in the varus knee should be minimised, as it may inadvertently result in a combined laxity pattern. There is increasing interest in preserving constitutional varus in TKA, and this work argues for preservation of the sMCL to afford the surgeon consistent restraint and maintain a balanced knee for the patient.

Assessment of medial elbow laxity by gravity stress radiography: comparison of valgus stress radiography with gravity and a Telos stress device.

PubMed

Harada, Mikio; Takahara, Masatoshi; Maruyama, Masahiro; Nemoto, Tadanobu; Koseki, Kazuhiko; Kato, Yoshihiro

2014-04-01

Valgus instability was reported to be higher with the elbow in 60° of flexion, rather than in 30° of flexion, although there are no studies using valgus stress radiography by gravity (gravity radiography) with the elbow in 60° of flexion. Fifty-seven patients with medial elbow pain participated. For both elbows, valgus stress radiography by use of a Telos device (Telos radiography) and gravity radiography, with the elbow in 60° of flexion, were performed for the assessment of medial elbow laxity. In both radiographs, the medial elbow joint space (MJS) on the affected side was compared with that on the opposite side, and the increase in the MJS on the affected side was assessed. For the Telos radiographs, the mean MJS was 4.7 mm on the affected side and 4.0 mm on the opposite side, with the mean increase in the MJS on the affected side being 0.7 mm. For the gravity radiographs, the mean MJS was 5.0 mm on the affected side and 4.2 mm on the opposite side, with the mean increase in the MJS on the affected side being 0.8 mm. There were significant correlations between the Telos and gravity radiographs in the MJS on the affected side, the MJS on the opposite side, and the increase in the MJS on the affected side (respectively, P < .0001). There was also a high level of intraobserver and interobserver reliability for the assessment of the gravity radiographs. Gravity radiography is useful for assessment of medial elbow laxity, similar to Telos radiography. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Foot Morphological Difference between Habitually Shod and Unshod Runners.

PubMed

Shu, Yang; Mei, Qichang; Fernandez, Justin; Li, Zhiyong; Feng, Neng; Gu, Yaodong

2015-01-01

Foot morphology and function has received increasing attention from both biomechanics researchers and footwear manufacturers. In this study, 168 habitually unshod runners (90 males whose age, weight & height were 23±2.4 years, 66±7.1 kg & 1.68±0.13 m and 78 females whose age, weight & height were 22±1.8 years, 55±4.7 kg & 1.6±0.11 m) (Indians) and 196 shod runners (130 males whose age, weight & height were 24±2.6 years, 66±8.2 kg & 1.72±0.18 m and 66 females whose age, weight & height were 23±1.5 years, 54±5.6 kg & 1.62±0.15 m) (Chinese) participated in a foot scanning test using the easy-foot-scan (a three-dimensional foot scanning system) to obtain 3D foot surface data and 2D footprint imaging. Foot length, foot width, hallux angle and minimal distance from hallux to second toe were calculated to analyze foot morphological differences. This study found that significant differences exist between groups (shod Chinese and unshod Indians) for foot length (female p = 0.001), width (female p = 0.001), hallux angle (male and female p = 0.001) and the minimal distance (male and female p = 0.001) from hallux to second toe. This study suggests that significant differences in morphology between different ethnicities could be considered for future investigation of locomotion biomechanics characteristics between ethnicities and inform last shape and design so as to reduce injury risks and poor performance from mal-fit shoes.

Immediate effect of valgus bracing on knee joint moments in meniscectomised patients: An exploratory study.

PubMed

Thorning, Maria; Thorlund, Jonas B; Roos, Ewa M; Wrigley, Tim V; Hall, Michelle

2016-12-01

Patients undergoing medial arthroscopic partial meniscectomy are at increased risk of developing and/or progressing knee osteoarthritis, with increased medial compartment load being a potential contributor. The aim of this study was to evaluate the immediate effect of a valgus unloader knee brace on knee joint moments in patients following medial arthroscopic partial meniscectomy. Within-participant design. Twenty-two patients (age 35-55 years) who had undergone medial arthroscopic partial meniscectomy within the previous 8-15 months completed three-dimensional analysis of gait, forward lunge and one-leg rise during two conditions: with and without a valgus unloader knee brace. Outcome measures included the peak and impulse of the knee adduction moment and the peak knee flexion moment. The peak knee flexion moment increased during brace condition for forward lunge (mean difference [95% CI]) 0.54 [0.27-0.82] (Nm/(BW×HT)%), p<0.001 and one-leg rise (mean difference 0.45 [95% CI 0.08-0.82] (Nm/(BW×HT)%), p=0.022). No other significant differences were found between conditions in any of the included tasks. A significant effect of the knee brace was detected in terms of an increase in peak knee flexion moment during the more demanding tasks such as forward lunge and one-leg rise. This increase implies enhanced stability of the knee provided by the brace, which may induce increased knee function and knee-related confidence during strenuous tasks. Future research is required to explore the structural implications. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

The effect of conformation on orthopaedic health and performance in a cohort of National Hunt racehorses: preliminary results.

PubMed

Weller, R; Pfau, T; Verheyen, K; May, S A; Wilson, A M

2006-11-01

There is a lack of scientific data and studies on the effect of conformation on performance or on orthopaedic health. To investigate the relationship between conformation, injury and performance in racehorses used for racing over fences. Over 2 years, 108 National Hunt racehorses were followed and their medical and performance data recorded. Conformation was measured in 3D with a computerised motion analysis system. Linear multiple regression models were used to evaluate the effect of conformation on measures of race performance and stepwise forward logistic regression models to assess the effect on risk of injury. An increase in intermandibular width, flexor angle of the shoulder joint and coxal angle (the angle between the ilium and ischium) was demonstrated to have a positive effect on performance. Performance decreased with increasing girth, length of the hind digit and valgus conformation of the metacarpophalangeal joint. The risk of suffering from superficial digital flexor tendon injury increased with increasing metacarpophalangeal joint angle and with carpus valgus conformation. The risk of pelvic fracture increased with valgus conformation of the tarsus and decreased with an increasing coxal angle. Valgus deformation was demonstrated to be detrimental to performance or increased risk of injury, perhaps resulting in higher loads on musculoskeletal structures. The coxal angle was the only parameter to have an effect on both risk of injury and performance. An alignment of the muscles with the axis of the pelvis may be beneficial for force transmission and decrease the bending moment of the muscles on the bones. The statistical power of this study is limited, however it provides preliminary data necessary for the planning of a larger scale study on the effect of conformation on performance and risk of injury. Studies of the effects of conformation on performance and risk of injury may aid in identifying individuals likely to perform well on the racecourse and

Combined Effects of Fatigue and Surface Instability on Jump Biomechanics in Elite Athletes.

PubMed

Prieske, Olaf; Demps, Marie; Lesinski, Melanie; Granacher, Urs

2017-09-01

The present study aimed to examine the effects of fatigue and surface instability on kinetic and kinematic jump performance measures. Ten female and 10 male elite volleyball players (18±2 years) performed repetitive vertical double-leg box jumps until failure. Pre and post fatigue, jump height/performance index, ground reaction force and knee flexion/valgus angles were assessed during drop and countermovement jumps on stable and unstable surfaces. Fatigue, surface condition, and sex resulted in significantly lower drop jump performance and ground reaction force (p≤0.031, 1.1≤d≤3.5). Additionally, drop jump knee flexion angles were significantly lower following fatigue (p=0.006, d=1.5). A significant fatigue×surface×sex interaction (p=0.020, d=1.2) revealed fatigue-related decrements in drop jump peak knee flexion angles under unstable conditions and in men only. Knee valgus angles were higher on unstable compared to stable surfaces during drop jumps and in females compared to males during drop and countermovement jumps (p≤0.054, 1.0≤d≤1.1). Significant surface×sex interactions during countermovement jumps (p=0.002, d=1.9) indicated that knee valgus angles at onset of ground contact were significantly lower on unstable compared to stable surfaces in males but higher in females. Our findings revealed that fatigue and surface instability resulted in sex-specific knee motion strategies during jumping in elite volleyball players. © Georg Thieme Verlag KG Stuttgart · New York.

Foot Morphological Difference between Habitually Shod and Unshod Runners

PubMed Central

Shu, Yang; Mei, Qichang; Fernandez, Justin; Li, Zhiyong; Feng, Neng; Gu, Yaodong

2015-01-01

Foot morphology and function has received increasing attention from both biomechanics researchers and footwear manufacturers. In this study, 168 habitually unshod runners (90 males whose age, weight & height were 23±2.4years, 66±7.1kg & 1.68±0.13m and 78 females whose age, weight & height were 22±1.8years, 55±4.7kg & 1.6±0.11m) (Indians) and 196 shod runners (130 males whose age, weight & height were 24±2.6years, 66±8.2kg & 1.72±0.18m and 66 females whose age, weight & height were 23±1.5years, 54±5.6kg & 1.62±0.15m)(Chinese) participated in a foot scanning test using the easy-foot-scan (a three-dimensional foot scanning system) to obtain 3D foot surface data and 2D footprint imaging. Foot length, foot width, hallux angle and minimal distance from hallux to second toe were calculated to analyze foot morphological differences. This study found that significant differences exist between groups (shod Chinese and unshod Indians) for foot length (female p = 0.001), width (female p = 0.001), hallux angle (male and female p = 0.001) and the minimal distance (male and female p = 0.001) from hallux to second toe. This study suggests that significant differences in morphology between different ethnicities could be considered for future investigation of locomotion biomechanics characteristics between ethnicities and inform last shape and design so as to reduce injury risks and poor performance from mal-fit shoes. PMID:26148059

Differences in Neuromuscular Strategies Between Landing and Cutting Tasks in Female Basketball and Soccer Athletes

PubMed Central

Cowley, Hanni R; Ford, Kevin R; Myer, Gregory D; Kernozek, Thomas W; Hewett, Timothy E

2006-01-01

Context: High school female athletes are most likely to sustain a serious knee injury during soccer or basketball, 2 sports that often involve a rapid deceleration before a change of direction or while landing from a jump. Objective: To determine if female high school basketball and soccer players show neuromuscular differences during landing and cutting tasks and to examine neuromuscular differences between tasks and between dominant and nondominant sides. Design: A 3-way mixed factorial design investigating the effects of sport (basketball, soccer), task (jumping, cutting), and side (dominant, nondominant). Setting: Laboratory. Patients or Other Participants: Thirty high school female athletes who listed either basketball or soccer as their only sport of participation (basketball: n = 15, age = 15.1 ± 1.7 years, experience = 6.9 ± 2.2 years, height = 165.3 ± 7.9 cm, mass = 61.8 ± 9.3 kg; soccer: n = 15, age = 14.8 ± 0.8 years, experience = 8.8 ± 2.5 years, height = 161.8 ± 4.1 cm, mass = 54.6 ± 7.6 kg). Main Outcome Measure(s): Ground reaction forces, stance time, valgus angles, and valgus moments were assessed during (1) a drop vertical jump with an immediate maximal vertical jump and (2) an immediate side-step cut at a 45° angle. Results: Basketball athletes had greater ground reaction forces (P < .001) and decreased stance time (P < .001) during the drop vertical jump, whereas soccer players had greater ground reaction forces (P <.001) and decreased stance time (P < .001) during the cut. Subjects in both sports had greater valgus angles (initial contact and maximum, P = .02 and P = .012, respectively) during cutting than during the drop vertical jump. Greater valgus moments (P = .006) were noted on the dominant side during cutting. Conclusions: Our subjects demonstrated differences in ground reaction forces and stance times during 2 movements associated with noncontact anterior cruciate ligament injuries. Knee valgus moment and angle were

Do CAS measurements correlate with EOS 3D alignment measurements in primary TKA?

PubMed

Meijer, Marrigje F; Boerboom, Alexander L; Bulstra, Sjoerd K; Reininga, Inge H F; Stevens, Martin

2017-09-01

Objective of this study was to compare intraoperative computer-assisted surgery (CAS) alignment measurements during total knee arthroplasty (TKA) with pre- and postoperative coronal alignment measurements using EOS 3D reconstructions. In a prospective study, 56 TKAs using imageless CAS were performed and coronal alignment measurements were recorded twice: before bone cuts were made and after implantation of the prosthesis. Pre- and postoperative coronal alignment measurements were performed using EOS 3D reconstructions. Thanks to the EOS radiostereography system, measurement errors due to malpositioning and deformity during acquisition are eliminated. CAS measurements were compared with EOS 3D reconstructions. Varus/valgus angle (VV), mechanical lateral distal femoral angle (mLDFA) and mechanical medial proximal tibial angle (mMPTA) were measured. Significantly different VV angles were measured pre- and postoperatively with CAS compared to EOS. For preoperative measurements, mLDFA did not differ significantly, but a significantly larger mMPTA in valgus was measured with CAS. Results of this study indicate that differences in alignment measurements between CAS measurements and pre- and postoperative EOS 3D are due mainly to the difference between weight-bearing and non-weight-bearing position and potential errors in validity and reliability of the CAS system. EOS 3D measurements overestimate VV angle in lower limbs with substantial mechanical axis deviation. For lower limbs with minor mechanical axis deviation as well as for mMPTA measurements, CAS measures more valgus than EOS. Eventually the results of this study are of clinical relevance, since it raises concerns regarding the validity and reliability of CAS systems in TKA. IIb.

Knee Control and Jump-Landing Technique in Young Basketball and Floorball Players.

PubMed

Leppänen, M; Pasanen, K; Kulmala, J-P; Kujala, U M; Krosshaug, T; Kannus, P; Perttunen, J; Vasankari, T; Parkkari, J

2016-04-01

Poor knee alignment is associated with increased loading of the joints, ligaments and tendons, and may increase the risk of injury. The study purpose was to compare differences in knee kinematics between basketball and floorball players during a vertical drop jump (VDJ) task. We wanted to investigate whether basketball players, whose sport includes frequent jump-landings, exhibited better knee control compared with floorball players, whose sport involves less jumping. Complete data was obtained from 173 basketball and 141 floorball players. Peak knee valgus and flexion angles during the VDJ were analyzed by 3D motion analysis.Larger knee valgus angles were observed among basketball players (- 3.2°, 95%CI -4.5 to - 2.0) compared with floorball players (- 0.9°, 95%CI -2.3 to 0.6) (P=0.022). Basketball players landed with a decreased peak knee flexion angle (83.1°, 95%CI 81.4 to 84.8) compared with floorball players (86.5°, 95%CI 84.6 to 88.4) (P=0.016). There were no significant differences in height, weight or BMI between basketball and floorball players. Female athletes exhibited significantly greater valgus angles than males. This study revealed that proper knee control during jump-landing does not seem to develop in young athletes simply by playing the sport, despite the fact that jump-landings occur frequently in practice and games. © Georg Thieme Verlag KG Stuttgart · New York.

Prospective comparative study of two methods for fixation after distal femur corrective osteotomy for valgus deformity; retrograde intramedullary nailing versus less invasive stabilization system plating.

PubMed

Özcan, Çağrı; Sökücü, Sami; Beng, Kubilay; Çetinkaya, Engin; Demir, Bilal; Kabukçuoğlu, Yavuz Selim

2016-10-01

The aim of this study was to compare the radiological and functional results of two different methods of fixation for the correction of femoral valgus deformities. Patients who had undergone osteotomy and correction of a valgus deformity from 2007 to 2013 were prospectively followed. Thirty three patients (20 females, 13 males) with 39 lower limbs were included in the study. Seventeen lower limbs were treated with retrograde intramedullary nailing (IMN) and 22 with less invasive stabilization system plating. Standing orthoroentgenograms of the lower limbs were taken pre-operatively and at the final follow-up. mLDFA, aLDFA, mechanical axis deviation (MAD) were measured in this orthoroentgenograms. Knee osteoarthritis outcome score (KOOS) and knee range of motion were used pre-operatively and at the final follow-up as part of the evaluation of the clinical results. All patients duration of surgery, length of hospital stay were assessed. Operations were performed by two orthopedic surgeons. The choice of correction method for each patient was determined by the surgeon. Pre-operative and post-operative values were simultaneously measured by two additional orthopedic surgeons. The mean age of the patients was 26.2 years (18.0-51.0) in the plating group and 29.3 years (18.0-55.0) in the nailing group. Patients in the plating and nailing groups were followed up for 24.0 (12.0-60.0) and 27.8 (12.0-60.0) months. All patients were followed for a minimum of 12 months. No significant differences were observed between the groups in terms of age, sex, or duration of follow-up (p > 0.05) Comparison of the pre- and post-operative mLDFA, aLDFA, MAD, length of hospital stay, and duration of surgery between the plating group and nailing group, no significant difference was observed between the groups (p > 0.05). However, patients treated with retrograde IMN had significantly better post-operative results in terms of the KOOS and range of motion of the knee according to

Landing Biomechanics in Participants With Different Static Lower Extremity Alignment Profiles

PubMed Central

Nguyen, Anh-Dung; Shultz, Sandra J.; Schmitz, Randy J.

2015-01-01

Context: Whereas static lower extremity alignment (LEA) has been identified as a risk factor for anterior cruciate ligament injury, little is known about its influence on joint motion and moments commonly associated with anterior cruciate ligament injury. Objective: To cluster participants according to combinations of LEA variables and compare these clusters in hip- and knee-joint kinematics and kinetics during the landing phase of a drop-jump task. Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: A total of 141 participants (50 men: age = 22.2 ± 2.8 years, height = 177.9 ± 9.3 cm, weight = 80.9 ± 13.3 kg; 91 women: age = 21.2 ± 2.6 years, height = 163.9 ± 6.6 cm, weight = 61.1 ± 8.7 kg). Main Outcome Measure(s): Static LEA included pelvic angle, femoral anteversion, quadriceps angle, tibiofemoral angle, genu recurvatum, tibial torsion, and navicular drop. Cluster analysis grouped participants according to their static LEA profiles, and these groups were compared on their hip- and knee-joint kinematics and external moments during the landing phase of a double-legged drop jump. Results: Three distinct clusters (C1–C3) were identified based on their static LEAs. Participants in clusters characterized with static internally rotated hip and valgus knee posture (C1) and externally rotated knee and valgus knee posture (C3) alignments demonstrated greater knee-valgus motion and smaller hip-flexion moments than the cluster with more neutral static alignment (C2). Participants in C1 also experienced greater hip internal-rotation and knee external-rotation moments than those in C2 and C3. Conclusions: Static LEA clusters that are positioned anatomically with a more rotated and valgus knee posture experienced greater dynamic valgus along with hip and knee moments during landing. Whereas static LEA contributes to differences in hip and knee rotational moments, sex may influence the differences in frontal-plane knee

Do hip muscle weakness and dynamic knee valgus matter for the clinical evaluation and decision-making process in patients with patellofemoral pain?

PubMed

Rabelo, Nayra Deise Dos Anjos; Lucareli, Paulo Roberto Garcia

Patellofemoral pain is a very common musculoskeletal condition. In the last years, evidence regarding this disease increased exponentially. Although widely investigated, this problem still frustrates patients and clinicians for having an unfavorable prognosis. Some gaps still exist in the understanding and managing of patellofemoral pain. Numerous cross-sectional association studies show an association between gluteus muscular strength and dynamic knee valgus in patients with patellofemoral pain. In spite of this biological plausibility, many evidences challenge the direct relationship between these factors. Recent studies have concluded that women with patellofemoral pain show muscular weakness of the hip based on the cross-sectional studies, however prospective studies indicate that hip weakness cannot be considered a risk for development of patellofemoral pain. In addition, some clinical trials have demonstrated that strength training of the gluteal muscles promotes significant improvement in symptoms but not alter the kinematics of the patients with patellofemoral pain. These findings cast doubt on whether the cause of this condition is really being treated, whether all individuals suffering from patellofemoral pain present dynamic knee valgus or if this is a disturbance present in only a subgroup of patients and whether the strengthening of the hip musculature is an option to consider for prevention of patellofemoral pain. Certainly, more studies should be conducted to clarify the influence of mechanical patterns on this condition, but with the existing evidence so far, the importance given to these issues in the evaluation and clinical decision on treatment of these patients seems questionable. Therefore, this masterclass explores the understanding about patellofemoral pain, highlighting mainly the importance of muscular strength and dynamic knee valgus, as well as other possible factors that must be consider during the evaluation and the decision making in

Surgical correction of bilateral metacarpophalangeal valgus with curved osteotomies and type II external skeletal fixation in a seven-month-old alpaca.

PubMed

Schoonover, Mike J; Whitfield, Chase T; Rochat, Mark C; Streeter, Robert N; Sippel, Kate

2016-09-20

To report the successful surgical correction of severe bilateral metacarpophalangeal valgus angular limb deformities in a seven-month-old intact male alpaca cria using curved osteotomies stabilized with type II external skeletal fixation. Using a 21 mm crescentic shaped oscillating saw blade, bilateral osteotomies were performed in the distal metaphyses of the fused third and fourth metacarpal bones to correct valgus angular limb deformity of the metacarpophalangeal joints. Axial alignment of each limb was achieved by medially rotating the distal metacarpus in the frontal plane along the curved osteotomies. The osteotomies were stabilized using type II external skeletal fixators. The alpaca was immediately weight-bearing following the surgical procedure and no to minimal lameness was observed during healing of the osteotomies. Evaluation at five and 10 months following the surgery demonstrated acceptable axial alignment in the left forelimb while moderate to severe varus deformity (overcorrection) was observed in the right. Curved osteotomy of the distal metacarpus stabilized with type II external skeletal fixation can provide a favourable outcome in older alpaca crias affected with metacarpophalangeal angular limb deformities. Placement of the distal transfixation pins relative to the metacarpal physes should be carefully evaluated as overcorrection is possible, especially if growthpotential remains in only one physis of the fused third and fourth metacarpal bones.

Axial loading screw fixation for chevron type osteotomies of the distal first metatarsal: a retrospective outcomes analysis.

PubMed

Murphy, Ryan M; Fallat, Lawrence M; Kish, John P

2014-01-01

The distal chevron osteotomy is a widely accepted technique for the treatment of hallux abductovalgus deformity. Although the osteotomy is considered to be stable, displacements of the capital fragment has been described. We propose a new method for fixation of the osteotomy involving the axial loading screw (ALS) used in addition to single screw fixation. We believe this method will provide a more mechanically stable construct. We reviewed the charts of 46 patients in whom 52 feet underwent a distal chevron osteotomy that was fixated with either 1 screw or 2 screws that included the ALS. We hypothesized that the ALS group would have fewer displacements and would heal more quickly than the single screw fixation group. We found that the group with ALS fixation had healed at a mean of 6.5 weeks and that the group with single screw fixation had healed at 9.53 weeks (p = .001). Also, 8 cases occurred of displacement of the capital fragment in the single screw, control group compared with 2 cases of displacement in the ALS group. However, this finding was not statistically significant. The addition of the ALS to single screw fixation allowed the patients to heal approximately 3 weeks earlier than single screw fixation alone. The ALS is a fixation option for the surgeon to consider when osseous correction of hallux abducto valgus is performed. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Foot care for the aging.

PubMed

Edelstein, J E

1988-12-01

Age-related changes in the feet include alterations in the skin, which becomes dry, inelastic, and cool and often exhibits hyperkeratoses. Thickened and brittle toenails complicate pedicure. The contour of the foot widens with age and may have increased forefoot height in the presence of toe deformities. Sensory acuity diminishes, as does joint mobility, muscle-force production, and ability to withstand stress. The elderly person's gait is slower and less forceful, with shorter strides. Visual loss affects footwear donning and toenail trimming. Older individuals on a limited income are less likely to have appropriate shoes and hose. Preventive care begins with good hygiene and continues with selection of suitable hosiery and shoes. Conservative management of the podiatric conditions most often seen in geriatric patients (eg, metatarsalgia and hallux valgus) should be based on relating the pathomechanics of the disorder to the options available in shoe selection, modification, and insert design.

Ophthalmologic Findings in H Syndrome: A Unique Diagnostic Clue.

PubMed

Molho-Pessach, Vered; Mechoulam, Hadas; Siam, Rula; Babay, Sofia; Ramot, Yuval; Zlotogorski, Abraham

2015-01-01

H syndrome is an autosomal recessive histiocytosis with multisystemic involvement caused by mutations in the SLC29A3 gene. The term H syndrome was coined to denote the major clinical findings which include hyperpigmentation, hypertrichosis, hearing loss, hepatosplenomegaly, hypogonadism, hyperglycemia/diabetes mellitus and hallux valgus/flexion contractures. Almost 100 individuals affected with this disorder have been reported, however, a thorough evaluation of the ophthalmologic features of H syndrome has not yet been performed. Ophthalmic examination of a 50-year-old male with H syndrome. Mutation analysis of SLC29A3 was also performed in this patient. Ophthalmic findings included; shallow orbits with exorbitism, bilateral pterygium, limbal thickening, corneal arcus and cortical cataract. We also review ophthalmologic findings in previously reported H syndrome patients. The presence of dilated lateral scleral vessels, corneal arcus and shallow orbits should raise the suspicion of H syndrome, especially when seen in young age.

Effect of distal ulnar collateral ligament tear pattern on contact forces and valgus stability in the posteromedial compartment of the elbow.

PubMed

Hassan, Sheref E; Parks, Brent G; Douoguih, Wiemi A; Osbahr, Daryl C

2015-02-01

It is not known whether the pattern of ulnar collateral ligament (UCL) tear affects elbow biomechanics. There will be a significant change in elbow biomechanics with 50% proximal but not 50% distal simulated rupture of the UCL. Controlled laboratory study. Pressure sensors in the posteromedial elbow joint of 25 male cadaveric elbows (average age, 54.9 years; range, 26-66 years) were used to measure contact area, pressure, and valgus torque at 90° and 30° of elbow flexion. Thirteen specimens were tested with the UCL intact, then with proximal-to-distal detachment of 50%, and then with proximal-to-distal detachment of 100% of the anterior band of the UCL from the ulnar attachment. This method was repeated in the remaining 12 specimens in a distal-to-proximal direction. With 50% proximal-to-distal detachment, contact area decreased significantly versus intact at 90° (91.3 ± 23.6 vs 112.2 ± 26.0 mm(2); P < .001) and 30° (69.3 ± 14.8 vs 83.1 ± 21.6 mm(2); P < .001) of elbow flexion; the center of pressure (COP) moved significantly proximally versus intact at 90° (3.8 ± 2.5 vs 5.4 ± 2.3 mm; P < .001) and 30° (5.9 ± 2.8 vs 7.4±1.9 mm; P < .001). With 50% distal-to-proximal UCL detachment versus intact, no significant change was observed in contact area, movement of the COP, or valgus laxity at either flexion position. With 100% proximal-to-distal and distal-to-proximal detachment, significant change in contact area, movement of the COP, and valgus laxity versus intact was found at 90° and 30° of elbow flexion (P < .05). No significant difference in contact pressure was observed in any test conditions. Significant change in contact area and proximal movement of the COP with 50% proximal UCL detachment and the lack of significant change with 50% distal UCL detachment suggest that the proximal half of the UCL ulnar footprint has a primary role in maintaining posteromedial elbow biomechanics. The findings suggest that surgical reconstruction should aim to

Postoperative limb alignment and its determinants after minimally invasive Oxford medial unicompartmental knee arthroplasty.

PubMed

Mullaji, Arun B; Shetty, Gautam M; Kanna, Raj

2011-09-01

One hundred twenty-two consecutive minimally invasive Oxford phase 3 medial unicompartmental knee arthroplasties in 109 patients were evaluated for postoperative limb alignment and the influence of factors such as preoperative limb alignment, age, body mass index, sex, insert thickness, and surgeon's experience. The mean mechanical preoperative hip-knee-ankle (HKA) angle of 172.2° ± 3.1° improved to 177.1° ± 2.9° postoperatively. In 75% of the limbs, the HKA angle was restored to within an acceptable alignment of 177° ± 3°, 14% of the limbs were in excessive varus (<174°), and 11% were in valgus (>180°). Only preoperative HKA angle was predictive of postoperative HKA angle. Although most of the limbs had acceptable limb alignment after unicompartmental knee arthroplasty, limbs with more severe preoperative varus deformity had a tendency to remain in excessive varus, and limbs with lesser preoperative varus deformity had a greater tendency to go into valgus postoperatively. Copyright © 2011 Elsevier Inc. All rights reserved.

A study of anatomy of distal femur pertaining to total knee replacement: an analysis, conclusions and recommendations.

PubMed

Kumar, K; Sharma, D

2018-04-01

Multiple landmarks including the transepicondylar axis (TEA), posterior condylar axis (PCA) and anterior trochlear line (TL) have been used to set up the femoral component rotation, but each is faced with its own practical obstacle that limits its usage. Also a common practice is to set the femoral component rotation at 3° external rotation to PCA and valgus resection angle at 5°-7° to anatomical axis of femur. For the reason that the anatomy of each knee is different, it may not be justified to practice such a set protocol in all cases. The aim of the study was to compare the anatomical landmarks used to set up the femoral component rotation and to study the variability in the different anatomical relationships relevant to total knee replacement. The study had 52 patients (94 knees) with grade IV osteoarthritis. Full-length lower limb scanogram and 1 mm cross-sectional cuts of distal femur were taken. aTEA, sTEA, PCL, TL, CTA, PCA, TLA and valgus angles were taken for all knees. aTEA is identifiable in all cases but sTEA in only 59 knees (62.77%). Correspondingly, CTA is calculable in all knees and PCA in 62.77% cases. Mean CTA and mean PCA were 5.4° ± 1.88° SD and 0.71° ± 1.95° SD, respectively. Mean angle between aTEA and sTEA was 4.88. TL is a line difficult to draw because of high incidence of anterior osteophytes, making CTA a more reliable parameter than TLA. Mean TLA was 10.31° ± 3.52° SD. Mean valgus resection angle was 4.86° ± 2.53° SD. Gender- or side-based differences in any of these values were not statistically different. Using aTEA or sTEA can make a big difference in femoral component rotation; therefore, whether aTEA or sTEA should be used needs to be further investigated. CTA, PCA and valgus resection angle need to be individually calculated for each knee. Use of TLA is not recommended.

Three-dimensional quantitative analysis of healthy foot shape: a proof of concept study.

PubMed

Stanković, Kristina; Booth, Brian G; Danckaers, Femke; Burg, Fien; Vermaelen, Philippe; Duerinck, Saartje; Sijbers, Jan; Huysmans, Toon

2018-01-01

Foot morphology has received increasing attention from both biomechanics researches and footwear manufacturers. Usually, the morphology of the foot is quantified by 2D footprints. However, footprint quantification ignores the foot's vertical dimension and hence, does not allow accurate quantification of complex 3D foot shape. The shape variation of healthy 3D feet in a population of 31 adult women and 31 adult men who live in Belgium was studied using geometric morphometric methods. The effect of different factors such as sex, age, shoe size, frequency of sport activity, Body Mass Index (BMI), foot asymmetry, and foot loading on foot shape was investigated. Correlation between these factors and foot shape was examined using multivariate linear regression. The complex nature of a foot's 3D shape leads to high variability in healthy populations. After normalizing for scale, the major axes of variation in foot morphology are (in order of decreasing variance): arch height, combined ball width and inter-toe distance, global foot width, hallux bone orientation (valgus-varus), foot type (e.g. Egyptian, Greek), and midfoot width. These first six modes of variation capture 92.59% of the total shape variation. Higher BMI results in increased ankle width, Achilles tendon width, heel width and a thicker forefoot along the dorsoplantar axis. Age was found to be associated with heel width, Achilles tendon width, toe height and hallux orientation. A bigger shoe size was found to be associated with a narrow Achilles tendon, a hallux varus, a narrow heel, heel expansion along the posterior direction, and a lower arch compared to smaller shoe size. Sex was found to be associated with differences in ankle width, Achilles tendon width, and heel width. Frequency of sport activity was associated with Achilles tendon width and toe height. A detailed analysis of the 3D foot shape, allowed by geometric morphometrics, provides insights in foot variations in three dimensions that can not be

A comparison of the readability of two patient-reported outcome measures used to evaluate foot surgery.

PubMed

Alvey, James; Palmer, Simon; Otter, Simon

2012-01-01

Measuring the outcome of surgical intervention is an integral part of modern-day healthcare provision. The increasing requirement to monitor patient-reported outcomes highlights the need for patients to be able to read and understand health outcomes questionnaires. The present study compared the readability of 2 commonly used, validated, foot surgery outcome questionnaires (the Foot Health Status Questionnaire and the Manchester-Oxford Foot Questionnaire) using the Flesch Reading Ease score and the Flesch-Kincaid grade level score. The Manchester-Oxford Foot Questionnaire had a significantly greater (p < .003) score for reading ease and a significantly lower reading grade score (p < .005) than the Foot Health Status Questionnaire. These findings suggest the Manchester-Oxford Foot Questionnaire is a more suitable instrument in terms of readability and comprehension for a greater proportion of the population undergoing hallux valgus surgery. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Surgical treatment of subacute and chronic valgus instability in multiligament-injured knees with superficial medial collateral ligament reconstruction using Achilles allografts: a quantitative analysis with a minimum 2-year follow-up.

PubMed

Liu, Xin; Feng, Hua; Zhang, Hui; Hong, Lei; Wang, Xue Song; Zhang, Jin; Shen, Jie Wei

2013-05-01

Symptomatic medial collateral ligament (MCL) instability is rare, and it is frequently associated with multiligament injuries. Most clinical investigations have failed to clearly define the specific objective outcome measures assessing the stability of the MCL quantitatively before and after the reconstruction procedure. To quantitatively evaluate the early clinical outcomes of patients with valgus instability of knee joints who had undergone superficial MCL reconstruction using Achilles tendon allografts. Case series; Level of evidence, 4. From August 2005 to December 2010, 19 consecutive patients with MCL injuries were included in this study. The inclusion criteria were (1) a subacute or chronic MCL injury, with a time from initial injury to surgery of longer than 3 weeks, and (2) valgus laxity graded C or D according to the International Knee Documentation Committee (IKDC). All patients underwent superficial MCL reconstruction using Achilles tendon allografts. To evaluate the laxity of the MCL preoperatively and postoperatively, valgus stress radiographs using a Telos device were used. Other assessments included the IKDC subjective functional evaluation and Lysholm score estimation. Sixteen of the 19 patients (12 men and 4 women) were available for final follow-up. The median age of the patients was 37 years (range, 19-53 years); mean body mass index (BMI) was 26.4 (range, 21.7-29.4). The mean time from injury to surgery was 15.9 months (range, 24 days to 84 months), and median follow-up period was 34 months (range, 24-67 months). The mean medial knee laxity (side-to-side difference) was 8.9 ± 3.2 mm (range, 6-15.9 mm) preoperatively and 1.1 ± 0.9 mm (range, -1.1 to 3.2 mm) postoperatively (P < .001). The preoperative mean IKDC subjective knee functional score was 49.8 ± 6.9 (range, 31-57.5), while the postoperative functional score was 84.3 ± 6.0 (range, 71.3-93.1) (P < .001). The mean Lysholm score was 69.3 ± 5.9 (range, 55-78) preoperatively and 88.6 �

Equilibrium contact angle or the most-stable contact angle?

PubMed

Montes Ruiz-Cabello, F J; Rodríguez-Valverde, M A; Cabrerizo-Vílchez, M A

2014-04-01

It is well-established that the equilibrium contact angle in a thermodynamic framework is an "unattainable" contact angle. Instead, the most-stable contact angle obtained from mechanical stimuli of the system is indeed experimentally accessible. Monitoring the susceptibility of a sessile drop to a mechanical stimulus enables to identify the most stable drop configuration within the practical range of contact angle hysteresis. Two different stimuli may be used with sessile drops: mechanical vibration and tilting. The most stable drop against vibration should reveal the changeless contact angle but against the gravity force, it should reveal the highest resistance to slide down. After the corresponding mechanical stimulus, once the excited drop configuration is examined, the focus will be on the contact angle of the initial drop configuration. This methodology needs to map significantly the static drop configurations with different stable contact angles. The most-stable contact angle, together with the advancing and receding contact angles, completes the description of physically realizable configurations of a solid-liquid system. Since the most-stable contact angle is energetically significant, it may be used in the Wenzel, Cassie or Cassie-Baxter equations accordingly or for the surface energy evaluation. © 2013 Elsevier B.V. All rights reserved.

Longitudinal changes of angle configuration in primary angle-closure suspects: the Zhongshan Angle-Closure Prevention Trial.

PubMed

Jiang, Yuzhen; Chang, Dolly S; Zhu, Haogang; Khawaja, Anthony P; Aung, Tin; Huang, Shengsong; Chen, Qianyun; Munoz, Beatriz; Grossi, Carlota M; He, Mingguang; Friedman, David S; Foster, Paul J

2014-09-01

To determine longitudinal changes in angle configuration in the eyes of primary angle-closure suspects (PACS) treated by laser peripheral iridotomy (LPI) and in untreated fellow eyes. Longitudinal cohort study. Primary angle-closure suspects aged 50 to 70 years were enrolled in a randomized, controlled clinical trial. Each participant was treated by LPI in 1 randomly selected eye, with the fellow eye serving as a control. Angle width was assessed in a masked fashion using gonioscopy and anterior segment optical coherence tomography (AS-OCT) before and at 2 weeks, 6 months, and 18 months after LPI. Angle width in degrees was calculated from Shaffer grades assessed under static gonioscopy. Angle configuration was also evaluated using angle opening distance (AOD250, AOD500, AOD750), trabecular-iris space area (TISA500, TISA750), and angle recess area (ARA) measured in AS-OCT images. No significant difference was found in baseline measures of angle configuration between treated and untreated eyes. At 2 weeks after LPI, the drainage angle on gonioscopy widened from a mean of 13.5° at baseline to a mean of 25.7° in treated eyes, which was also confirmed by significant increases in all AS-OCT angle width measures (P<0.001 for all variables). Between 2 weeks and 18 months after LPI, a significant decrease in angle width was observed over time in treated eyes (P<0.001 for all variables), although the change over the first 5.5 months was not statistically significant for angle width measured under gonioscopy (P = 0.18), AOD250 (P = 0.167) and ARA (P = 0.83). In untreated eyes, angle width consistently decreased across all follow-up visits after LPI, with a more rapid longitudinal decrease compared with treated eyes (P values for all variables ≤0.003). The annual rate of change in angle width was equivalent to 1.2°/year (95% confidence interval [CI], 0.8-1.6) in treated eyes and 1.6°/year (95% CI, 1.3-2.0) in untreated eyes (P<0.001). Angle width of treated eyes

Patellofemoral pain in athletes

PubMed Central

Petersen, Wolf; Rembitzki, Ingo; Liebau, Christian

2017-01-01

Patellofemoral pain (PFP) is a frequent cause of anterior knee pain in athletes, which affects patients with and without structural patellofemoral joint (PFJ) damage. Most younger patients do not have any structural changes to the PFJ, such as an increased Q angle and a cartilage damage. This clinical entity is known as patellofemoral pain syndrome (PFPS). Older patients usually present with signs of patellofemoral osteoarthritis (PFOA). A key factor in PFPS development is dynamic valgus of the lower extremity, which leads to lateral patellar maltracking. Causes of dynamic valgus include weak hip muscles and rearfoot eversion with pes pronatus valgus. These factors can also be observed in patients with PFOA. The available evidence suggests that patients with PFP are best managed with a tailored, multimodal, nonoperative treatment program that includes short-term pain relief with nonsteroidal anti-inflammatory drugs (NSAIDs), passive correction of patellar maltracking with medially directed tape or braces, correction of the dynamic valgus with exercise programs that target the muscles of the lower extremity, hip, and trunk, and the use of foot orthoses in patients with additional foot abnormalities. PMID:28652829

Treatment of post-traumatic elbow deformities in children with the Ilizarov distraction osteogenesis technique.

PubMed

Özkan, Cenk; Deveci, Mehmet Ali; Tekin, Mustafa; Biçer, Ömer Sunkar; Gökçe, Kadir; Gülşen, Mahir

2017-01-01

The present study assessed functional and radiographic outcomes of distraction osteogenesis treatment of post-traumatic elbow deformities in children. Eight children were treated between 2008 and 2013 for post-traumatic elbow deformities using distraction osteogenesis. Mean age at time of operation was 10.9 years. Six patients had varus and 2 had valgus deformity. Magnitude of correction, fixator index, complications, carrying angle, and elbow range of motion were assessed. Functional results were graded according to protocol of Bellemore et al. Mean follow-up was 43 months. Mean preoperative varus deformity in 6 patients was 29.2° and valgus deformity in 2 patients was 28.5°. Preoperative flexion and extension of elbow were 123.8° and -10.6°, respectively. Mean carrying angle was 9° valgus at last follow-up. Mean flexion and extension were 134.4° and -6.0°, respectively. Change in carrying angle was statistically significant (p = 0.002). There were 2 grade 1 pin tract infections and 1 diaphyseal fracture of humerus. Functional outcome was rated excellent in 7 patients and good in 1 patient. Ilizarov distraction osteogenesis is a valuable alternative in treatment of elbow deformities in children. The surgical technique is simple and correction is adjustable. Gradual correction prevents possible neurovascular complications and minimally invasive surgery produces less scarring. Compliance of patient and family is key factor in the success of the outcome. Level IV, therapeutic study. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

The influence of local bone quality on fracture pattern in proximal humerus fractures.

PubMed

Mazzucchelli, Ruben A; Jenny, Katharina; Zdravkovic, Vilijam; Erhardt, Johannes B; Jost, Bernhard; Spross, Christian

2018-02-01

Bone mineral density and fracture morphology are widely discussed and relevant factors when considering the different treatment options for proximal humerus fractures. It was the aim of this study to investigate the influence of local bone quality on fracture patterns of the Neer classification as well as on fracture impaction angle in these injuries. All acute, isolated and non-pathological proximal humerus fractures admitted to our emergency department were included. The fractures were classified according to Neer and the humeral head impaction angle was measured. Local bone quality was assessed using the Deltoid Tuberosity Index (DTI). The distribution between DTI and fracture pattern was analysed. 191 proximal humerus fractures were included (61 men, mean age 59 years; 130 women, mean age 69.5). 77 fractures (40%) were classified as one-part, 72 (38%) were two-part, 24 (13%) were three- and four-part and 18 (9%) were fracture dislocations. 30 fractures (16%) were varus impacted, whereas 45 fractures (24%) were classified as valgus impacted. The mean DTI was 1.48. Valgus impaction significantly correlated with good bone quality (DTI ≥ 1.4; p = 0.047) whereas no such statistical significance was found for the Neer fracture types. We found that valgus impaction significantly depended on good bone quality. However, neither varus impaction nor any of the Neer fracture types correlated with bone quality. We conclude that the better bone quality of valgus impacted fractures may be a reason for their historically benign amenability to ORIF. On the other hand, good local bone quality does not prevent fracture comminution. Copyright © 2017 Elsevier Ltd. All rights reserved.

Ulnar collateral ligament reconstruction using bisuspensory fixation: a biomechanical comparison with the docking technique.

PubMed

Jackson, Timothy J; Adamson, Gregory J; Peterson, Alexander; Patton, John; McGarry, Michelle H; Lee, Thay Q

2013-05-01

Many ulnar collateral ligament (UCL) reconstruction techniques have been created and biomechanically tested. Single-bundle reconstructions aim to re-create the important anterior bundle of the UCL. To date, no technique has utilized suspensory fixation on the ulnar and humeral sides to create a single-bundle reconstruction. The bisuspensory technique will restore valgus laxity to its native state, with comparable load-to-failure characteristics to the docking technique. Controlled laboratory study. Six matched pairs of fresh-frozen cadaveric elbows were randomized to undergo UCL reconstruction using either the docking technique or a novel single-bundle bisuspensory technique. Valgus laxity and rotation measurements were quantified using a MicroScribe 3DLX digitizer at various flexion angles for the native ligament, transected ligament, and 1 of the 2 tested reconstructed ligaments. Laxity testing was performed from maximum extension to 120° of flexion. Each reconstruction was then tested to failure, and the method of failure was recorded. Valgus laxity was restored to the intact state at all degrees of elbow flexion for both the docking and bisuspensory techniques. In load-to-failure testing, there was no significant difference with regard to stiffness, ultimate torque, ultimate torque angle, energy absorbed, and applied moment to reach 10° of valgus. Yield torques for the bisuspensory and docking reconstructions were 18.7 ± 7.8 N·m and 18.6 ± 4.4 N·m, respectively (P = .95). The ultimate torque for the bisuspensory technique measured 26.5 ± 9.2 N·m and for the docking technique measured 25.1 ± 7.1 N·m (P = .78). The bisuspensory fixation technique, a reproducible single-bundle reconstruction, was able to restore valgus laxity to the native state, with similar load-to-failure characteristics as the docking technique. This reconstruction technique could be considered in a clinical setting as a primary method of UCL reconstruction or as a backup fixation

Landing Kinematics in Elite Male Youth Soccer Players of Different Chronologic Ages and Stages of Maturation.

PubMed

Read, Paul J; Oliver, Jon L; De Ste Croix, Mark B A; Myer, Gregory D; Lloyd, Rhodri S

2018-04-01

  Despite the high frequency of knee injuries in athletes, few researchers have studied the effects of chronologic age and stage of maturation on knee-joint kinematics in male youth soccer players.   To use a coach-friendly screening tool to examine knee-valgus scores for players of different ages and at different stages of maturation.   Cross-sectional study.   Academy soccer clubs.   A total of 400 elite male youth soccer players aged 10 to 18 years categorized by chronologic age and stage of maturation based on their years from peak height velocity (PHV).   Knee valgus was evaluated during the tuck-jump assessment via 2-dimensional analysis. Frontal-plane projection angles were subjectively classified as minor (<10°), moderate (10°-20°), or severe (>20°), and using these classifications, we scored knee valgus in the tuck jump as 0 ( no valgus), 1 ( minor), 2 ( moderate), or 3 ( severe).   A trend toward higher valgus scores was observed in the younger age groups and the pre-PHV group. The lowest frequency of no valgus occurred in the U18 and post-PHV groups. The highest percentages of severe scores were in the U13 and pre-PHV groups for the right limb. Knee-valgus scores were lower for both lower extremities in the U18 group than in all other age groups ( P < .001) except the U16 group. Scores were lower for the post-PHV than the pre-PHV group for the right limb ( P < .001) and both pre-PHV and circa-PHV groups for the left limb ( P < .001). Noteworthy interlimb asymmetries were evident in the U14, U15, and circa-PHV groups.   Reductions in knee valgus with incremental age and during the later stages of maturation indicated that this risk factor was more prevalent in younger players. Interlimb asymmetry may also emerge around the time of the peak growth spurt and early adolescence, potentially increasing the risk of traumatic injury.

Longitudinal Changes of Angle Configuration in Primary Angle-Closure Suspects

PubMed Central

Jiang, Yuzhen; Chang, Dolly S.; Zhu, Haogang; Khawaja, Anthony P.; Aung, Tin; Huang, Shengsong; Chen, Qianyun; Munoz, Beatriz; Grossi, Carlota M.

2015-01-01

Objective To determine longitudinal changes in angle configuration in the eyes of primary angle-closure suspects (PACS) treated by laser peripheral iridotomy (LPI) and in untreated fellow eyes. Design Longitudinal cohort study. Participants Primary angle-closure suspects aged 50 to 70 years were enrolled in a randomized, controlled clinical trial. Methods Each participant was treated by LPI in 1 randomly selected eye, with the fellow eye serving as a control. Angle width was assessed in a masked fashion using gonioscopy and anterior segment optical coherence tomography (AS-OCT) before and at 2 weeks, 6 months, and 18 months after LPI. Main Outcome Measures Angle width in degrees was calculated from Shaffer grades assessed under static gonioscopy. Angle configuration was also evaluated using angle opening distance (AOD250, AOD500, AOD750), trabecular-iris space area (TISA500, TISA750), and angle recess area (ARA) measured in AS-OCT images. Results No significant difference was found in baseline measures of angle configuration between treated and untreated eyes. At 2 weeks after LPI, the drainage angle on gonioscopy widened from a mean of 13.5° at baseline to a mean of 25.7° in treated eyes, which was also confirmed by significant increases in all AS-OCT angle width measures (P<0.001 for all variables). Between 2 weeks and 18 months after LPI, a significant decrease in angle width was observed over time in treated eyes (P<0.001 for all variables), although the change over the first 5.5 months was not statistically significant for angle width measured under gonioscopy (P = 0.18), AOD250 (P = 0.167) and ARA (P = 0.83). In untreated eyes, angle width consistently decreased across all follow-up visits after LPI, with a more rapid longitudinal decrease compared with treated eyes (P values for all variables ≤0.003). The annual rate of change in angle width was equivalent to 1.2°/year (95% confidence interval [CI], 0.8–1.6) in treated eyes and 1.6°/year (95% CI, 1

Assessing coronal laxity in extension and flexion at a minimum of 10 years after primary total knee arthroplasty.

PubMed

Yoshihara, Yasushi; Arai, Yuji; Nakagawa, Shuji; Inoue, Hiroaki; Ueshima, Keiichiro; Fujiwara, Hiroyoshi; Oda, Ryo; Taniguchi, Daigo; Kubo, Toshikazu

2016-08-01

Favourable long-term results after total knee arthroplasty (TKA) require appropriate soft tissue balance. However, the relationships between long-term results after TKA surgery and mediolateral laxities at extension and at 90° flexion remain unknown. This study therefore quantitatively assessed ligament balance at extension and at 90° knee flexion at least 10 years after primary TKA, as well as clarifying the relationships between long-term outcomes and mediolateral laxities. This study included 49 knees (19 CR type and 30 PS type) of 33 patients followed up for at least 10 years after TKA at our hospital. Plain radiographs were obtained with about 150 N of varus or valgus stress using a Telos arthrometer at extension. At 90° flexion, epicondylar views were obtained under a 1.5-kg load and with about 10 kg of varus or valgus stress. Lateral laxity of about 5° was observed in both extension and flexion, with total laxities of varus and valgus stress each less than 10°. Postoperative clinical outcomes were good, with significant improvements in extension angle, femorotibial angle, and KSS, and no loosening in any knee. Good long-term results of TKA can be obtained with a lateral laxity of about 5°, equivalent to that of healthy knees. III.

Measurement of varus-valgus and internal-external rotational knee laxities in vivo--Part II: relationship with anterior-posterior and general joint laxity in males and females.

PubMed

Shultz, Sandra J; Shimokochi, Yohei; Nguyen, Anh-Dung; Schmitz, Randy J; Beynnon, Bruce D; Perrin, David H

2007-08-01

We examined sex differences in general joint laxity (GJL), and anterior-posterior displacement (ANT-POST), varus-valgus rotation (VR-VL), and internal-external rotation (INT-EXT) knee laxities, and determined whether greater ANT and GJL predicted greater VR-VL and INT-EXT. Twenty subjects were measured for GJL, and scored on a scale of 0-9. ANT and POST were measured using a standard knee arthrometer at 133 N. VR-VL and INT-EXT were measured using a custom joint laxity testing device, defined as the angular displacements (deg) of the tibia relative to the femur produced by 0-10 Nm of varus-valgus torques, and 0-5 Nm of internal-external torques, respectively. INT-EXT were measured during both non-weight-bearing (NWB) and weight-bearing (WB = 40% body weight) conditions while VR-VL were measured NWB. All laxity measures were greater for females compared to males except for POST. ANT and GJL positively predicted 62.5% of the variance in VR-VL and 41.8% of the variance in WB INT-EXT. ANT was the sole predictor of INT-EXT in NWB, explaining 42.3% of the variance. These findings suggest that subjects who score higher on clinical measures of GJL and ANT are also likely to have greater VR-VL and INT-EXT knee laxities.

Discrepancy of alignment in different weight bearing conditions before and after high tibial osteotomy.

PubMed

Wang, Joon Ho; Shin, Jung Min; Kim, Hyun Ho; Kang, Seung-Hoon; Lee, Byung Hoon

2017-01-01

To evaluate the differences in the amount of varus malalignment and valgus (over) correction in relation to three different weight bearing conditions from whole leg AP radiographs (single-limb (SL) stance, double-limb (DL) stance, supine position (S)) before and after high tibial osteotomy (HTO), and to evaluate which alignment parameters affect the changes for patients in three different weight bearing conditions. A total of 40 consecutive patients (43 knees) with varus osteoarthritis underwent navigation assisted open wedge HTO. Mechanical axis angle (MA) was measured before and after surgery from hip-to-ankle radiographs taken with patients in three different weight bearing conditions. To find significant factors that affect the alignment differences, several variables including patient demographics, soft tissue laxity, pelvic obliquity, and ground mechanical axis deviation of tibia (calculated by the angle between two lines, tibial anatomical axis and weight-bearing line) were evaluated. Pre-operatively, mean MA measured on SL stance radiographs was significantly more varus than on DL stance (10.1° ± 2.4° and 8.0° ± 2.6°, respectively, p < 0.001), which was significantly more varus than on supine position (6.6° ± 2.6°, p < 0.001). Meanwhile, in patients with post-operatively valgus corrected knee, MA did not show the same pattern of change as with pre-operative varus knee. Mean MA measured on DL stance radiographs was more valgus than in supine position (-3.0 o  ± 2.4 o and -2.6 o  ± 3.1 o , p = 0.455), while mean MA on SL stance radiographs (-2.0 o  ± 2.1 o ) was significantly less valgus than on DL stance (p = 0.002). The ground mechanical axis deviation of tibia showed a significant correlation with MA difference between SL and DL stance radiographs before (β = -0.341, p = 0.045) and after surgery (β = -0.536, p = 0.001). In pre-operative varus knee, the mean MA on SL stance was changed to

Evaluation of an Innovative Fixation System for Chevron Bunionectomy.

PubMed

Bennett, Gordon L; Sabetta, James A

2016-02-01

Distal chevron metatarsal osteotomy bunionectomy is a commonly performed procedure for the treatment of mild to moderate hallux valgus deformity. There are several different methods to stabilize this osteotomy. We evaluated a new intramedullary plate system. We prospectively evaluated 57 consecutive patients who underwent distal chevron metatarsal osteotomy bunionectomy utilizing the intramedullary plate system. All operative procedures were performed by the senior author. Patients were evaluated preoperatively, postoperatively, and at a final follow-up utilizing the American Orthopaedic Foot & Ankle Society (AOFAS) forefoot scoring system. Sixty-three surgically corrected feet went on to heal the osteotomy site. There were no hardware failures. We had one patient that expressed mild discomfort over the plate. All patients significantly improved their AOFAS scores compared with preoperative values. We concluded that the distal chevron metatarsal osteotomy bunionectomy resulted in excellent function and pain relief. The new plate system was a reliable and stable implant with a low profile, good strength, and ease of use. Level IV, retrospective case series. © The Author(s) 2015.

Apparent contact angle and contact angle hysteresis on liquid infused surfaces.

PubMed

Semprebon, Ciro; McHale, Glen; Kusumaatmaja, Halim

2016-12-21

We theoretically investigate the apparent contact angle and contact angle hysteresis of a droplet placed on a liquid infused surface. We show that the apparent contact angle is not uniquely defined by material parameters, but also has a dependence on the relative size between the droplet and its surrounding wetting ridge formed by the infusing liquid. We derive a closed form expression for the contact angle in the limit of vanishing wetting ridge, and compute the correction for small but finite ridge, which corresponds to an effective line tension term. We also predict contact angle hysteresis on liquid infused surfaces generated by the pinning of the contact lines by the surface corrugations. Our analytical expressions for both the apparent contact angle and contact angle hysteresis can be interpreted as 'weighted sums' between the contact angles of the infusing liquid relative to the droplet and surrounding gas phases, where the weighting coefficients are given by ratios of the fluid surface tensions.

Ankle joint pressure changes in a pes cavovarus model: supramalleolar valgus osteotomy versus lateralizing calcaneal osteotomy.

PubMed

Schmid, Timo; Zurbriggen, Sebastian; Zderic, Ivan; Gueorguiev, Boyko; Weber, Martin; Krause, Fabian G

2013-09-01

A fixed cavovarus foot deformity can be associated with anteromedial ankle arthrosis due to elevated medial joint contact stresses. Supramalleolar valgus osteotomies (SMOT) and lateralizing calcaneal osteotomies (LCOT) are commonly used to treat symptoms by redistributing joint contact forces. In a cavovarus model, the effects of SMOT and LCOT on the lateralization of the center of force (COF) and reduction of the peak pressure in the ankle joint were compared. A previously published cavovarus model with fixed hindfoot varus was simulated in 10 cadaver specimens. Closing wedge supramalleolar valgus osteotomies 3 cm above the ankle joint level (6 and 11 degrees) and lateral sliding calcaneal osteotomies (5 and 10 mm displacement) were analyzed at 300 N axial static load (half body weight). The COF migration and peak pressure decrease in the ankle were recorded using high-resolution TekScan pressure sensors. A significant lateral COF shift was observed for each osteotomy: 2.1 mm for the 6 degrees (P = .014) and 2.3 mm for the 11 degrees SMOT (P = .010). The 5 mm LCOT led to a lateral shift of 2.0 mm (P = .042) and the 10 mm LCOT to a shift of 3.0 mm (P = .006). Comparing the different osteotomies among themselves no significant differences were recorded. No significant anteroposterior COF shift was seen. A significant peak pressure reduction was recorded for each osteotomy: The SMOT led to a reduction of 29% (P = .033) for the 6 degrees and 47% (P = .003) for the 11 degrees osteotomy, and the LCOT to a reduction of 41% (P = .003) for the 5 mm and 49% (P = .002) for the 10 mm osteotomy. Similar to the COF lateralization no significant differences between the osteotomies were seen. LCOT and SMOT significantly reduced anteromedial ankle joint contact stresses in this cavovarus model. The unloading effects of both osteotomies were equivalent. More correction did not lead to significantly more lateralization of the COF or more reduction of peak pressure but a trend was

Automated analysis of angle closure from anterior chamber angle images.

PubMed

Baskaran, Mani; Cheng, Jun; Perera, Shamira A; Tun, Tin A; Liu, Jiang; Aung, Tin

2014-10-21

To evaluate a novel software capable of automatically grading angle closure on EyeCam angle images in comparison with manual grading of images, with gonioscopy as the reference standard. In this hospital-based, prospective study, subjects underwent gonioscopy by a single observer, and EyeCam imaging by a different operator. The anterior chamber angle in a quadrant was classified as closed if the posterior trabecular meshwork could not be seen. An eye was classified as having angle closure if there were two or more quadrants of closure. Automated grading of the angle images was performed using customized software. Agreement between the methods was ascertained by κ statistic and comparison of area under receiver operating characteristic curves (AUC). One hundred forty subjects (140 eyes) were included, most of whom were Chinese (102/140, 72.9%) and women (72/140, 51.5%). Angle closure was detected in 61 eyes (43.6%) with gonioscopy in comparison with 59 eyes (42.1%, P = 0.73) using manual grading, and 67 eyes (47.9%, P = 0.24) with automated grading of EyeCam images. The agreement for angle closure diagnosis between gonioscopy and both manual (κ = 0.88; 95% confidence interval [CI), 0.81-0.96) and automated grading of EyeCam images was good (κ = 0.74; 95% CI, 0.63-0.85). The AUC for detecting eyes with gonioscopic angle closure was comparable for manual and automated grading (AUC 0.974 vs. 0.954, P = 0.31) of EyeCam images. Customized software for automated grading of EyeCam angle images was found to have good agreement with gonioscopy. Human observation of the EyeCam images may still be needed to avoid gross misclassification, especially in eyes with extensive angle closure. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

Effects of toe-in and toe-in with wider step width on level walking knee biomechanics in varus, valgus, and neutral knee alignments.

PubMed

Bennett, Hunter J; Shen, Guangping; Cates, Harold E; Zhang, Songning

2017-12-01

Increased peak external knee adduction moments exist for individuals with knee osteoarthritis and varus knee alignments, compared to healthy and neutrally aligned counterparts. Walking with increased toe-in or increased step width have been individually utilized to successfully reduce 1st and 2nd peak knee adduction moments, respectfully, but have not previously been combined or tested among all alignment groups. The purpose of this study was to compare toe-in only and toe-in with wider step width gait modifications in individuals with neutral, valgus, and varus alignments. Thirty-eight healthy participants with confirmed varus, neutral, or valgus frontal-plane knee alignment through anteroposterior radiographs, performed level walking in normal, toe-in, and toe-in with wider step width gaits. A 3×3 (group×intervention) mixed model repeated measures ANOVA compared alignment groups and gait interventions (p<0.05). The 1st peak knee adduction moment was reduced in both toe-in and toe-in with wider step width compared to normal gait. The 2nd peak adduction moment was increased in toe-in compared to normal and toe-in with wider step width. The adduction impulse was also reduced in toe-in and toe-in with wider step width compared to normal gait. Peak knee flexion and external rotation moments were increased in toe-in and toe-in with wider step width compared to normal gait. Although the toe-in with wider step width gait seems to be a viable option to reduce peak adduction moments for varus alignments, sagittal, and transverse knee loadings should be monitored when implementing this gait modification strategy. Copyright © 2017 Elsevier B.V. All rights reserved.

Cartilage loss patterns within femorotibial contact regions during deep knee bend.

PubMed

Michael Johnson, J; Mahfouz, Mohamed R

2016-06-14

Osteoarthritis (OA) can alter knee kinematics and stresses. The relationship between cartilage loss in OA and kinematics is unclear, with existing work focusing on static wear and morphology. In this work, femorotibial cartilage maps were coupled with kinematics to investigate the relationship between kinematics and cartilage loss, allowing for more precise treatment and intervention. Cartilage thickness maps were created from healthy and OA subgroups (varus, valgus, and neutral) and mapped to a statistical bone atlas. Video fluoroscopy determined contact regions from 0° to 120° flexion. Varus and valgus subgroups displayed different wear patterns across the range of flexion, with varus knees showing more loss in early flexion and valgus in deeper flexion. For the femur, varus knees had more wear in the medial compartment than neutral or valgus and most wear at both 0° and 20° flexion. In the lateral femoral compartment, the valgus subgroup showed significantly more wear from 20° to 60° flexion as compared to other angles, though varus knees displayed highest magnitude of wear. For the tibia, most medial wear occurred at 0-40° flexion and most lateral occurred after 60° flexion. Knowing more about cartilage changes in OA knees provides insight as to expected wear or stresses on implanted components after arthroplasty. Combining cartilage loss patterns with kinematics allows for pre-surgical intervention and treatments tailored to the patient׳s alignment and kinematics. Reported wear patterns may also serve as a gauge for post-operative loading to be considered when placing implant components. Copyright © 2016. Published by Elsevier Ltd.

Development and validation of self-reported line drawings for assessment of knee malalignment and foot rotation: a cross-sectional comparative study

PubMed Central

2010-01-01

Background For large scale epidemiological studies clinical assessments and radiographs can be impractical and expensive to apply to more than just a sample of the population examined. The study objectives were to develop and validate two novel instruments for self-reported knee malalignment and foot rotation suitable for use in questionnaire studies of knee pain and osteoarthritis. Methods Two sets of line drawings were developed using similar methodology. Each instrument consisted of an explanatory question followed by a set of drawings showing straight alignment, then two each at 7.5° angulation and 15° angulation in the varus/valgus (knee) and inward/outward (foot) directions. Forty one participants undertaking a community study completed the instruments on two occasions. Participants were assessed once by a blinded expert clinical observer with demonstrated excellent reproducibility. Validity was assessed by sensitivity, specificity and likelihood ratio (LR) using the observer as the reference standard. Reliability was assessed using weighted kappa (κ). Knee malalignment was measured on 400 knee radiographs. General linear model was used to assess for the presence of a linear increase in knee alignment angle (measured medially) from self-reported severe varus to mild varus, straight, mild valgus and severe valgus deformity. Results Observer reproducibility (κ) was 0.89 and 0.81 for the knee malalignment and foot rotation instruments respectively. Self-reported participant reproducibility was also good for the knee (κ 0.73) and foot (κ 0.87) instruments. Validity was excellent for the knee malalignment instrument, with a sensitivity of 0.74 (95%CI 0.54, 0.93) and specificity of 0.97 (95%CI 0.94, 1.00). Similarly the foot rotation instrument was also found to have high sensitivity (0.92, 95%CI 0.83, 1.01) and specificity (0.96, 95%CI 0.93, 1.00). The knee alignment angle increased progressively from self reported severe varus to mild varus, straight, mild

Boomerang proximal tibial osteotomy for the treatment of severe varus gonarthrosis.

PubMed

Sangkaew, Chanchit; Piyapittayanun, Peerapong

2013-06-01

The purpose of the study was to review the results of modified infratubercle displacement osteotomy in patients with severe varus gonarthrosis and to determine the factors influencing outcomes. A total of 177 knees in 133 patients with severe varus gonarthrosis were treated with infratubercle boomerang-shaped osteotomy, stabilised with dual plates. The mean age of the patients was 63.8 years (range 43-80 years), and the mean follow-up period was 61.4 months (range 24 -139 months). The factors associated with clinical and survival outcomes were analysed including age, gender, body mass index (BMI), preoperative and post-operative femorotibial angle and femorotibial angle at one year after surgery. Using the Knee Society clinical rating system 149 knees or 84.2 % were rated as having good to excellent results and 21 knees or 15.8 % as having fair to poor results. Overall, the mean preoperative knee score of 33.6 points had improved significantly to 80.7 points at the final follow-up (p < 0.001). Using Kaplan-Meier survivorship analysis the five-year survival was 97.1 % with conversion to arthroplasty or second osteotomy as the end point and 89.2 % with a knee score of under 70 points as the end point. The anatomical femorotibial angle at one year after osteotomy had the most significant positive effect on the clinical (p < 0.001) and survival outcomes for all end points (p = 0.002 for conversion to arthroplasty or second osteotomy and p < 0.001 for knee score less than 70 points). The boomerang osteotomy can create adequate valgus alignment in severe varus gonarthrosis. The one-year post-operative knee alignment of 11° valgus provided the most satisfactory results and that between six and 15° valgus the longest survival time.

Optimal reconstruction angles

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cook, G.O. Jr.; Knight, L.

1979-07-01

The question of optimal projection angles has recently become of interest in the field of reconstruction from projections. Here, studies are concentrated on the n x n pixel space, where literative algorithms such as ART and direct matrix techniques due to Katz are considered. The best angles are determined in a Gauss--Markov statistical sense as well as with respect to a function-theoretical error bound. The possibility of making photon intensity a function of angle is also examined. Finally, the best angles to use in an ART-like algorithm are studied. A certain set of unequally spaced angles was found to bemore » preferred in several contexts. 15 figures, 6 tables.« less

Is head-shaft angle a valuable continuous risk factor for hip migration in cerebral palsy?

PubMed

Chougule, Sanjay; Dabis, John; Petrie, Aviva; Daly, Karen; Gelfer, Yael

2016-12-01

Reimer's migration percentage (MP) is the most established radiographic risk factor for hip migration in cerebral palsy (CP), and it assists surgical decision-making. The head-shaft angle (HSA) measures the valgus of the head and neck in relation to the shaft and may also be a useful predictor of hip migration at a young age. This study first defined normal values and investigated whether the head-shaft angle (HSA) is a continuous risk factor for hip migration in CP. Three hundred and fifty AP pelvic radiographs of 100 consecutive children comprising the hip surveillance programme in our region were analysed for MP and HSA. Inclusion criteria were children with spastic CP and Gross Motor Function Classification System (GMFCS) levels of III-V, along with a minimum follow-up of 5 years. The mean age was 8.8 (range 3-18) years and the mean follow-up time was 7.5 (range 5-10) years. Radiographs of 103 typically developing children (TDC) were selected for the control group. The reliability of the measurements was determined. A random effects analysis was used to assess the relationship between MP and HSA for all data and for MP > 40 %. The TDC cohort had a mean HSA of 157.7° whilst that for the CP cohort was 161.7°. The value declined with age in both groups but remained consistently higher in the CP group. A random effects analysis considering the longitudinal data showed that there was no significant effect of HSA on MP. Similarly, when excluding CP patients with MP < 40 %, there was no significant effect of HSA on MP. This study found no correlation between HSA and hip migration in children with CP in this age group. Using the HSA as a routine radiographic measure in the management pathway across childhood does not offer any added value. Early enrolment onto the hip surveillance programme could offer a better prediction of hip migration using the HSA at a very young age. II retrospective prognostic study.

The Thrower's Elbow: Arthroscopic Treatment of Valgus Extension Overload Syndrome

PubMed Central

Altchek, David W.

2006-01-01

Injury to the medial collateral ligament of the elbow (MCL) can be a career-threatening injury for an overhead athlete without appropriate diagnosis and treatment. It has been considered separately from other athletic injuries due to the unique constellation of pathology that results from repetitive overhead throwing. The past decade has witnessed tremendous gains in understanding of the complex interplay between the dynamic and static stabilizers of the athlete's elbow. Likewise, the necessity to treat these problems in a minimally invasive manner has driven the development of sophisticated techniques and instrumentation for elbow arthroscopy. MCL injuries, ulnar neuritis, valgus extension overload with osteophyte formation and posteromedial impingement, flexor pronator strain, medial epicondyle pathology, and osteochondritis dissecans (OCD) of the capitellum have all been described as sequelae of the overhead throwing motion. In addition, loose body formation, bony spur formation, and capsular contracture can all be present in conjunction with these problems or as isolated entities. Not all pathology in the thrower's elbow is amenable to arthroscopic treatment; however, the clinician must be familiar with all of these problems in order to form a comprehensive differential diagnosis for an athlete presenting with elbow pain, and he or she must be comfortable with the variety of open and arthroscopic treatments available to best serve the patient. An understanding of the anatomy and biomechanics of the thrower's elbow is critical to the care of this population. The preoperative evaluation should focus on a thorough history and physical examination, as wellas on specific diagnostic imaging modalities. Arthroscopic setup, including anesthesia, patient positioning, and portal choices will be discussed. Operative techniques in the anterior and posterior compartments will bereviewed, as well as postoperative rehabilitationandsurgical results. Lastly, complications will

Porous Titanium Wedges in Lateral Column Lengthening for Adult-Acquired Flatfoot Deformity.

PubMed

Moore, Spencer H; Carstensen, S Evan; Burrus, M Tyrrell; Cooper, Truitt; Park, Joseph S; Perumal, Venkat

2017-10-01

Lateral column lengthening (LCL) is a common procedure for reconstruction of stage II flexible adult-acquired flatfoot deformity (AAFD). The recent development of porous titanium wedges for this procedure provides an alternative to allograft and autograft. The purpose of this study was to report radiographic and clinical outcomes achieved with porous titanium wedges in LCL. A retrospective analysis of 34 feet in 30 patients with AAFD that received porous titanium wedges for LCL from January 2011 to October 2014. Deformity correction was assessed using both radiographic and clinical parameters. Radiographic correction was assessed using the lateral talo-first metatarsal angle, the talonavicular uncoverage percentage, and the first metatarsocuneiform height. The hindfoot valgus angle was measured. Patients were followed from a minimum of 6 months up to 4 years (mean 16.1 months). Postoperative radiographs demonstrated significant correction in all 3 radiographic criteria and the hindfoot valgus angle. We had no cases of nonunion, no wedge migration, and no wedges have been removed to date. The most common complication was calcaneocuboid joint pain (14.7%). Porous titanium wedges in LCL can achieve good radiographic and clinical correction of AAFD with a low rate of nonunion and other complications. Level IV: Case series.

Blood supply to the first metatarsal head and vessels at risk with a chevron osteotomy.

PubMed

Malal, J J George; Shaw-Dunn, J; Kumar, C Senthil

2007-09-01

Chevron osteotomy, a commonly performed procedure for the treatment of hallux valgus, results in osteonecrosis of the first metatarsal head in 0% to 20% of cases. The aim of this study was to map out the arrangement of the vascular supply to the first metatarsal head and its relationship to the limbs of the chevron osteotomy. Ten cadaveric lower limbs were injected with an India ink-latex mixture, and the feet were dissected to assess the blood supply to the first metatarsal head. The dissection was carried out by tracing the branches of the dorsalis pedis and posterior tibial vessels. A distal chevron osteotomy was mapped, with the limbs of the osteotomy set at an angle of 60 degrees from the geometric center of the first metatarsal head. The relationship of the limbs of the osteotomy to the blood vessels was recorded. The first metatarsal head was found to be supplied by branches from the first dorsal metatarsal, first plantar metatarsal, and medial plantar arteries. The first dorsal metatarsal artery was the dominant vessel among the three arteries in eight specimens. All of the vessels formed a plexus at the plantar-lateral aspect of the metatarsal neck, just proximal to the capsular attachment, with a varying number of branches from the plexus then entering the metatarsal head. The plantar limb of the proposed chevron cuts exited through this plexus of vessels in all specimens. Contrary to the widely held view, only minor vascular branches could be found entering the dorsal aspect of the neck. The identification of the plantar-lateral corner of the metatarsal neck as the major site of vascular ingress into the first metatarsal head suggests that constructing the chevron osteotomy with a long plantar limb exiting well proximal to the capsular attachment may decrease the postoperative prevalence of osteonecrosis of the first metatarsal head.

{l_angle}110{r_angle} dendrite growth in aluminum feathery grains

DOE Office of Scientific and Technical Information (OSTI.GOV)

Henry, S.; Rappaz, M.; Jarry, P.

1998-11-01

Automatic indexing of electron backscattered diffraction patterns, scanning electron microscopy, and optical microscopy observations have been carried out on aluminum-magnesium-silicon, aluminum-copper, and aluminum-silicon alloys directionally solidified or semicontinuously cast using the direct chill casting process. From these combined observations, it is shown that the feathery grains are made of {l_angle}110{r_angle} primary dendrite trunks (e.g., [011{bar 1}]) split in their centers by a coherent (111) twin plane. The average spacing of the dendrite trunks in the twin plane (about 10 to 20 {micro}m) is typically one order of magnitude smaller than that separating successive rows of trunks (or twin planes). Themore » [011{bar 1}] orientation of these trunks is close to the thermal gradient direction (typically within 15 deg)--a feature probably resulting from a growth competition mechanism similar to that occurring during normal <100> columnar dendrite growth. On both sides of these trunks, secondary dendrite arms also grow along {l_angle}110{r_angle} directions. Their impingement creates wavy noncoherent twin boundaries between the coherent twin planes. In the twin plane, evidence is shown that {l_angle}110{r_angle} branching mechanisms lead to the propagation of the twinned regions, to the regular arrangement of the primary dendrite trunks along a [{bar 2}11] direction, and to coherent planar twin boundaries. From these observations, it is concluded that the feathery grains are probably the result of a change from a normal <100> to a {l_angle}110{r_angle} surface tension/attachment kinetics anisotropy growth mode. Finally, the proposed mechanisms of leathery grain growth are further supported by the observation of {l_angle}110{r_angle} dendrite growth morphologies in thin aluminum-zinc coatings.« less

THE INFLUENCE OF HIP STRENGTH ON KNEE KINEMATICS DURING A SINGLE-LEGGED MEDIAL DROP LANDING AMONG COMPETITIVE COLLEGIATE BASKETBALL PLAYERS.

PubMed

Suzuki, Hidetomo; Omori, Go; Uematsu, Daisuke; Nishino, Katsutoshi; Endo, Naoto

2015-10-01

A smaller knee flexion angle and larger knee valgus angle during weight-bearing activities have been identified as risk factors for non-contact anterior cruciate ligament (ACL) injuries. To prevent such injuries, attention has been focused on the role of hip strength in knee motion control. However, gender differences in the relationship between hip strength and knee kinematics during weight-bearing activities in the frontal plane have not been evaluated. The purpose of this study was to determine the influence of hip strength on knee kinematics in both genders during a single-legged landing task in the frontal plane. The hypotheses were that 1) subjects with a greater hip strength would demonstrate larger knee flexion and smaller knee valgus and internal rotation angles and 2) no gender differences would exist during the single-legged landing task. Forty-three Japanese collegiate basketball players (20 males, 23 females) participated in this study. Three-dimensional motion analysis was used to evaluate knee kinematics during a single-legged medial drop landing (SML). A hand-held dynamometer was used to assess hip extensor (HEXT), abductor (HAB), and external rotator (in two positions: seated position [SHER] and prone [PHER]) isometric strength. Spearman rank correlation coefficients (ρ) were determined for correlations between hip strength and knee kinematics at initial contact (IC) and peak (PK) during SML (p < 0.05). Negative correlations were observed between the knee valgus angle at IC and HEXT (ρ = -0.48, p = 0.02), HAB (ρ = -0.46, p = 0.03) and PHER (ρ = -0.44, p = 0.04) strength in females. In addition, a significant positive correlation was observed between the knee flexion angle at PK and HEXT strength (ρ = 0.61, p = 0.004) in males. Significant correlations between hip strength and knee kinematics during SML were observed in both genders. Hip strength may, therefore, play an important role in knee motion control during sports activities

Differences in lower extremity anatomical and postural characteristics in males and females between maturation groups.

PubMed

Shultz, Sandra J; Nguyen, Anh-Dung; Schmitz, Randy J

2008-03-01

Descriptive, cross-sectional. We compared lower extremity anatomical characteristics in males and females between different maturation groups. Sex differences have been observed in lower extremity anatomical characteristics. While the reasons contributing to these sex differences in adults are unknown, there is evidence that anatomy and posture change considerably during growth and development. One hundred seventy-three young athletes (age range, 9-18 years) were assessed for stage of maturation and placed into 1 of 3 groups, according to Tanners stages 1 and 2 (MatGrp1), 3 and 4 (MatGrp2), and 5 (MatGrp3). Participants were measured for pelvic angle, hip anteversion, quadriceps angle, tibiofemoral angle, femur length, tibial length, genu recurvatum, tibial torsion, navicular drop, general joint laxity, and anterior knee laxity. Data were compared by sex and maturation group. When comparing maturation groups, limb length, pelvic angle, and tibial torsion increased with maturation, and anterior knee laxity, genu recurvatum, tibiofemoral angle, and foot pronation decreased with maturation. Females had greater general joint laxity, hip anteversion, and tibiofemoral angles, and shorter femur and tibial lengths than males, regardless of maturation group. Maturational changes in knee laxity and quadriceps angles were sex dependent. We observed a general change of posture with maturation that began with greater knee valgus, knee recurvatum, and foot pronation in MatGrp1, then moved toward a relative straightening and external rotation of the knee, and supination of the foot in later maturation groups. While the majority of the measures changed similarly in males and females across maturation groups, decreases in quadriceps angles and anterior knee laxity were greater in males compared to females, and females were observed to have a more inwardly rotated hip and valgus knee posture, compared to males, particularly in later maturation groups.

The Critical Angle Can Override the Brewster Angle

ERIC Educational Resources Information Center

Froehle, Peter H.

2009-01-01

As a culminating activity in their study of optics, my students investigate polarized light and the Brewster angle. In this exercise they encounter a situation in which it is impossible to measure the Brewster angle for light reflecting from a particular surface. This paper describes the activity and explains the students' observations.

Undetected angle closure in patients with a diagnosis of open-angle glaucoma.

PubMed

Varma, Devesh K; Simpson, Sarah M; Rai, Amandeep S; Ahmed, Iqbal Ike K

2017-08-01

The aim of this study was to identify the proportion of patients referred to a tertiary glaucoma centre with a diagnosis of open-angle glaucoma (OAG) who were found to have angle closure glaucoma. Retrospective chart review. Consecutive new patients referred for glaucoma management to a tertiary centre between July 2010 and December 2011 were reviewed. Patients whose referrals for glaucoma assessment specified angle status as "open" were included. The data collected included glaucoma specialist's angle assessment, diagnosis, and glaucoma severity. The status of those with 180 degrees or more Shaffer angle grading of 0 was classified as "closed." From 1234 glaucoma referrals, 179 cases were specified to have a diagnosis of OAG or when angles were known to be open. Of these, 16 (8.9%) were found on examination by the glaucoma specialist to have angle closure. Pseudoexfoliation was present in 4 of 16 patients (25%) in the missed angle-closure glaucoma (ACG) group and 22 of 108 patients (13.5%) in the remaining OAG group. There was no difference found in demographic or ocular biometric parameters between those with confirmed OAG versus those with missed ACG. Almost 1 in 11 patients referred by ophthalmologists to a tertiary glaucoma centre with a diagnosis of OAG were in fact found to have angle closure. Given the different treatment approaches for ACG versus OAG, this study suggests a need to strengthen angle evaluations. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Evaluation of blotchy pigments in the anterior chamber angle as a sign of angle closure

PubMed Central

Rao, Harsha L; Mungale, Sachin C; Kumbar, Tukaram; Parikh, Rajul S; Garudadri, Chandra S

2012-01-01

Background: Blotchy pigments in the anterior chamber (AC) angle are considered diagnostic of primary angle closure (PAC). But there are no reports either on the prevalence of blotchy pigments in AC angles or the validity of this sign. Aims: To determine the prevalence of blotchy pigments in AC angles and to evaluate their relationship with glaucomatous optic neuropathy (GON) in eyes with occludable angles. Setting and Design: Cross-sectional, comparative study. Materials and Methods: Gonioscopy was performed in 1001 eyes of 526 subjects (245 eyes of 148 consecutive, occludable angle subjects and 756 eyes of 378 non-consecutive, open angle subjects), above 35 years of age. Quadrant-wise location of blotchy pigments was documented. Statistical Analysis: Odds of blotchy pigments in occludable angles against that in open angles were evaluated. Relationship of GON with blotchy pigments in occludable angle eyes was evaluated using a multivariate model. Results: Prevalence of blotchy pigments in occludable angles was 28.6% (95% CI, 22.9-34.3) and in open angles was 4.7% (95% CI, 3.2-6.3). Blotchy pigments were more frequently seen in inferior (16%) and superior quadrants (15%) of occludable angles, and inferior quadrant of open angles (4%). Odds of superior quadrant blotchy pigments in occludable angles were 33 times that in open angles. GON was seen in 107 occludable angle eyes. Blotchy pigments were not significantly associated with GON (odds ratio = 0.5; P = 0.1). Conclusions: Blotchy pigments were seen in 28.6% of occludable angle eyes and 4.7% of open angles eyes. Presence of blotchy pigments in the superior quadrant is more common in occludable angles. Presence of GON in occludable angle eyes was not associated with blotchy pigments. PMID:23202393

Biomechanical Effects of an Injury Prevention Program in Preadolescent Female Soccer Athletes.

PubMed

Thompson, Julie A; Tran, Andrew A; Gatewood, Corey T; Shultz, Rebecca; Silder, Amy; Delp, Scott L; Dragoo, Jason L

2017-02-01

Anterior cruciate ligament (ACL) injuries are common, and children as young as 10 years of age exhibit movement patterns associated with an ACL injury risk. Prevention programs have been shown to reduce injury rates, but the mechanisms behind these programs are largely unknown. Few studies have investigated biomechanical changes after injury prevention programs in children. Purpose/Hypothesis: To investigate the effects of the F-MARC 11+ injury prevention warm-up program on changes to biomechanical risk factors for an ACL injury in preadolescent female soccer players. We hypothesized that the primary ACL injury risk factor of peak knee valgus moment would improve after training. In addition, we explored other kinematic and kinetic variables associated with ACL injuries. Controlled laboratory study. A total of 51 female athletes aged 10 to 12 years were recruited from soccer clubs and were placed into an intervention group (n = 28; mean [±SD] age, 11.8 ± 0.8 years) and a control group (n = 23; mean age, 11.2 ± 0.6 years). The intervention group participated in 15 in-season sessions of the F-MARC 11+ program (2 times/wk). Pre- and postseason motion capture data were collected during preplanned cutting, unanticipated cutting, double-leg jump, and single-leg jump tasks. Lower extremity joint angles and moments were estimated using OpenSim, a biomechanical modeling system. Athletes in the intervention group reduced their peak knee valgus moment compared with the control group during the double-leg jump (mean [±standard error of the mean] pre- to posttest change, -0.57 ± 0.27 %BW×HT vs 0.25 ± 0.25 %BW×HT, respectively; P = .034). No significant differences in the change in peak knee valgus moment were found between the groups for any other activity; however, the intervention group displayed a significant pre- to posttest increase in peak knee valgus moment during unanticipated cutting ( P = .044). Additional analyses revealed an improvement in peak ankle eversion

Investigations of interpolation errors of angle encoders for high precision angle metrology

NASA Astrophysics Data System (ADS)

Yandayan, Tanfer; Geckeler, Ralf D.; Just, Andreas; Krause, Michael; Asli Akgoz, S.; Aksulu, Murat; Grubert, Bernd; Watanabe, Tsukasa

2018-06-01

Interpolation errors at small angular scales are caused by the subdivision of the angular interval between adjacent grating lines into smaller intervals when radial gratings are used in angle encoders. They are often a major error source in precision angle metrology and better approaches for determining them at low levels of uncertainty are needed. Extensive investigations of interpolation errors of different angle encoders with various interpolators and interpolation schemes were carried out by adapting the shearing method to the calibration of autocollimators with angle encoders. The results of the laboratories with advanced angle metrology capabilities are presented which were acquired by the use of four different high precision angle encoders/interpolators/rotary tables. State of the art uncertainties down to 1 milliarcsec (5 nrad) were achieved for the determination of the interpolation errors using the shearing method which provides simultaneous access to the angle deviations of the autocollimator and of the angle encoder. Compared to the calibration and measurement capabilities (CMC) of the participants for autocollimators, the use of the shearing technique represents a substantial improvement in the uncertainty by a factor of up to 5 in addition to the precise determination of interpolation errors or their residuals (when compensated). A discussion of the results is carried out in conjunction with the equipment used.

The impact of proximal femoral morphology on failure strength with a mid-head resection short-stem hip arthroplasty.

PubMed

Olsen, Michael; Al Saied, Mohamed; Morison, Zachary; Sellan, Michael; Waddell, James P; Schemitsch, Emil H

2014-12-01

Mid-head resection short-stem hip arthroplasty is a conservative alternative to conventional total hip replacement and addresses proximal fixation challenges in patients not suitable for hip resurfacing. It is unclear whether proximal femoral morphology impacts the ultimate failure load of mid-head resection implanted femurs, thus the aim of this study was to investigate the effect of native neck-shaft angle (NSA) and coronal implant alignment on proximal femoral strength. In total, 36 synthetic femurs with two different proximal femoral morphologies were utilized in this study. Of them, 18 femurs with a varus NSA of 120° and 18 femurs with a valgus NSA of 135° were each implanted with a mid-head resection prosthesis. Femurs within the two different femoral morphology groups were divided into three equal coronal implant alignment groups: 10° valgus, 10° varus or neutral alignment. Prepared femurs were tested for stiffness and to failure in axial compression. There was no significant difference in stiffness nor failure load between femurs implanted with valgus-, varus- or neutrally aligned implants in femurs with a NSA of 120° (p = 0.396, p = 0.111, respectively). Femurs implanted in valgus orientation were significantly stiffer and failed at significantly higher loads than those implanted in varus alignment in femurs with a NSA of 135° (p = 0.001, p = 0.007, respectively). A mid-head resection short-stem hip arthroplasty seems less sensitive to clinically relevant variations of coronal implant alignment and may be more forgiving upon implantation in some femoral morphologies, however, a relative valgus component alignment is recommended. © IMechE 2014.

Angle performance on optima MDxt

DOE Office of Scientific and Technical Information (OSTI.GOV)

David, Jonathan; Kamenitsa, Dennis

2012-11-06

Angle control on medium current implanters is important due to the high angle-sensitivity of typical medium current implants, such as halo implants. On the Optima MDxt, beam-to-wafer angles are controlled in both the horizontal and vertical directions. In the horizontal direction, the beam angle is measured through six narrow slits, and any angle adjustment is made by electrostatically steering the beam, while cross-wafer beam parallelism is adjusted by changing the focus of the electrostatic parallelizing lens (P-lens). In the vertical direction, the beam angle is measured through a high aspect ratio mask, and any angle adjustment is made by slightlymore » tilting the wafer platen prior to implant. A variety of tests were run to measure the accuracy and repeatability of Optima MDxt's angle control. SIMS profiles of a high energy, channeling sensitive condition show both the cross-wafer angle uniformity, along with the small-angle resolution of the system. Angle repeatability was quantified by running a channeling sensitive implant as a regular monitor over a seven month period and measuring the sheet resistance-to-angle sensitivity. Even though crystal cut error was not controlled for in this case, when attributing all Rs variation to angle changes, the overall angle repeatability was measured as 0.16 Degree-Sign (1{sigma}). A separate angle repeatability test involved running a series of V-curves tests over a four month period using low crystal cut wafers selected from the same boule. The results of this test showed the angle repeatability to be <0.1 Degree-Sign (1{sigma}).« less

Do Ergogenic Aids Alter Lower Extremity Joint Alignment During a Functional Movement Lunge Prior to and Following an Exercise Bout?

PubMed Central

Mills, Chris; Knight, James; Milligan, Gemma

2015-01-01

Ergogenic aids have been used to alter joint kinematics in an attempt to minimise injury risk, yet the effectiveness of these aids may be compromised following a bout of exercise. This preliminary study aimed to measure the effect of compression garments and Kinesio Tape® on lower extremity joint alignment prior to and following an exercise bout. Eight male athletes (age = 24.1 ± 3.0 years, body height = 177.4 ± 5.2 cm, body mass = 72.3 ± 7.2 kg) volunteered to participant in this study. Joint kinematics were recorded whilst all participants performed three rotational lunges, in three conditions (control, compression garment, Kinesio Tape®), prior to and following a 10 minute exercise bout. Frontal plane kinematics (lateral pelvic tilt, knee valgus, ankle inversion/eversion) were used to assess ergogenic aid effectiveness during the lunge. Participants exhibited no significant differences in joint kinematics between ergogenic aid conditions prior to the exercise bout. Following exercise the only significant difference occurred within the Kinesio Tape® condition where maximum knee valgus angle significantly increased from 6.5° prior to exercise, to 7.7° following the exercise bout. The results of this study suggest joint kinematics are not affected by the ergogenic aids in this study prior to an exercise bout. However, there is evidence to suggest that the application of Kinesio Tape® may allow an increase in knee valgus angle following a bout of exercise, yet, compression garments are effective at maintaining joint alignment following a bout of exercise. PMID:25964805

The biomechanical evaluation of a novel 3-strand docking technique for ulnar collateral ligament reconstruction in the elbow.

PubMed

Williams, Phillip N; McGarry, Michelle H; Ihn, Hansel; Schulz, Brian M; Limpisvasti, Orr; ElAttrache, Neal S; Lee, Thay Q

2018-05-07

The original 2-strand docking technique for elbow ulnar collateral ligament reconstruction has recently been modified to use a 3-strand graft. To date, no biomechanical study has compared the 2 techniques. We hypothesized that the 3-strand docking technique would restore valgus laxity to its native state, with comparable load-to-failure characteristics to the 2-strand docking technique. Sixteen fresh cadaveric elbows were matched to the corresponding contralateral side from the same individual to create 8 matched pairs and were then randomized to undergo ulnar collateral ligament reconstruction using either the 2- or 3-strand technique. Valgus laxity and rotation measurements were quantified using a MicroScribe 3DLX digitizer at various flexion angles for the native state, transected state, and 1 of the 2 tested reconstructed ligaments. Each reconstruction was then tested to failure. Valgus laxity for the intact state at elbow flexion angles of 30°, 60°, 90°, and 120° was 7° ± 2°, 7° ± 2°, 6° ± 1°, and 5° ± 2°, respectively. These values were similar to those of both reconstruction techniques. On load-to-failure testing, there was no significant difference in any parameter recorded. Yield torques for the 3- and 2-strand reconstructions were 13.4 ± 4.80 N/m and 11.8 ± 4.76 N/m, respectively (P = .486). The ultimate torques were 15.7 ± 6.10 N/m and 14.4 ± 5.58 N/m for the 3- and 2-strand techniques, respectively (P = .582). The 3-strand docking technique was able to restore valgus laxity to the native state, with similar load-to-failure characteristics to the 2-strand docking technique. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Results of computer assisted mini-incision subvastus approach for total knee arthroplasty.

PubMed

Turajane, Thana; Larbpaiboonpong, Viroj; Kongtharvonskul, Jatupon; Maungsiri, Samart

2009-12-01

Mini-incision subvastus approach is soft tissue preservation of the knee. Advantages of the mini-incision subvastus approach included reduced blood loss, reduced pain, self rehabilitation and faster recovery. However, the improved visualization, component alignment, and more blood preservation have been debatable to achieve the better outcome and preventing early failure of the Total Knee Arthroplasty (TKA). The computer navigation has been introduced to improve alignment and blood loss. The purpose of this study was to evaluate the short term outcomes of the combination of computer assisted mini-incision subvastus approach for Total Knee Arthroplasty (CMS-TKA). A prospective case series of the initial 80 patients who underwent computer assisted mini-incision subvastus approach for CMS-TKA from January 2007 to October 2008 was carried out. The patients' conditions were classified into 2 groups, the simple OA knee (varus deformity was less than 15 degree, BMI was less than 20%, no associated deformities) and the complex deformity (varus deformity was more than 15 degrees, BMI more was than 20%, associated with flexion contractor). There were 59 patients in group 1 and 21 patients in group 2. Of the 80 knees, 38 were on the left and 42 on the right. The results of CMS-TKA [the mean (range)] in group 1: group 2 were respectively shown as the incision length [10.88 (8-13): 11.92 (10-14], the operation time [118 (111.88-125.12): 131 (119.29-143.71) minutes, lateral releases (0 in both groups), postoperative range of motion in flexion [94.5 (90-100): 95.25 (90-105) degree] and extension [1.75 (0-5): 1.5 (0-5) degree] Blood loss in 24 hours [489.09 (414.7-563.48): 520 (503.46-636.54) ml] and blood transfusion [1 (0-1) unit? in both groups], Tibiofemoral angle preoperative [Varus = 4 (varus 0-10): Varus = 17.14 (varus 15.7-18.5) degree, Tibiofemoral angle postoperative [Valgus = 1.38 (Valgus 0-4): Valgus = 2.85 (valgus 2.1-3.5) degree], Tibiofemoral angle outlier (85% both

Three saints with deformed extremities in an Italian Renaissance altarpiece.

PubMed

Albury, W R; Weisz, G M

2017-03-01

A fifteenth-century Florentine altarpiece painted by the Pollaiuolo brothers, Antonio (1433-1498) and Piero (1443-1496), shows three saints with evident deformities of the hands and feet. The pathologies concerned are tentatively identified, and various rationales for their presence in the painting are discussed. Of particular importance is the location of the altarpiece in a chapel which houses the tomb of the Cardinal of Portugal, Prince James of Lusitania (1433-1459). It is argued that both the artistic style of the day and the religious symbolism of the Cardinal's funeral chapel contributed to the artists' decision to portray the saints with deformities. An unnatural curvature of the fifth finger was apparently considered elegant in fifteenth-century paintings, and the depiction of bare feet with hallux valgus gave them a shape which approximated and could have been caused by fashionable pointed shoes. But in addition, deformities in religious art could be symbolic of suffering and martyrdom, a theme which the Cardinal's chapel emphasised in a number of ways. It is suggested therefore that the Pollaiuolo altarpiece reconciles these two disparate factors, portraying genuine deformities in a way that was artistically stylish and symbolically meaningful.

Angle classification revisited 2: a modified Angle classification.

PubMed

Katz, M I

1992-09-01

Edward Angle, in his classification of malocclusions, appears to have made Class I a range of abnormality, not a point of ideal occlusion. Current goals of orthodontic treatment, however, strive for the designation "Class I occlusion" to be synonymous with the point of ideal intermeshing and not a broad range. If contemporary orthodontists are to continue to use Class I as a goal, then it is appropriate that Dr. Angle's century-old classification, be modified to be more precise.

[Spectral Study on the Effects of Angle-Tuned Filter Wedge Angle Parameter to Reflecting Characteristics].

PubMed

Yu, Kan; Huang, De-xiu; Yin, Juan-juan; Bao, Jia-qi

2015-08-01

Three-port tunable optical filter is a key device in the all-optic intelligent switching network and dense wavelength division multiplexing system. The characteristics of the reflecting spectrum, especially the reflectivity and the isolation degree are very important to the three-port filter. Angle-tuned thin film filter is widely used as a three-port tunable filter for its high rectangular degree and good temperature stability. The characteristics of the reflecting spectrum are greatly influenced not only by the incident angle, but also by the wedge angle parameter of the non-paralleled wedge thin film filter. In the present paper, the influences of the wedge angle parameter to the reflectivity and the half bandwidth are analyzed, and the reflecting spectrum characterstics are simulationed in different wedge angle parameter and polarity. The wedge angle-tuned thin film filter with 0.8° wedge angle parameter is fabricated. The experimental results show that keeping the wedge angle the same orientation to the incident angle will worsen the reflectivity and the rectangular degree of the reflecting spectrum. However, keeping the wedge angle orientation reverse to the incident angle will enhance the reflectivity and decrease the bandwidth, which will give higher reflectivity and isolation degree to the three-port filter than that of high parallel degree angle-tuned thin film filter.

A predictive factor for acquiring an ideal lower limb realignment after opening-wedge high tibial osteotomy.

PubMed

Bito, Haruhiko; Takeuchi, Ryohei; Kumagai, Ken; Aratake, Masato; Saito, Izumi; Hayashi, Riku; Sasaki, Yohei; Aota, Yoichi; Saito, Tomoyuki

2009-04-01

Obtaining a correct postoperative limb alignment is an important factor in achieving a successful clinical outcome after an opening-wedge high tibial osteotomy (OWHTO). To better predict some of the aspects that impact upon the clinical outcomes following this procedure, including postoperative correction loss and over correction, we examined the changes in the frontal plane of the lower limb in a cohort of patients who had undergone OWHTO using radiography. Forty-two knees from 33 patients (23 cases of osteoarthritis and 10 of osteonecrosis) underwent a valgus realignment OWHTO procedure and were radiographically assessed for changes that occurred pre- and post-surgery. The mean femorotibial angle (FTA) was found to be 182.1 +/- 2.0 degrees (12 +/- 2.0 anatomical varus angulation) preoperatively and 169.6 +/- 2.4 degrees (10.4 +/- 2.4 anatomical valgus angulation) postoperatively. These measurements thus revealed significant changes in the weight bearing line ratio (WBL), femoral axis angle (FA), tibial axis angle (TA), tibia plateau angle (TP), tibia vara angle (TV) and talar tilt angle (TT) following OWHTO. In contrast, no significant change was found in the weight bearing line angle (WBLA) after these treatments. To assess the relationship between the correction angle and these indexes, 42 knees were divided into the following three groups according to the postoperative FTA; a normal correction group (168 degrees < or = FTA < or = 172 degrees ), an over-correction group (FTA < 168 degrees ), and an under-correction group (FTA > 172 degrees ). There were significant differences in the delta angle [DA; calculated as (pre FTA - post FTA) - (pre TV - post TV)] among each group of patients. Our results thus indicate a negative correlation between the DA and preoperative TA (R(2) = 0.148, p < 0.05). Hence, given that the correction errors in our patients appear to negatively correlate with the preoperative TA, postoperative malalignments are likely to be predictable

Angle Performance on Optima XE

DOE Office of Scientific and Technical Information (OSTI.GOV)

David, Jonathan; Satoh, Shu

2011-01-07

Angle control on high energy implanters is important due to shrinking device dimensions, and sensitivity to channeling at high beam energies. On Optima XE, beam-to-wafer angles are controlled in both the horizontal and vertical directions. In the horizontal direction, the beam angle is measured through a series of narrow slits, and any angle adjustment is made by steering the beam with the corrector magnet. In the vertical direction, the beam angle is measured through a high aspect ratio mask, and any angle adjustment is made by slightly tilting the wafer platen during implant.Using a sensitive channeling condition, we were ablemore » to quantify the angle repeatability of Optima XE. By quantifying the sheet resistance sensitivity to both horizontal and vertical angle variation, the total angle variation was calculated as 0.04 deg. (1{sigma}). Implants were run over a five week period, with all of the wafers selected from a single boule, in order to control for any crystal cut variation.« less

Manifold angles, the concept of self-similarity, and angle-enhanced bifurcation diagrams

PubMed Central

Beims, Marcus W.; Gallas, Jason A. C.

2016-01-01

Chaos and regularity are routinely discriminated by using Lyapunov exponents distilled from the norm of orthogonalized Lyapunov vectors, propagated during the temporal evolution of the dynamics. Such exponents are mean-field-like averages that, for each degree of freedom, squeeze the whole temporal evolution complexity into just a single number. However, Lyapunov vectors also contain a step-by-step record of what exactly happens with the angles between stable and unstable manifolds during the whole evolution, a big-data information permanently erased by repeated orthogonalizations. Here, we study changes of angles between invariant subspaces as observed during temporal evolution of Hénon’s system. Such angles are calculated numerically and analytically and used to characterize self-similarity of a chaotic attractor. In addition, we show how standard tools of dynamical systems may be angle-enhanced by dressing them with informations not difficult to extract. Such angle-enhanced tools reveal unexpected and practical facts that are described in detail. For instance, we present a video showing an angle-enhanced bifurcation diagram that exposes from several perspectives the complex geometrical features underlying the attractors. We believe such findings to be generic for extended classes of systems. PMID:26732416

Manifold angles, the concept of self-similarity, and angle-enhanced bifurcation diagrams

NASA Astrophysics Data System (ADS)

Beims, Marcus W.; Gallas, Jason A. C.

2016-01-01

Chaos and regularity are routinely discriminated by using Lyapunov exponents distilled from the norm of orthogonalized Lyapunov vectors, propagated during the temporal evolution of the dynamics. Such exponents are mean-field-like averages that, for each degree of freedom, squeeze the whole temporal evolution complexity into just a single number. However, Lyapunov vectors also contain a step-by-step record of what exactly happens with the angles between stable and unstable manifolds during the whole evolution, a big-data information permanently erased by repeated orthogonalizations. Here, we study changes of angles between invariant subspaces as observed during temporal evolution of Hénon’s system. Such angles are calculated numerically and analytically and used to characterize self-similarity of a chaotic attractor. In addition, we show how standard tools of dynamical systems may be angle-enhanced by dressing them with informations not difficult to extract. Such angle-enhanced tools reveal unexpected and practical facts that are described in detail. For instance, we present a video showing an angle-enhanced bifurcation diagram that exposes from several perspectives the complex geometrical features underlying the attractors. We believe such findings to be generic for extended classes of systems.

Differences in neutral foot positions when measured barefoot compared to in shoes with varying stiffnesses.

PubMed

Shultz, R; Birmingham, T B; Jenkyn, T R

2011-12-01

This study examined the absolute differences in neutral positions of the joints of the foot with different footwear. This addresses the question of whether separate static trials should be collected for each footwear condition to establish neutral positions. A multi-segment kinematic foot model and optical motion analysis system measured four inter-segmental joints of the foot: (1) hindfoot-to-midfoot in the frontal plane, (2) forefoot-to-midfoot in the frontal plane, (3) hallux-to-forefoot in the sagittal plane, and (4) the height-to-length ratio of the medial longitudinal arch. Barefoot was compared to three shoe condition using Nike Free trainers of varying longitudinal torsional stiffness in ten male volunteers. There was high variability both within subjects and shoe conditions. Shoes in general tended to raise the medial longitudinal arch and dorsiflex the hallux compared to barefoot condition. For the hallux, a minimum important difference of 5° or more was found between shoe conditions and the barefoot condition for majority of the subjects in all three shoe conditions (90% for control, 60% for least stiff, 50% for most stiff). This was less for the frontal plane inter-segmental joints of the foot where 50% of the subjects experience a change above 5° for at least one of the conditions. The choice of using condition-specific neutral trials versus a single common neutral trials should be considered carefully. A single common trial allows for differences in absolute joint angles to be compared between footwear conditions. This can be important clinically to determine whether a joint is approaching its end-of-range and therefore at risk of injury. Several condition-specific neutral trials allows for subtleties in kinematic waveforms to be better compared between conditions, since absolute shifts in joint angles due to changing neutral position are removed and the waveforms are better aligned. Copyright © 2011. Published by Elsevier Ltd.

Setting the magic angle for fast magic-angle spinning probes.

PubMed

Penzel, Susanne; Smith, Albert A; Ernst, Matthias; Meier, Beat H

2018-06-15

Fast magic-angle spinning, coupled with 1 H detection is a powerful method to improve spectral resolution and signal to noise in solid-state NMR spectra. Commercial probes now provide spinning frequencies in excess of 100 kHz. Then, one has sufficient resolution in the 1 H dimension to directly detect protons, which have a gyromagnetic ratio approximately four times larger than 13 C spins. However, the gains in sensitivity can quickly be lost if the rotation angle is not set precisely. The most common method of magic-angle calibration is to optimize the number of rotary echoes, or sideband intensity, observed on a sample of KBr. However, this typically uses relatively low spinning frequencies, where the spinning of fast-MAS probes is often unstable, and detection on the 13 C channel, for which fast-MAS probes are typically not optimized. Therefore, we compare the KBr-based optimization of the magic angle with two alternative approaches: optimization of the splitting observed in 13 C-labeled glycine-ethylester on the carbonyl due to the Cα-C' J-coupling, or optimization of the H-N J-coupling spin echo in the protein sample itself. The latter method has the particular advantage that no separate sample is necessary for the magic-angle optimization. Copyright © 2018. Published by Elsevier Inc.

A Different Angle on Perspective

ERIC Educational Resources Information Center

Frantz, Marc

2012-01-01

When a plane figure is photographed from different viewpoints, lengths and angles appear distorted. Hence it is often assumed that lengths, angles, protractors, and compasses have no place in projective geometry. Here we describe a sense in which certain angles are preserved by projective transformations. These angles can be constructed with…

The gonial angle stripper: an instrument for the treatment of prominent gonial angle.

PubMed

Kyutoku, S; Yanagida, A; Kusumoto, K; Ogawa, Y

1994-12-01

In the Orient, a prominent gonial angle, so-called benign masseteric hypertrophy, is rather common and considered unattractive. Therefore, its surgical correction is one of the most popular forms of facial skeletal contouring. For accurate and safe osteotomy of the mandibular angle region, a gonial angle stripper was specially invented. It has a small projection that will ease identification of the osteotomy line in a narrow operative field. The tool has been clinically used in eight patients to prove its usefulness, especially for a posteriorly developed mandibular angle.

Biomechanical Effects of an Injury Prevention Program in Preadolescent Female Soccer Athletes

PubMed Central

Thompson, Julie A.; Tran, Andrew A.; Gatewood, Corey T.; Shultz, Rebecca; Silder, Amy; Delp, Scott L.; Dragoo, Jason L.

2017-01-01

Background Anterior cruciate ligament (ACL) injuries are common, and children as young as 10 years of age exhibit movement patterns associated with an ACL injury risk. Prevention programs have been shown to reduce injury rates, but the mechanisms behind these programs are largely unknown. Few studies have investigated biomechanical changes after injury prevention programs in children. Purpose/Hypothesis To investigate the effects of the F-MARC 11+ injury prevention warm-up program on changes to biomechanical risk factors for an ACL injury in preadolescent female soccer players. We hypothesized that the primary ACL injury risk factor of peak knee valgus moment would improve after training. In addition, we explored other kinematic and kinetic variables associated with ACL injuries. Study Design Controlled laboratory study. Methods A total of 51 female athletes aged 10 to 12 years were recruited from soccer clubs and were placed into an intervention group (n = 28; mean [±SD] age, 11.8 ± 0.8 years) and a control group (n = 23; mean age, 11.2 ± 0.6 years). The intervention group participated in 15 in-season sessions of the F-MARC 11+ program (2 times/wk). Pre- and postseason motion capture data were collected during preplanned cutting, unanticipated cutting, double-leg jump, and single-leg jump tasks. Lower extremity joint angles and moments were estimated using OpenSim, a biomechanical modeling system. Results Athletes in the intervention group reduced their peak knee valgus moment compared with the control group during the double-leg jump (mean [±standard error of the mean] pre- to posttest change, −0.57 ± 0.27 %BW×HT vs 0.25 ± 0.25 %BW×HT, respectively; P = .034). No significant differences in the change in peak knee valgus moment were found between the groups for any other activity; however, the intervention group displayed a significant pre- to posttest increase in peak knee valgus moment during unanticipated cutting (P = .044). Additional analyses

Computer-assisted measurements of coronal knee joint laxity in vitro are related to low-stress behavior rather than structural properties of the collateral ligaments.

PubMed

Wilson, W T; Deakin, A H; Wearing, S C; Payne, A P; Clarke, J V; Picard, F

2013-01-01

The relationship between coronal knee laxity and the restraining properties of the collateral ligaments remains unknown. This study investigated correlations between the structural properties of the collateral ligaments and stress angles used in computer-assisted total knee arthroplasty (TKA), measured with an optically based navigation system. Ten fresh-frozen cadaveric knees (mean age: 81 ± 11 years) were dissected to leave the menisci, cruciate ligaments, posterior joint capsule and collateral ligaments. The resected femur and tibia were rigidly secured within a test system which permitted kinematic registration of the knee using a commercially available image-free navigation system. Frontal plane knee alignment and varus-valgus stress angles were acquired. The force applied during varus-valgus testing was quantified. Medial and lateral bone-collateral ligament-bone specimens were then prepared, mounted within a uni-axial materials testing machine, and extended to failure. Force and displacement data were used to calculate the principal structural properties of the ligaments. The mean varus laxity was 4 ± 1° and the mean valgus laxity was 4 ± 2°. The corresponding mean manual force applied was 10 ± 3 N and 11 ± 4 N, respectively. While measures of knee laxity were independent of the ultimate tensile strength and stiffness of the collateral ligaments, there was a significant correlation between the force applied during stress testing and the instantaneous stiffness of the medial (r = 0.91, p = 0.001) and lateral (r = 0.68, p = 0.04) collateral ligaments. These findings suggest that clinicians may perceive a rate of change of ligament stiffness as the end-point during assessment of collateral knee laxity.

Survival and Growth of Cottonwood Clones After Angle Planting and Base Angle Treatments

Treesearch

W.K. Randall; Harvey E. Kennedy

1976-01-01

Presently, commercial cottonwood plantations in the lower Mississippi Valley are established using vertically planted, unrooted cuttings with a flat (90°) base. Neither survival nor first-year growth of a group of six Stoneville clones was improved by angle planting or cutting base angles diagonally. For one clone, survival was significantly better when base angle was...

Photoelectric angle converter

NASA Astrophysics Data System (ADS)

Podzharenko, Volodymyr A.; Kulakov, Pavlo I.

2001-06-01

The photo-electric angle transmitter of rotation is offered, at which the output voltage is linear function of entering magnitude. In a transmitter the linear phototransducer is used on the basis of pair photo diode -- operating amplifier, which output voltage is linear function of the area of an illuminated photosensitive stratum, and modulator of a light stream of the special shape, which ensures a linear dependence of this area from an angle of rotation. The transmitter has good frequent properties and can be used for dynamic measurements of an angular velocity and angle of rotation, in systems of exact drives and systems of autocontrol.

The effect of hip positioning on the projected femoral neck-shaft angle: a modeling study.

PubMed

Bhashyam, Abhiram R; Rodriguez, Edward K; Appleton, Paul; Wixted, John J

2018-04-03

The femoral neck-shaft angle (NSA) is used to restore normal hip geometry during hip fracture repair. Femoral rotation is known to affect NSA measurement, but the effect of hip flexion-extension is unknown. The goals of this study were to determine and test mathematical models of the relationship between hip flexion-extension, femoral rotation and NSA. We hypothesized that hip flexion-extension and femoral rotation would result in NSA measurement error. Two mathematical models were developed to predict NSA in varying degrees of hip flexion-extension and femoral rotation. The predictions of the equations were tested in vitro using a model that varied hip flexion-extension while keeping rotation constant, and vice versa. The NSA was measured from an AP radiograph obtained with a C-arm. Attributable measurement error based on hip positioning was calculated from the models. The predictions of the model correlated well with the experimental data (correlation coefficient = 0.82 - 0.90). A wide range of patient positioning was found to result in less than 5-10 degree error in the measurement of NSA. Hip flexion-extension and femoral rotation had a synergistic effect in measurement error of the NSA. Measurement error was minimized when hip flexion-extension was within 10 degrees of neutral. This study demonstrates that hip flexion-extension and femoral rotation significantly affect the measurement of the NSA. To avoid inadvertently fixing the proximal femur in varus or valgus, the hip should be positioned within 10 degrees of neutral flexion-extension with respect to the C-arm to minimize positional measurement error. N/A, basic science study.

A prospective 24 months follow-up of a three component press-fit prosthesis for hallux rigidus.

PubMed

Wassink, S; Burger, B J; Saragas, N P; Asunción Márquez, J; Trtik, L; Harlaar, J

2017-09-01

The aim of this study was to evaluate the results following total first metatarsophalangeal (FMTP) joint replacement arthroplasty using a modular three component press fit prosthesis at two year follow up. All patient data was collected in a prospective way in four study centres. Both preoperative and postoperative evaluation consisted of an assessment using the AOFAS-HMI score, visual analogue scale for pain, evaluation of the range of motion and patient satisfaction scores. Postoperative X-rays were reviewed for loosening and radiolucency up to two years. Fifty-five feet were available for analysis at 24 months. Two implants were removed during the study. Six more feet had additional surgery due to stiffness or malalignment. Postoperative AOFAS-HMI scores improved significantly by 32.4 points at two year follow-up (p<0.001). The visual analogue scale for pain improved significantly from 6.8 (std 1,6) preoperatively to 1.6 (std 1,9) postoperatively (p<0.0001). Mean dorsiflexion improved from 12.6 (std 10,1) degrees preoperatively to 31.2 (std 16,8) degrees postoperatively. Eighty-seven percent of patients were moderately to well satisfied with the end result. Eighteen prostheses showed radiolucency at 24 months. Implantation of a Metis ® modular three component press fit prosthesis for the metatarsophalangeal joint in hallux rigidus shows significant improvement in AOFAS-HMI scores and a decrease in pain. Concerns remain with regard to early reoperation rate (14.5%) and long term survival of the implant. Future studies will have to address these aspects. Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Behavior of Tilted Angle Shear Connectors.

PubMed

Khorramian, Koosha; Maleki, Shervin; Shariati, Mahdi; Ramli Sulong, N H

2015-01-01

According to recent researches, angle shear connectors are appropriate to transfer longitudinal shear forces across the steel-concrete interface. Angle steel profile has been used in different positions as L-shaped or C-shaped shear connectors. The application of angle shear connectors in tilted positions is of interest in this study. This study investigates the behaviour of tilted-shaped angle shear connectors under monotonic loading using experimental push out tests. Eight push-out specimens are tested to investigate the effects of different angle parameters on the ultimate load capacity of connectors. Two different tilted angles of 112.5 and 135 degrees between the angle leg and steel beam are considered. In addition, angle sizes and lengths are varied. Two different failure modes were observed consisting of concrete crushing-splitting and connector fracture. By increasing the size of connector, the maximum load increased for most cases. In general, the 135 degrees tilted angle shear connectors have a higher strength and stiffness than the 112.5 degrees type.

A clinically applicable six-segmented foot model.

PubMed

De Mits, Sophie; Segers, Veerle; Woodburn, Jim; Elewaut, Dirk; De Clercq, Dirk; Roosen, Philip

2012-04-01

We describe a multi-segmented foot model comprising lower leg, rearfoot, midfoot, lateral forefoot, medial forefoot, and hallux for routine use in a clinical setting. The Ghent Foot Model describes the kinematic patterns of functional units of the foot, especially the midfoot, to investigate patient populations where midfoot deformation or dysfunction is an important feature, for example, rheumatoid arthritis patients. Data were obtained from surface markers by a 6 camera motion capture system at 500 Hz. Ten healthy subjects walked barefoot along a 12 m walkway at self-selected speed. Joint angles (rearfoot to shank, midfoot to rearfoot, lateral and medial forefoot to midfoot, and hallux to medial forefoot) in the sagittal, frontal, and transverse plane are reported according to anatomically based reference frames. These angles were calculated and reported during the foot rollover phases in stance, detected by synchronized plantar pressure measurements. Repeated measurements of each subject revealed low intra-subject variability, varying between 0.7° and 2.3° for the minimum values, between 0.5° and 2.1° for the maximum values, and between 0.8° and 5.8° for the ROM. The described movement patterns were repeatable and consistent with biomechanical and clinical knowledge. As such, the Ghent Foot model permits intersegment, in vivo motion measurement of the foot, which is crucial for both clinical and research applications. Copyright © 2011 Orthopaedic Research Society.

Growth Angle - a Microscopic View

NASA Technical Reports Server (NTRS)

Mazurak, K.; Volz, M. P.; Croll, A.

2017-01-01

The growth angle that is formed between the side of the growing crystal and the melt meniscus is an important parameter in the detached Bridgman crystal growth method, where it determines the extent of the crystal-crucible wall gap, and in the Czochralski and float zone methods, where it influences the size and stability of the crystals. The growth angle is a non-equilibrium parameter, defined for the crystal growth process only. For a melt-crystal interface translating towards the crystal (melting), there is no specific angle defined between the melt and the sidewall of the solid. In this case, the corner at the triple line becomes rounded, and the angle between the sidewall and the incipience of meniscus can take a number of values, depending on the position of the triple line. In this work, a microscopic model is developed in which the fluid interacts with the solid surface through long range van der Waals or Casimir dispersive forces. This growth angle model is applied to Si and Ge and compared with the macroscopic approach of Herring. In the limit of a rounded corner with a large radius of curvature, the wetting of the melt on the crystal is defined by the contact angle. The proposed microscopic approach addresses the interesting issue of the transition from a contact angle to a growth angle as the radius of curvature decreases.

Behavior of Tilted Angle Shear Connectors

PubMed Central

Khorramian, Koosha; Maleki, Shervin; Shariati, Mahdi; Ramli Sulong, N. H.

2015-01-01

According to recent researches, angle shear connectors are appropriate to transfer longitudinal shear forces across the steel-concrete interface. Angle steel profile has been used in different positions as L-shaped or C-shaped shear connectors. The application of angle shear connectors in tilted positions is of interest in this study. This study investigates the behaviour of tilted-shaped angle shear connectors under monotonic loading using experimental push out tests. Eight push-out specimens are tested to investigate the effects of different angle parameters on the ultimate load capacity of connectors. Two different tilted angles of 112.5 and 135 degrees between the angle leg and steel beam are considered. In addition, angle sizes and lengths are varied. Two different failure modes were observed consisting of concrete crushing-splitting and connector fracture. By increasing the size of connector, the maximum load increased for most cases. In general, the 135 degrees tilted angle shear connectors have a higher strength and stiffness than the 112.5 degrees type. PMID:26642193

Two-dimensional planning can result in internal rotation of the femoral component in total knee arthroplasty.

PubMed

Okamoto, Shigetoshi; Mizu-uchi, Hideki; Okazaki, Ken; Hamai, Satoshi; Tashiro, Yasutaka; Nakahara, Hiroyuki; Iwamoto, Yukihide

2016-01-01

The first purpose of this study was to compare the reproducibility of two-dimensional (2D) and three-dimensional (3D) measurements for preoperative planning of the femoral side in total knee arthroplasty (TKA). The second purpose was to evaluate the factors affecting the differences between the 2D and 3D measurements. Two-dimensional and 3D measurements for preoperative planning of the femoral side in TKA were evaluated in 75 varus knees with osteoarthritis. The femoral valgus angle, defined as the angle between the mechanical and anatomical axes of the femur, and the clinical rotation angle and surgical rotation angle, defined by the angles between the posterior condylar line and the clinical or surgical transepicondylar axes, respectively, were analysed using 2D (radiographs and axial CT slices) and 3D (3D bone models reconstructed from CT images) measurements. For all variables, 3D measurements were more reliable and reproducible than 2D measurements. The medians and ranges of the clinical rotation angle and surgical rotation angle were 6.6° (-1.7° to 12.1°) and 2.3° (-2.5° to 8.6°) in 2D, and 7.1° (2.7° to 11.4°) and 3.0° (-2.0° to 7.5°) in 3D. Varus/valgus alteration of the CT scanning direction relative to the mechanical axis affected the difference in clinical rotation angles between 2D and 3D measurements. Significantly, smaller values of the clinical rotation angle and surgical rotation angle were obtained by 2D compared to 3D measurements, which could result in internal rotation of the femoral component even if the surgeon performs the bone cutting precisely. Regarding clinical relevance, first, this study confirmed the reliability of 3D measurements. Second, it underscored the risk of internal rotation of the femoral component when using 2D measurement, even with precise bone cutting technique. These results will help surgeons avoid malpositioning of the femoral component if 2D measurements are used for preoperative planning in TKA

Radiologic changes of ankle joint after total knee arthroplasty.

PubMed

Lee, Jung Hee; Jeong, Bi O

2012-12-01

The authors noticed that ankle joint osteoarthritis was not uncommon when lower extremity malalignment, such as a knee varus deformity, was present as a result of severe osteoarthritis of the knee. The purpose of this study was to analyze radiologic changes of the ankle joint after total knee arthroplasty. This study included 142 cases in 110 patients who underwent total knee arthroplasty and were followed for at least 3 years. The varus knee group included 128 cases and the valgus knee group included 14 cases. On anteroposterior standing lower extremity radiographs, varus and valgus angles of the knee were measured preoperatively and at the last follow-up. The angle between the ground surface and the distal tibial plafond as well as the upper talus was also measured. In addition, tibial anterior surface angle, talar tilt, space between the medial malleolar distal tip and the medial articular surface of the talus, and medial tibiotalar joint space of the ankle joint were measured. Out of 142 cases, 50 (35.2%) had arthritis in the ankle before total knee arthroplasty and 31 (21.8%) had newly developed or progressive arthritis after surgery. In particular, the varus knee group demonstrated statistically significant differences in preoperative varus deformity, preoperative talar tilt, and postoperative correction angle between the cases that developed or had progressive arthritis and those that did not show any changes (p < .05). After total knee arthroplasty, arthritis developed or progressed in the ankle of many cases radiographically. In particular, when the preoperative talar tilt increased medial to the ankle or the postoperative correction angle was large, the incidence of arthritis in the ankle joint increased. The authors recommend more cautious follow-up on the symptoms of the ankle joint after total knee arthroplasty.

View angle effect in LANDSAT imagery

NASA Technical Reports Server (NTRS)

Kaneko, T.; Engvall, J. L.

1977-01-01

The view angle effect in LANDSAT 2 imagery was investigated. The LANDSAT multispectral scanner scans over a range of view angles of -5.78 to 5.78 degrees. The view angle effect, which is caused by differing view angles, could be studied by comparing data collected at different view angles over a fixed location at a fixed time. Since such LANDSAT data is not available, consecutive day acquisition data were used as a substitute: they were collected over the same geographical location, acquired 24 hours apart, with a view angle change of 7 to 8 degrees at a latitude of 35 to 45 degrees. It is shown that there is approximately a 5% reduction in the average sensor response on the second-day acquisitions as compared with the first-day acquisitions, and that the view angle effect differs field to field and crop to crop. On false infrared color pictures the view angle effect causes changes primarily in brightness and to a lesser degree in color (hue and saturation). An implication is that caution must be taken when images with different view angles are combined for classification and a signature extension technique needs to take the view angle effect into account.

Demonstration of angle widening using EyeCam after laser peripheral iridotomy in eyes with angle closure.

PubMed

Perera, Shamira A; Quek, Desmond T; Baskaran, Mani; Tun, Tin A; Kumar, Rajesh S; Friedman, David S; Aung, Tin

2010-06-01

To evaluate EyeCam in detecting changes in angle configuration after laser peripheral iridotomy (LPI) in comparison to gonioscopy, the reference standard. Prospective comparative study. Twenty-four subjects (24 eyes) with primary angle-closure glaucoma (PACG) were recruited. Gonioscopy and EyeCam (Clarity Medical Systems) imaging of all 4 angle quadrants were performed, before and 2 weeks after LPI. Images were graded according to angle structures visible by an observer masked to clinical data or the status of LPI, and were performed in a random order. Angle closure in a quadrant was defined as the inability to visualize the posterior trabecular meshwork. We determined the number of quadrants with closed angles and the mean number of clock hours of angle closure before and after LPI in comparison to gonioscopy. Using EyeCam, all 24 eyes showed at least 1 quadrant of angle widening after LPI. The mean number of clock hours of angle closure decreased significantly, from 8.15 +/- 3.47 clock hours before LPI to 1.75 +/- 2.27 clock hours after LPI (P < .0001, Wilcoxon signed rank test). Overall, gonioscopy showed 1.0 +/- 1.41 (95% CI, 0.43-1.57) quadrants opening from closed to open after LPI compared to 2.0 +/- 1.28 (95% CI, 1.49-2.51, P = .009) quadrants with EyeCam. Intra-observer reproducibility of grading the extent of angle closure in clock hours in EyeCam images was moderate to good (intraclass correlation coefficient 0.831). EyeCam may be used to document changes in angle configuration after LPI in eyes with PACG. Copyright 2010 Elsevier Inc. All rights reserved.

Bilateral mandibular angle fractures: clinical considerations.

PubMed

Boffano, Paolo; Roccia, Fabio

2010-03-01

The mandibular angle is a frequent site of fracture. It is a weak zone that is more exposed to fractures than other areas of the mandibular bone. The presence of incompletely erupted third molars is associated with a further increased risk of angle fractures. Our objective was to evaluate and discuss the surgical outcomes of a group of patients with bilateral mandibular angle fractures.In our study, patients with bilateral mandibular angle fractures surgically treated from January 1, 2001, to June 30, 2009, at the Division of Maxillofacial Surgery of the University of Turin were retrospectively analyzed. A combined transbuccal and intraoral approach or an intraoral approach only was adopted.Eight patients (7 men and 1 woman) underwent surgery for bilateral mandibular angle fractures. Good to satisfactory reduction of the fractures was obtained with both surgical techniques. Good to fair restored occlusion was observed postoperatively in all patients.Successful treatment of bilateral mandibular angle fractures may be achieved via different techniques. Superficially impacted third molars seem to be associated with an increased risk of angle fractures. Bilateral angle fractures are an ideal model to study the biomechanical pathogenesis of angle fractures.

Greater Hip Extension but Not Hip Abduction Explosive Strength Is Associated With Lesser Hip Adduction and Knee Valgus Motion During a Single-Leg Jump-Cut

PubMed Central

Cronin, Baker; Johnson, Samuel T.; Chang, Eunwook; Pollard, Christine D.; Norcross, Marc F.

2016-01-01

Background: The relationships between hip abductor and extensor strength and frontal plane hip and knee motions that are associated with anterior cruciate ligament injury risk are equivocal. However, previous research on these relationships has evaluated relatively low-level movement tasks and peak torque rather than a time-critical strength measure such as the rate of torque development (RTD). Hypothesis: Females with greater hip abduction and extension RTD would exhibit lesser frontal plane hip and knee motion during a single-leg jump-cutting task. Study Design: Descriptive laboratory study. Methods: Forty recreationally active females performed maximal isometric contractions and single-leg jump-cuts. From recorded torque data, hip extension and abduction RTD was calculated from torque onset to 200 ms after onset. Three-dimensional motion analysis was used to quantify frontal plane hip and knee kinematics during the movement task. For each RTD measure, jump-cut biomechanics were compared between participants in the highest (high) and lowest (low) RTD tertiles. Results: No differences in frontal plane hip and knee kinematics were identified between high and low hip abduction RTD groups. However, those in the high hip extension RTD group exhibited lower hip adduction (high, 3.8° ± 3.0°; low, 6.5° ± 3.0°; P = .019) and knee valgus (high, –2.5° ± 2.3°; low, –4.4° ± 3.2°; P = .046) displacements during the jump-cut. Conclusion: In movements such as cutting that are performed with the hip in a relatively abducted and flexed position, the ability of the gluteus medius to control hip adduction may be compromised. However, the gluteus maximus, functioning as a hip abductor, may take on a pivotal role in controlling hip adduction and knee valgus motion during these types of tasks. Clinical Relevance: Training with a specific emphasis on increasing explosive strength of the hip extensors may be a means through which to improve frontal plane hip and knee

Reading angles in maps.

PubMed

Izard, Véronique; O'Donnell, Evan; Spelke, Elizabeth S

2014-01-01

Preschool children can navigate by simple geometric maps of the environment, but the nature of the geometric relations they use in map reading remains unclear. Here, children were tested specifically on their sensitivity to angle. Forty-eight children (age 47:15-53:30 months) were presented with fragments of geometric maps, in which angle sections appeared without any relevant length or distance information. Children were able to read these map fragments and compare two-dimensional to three-dimensional angles. However, this ability appeared both variable and fragile among the youngest children of the sample. These findings suggest that 4-year-old children begin to form an abstract concept of angle that applies both to two-dimensional and three-dimensional displays and that serves to interpret novel spatial symbols. © 2013 The Authors. Child Development © 2013 Society for Research in Child Development, Inc.

Anterior Segment Imaging for Angle Closure.

PubMed

Chansangpetch, Sunee; Rojanapongpun, Prin; Lin, Shan C

2018-04-01

To summarize the role of anterior segment imaging (AS-imaging) in angle closure diagnosis and management, and the possible advantages over the current standard of gonioscopy. Literature review and perspective. Review of the pertinent publications with interpretation and perspective in relation to the use of AS-imaging in angle closure assessment focusing on anterior segment optical coherence tomography and ultrasound biomicroscopy. Several limitations have been encountered with the reference standard of gonioscopy for angle assessment. AS-imaging has been shown to have performance in angle closure detection compared to gonioscopy. Also, imaging has greater reproducibility and serves as better documentation for long-term follow-up than conventional gonioscopy. The qualitative and quantitative information obtained from AS-imaging enables better understanding of the underlying mechanisms of angle closure and provides useful parameters for risk assessment and possible prediction of the response to laser and surgical intervention. The latest technologies-including 3-dimensional imaging-have allowed for the assessment of the angle that simulates the gonioscopic view. These advantages suggest that AS-imaging has a potential to be a reference standard for the diagnosis and monitoring of angle closure disease in the future. Although gonioscopy remains the primary method of angle assessment, AS-imaging has an increasing role in angle closure screening and management. The test should be integrated into clinical practice as an adjunctive tool for angle assessment. It is arguable that AS-imaging should be considered first-line screening for patients at risk for angle closure. Copyright © 2018 Elsevier Inc. All rights reserved.

Angle-Ply Weaving

NASA Technical Reports Server (NTRS)

Farley, Gary L.

1990-01-01

Bias-direction or angle-ply weaving is proposed new process for weaving fibers along bias in conventional planar fabric or in complicated three-dimensional multilayer fabric preform of fiber-reinforced composite structure. Based upon movement of racks of needles and corresponding angle yarns across fabric as fabric being formed. Fibers woven along bias increases shear stiffness and shear strength of preform, increasing value of preform as structural member.

Medial-to-lateral Ratio of Tibiofemoral Subchondral Bone Area is Adapted to Alignment and Mechanical Load

PubMed Central

Eckstein, Felix; Hudelmaier, Martin; Cahue, September; Marshall, Meredith; Sharma, Leena

2010-01-01

Malalignment is known to impact the medial-to-lateral load distribution in the tibiofemoral joint. In this longitudinal study, we test the hypothesis that subchondral bone surface areas functionally adapt to the load distribution in malaligned knees. Alignment (hip-knee-ankle angle) was measured from full limb films in 174 participants with knee osteoarthritis. Coronal MR images were acquired at baseline and 26.6±5.4 months later. The subchondral bone surface area of the weight-bearing tibiofemoral cartilages was segmented, with readers blinded to the order of acquisition. The size of the subchondral bone surface areas was computed after triangulation using proprietary software. The hip-knee-ankle angle showed a significant correlation with the tibial (r2=0.25, p<0.0001) and femoral (r2=0.07, p<0.001) ratio of medial-to-lateral subchondral bone surface area. In the tibia, the ratio was significantly different between varus (1.28:1), neutral (1.18:1) and valgus (1.13:1) knees (ANOVA; p<0.00001). Similar observations were made in the weight-bearing femur (0.94:1 in neutral, 0.97.1 in varus, 0.91:1 in valgus knees; ANOVA p=0.018). The annualized longitudinal increase in subchondral bone surface area was significant (p<0.05) in the medial tibia (+0.13%), medial femur (+0.26%) and lateral tibia (+0.19%). In the medial femur, the change between baseline and follow-up was significantly different (ANOVA; p=0.020) between neutral, varus and valgus knees, the increase in surface area being significantly greater (p=0.019) in varus than in neutral knees. Tibiofemoral subchondral bone surface areas are shown to be functionally adapted to the medial-to-lateral load distribution. The longitudinal findings indicate that this adaptational process may continue to take place at advanced age. PMID:19148562

Wafer scale oblique angle plasma etching

DOEpatents

Burckel, David Bruce; Jarecki, Jr., Robert L.; Finnegan, Patrick Sean

2017-05-23

Wafer scale oblique angle etching of a semiconductor substrate is performed in a conventional plasma etch chamber by using a fixture that supports a multiple number of separate Faraday cages. Each cage is formed to include an angled grid surface and is positioned such that it will be positioned over a separate one of the die locations on the wafer surface when the fixture is placed over the wafer. The presence of the Faraday cages influences the local electric field surrounding each wafer die, re-shaping the local field to be disposed in alignment with the angled grid surface. The re-shaped plasma causes the reactive ions to follow a linear trajectory through the plasma sheath and angled grid surface, ultimately impinging the wafer surface at an angle. The selected geometry of the Faraday cage angled grid surface thus determines the angle at with the reactive ions will impinge the wafer.

Spinning angle optical calibration apparatus

DOEpatents

Beer, Stephen K.; Pratt, II, Harold R.

1991-01-01

An optical calibration apparatus is provided for calibrating and reproducing spinning angles in cross-polarization, nuclear magnetic resonance spectroscopy. An illuminated magnifying apparatus enables optical setting an accurate reproducing of spinning "magic angles" in cross-polarization, nuclear magnetic resonance spectroscopy experiments. A reference mark scribed on an edge of a spinning angle test sample holder is illuminated by a light source and viewed through a magnifying scope. When the "magic angle" of a sample material used as a standard is attained by varying the angular position of the sample holder, the coordinate position of the reference mark relative to a graduation or graduations on a reticle in the magnifying scope is noted. Thereafter, the spinning "magic angle" of a test material having similar nuclear properties to the standard is attained by returning the sample holder back to the originally noted coordinate position.

Prevalence of podiatric conditions seen in Special Olympics athletes: a comparison of USA data to an international population.

PubMed

Jenkins, David W; Cooper, Kimbal; Heigh, Evelyn G

2015-03-01

Persons with intellectual disabilities frequently have podiatric conditions. Limited information exists on their prevalence in international cohorts of Special Olympics (SO) athletes. Findings from multiple United States (US) venues are compared to those from athletes screened at the 2011 Special Olympics World Summer Games in Athens, Greece (ATHENS). Data from Fit Feet screenings from 2096 ATHENS participants was compared to 7192 US participants. Frequently noted in the ATHENS population were motion restriction in both the ankle and the first metatarsal phalangeal joint (1st MTPJ), pes planus, metatarsus adductus, brachymetatarsia, hallux abducto valgus (HAV), onychomycosis, onychocryptosis, and tinea pedis. ATHENS differed from the US cohort as HAV and restricted ankle joint and 1st MTPJ joint motion was less frequent. Significantly more tinea pedis, xerosis, and hyperhidrosis were present in the ATHENS population. SO athletes have a higher prevalence of podiatric structural conditions compared to the general population, and some vary between ATHENS versus US. Less prevalent in ATHENS was HAV, and restricted motion in both the ankle and 1st MTPJ. This may reflect differences due to varied clinical observers. The higher rates of several dermatological conditions in ATHENS may reflect venue seasonal climate, or social factors. Copyright © 2014 Elsevier Ltd. All rights reserved.

Ergonomic footwear for Sri Lankan primary schoolchildren: A review of the literature.

PubMed

Hettigama, I S; Punchihewa, H K G; Heenkenda, N K

2016-10-17

Foot ailments are common among schoolchildren, some of which may be attributed to wearing ill-fitting footwear. As schoolchildren often participate in athletic activity, they are doubly vulnerable to foot ailments, and are particularly vulnerable to conditions such as hallux valgus, Achilles tendonitis, athlete's foot, corns and calluses. Thus, there is an acute need for the design and manufacture of ergonomic footwear for this target group. While research on appropriate footwear for children has been carried out in relation to child populations in other societies, research on the circumstances of Sri Lankan schoolchildren is lacking. Neither the requisite design know-how nor the information for design is available to footwear manufacturers. This review of the literature is aimed at confirming the need for ergonomic footwear from the point of view of the effects of wearing ill-fitting shoes and at identifying the requirements in terms of design information, especially for schoolchildren of the age group five to ten years, to empower footwear manufacturers. PubMed, Google scholar and Science Direct were used for the literature search. 208 publications were read in full, 94 of which are referenced in this review. The review shows morphological measurements, behavior and activity patterns of schoolchildren and environmental conditions they are exposed to should be determined to formulate design information.

Foot and ankle risk factors for falls in older people: a prospective study.

PubMed

Menz, Hylton B; Morris, Meg E; Lord, Stephen R

2006-08-01

Foot problems are common in older people and are associated with impaired balance and functional ability. Few prospective studies, however, have been undertaken to determine whether foot problems are a risk factor for falls. One hundred seventy-six people (56 men and 120 women, mean age 80.1, standard deviation 6.4 years) residing in a retirement village underwent tests of foot and ankle characteristics (including foot posture, range of motion, strength, and deformity) and physiological falls risk factors (including vision, sensation, strength, reaction time, and balance) and were followed for 12 months to determine the incidence of falls. Seventy-one participants (41%) reported falling during the follow-up period. Compared to those who did not fall, fallers exhibited decreased ankle flexibility, more severe hallux valgus deformity, decreased plantar tactile sensitivity, and decreased toe plantarflexor strength; they were also more likely to have disabling foot pain. Discriminant function analysis revealed that decreased toe plantarflexor strength and disabling foot pain were significantly and independently associated with falls after accounting for physiological falls risk factors and age. Foot and ankle problems increase the risk of falls in older people. Interventions to address these factors may hold some promise as a falls prevention strategy.

Spinning angle optical calibration apparatus

DOE Office of Scientific and Technical Information (OSTI.GOV)

Beer, S.K.; Pratt, H.R. II.

1989-09-12

An optical calibration apparatus is provided for calibrating and reproducing spinning angles in cross-polarization, nuclear magnetic resonance spectroscopy. An illuminated magnifying apparatus enables optical setting and accurate reproducing of spinning magic angles in cross-polarization, nuclear magnetic resonance spectroscopy experiments. A reference mark scribed on an edge of a spinning angle test sample holder is illuminated by a light source and viewed through a magnifying scope. When the magic angle of a sample material used as a standard is attained by varying the angular position of the sample holder, the coordinate position of the reference mark relative to a graduation ormore » graduations on a reticle in the magnifying scope is noted. Thereafter, the spinning magic angle of a test material having similar nuclear properties to the standard is attained by returning the sample holder back to the originally noted coordinate position. 2 figs.« less

Growth Angle: A Microscopic View

NASA Technical Reports Server (NTRS)

Mazuruk, Konstantin; Croll, Arne; Volz, Martin P.

2017-01-01

A microscopic continuum mechanical model of the growth angle is proposed. It is based on the van der Waals type framework that is used for surface force phenomena. The obtained augmented Laplace type integro-differential equations are, in general, difficult to analyze. Here we focused primarily on the particular case of equal melt and crystal surface energies. We derived an approximate equation for the meniscus shape, and obtained an analytical relationship between the contact and the growth angle. Interestingly, the same result can be obtained using the macroscopic model of Herring. The case of a macroscopically sharp corner is also considered. For this case, the macroscopic angle is not defined and it can be any angle between the contact angles of both flat surfaces. The microscopic model yields the smooth shape for the meniscus that also is not unique, but depends on the initial position of the meniscus.

A randomised trial into the effect of an isolated hip abductor strengthening programme and a functional motor control programme on knee kinematics and hip muscle strength.

PubMed

Palmer, Kathryn; Hebron, Clair; Williams, Jonathan M

2015-05-03

Dynamic knee valgus and internal femoral rotation are proposed to be contributory risk factors for patellofemoral pain and anterior cruciate ligament injuries. Multimodal interventions including hip abductor strengthening or functional motor control programmes have a positive impact of pain, however their effect on knee kinematics and muscle strength is less clear. The aim of this study was to examine the effect of isolated hip abductor strengthening and a functional motor control exercise on knee kinematics and hip abductor strength. This prospective, randomised, repeated measures design included 29 asymptomatic volunteers presenting with increase knee valgus and femoral internal rotation. Participants completed either isolated hip abductor strengthening or a functional motor control exercise for 5 weeks. Knee kinematics were measured using inertial sensors during 2 functional activities and hip abductor strength measured using a load cell during isometric hip abduction. There were no significant differences in dynamic knee valgus and internal rotation following the isolated hip abductor or functional motor control intervention, and no significant differences between the groups for knee angles. Despite this, the actual magnitude of reduction in valgus was 10° and 5° for the functional motor control group and strengthening group respectively. The actual magnitude of reduction in internal rotation was 9° and 18° for the functional motor control group and strengthening group respectively. Therefore there was a tendency towards clinically significant improvements in knee kinematics in both exercise groups. A statistically significant improvement in hip abductor strength was evident for the functional motor control group (27% increase; p = 0.008) and strengthening group (35% increase; p = 0.009) with no significant difference between the groups being identified (p = 0.475). Isolated hip strengthening and functional motor control exercises resulted in

Angle closure in younger patients.

PubMed Central

Chang, Brian M; Liebmann, Jeffrey M; Ritch, Robert

2002-01-01

PURPOSE: Angle-closure glaucoma is rare in children and young adults. Only scattered cases associated with specific clinical entities have been reported. We evaluated the findings in patients in our database aged 40 or younger with angle closure. METHODS: Our database was searched for patients with angle closure who were 40 years old or younger. Data recorded included age at initial consultation; age at the time of diagnosis; gender; results of slit-lamp examination, gonioscopy, and ultrasound biomicroscopy (from 1993 onward); clinical diagnosis; and therapy. Patients with previous incisional surgery were excluded, as were patients with anterior chamber proliferative mechanisms leading to angle closure. RESULTS: Sixty-seven patients (49 females, 18 males) met entry criteria. Mean age (+/- SD) at the time of consultation was 34.4 +/- 9.4 years (range, 3-68 years). Diagnoses included plateau iris syndrome (35 patients), iridociliary cysts (8 patients), retinopathy of prematurity (7 patients), uveitis (5 patients), isolated nanophthalmos (3 patients), relative pupillary block (2 patients), Weill-Marchesani syndrome (3 patients), and 1 patient each with Marfan syndrome, miotic-induced angle closure, persistent hyperplastic primary vitreous, and idiopathic lens subluxation. CONCLUSION: The etiology of angle closure in young persons is different from that in the older population and is typically associated with structural or developmental ocular anomalies rather than relative pupillary block. Following laser iridotomy, these eyes should be monitored for recurrent angle closure and the need for additional laser or incisional surgical intervention. PMID:12545694

Rotation of intramedullary alignment rods affects distal femoral cutting plane in total knee arthroplasty.

PubMed

Maderbacher, Günther; Matussek, Jan; Keshmiri, Armin; Greimel, Felix; Baier, Clemens; Grifka, Joachim; Maderbacher, Hermann

2018-02-17

Intramedullary rods are widely used to align the distal femoral cut in total knee arthroplasty. We hypothesised that both coronal (varus/valgus) and sagittal (extension/flexion) cutting plane are affected by rotational changes of intramedullary femoral alignment guides. Distal femoral cuts using intramedullary alignment rods were simulated by means of a computer-aided engineering software in 4°, 6°, 8°, 10°, and 12° of valgus in relation to the femoral anatomical axis and 4° extension, neutral, as well as 4°, 8°, and 12° of flexion in relation to the femoral mechanical axis. This reflects the different angles between anatomical and mechanical axis in coronal and sagittal planes. To assess the influence of rotation of the alignment guide on the effective distal femoral cutting plane, all combinations were simulated with the rod gradually aligned from 40° of external to 40° of internal rotation. Rotational changes of the distal femoral alignment guides affect both the coronal and sagittal cutting planes. When alignment rods are intruded neutrally with regards to sagittal alignment, external rotation causes flexion, while internal rotation causes extension of the sagittal cutting plane. Simultaneously the coronal effect (valgus) decreases resulting in an increased varus of the cutting plane. However, when alignment rods are intruded in extension or flexion partly contradictory effects are observed. Generally the effect increases with the degree of valgus preset, rotation and flexion. As incorrect rotation of intramedullary alignment guides for distal femoral cuts causes significant cutting errors, exact rotational alignment is crucial. Coronal cutting errors in the distal femoral plane might result in overall leg malalignment, asymmetric extension gaps and subsequent sagittal cutting errors.

SU-E-T-446: Group-Sparsity Based Angle Generation Method for Beam Angle Optimization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gao, H

2015-06-15

Purpose: This work is to develop the effective algorithm for beam angle optimization (BAO), with the emphasis on enabling further improvement from existing treatment-dependent templates based on clinical knowledge and experience. Methods: The proposed BAO algorithm utilizes a priori beam angle templates as the initial guess, and iteratively generates angular updates for this initial set, namely angle generation method, with improved dose conformality that is quantitatively measured by the objective function. That is, during each iteration, we select “the test angle” in the initial set, and use group-sparsity based fluence map optimization to identify “the candidate angle” for updating “themore » test angle”, for which all the angles in the initial set except “the test angle”, namely “the fixed set”, are set free, i.e., with no group-sparsity penalty, and the rest of angles including “the test angle” during this iteration are in “the working set”. And then “the candidate angle” is selected with the smallest objective function value from the angles in “the working set” with locally maximal group sparsity, and replaces “the test angle” if “the fixed set” with “the candidate angle” has a smaller objective function value by solving the standard fluence map optimization (with no group-sparsity regularization). Similarly other angles in the initial set are in turn selected as “the test angle” for angular updates and this chain of updates is iterated until no further new angular update is identified for a full loop. Results: The tests using the MGH public prostate dataset demonstrated the effectiveness of the proposed BAO algorithm. For example, the optimized angular set from the proposed BAO algorithm was better the MGH template. Conclusion: A new BAO algorithm is proposed based on the angle generation method via group sparsity, with improved dose conformality from the given template. Hao Gao was partially supported by

Individualized optimal release angles in discus throwing.

PubMed

Leigh, Steve; Liu, Hui; Hubbard, Mont; Yu, Bing

2010-02-10

The purpose of this study was to determine individualized optimal release angles for elite discus throwers. Three-dimensional coordinate data were obtained for at least 10 competitive trials for each subject. Regression relationships between release speed and release angle, and between aerodynamic distance and release angle were determined for each subject. These relationships were linear with subject-specific characteristics. The subject-specific relationships between release speed and release angle may be due to subjects' technical and physical characteristics. The subject-specific relationships between aerodynamic distance and release angle may be due to interactions between the release angle, the angle of attack, and the aerodynamic distance. Optimal release angles were estimated for each subject using the regression relationships and equations of projectile motion. The estimated optimal release angle was different for different subjects, and ranged from 35 degrees to 44 degrees . The results of this study demonstrate that the optimal release angle for discus throwing is thrower-specific. The release angles used by elite discus throwers in competition are not necessarily optimal for all discus throwers, or even themselves. The results of this study provide significant information for understanding the biomechanics of discus throwing techniques. Copyright 2009 Elsevier Ltd. All rights reserved.

The Semiotic and Conceptual Genesis of Angle

ERIC Educational Resources Information Center

Tanguay, Denis; Venant, Fabienne

2016-01-01

In the present study, we try to understand how students at the end of primary school conceive of angle: Is an angle a magnitude for them or a geometric figure, and how do they manage to coordinate the two aspects in their understanding of the concepts of angle and of angle measurement? With the aim of better grasping the way "angle" is…

SU-E-I-56: Scan Angle Reduction for a Limited-Angle Intrafraction Verification (LIVE) System

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ren, L; Zhang, Y; Yin, F

Purpose: To develop a novel adaptive reconstruction strategy to further reduce the scanning angle required by the limited-angle intrafraction verification (LIVE) system for intrafraction verification. Methods: LIVE acquires limited angle MV projections from the exit fluence of the arc treatment beam or during gantry rotation between static beams. Orthogonal limited-angle kV projections are also acquired simultaneously to provide additional information. LIVE considers the on-board 4D-CBCT images as a deformation of the prior 4D-CT images, and solves the deformation field based on deformation models and data fidelity constraint. LIVE reaches a checkpoint after a limited-angle scan, and reconstructs 4D-CBCT for intrafractionmore » verification at the checkpoint. In adaptive reconstruction strategy, a larger scanning angle of 30° is used for the first checkpoint, and smaller scanning angles of 15° are used for subsequent checkpoints. The onboard images reconstructed at the previous adjacent checkpoint are used as the prior images for reconstruction at the current checkpoint. As the algorithm only needs to reconstruct the small deformation occurred between adjacent checkpoints, projections from a smaller scan angle provide enough information for the reconstruction. XCAT was used to simulate tumor motion baseline drift of 2mm along sup-inf direction at every subsequent checkpoint, which are 15° apart. Adaptive reconstruction strategy was used to reconstruct the images at each checkpoint using orthogonal 15° kV and MV projections. Results: Results showed that LIVE reconstructed the tumor volumes accurately using orthogonal 15° kV-MV projections. Volume percentage differences (VPDs) were within 5% and center of mass shifts (COMS) were within 1mm for reconstruction at all checkpoints. Conclusion: It's feasible to use an adaptive reconstruction strategy to further reduce the scan angle needed by LIVE to allow faster and more frequent intrafraction verification to

Spinning angle optical calibration apparatus

DOE Office of Scientific and Technical Information (OSTI.GOV)

Beer, S.K.; Pratt, H.R.

1991-02-26

This patent describes an optical calibration apparatus provided for calibrating and reproducing spinning angles in cross-polarization, nuclear magnetic resonance spectroscopy. An illuminated magnifying apparatus enables optical setting an accurate reproducing of spinning magic angles in cross-polarization, nuclear magnetic resonance spectroscopy experiments. A reference mark scribed on an edge of a spinning angle test sample holder is illuminated by a light source and viewed through a magnifying scope. When the magic angle of a sample material used as a standard is attained by varying the angular position of the sample holder, the coordinate position of the reference mark relative to amore » graduation or graduations on a reticle in the magnifying scope is noted.« less

Northwest Angle, Minnesota

NASA Image and Video Library

2017-10-02

Minnesota's Northwest Angle is the northernmost point of the continental United States. The Angle became part of the US due to a map error during the 1783 Treaty of Paris. Located in the Lake of the Woods, driving there requires crossing the US-Canada border twice. The image was acquired September 22, 2013, covers an area of 40 by 55 km, and is located at 49.2 degrees north, 95.1 degrees west. https://photojournal.jpl.nasa.gov/catalog/PIA21997

A comparative biomechanical analysis of habitually unshod and shod runners based on a foot morphological difference.

PubMed

Mei, Qichang; Fernandez, Justin; Fu, Weijie; Feng, Neng; Gu, Yaodong

2015-08-01

Running is one of the most accessible physical activities and running with and without footwear has attracted extensive attention in the past several years. In this study 18 habitually male unshod runners and 20 habitually male shod runners (all with dominant right feet) participated in a running test. A Vicon motion analysis system was used to capture the kinematics of each participant's lower limb. The in-shoe plantar pressure measurement system was employed to measure the pressure and force exerted on the pressure sensors of the insole. The function of a separate hallux in unshod runners is analyzed through the comparison of plantar pressure parameters. Owing to the different strike patterns in shod and unshod runners, peak dorsiflexion and plantarflexion angle were significantly different. Habitually shod runners exhibited a decreased foot strike angle (FSA) under unshod conditions; and the vertical average loading rate (VALR) of shod runners under unshod conditions was larger than that under shod conditions. This suggests that the foot strike pattern is more important than the shod or unshod running style and runners need to acquire the technique. It can be concluded that for habitually unshod runners the separate hallux takes part of the foot loading and reduces loading to the forefoot under shod conditions. The remaining toes of rearfoot strike (RFS) runners function similarly under unshod conditions. These morphological features of shod and unshod runners should be considered in footwear design to improve sport performance and reduce injury. Copyright © 2015 Elsevier B.V. All rights reserved.

Arthrodesis of the first metatarsophalangeal joint using a dorsal titanium contoured plate.

PubMed